Communicable diseases: rabies post-exposure prophylaxis: practice question

A PSM question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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PSM · Communicable diseases: rabies post-exposure prophylaxis

Sample item

A 9-year-old girl is scratched on the forearm by an unvaccinated stray dog while feeding it. The scratches are minor and there is no bleeding. What is the most appropriate management?

AWash the wounds and observe the dog without vaccinating the girl for 10 daysBWash the wounds and infiltrate rabies immunoglobulin into them along with vaccineCWash the wounds with soap and running water and give anti-rabies vaccine without immunoglobulinDReassurance only, because there is no bleeding

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Wash the wounds with soap and running water and give anti-rabies vaccine without immunoglobulin

Minor scratches or abrasions without bleeding, or nibbling of uncovered skin, are WHO category II exposure and need immediate wound washing and a course of vaccine. Immunoglobulin is added for category III exposure, which includes transdermal bites, scratches that bleed, licks on broken skin and mucous membrane exposure. Vaccination is not delayed for an unobservable stray animal.

Option by option

A. Wash the wounds and observe the dog without vaccinating the girl for 10 days
Observation of the animal is not feasible for a stray dog, and a child should not wait for symptoms in the animal before receiving the vaccine.
B. Wash the wounds and infiltrate rabies immunoglobulin into them along with vaccine
Immunoglobulin infiltration is reserved for category III exposures and is not needed here.
C. Wash the wounds with soap and running water and give anti-rabies vaccine without immunoglobulin (correct)
Correct. Category II exposure needs wound washing and vaccine only.
D. Reassurance only, because there is no bleeding
Any scratch from an unvaccinated stray animal is an exposure that needs prophylaxis, so reassurance alone is unsafe.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this PSM question

What is the answer to this PSM question?

The best answer is C, Wash the wounds with soap and running water and give anti-rabies vaccine without immunoglobulin. Minor scratches or abrasions without bleeding, or nibbling of uncovered skin, are WHO category II exposure and need immediate wound washing and a course of vaccine.

Why is "Wash the wounds and observe the dog without vaccinating the girl for…" not the answer?

Observation of the animal is not feasible for a stray dog, and a child should not wait for symptoms in the animal before receiving the vaccine.

Why is "Wash the wounds and infiltrate rabies immunoglobulin into them along…" not the answer?

Immunoglobulin infiltration is reserved for category III exposures and is not needed here.

Why is "Reassurance only, because there is no bleeding" not the answer?

Any scratch from an unvaccinated stray animal is an exposure that needs prophylaxis, so reassurance alone is unsafe.

What concept does this question test?

It tests Communicable diseases: rabies post-exposure prophylaxis in PSM. Immunoglobulin is added for category III exposure, which includes transdermal bites, scratches that bleed, licks on broken skin and mucous membrane exposure. Vaccination is not delayed for an unobservable stray animal.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Communicable diseases: rabies post-exposure prophylaxis?

Practise biostatistics with small calculations until sensitivity, predictive values and risk measures are automatic. Then use the flashcards and the other PSM questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.