Question Easy:
A 32-year-old woman, 16 weeks pregnant, presents to the clinic with fever, malaise, and a rash on her face that appears like a “slapped cheek.” Which of the following is the most likely diagnosis?
A) Measles
B) Rubella
C) Erythema infectiosum
D) Roseola infantum
E) Kawasaki disease
Explanations & Answers:
Question Easy Answer:
C) Erythema infectiosum
Question Easy Explanation:
Erythema infectiosum, also known as “slapped cheek syndrome,” is caused by parvovirus B19. It commonly presents with a distinctive red rash on the face that can later spread to other parts of the body. Pregnant women need to be cautious as the infection can affect the fetus.
Question Medium:
A 28-year-old woman comes to the clinic with intermenstrual bleeding and postcoital bleeding. She has been on combined oral contraceptive pills for five years. A speculum examination reveals a friable, hyperemic lesion on the cervix. What is the most appropriate next step in management?
A) Repeat Pap smear
B) Immediate colposcopy
C) Ultrasound pelvis
D) Change oral contraceptives
E) HPV vaccination
Explanations & Answers:
Question Medium Answer:
B) Immediate colposcopy
Question Medium Explanation:
The presence of intermenstrual and postcoital bleeding with a friable cervical lesion is concerning for cervical pathology, potentially including cervical cancer. Immediate colposcopy and biopsy are warranted to assess and differentiate benign from malignant lesions, following NHS cervical screening guidelines.
Question Hard:
A 25-year-old G1P0 woman at 37 weeks’ gestation presents with severe pruritus, predominantly on the palms and soles, with no associated rash. Liver function tests reveal elevated transaminases and bile acids. Which of the following is the most appropriate intervention?
A) Cholestyramine
B) Ursodeoxycholic acid
C) Antihistamines
D) Topical steroids
E) Early induction of labor at 40 weeks
Explanations & Answers:
Question Hard Answer:
B) Ursodeoxycholic acid
Question Hard Explanation:
The woman is likely suffering from intrahepatic cholestasis of pregnancy (ICP), characterized by pruritus without rash and elevated bile acids. Ursodeoxycholic acid is the treatment of choice as it helps reduce bile acids and improves liver function tests. Early delivery may be indicated depending on the severity and gestational age, but the preference for induction of labor is usually around 37-38 weeks to prevent stillbirth, in line with NICE guidelines.
Medical fact of the day:
Did you know? Endometrial cancer is the most common gynaecological cancer in the UK. Early diagnosis is key, and abnormal uterine bleeding in postmenopausal women should always prompt further investigation.
Quote of the day:
“In the constant rush of saving lives, take a moment to breathe, for your health fuels your purpose.” 🌈