Question Easy:
A 28-year-old woman, who is 36 weeks pregnant, presents to the antenatal clinic with complaints of persistent itching, particularly on her palms and soles. She has no skin lesions. Blood tests reveal elevated bile acids. What is the most likely diagnosis? 🫄
A) Preeclampsia
B) Gestational diabetes
C) Obstetric cholestasis
D) PUPPP syndrome
E) Acute fatty liver of pregnancy
Explanations & Answers:
Question Easy Answer: C) Obstetric cholestasis
Question Easy Explanation: Obstetric cholestasis, also known as intrahepatic cholestasis of pregnancy, is characterized by itching without a rash, often on the palms and soles. It is confirmed by elevated bile acids and requires monitoring due to potential risks to both mother and fetus in alignment with NICE guidelines.
Question Medium:
A 32-year-old woman presents with heavy menstrual bleeding and painful periods. Examination reveals an enlarged, irregularly shaped uterus. An ultrasound is performed, showing a heterogeneous mass within the uterine wall. What is the most likely diagnosis? 🤔
A) Endometriosis
B) Fibroids
C) Adenomyosis
D) Polycystic ovary syndrome
E) Endometrial hyperplasia
Explanations & Answers:
Question Medium Answer: B) Fibroids
Question Medium Explanation: Fibroids, or uterine leiomyomas, are benign smooth muscle tumours of the uterus. Characteristically, they cause an enlarged, irregular uterus and symptoms such as heavy menstrual bleeding and dysmenorrhea. The diagnosis is supported by ultrasound findings of a heterogeneous mass.
Question Hard:
A 30-year-old woman comes to the emergency department with severe abdominal pain and vaginal bleeding. She is 10 weeks pregnant, and ultrasound shows free fluid in the pelvis but no intrauterine gestational sac. What is the most important immediate management step? 🚨
A) Methotrexate administration
B) Expectant management
C) Diagnostic laparoscopy
D) Blood transfusion
E) Administration of anti-D immunoglobulin
Explanations & Answers:
Question Hard Answer: C) Diagnostic laparoscopy
Question Hard Explanation: The presentation is suggestive of a ruptured ectopic pregnancy, a surgical emergency. Immediate diagnostic laparoscopy helps to confirm the diagnosis and allows for surgical treatment, crucial in cases with free fluid (indicative of bleeding) and the absence of an intrauterine pregnancy on ultrasound.
Medical fact of the day: In the UK, approximately 1 in 7 couples may experience infertility, and female factors contribute to about 30% of infertility cases, often due to issues such as tubal blockage or ovulatory disorders.
Quote of the day: “In the realm of healing, small acts of kindness are the most powerful prescription.” 🌟