NBME Step 2 CK Form 7 Intravenous penicillin G (NBME Answers)

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Retired NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 3/Question#8 (reveal difficulty score)
A 24-year-old primigravid woman at 38 weeks' ...
Intravenous penicillin G 🔍 / 📺 / 🌳 / 📖
tags: repro inc

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submitted by ∗step_prep5(246)

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Indications for intrapartum prophylaxis against GBS infection: (1) GBS-positive rectovaginal culture during current pregnancy (2) GBS bacteriuria or GBS UTI in current pregnancy (3) Unknown GBS status + <37 weeks gestation OR intrapartum fever OR rupture of membranes for >18 hours
GBS with no allergy: IV penicillin
GBS with mild penicillin allergy (prior maculopapular rash without pruritis): Cefazolin
GBS with severe penicillin allergy (high risk of anaphylaxis, respiratory distress and urticaria): Clindamycin/erythromycin

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submitted by ∗carolebaskin(109)

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The mother was already treated for GBS -- observation is indicated in the newborn.

AAP: "For well-appearing term newborn infants born to mothers with an indication for intrapartum antibiotic prophylaxis (IAP) to prevent GBS disease and receipt of 4 or more hours of penicillin, ampicillin or cefazolin at the appropriate doses before delivery, routine care, and 48 hours of observation continue to be recommended."

But, this mother was already treated, so they do not even have an indication for IAP

https://pediatrics.aappublications.org/content/128/3/611

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dreamyyn per uptodate, you should still give them prophylaxis: Women with GBS bacteriuria any time in pregnancy (Grade 2B) or an infant with early-onset GBS infection in a previous pregnancy (Grade 2C) should routinely receive intrapartum antibiotic prophylaxis +

machetebetty I wonder if there was confusion about who is receiving the penicillin? The patient in the stem is the woman, not the newborn; the laboring patient is receiving the (indicated) penicillin. +

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