tommyk
10-05-2006, 10:25 AM
Hy 2415 This concept was on the summer tests, can you pass THIS test?
21-year-old woman named Hilary Duff in labor progresses to 7 cm dilation, and then has no further progress. She therefore undergoes a primary cesarean section (Hint: Are there bacterial risks w/ a C-section?). Examination 2 days after the section shows a temperature of (103.5 F which is very high and a key finding), blood pressure of 110/70 mm Hg, pulse of 100/min, and respirations of 15/min. Lungs are clear to auscultation bilaterally. Her abdomen is moderately tender. The incision is clean, dry, and intact, with no evidence of erythema. Pelvic examination demonstrates uterine tenderness. She has some foul discharge. Which of the following is the most appropriate pharmacotherapy? What is the LIKELY DISEASE, if any???
1- Ampillicin
2- Ampillicin & Gentamycin
3- Clarithyromycin
4- Clindamycin
5- Clindamycin & Gentamycin
6- Clindamycin & metronidazole
7- Metronidazole
8- Vancomycin
9- Poison
10- No treatment, just observation
11- NSAIDS
12- Acetominophen
13- Emergent surgery and reclosure
14- Warm compresses
a) pick #5. Clindamycin & Gentamycin. This pt. Has endometritis! Look at the risks and the vitals and the pain. There IS a bacterial infection going on. This patient has signs and symptoms that are most consistent with endometritis. Postpartum endometritis is believed to result from organisms ascending from the vagina and causing a polymicrobial infection of the endometrium. Infection may also involve the myometrium and parametrial tissues. Patients with endometritis typically present with fever and chills, lower abdominal pain, a foul-smelling vaginal discharge, and malaise. Examination is significant for fever, abdominal tenderness, and uterine tenderness. Cesarean section is the major risk factor. The treatment of choice for endometritis following a cesarean section must include anaerobic coverage, along with gram-positive and gram-negative coverage. Therefore, the treatment of choice is clindamycin and gentamicin. Ampicillin and ampicillin-gentamicin fail to cover the anaerobic organisms that play an important role in the pathophysiology of post-cesarean section endometritis. Clindamycin-metronidazole and metronidazole have good activity against anaerobic organisms, but fail to cover gram-negative organisms. Got it? This was a hard concept but one w/ 20 concepts in one.
21-year-old woman named Hilary Duff in labor progresses to 7 cm dilation, and then has no further progress. She therefore undergoes a primary cesarean section (Hint: Are there bacterial risks w/ a C-section?). Examination 2 days after the section shows a temperature of (103.5 F which is very high and a key finding), blood pressure of 110/70 mm Hg, pulse of 100/min, and respirations of 15/min. Lungs are clear to auscultation bilaterally. Her abdomen is moderately tender. The incision is clean, dry, and intact, with no evidence of erythema. Pelvic examination demonstrates uterine tenderness. She has some foul discharge. Which of the following is the most appropriate pharmacotherapy? What is the LIKELY DISEASE, if any???
1- Ampillicin
2- Ampillicin & Gentamycin
3- Clarithyromycin
4- Clindamycin
5- Clindamycin & Gentamycin
6- Clindamycin & metronidazole
7- Metronidazole
8- Vancomycin
9- Poison
10- No treatment, just observation
11- NSAIDS
12- Acetominophen
13- Emergent surgery and reclosure
14- Warm compresses
a) pick #5. Clindamycin & Gentamycin. This pt. Has endometritis! Look at the risks and the vitals and the pain. There IS a bacterial infection going on. This patient has signs and symptoms that are most consistent with endometritis. Postpartum endometritis is believed to result from organisms ascending from the vagina and causing a polymicrobial infection of the endometrium. Infection may also involve the myometrium and parametrial tissues. Patients with endometritis typically present with fever and chills, lower abdominal pain, a foul-smelling vaginal discharge, and malaise. Examination is significant for fever, abdominal tenderness, and uterine tenderness. Cesarean section is the major risk factor. The treatment of choice for endometritis following a cesarean section must include anaerobic coverage, along with gram-positive and gram-negative coverage. Therefore, the treatment of choice is clindamycin and gentamicin. Ampicillin and ampicillin-gentamicin fail to cover the anaerobic organisms that play an important role in the pathophysiology of post-cesarean section endometritis. Clindamycin-metronidazole and metronidazole have good activity against anaerobic organisms, but fail to cover gram-negative organisms. Got it? This was a hard concept but one w/ 20 concepts in one.