COMLEX-USA Obstetrics and Gynecology 2 — Questions and Answers
Question 1: A 16-year-old girl has sudden onset severe right lower quadrant pain, nausea, and vomiting. Ultrasound shows an enlarged right ovary (6 cm) with absent Doppler blood flow. Which intervention is most appropriate?
- Laparoscopic detorsion (Correct answer)
- Right salpingo-oophorectomy
- IV antibiotics and observation
- Appendectomy
Correct answer: Laparoscopic detorsion
Ovarian torsion requires urgent laparoscopic detorsion to restore blood flow; oophorectomy is reserved for clearly non-viable ovaries.
Question 2: A woman at 34 weeks gestation has platelet count 68,000/μL, AST 210 U/L, elevated LDH, and severe headache. HELLP syndrome is diagnosed. What is the most critical next step?
- IV magnesium sulfate alone
- Prompt delivery regardless of gestational age (Correct answer)
- Corticosteroids and delay delivery 48 hours
- Plasma exchange transfusion
Correct answer: Prompt delivery regardless of gestational age
HELLP syndrome is a life-threatening variant of severe preeclampsia; delivery is the definitive and required treatment regardless of gestational age.
Question 3: A 50-year-old postmenopausal woman presents with vaginal bleeding. Transvaginal ultrasound shows an endometrial stripe of 6 mm. What is the next step in evaluation?
- Repeat Pap smear
- Colposcopy with biopsy
- Endometrial biopsy (Correct answer)
- Pelvic MRI
Correct answer: Endometrial biopsy
Postmenopausal bleeding with endometrial stripe ≥5 mm requires endometrial biopsy to exclude endometrial carcinoma.
Question 4: A 22-year-old sexually active woman has lower abdominal pain, cervical motion tenderness, uterine tenderness, and mucopurulent cervical discharge with temperature of 38.3°C. Which organism is most likely responsible?
- Treponema pallidum
- Chlamydia trachomatis or Neisseria gonorrhoeae (Correct answer)
- Gardnerella vaginalis
- Trichomonas vaginalis
Correct answer: Chlamydia trachomatis or Neisseria gonorrhoeae
Pelvic inflammatory disease is most commonly caused by ascending infection from Chlamydia trachomatis and/or Neisseria gonorrhoeae.
Question 5: A 29-year-old woman at 33 weeks gestation has regular uterine contractions with cervical dilation of 2 cm. Which tocolytic agent is CONTRAINDICATED at this gestational age?
- Nifedipine
- Indomethacin (Correct answer)
- Magnesium sulfate
- Subcutaneous terbutaline
Correct answer: Indomethacin
Indomethacin is contraindicated after 32 weeks gestation due to risk of premature closure of the ductus arteriosus and fetal renal impairment.
Question 6: A 45-year-old woman has heavy menstrual bleeding, urinary frequency, and a 14-week-size uterus on exam. Ultrasound confirms multiple intramural fibroids. She wishes to maintain fertility. What is the most appropriate surgical treatment?
- Total abdominal hysterectomy
- Uterine artery embolization
- Myomectomy (Correct answer)
- Endometrial ablation
Correct answer: Myomectomy
Myomectomy removes fibroids while preserving the uterus and is the preferred surgical option for women who desire future fertility.
Question 7: A 50-year-old woman reports 9 months of hot flashes, night sweats, and vaginal dryness. FSH is 58 mIU/mL and estradiol is 12 pg/mL. She has had no menses for 13 months. What is the diagnosis?
- Primary ovarian insufficiency
- Menopause (Correct answer)
- Hypothyroidism
- Pituitary adenoma
Correct answer: Menopause
Menopause is defined as 12 consecutive months of amenorrhea with elevated FSH (>40 mIU/mL) and low estradiol in a woman typically over 45 years.
COMLEX-USA Obstetrics and Gynecology 2
A 16-year-old girl has sudden onset severe right lower quadrant pain, nausea, and vomiting.
Ultrasound shows an enlarged right ovary (6 cm) with absent Doppler blood flow.
Which intervention is most appropriate?