Question Easy:
A 27-year-old primigravida at 28 weeks gestation presents with complaints of difficulty sleeping, back pain, and mild swelling in her feet. Which of the following is a normal physiological change in pregnancy that is likely contributing to her symptoms?
A) Increased cardiac output
B) Decreased renal function
C) Decreased blood volume
D) Hyperparathyroidism
E) Increased gastric motility
Explanations & Answers:
Question Easy Answer: A)
Question Easy Explanation: Increased cardiac output is a normal physiological change in pregnancy, occurring to meet the increased metabolic demands of both the mother and the developing fetus. This can contribute to symptoms such as difficulty sleeping and mild swelling in the feet. Decreased renal function and blood volume are not normal in pregnancy. Hyperparathyroidism and increased gastric motility are also incorrect. This aligns with NICE guidelines on normal pregnancy changes.
Question Medium:
A 32-year-old woman presents with heavy menstrual bleeding for the past six months, which has been affecting her quality of life. She has a history of hypothyroidism, managed well with levothyroxine. Her pelvic examination is unremarkable, and her thyroid function tests are normal. What is the next most appropriate management step?
A) Endometrial biopsy
B) Levonorgestrel intrauterine system (LNG-IUS)
C) Oral iron supplementation
D) Hysterectomy
E) Combined oral contraceptive pill
Question Medium Answer: B)
Question Medium Explanation: The levonorgestrel intrauterine system (LNG-IUS) is recommended by NICE as a first-line treatment for heavy menstrual bleeding when there are no contraindications. It is highly effective and can also serve as contraception. Endometrial biopsy is indicated if there’s suspicion of endometrial pathology, which seems unlikely given the unremarkable examination. Oral iron supplementation could address anemia but does not treat the underlying issue. Hysterectomy is a last resort, and the combined oral contraceptive pill may not be the first choice, especially considering her hypothyroidism.
Question Hard:
A 40-year-old woman with a BMI of 32 presents with irregular periods and hirsutism. On examination, she has acanthosis nigricans. Laboratory investigations show elevated serum testosterone and LH:FSH ratio > 2. What is the most appropriate initial management for her condition?
A) Spironolactone
B) Metformin
C) Lifestyle modifications
D) Clomiphene citrate
E) Ovarian drilling
Question Hard Answer: C)
Question Hard Explanation: Lifestyle modifications, including weight loss through diet and exercise, are the first-line management recommended by NICE for women with PCOS (Polycystic Ovary Syndrome), especially those with obesity. Metformin can also be considered, particularly for managing insulin resistance, but initial management focuses on lifestyle. Spironolactone can be used for hirsutism but is not the first-line therapy. Clomiphene citrate and ovarian drilling are usually reserved for infertility management and not the first steps in managing PCOS.
Medical fact of the day: The UK’s National Institute for Health and Care Excellence (NICE) recommends the use of the levonorgestrel-releasing intrauterine system (LNG-IUS) as a first-line treatment for heavy menstrual bleeding, which can decrease menstrual blood loss by up to 90%.
Quote of the day: “In the heart of medicine lies a blend of science and compassion—healing hands guided by noble aims.”