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 medical technician is trying to isolate a pathogen from the sputum sample of a patient. The sample is heat fixed to a slide then covered with carbol fuchsin stain and heated again. After washing off the stain with clean water, the slide is covered with 1% sulfuric acid for decolorization. The sample is rinsed again and stained with methylene blue. Microscopic examination shows numerous red, branching filamentous organisms. Which of the following is the most likely isolated pathogen?
ACryptococcus neoformans
BTropheryma whipplei
CNocardia asteroides
DRickettsia rickettsii
EStaphylococcus aureus
A 57-year-old man comes to the physician because of generalized malaise, yellowish discoloration of the eyes, and pruritus on the back of his hands that worsens when exposed to sunlight for the past several months. He has not seen a physician in 15 years. Physical examination shows scleral icterus and mild jaundice. There is a purpuric rash with several small vesicles and hyperpigmented lesions on the dorsum of both hands. The causal pathogen of this patient's underlying condition was most likely acquired in which of the following ways?
AIngestion of raw shellfish
BInhalation of spores
CNeedlestick injury
DBathing in freshwater
ESexual contact
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