Question Easy:
A 28-year-old woman presents to the GP with complaints of low mood, fatigue, and irritability, which she noticed a week before her periods for the past six months. She also experiences breast tenderness and bloating. What is the most likely diagnosis?
A) Premature ovarian insufficiency
B) Premenstrual syndrome (PMS)
C) Polycystic ovary syndrome (PCOS)
D) Endometriosis
E) Menorrhagia
Question Medium:
A 32-year-old woman in her first trimester of pregnancy presents to the emergency department with severe right lower abdominal pain and vaginal bleeding. Her menstrual period is delayed by 7 weeks and her serum beta-hCG levels are 1600 IU/L without any ultrasound evidence of an intrauterine pregnancy. What is the most likely diagnosis?
A) Threatened miscarriage
B) Ectopic pregnancy
C) Molar pregnancy
D) Appendicitis
E) Urinary tract infection
Question Hard:
A 45-year-old woman presents with irregular bleeding and an ultrasound shows a thickened endometrial lining. An endometrial biopsy reveals atypical hyperplasia. What is the optimal management for this patient who desires to retain her uterus and has no immediate plans for future pregnancies?
A) Progestin therapy with regular follow-up
B) Total abdominal hysterectomy
C) Combined oral contraceptive pill
D) Thermal balloon endometrial ablation
E) Watchful waiting with periodic ultrasounds
Explanations & Answers:
Question Easy Answer: B) Premenstrual syndrome (PMS)
Question Easy Explanation: Premenstrual syndrome is characterised by emotional and physical symptoms occurring in the luteal phase of the menstrual cycle, such as low mood, irritability, fatigue, breast tenderness, and bloating. According to NICE guidelines, lifestyle changes are the first step in managing PMS.
Question Medium Answer: B) Ectopic pregnancy
Question Medium Explanation: The combination of abdominal pain, amenorrhea, positive pregnancy test, and absence of intrauterine pregnancy on ultrasound in the setting of an elevated beta-hCG level strongly suggests an ectopic pregnancy. NICE guidelines recommend early surgical or medical intervention due to the risk of rupture.
Question Hard Answer: A) Progestin therapy with regular follow-up
Question Hard Explanation: For a woman with atypical endometrial hyperplasia who wishes to preserve her uterus, progestin therapy is recommended. NICE guidelines suggest medical management with regular follow-up biopsies to monitor treatment response, aligning with the patient’s wish to maintain fertility.
Medical fact of the day: The UK has one of the lowest maternal mortality rates globally, with significant improvements attributed to comprehensive antenatal care and effective management of complications during pregnancy.
Quote of the day: “In the midst of every challenge lies a profound opportunity to grow, both as healers and as humans.”