Question Easy:
A 28-year-old woman, who is 32 weeks pregnant, presents to the antenatal clinic with complaints of itching all over her body, particularly on the palms and soles. She reports that the itching worsens at night 🌜. There are no rashes visible on examination. What is the most likely diagnosis?
A) Gestational diabetes
B) Preeclampsia
C) Intrahepatic cholestasis of pregnancy
D) Pruritic urticarial papules and plaques of pregnancy (PUPPP)
E) Allergic reaction
Explanations & Answers:
Question Easy Answer: C
Question Easy Explanation: This presentation is typical for intrahepatic cholestasis of pregnancy, which is characterised by severe pruritus, particularly on the palms and soles, and worsens at night. It is important to recognise as it can have implications for fetal outcomes. NICE guidelines recommend monitoring and managing bile acid levels and considering delivery at around 37 weeks if warranted.
Question Medium:
A 35-year-old woman presents with heavy menstrual bleeding. A transvaginal ultrasound shows an enlarged, irregularly shaped uterus, particularly at the posterior wall. She complains of dysmenorrhea and pelvic pain. What is the most likely diagnosis?
A) Endometrial hyperplasia
B) Uterine fibroids
C) Adenomyosis
D) Endometriosis
E) Polycystic ovary syndrome (PCOS)
Explanations & Answers:
Question Medium Answer: C
Question Medium Explanation: Adenomyosis is characterised by the presence of endometrial tissue within the myometrium, leading to an enlarged and irregular uterus, menorrhagia, and dysmenorrhea. It can be differentiated from fibroids, which tend to cause more defined uterine masses, through imaging features and clinical presentation as outlined in NHS guidelines.
Question Hard:
During a routine prenatal visit, a 30-year-old woman at 34 weeks gestation is found to have blood pressure reading of 155/95 mmHg. Laboratory tests reveal proteinuria (3+ on dipstick). She reports occasional headaches but no visual disturbances. What is the appropriate management step at this point?
A) Initiate labetalol treatment
B) Immediate induction of labour
C) Observe and review in one week
D) Hospital admission for monitoring and further assessment
E) Commence magnesium sulphate
Explanations & Answers:
Question Hard Answer: D
Question Hard Explanation: The clinical picture is consistent with pre-eclampsia. Hospital admission for closer monitoring and assessment is crucial to prevent complications, as outlined by NICE guidelines. Labetalol may be initiated to manage high blood pressure, but immediate induction of labour is not indicated unless there are severe symptoms or fetal distress. Magnesium sulphate is typically used as a preventative measure for eclampsia if severe features develop.
Medical fact of the day: In the UK, pre-eclampsia affects around 5-8% of pregnancies. It remains a leading cause of maternal and perinatal morbidity and mortality, prompting early recognition and management as crucial aspects of obstetric care.
Quote of the day: “Healthcare is not just a science; it’s an art of healing hearts and inspiring hope.”