Question Easy:
A 32-year-old woman in her first pregnancy attends her 36-week antenatal appointment. She reports feeling well but mentions noticing her feet are a bit swollen by the end of the day. All routine observations are within normal limits. What is the most likely cause of her symptoms? 🌸
A) Pre-eclampsia
B) Deep vein thrombosis
C) Physiological changes in late pregnancy
D) Fetal macrosomia
E) Gestational diabetes
Question Medium:
A 28-year-old woman presents to the A&E with severe lower abdominal pain and vaginal bleeding. She is 8 weeks pregnant and has a history of pelvic inflammatory disease. On examination, she has cervical motion tenderness and a positive urine pregnancy test. What is the most likely diagnosis?
A) Miscarriage
B) Ectopic pregnancy
C) Ovarian torsion
D) Appendicitis
E) Endometriosis
Question Hard:
A 45-year-old woman visits the GP with irregular menstrual bleeding. She is obese, has hypertension, and a family history of endometrial cancer. What is the most appropriate next step in management according to current guidelines?
A) Start metformin therapy
B) Initiate oral contraceptive pills
C) Reassurance and watchful waiting
D) Endometrial biopsy
E) Ultrasound scan
Explanations & Answers:
Question Easy Answer: C) Physiological changes in late pregnancy
Question Easy Explanation: Mild to moderate lower limb oedema is a common physiological change during late pregnancy due to increased blood volume and pressure from the growing uterus, which can impede venous return.
Question Medium Answer: B) Ectopic pregnancy
Question Medium Explanation: The combination of severe abdominal pain, vaginal bleeding, a positive pregnancy test, and history of pelvic inflammatory disease raises high suspicion for an ectopic pregnancy, which requires urgent management.
Question Hard Answer: D) Endometrial biopsy
Question Hard Explanation: Given the risk factors of obesity, hypertension, and family history, an endometrial biopsy is necessary to rule out endometrial hyperplasia or carcinoma as the cause of irregular bleeding, in line with NICE guidelines.
Medical fact of the day: Did you know that the UK’s NHS offers midwife-led birth centres as an alternative to traditional hospital births for women with low-risk pregnancies? These centres promote a more homely environment and are becoming an increasingly popular choice for expectant mothers.
Quote of the day: “The art of medicine consists of amusing the patient while nature cures the disease.”