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+--- Thread: nmbe# 30 - clinical (/showthread.php?tid=686698)
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nmbe# 30 - clinical - ArchivalUser - 07-07-2012
30. A 20-year-old woman returns to the office for the results of her prenatal laboratory studies. By date of her last menstrual period she is 14 weeks pregnant with her second child. Her first pregnancy, which you followed, resulted in an uncomplicated vaginal delivery approximately 11 months ago. Her prenatal serology screening for syphilis is positive with a titer of 1:126, and a fluorescent treponemal antibody absorption (FTA-ABS) test is positive. The patient denies having lesions consistent with syphilis, and her current physical examination shows no lesions. Serology during her first pregnancy was negative. At this time, which of the following is the most appropriate management?
A
) Do an amniocentesis to obtain fluid for darkfield evaluation
B
) Follow the treatment regimen recommended for primary or secondary syphilis
C
) Postpone treatment until the patient is at least 20 weeks pregnant
D
) Schedule a lumbar puncture before instituting treatment
E
) Withhold treatment until further studies rule out a biologic false-positive
i just woundering the indication of CSF in syphlis .........dou do a CSF in latent syphilis or not ??
0 - ArchivalUser - 07-08-2012
which answer do you think it is? i think c.
if you are considering d... mmm. dd is quite possible because there are different PCNs. (neurosyphilis use aqueous PCN for 14 days and the other syphilis use benzathine.) neurosyphilis could be tabes dorsalis, paraplegia, dementia, argyll-roberson pupil...etc quite protean. most common form is asymptomatic. so go ahead choose DD. i am going to change it, too
0 - ArchivalUser - 07-08-2012
we do lp in case of hiv pt ,3 syphills with sympt or immuncompromised pt. i will go for treatment,that is b.
0 - ArchivalUser - 07-08-2012
According to UpToDate,
Pregnancy alone is not an indication for lumbar puncture.
CSF examination is essential if
1) there is any clinical evidence to suggest neurosyphilis, such as cranial nerve dysfunction, meningitis, stroke, acute or chronic altered mental status, loss of vibration sense, auditory or ophthalmic abnormalities
2)we suggest lumbar puncture for all asymptomatic or symptomatic patients with a serum RPR titer ≥1:32 or the presence of HIV infection with a CD4 count ≤350 cells/mm3.
I will go with D
0 - ArchivalUser - 07-09-2012
great. that's what we all need. thanks mafiafreeze.
0 - ArchivalUser - 07-09-2012
Sure,
Any time
101001000 - ArchivalUser - 07-09-2012
she has titer 1:126. Is it greater than 1:32 ???
Just joking... Still confusion between C and D.
0 - ArchivalUser - 07-09-2012
b.
0 - ArchivalUser - 07-09-2012
b...........
0 - ArchivalUser - 07-18-2012
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