STI reviewer

Question 1

Answer 1

Question 2

Answer 2

Question 3

Answer 3

Question 4

Answer 4

Question 5

Answer 5

Question 6

A 29-year-old G1P0 at 38 weeks gestation presents in active labor. Her GBS culture results are unknown, but her history includes a previous child with early-onset neonatal GBS sepsis.

What is the best course of action?

A) Await culture results before initiating treatment
B) No antibiotics needed if there are no signs of infection
C) Administer intrapartum IV Penicillin G immediately
D) Perform cesarean section to reduce GBS transmission

Answer 6

C) Administer intrapartum IV Penicillin G immediately

Rationale:
Why not A (Await culture results)?
→ If GBS status is unknown AND the patient has a history of a previous child with GBS sepsis, antibiotics must be given immediately.

Why not B (No antibiotics)?
→ This patient is at high risk for GBS transmission, so prophylaxis is necessary regardless of symptoms.

Why IV Penicillin G immediately (C)?
→ History of a prior GBS-infected infant is an automatic indication for intrapartum prophylaxis, even if culture status is unknown.

Why not D (Cesarean section)?
→ C-section does NOT prevent vertical transmission of GBS, so IV antibiotics remain the preferred method.

Question 7

A 25-year-old pregnant woman at 22 weeks gestation presents for routine ultrasound. The scan reveals periventricular calcifications, microcephaly, and hepatosplenomegaly in the fetus. The mother reports a recent history of flu-like symptoms and works at a daycare center. Laboratory testing shows positive CMV IgM and low IgG avidity.

What is the most likely diagnosis?

A) Toxoplasmosis
B) Cytomegalovirus (CMV)
C) Rubella
D) Parvovirus B19

Answer 7

B) Cytomegalovirus (CMV)

Rationale:
Why CMV (B)?
→ Periventricular calcifications are pathognomonic for congenital CMV infection. Other key features include microcephaly, hepatosplenomegaly, and sensorineural hearing loss risk.
Why not A (Toxoplasmosis)?
→ Toxoplasmosis presents with diffuse intracranial calcifications, not periventricular calcifications.
Why not C (Rubella)?
→ Rubella presents with PDA, cataracts, and sensorineural deafness, not periventricular calcifications.
Why not D (Parvovirus B19)?
→ Parvovirus B19 is associated with hydrops fetalis, not periventricular calcifications.

Question 8

A 19-year-old primigravida at 14 weeks gestation presents with a vesicular rash in different stages of healing on her face, trunk, and arms. She reports fever, malaise, and exposure to her 5-year-old nephew, who had “chickenpox” last week. Fetal ultrasound at 20 weeks shows limb hypoplasia and skin scarring.

Which infection is most likely responsible for the fetal abnormalities?

A) Parvovirus B19
B) Rubella
C) Cytomegalovirus
D) Varicella-Zoster Virus (VZV)

Answer 8

D) Varicella-Zoster Virus (VZV)

Rationale:
Why VZV (D)?
→ Classic congenital VZV findings include limb hypoplasia, skin scarring, and microcephaly.
Why not A (Parvovirus B19)?
→ Parvovirus causes hydrops fetalis and severe fetal anemia, not limb abnormalities.
Why not B (Rubella)?
→ Rubella causes congenital heart defects and sensorineural deafness, not vesicular rashes or limb defects.
Why not C (CMV)?
→ CMV leads to periventricular calcifications, not limb hypoplasia or skin scarring.

Question 9

A 32-year-old woman at 28 weeks gestation presents with fever (39°C), myalgias, nonproductive cough, and dyspnea for three days. She is tachycardic and mildly hypoxic on room air. She has no history of influenza vaccination this season. Chest X-ray shows bilateral patchy infiltrates.

Which of the following is the most appropriate next step?

A) Supportive care and close monitoring
B) Oseltamivir antiviral therapy
C) Immediate delivery via C-section
D) Empiric IV antibiotics for pneumonia

Answer 9

B) Oseltamivir antiviral therapy

Rationale:
Why Oseltamivir (B)?
→ Pregnant women are at higher risk for severe influenza complications, and antiviral therapy reduces maternal morbidity.
Why not A (Supportive care)?
→ Influenza in pregnancy increases the risk of respiratory failure and preterm labor, requiring treatment.
Why not C (Immediate C-section)?
→ There is no indication for early delivery unless fetal distress occurs.
Why not D (Empiric antibiotics)?
→ Antibiotics are not first-line unless there is clear evidence of bacterial superinfection.

Question 10

A 35-year-old pregnant woman at 30 weeks gestation presents with dyspnea, anosmia, fever, and persistent dry cough for 5 days. Oxygen saturation is 92% on room air. She reports household exposure to a co-worker who tested positive for COVID-19. A nasopharyngeal PCR test confirms SARS-CoV-2 infection.

Which of the following complications is most concerning in this patient?

A) Preterm labor
B) Congenital malformations
C) Limb hypoplasia
D) Severe fetal anemia

Answer 10

A) Preterm labor

Rationale:
Why Preterm labor (A)?
→ SARS-CoV-2 in pregnancy is associated with increased risk of preterm labor, thrombosis, and severe maternal morbidity.
Why not B (Congenital malformations)?
→ Unlike rubella, COVID-19 does not cause congenital defects.
Why not C (Limb hypoplasia)?
→ Limb hypoplasia is seen in congenital VZV infection, not COVID-19.
Why not D (Severe fetal anemia)?
→ Parvovirus B19, not COVID-19, is associated with fetal anemia.

Question 11

A 27-year-old pregnant woman at 20 weeks gestation presents for routine ultrasound, which shows fetal hydrops (ascites, pleural effusion, skin edema), cardiomegaly, and polyhydramnios. She reports a recent exposure to a child with “slapped cheek” rash at her workplace.

What is the most likely cause of the fetal abnormalities?

A) Cytomegalovirus
B) Parvovirus B19
C) Toxoplasmosis
D) Rubella

Answer 11

B) Parvovirus B19

Rationale:
Why Parvovirus B19 (B)?
→ Parvovirus B19 infects fetal erythroid precursors, causing severe fetal anemia and hydrops fetalis.
Why not A (CMV)?
→ CMV does not typically cause hydrops fetalis but presents with periventricular calcifications.
Why not C (Toxoplasmosis)?
→ Toxoplasmosis causes diffuse intracranial calcifications but does not primarily lead to hydrops.
Why not D (Rubella)?
→ Rubella causes congenital heart defects and cataracts, not fetal hydrops.

Question 12

A 26-year-old G1P0 woman at 35 weeks gestation presents with fever (38.5°C), tachycardia (maternal HR 110 bpm, fetal HR 175 bpm), uterine tenderness, and foul-smelling amniotic fluid. She denies any recent urinary tract infections. Speculum examination shows clear amniotic fluid pooling in the vagina.

What is the most likely diagnosis?

