OBGYN EOR Exam Questions with Complete Solutions (A+ Graded)

A breastfeeding 28 y/o woman presents for eval of a painful R breast "lump" 3 wks after delivery of a healthy newborn. Exam reveals localized erythematous edema of the R breast, a 7/10 painfully palpable discrete induration & thick, yellow nipple discharge. The nipple & areola are not excoriated. The L breast is unremarkable. You refer the pt for a drainage procedure. In the meantime, what is an appropriate initial plan? Correct Answer *Start abx & continue breastfeeding w/ either breast* What is the MC causative organism of mastitis? Correct Answer *S. aureus* (tx = dicloxacillin, amoxicillin, or cephalexin) What are appropriate abx choices for tx of mastitis? Correct Answer *Dicloxacillin/ amoxicillin/ cephalexin* (all anti-staph abx) A 32 y/o woman comes to your office w/ fever & lower abdominal pain. She has a hx of PID. Her vitals are T 38.4°C, HR 133, & BP 101/60. On exam, the pt is toxic appearing & has marked lower abdominal tenderness to palpation w/ rebound & guarding. Pelvic exam reveals CMT, scant discharge, & L adnexal tenderness. The pt's urine beta-hCG is negative. A transvaginal USN is performed & reveals a complex cystic, thick-walled, well-defined mass in the L adnexa. What is the most appropriate next step in management? Correct Answer *Begin IV abx & admit for possible drainage* (dx = likely tubo-ovarian abscess) A 15 y/o girl presents to the ED w/ complaints of vaginal pruritus & discharge. She denies sexual activity. Speculum exam reveals a homogenous, grey discharge w/ a pH > 4.5. A wet prep reveals stippled epithelial cells. What tx is indicated? Correct Answer *Metronidazole 500mg orally BID for 7 days* OR metronidazole gel 0.75% intravag QD for 5 days OR clindamycin cream 2% intravag QHS for 7 days (dx = BV) A 26 y/o obese woman w/ a 2-yr hx of increased acne, abnormal hair growth, & menstrual abnormalities presents to her obstetrician for an infertility workup. A pelvic USN reveals enlarged cystic ovaries. She desires to become pregnant. What is the first line tx? Correct Answer *Weight reduction* Next line tx = clomiphene citrate (Clomid) -> gonadotropin therapy -> OCPs (dx = PCOS) A 21 y/o woman G1P0 at 35 wks gestation comes to the ED c/o HA, blurry vision, & shortness of breath. Vitals include a BP of 195/110 mmHg, HR of 90 bpm, respiratory rate of 21 bpm, oral temp of 37.1℃, & O2 sat of 90% on room air. UA reveals 3+ protein. A chest radiograph reveals pulmonary edema. Which medication should be administered to reduce BP? Correct Answer *Hydralazine* (dx = severe preeclampsia) Preeclampsia in first trimester think .. Correct Answer *Molar pregnancy* A 17 y/o G1P0 woman at 25 wks gestation comes in c/o intermittent blurred vision. On presentation, she is asymptomatic. Vitals are: HR 84, BP 175/113, O2 sat 97%. Physical exam reveals 2+ pitting edema on both lower extremities & UA has 3+ protein on dip. What is an appropriate next step? Correct Answer *Admit for further OB eval* (dx = severe preeclampsia) What are the components of HELP syndrome? Correct Answer *H*emolysis *E*levated *L*iver enzymes *L*ow *P*latelets A 15 y/o girl presents to clinic w/ vaginal discharge. She recently became sexually active but states that her partner does not have any symptoms of infection. Speculum exam reveals white discharge & an erythematous cervix. Bimanual exam is unremarkable. Urine PCR is positive for Chlamydia trachomatis. What is the most appropriate tx? Correct Answer *Azithromycin & ceftriaxone* (pt w/ + chlamydia & cervicitis/urethritis should also be treated for GC)