Question Easy:
A 25-year-old woman presents to her GP with irregular, heavy periods over the last six months. She has no other notable medical history, and her pregnancy test is negative. What is the most appropriate first-line treatment for managing her heavy menstrual bleeding (HMB)? 🌸
A) Tranexamic acid
B) Levonorgestrel-releasing intrauterine system (LNG-IUS)
C) Combined oral contraceptive pill (COCP)
D) Non-steroidal anti-inflammatory drugs (NSAIDs)
E) Oral norethisterone
Question Medium:
A 32-year-old pregnant woman presents at 32 weeks of gestation with a BP of 148/96 mmHg, proteinuria of 2+, and mild oedema. She complains of a headache but no visual disturbances. What is the most likely diagnosis? 🤰
A) Gestational hypertension
B) Chronic hypertension
C) Preeclampsia
D) Eclampsia
E) HELLP syndrome
Question Hard:
A 44-year-old woman with a history of endometrial hyperplasia presents with postmenopausal bleeding. Her recent endometrial biopsy shows complex hyperplasia with atypia. What is the most appropriate management plan according to NICE guidelines? 👩⚕️
A) Observation and repeat biopsy in 6 months
B) Hysteroscopy and dilation and curettage
C) Total abdominal hysterectomy with bilateral salpingo-oophorectomy
D) High-dose progestogen therapy
E) Endometrial ablation
Explanations & Answers:
Question Easy Answer: B) Levonorgestrel-releasing intrauterine system (LNG-IUS)
Question Easy Explanation: The NICE guidelines recommend the use of LNG-IUS as the first-line treatment for the management of heavy menstrual bleeding in women without underlying pathology who also require contraception. It releases levonorgestrel, which reduces endometrial thickness and menstrual blood loss.
Question Medium Answer: C) Preeclampsia
Question Medium Explanation: Preeclampsia is characterised by the onset of hypertension (≥140/90 mmHg) and proteinuria after 20 weeks of gestation in a previously normotensive woman. The presence of headache indicates progression towards moderate preeclampsia. Early identification and monitoring are crucial to prevent complications.
Question Hard Answer: C) Total abdominal hysterectomy with bilateral salpingo-oophorectomy
Question Hard Explanation: In cases of endometrial hyperplasia with atypia, especially in postmenopausal women, the risk of progression to endometrial carcinoma is significant. NICE guidelines suggest surgical management with a total hysterectomy with BSO to remove the source of hormone production and the abnormal endometrial tissue.
Medical fact of the day: Did you know that around 1 in 8 women in the UK will develop breast cancer at some point in their lives? The NHS Breast Screening Programme invites women aged 50 to 71 for screening every three years to detect cancer at an early and more treatable stage.
Quote of the day: “In the tapestry of healthcare, every thread of kindness weaves strength into the fabric of life.”