Complications of pregnancy: Jarisch-Herxheimer reaction: practice question

A OBG 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.

Try it

OBG · Complications of pregnancy: Jarisch-Herxheimer reaction

Sample item

A woman at 28 weeks with early syphilis receives benzathine penicillin. Within hours she has fever, uterine contractions and reduced fetal movements. What explains these features?

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

The answer and the reasoning

C. Jarisch-Herxheimer reaction

A Jarisch-Herxheimer reaction occurs a few hours after treatment as dying spirochaetes release cytokines. In pregnancy it can cause fever, contractions and fetal heart changes, so treatment is given where fetal monitoring is possible. It is not an allergy and does not mean treatment should stop.

Option by option

  • A. Placental abruption

    Abruption presents with pain, a tense uterus and bleeding rather than fever shortly after the injection.

  • B. Chorioamnionitis

    Chorioamnionitis needs ruptured membranes or ascending infection and does not follow penicillin so closely.

  • C. Jarisch-Herxheimer reaction (correct)

    Correct. A cytokine release within hours of penicillin fits the picture.

  • D. Penicillin anaphylaxis

    Anaphylaxis would show urticaria, bronchospasm and hypotension and not isolated fever and contractions.

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.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is C, Jarisch-Herxheimer reaction. A Jarisch-Herxheimer reaction occurs a few hours after treatment as dying spirochaetes release cytokines.

Why is "Placental abruption" not the answer?

Abruption presents with pain, a tense uterus and bleeding rather than fever shortly after the injection.

Why is "Chorioamnionitis" not the answer?

Chorioamnionitis needs ruptured membranes or ascending infection and does not follow penicillin so closely.

Why is "Penicillin anaphylaxis" not the answer?

Anaphylaxis would show urticaria, bronchospasm and hypotension and not isolated fever and contractions.

What concept does this question test?

It tests Complications of pregnancy: Jarisch-Herxheimer reaction in OBG. In pregnancy it can cause fever, contractions and fetal heart changes, so treatment is given where fetal monitoring is possible. It is not an allergy and does not mean treatment should stop.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Complications of pregnancy: Jarisch-Herxheimer reaction?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG 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.