Question Easy:
A 30-year-old primigravida presents at 10 weeks of gestation with symptoms of nausea, vomiting, and fatigue. She is worried about the health of her baby. What is the most likely diagnosis?
A) Hyperemesis gravidarum
B) Preeclampsia
C) Gestational diabetes
D) Placenta previa
E) Morning sickness
Question Medium:
A 26-year-old woman presents with lower abdominal pain, fever, and purulent cervical discharge. Upon examination, cervical motion tenderness is noted. What is the most appropriate initial management?
A) Oral doxycycline and metronidazole
B) Intramuscular ceftriaxone and oral doxycycline
C) Immediate laparoscopy
D) Oral azithromycin and metronidazole
E) Admission for intravenous antibiotics
Question Hard:
A 34-year-old woman presents at 32 weeks of gestation with shortness of breath, chest pain, and a sense of impending doom. Her blood pressure is 90/60 mmHg, heart rate is 120 beats per minute, and oxygen saturation is 85% on room air. What is the most appropriate next step in management?
A) Administer oxygen and perform a chest X-ray
B) Administer methyldopa and reassess in 30 minutes
C) Immediate transfer to ICU
D) Administer subcutaneous terbutaline
E) Administer low molecular weight heparin and perform a CT pulmonary angiogram
Explanations & Answers:
Question Easy Answer: E
Question Easy Explanation: Morning sickness is very common in early pregnancy, typically experienced in the first trimester. It involves nausea and vomiting but is generally not harmful to the mother or baby. Hyperemesis gravidarum, which involves severe nausea and vomiting, is less common and requires medical intervention. NICE guidelines distinguish between these two conditions based on severity and treatment needs.
Question Medium Answer: B
Question Medium Explanation: The presentation is characteristic of pelvic inflammatory disease (PID). According to NHS guidelines, the recommended initial management includes intramuscular ceftriaxone and oral doxycycline, providing broad-spectrum coverage against likely causative organisms such as Neisseria gonorrhoeae and Chlamydia trachomatis. Immediate laparoscopy would be reserved for suspected complications such as tubo-ovarian abscesses.
Question Hard Answer: E
Question Hard Explanation: The symptoms described and the clinical presentation suggest a possible pulmonary embolism, which is a medical emergency. Immediate administration of low molecular weight heparin is recommended as per BNF guidelines, followed by diagnostic imaging like a CT pulmonary angiogram to confirm the diagnosis. This is crucial to prevent maternal morbidity and mortality.
Medical fact of the day: In the UK, every pregnant woman is offered an ultrasound scan at around 20 weeks of pregnancy to check for structural abnormalities in the fetus, a policy which significantly reduces the rates of undiagnosed congenital conditions.
Quote of the day: “In the heart of healing lies the dedication of those who choose to care beyond the boundaries of comfort. Keep pushing forward, for every life you touch.”