A) Group B Streptococcus (GBS) colonization
B) Pyelonephritis
C) Chorioamnionitis
D) Preterm labor without infection

Answer 12

C) Chorioamnionitis

Rationale:
Why Chorioamnionitis (C)?
→ Fever, maternal and fetal tachycardia, uterine tenderness, and foul-smelling amniotic fluid are classic signs of chorioamnionitis, an ascending infection from the vagina into the amniotic sac.

Why not A (GBS colonization)?
→ GBS colonization alone does not cause infection unless it progresses to chorioamnionitis, neonatal sepsis, or pneumonia.

Why not B (Pyelonephritis)?
→ Pyelonephritis presents with fever and flank pain but lacks uterine tenderness and foul-smelling amniotic fluid.

Why not D (Preterm labor without infection)?
→ Preterm labor does not cause fever, foul-smelling amniotic fluid, or maternal tachycardia.

Question 13

A 28-year-old G2P1 at 38 weeks gestation presents in active labor with fever (39°C), uterine tenderness, and fetal tachycardia. Rupture of membranes occurred 18 hours ago. She has no known drug allergies.

What is the best next step in management?

A) Continue labor with expectant management
B) Administer IV antibiotics and expedite delivery
C) Start steroids for fetal lung maturity
D) Delay delivery until maternal fever resolves

Answer 13

B) Administer IV antibiotics and expedite delivery

Rationale:
Why IV antibiotics and delivery (B)?
→ Chorioamnionitis is an obstetric emergency requiring broad-spectrum IV antibiotics (Ampicillin + Gentamicin) and immediate delivery to prevent neonatal sepsis.

Why not A (Expectant management)?
→ Waiting increases the risk of maternal and neonatal complications such as sepsis and preterm birth.

Why not C (Steroids)?
→ Steroids are only given for preterm labor <34 weeks to aid fetal lung development. At 38 weeks, they are unnecessary.

Why not D (Delay delivery)?
→ Chorioamnionitis requires immediate delivery, as infection worsens with time.

Question 14

A 32-year-old woman at 37 weeks gestation undergoes routine prenatal screening. A vaginal-rectal swab culture is positive for Group B Streptococcus (GBS). She has no known allergies.

What is the most appropriate next step in management?

A) Oral amoxicillin now and repeat culture at 39 weeks
B) IV Penicillin G during labor
C) IV Vancomycin now and repeat culture in one week
D) No treatment unless the baby shows signs of infection after delivery

Answer 14

B) IV Penicillin G during labor

Rationale:
Why IV Penicillin G during labor (B)?
→ GBS is not treated before labor because recolonization can occur. IV antibiotics are only given during labor to prevent neonatal GBS infection.

Why not A (Oral amoxicillin now)?
→ Oral antibiotics do not eliminate GBS colonization long-term, and re-testing at 39 weeks is not recommended.

Why not C (Vancomycin)?
→ Vancomycin is only used if the patient has a severe penicillin allergy.

Why not D (No treatment)?
→ GBS colonization increases the risk of neonatal sepsis, pneumonia, and meningitis, making intrapartum prophylaxis essential.

Question 15

A 29-year-old G1P0 at 38 weeks gestation presents in active labor. Her GBS culture results are unknown, but her history includes a previous child with early-onset neonatal GBS sepsis.

What is the best course of action?

A) Await culture results before initiating treatment
B) No antibiotics needed if there are no signs of infection
C) Administer intrapartum IV Penicillin G immediately
D) Perform cesarean section to reduce GBS transmission

Answer 15

C) Administer intrapartum IV Penicillin G immediately

Rationale:
Why IV Penicillin G immediately (C)?
→ A history of a prior GBS-infected infant is an automatic indication for intrapartum prophylaxis, even if the current culture status is unknown.

Why not A (Await culture results)?
→ Waiting for results would delay treatment and increase the risk of neonatal GBS infection.

Why not B (No antibiotics)?
→ GBS colonization can be asymptomatic but still lead to neonatal sepsis.

Why not D (Cesarean section)?
→ C-section does NOT prevent vertical transmission of GBS, so IV antibiotics remain the standard of care.

Question 16

A 25-year-old pregnant woman at 16 weeks gestation has no symptoms but is found to have >100,000 CFU/mL of E. coli in her urine culture.

What is the most appropriate management?

A) No treatment needed
B) Nitrofurantoin or cephalexin
C) IV ceftriaxone
D) Delay treatment until symptoms develop

Answer 16

B) Nitrofurantoin or cephalexin

Rationale:
Why Nitrofurantoin or cephalexin (B)?
→ Asymptomatic bacteriuria must always be treated in pregnancy to prevent progression to pyelonephritis and preterm labor.

Why not A (No treatment)?
→ Untreated bacteriuria increases the risk of kidney infection, preterm labor, and low birth weight.

Why not C (IV ceftriaxone)?
→ IV antibiotics are reserved for pyelonephritis, not asymptomatic bacteriuria.

Why not D (Delay treatment)?
→ Early treatment prevents complications; waiting increases maternal and fetal risks.

Question 17

A 28-year-old woman at 24 weeks gestation presents with fever (39°C), flank pain, nausea, vomiting, and costovertebral angle tenderness. Urinalysis shows WBC casts and pyuria.

What is the most appropriate treatment?

A) Oral nitrofurantoin
B) IV ceftriaxone
C) No antibiotics unless symptoms worsen
D) Trimethoprim-sulfamethoxazole

Answer 17

B) IV ceftriaxone

Rationale:
Why IV ceftriaxone (B)?
→ Pyelonephritis in pregnancy is an emergency requiring hospitalization and IV antibiotics to prevent sepsis.

Why not A (Oral nitrofurantoin)?
→ Oral antibiotics are insufficient for severe infections like pyelonephritis.

Why not C (No antibiotics)?
→ Untreated pyelonephritis increases the risk of preterm labor, sepsis, and maternal mortality.

Why not D (TMP-SMX)?
→ Trimethoprim-sulfamethoxazole is contraindicated in pregnancy due to folate inhibition.

Question 18

A 28-year-old pregnant teacher at 10 weeks gestation presents with bilateral painful swelling of the parotid glands, fever, and malaise. She denies recent vaccinations. Examination reveals tender, swollen cheeks and mild orchitis in her partner.

Which of the following is the most likely complication in her pregnancy?

A) Congenital deafness
B) Spontaneous abortion
C) Microcephaly
D) PDA and cataracts

Answer 18

B) Spontaneous abortion

Rationale:
Why Spontaneous Abortion (B)?
→ Mumps infection during the first trimester increases the risk of miscarriage but does not cause congenital anomalies.
Why not A (Congenital deafness)?
→ Congenital deafness is a classic finding in Rubella, not Mumps.
Why not C (Microcephaly)?
→ Microcephaly is commonly associated with Cytomegalovirus (CMV) and Zika virus, not Mumps.
Why not D (PDA and cataracts)?
→ PDA and cataracts are features of congenital Rubella syndrome, not Mumps.

