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penetrated wound - figure1 - cases HISTORY A healthy 40-year -old male presents to the emergency room with a nail penetrating his right index finger. Before removing the nail and treating the wound, you ask the patient for his immunization history . He remembers receiving a tetanus booster sho around his 34th birthday. NOW   Which the following should you administer to this patient. ? 1)    _ Containing vaccine 2)    _ Immune globulin 3)    _ Antibiotic prophylaxis 4)    _ Toxoid-containing vaccine and tetanus immune globulin ANSWER ⇊ According to ➟ CDC recommendations, patients with puncture wounds or wounds containing dirt, feces, soil, or saliva should receive a tetanus toxoid-containing vaccine as soon as possible if their last tetanus shot was more than five years ago. lf their tetanus immunization history is uncertain or they have received less than three doses , tetanus immune globulin ...

AN OVERWEIGHT TEENAGER WITH THICKENED SKIN AROUND HER NECK History A 13-year-old girl attends your clinic with her mother. She is complaining of skin changes affecting her neck , which have been progressively worsening over the past 18 months . In particular the changes are leading to name-calling at school with her peers saying her neck is ‘ dirty ’. Her school attendance for the last term was only 87 per cent. She is a very quiet girl and there is little eye contact through the consultation. Both she and her mother acknowledge that she is overweight . Her menarche was at the age of 11 years and 3 months , her menses are irregular . She is not on medication . She is an only child. Her mother has type 2 diabetes , hypertension and is also overweight , her father suffers from asthma . Examination Her height is 163 cm and weight 97.5 kg – a body mass index ( BMI ) of 37 – and blood pressure 140/85 mmHg. She has symmetrical hyperp...