Question Easy:
A 26-year-old woman is 36 weeks pregnant. She presents with itching on her palms and soles. Her liver function tests reveal elevated bile acids. What is the most likely diagnosis? 🩺
A) Intrahepatic cholestasis of pregnancy
B) Preeclampsia
C) Acute fatty liver of pregnancy
D) Obstetric cholestasis
E) Gestational diabetes
Explanations & Answers:
Question Easy Answer: A) Intrahepatic cholestasis of pregnancy
Question Easy Explanation: Intrahepatic cholestasis of pregnancy (ICP) is characterised by pruritus, often on the palms and soles, and elevated serum bile acids. It usually presents in the third trimester. According to NICE guidelines, ICP must be considered in pregnant women with pruritus and abnormal liver function. The condition requires monitoring and management to prevent potential complications to the fetus.
Question Medium:
A 32-year-old woman presents with irregular menstrual bleeding. An ultrasound scan reveals numerous small cysts on the ovaries. Which of the following is the first-line treatment to regulate her menstrual cycle if she is not trying to conceive? 🏥
A) Metformin
B) Clomifene citrate
C) Ethinylestradiol and cyproterone acetate
D) Levonorgestrel-releasing intrauterine system
E) Combined oral contraceptive pill
Question Medium Answer: E) Combined oral contraceptive pill
Question Medium Explanation: The combined oral contraceptive pill (COCP) is the first-line treatment to regulate menstrual cycles in women with polycystic ovary syndrome (PCOS) who are not planning to conceive. It helps to regulate periods, protect the endometrium, and control symptoms like acne and hirsutism. This recommendation aligns with NICE guidelines for managing PCOS.
Question Hard:
A 45-year-old woman presents with heavy menstrual bleeding and pressure symptoms without significant dysmenorrhea. Examination reveals an enlarged, irregular uterus. Which imaging modality is most appropriate for further investigation? 🔬
A) MRI pelvis
B) CT abdomen and pelvis
C) Transvaginal ultrasound
D) Hysteroscopy
E) Plain abdominal X-ray
Question Hard Answer: C) Transvaginal ultrasound
Question Hard Explanation: Transvaginal ultrasound is the preferred imaging modality for women with symptoms suggestive of uterine fibroids, as it provides excellent images of the uterus and its pathological changes. It is non-invasive and can confirm the presence, size, and location of fibroids, which aligns with NICE and NHS guidelines for investigating heavy menstrual bleeding.
Medical fact of the day: Did you know that the risk of developing gestational diabetes in the UK is higher among women of South Asian, Black, and Middle Eastern descent compared to those of European descent? This highlights the importance of tailored screening and management strategies in diverse populations.
Quote of the day: “Empathy is the heartbeat of healthcare, turning compassion into care and knowledge into healing.” 🌟