skip to main content

Postoperative delirium — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardSurgery (post-operative, follow-up)Postoperative deliriumUSMLE Step 3

A pregnant patient with HIV is adherent to integrase-inhibitor-based ART. At 36 weeks, repeat HIV RNA is 3,800 copies/mL. There is no other indication for delivery. Which integrated intrapartum plan is recommended?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Continue ART; cesarean at 38 weeks; start IV zidovudine at least 3 hours before birth

The best answer is “Continue ART; cesarean at 38 weeks; start IV zidovudine at least 3 hours before birth”. HIV RNA above 1,000 copies/mL near birth warrants continuation of antepartum combination ART, scheduled cesarean birth at 38 weeks before labor or membrane rupture, and intravenous zidovudine beginning at least 3 hours before the operation. The alternatives each alter a consequential component: route, timing or continuation of combination ART.

Reference: NIH Perinatal HIV Clinical Guidelines: Intrapartum Care: https://clinicalinfo.hiv.gov/en/guidelines/perinatal/intrapartum-care