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Repeated USMLE Questions Step 2 CK- 436

A 28-year-old woman with a history of normal delivery 3 days ago after an uneventful pregnancy is admitted to the ICU because of high fever and foul-smelling vaginal discharge. General examination reveals temperature of 103.3 F, pulse 96/min and blood pressure 100/70 mmHg. Pelvic examination reveals bloody yellowish discharge and dilated, enlarged and bulky cervix.

What is the next step of action?

A-Blood samples and intravenous antibiotics

B-CT scans of the abdomen and pelvis

C-Observation and waiting for the results of blood culture

D-Oral ampicillin and gentamicin

E-MRI of the pelvis

Answer



This is a case of puerperal sepsis which is also known as postpartum infection. Predisposing factors are delivery by cesarean section (CS), premature rupture of membranes, and presence of group B-Streptococci in the vagina. Prolonged labor and manual removal of the placenta can lead to postpartum infections. Blood samples and vaginal discharge for culture should be collected before intravenous antibiotics to determine the causative organism and antibiotic sensitivity. Oral antibiotics are not recommended for high fever like this one. Image studies, if needed, should be done later after initiation of therapy. Observation and waiting for the results of blood culture are inappropriate in this case.

The correct answer is A


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