Question Easy:
A 28-year-old woman is 34 weeks pregnant, presenting with itchy palms and soles. She reports no rash but feels the itch is unbearable, especially at night. 😣 What is the most likely diagnosis?
A) Preeclampsia
B) Obstetric cholestasis
C) Gestational diabetes
D) Intrahepatic cholestasis of pregnancy
E) Psoriasis
Question Medium:
A 32-year-old woman with a history of polycystic ovarian syndrome (PCOS) is seeking advice on managing her condition. Which of the following lifestyle changes is most likely to improve her symptoms?
A) Reducing dairy intake
B) Increasing protein intake
C) Increasing physical activity
D) Strict low-fat diet
E) Reducing caffeine consumption
Question Hard:
A 37-year-old woman presents with heavy menstrual bleeding for the past 6 months. She has tried medical treatment, but her symptoms persist. An endometrial biopsy reveals atypical hyperplasia. Which of the following is the most appropriate next step in management according to NICE guidelines?
A) Hysteroscopy
B) Hysterectomy
C) Combined oral contraceptive pill
D) Endometrial ablation
E) Progestogen therapy
Explanations & Answers:
Question Easy Answer:
B) Obstetric cholestasis
Question Easy Explanation:
The symptoms of itchy palms and soles without a rash, particularly at night, in a pregnant woman are characteristic of obstetric cholestasis. This condition arises from impaired bile flow and can elevate bile acids, leading to itching. Management includes monitoring and potentially early delivery to prevent complications.
Question Medium Answer:
C) Increasing physical activity
Question Medium Explanation:
For women with PCOS, lifestyle changes such as increasing physical activity and maintaining a healthy weight can significantly improve symptoms and fertility prospects by improving insulin sensitivity and hormone levels. NICE guidelines recommend these interventions as first-line management.
Question Hard Answer:
B) Hysterectomy
Question Hard Explanation:
For a woman with heavy menstrual bleeding and atypical hyperplasia of the endometrium, the risk of progression to endometrial cancer is high. According to NICE guidelines, a hysterectomy is often recommended as the definitive treatment to prevent malignancy.
Medical fact of the day:
In the UK, obstetric cholestasis affects about 0.7% of pregnancies, with a higher prevalence among women of South Asian origin. It is one of the few conditions in pregnancy where the mother’s symptoms (itching) do not correspond directly to the severity of the liver dysfunction.
Quote of the day:
“Every small step you take in caring for others is a giant leap towards a healthier world. Keep moving forward, one compassionate act at a time.” 🌟