Question Easy: A 28-year-old woman presents to her GP with concerns about her menstrual cycle. She reports that her periods have been irregular and sometimes very heavy. She is not currently using any form of contraception and is sexually active. What is the first-line treatment for managing heavy menstrual bleeding according to NICE guidelines?
A) Tranexamic acid
B) Combined oral contraceptive pill
C) Non-steroidal anti-inflammatory drugs
D) Oral progesterone
E) Levonorgestrel-releasing intrauterine system (LNG-IUS)
Question Medium: A 32-year-old woman, who is 18 weeks pregnant, is admitted to the obstetric unit with severe lower abdominal pain and fresh vaginal bleeding. Ultrasound scan shows a low-lying placenta covering the internal os. What is the most appropriate next step in management?
A) Emergency caesarean section
B) Bed rest and monitoring
C) Blood transfusion
D) Administer anti-D immunoglobulin if Rh-negative
E) Immediate induction of labour
Question Hard: A 45-year-old woman presents to the gynaecology clinic with a 4-month history of post-coital bleeding. She leads a healthy lifestyle, has had regular cervical screenings, and there were no significant findings in her latest test. On examination, there is an erosion on the cervix. Besides cervical cancer, what is the most likely diagnosis?
A) Cervical ectropion
B) Endometriosis
C) Uterine fibroids
D) Polycystic ovary syndrome
E) Pelvic inflammatory disease
Explanations & Answers:
Question Easy Answer: E
Question Easy Explanation: The first-line treatment for heavy menstrual bleeding, as per NICE guidelines, is the levonorgestrel-releasing intrauterine system (LNG-IUS). It’s highly effective in reducing menstrual blood loss and is beneficial for long-term use.
Question Medium Answer: D
Question Medium Explanation: In the case of placenta praevia, it is important to administer anti-D immunoglobulin if the mother is Rh-negative to prevent Rh sensitization. This is crucial unless the patient is already sensitized, or the father is known to be Rh-negative. Further management would depend on the gestational age and the severity of bleeding.
Question Hard Answer: A
Question Hard Explanation: Cervical ectropion, also known as cervical erosion, occurs when the glandular cells that line the inside of the cervical canal spread to the outer surface of the cervix. It is a common and benign condition, often associated with post-coital bleeding, especially in women taking hormonal contraceptives or during times of hormonal change.
Medical fact of the day: Did you know that the UK has one of the lowest maternal mortality rates globally? This is largely due to the comprehensive antenatal care system which ensures early diagnosis and management of potential complications.
Quote of the day: “In the heart of every patient lies the story of resilience. As healthcare workers, we not only heal, but we illuminate the path to hope and recovery.”