SPEX Obstetrics and Gynecology 3 — Questions and Answers
Question 1: A 24-year-old presents with secondary amenorrhea, galactorrhea, and headaches. Serum prolactin is 180 ng/mL. What is the most likely diagnosis?
- Hypothyroidism
- Prolactinoma (Correct answer)
- Sheehan syndrome
- Polycystic ovary syndrome
Correct answer: Prolactinoma
Markedly elevated prolactin with galactorrhea, amenorrhea, and headaches (from mass effect) is classic for a prolactin-secreting pituitary adenoma (prolactinoma).
Question 2: During a routine gynecologic exam, a 45-year-old woman is found to have a vulvar lesion. Biopsy shows lichen sclerosus. Which is the first-line treatment?
- Topical estrogen cream
- High-potency topical corticosteroids (Correct answer)
- Topical testosterone
- Laser ablation
Correct answer: High-potency topical corticosteroids
High-potency topical corticosteroids such as clobetasol propionate are the first-line treatment for lichen sclerosus, providing symptom relief and preventing disease progression.
Question 3: A 30-year-old woman with recurrent implantation failure is found to have a submucosal fibroid. What is the recommended treatment?
- GnRH agonist therapy for 6 months
- Hysteroscopic myomectomy (Correct answer)
- Abdominal myomectomy
- Uterine artery embolization
Correct answer: Hysteroscopic myomectomy
Hysteroscopic myomectomy is the preferred minimally invasive approach to remove submucosal fibroids that distort the uterine cavity and impair implantation.
Question 4: Which laboratory finding is most consistent with a diagnosis of HELLP syndrome?
- Elevated platelet count, elevated LDH, low AST
- Low platelets, elevated LDH, elevated liver enzymes (Correct answer)
- Normal platelets, low LDH, elevated creatinine
- Elevated platelets, low LDH, elevated bilirubin
Correct answer: Low platelets, elevated LDH, elevated liver enzymes
HELLP syndrome is defined by Hemolysis (elevated LDH), Elevated Liver enzymes (AST/ALT), and Low Platelets — a life-threatening complication of severe preeclampsia.
Question 5: A 22-year-old presents with acute pelvic pain, fever, cervical motion tenderness, and mucopurulent cervical discharge. What is the recommended outpatient antibiotic regimen?
- Amoxicillin-clavulanate alone
- Ceftriaxone IM plus doxycycline and metronidazole (Correct answer)
- Azithromycin monotherapy
- Ciprofloxacin plus clindamycin
Correct answer: Ceftriaxone IM plus doxycycline and metronidazole
CDC guidelines recommend ceftriaxone IM plus doxycycline with metronidazole for outpatient treatment of PID to cover gonorrhea, chlamydia, and anaerobes.
Question 6: A postmenopausal woman on tamoxifen for breast cancer reports vaginal bleeding. What is the most important next diagnostic step?
- Pap smear
- Endometrial biopsy (Correct answer)
- Pelvic MRI
- Colposcopy
Correct answer: Endometrial biopsy
Tamoxifen increases endometrial cancer risk; any postmenopausal bleeding in a tamoxifen user requires endometrial biopsy to rule out endometrial carcinoma.
Question 7: Which type of urinary incontinence is best treated with pelvic floor physical therapy and bladder training?
- Overflow incontinence
- Urge incontinence (Correct answer)
- Stress incontinence
- Fistula-related incontinence
Correct answer: Urge incontinence
Urge incontinence (overactive bladder) responds well to behavioral interventions including bladder training and pelvic floor exercises as first-line therapy.
SPEX Obstetrics and Gynecology 3
A 24-year-old presents with secondary amenorrhea, galactorrhea, and headaches.
Serum prolactin is 180 ng/mL.
What is the most likely diagnosis?