Question Easy:
A 30-year-old pregnant woman at 32 weeks gestation presents with swelling in her hands and feet, facial puffiness, and elevated blood pressure of 150/95 mmHg. A urine dipstick test shows a protein level of 2+. What is the most likely diagnosis? 🌸
A) Gestational hypertension
B) Pre-eclampsia
C) Chronic hypertension
D) Eclampsia
E) Hyperemesis gravidarum
Question Medium:
A 28-year-old woman presents with secondary amenorrhea. She had a miscarriage 6 months ago and underwent a dilation and curettage (D&C) procedure. Since then, her periods have not returned. Ultrasound shows intrauterine adhesions. What is the most appropriate management? 🤔
A) Combined oral contraceptive pill
B) Intrauterine device (IUD) insertion
C) Hysteroscopic adhesiolysis
D) Clomiphene citrate
E) Oral progesterone therapy
Question Hard:
A 34-year-old woman is diagnosed with endometriosis and experiences severe dysmenorrhoea. She has tried NSAIDs and the combined oral contraceptive pill with limited relief. She is keen to have children in the future. What is the next most suitable management option according to guidelines? 🌿
A) Hysterectomy
B) GnRH agonists
C) Laparoscopic excision of endometriosis
D) Danazol
E) Mirena (levonorgestrel-releasing intrauterine system)
Explanations & Answers:
Question Easy Answer:
B) Pre-eclampsia
Question Easy Explanation:
Pre-eclampsia is characterised by hypertension and significant proteinuria after 20 weeks of gestation. The presence of swelling and elevated blood pressure, along with proteinuria, are classic indicators. According to NICE guidelines, this requires monitoring and potential intervention to prevent progression to eclampsia.
Question Medium Answer:
C) Hysteroscopic adhesiolysis
Question Medium Explanation:
The woman likely has Asherman’s syndrome, which consists of intrauterine adhesions often following procedures like D&C. The recommended management is hysteroscopic adhesiolysis to remove these adhesions and restore normal uterine function, facilitating menstruation and potentially fertility.
Question Hard Answer:
C) Laparoscopic excision of endometriosis
Question Hard Explanation:
For women with endometriosis who have severe symptoms and wish to preserve fertility, laparoscopic excision of endometriosis is recommended according to NICE guidelines. It helps relieve symptoms and may potentially improve fertility outcomes compared to hormonal treatments, which prevent ovulation.
Medical fact of the day: In the UK, the mid-urethral sling procedure (MUSP) is used to treat stress urinary incontinence and has a high success rate. However, it’s important for women to discuss the benefits and risks, such as the potential for mesh-related complications, with their healthcare provider.
Quote of the day: “Every patient you care for may teach you something invaluable; embrace every opportunity to learn and grow in your practice.”