MCQ Obstetrics Answer 32

The correct answer is D.

This patient has syphilis. Syphilis is a disease caused by Treponema pallidum, a spirochete. A painless ulcer, called a chancre, typically found on the vagina or cervix, characterizes primary syphilis. If primary syphilis is untreated it can progress to secondary syphilis, which is characterized by "moth-eaten" alopecia, a maculopapular skin rash involving the palms and soles, and white patches on the tongue.

Gumma formation, cardiac lesions, and central nervous system abnormalities characterize tertiary syphilis. Syphilis in pregnancy is associated with increased rates of preterm delivery, intrauterine growth retardation, and fetal demise. However, the most devastating complication of syphilis in pregnancy is congenital infection.

Congenital infection of the fetus can lead to severe fetal morbidity and mortality. The key to preventing congenital infection of the fetus is adequate treatment of the mother. Therefore, every woman should be tested for syphilis during routine prenatal care. The RPR test and Venereal Disease Research Laboratory (VDRL) are screening tests for syphilis and are not entirely specific for Treponema pallidum infection. Certain other conditions, such as autoimmune syndromes and pregnancy itself, can give a falsely positive RPR test. Therefore, the RPR test should be followed up with a test that is specific for syphilis, such as the MHA-TP test.

When both of these tests are positive and there is no history of syphilis infection and treatment, then the patient should be treated with intramuscular penicillin.

Erythromycin (choice A) is recommended by some as the first-line treatment for chlamydia in pregnancy (others recommend azithromycin). Erythromycin is not the drug of choice for syphilis in pregnancy.

Levofloxacin (choice B) and the other fluoroquinolones are considered contraindicated in pregnancy because of an association with musculoskeletal congenital anomalies.

Metronidazole (choice C) is used during pregnancy for the treatment of bacterial vaginosis and trichomoniasis. It is not used for treatment of syphilis.

Tetracycline (choice E) is contraindicated during pregnancy because of effects on fetal bones and teeth.

Category: Obstetrics MCQs