Question Easy:
A 25-year-old woman is in her third trimester of pregnancy and presents to the antenatal clinic concerned about pain and swelling in her left lower leg. On examination, the leg is tender and warm to touch. What is the most appropriate investigation to confirm a diagnosis of deep vein thrombosis (DVT) during pregnancy? 🦵
A) D-dimer
B) Doppler ultrasound
C) CT pulmonary angiography
D) MRI
E) Chest X-ray
Question Medium:
A 32-year-old woman presents with excessive bleeding during her periods, lasting longer than seven days. She has just been diagnosed with fibroids. What is the recommended first-line medical treatment to manage her heavy menstrual bleeding according to NICE guidelines?
A) Tranexamic acid
B) Levonorgestrel-releasing intrauterine system (LNG-IUS)
C) Combined oral contraceptives
D) Nonsteroidal anti-inflammatory drugs (NSAIDs)
E) Oral progesterone
Question Hard:
A 45-year-old woman with a history of endometriosis is experiencing persistent pelvic pain. After attempts at hormonal therapy fail, her consultant offers her a surgical option to manage her symptoms. Which surgical intervention is most appropriate for definitive management of severe endometriosis causing chronic pain?
A) Laparoscopic excision of endometriosis
B) Hysterectomy with ovarian conservation
C) Bilateral salpingo-oophorectomy
D) Hysterectomy with bilateral salpingo-oophorectomy
E) Presacral neurectomy
Explanations & Answers:
Question Easy Answer: B) Doppler ultrasound
Question Easy Explanation: Doppler ultrasound is the investigation of choice to confirm a diagnosis of DVT in pregnancy. It is non-invasive, safe for both the mother and the unborn child, and provides reliable diagnostic information by visualizing the flow of blood through the veins.
Question Medium Answer: B) Levonorgestrel-releasing intrauterine system (LNG-IUS)
Question Medium Explanation: The LNG-IUS is recommended by NICE as the first-line choice for medical management of heavy menstrual bleeding in women, including those with fibroids, unless contraindicated. It releases levonorgestrel locally to reduce menstrual bleeding.
Question Hard Answer: D) Hysterectomy with bilateral salpingo-oophorectomy
Question Hard Explanation: For women with severe endometriosis and chronic pain unresponsive to medical management, a hysterectomy with bilateral salpingo-oophorectomy is considered the definitive surgical treatment. This procedure removes both the uterus and ovaries, thereby eliminating the hormonal sources driving endometriosis. However, it is only considered in women who have completed their family and after thorough counselling.
Medical fact of the day: Did you know that the UK sees approximately 1 in 7 couples experiencing difficulty in conceiving? This affects an estimated 3.5 million people in the UK, highlighting the importance of accessible and comprehensive fertility services.
Quote of the day: “In the tapestry of care, each thread of compassion weaves healing into the fabric of hope.”