Question 19

A 26-year-old pregnant woman at 18 weeks gestation presents with high fever, cough, coryza, conjunctivitis, and a maculopapular rash that started on her face and spread downward. On oral examination, you note white spots on an erythematous base inside her cheeks.

What is the most likely diagnosis?

A) Rubella
B) Measles (Rubeola)
C) Varicella
D) Parvovirus B19

Answer 19

B) Measles (Rubeola)

Rationale:
Why Measles (B)?
→ The presence of the classic “3 Cs” (Cough, Coryza, Conjunctivitis) along with a maculopapular rash and Koplik spots is diagnostic for Measles.
Why not A (Rubella)?
→ Rubella presents with postauricular lymphadenopathy and does not have the “3 Cs” or Koplik spots.
Why not C (Varicella)?
→ Varicella presents with a vesicular rash at different stages of healing, not a descending maculopapular rash.
Why not D (Parvovirus B19)?
→ Parvovirus B19 causes hydrops fetalis and “slapped cheek” rash in children, not Measles.

Question 20

A 23-year-old unvaccinated woman at 12 weeks gestation presents with low-grade fever, lymphadenopathy (postauricular and occipital), and a pink maculopapular rash that spreads from the face downward. Fetal ultrasound at 22 weeks reveals congenital heart defects and cataracts.

Which of the following is the most likely diagnosis?

A) Measles
B) Rubella
C) Parvovirus B19
D) Cytomegalovirus

Answer 20

B) Rubella

Rationale:
Why Rubella (B)?
→ Rubella is characterized by postauricular and occipital lymphadenopathy, a descending rash, and congenital anomalies including PDA, cataracts, and congenital deafness.
Why not A (Measles)?
→ Measles presents with Koplik spots and does not cause congenital heart defects or cataracts.
Why not C (Parvovirus B19)?
→ Parvovirus B19 is associated with fetal hydrops and severe anemia, not congenital cataracts or heart defects.
Why not D (Cytomegalovirus)?
→ CMV causes periventricular calcifications and sensorineural hearing loss but not cardiac defects or cataracts.

Question 21

A 35-year-old G2P1 woman at 37 weeks gestation presents for routine prenatal screening. Her vaginal-rectal culture tests positive for Group B Streptococcus (GBS). She has no known drug allergies.

What is the most appropriate management at the time of labor?

A) No treatment is needed
B) Intravenous penicillin G during labor
C) Oral amoxicillin now and repeat culture at 39 weeks
D) Elective cesarean section

Answer 21

B) Intravenous penicillin G during labor

Rationale:
Why IV Penicillin G during labor (B)?
→ GBS colonization is treated during labor, NOT before, because recolonization can occur. Intrapartum prophylaxis reduces the risk of neonatal sepsis, pneumonia, and meningitis.

Why not A (No treatment needed)?
→ Untreated maternal GBS colonization increases the risk of neonatal infection, requiring prophylaxis during labor.

Why not C (Oral amoxicillin now and repeat culture)?
→ Oral antibiotics before labor do not reliably eliminate GBS and are not the recommended approach.

Why not D (Elective cesarean section)?
→ C-section does NOT reduce the risk of GBS transmission; antibiotics are still required if labor begins before delivery.

Question 22

A 22-year-old pregnant woman at 16 weeks gestation presents with a painless genital ulcer that healed spontaneously. She was lost to follow-up and now returns at 28 weeks with a maculopapular rash involving the palms and soles and generalized lymphadenopathy. VDRL and FTA-ABS tests are positive.

What is the most appropriate treatment?

A) Ceftriaxone
B) Doxycycline
C) Acyclovir
D) Penicillin G

Answer 22

D) Penicillin G

Rationale:
Why Penicillin G (D)?
→ Penicillin G is the ONLY recommended treatment for syphilis in pregnancy, as it crosses the placenta and prevents congenital syphilis.

Why not A (Ceftriaxone)?
→ Ceftriaxone is used for gonorrhea, not syphilis.

Why not B (Doxycycline)?
→ Doxycycline is contraindicated in pregnancy due to risks of fetal bone and teeth discoloration.

Why not C (Acyclovir)?
→ Acyclovir is used for herpes simplex virus, not syphilis.

Question 23

A 27-year-old woman at 38 weeks gestation presents with multiple painful vesicular lesions on an erythematous base in her genital area. She has a history of recurrent HSV infections and did not take prophylactic antivirals during pregnancy.

What is the best next step in management?

A) Vaginal delivery with intrapartum IV acyclovir
B) Cesarean section
C) Observation and allow for spontaneous delivery
D) Empiric IV antibiotics

Answer 23

B) Cesarean section

Rationale:
Why Cesarean section (B)?
→ Active genital HSV lesions at delivery are an indication for cesarean section to prevent neonatal herpes, which can cause encephalitis and sepsis.

Why not A (Vaginal delivery with IV acyclovir)?
→ Acyclovir is used as prophylaxis starting at 36 weeks, but active lesions at delivery still require C-section.

Why not C (Observation and spontaneous delivery)?
→ Vaginal delivery in the presence of active lesions risks neonatal HSV transmission.

Why not D (Empiric IV antibiotics)?
→ HSV is a viral infection, so antibiotics are ineffective.

Question 24

A 29-year-old woman at 34 weeks gestation is diagnosed with HIV during prenatal screening. Her viral load is 5,000 copies/mL. She has been compliant with antiretroviral therapy (ART), and her CD4 count is within normal limits.

What is the recommended mode of delivery?

A) Vaginal delivery
B) Cesarean section at 39 weeks
C) Induction of labor at 37 weeks
D) Cesarean section at 38 weeks if viral load > 1,000 copies/mL

Answer 24

D) Cesarean section at 38 weeks if viral load > 1,000 copies/mL

Rationale:
Why Cesarean at 38 weeks if viral load >1,000 copies/mL (D)?
→ HIV-positive mothers with a high viral load (>1,000 copies/mL) require a scheduled C-section at 38 weeks to reduce vertical transmission risk.

Why not A (Vaginal delivery)?
→ Vaginal delivery is only recommended if viral load is <1,000 copies/mL at 36 weeks.

Why not B (C-section at 39 weeks)?
→ Elective C-section is done at 38 weeks to minimize the risk of labor onset and rupture of membranes, which increases vertical transmission.

Why not C (Induction at 37 weeks)?
→ Induction at 37 weeks is not necessary unless there are obstetric indications.

Question 25

A 25-year-old pregnant woman at 16 weeks gestation has no symptoms but is found to have >100,000 CFU/mL of E. coli in her urine culture. What is the most appropriate management? A) No treatment needed B) Nitrofurantoin or cephalexin C) IV ceftriaxone D) Delay treatment until symptoms develop

Answer 25

B) Nitrofurantoin or cephalexin Rationale: Why Nitrofurantoin or cephalexin (B)? → Asymptomatic bacteriuria (ASB) must always be treated in pregnancy to prevent progression to pyelonephritis, which increases the risk of preterm labor and maternal sepsis. → Nitrofurantoin and cephalexin are safe in pregnancy and effective against E. coli. Why not A (No treatment needed)? → ASB is not benign in pregnancy—it has a higher risk of developing into pyelonephritis, leading to adverse maternal and fetal outcomes. Why not C (IV ceftriaxone)? → IV antibiotics are reserved for pyelonephritis or severe symptomatic UTI, not ASB. Why not D (Delay treatment until symptoms develop)? → Delaying treatment increases the risk of kidney infection, sepsis, and preterm labor.

