Question Easy:
A 25-year-old woman presents to the clinic with symptoms of dysuria, increased urinary frequency, and suprapubic pain. She also notes discomfort during intercourse. A urine dipstick test shows leukocytes and nitrites. What is the most likely diagnosis? 🚺
A) Bacterial vaginosis
B) Cystitis
C) Pelvic inflammatory disease
D) Endometriosis
E) Urinary tract infection
Question Medium:
A 32-year-old woman comes in concerned about her menstrual cycle. She experiences heavy menstrual bleeding, with each cycle lasting around 7 days. Recently, she has been feeling dizzy and fatigued. Laboratory tests reveal a haemoglobin level of 10 g/dL. What would be the most appropriate first line of treatment in managing her heavy menstrual bleeding according to NICE guidelines? 💊
A) Tranexamic acid
B) Combined oral contraceptive pill
C) Iron supplements
D) Mirena coil (levonorgestrel-releasing intrauterine system)
E) Oral progesterone
Question Hard:
A 29-year-old pregnant woman is at 36 weeks of gestation with her first child. During a routine antenatal visit, her blood pressure is recorded at 160/110 mmHg, and she presents with proteinuria (+++). She complains of persistent headache, visual disturbances, and epigastric pain. What is the immediate treatment of choice in this situation? 🚨
A) Methyldopa
B) Labetalol
C) Nifedipine
D) Hydralazine
E) Magnesium sulphate
Explanations & Answers:
Question Easy Answer: E) Urinary tract infection
Question Easy Explanation: The symptoms and positive urine dipstick test indicate a urinary tract infection. A UTI is characterised by dysuria, increased frequency, and suprapubic pain, and the presence of nitrites and leukocytes on a dipstick test is highly suggestive. Cystitis is a form of UTI, and although B) is a possible option, E) is more encompassing.
Question Medium Answer: D) Mirena coil (levonorgestrel-releasing intrauterine system)
Question Medium Explanation: According to NICE guidelines, the levonorgestrel-releasing intrauterine system (LNG-IUS), such as the Mirena coil, is recommended as the first-line treatment for managing heavy menstrual bleeding when no underlying pathology is identified. It reduces menstrual blood loss effectively and is often preferred over oral medications like tranexamic acid or hormonal treatments in cases without contraindications.
Question Hard Answer: E) Magnesium sulphate
Question Hard Explanation: In the context of severe pre-eclampsia, which is suggested by the high blood pressure, proteinuria, headaches, visual disturbances, and epigastric pain, the immediate concern is the prevention of seizures. Magnesium sulphate is the drug of choice for the prevention and treatment of eclamptic seizures. Antihypertensive treatment such as labetalol (B) may be used subsequently to manage blood pressure, but the immediate priority is seizure prophylaxis.
Medical fact of the day: In the UK, around 1 in 3 women will have surgery to repair a pelvic organ prolapse (POP) during their lifetime. The risk increases with age and multiplies with vaginal childbirth, which can weaken the pelvic floor muscles.
Quote of the day: “Every challenge in medicine is an opportunity to grow, learn, and teach. Remember, your compassion is the one prescription your patients will never forget.”