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Ectopic pregnancy — USMLE Step 3 MCQ

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HardOB/GYN (Prenatal / Contraception / Screening)Ectopic pregnancyUSMLE Step 3

A 46-year-old man returns from Nigeria with fever, confusion, jaundice, creatinine 3.1 mg/dL, and Plasmodium falciparum parasitemia of 12%. Glucose is 58 mg/dL and intravenous artesunate can be obtained immediately. Which antimalarial strategy is most appropriate?

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Correct answer: C — Begin intravenous artesunate, followed by a complete oral antimalarial regimen

The best answer is “Begin intravenous artesunate, followed by a complete oral antimalarial regimen”. Altered mental status, renal injury, hypoglycemia, jaundice, and high parasitemia establish severe falciparum malaria. CDC guidance requires immediate intravenous artesunate, followed by a complete oral regimen after parenteral treatment criteria are met. Oral-only therapy is inadequate, quinidine is no longer the preferred US regimen, exchange transfusion is not recommended routinely, and confirmation must not delay treatment.

Reference: CDC Treatment of Severe Malaria: https://www.cdc.gov/malaria/hcp/clinical-guidance/treatment-of-severe-malaria.html