Question 26

A 28-year-old woman at 24 weeks gestation presents with fever (39°C), flank pain, nausea, vomiting, and costovertebral angle tenderness. Urinalysis shows WBC casts and pyuria. What is the most appropriate treatment? A) Oral nitrofurantoin B) IV ceftriaxone C) No antibiotics unless symptoms worsen D) Trimethoprim-sulfamethoxazole

Answer 26

B) IV ceftriaxone Rationale: Why IV ceftriaxone (B)? → Pyelonephritis in pregnancy is a medical emergency requiring hospitalization and IV antibiotics to prevent maternal sepsis and preterm labor. → Ceftriaxone is a first-line choice for pyelonephritis in pregnancy. Why not A (Oral nitrofurantoin)? → Oral antibiotics are not sufficient for systemic infections like pyelonephritis, which requires IV therapy. Why not C (No antibiotics unless symptoms worsen)? → Pyelonephritis requires immediate treatment; delaying increases maternal and fetal morbidity. Why not D (Trimethoprim-sulfamethoxazole)? → TMP-SMX is avoided in pregnancy, especially in the first and third trimesters, due to teratogenic and neonatal kernicterus risks.

Question 27

A 24-year-old woman at 20 weeks gestation presents for routine prenatal screening. She has no symptoms, but her VDRL test is positive. A confirmatory Treponema pallidum particle agglutination (TP-PA) test is also positive. What is the most likely diagnosis? A) False-positive VDRL test B) Early syphilis C) Neurosyphilis D) Congenital syphilis

Answer 27

B) Early syphilis Rationale: Why Early Syphilis (B)? → Positive VDRL/RPR tests with confirmatory treponemal testing (TP-PA) indicate active syphilis infection. → If asymptomatic, it may be early latent syphilis, requiring treatment to prevent congenital transmission. Why not A (False-positive VDRL test)? → False positives can occur in conditions like lupus, but a confirmatory treponemal test (TP-PA) rules out false positives. Why not C (Neurosyphilis)? → Neurosyphilis requires neurological symptoms (e.g., tabes dorsalis, Argyll Robertson pupils), which are absent here. Why not D (Congenital syphilis)? → This is maternal syphilis; congenital syphilis occurs in the fetus/newborn when the mother is untreated.

Question 28

A 22-year-old pregnant woman at 16 weeks gestation presents with a painless genital ulcer that healed spontaneously. She was lost to follow-up and now returns at 28 weeks with a maculopapular rash on her palms and soles, and generalized lymphadenopathy. VDRL and FTA-ABS tests are positive. What is the most appropriate treatment? A) Ceftriaxone B) Doxycycline C) Acyclovir D) Penicillin G

Answer 28

D) Penicillin G Rationale: Why Penicillin G (D)? → Penicillin G is the ONLY effective treatment in pregnancy to prevent congenital syphilis. Why not A (Ceftriaxone)? → Ceftriaxone is used for gonorrhea, not syphilis. Why not B (Doxycycline)? → Doxycycline is contraindicated in pregnancy due to risks of fetal bone and teeth discoloration. Why not C (Acyclovir)? → Acyclovir is used for herpes simplex virus, not syphilis.

Question 29

A 32-year-old woman at 18 weeks gestation is diagnosed with early latent syphilis based on positive VDRL and confirmatory treponemal testing. She has a documented anaphylactic reaction to penicillin in the past. What is the next step in management? A) Doxycycline for 14 days B) Ceftriaxone for 10 days C) Penicillin desensitization followed by Penicillin G D) No treatment needed unless symptoms develop

Answer 29

C) Penicillin desensitization followed by Penicillin G Rationale: Why Penicillin Desensitization (C)? → Penicillin is the only treatment that effectively prevents congenital syphilis. → If allergic, the patient must undergo desensitization and then receive Penicillin G. Why not A (Doxycycline for 14 days)? → Doxycycline is contraindicated in pregnancy. Why not B (Ceftriaxone for 10 days)? → Ceftriaxone is not first-line for syphilis in pregnancy. Why not D (No treatment)? → Untreated syphilis increases the risk of congenital syphilis, leading to stillbirth, deafness, and skeletal abnormalities.

Question 30

A 28-year-old woman at 34 weeks gestation was diagnosed with syphilis at 12 weeks but did not receive treatment. She now presents in labor. What is the most likely neonatal complication if the baby is exposed in utero? A) Sensorineural hearing loss B) Cardiac anomalies C) Microcephaly D) Diaphragmatic hernia

Answer 30

A) Sensorineural hearing loss Rationale: Why Sensorineural Hearing Loss (A)? → Congenital syphilis can cause hearing loss, Hutchinson teeth, saddle nose, and saber shins. Why not B (Cardiac anomalies)? → Cardiac defects are associated with congenital rubella, not syphilis. Why not C (Microcephaly)? → Microcephaly is commonly seen in congenital CMV and Zika virus, not syphilis. Why not D (Diaphragmatic hernia)? → Diaphragmatic hernia is a structural defect unrelated to syphilis.

Question 31

A 25-year-old pregnant woman at 16 weeks gestation presents for a routine prenatal visit. She has no urinary symptoms, but her urine culture shows >100,000 CFU/mL of E. coli. What is the most appropriate management? A) No treatment is needed B) Nitrofurantoin or cephalexin for 3–7 days C) IV ceftriaxone D) Delay treatment until symptoms develop

Answer 31

B) Nitrofurantoin or cephalexin for 3–7 days Rationale: Why Nitrofurantoin or Cephalexin (B)? → Asymptomatic bacteriuria (ASB) in pregnancy must always be treated to prevent progression to pyelonephritis, which increases the risk of preterm labor and maternal sepsis. Why not A (No treatment needed)? → ASB is not benign in pregnancy—it increases the risk of pyelonephritis, leading to adverse maternal and fetal outcomes. Why not C (IV ceftriaxone)? → IV antibiotics are reserved for pyelonephritis or severe symptomatic UTI, not ASB. Why not D (Delay treatment until symptoms develop)? → Delaying treatment increases the risk of pyelonephritis and complications like preterm labor.

