Gynaecological infections: toxic shock syndrome: 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.

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OBG · Gynaecological infections: toxic shock syndrome

Sample item

A 19-year-old develops high fever, a diffuse sunburn-like rash, vomiting, hypotension and confusion on day 4 of her period while using a super-absorbent tampon. Which is the best initial management?

ARemove the tampon, give intravenous fluids and antistaphylococcal therapy including clindamycinBStart oral fluconazoleCReassure and advise oral paracetamolDGive corticosteroids only

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

The answer and the reasoning

A. Remove the tampon, give intravenous fluids and antistaphylococcal therapy including clindamycin

Menstrual toxic shock syndrome is caused by toxin TSST-1 from Staphylococcus aureus, with fever, rash that later desquamates, hypotension and multiorgan involvement. Treatment is removal of the source, aggressive fluids, antibiotics such as flucloxacillin or vancomycin with clindamycin to reduce toxin production, and sometimes immunoglobulin. Delay can be fatal.

Option by option

A. Remove the tampon, give intravenous fluids and antistaphylococcal therapy including clindamycin (correct)
Correct. Remove the source, resuscitate and give antistaphylococcal drugs with clindamycin.
B. Start oral fluconazole
Candida does not cause this toxin-mediated shock.
C. Reassure and advise oral paracetamol
This is a life-threatening illness that requires hospital care, not reassurance.
D. Give corticosteroids only
Steroids do not treat the toxin-mediated illness.

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 OBG question

What is the answer to this OBG question?

The best answer is A, Remove the tampon, give intravenous fluids and antistaphylococcal therapy including clindamycin. Menstrual toxic shock syndrome is caused by toxin TSST-1 from Staphylococcus aureus, with fever, rash that later desquamates, hypotension and multiorgan involvement.

Why is "Start oral fluconazole" not the answer?

Candida does not cause this toxin-mediated shock.

Why is "Reassure and advise oral paracetamol" not the answer?

This is a life-threatening illness that requires hospital care, not reassurance.

Why is "Give corticosteroids only" not the answer?

Steroids do not treat the toxin-mediated illness.

What concept does this question test?

It tests Gynaecological infections: toxic shock syndrome in OBG. Treatment is removal of the source, aggressive fluids, antibiotics such as flucloxacillin or vancomycin with clindamycin to reduce toxin production, and sometimes immunoglobulin. Delay can be fatal.

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 Gynaecological infections: toxic shock syndrome?

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.