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NBME 22 Answers

nbme22/Block 1/Question#49

A 17-year-old primigravid woman at 16 weeks' ...


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submitted by adong(14),

the patient is pregnant so not doxy. azithro is alternative (see sketchy vid)

Why is it azithromycin not doxycycline? According to sketchy, you treat chlamydia with macrolides/doxy +ceftriaxone. You treat neisseria gonorrhea with ceftriaxone+azithromycin+doxycycline.

‚ÄčNot sure what this question is testing -- is it wanting us to know that gonorrhea has to be treated as well? In that case, doxy would work for both according to sketchy ... Any other reasonings appreciated!

dr_salface  The patient in the stem is pregnant! The question wants to see if you know that doxy is a teratogen. Tetracyclines in general like to bind to fetal bone/teeth which can impair development. +12  
dr_salface  As a side note, treating chlamydia alone only requires macrolides or doxy. Treating gonorrhea alone only requires ceftriaxone or macrolides. The reason sketchy includes all three is because you usually treat one infection and co-treat the other. +2  
yotsubato  Theres a crow in the chlamydia sketchy. You can use Macrolides, OR Ceftriaxone, OR Doxycycline. Most doctors in real life just give the azithromycin z pack (which kicks ass cause its one drug 5 doses thats it) +2