USMLE-Rx Step 2 Qmax Challenge #21213

Check out today’s Step 2 CK Qmax Question Challenge.

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A 19-year-old woman undergoes a bone-marrow transplant from her human leukocyte antigen–matched sister to treat refractory acute lymphoblastic leukemia. In addition to antibiotic prophylaxis, her oncologist recognizes the need for vaccination against likely pathogens. She received all required immunizations prior to enrolling in college last year, including meningococcal vaccines.

What is the appropriate vaccination schedule for protection against Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis?

A. Forgo vaccination of the patient because of the risk of pathogen reactivation in the immunosuppressed host, but vaccinate all household members
B. No different than vaccination schedule for general population
C. Vaccinate 3–6 months after transplantation, avoid live vaccinations, and confirm that all household members have been vaccinated
D. Vaccinate immediately after giving donor bone marrow to condition the marrow as it engrafts
E. Vaccinate the patient against H. influenzae, S. pnumoniae, N. meningiditis prior to beginning the immunosuppressive transplant protocol


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10 thoughts on “USMLE-Rx Step 2 Qmax Challenge #21213”

  1. C. Guidelines recommend vaccinations 3-6 months after BMT and deferment of live vaccines until 24 months after BMT. Family members should be vaccinated.

    Even though patient had been previously vaccinated, the decrease in B cells puts them at risk of suffering from encapsulated pathogen diseases.

    1. Dr. Raymond G. Whitham

      The exact question was “What is the appropriate vaccination schedule for protection against Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis?”

      No other vaccinations are included. There are no live vaccines for any of these. “C” concerns other vaccines not included in the questions.

  2. C.Diphtheria and TT, inactivated poliovirus, Hib, influenza and pneumococcal vaccines are recommended routinely after BMT

  3. D. This is considered an opportunity to condition the donor bone marrow and build up immunity.

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