| A 9-year-old boy is brought to the hospital with a wound to his left hand. He was in a fight with peer who bit him. His past medical history is unremarkable and he takes no medications. He has no known allergies. On examination, the child is crying. There is a 2-cm wound over the dorsum of his palm. What is the most appropriate course of action? | |
| A. Clean the wound and prescribe amoxicillin-clavulanate. | |
| B. Clean the wound and prescribe doxycycline. | |
| C. Clean the wound and prescribe ciprofloxacin. | |
| D. Clean the wound, close it with interrupted sutures and prescribe ciprofloxacin. | |
| E. Clean the wound, close it with interrupted sutures and prescribe amoxicillin-clavulanate. | |
Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: Archer Infectious Diseases, archer pediatrics, USMLE STEP 3 INFECTIOUS DISEASES, USMLE STEP3 PEDIATRICS |
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B is answer
E is the answer
A
A
A. Two things to consider here: 1) to close, or not to close ? – generally do not close. 2) Antibiotic – Eikenella corrodens would need more than just amoxicillin since it has betalactamase activity. Another tiny thingy would be the 8 year old treshold, after which one could use doxycycline. Here, though it would be enough to give Sulbactam.
There’s a third thing that might be asked in this scenario: Tetanus prophylaxis – tetanus immune globulin and the 3-dose vaccine series should be administered to patients with an unknown tetanus vaccine history or those who have received fewer than 3 doses. It is also indicated for patients who received the complete tetanus series, but whose booster administration was more than 5 years ago. For patients with a history of 3 or more doses of tetanus and diphtheria vaccine who received a booster less than 5 years ago, no tetanus booster is required.
A fourth issue might be a positive HIV status of the one who bit the hand: starting the postexposure HAART might be needed depending how big the wound is, how much of a risk would be the contact between blood of both people.