Question Easy:
A 28-year-old woman at 8 weeks of gestation presents to the GP surgery with nausea and vomiting. She is unable to keep any food down but is still managing to sip water. What is the most appropriate initial management step? 🤢
A) Start ondansetron
B) Advise dietary modification and ginger supplementation
C) Prescribe metoclopramide
D) Arrange for hospital admission
E) Recommend complete bed rest
Question Medium:
A 32-year-old woman presents with post-coital bleeding. She has no other symptoms and her menstrual cycle is regular. She is up to date with her cervical smears. What is the most appropriate next step in management? 🤔
A) Urgent referral to the gynaecology clinic
B) Immediate colposcopy
C) Pelvic ultrasound
D) Cervical swab for chlamydia
E) Repeat cervical smear
Question Hard:
A 42-year-old woman presents with increasing abdominal distension and a pelvic mass on examination. CA-125 levels are elevated. An ultrasound reveals a large complex ovarian mass with areas of solid and cystic components. What is the most appropriate next investigation? 🧐
A) MRI pelvis
B) Diagnostic laparoscopy
C) CT abdomen and pelvis
D) Tumour markers for germ cell tumour
E) Endometrial biopsy
Explanations & Answers:
Question Easy Answer:
B
Question Easy Explanation:
For the management of nausea and vomiting in early pregnancy, NICE guidelines recommend lifestyle and dietary modifications as the first-line treatment. This includes small, frequent meals and ginger supplementation to alleviate symptoms. Medications like metoclopramide and ondansetron are typically reserved for more severe cases or when dietary changes are ineffective.
Question Medium Answer:
D
Question Medium Explanation:
Post-coital bleeding can be a symptom of cervical infection, and chlamydia is a common cause. A cervical swab for chlamydia is a practical initial step. Given her regular screening, an urgent referral or colposcopy isn’t immediately warranted unless other risk factors or symptoms are present.
Question Hard Answer:
C
Question Hard Explanation:
An elevated CA-125 and a complex ovarian mass on ultrasound are concerning for ovarian cancer. A CT scan of the abdomen and pelvis is the next step to assess the extent of the disease and to plan for further management, following NHS guidelines for suspected ovarian cancer.
Medical fact of the day:
Around one in ten women worldwide is affected by endometriosis, a condition often underdiagnosed despite its prevalence. In the UK, it takes an average of 7.5 years from the onset of symptoms to receive a diagnosis.
Quote of the day:
“In the middle of every difficulty lies opportunity. Keep pushing boundaries, for today’s lessons will be tomorrow’s strength.” 🌟