Question Easy:
🤰 A 28-year-old pregnant woman at 24 weeks’ gestation comes to the clinic for a routine check-up. She has been experiencing occasional shortness of breath but is otherwise healthy. Which of the following changes is responsible for increased shortness of breath during a normal pregnancy?
A) Increased tidal volume
B) Decreased functional residual capacity
C) Increased respiratory rate
D) Decreased vital capacity
E) Increased residual volume
Explanations & Answers:
Question Easy Answer: A
Question Easy Explanation: During pregnancy, the tidal volume increases due to hormonal changes that lead to increased oxygen demand and improved efficiency in gas exchange. Although the respiratory rate may slightly increase, the primary reason for increased shortness of breath is the increased tidal volume. This is in line with recommendations from NICE which detail typical physiological changes in pregnancy.
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Question Medium:
🩸 A 35-year-old woman attends the gynaecology clinic with heavy menstrual bleeding. She reports clotting and cycles lasting for up to 10 days. She is otherwise well and denies any pelvic pain. Which first-line treatment is recommended according to NICE guidelines if she requires contraception as well?
A) Tranexamic acid
B) Mefenamic acid
C) Combined oral contraceptive pill
D) Levonorgestrel-releasing intrauterine system (LNG-IUS)
E) Norethisterone
Explanations & Answers:
Question Medium Answer: D
Question Medium Explanation: The levonorgestrel-releasing intrauterine system (LNG-IUS) is recommended as a first-line treatment for heavy menstrual bleeding when contraception is also desired. This method is effective in reducing menstrual loss and provides reliable contraception, consistent with NICE guidelines.
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Question Hard:
👶 A 30-year-old woman, G2P1, at 32 weeks’ gestation presents with painless bright red vaginal bleeding. She is haemodynamically stable, and there is no history of trauma or recent sexual intercourse. What is the most appropriate initial management?
A) Immediate cesarean section
B) Digital vaginal examination
C) Transabdominal ultrasound scan
D) Administer anti-D immunoglobulin
E) Induction of labour
Explanations & Answers:
Question Hard Answer: C
Question Hard Explanation: In the case of painless vaginal bleeding in the third trimester, placenta previa must be considered. A transabdominal ultrasound scan is the most appropriate initial investigation to confirm the diagnosis. It is critical not to perform a digital vaginal examination due to the risk of provoking severe bleeding. This approach aligns with NHS guidelines on managing antepartum haemorrhage.
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Medical fact of the day: Did you know that the longest recorded human pregnancy lasted 375 days and resulted in a healthy baby? While that might sound extreme, the typical duration ranges around 280 days or 40 weeks!
Quote of the day: “Caring for others is the essence of nursing, but it is also the strength that heals both patient and practitioner. Keep this light shining, one heartbeat at a time.”