Question 32

A 28-year-old woman at 24 weeks gestation presents with fever (39°C), flank pain, nausea, vomiting, and costovertebral angle tenderness. Urinalysis shows WBC casts and pyuria. What is the most appropriate treatment? A) Oral nitrofurantoin for 10 days B) IV ceftriaxone, then switch to oral antibiotics when stable C) No antibiotics unless symptoms worsen D) Trimethoprim-sulfamethoxazole

Answer 32

B) IV ceftriaxone, then switch to oral antibiotics when stable Rationale: Why IV Ceftriaxone (B)? → Pyelonephritis in pregnancy is a medical emergency requiring hospitalization and IV antibiotics to prevent maternal sepsis and preterm labor. → Once the patient is stable (afebrile for 48 hours), they can be switched to oral antibiotics for completion of therapy. Why not A (Oral nitrofurantoin)? → Oral antibiotics are not sufficient for systemic infections like pyelonephritis, which requires IV therapy. Why not C (No antibiotics unless symptoms worsen)? → Pyelonephritis requires immediate treatment; delaying increases maternal and fetal morbidity. Why not D (Trimethoprim-sulfamethoxazole)? → TMP-SMX is avoided in pregnancy, especially in the first and third trimesters, due to teratogenic and neonatal kernicterus risks.

Question 33

A 30-year-old woman at 26 weeks gestation is admitted for acute pyelonephritis with high fever, tachycardia, and respiratory distress. She has been receiving IV ceftriaxone for 48 hours. What additional investigations are warranted? A) Urine culture only B) Chest X-ray and urine output monitoring C) Repeat urinalysis every 6 hours D) No further investigations are needed

Answer 33

B) Chest X-ray and urine output monitoring Rationale: Why Chest X-ray & Urine Output Monitoring (B)? → Severe pyelonephritis can lead to acute respiratory distress syndrome (ARDS) and sepsis, requiring chest X-ray if respiratory distress is present. → Monitoring urine output ensures renal function is preserved and prevents hypovolemic shock. Why not A (Urine culture only)? → Urine culture is useful for guiding antibiotic therapy but does not assess severe complications like ARDS or sepsis. Why not C (Repeat urinalysis every 6 hours)? → Frequent urinalysis is unnecessary once pyelonephritis is diagnosed and appropriately treated. Why not D (No further investigations)? → Severe pyelonephritis can have systemic complications requiring close monitoring.

Question 34

A 29-year-old woman at 36 weeks gestation has a history of recurrent genital herpes. She has no active lesions at this time. What is the most appropriate management to prevent neonatal HSV transmission? A) Vaginal delivery without antiviral therapy B) Cesarean section at 38 weeks C) Acyclovir suppression therapy until delivery D) IV acyclovir during labor

Answer 34

C) Acyclovir suppression therapy until delivery Rationale: Why Acyclovir Suppression Therapy (C)? → Pregnant women with recurrent HSV should receive suppressive therapy with Acyclovir 400 mg PO TID starting at 36 weeks gestation until delivery. → This reduces the risk of active lesions at delivery, allowing for a safe vaginal birth. Why not A (Vaginal delivery without therapy)? → Without suppressive therapy, there is a higher risk of recurrent HSV outbreak at delivery, increasing neonatal transmission risk. Why not B (Cesarean section at 38 weeks)? → C-section is only required if active genital lesions are present at the time of delivery. Why not D (IV acyclovir during labor)? → IV acyclovir is reserved for severe disseminated HSV infection, not for routine suppression.

Question 35

A 27-year-old woman at 38 weeks gestation presents in active labor with multiple painful vesicular lesions on her labia and perineum. She was not on suppressive therapy during pregnancy. What is the best next step in management? A) Proceed with vaginal delivery and start neonatal acyclovir B) Perform an emergency cesarean section C) Give IV acyclovir to the mother and continue vaginal delivery D) Delay delivery until lesions heal

Answer 35

B) Perform an emergency cesarean section Rationale: Why C-Section (B)? → Active genital HSV lesions at delivery require a cesarean section to prevent neonatal HSV transmission, which can lead to encephalitis, sepsis, and high mortality. Why not A (Vaginal delivery with neonatal acyclovir)? → Neonatal acyclovir is given if there is suspected or confirmed neonatal HSV, but it does not prevent initial transmission during vaginal birth. Why not C (IV acyclovir to mother and vaginal delivery)? → IV acyclovir does not eliminate the risk of HSV transmission during vaginal birth if active lesions are present. Why not D (Delay delivery until lesions heal)? → Waiting is not an option at 38 weeks in active labor.

Question 36

A 26-year-old woman at 22 weeks gestation undergoes a routine fetal anomaly scan. The ultrasound shows intracranial calcifications, ventriculomegaly, and echogenic bowel. Her serologic testing is CMV IgM positive with low IgG avidity. What is the most likely diagnosis? A) Toxoplasmosis B) Cytomegalovirus (CMV) C) Rubella D) Parvovirus B19

Answer 36

B) Cytomegalovirus (CMV) Rationale: Why CMV (B)? → Congenital CMV presents with periventricular calcifications, ventriculomegaly, and sensorineural hearing loss. → Echogenic bowel is also commonly seen in CMV infections. Why not A (Toxoplasmosis)? → Toxoplasmosis has diffuse intracranial calcifications, while CMV has periventricular calcifications. Why not C (Rubella)? → Rubella presents with congenital heart defects (PDA), cataracts, and sensorineural hearing loss, not intracranial calcifications. Why not D (Parvovirus B19)? → Parvovirus B19 is associated with fetal hydrops and severe anemia, not brain calcifications.

Question 37

A 30-year-old woman at 16 weeks gestation is diagnosed with primary CMV infection based on positive CMV IgM with low IgG avidity. She is asymptomatic. What is the most appropriate next step? A) Start antiviral therapy with ganciclovir B) Offer targeted congenital anomaly scan and amniocentesis C) Administer CMV hyperimmune globulin D) Terminate the pregnancy due to high fetal risk

Answer 37

: B) Offer targeted congenital anomaly scan and amniocentesis Rationale: Why Targeted Congenital Anomaly Scan & Amniocentesis (B)? → If maternal CMV infection occurs in the first half of pregnancy, fetal anomaly scans can assess for brain calcifications, ventriculomegaly, and growth restriction. → Amniocentesis for CMV PCR can confirm fetal infection if ultrasound findings are suspicious. Why not A (Start ganciclovir)? → There is no proven antenatal treatment for congenital CMV. Ganciclovir is used postnatally for symptomatic newborns. Why not C (Administer CMV hyperimmune globulin)? → Hyperimmune globulin is not a standard treatment due to inconsistent evidence of benefit. Why not D (Terminate pregnancy)? → Congenital CMV can cause serious complications, but routine termination is not recommended; monitoring and parental counseling are preferred.

Question 38

: B) Offer targeted congenital anomaly scan and amniocentesis Rationale: Why Targeted Congenital Anomaly Scan & Amniocentesis (B)? → If maternal CMV infection occurs in the first half of pregnancy, fetal anomaly scans can assess for brain calcifications, ventriculomegaly, and growth restriction. → Amniocentesis for CMV PCR can confirm fetal infection if ultrasound findings are suspicious. Why not A (Start ganciclovir)? → There is no proven antenatal treatment for congenital CMV. Ganciclovir is used postnatally for symptomatic newborns. Why not C (Administer CMV hyperimmune globulin)? → Hyperimmune globulin is not a standard treatment due to inconsistent evidence of benefit. Why not D (Terminate pregnancy)? → Congenital CMV can cause serious complications, but routine termination is not recommended; monitoring and parental counseling are preferred.

