Question Easy: 🤰 A 25-year-old woman, 30 weeks pregnant, visits the antenatal clinic for a routine check-up. She feels well but mentions she hasn’t felt her baby move as much as usual over the past day. What is the most appropriate initial action?
A) Perform a bedside ultrasound.
B) Advise her to monitor fetal movements for the next 2 hours.
C) Reassure her that reduced fetal movement is normal at this stage.
D) Admit her for continuous fetal monitoring.
E) Refer her for an immediate CTG (Cardiotocography).
Question Medium: 🩺 A 34-year-old woman presents with heavy menstrual bleeding (HMB) and associated dysmenorrhea. She has a BMI of 33 and wishes to preserve fertility. Which initial pharmacological treatment would you recommend according to NICE guidelines?
A) Tranexamic acid
B) Combined oral contraceptive pill
C) Levonorgestrel-releasing intrauterine system (LNG-IUS)
D) Oral progestogens
E) NSAIDs
Question Hard: 👶 A 42-year-old woman in her 37th week of gestation presents with severe headaches and visual disturbances. Her blood pressure is 160/110 mmHg, and urinalysis reveals +3 proteinuria. What is the most appropriate next step in her management?
A) Administer oral antihypertensives
B) Perform immediate caesarean section
C) Admit for close monitoring and prepare for potential delivery
D) Administer magnesium sulfate
E) Induce labour
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: According to NICE guidelines, a pregnant woman who notices reduced fetal movements should be encouraged to monitor the baby’s movements. If there is no improvement, further assessment such as a CTG may be necessary. Immediate ultrasound is not indicated unless there are additional risks.
Question Medium Answer: C
Question Medium Explanation: The NICE guidelines recommend the levonorgestrel-releasing intrauterine system (LNG-IUS) as the first-line treatment for women with heavy menstrual bleeding who wish to preserve fertility. It is effective in reducing menstrual blood loss and can be used in women with a higher BMI.
Question Hard Answer: D
Question Hard Explanation: The woman’s symptoms and signs are suggestive of severe pre-eclampsia, which requires careful management to prevent complications. Magnesium sulfate is administered to prevent seizures, a serious complication of pre-eclampsia. Immediate delivery is often necessary, but ensuring seizure prevention is a critical step.
Medical fact of the day: The UK pioneered the Montgomery ruling, emphasizing informed consent where doctors must ensure patients understand potential risks associated with treatment options, especially relevant in obstetrics when discussing delivery choices and potential interventions.
Quote of the day: “In the world of healthcare, ultimately, it’s the care that heals, not just the cure.”