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Volume 20, Number 2—February 2014

CME ACTIVITY - Online Report

Peer Reviewed Report Available Online Only

Special Considerations for Prophylaxis for and Treatment of Anthrax in Pregnant and Postpartum Women

Earning CME Credit

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions (with a minimum 70% passing score) and earn continuing medical education (CME) credit, please go to www.medscape.org/journal/eid. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers. You must be a registered user on Medscape.org. If you are not registered on Medscape.org, please click on the New Users: Free Registration link on the left hand side of the website to register. Only one answer is correct for each question. Once you successfully answer all post-test questions you will be able to view and/or print your certificate. For questions regarding the content of this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@webmd.net. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please refer to http://www.ama-assn.org/ama/pub/category/2922.html. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit may be acceptable as evidence of participation in CME activities. If you are not licensed in the US, please complete the questions online, print the certificate and present it to your national medical association for review.

Article Title:
Special Considerations for Prophylaxis for and Treatment of Anthrax
in Pregnant and Postpartum Women

CME Questions

1. A 24-year-old woman presents to the emergency department 4 days after an outbreak of anthrax in a large city. She has fever and malaise and is currently pregnant at 33 weeks’ gestation with her first pregnancy. What should you consider regarding the clinical presentation and diagnosis of anthrax during pregnancy?

A. Computed tomography scans are to be avoided because of the danger of radiation exposure to the fetus

B. Hypotension may be more severe among pregnant women with anthrax compared with nonpregnant women

C. Anthrax has no effect on the risk for preterm labor

D. The fetal compartment is immune from infection with anthrax

2. This patient undergoes a thorough evaluation and is found not to have anthrax, although she was exposed. What is the best antimicrobial treatment strategy for this patient as postexposure prophylaxis?

A. No antimicrobial treatment should be given

B. She should receive treatment with ciprofloxacin

C. She should receive treatment with levofloxacin or moxifloxacin

D. She should receive treatment with doxycycline

3. What else should you consider regarding the treatment of this patient?

A. Prophylactic treatment should be limited to 30 days

B. The dose of ciprofloxacin should be elevated beyond the normal range for nonpregnant adults

C. The prophylactic antimicrobial should not cross the placenta

D. She should receive the anthrax vaccine

4. Despite prophylaxis, pulmonary anthrax develops 3 days later in this patient. What should you consider regarding her treatment now?

A. Paracentesis and thoracentesis may be performed under ultrasound guidance

B. Routine tocolysis of preterm contractions is indicated

C. She should not receive antitoxins

D. She should not breast-feed if delivery of the baby becomes necessary

Activity Evaluation

1. The activity supported the learning objectives.

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2. The material was organized clearly for learning to occur.

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3. The content learned from this activity will impact my practice.

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4. The activity was presented objectively and free of commercial bias.

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