Question Easy: 😊 A 28-year-old woman who is 12 weeks pregnant attends her GP surgery with symptoms of frequent urination and increased thirst. Which of the following is the most appropriate initial management step?
A) Start metformin
B) Refer for an oral glucose tolerance test (OGTT)
C) Advise on diet and exercise
D) Prescribe insulin
E) Perform a random blood glucose test
Question Medium: 🤰 A 30-year-old woman presents with prolonged heavy menstrual bleeding and dysmenorrhea. Ultrasound confirms a fibroid. What is the first-line medical treatment recommended by NICE for managing her symptoms?
A) Tranexamic acid
B) NSAIDs
C) Oral combined contraceptive pill
D) Levonorgestrel-releasing intrauterine system (LNG-IUS)
E) Hysterectomy
Question Hard: 🍼 A 35-year-old woman at 34 weeks of gestation presents with pruritus and dark urine. Her blood tests reveal markedly elevated bile acids. What is the most appropriate management option in line with NICE guidelines?
A) Prescribe chlorphenamine
B) Emergency delivery
C) Initiate ursodeoxycholic acid treatment
D) Start corticosteroids
E) Vitamin K supplementation
Explanations & Answers:
Question Easy Answer: E
Question Easy Explanation: For pregnant women who present with symptoms suggestive of diabetes, such as polyuria and polydipsia, a random blood glucose test is the first step to assess for gestational diabetes. Further testing with an OGTT might be indicated based on initial results.
Question Medium Answer: D
Question Medium Explanation: According to NICE guidelines, the levonorgestrel-releasing intrauterine system (LNG-IUS) is recommended as the first-line medical treatment for heavy menstrual bleeding, especially in the presence of fibroids, unless contraindicated.
Question Hard Answer: C
Question Hard Explanation: The presentation is suggestive of obstetric cholestasis, characterized by pruritus and elevated bile acids, which can complicate pregnancy. Understanding NICE guidelines, initiating treatment with ursodeoxycholic acid can help alleviate symptoms and reduce bile acids.
Medical fact of the day: The UK has one of the highest rates of caesarean sections in Europe, with many being performed for non-medical reasons. NICE guidelines stress the importance of informed discussions with women about the risks and benefits of elective caesarean deliveries.
Quote of the day: “In the quiet moments of medicine, let empathy be your guiding light, for it is compassion that heals as much as science.”