Question Easy:
A 28-year-old woman, G2P1, at 36 weeks of gestation, presents with new-onset facial and hand swelling and a headache. Her blood pressure is recorded at 165/110 mmHg. What is the most likely diagnosis?
A) Gestational diabetes
B) Pre-eclampsia
C) Urinary tract infection
D) Anaemia
E) Hyperthyroidism
Explanations & Answers:
Question Easy Answer:
B) Pre-eclampsia
Question Easy Explanation:
Pre-eclampsia is characterised by the development of hypertension and proteinuria after 20 weeks of gestation. Symptoms may include severe headaches, vision problems, and swelling of the hands and face. According to NICE guidelines, women with pre-eclampsia must be managed closely to prevent complications for both the mother and the baby.
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Question Medium:
A 33-year-old woman presents with heavy menstrual bleeding (menorrhagia) that has been progressively worsening over the past six months. She reports using double protection and soaking through her sanitary products every 2-3 hours. She has no significant past medical history and is currently not on any medication. What is the first-line management option for this patient, according to NICE guidelines?
A) Hysterectomy
B) Tranexamic acid
C) Combined oral contraceptive pill
D) NSAIDs
E) Endometrial ablation
Explanations & Answers:
Question Medium Answer:
C) Combined oral contraceptive pill
Question Medium Explanation:
According to NICE guidelines, the combined oral contraceptive (COCP) pill is often first-line for managing menorrhagia in women without contraindications. It helps regulate menstrual cycles and reduce menstrual blood loss. Tranexamic acid or NSAIDs can be considered second-line if the COCP is not suitable or effective.
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Question Hard:
A 26-year-old woman, G0P0, presents with intermittent lower abdominal pain, increased urinary frequency, and a palpable pelvic mass on examination. An ultrasound reveals a solid ovarian mass measuring 8 cm with mixed echogenicity. What is the most appropriate next step in management?
A) Laparoscopic cystectomy
B) MRI pelvis
C) Serial follow-up ultrasounds
D) CA-125 blood test
E) Empirical antibiotic therapy
Explanations & Answers:
Question Hard Answer:
D) CA-125 blood test
Question Hard Explanation:
The CA-125 blood test is a tumour marker often elevated in ovarian cancer, though it can also be elevated in benign conditions. NICE guidelines recommend this test as part of the initial workup for suspected ovarian malignancy in premenopausal women with an ovarian mass. Further management would depend on the results of this test and additional imaging such as MRI, if indicated.
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Medical fact of the day:
Endometriosis affects approximately 1 in 10 women of reproductive age in the UK and can significantly impact quality of life. Despite its prevalence, it takes on average 7.5 years from the onset of symptoms to receive a diagnosis.
Quote of the day:
“Compassion in healthcare is the thread that connects our strength with our patients’ hopes.”