Question Easy:
A 25-year-old woman presents with heavy menstrual bleeding (HMB) lasting more than 7 days and causing significant disruption to her life. She is otherwise healthy and is not on any medication. What is the first-line treatment for HMB according to NICE guidelines?
A) Tranexamic acid
B) Levonorgestrel-releasing intrauterine system (LNG-IUS)
C) Combined oral contraceptive pill
D) Non-steroidal anti-inflammatory drugs (NSAIDs)
E) Endometrial ablation
Explanations & Answers:
Question Easy Answer:
B) Levonorgestrel-releasing intrauterine system (LNG-IUS)
Question Easy Explanation:
According to NICE guidelines, the first-line treatment for heavy menstrual bleeding in most women, provided there are no contraindications and they have no preference, is the levonorgestrel-releasing intrauterine system (LNG-IUS). It is very effective and can significantly reduce menstrual blood loss.
Question Medium:
A 32-year-old pregnant woman, G2P1, presents at 28 weeks of gestation complaining of severe itching, especially on her palms and soles. On examination, there is no rash. A liver function test reveals elevated bile acids. What is the most likely diagnosis?
A) Acute fatty liver of pregnancy
B) Intrahepatic cholestasis of pregnancy (ICP)
C) PUPPP (Pruritic Urticarial Papules and Plaques of Pregnancy)
D) Herpes gestationis
E) Eczema
Explanations & Answers:
Question Medium Answer:
B) Intrahepatic cholestasis of pregnancy (ICP)
Question Medium Explanation:
Intrahepatic cholestasis of pregnancy (ICP) typically presents in the third trimester with pruritus, especially on the palms and soles, and elevated bile acids. There is usually no associated rash. It is an important diagnosis as it is linked with increased risks for the fetus, including preterm birth and stillbirth.
Question Hard:
A 29-year-old woman presents with a 6-month history of deep dyspareunia and dysmenorrhea. She has no significant past medical history. Pelvic examination reveals nodularity in the posterior fornix. What is the most likely diagnosis?
A) Endometriosis
B) Adenomyosis
C) Uterine fibroids
D) Chronic pelvic inflammatory disease (PID)
E) Ovarian cyst
Explanations & Answers:
Question Hard Answer:
A) Endometriosis
Question Hard Explanation:
Endometriosis is characterized by the presence of endometrial tissue outside the uterus, leading to symptoms such as deep dyspareunia (painful intercourse) and dysmenorrhea (painful periods). Pelvic examination findings, such as nodularity in the posterior fornix and tenderness, are suggestive of endometriosis.
Medical fact of the day:
Endometriosis affects approximately 1 in 10 women in the UK, significantly impacting their quality of life, and is a common cause of chronic pelvic pain and infertility.
Quote of the day:
“Medicine is a science of uncertainty and an art of probability. Keep learning, stay humble, and always strive for excellence. 🌟”