13/07/2024 – Obstetrics and Gynaecology

Question Easy:
A 30-year-old woman presents with a positive pregnancy test and amenorrhea for 6 weeks. She is experiencing mild abdominal pain and spotting. What is the most appropriate initial investigation?
A) Transabdominal ultrasound
B) Transvaginal ultrasound
C) Serum progesterone levels
D) Serum β-hCG levels
E) Abdominal X-ray

Question Medium:
A 28-year-old woman with a known history of polycystic ovary syndrome (PCOS) presents with complaints of severe, sudden, lower abdominal pain. On examination, she has tenderness on the lower right side. What is the most likely diagnosis?
A) Ectopic pregnancy
B) Ovarian torsion
C) Pelvic inflammatory disease
D) Appendicitis
E) Ruptured ovarian cyst

Question Hard:
A 35-year-old woman at 32 weeks of gestation presents with painless vaginal bleeding. Her antenatal scans have been normal up until now. On examination, her uterus is non-tender, and the foetal heart rate is normal. What is the most likely diagnosis?
A) Placenta Previa
B) Placental Abruption
C) Vasa Previa
D) Uterine Rupture
E) Cervical Polyp

Explanations & Answers:

Question Easy Answer: B) Transvaginal ultrasound
Question Easy Explanation: A transvaginal ultrasound is the most appropriate initial investigation to evaluate a pregnancy of unknown location, particularly when there’s a risk of an ectopic pregnancy. This test provides more detailed imaging of the pelvis compared to a transabdominal ultrasound and can help identify the location of the pregnancy and any potential complications as per NICE guidelines.

Question Medium Answer: B) Ovarian torsion
Question Medium Explanation: Ovarian torsion is a known complication of polycystic ovary syndrome (PCOS) and presents with sudden, severe lower abdominal pain. The pain is usually unilateral and may be accompanied by nausea or vomiting. Timely diagnosis and management are critical to avoid ovarian loss, as recommended by NHS protocols.

Question Hard Answer: A) Placenta Previa
Question Hard Explanation: Placenta previa presents with painless vaginal bleeding in the second half of pregnancy. It’s vital to conduct an ultrasound to confirm the diagnosis and avoid a digital cervical examination due to the risk of causing heavy bleeding, adhering to BNF guidelines.

Medical fact of the day: In the UK, approximately 1 in 7 couples may have difficulty conceiving. This translates to about 3.5 million people and highlights the importance of addressing infertility issues promptly and effectively.

Quote of the day: “In the midst of delivering life, remember to take a moment to nurture your own. Self-care fuels the care we give to others.” 🌿