A High Yield question from UW

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A High Yield question from UW

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usmle-china
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09/12/07 - 12:15 PM

A 16 yr girl presents to the office with complaints of burning sensation with urinating for past 2 weeks. She was seen in the office a weeks ago and treated with TMP/SMZ for UTI, her symptoms have not improved. She is sexually active and use pills for contraception. She has also noticed yellowish purulent vaginal discharge for past 2 weeks. She is afebrile and no other complaints. Pelvic exam show yellow mucoid endcervical discharge and an edematous friable cervix. A gram stains of the discharge reveals greater than 30 WBC/HPF and absence of organism. What is the most appropriate next step in the managemant?

A. Board spectrum antibiotics for resistant UTI
B. Treat patient and partner with single dose Azithromycin.
C. Single dose Azithromycin plus single dose IM Ceftriaxone
D. Single dose IM Ceftriaxone plus Doxycycline 7 days
E. Admit and IV cefoteta plus oral doxycycline
F. 7 days Doxycycline for both the patient and the partner.

dr in trouble
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09/12/07 - 01:36 PM

D--PID--sexually active, treat for chlamydia and gonorrhea.

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Justice
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09/12/07 - 01:36 PM

D. Single dose IM Ceftriaxone plus Doxycycline 7 days

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Justice
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09/12/07 - 01:37 PM

dr in trouble wrote:
D--PID--sexually active, treat for chlamydia and gonorrhea.

This one also could be rigth:
F. 7 days Doxycycline for both the patient and the partner since this is most likely chlamydial endocervicitis

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peraspera
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09/12/07 - 04:35 PM

starcraftbw
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09/12/07 - 08:16 PM

docfor99
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09/12/07 - 09:25 PM

b...chlamydia inf....we need not cover for gonorrhoea but for gonorrhoae we need to give coverage for chlamydia....7 days doxy is also good but compliance is better with single dose azithro

usmle-china
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09/13/07 - 08:03 AM

Yes, the correct answer is B.

Some questions look like easy, actually there are trap or trick inside. This question is one of them. That is why some exam taker felt very good after the exam but end up with a disappointed score.

For some high-yield disease, such as Chlamydia infection, Lyme disease , you should not only know the common treatment, but also the best treatment.

In this case, the Gram stains didn't find the organism means this patient had Chlamydia infection ( Chlamydia Cervitis ), which is a STD. STD should treat both patient and partner, so the answer can be norrowed to B and F. Which one is best? We all know Chlamydia infecation is treated with Doxycycline 7 days. However, a single dose of Azithromycin is a best choice for both patient and partner simply due to good compliance.

Please remember this question! you might meet the same question in your real exam.

njcjzy
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09/13/07 - 09:03 PM

Good explanation and good advise, thanks! smiling face

elitoki
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09/17/07 - 03:30 PM

#10

GOGETA
I'm Dr. GOGETA
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09/17/07 - 03:36 PM

#11

I tought that was D or C.
B was tempting but then I remember that what we do in practice does not mean is the correct answer for the test. Based on Dr. Dorothy from behavio kaplan

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starcraftbw
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09/18/07 - 03:26 PM

#12

very good explaination, i fell into the trap smiling face

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