National programmes: visceral leishmaniasis in pregnancy: practice question

A PSM question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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PSM · National programmes: visceral leishmaniasis in pregnancy

Sample item

A 28-year-old woman at 14 weeks of pregnancy in a kala-azar endemic block in Bihar has fever for two months, massive splenomegaly and a positive rK39 test. Which drug is most appropriate?

AOral miltefosine for 28 daysBSodium stibogluconate for 30 daysCSingle-dose liposomal amphotericin B 10 mg/kg intravenouslyDIntramuscular paromomycin for 21 days

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Single-dose liposomal amphotericin B 10 mg/kg intravenously

Single-dose liposomal amphotericin B (10 mg/kg) is the first-line treatment of kala-azar under the national programme and is safe in pregnancy. Miltefosine is teratogenic and contraindicated in pregnancy. Antimonials are no longer used in Bihar because of resistance and toxicity.

Option by option

A. Oral miltefosine for 28 days
Miltefosine is teratogenic and must be avoided in women of childbearing potential who are pregnant.
B. Sodium stibogluconate for 30 days
Sodium stibogluconate has been abandoned in Bihar because of resistance and toxicity.
C. Single-dose liposomal amphotericin B 10 mg/kg intravenously (correct)
Correct. Liposomal amphotericin B is first-line and can be used in pregnancy.
D. Intramuscular paromomycin for 21 days
Paromomycin is an aminoglycoside with nephrotoxic and ototoxic risk and is not first-line.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this PSM question

What is the answer to this PSM question?

The best answer is C, Single-dose liposomal amphotericin B 10 mg/kg intravenously. Single-dose liposomal amphotericin B (10 mg/kg) is the first-line treatment of kala-azar under the national programme and is safe in pregnancy.

Why is "Oral miltefosine for 28 days" not the answer?

Miltefosine is teratogenic and must be avoided in women of childbearing potential who are pregnant.

Why is "Sodium stibogluconate for 30 days" not the answer?

Sodium stibogluconate has been abandoned in Bihar because of resistance and toxicity.

Why is "Intramuscular paromomycin for 21 days" not the answer?

Paromomycin is an aminoglycoside with nephrotoxic and ototoxic risk and is not first-line.

What concept does this question test?

It tests National programmes: visceral leishmaniasis in pregnancy in PSM. Miltefosine is teratogenic and contraindicated in pregnancy. Antimonials are no longer used in Bihar because of resistance and toxicity.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study National programmes: visceral leishmaniasis in pregnancy?

Practise biostatistics with small calculations until sensitivity, predictive values and risk measures are automatic. Then use the flashcards and the other PSM questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.