cirus
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26) A 21-year-old woman, gravida 2, para 1, at 22 weeks' gestation comes to the physician because of a malodorous vaginal discharge. She states that she first noticed the discharge 2 days ago and since then it has become more profuse and malodorous. Her prenatal course has been unremarkable during this pregnancy. Her prior pregnancy was complicated by preterm labor and delivery at 31 weeks' gestation. Examination shows a grayish vaginal discharge. A strong amine odor is released when KOH is applied to a sample of the discharge. Examination of a normal saline ("wet") preparation reveals numerous "clue" cells. Which of the following is the most appropriate pharmacotherapy?
A. No treatment is needed
B. Oral metronidazole
C. Intramuscular penicillin
D. IV penicillin
E. Oral penicillin
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| neuroblastoma
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B ORAL /VAGINALLLY METRONIDAZOLE
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| cirus
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this is th only choice by exclusions, but this PT is PREGNANT & oral metronidazole is contraindicated with pregnancy , so thats why I posted this q??
any comments
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| neuroblastoma
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i guess it should be vaginally metranidazole.. or clindamycin alternate
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| neuroblastoma
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clindamycin cream cream is t/t chice
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| cirus
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treat in preg is clindamycin...
but accord to Kapl:
The correct answer is
B. This patient has signs and symptoms that are most consistent with bacterial vaginosis. Bacterial vaginosis represents a change in milieu of the vagina such that there is a decrease in the number of lactobacilli and an increase in anaerobic organisms. Patients with bacterial vaginosis usually complain of a malodorous vaginal discharge. The examination is significant for a grayish discharge that releases a strong amine (or fishy) odor when KOH is applied to it. This is known as a positive "whiff" test. Microscopic examination reveals clue cells, which are vaginal epithelial cells that are covered with bacteria. Studies have demonstrated an association between bacterial vaginosis and preterm delivery. There is some evidence that treatment of bacterial vaginosis with oral metronidazole in women at high risk for preterm delivery [i.e., women with a prior preterm delivery or a low prepregnancy weight (<50kg)] will help to prevent preterm delivery. Oral metronidazole appears to be better than the topical, vaginal formulation for the prevention of preterm delivery. To state that no treatment is needed (choice A) is incorrect. First, this patient is symptomatic; therefore, treatment is reasonable. Second, treatment of bacterial vaginosis in the second trimester in women at high risk for preterm delivery may prevent a preterm delivery. Intramuscular penicillin (choice C) is used during pregnancy for women with syphilis. It is not used to treat bacterial vaginosis. IV penicillin (choice D) is used during labor to prevent neonatal group B Streptococcus infection. It is not used for bacterial vaginosis. Oral penicillin (choice E), like intramuscular and IV penicillin, is used for gram-positive infections. Patients with bacterial vaginosis require treatment with a drug that will cover anaerobic infections (e.g., metronidazole.)
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| neuroblastoma
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YEAH RIGHT,,CAN BE USED IN SECOND TRIMESTER, BUT NOT IN FIRST TRIMESTER
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