WBR0082

Author	[[PageAuthor::Aditya Govindavarjhulla (Reviewed by Jad Al Danaf, Rim Halaby, M.D. [1], and Yazan Daaboul)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Microbiology
Sub Category	SubCategory::Reproductive
Prompt	[[Prompt::A 26-year-old G1P0 pregnant woman who received no prenatal care presents to her physician's office at 8 weeks gestation for low-grade fever, cough, and myalgia. She just returned from a trip to Africa where she was exposed five days ago to her sick niece who had fever, cough, and a 3-day maculopapular rash that "looked like measles". The patient did not receive her childhood vaccinations due to religious beliefs. She does not smoke or drink alcohol. She does not take any medications and has no known allergies. Her blood pressure is 110/72 mmHg, heart rate is 80/min, temperature is 38.3 °C (100.9 °F), and respiratory rate is 16/min. Physical examination is remarkable for The patient requests further information regarding regarding her recent exposure and asks if there are any risks to the fetus. Which of the following congenital disorders is most commonly associated with the infectious agent responsible for the patient's condition?]]
Answer A	AnswerA::Preconception
Answer A Explanation	AnswerAExp::The risk of congenital infection and defects is highest during the first 12 weeks of gestation.
Answer B	AnswerB::0-12 weeks
Answer B Explanation	AnswerBExp::The risk of congenital infection and defects is highest during the first 12 weeks of gestation.
Answer C	AnswerC::12-24 weeks
Answer C Explanation	AnswerCExp::The risk of congenital infection and defects is highest during the first 12 weeks of gestation and decreases after the 12th week of gestation with defects rare after the 20th week of gestation.
Answer D	AnswerD::24-36 weeks
Answer D Explanation	AnswerDExp::The risk of congenital infection and defects is highest during the first 12 weeks of gestation with defects rare after the 20th week of gestation.
Answer E	AnswerE::After 36 weeks
Answer E Explanation	AnswerEExp::The risk of congenital infection and defects is highest during the first 12 weeks of gestation with defects rare after the 20th week of gestation.
Right Answer	RightAnswer::B
Explanation	[[Explanation::Rubella is a viral illness caused by a togavirus of the genus Rubivirus and is characterized by a mild, maculopapular rash. Children usually develop few or no constitutional symptoms, but adults may experience a 1–5-day prodrome of low grade fever, headache, malaise, mild coryza, and conjunctivitis. Postauricular, occipital and posterior cervical lymphadenopathy is characteristic and precedes the rash by 5–10 days. Arthralgia or arthritis may occur in up to 70% of adult women with rubella. Congenital rubella syndrome (CRS) is an illness resulting from rubella virus infection during pregnancy. When rubella infection occurs during early pregnancy, serious consequences—such as miscarriages, stillbirths, and a constellation of severe birth defects in infants can result. The risk of congenital infection and defects is highest during the first 12 weeks of gestation and decreases after the 12th week of gestation with defects rare after the 20th week of gestation. Common congenital defects of CRS include cataracts, congenital heart disease, hearing impairment, and developmental delay. Infants with CRS usually present with more than one sign or symptom consistent with congenital rubella infection. However, infants may present with a single defect. Hearing impairment is the most common single defect. Educational Objective: When rubella infection occurs during pregnancy, especially during the first 12 weeks, serious consequences can result. These include miscarriages, fetal deaths/stillbirths, and a constellation of severe birth defects known as congenital rubella syndrome (CRS). The most common congenital defects are cataracts, heart defects and hearing impairment. References: First Aid 2014 page 163 CDC.gov [2] Miller E, Cradock-Watson JE, Pollock TM. Consequences of confirmed maternal rubella at successive stages of pregnancy. Lancet 1982;2(8302):781–84.]]
Approved	Approved::Yes
Keyword	WBRKeyword::rubella, WBRKeyword::congenital rubella syndrome, WBRKeyword::pregnancy, WBRKeyword::fetal transmission, WBRKeyword::Microbiology, WBRKeyword::Virus, WBRKeyword::Virology, WBRKeyword::RNA virus
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