Answer 38

C) Good hand hygiene and avoiding saliva exposure from children Rationale: Why Hand Hygiene & Avoiding Saliva (C)? → CMV is transmitted via saliva, urine, and other body fluids, especially in daycare settings. Pregnant women should avoid sharing utensils, kissing children on the mouth, and practice strict handwashing. Why not A (CMV vaccine)? → There is no licensed CMV vaccine available for prevention. Why not B (Antiviral prophylaxis)? → Antiviral prophylaxis (ganciclovir, valganciclovir) is not used in pregnancy for prevention. Why not D (Routine serologic screening)? → Routine screening is not recommended because many women have past CMV exposure, and serology alone cannot predict fetal infection risk.

Question 39

A 28-year-old pregnant woman at 24 weeks gestation presents with fever, malaise, and a vesicular rash in different stages of healing on her face, chest, and back. She reports recent contact with her 5-year-old niece who had chickenpox. What is the best next step in management? A) No intervention; reassure the patient B) Start oral acyclovir therapy C) Administer varicella vaccine D) Perform a chest X-ray

Answer 39

D) Perform a chest X-ray Rationale: Why Chest X-ray (D)? → Pregnant women with varicella are at higher risk of varicella pneumonia, which can be life-threatening. A chest radiograph is indicated if respiratory symptoms develop (e.g., cough, dyspnea). Why not A (No intervention)? → Varicella in pregnancy carries risks for both the mother (pneumonia) and fetus (congenital varicella syndrome). Why not B (Start oral acyclovir therapy)? → Acyclovir is used for maternal treatment but does not replace the need for chest X-ray if pneumonia is suspected. Why not C (Varicella vaccine)? → Varicella vaccine is contraindicated in pregnancy.

Question 40

A 32-year-old pregnant woman at 20 weeks gestation presents with a widespread vesicular rash, fever, and malaise. She had no prior varicella vaccination or history of chickenpox. What is the most appropriate treatment for the mother? A) Acyclovir B) Varicella vaccine C) Varicella-zoster immune globulin (VZIG) D) No treatment; observe for resolution

Answer 40

A) Acyclovir Rationale: Why Acyclovir (A)? → Acyclovir reduces the severity and duration of varicella in pregnancy if given within 24–72 hours of rash onset. Why not B (Varicella vaccine)? → The varicella vaccine is a live virus vaccine and is contraindicated in pregnancy. Why not C (VZIG)? → Varicella-zoster immune globulin (VZIG) is given for post-exposure prophylaxis, not for active varicella infection. Why not D (No treatment)? → Untreated varicella can lead to complications such as pneumonia, preterm labor, and fetal varicella syndrome.

Question 41

A woman at 38 weeks gestation develops varicella rash 2 days before delivery. She delivers a healthy baby at term. What is the best management for the newborn? A) Acyclovir treatment B) Varicella-zoster immune globulin (VZIG) within 96 hours C) Varicella vaccine D) No intervention needed

Answer 41

B) Varicella-zoster immune globulin (VZIG) within 96 hours Rationale: Why VZIG (B)? → Newborns exposed to maternal varicella within 5 days before delivery or within 2 days after birth should receive VZIG within 96 hours to reduce disease severity. Why not A (Acyclovir treatment)? → Acyclovir is used if the neonate develops severe varicella, not for prophylaxis. Why not C (Varicella vaccine)? → The varicella vaccine is a live virus vaccine and is contraindicated in neonates. Why not D (No intervention)? → Neonates are at high risk of severe varicella, so prophylaxis with VZIG is required.

Question 42

A 27-year-old woman at 30 weeks gestation presents for a routine prenatal visit in the middle of flu season. She has no symptoms but asks whether she should receive the influenza vaccine. What is the most appropriate response? A) The influenza vaccine is contraindicated in pregnancy B) The influenza vaccine is recommended and safe in pregnancy C) The influenza vaccine should only be given postpartum D) The influenza vaccine is only for high-risk patients

Answer 42

B) The influenza vaccine is recommended and safe in pregnancy Rationale: Why Influenza Vaccine (B)? → Influenza vaccine (inactivated) is recommended for all pregnant women during flu season because pregnancy increases the risk of severe influenza complications. Why not A (Contraindicated in pregnancy)? → The inactivated influenza vaccine is safe in all trimesters. Why not C (Only given postpartum)? → Vaccination during pregnancy protects both the mother and newborn through passive antibody transfer. Why not D (Only for high-risk patients)? → All pregnant women are considered high-risk for influenza complications and should be vaccinated.

Question 43

A 30-year-old pregnant woman at 28 weeks gestation presents with fever (38.5°C), cough, myalgias, and sore throat. She tested positive for Influenza A. What is the most appropriate treatment? A) Supportive care only B) Oseltamivir (Tamiflu) 75 mg BID for 5 days C) Influenza vaccine D) No treatment, only monitor symptoms

Answer 43

B) Oseltamivir (Tamiflu) 75 mg BID for 5 days Rationale: Why Oseltamivir (B)? → Oseltamivir is the antiviral of choice for pregnant women with influenza. Treatment should be started as soon as possible to reduce disease severity and maternal complications. Why not A (Supportive care only)? → Antiviral therapy reduces the risk of pneumonia, hospitalization, and mortality in pregnant women. Why not C (Influenza vaccine)? → The vaccine is for prevention, not treatment of active influenza. Why not D (No treatment, only monitoring)? → Delaying treatment increases the risk of complications, especially in the third trimester.

Question 44

A 30-year-old woman at 32 weeks gestation presents with fever, cough, shortness of breath, and anosmia for the past 3 days. She recently attended a family gathering where multiple people later tested positive for COVID-19. What is the best diagnostic test for confirmation? A) Chest X-ray B) COVID-19 IgG and IgM serology C) RT-PCR (Nasopharyngeal swab) D) COVID-19 rapid antigen test

Answer 44

C) RT-PCR (Nasopharyngeal swab) Rationale: Why RT-PCR (C)? → RT-PCR is the gold standard for COVID-19 diagnosis in pregnancy. → It has the highest sensitivity and specificity for detecting SARS-CoV-2. Why not A (Chest X-ray)? → Chest X-ray is only used if there is concern for pneumonia or respiratory distress. Why not B (COVID-19 serology)? → Serologic tests (IgG, IgM) detect past infection, not acute cases. Why not D (Rapid antigen test)? → Rapid antigen tests have lower sensitivity and can miss early or mild infections.

