WBR0968

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Primary Care Office
Sub Category	SubCategory::Genitourinary, SubCategory::Obstetrics & Gynecology
Prompt	[[Prompt::A 30 year old woman comes to the office with complaints of burning micturition for the past 2 days. She also complaints increased urinary frequency and urgency which is causing extreme discomfort at the work place. She also complaints of mild supra-pubic pain. Her past history is otherwise insignificant and her family history is unremarkable. She is a nonsmoker, but occasionally consumes alcohol. Her menstrual history were regular 3 months back, but has missed her periods since then. She is sexually active with her husband and does not use contraception. Her vitals are temperature: 36.7 C, blood pressure: 140/80 mmHg, pulse: 80/min and respiration: 15/min. All system examinations were normal and there is no costovertebral tenderness. Urine analysis reveals pH: 6.6, WBC: 40+/HPF, RBC: 3/HPF, leukocyte esterase and nitrite positive. What is the most appropriate antibiotic in this patient?]]
Answer A	AnswerA::Nitrofurantoin
Answer A Explanation	[[AnswerAExp:: Incorrect  : Nitrofurantoin (FDA category B) and sulfonamides (FDA category B) have been associated with birth defects and also been reported to cause hemolytic anemia in the mother and fetus with G-6PD deficiency. Nitofurantoin can be used if penicillin and cephalosporin are not available.]]
Answer B	AnswerB::Cephalexin
Answer B Explanation	[[AnswerBExp:: Correct  : Cephalosporins (FDA category B) are safe in pregnancy except ceftriaxone that can cause bilirubin displacement and subsequent kernicterus.]]
Answer C	AnswerC::Trimethoprim
Answer C Explanation	[[AnswerCExp:: Incorrect  : Trimethoprim (FDA category C) is generally avoided in the first trimester because it is a folic acid antagonist, that can cause abnormal embryo development.]]
Answer D	AnswerD::Ciporfloxacin
Answer D Explanation	[[AnswerDExp:: Incorrect  : Fluoroquinolones (FDA category C) are contraindicated during pregnancy.]]
Answer E	AnswerE::Tetracyclines
Answer E Explanation	[[AnswerEExp:: Incorrect  : Tetracyclines (FDA category D) are contraindicated during pregnancy.]]
Right Answer	RightAnswer::B
Explanation	[[Explanation::Urinary tract infections (UTIs) are common in pregnant women. Bacteriuria often develops in the first month of pregnancy and is frequently associated with a reduction in concentrating ability, suggesting involvement of the kidney. The smooth muscle relaxation and subsequent ureteral dilatation that accompany pregnancy are thought to facilitate the ascent of bacteria from the bladder to the kidney. As a result, bacteriuria during pregnancy has a greater propensity to progress to pyelonephritis (up to 40 percent) than in nonpregnant women. Bacteriuria has been associated with an increased risk of preterm birth, low birth weight, and perinatal mortality. The diagnosis of asymptomatic bacteriuria should be based on culture of a urine specimen collected in a manner that minimizes contamination. It is generally accepted that penicillins and cephalosporins (FDA category B) are safe in pregnancy. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::UTI, WBRKeyword::Pregnancy
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::