A 29-year-old man comes to the physician for a routine health maintenance examination. He feels well. He works as a nurse at a local hospital in the city. Three days ago, he had a needlestick injury from a patient whose serology is positive for hepatitis B. He completed the 3-dose regimen of the hepatitis B vaccine 2 years ago. His other immunizations are up-to-date. He appears healthy. Physical examination shows no abnormalities. He is concerned about his risk of being infected with hepatitis B following his needlestick injury. Serum studies show negative results for hepatitis B surface antigen, hepatitis B surface antibody, and hepatitis C antibody. Which of the following is the most appropriate next step in management?
ARevaccinate with 3-dose regimen of hepatitis B vaccine
BRevaccinate with two doses of hepatitis B vaccine
CAdminister hepatitis B immunoglobulin
DAdminister hepatitis B immunoglobulin and 3-dose regimen of hepatitis B vaccine
EAdminister hepatitis B immunoglobulin and single dose hepatitis B vaccine
A 40-year-old pregnant woman, G4 P3, visits your office at week 30 of gestation. She is very excited about her pregnancy and wants to be the healthiest she can be in preparation for labor and for her baby. What vaccination should she receive at this visit?
AMeasles, mumps, and rubella (MMR)
BVaricella vaccine
CHerpes zoster vaccine
DLive attenuated influenza vaccine
ETetanus, diphtheria, and acellular pertussis (Tdap)
A 7-year-old African-American boy presents to his physician with fatigue, bone and abdominal pain, and mild jaundice. The pain is dull and remitting, and the patient complains it sometimes migrates from one extremity to another. His mother reports that his jaundice and pain have occurred periodically for the past 5 years. At the time of presentation, his vital signs are as follows: the blood pressure is 80/50 mm Hg, the heart rate is 87/min, the respiratory rate is 17/min, and the temperature is 36.5°C (97.7°F). On physical examination, the patient appears to be pale with mildly icteric sclera and mucous membranes. On auscultation, there is a soft systolic ejection murmur, and palpation reveals hepatosplenomegaly. His musculoskeletal examination shows no abnormalities. Laboratory investigations show the following results: Complete blood count Erythrocytes 3.7 x 106/mm3 Hgb 11 g/dL Total leukocyte count Neutrophils Lymphocytes Eosinophils Monocytes Basophils 7,300/mm3 51% 40% 2% 7% 0 Platelet count 151,000/mm3 Chemistry Total bilirubin 3.1 mg/dL (53 µmol/L) Direct bilirubin 0.5 mg/dL (8.55 µmol/L) A peripheral blood smear shows numerous sickle-shaped red blood cells. Among other questions, the patient’s mother asks you how his condition would influence his vaccination schedule. Which of the following statements is true regarding vaccination in this patient?
AThe patient’s condition does not affect his chances to get any infection; thus, additional vaccinations are not advised.
BThe patient should not receive meningococcal, pneumococcal, or Haemophilus influenzae vaccines, because they are likely to cause complications or elicit disease in his case.
CThe patient should receive the pneumococcal polysaccharide vaccine as soon as possible, because he is at higher risk of getting pneumococcal infection than other children.
DThe patient should receive serogroup B meningococcal vaccination at the age of 10 years.
EThe patient should receive serogroup B meningococcal vaccination as soon as possible, because he is at higher risk of getting meningococcal infection than other children.
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