Question 45

A 27-year-old pregnant woman at 10 weeks gestation is hesitant about getting the COVID-19 vaccine because she is unsure if it is safe for her baby. What is the most appropriate counseling? A) The vaccine should be avoided until the second trimester B) mRNA COVID-19 vaccines are safe in all trimesters C) COVID-19 vaccination is contraindicated in pregnancy D) Wait until postpartum to receive the vaccine

Answer 45

B) mRNA COVID-19 vaccines are safe in all trimesters Rationale: Why mRNA vaccines (B)? → Pfizer and Moderna (mRNA vaccines) are safe in pregnancy and reduce the risk of severe disease and preterm birth. Why not A (Avoid in first trimester)? → There is no evidence that vaccination in early pregnancy increases fetal risks. Why not C (Contraindicated)? → COVID-19 vaccination is recommended, not contraindicated, in pregnancy. Why not D (Wait until postpartum)? → Delaying vaccination increases the risk of severe COVID-19 complications in pregnancy.

Question 46

A 26-year-old pregnant woman at 18 weeks gestation presents with high fever, cough, coryza, conjunctivitis, and a maculopapular rash that started on her face and spread downward. On oral examination, you note white spots on an erythematous base inside her cheeks. What is the most likely diagnosis? A) Rubella B) Measles (Rubeola) C) Varicella D) Parvovirus B19

Answer 46

B) Measles (Rubeola) Rationale: Why Measles (B)? → The presence of the classic "3 Cs" (Cough, Coryza, Conjunctivitis) along with a maculopapular rash and Koplik spots is diagnostic for Measles. Why not A (Rubella)? → Rubella presents with postauricular lymphadenopathy and does not have Koplik spots. Why not C (Varicella)? → Varicella presents with a vesicular rash at different stages of healing, not a descending maculopapular rash. Why not D (Parvovirus B19)? → Parvovirus B19 causes hydrops fetalis and "slapped cheek" rash in children, not Measles.

Question 47

A 28-year-old pregnant woman at 22 weeks gestation was exposed to a co-worker with confirmed measles. She is unsure of her vaccination status and is asymptomatic. What is the best next step? A) Administer IVIG within 6 days of exposure B) Administer MMR vaccine C) Start antiviral therapy D) Observe for symptoms and treat only if they appear

Answer 47

A) Administer IVIG within 6 days of exposure Rationale: Why IVIG (A)? → Pregnant women exposed to measles should receive intravenous immune globulin (IVIG) within 6 days to prevent or reduce disease severity. Why not B (MMR vaccine)? → MMR vaccine is a live vaccine and is contraindicated in pregnancy. Why not C (Antiviral therapy)? → There are no antivirals for measles. Why not D (Observe for symptoms)? → Measles can be severe in pregnancy, so post-exposure prophylaxis is necessary.

Question 48

A 29-year-old woman at 8 weeks gestation receives routine prenatal labs, which show she is non-immune to measles and mumps. What is the best next step? A) Administer the MMR vaccine now B) Advise her to receive the MMR vaccine postpartum C) Start antiviral prophylaxis D) No intervention is necessary

Answer 48

B) Advise her to receive the MMR vaccine postpartum Rationale: Why Postpartum Vaccination (B)? → The MMR vaccine is a live vaccine and is contraindicated in pregnancy. However, non-immune women should receive it postpartum to prevent future infections. Why not A (Administer MMR now)? → Live vaccines are not given during pregnancy due to theoretical risks of fetal harm. Why not C (Antiviral prophylaxis)? → There are no antivirals for measles or mumps. Why not D (No intervention)? → Immunity is important for future pregnancies, so postpartum vaccination is recommended.

Question 49

A 24-year-old woman at 10 weeks gestation presents with low-grade fever, postauricular lymphadenopathy, and a pink maculopapular rash that spread from her face downward. She recently had contact with a child diagnosed with rubella. Her prenatal labs indicate she is non-immune to rubella. What is the most likely fetal complication? A) Hydrocephalus and periventricular calcifications B) PDA, congenital cataracts, and sensorineural hearing loss C) Limb hypoplasia and skin scarring D) Severe fetal anemia and hydrops fetalis

Answer 49

B) PDA, congenital cataracts, and sensorineural hearing loss Rationale: Why PDA, cataracts, and sensorineural hearing loss (B)? → Congenital Rubella Syndrome (CRS) is characterized by the "classic triad": Cardiac defects (Patent Ductus Arteriosus - PDA) Congenital cataracts Sensorineural hearing loss Why not A (Hydrocephalus and periventricular calcifications)? → These findings are seen in congenital CMV, not rubella. Why not C (Limb hypoplasia and skin scarring)? → These findings are characteristic of congenital varicella syndrome. Why not D (Severe fetal anemia and hydrops fetalis)? → Parvovirus B19 is the primary cause of fetal hydrops, not rubella.

Question 50

A 26-year-old woman at 8 weeks gestation presents for her first prenatal visit. Routine bloodwork shows she is non-immune to rubella. She asks whether she should receive the MMR vaccine now to protect her baby. What is the most appropriate response? A) Administer MMR vaccine immediately B) Delay vaccination until the second trimester C) Vaccinate immediately and monitor for complications D) Advise MMR vaccination postpartum

Answer 50

D) Advise MMR vaccination postpartum Rationale: Why MMR postpartum (D)? → MMR is a live vaccine and is contraindicated in pregnancy due to theoretical risks of fetal infection. However, postpartum vaccination is recommended to prevent rubella in future pregnancies. Why not A (Administer MMR immediately)? → Live vaccines are avoided in pregnancy due to potential teratogenic risks. Why not B (Delay to second trimester)? → Rubella vaccination is not given at any point during pregnancy. Why not C (Vaccinate immediately and monitor)? → There is no role for live vaccine administration during pregnancy, even with monitoring.

Question 51

A 28-year-old pregnant woman at 20 weeks gestation presents for routine ultrasound, which reveals fetal hydrops (ascites, pleural effusion, skin edema), cardiomegaly, and polyhydramnios. She reports recent exposure to a child with "slapped-cheek" rash at her workplace. What is the most likely cause of the fetal abnormalities? A) Cytomegalovirus B) Parvovirus B19 C) Toxoplasmosis D) Rubella

Answer 51

B) Parvovirus B19 Rationale: Why Parvovirus B19 (B)? → Parvovirus B19 infects fetal erythroid precursors, causing severe fetal anemia and hydrops fetalis. Why not A (CMV)? → CMV does not typically cause hydrops fetalis but presents with periventricular calcifications. Why not C (Toxoplasmosis)? → Toxoplasmosis causes diffuse intracranial calcifications but does not primarily lead to hydrops. Why not D (Rubella)? → Rubella causes congenital heart defects and cataracts, not fetal hydrops.

