Question Easy: 🤰 A 28-year-old woman, 32 weeks pregnant, presents with itching all over her body, particularly on her palms and soles. There are no rashes. Blood tests are performed. Which of the following is the most appropriate step in management for this condition?
A) Antihistamines
B) Ursodeoxycholic acid
C) Topical corticosteroids
D) Emollients
E) Antibiotics
Question Medium: 🏥 A 35-year-old woman presents to the GP with heavy menstrual bleeding lasting 8 days each cycle. She has no other significant medical history and is not taking any medications. What is the first-line pharmacological treatment according to NICE guidelines?
A) Tranexamic acid
B) Combined oral contraceptive pill
C) Levonorgestrel-releasing intrauterine system (LNG-IUS)
D) Oral norethisterone
E) Non-steroidal anti-inflammatory drugs (NSAIDs)
Question Hard: 🤔 A 40-year-old woman is diagnosed with stage 1a endometrial cancer. She wishes to preserve her fertility. What is the most appropriate management option?
A) Total abdominal hysterectomy and bilateral salpingo-oophorectomy
B) High-dose progestogen therapy
C) Pelvic radiotherapy
D) Chemotherapy
E) Radical hysterectomy
Explanations & Answers:
Question Easy Answer: B) Ursodeoxycholic acid
Question Easy Explanation: The symptoms and signs described are consistent with obstetric cholestasis, also known as intrahepatic cholestasis of pregnancy. Ursodeoxycholic acid is used to reduce bile acid levels and alleviate itching. According to NICE guidelines, this is the standard treatment.
Question Medium Answer: C) Levonorgestrel-releasing intrauterine system (LNG-IUS)
Question Medium Explanation: NICE guidelines recommend the levonorgestrel-releasing intrauterine system (LNG-IUS) as the first-line treatment for heavy menstrual bleeding in the absence of contraindications, especially when long-term management is desired. It is more effective than oral medications in reducing menstrual blood loss.
Question Hard Answer: B) High-dose progestogen therapy
Question Hard Explanation: Fertility preservation in the face of stage 1a endometrial cancer can be managed with high-dose progestogen therapy. This approach is suitable for women who wish to retain their fertility and involves regular monitoring to ensure no progression of the disease.
Medical fact of the day: The most common cause of maternal death during childbirth in the UK is thromboembolism. The Confidential Enquiry into Maternal Deaths recommends that all pregnant women should be assessed for venous thromboembolism risk at booking and after each hospital admission.
Quote of the day: “In times of challenge, remember why you started this journey. Every step you take is a step towards healing, learning, and growing.” 🌟