21/09/2024 – Obstetrics and Gynaecology

Question Easy:
A 28-year-old woman presents to the GP with missed periods and morning sickness. A urine pregnancy test confirms she is pregnant. What is the next appropriate step in her management? 🤰💊

A) Initiate folic acid supplementation
B) Prescribe oral progesterone
C) Start combined oral contraceptive pill
D) Schedule her for an immediate ultrasound
E) Refer her to a fertility specialist

Explanations & Answers:

Question Easy Answer:
A) Initiate folic acid supplementation

Question Easy Explanation:
According to NICE guidelines, all pregnant women are advised to take folic acid supplements to reduce the risk of neural tube defects in the fetus. Oral progesterone and combined oral contraceptive pills are not appropriate in pregnancy, and an immediate ultrasound is not typically needed at this early stage unless there are specific concerns. Referral to a fertility specialist is not relevant as the woman is already pregnant.

Question Medium:
A 34-year-old woman presents to the gynaecology clinic with heavy menstrual bleeding. Her history includes three full-term pregnancies and no contraception. What is the most appropriate initial investigation? 🩸🩺

A) Endometrial biopsy
B) Pelvic ultrasound
C) Hysteroscopy
D) Transvaginal ultrasound
E) Pelvic MRI

Explanations & Answers:

Question Medium Answer:
D) Transvaginal ultrasound

Question Medium Explanation:
Transvaginal ultrasound is recommended as the first-line imaging investigation for women with heavy menstrual bleeding, as it provides detailed imagery of the endometrium and myometrium. According to NICE guidelines, it helps identify structural abnormalities such as fibroids or polyps more effectively than a pelvic ultrasound. Endometrial biopsy and hysteroscopy are more invasive and typically reserved for cases where malignancy or specific pathology is suspected. Pelvic MRI is not considered a first-line investigation in this context.

Question Hard:
A 40-year-old woman presents with post-coital bleeding and a normal cervical smear history. Speculum examination reveals an ectropion. What is the appropriate management for cervical ectropion in this case? 👩‍⚕️🔍

A) Immediate colposcopy
B) Cryotherapy
C) Reassurance and advice on avoiding irritants
D) Electrocautery
E) Referral for LLETZ procedure

Explanations & Answers:

Question Hard Answer:
C) Reassurance and advice on avoiding irritants

Question Hard Explanation:
Cervical ectropion is a common benign condition best managed with reassurance and advice. According to NICE and NHS guidance, it often resolves on its own and typically does not require invasive treatment unless symptomatic issues such as significant bleeding or pain persist. Cryotherapy and electrocautery are reserved for severe cases, while immediate colposcopy and LLETZ (Large Loop Excision of the Transformation Zone) are necessary only if there are concerning features suggestive of malignancy.

Medical fact of the day:
Did you know that the UK has one of the highest rates of caesarean sections in Europe, with nearly 1 in 4 babies delivered this way? 🏥👶

Quote of the day:
“Compassion is the language the deaf can hear and the blind can see.” 🌟