Question 52

A 30-year-old pregnant woman at 18 weeks gestation is diagnosed with Parvovirus B19 infection after recent exposure to an infected child. Fetal ultrasound is normal. What is the most appropriate next step in management? A) Start antiviral therapy B) Serial ultrasound monitoring for fetal anemia C) Immediate intrauterine fetal blood transfusion D) Terminate the pregnancy due to high fetal risk

Answer 52

B) Serial ultrasound monitoring for fetal anemia Rationale: Why Serial Ultrasound Monitoring (B)? → Parvovirus B19 can cause fetal anemia and hydrops fetalis. Serial Doppler ultrasounds of the middle cerebral artery (MCA) are performed to detect anemia. Why not A (Start antiviral therapy)? → There is no effective antiviral treatment for Parvovirus B19. Why not C (Immediate intrauterine transfusion)? → Transfusion is only performed if severe fetal anemia is detected. Why not D (Terminate pregnancy)? → Not all cases lead to fetal demise; monitoring allows for timely intervention.

Question 53

A 27-year-old woman at 26 weeks gestation is being followed for Parvovirus B19 infection. A Doppler ultrasound shows increased peak systolic velocity in the middle cerebral artery (MCA), consistent with severe fetal anemia. What is the most appropriate next step? A) Deliver the baby immediately B) Intrauterine fetal blood transfusion C) Start corticosteroids for fetal lung maturity D) Observe and repeat ultrasound in 1 week

Answer 53

B) Intrauterine fetal blood transfusion Rationale: Why Fetal Blood Transfusion (B)? → Intrauterine transfusion corrects severe fetal anemia and prevents fetal hydrops progression. Why not A (Immediate delivery)? → Preterm delivery is not the first-line management if intrauterine transfusion is an option. Why not C (Corticosteroids)? → Steroids do not treat anemia and are only used if preterm delivery is imminent. Why not D (Observe and repeat ultrasound)? → Severe anemia requires urgent intervention, not just observation.

Question 54

A 29-year-old woman at 12 weeks gestation is newly diagnosed with HIV during routine prenatal screening. She has no known drug allergies, and her CD4 count is 550 cells/mm³. What is the most appropriate first-line antiretroviral therapy (ART) for this patient? A) Efavirenz + Tenofovir + Emtricitabine B) Zidovudine + Lamivudine + Ritonavir-boosted Lopinavir C) Dolutegravir + Tenofovir + Lamivudine D) Stavudine + Didanosine + Nevirapine

Answer 54

C) Dolutegravir + Tenofovir + Lamivudine Rationale: Why Dolutegravir + Tenofovir + Lamivudine (C)? → This is the preferred first-line regimen for pregnant women with HIV because it is highly effective, well-tolerated, and has a high barrier to resistance. Why not A (Efavirenz + Tenofovir + Emtricitabine)? → Efavirenz was previously avoided in the first trimester due to concerns about teratogenicity, though newer data suggest it is safe. However, Dolutegravir-based regimens are now preferred. Why not B (Zidovudine + Lamivudine + Ritonavir-boosted Lopinavir)? → Zidovudine-based regimens are outdated and have more side effects than Tenofovir-based regimens. Why not D (Stavudine + Didanosine + Nevirapine)? → This combination is outdated due to high toxicity and risk of lactic acidosis.

Question 55

A 32-year-old HIV-positive woman at 39 weeks gestation presents in labor. Her most recent viral load (VL) is <50 copies/mL, and she has been fully adherent to ART throughout pregnancy. What is the most appropriate neonatal management? A) No treatment required B) Zidovudine (AZT) alone for 4 weeks C) Zidovudine + Lamivudine + Nevirapine for 6 weeks D) Immediate initiation of full ART regimen

Answer 55

B) Zidovudine (AZT) alone for 4 weeks Rationale: Why Zidovudine alone for 4 weeks (B)? → For neonates born to mothers with well-controlled HIV (VL <50 copies/mL), Zidovudine monotherapy for 4 weeks is sufficient to reduce the risk of perinatal transmission. Why not A (No treatment required)? → Even with a low maternal viral load, Zidovudine prophylaxis is still needed for neonates. Why not C (Zidovudine + Lamivudine + Nevirapine for 6 weeks)? → This is used for high-risk neonates (if maternal VL is >1000 copies/mL or if the mother was not on ART during pregnancy). Why not D (Immediate full ART regimen)? → Newborns only require full ART if perinatal HIV transmission is confirmed.

Question 56

A 28-year-old HIV-positive woman at 38 weeks gestation is being evaluated for delivery planning. Her most recent viral load is 850 copies/mL, and she has been on ART throughout pregnancy. What is the recommended delivery mode? A) Vaginal delivery at term B) Scheduled cesarean section at 38 weeks with IV Zidovudine C) Elective cesarean section at 39 weeks without IV therapy D) Induction of labor at 37 weeks to minimize exposure

Answer 56

B) Scheduled cesarean section at 38 weeks with IV Zidovudine Rationale: Why Scheduled C-section + IV Zidovudine at 38 weeks (B)? → If maternal VL is >1000 copies/mL at delivery, a scheduled C-section at 38 weeks + IV Zidovudine is recommended to reduce perinatal transmission. Why not A (Vaginal delivery)? → Vaginal delivery is only acceptable if VL is <1000 copies/mL. Why not C (Elective C-section at 39 weeks)? → The optimal timing for reducing perinatal transmission is 38 weeks to avoid spontaneous labor. Why not D (Induction at 37 weeks)? → Preterm induction is not indicated unless there is an obstetric indication.

Question 57

A 26-year-old woman with HIV presents in labor at 37 weeks gestation. She was not on ART during pregnancy, and her viral load at delivery is >1000 copies/mL. What is the most appropriate neonatal management? A) No treatment necessary B) Zidovudine (AZT) alone for 4 weeks C) Zidovudine + Lamivudine + Nevirapine for 6 weeks D) Immediate initiation of full ART regimen

Answer 57

C) Zidovudine + Lamivudine + Nevirapine for 6 weeks Rationale: Why Zidovudine + Lamivudine + Nevirapine for 6 weeks (C)? → This triple-drug regimen is used for neonates at high risk of HIV transmission (e.g., mother not on ART, VL >1000 copies/mL at delivery). Why not A (No treatment necessary)? → High-risk neonates require immediate post-exposure prophylaxis (PEP). Why not B (Zidovudine alone for 4 weeks)? → Monotherapy is only used for low-risk neonates (maternal VL <50 copies/mL). Why not D (Full ART regimen)? → Full ART is only given if HIV transmission is confirmed.

Question 58

A newborn delivered to an HIV-positive mother receives Zidovudine prophylaxis. The mother’s viral load was <50 copies/mL at delivery. What is the best method to confirm whether the neonate has acquired HIV? A) HIV antibody testing at birth B) HIV DNA PCR testing at birth and 2 weeks C) HIV viral load at 6 months D) HIV RNA PCR at 12 months

Answer 58

B) HIV DNA PCR testing at birth and 2 weeks Rationale: Why HIV DNA PCR (B)? → HIV DNA PCR is the gold standard for early infant diagnosis, as maternal antibodies can persist in the neonate for up to 18 months. Why not A (HIV antibody testing)? → HIV antibodies from the mother can persist in the baby for over a year, leading to false-positive results. Why not C or D (Viral load testing at 6–12 months)? → Early testing is essential for prompt intervention, and HIV DNA PCR is more accurate in neonates.