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Intrahepatic cholestasis of pregnancy — USMLE Step 3 MCQ

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HardOB/GYNIntrahepatic cholestasis of pregnancyUSMLE Step 3

A 34-year-old receiving induction chemotherapy for acute lymphoblastic leukemia had prolonged household exposure to a person with confirmed measles 48 hours ago. He has no symptoms and has documentation of two childhood MMR doses. What is the most appropriate post-exposure intervention?

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Correct answer: C — Give intravenous immune globulin 400 mg/kg now as post-exposure prophylaxis

The best answer is “Give intravenous immune globulin 400 mg/kg now as post-exposure prophylaxis”. Severely immunocompromised patients exposed to measles should receive intravenous immune globulin at 400 mg/kg within 6 days of exposure, regardless of prior vaccination status, because vaccine-derived protection may be unreliable. Live MMR vaccine is contraindicated during intensive leukemia chemotherapy. Intramuscular immune globulin is not the recommended adult product, and testing must not delay time-limited prophylaxis.

Reference: CDC: Immune Globulin for Measles Post-Exposure Prophylaxis: https://www.cdc.gov/measles/downloads/measles-immune-globulin-post-exposure-prophylaxis.pdf