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Medication error disclosure — USMLE Step 3 MCQ

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HardEthics, Patient Safety, Quality Improvement, Systems-Based PracticeMedication error disclosureUSMLE Step 3

A term newborn has hepatosplenomegaly, snuffles, generalized desquamating rash, and thrombocytopenia. The mother had untreated secondary syphilis at delivery. The infant serum quantitative nontreponemal titer is eightfold higher than the maternal titer. Which treatment is most appropriate after the recommended evaluation is obtained?

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Correct answer: D — Give aqueous crystalline penicillin G intravenously for a full 10-day course

The best answer is “Give aqueous crystalline penicillin G intravenously for a full 10-day course”. This infant has clinical and serologic evidence of proven or highly probable congenital syphilis. After CSF, blood count, and long-bone evaluation, treatment is a 10-day parenteral penicillin course. Single-dose benzathine penicillin is reserved for carefully defined lower-risk scenarios with a normal evaluation and reliable follow-up; alternative antibiotics and observation are not adequate for symptomatic disease.

Reference: CDC STI Guidelines: Congenital Syphilis: https://www.cdc.gov/std/treatment-guidelines/congenital-syphilis.htm