WBR0521

Author	PageAuthor::Vendhan Ramanujam
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Community Medical Health Center, MainCategory::Primary Care Office, MainCategory::Emergency Room
Sub Category	SubCategory::Preventive Medicine
Prompt	[[Prompt::A wildlife worker presents to the emergency room after he was bitten on the hand by a raccoon while trying to capture the animal. On further history taking, he says that the animal appeared to be ill. He further states that he received a primary course of rabies vaccination before two years when he first started his job. The wound is immediately thoroughly cleaned by the emergency room staff. The wound appeared to be small because the patient was wearing gloves while trying to capture the animal. Which will be the most appropriate intervention for rabies prevention?]]
Answer A	AnswerA::No further prophylaxis is necessary because of his history of previous vaccination.
Answer A Explanation	AnswerAExp::'''Incorrect'''-This bite from an ill appearing raccoon carries a high risk of rabies. So definitely the patient will require post exposure prophylaxis.
Answer B	AnswerB::Administer rabies immune globulin only
Answer B Explanation	AnswerBExp::'''Incorrect'''-Rabies immune globulin is not recommended in those who were previously immunized.
Answer C	AnswerC::Administer one dose of vaccine only
Answer C Explanation	AnswerCExp::'''Incorrect'''-A single dose of vaccine alone is an incomplete prophylaxis that will increase the risk of developing rabies.
Answer D	AnswerD::Administer rabies immune globulin and one dose of vaccine
Answer D Explanation	AnswerDExp::'''Incorrect'''-Rabies immune globulin is not recommended and a single dose of vaccine alone is an incomplete prophylaxis in this patient.
Answer E	AnswerE::Administer two doses of vaccine
Answer E Explanation	[[AnswerEExp::Correct-Following a bite of an ill appearing raccoon, which carries a high risk of rabies, the patient has to receive a post exposure prophylaxis immediately following wound cleansing. Two doses of vaccine intramuscularly, one immediately and one 3 days later, are recommended for those who were previously immunized. Rabies immune globulin is unnecessary and should not be administered to these persons because an anamnestic response will follow the administration of a booster regardless of the pre-booster antibody titer. A primary course of vaccination consists of three doses of vaccines at 0, 7, and 21 or 28 days. It is recommended for persons in high-risk groups, such as veterinarians, animal handlers, and certain laboratory personnel.]]
Right Answer	RightAnswer::E
Explanation	[[Explanation::Following a bite of an ill appearing raccoon, which carries a high risk of rabies, the patient has to receive a post exposure prophylaxis immediately following wound cleansing. Two doses of vaccine intramuscularly, one immediately and one 3 days later, are recommended for those who were previously immunized. Rabies immune globulin is unnecessary and should not be administered to these persons because an anamnestic response will follow the administration of a booster regardless of the pre-booster antibody titer. A primary course of vaccination consists of three doses of vaccines at 0, 7, and 21 or 28 days. It is recommended for persons in high-risk groups, such as veterinarians, animal handlers, and certain laboratory personnel. Educational Objective: Post exposure prophylaxis against rabies in a previously immunized individual includes two doses of rabies vaccine intramuscularly, one immediately and one 3 days later, immediately following wound cleansing. Rabies immune globulin is not recommended in patients who were previously immunized. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Rabies, WBRKeyword::Rabies vaccine, WBRKeyword::Rabies immune globulin
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::