Repeated USMLE Questions Step 2 CK- 259

A 28 year old woman with a history of normal delivery 3 days ago after an uneventful pregnancy is admitted to the ICU because of high fever and foul-smelling vaginal discharge. General examination reveals temperature of 103.3 F, pulse 96/min and blood pressure 100/70 mmHg. Pelvic examination reveals bloody yellowish discharge and dilated, enlarged and bulky cervix.

What is the next step of action?

A-Blood samples and intravenous antibiotics

B-CT scans of the abdomen and pelvis

C-Observation and waiting for the results of blood culture

D-Oral ampicillin and gentamicin

E-MRI of the pelvis

Answer







This is a case of puerperal sepsis which is also known as postpartum infection. Predisposing factors are delivery by cesarean section (CS), premature rupture of membranes, and presence of group B-Streptococci in the vagina. Prolonged labor and manual removal of the placenta can lead to postpartum infections. Blood samples and vaginal discharge for culture should be collected before intravenous antibiotics to determine the causative organism and antibiotic sensitivity. Oral antibiotics are not recommended for high fever like this one. Image studies, if needed, should be done later after initiation of therapy. Observation and waiting for the results of blood culture are inappropriate in this case.

The correct answer is A

Repeated USMLE Questions Step 2 CK- 302

A 16 year old woman is brought to the emergency room by her mother following a seizure. She is 30 week pregnant with twins. Her mother told you that her daughter was eating lunch and when she stood up she fell on the floor and started shaking. She never had any seizures before. During last week, she complained of headache and swelling of her face. She missed her last two obstetrician's appointments.

On Examination, she is unresponsive and difficult to arouse. Her blood pressure is 210/120. There is edema of her face and both hands. Fetal heart rate is 140/min.

What is the next step of management of this patient?

A- Hospitalization and treatment with antihypertensive and epileptic drugs and wait until delivery at term

B- Hospitalization and observation until delivery at term

C- Hospitalization and induction of labor

D- Outpatient treatment and recommend regular visits to the clinic

Answer:

This is a typical presentation of eclampsia. The only effective treatment of eclampsia is delivery. There is no role of epileptic drugs in this case. Induction of labor is mandatory to save mother’s life. Meanwhile her babies don’t have a lot of risks on their 30th week pregnancy.

The correct answer is C