Question Easy:
A 27-year-old woman presents to the antenatal clinic for her routine 20-week ultrasound scan. The sonographer identifies a low-lying placenta, covering the internal os. What is the most appropriate management at this stage?
A) Immediate caesarean section
B) Reassess with another ultrasound at 32 weeks
C) Bed rest until delivery
D) Tocolytic therapy
E) Immediate hospital admission
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: According to NICE guidelines, if a low-lying placenta is identified at the 20-week scan, it should be reassessed with a follow-up ultrasound at around 32 weeks to determine whether it has moved. Placental coverage of the internal os at this stage does not necessitate immediate intervention.
Question Medium:
A 32-year-old woman presents with heavy menstrual bleeding lasting more than seven days each cycle. She has no other significant medical history. What is the first-line pharmacological treatment according to NICE guidelines?
A) Combined oral contraceptive pill
B) NSAIDs
C) Tranexamic acid
D) Progesterone-only pill
E) Endometrial ablation
Question Medium Answer: C
Question Medium Explanation: Tranexamic acid is considered a first-line treatment for heavy menstrual bleeding in women who do not have contraindications. NICE suggests that this antifibrinolytic agent can reduce menstrual blood loss by up to 50%, making it a practical and widely used option.
Question Hard:
A 35-year-old woman with a BMI of 32 and a history of polycystic ovary syndrome (PCOS) presents with infertility. She has tried lifestyle modifications and has been taking metformin for six months without success. According to NICE guidelines, what is the next recommended treatment step?
A) In vitro fertilisation (IVF)
B) Clomifene citrate
C) Gonadotropin injections
D) Laparoscopic ovarian drilling
E) Letrozole
Question Hard Answer: B
Question Hard Explanation: For women with PCOS and a BMI of 30 or above, clomifene citrate is recommended as the first-line pharmacological treatment for ovulation induction, as per NICE guidelines. This treatment has been shown to effectively improve ovulation rates and increase the chances of pregnancy.
Medical fact of the day: In UK obstetric practice, the use of low-dose aspirin (75-150 mg daily) is recommended by NICE for women at high risk of pre-eclampsia, starting from 12 weeks of gestation until birth. This can significantly reduce the incidence of this potentially serious condition.
Quote of the day: “Caring for others is a privilege that transforms lives, including your own. Keep shining, healthcare heroes!” 🌟