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NBME 22 Answers

nbme22/Block 1/Question#49 (21.6 difficulty score)
A 17-year-old primigravid woman at 16 weeks' ...

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submitted by adong(82),

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

In addition to all the great points already made, FA also says that Azithromycin is first-line and favored in general because it's a one-time treatment. You would use doxy though to treat lymphogranuloma venereum (FA 2019 and 2020, pg 148-149).

Neisseria gonorrhea - ceftriaxone

  • chlamydia coinfection: +azithromycin or doxycycline

Chlamydia - azithromycin (1st line); doxycycline (2nd line, or for LGV)

  • gonorrhea coinfection: +ceftriaxone
anjum  It's probably simpler to just memorize treatment as: chlamydia: azithromycin gonorrhea: ceftriaxone It's correct and won't trip you up on pregnant women questions +  

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oNt​ esur htwa sith tonqsuei si gtstnie -- is it ngntwai us ot ownk tath oroegarnh has ot eb edaetrt as we?ll In hatt asce, oxyd wludo krwo rfo bhto rigadcnco ot cktyehs ... ynA treho snsoignaer acpdiee!prat

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. +24  
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. +3  
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) +3