Examkin

Question

Difficulty: MediumInfectious Diseases

Match each clinical exposure scenario with the most appropriate guideline-directed post-exposure prophylaxis (PEP) or preventative management.

  • A 24-year-old healthcare worker sustains a deep, hollow-bore needlestick injury after drawing blood from a patient with untreated HIV.Tenofovir-emtricitabine plus dolutegravir for 28 days
  • A 19-year-old college student shares a small dormitory room with a peer recently hospitalized for Neisseria meningitidis meningitis.A single dose of oral ciprofloxacin or intramuscular ceftriaxone
  • A 35-year-old camper awakens in a cabin to find a bat flying around the room, though no bite or scratch marks are found.Human rabies immune globulin and rabies vaccine series
  • A 28-year-old pregnant woman in her second trimester has a toddler at home who was just diagnosed with Bordetella pertussis infection.A 5-day course of oral azithromycin

Answer

The correct pairings successfully match HIV occupational exposure with a 28-day three-drug antiretroviral regimen, meningococcal exposure with a single dose of ciprofloxacin or ceftriaxone, occult bat exposure with rabies immune globulin and vaccine series, and pertussis exposure during pregnancy with a 5-day course of azithromycin.
The correct matches pair each specific infectious exposure with its evidence-based post-exposure prophylaxis. High-risk HIV exposure requires a 28-day three-drug antiretroviral regimen. Meningococcal exposure for close contacts necessitates rapid eradication of nasopharyngeal carriage with agents like ciprofloxacin or ceftriaxone. Occult bat exposures demand immediate rabies PEP (immune globulin and vaccination) due to the fatal nature of the disease and potential for undetectable bites. Finally, pertussis contacts, including pregnant women, require macrolide prophylaxis to prevent transmission to vulnerable individuals.

Step-by-Step Solution

1
Analyze the occupational HIV exposure scenario.
Identified the need for full three-drug antiretroviral post-exposure prophylaxis.
Due to the high-risk nature of the deep, hollow-bore injury involving an untreated HIV source, maximum prevention with a regimen such as tenofovir-emtricitabine and dolutegravir is required.
2
Evaluate the meningococcal exposure scenario.
Determined that sharing a dormitory qualifies as a close contact exposure requiring clearance of nasopharyngeal colonization.
Close contacts of patients with Neisseria meningitidis are at high risk for secondary cases and require immediate chemoprophylaxis via ceftriaxone, ciprofloxacin, or rifampin.
3
Assess the bat exposure scenario.
Recognized that sleeping in the same room as a bat is an absolute indication for rabies prophylaxis.
Rabies immune globulin and the vaccine series must be administered since bat bites can be entirely imperceptible and rabies is universally fatal without prophylaxis.
4
Review the pertussis exposure in a pregnant patient.
Identified that the pregnant woman is a household contact of a toddler with pertussis and requires a macrolide.
Azithromycin is the drug of choice for pertussis post-exposure prophylaxis and is well-established as safe during pregnancy.

Key Concept

Identifying appropriate post-exposure prophylaxis (PEP) regimens based on specific infectious exposures
Rate this question

Topics

Infectious Diseases

More questions from this topic