Clinical Management Flashcards
A 16-year-old woman presents with secondary amenorrhoea. She is healthy, with no past medical history. Her BMI is 17. What is the most appropriate initial investigation?
The answer is follicle-stimulating hormone measurement. The likely diagnosis is amenorrhoea caused by weight loss, so follicle-stimulating hormone measurements would be appropriate.
A 55-year-old woman presents to the clinic enquiring about the use of hormone replacement therapy (HRT). She had a hysterectomy 8 years ago for fibroids. She has no contraindications or other past medical history, except a strong family history of osteoporosis. Her main symptoms are hot flushes and vaginal dryness. What would be your first treatment option?
The answer is estrogen-only HRT. HRT provides the most effective method of treating climacteric hot flushes and vaginal dryness, as well as postmenopausal osteoporosis. Estrogen-only HRT is appropriate following a hysterectomy, as the risk of endometrial carcinoma is not present.
An 18-year-old woman presents to an early pregnancy unit with light vaginal bleeding after 10 weeks of amenorrhea. She had taken a pregnancy test 4 weeks ago that had tested positive. A transvaginal ultrasound scan showed an irregular gestation sac with no fetal pole. What is the likely diagnosis?
The answer is anembryonic pregnancy.
In this case, the woman is considered to be pregnant, although no embryonic tissue is present. Therefore, the most likely diagnosis is anembryonic pregnancy.
Delay in first stage of labour:
Delay in the first stage of labour is considered when there is either:
Less than 2cm of cervical dilatation in 4 hours
Slowing of progress in a multiparous women
Delay in second stage of labour:
When active pushing lasts:
2 hours in a nulliparous woman
1 hour in a multiparous woman
Delay in third stage of labour:
More than 30 minutes with active management
More than 60 minutes with physiological management
A 17-year-old woman presents to the sexual health clinic with vulval ulceration and difficulty in passing urine. She is sexually active and has had unprotected intercourse with her new boyfriend. She takes the combined oral contraceptive pill. What is the most likely diagnosis?
Herpes
What is the most common cause of PPH?
Approximately 70% of all postpartum haemorrhages are due to uterine atony.
A cardiotocograph shows type 1 variable decelerations. What is the cause of this feature?
The answer is umbilical cord compression. Variable decelerations are due to umbilical cord compression.
What causes early decelerations?
compression of the fetal head
What causes late decelerations?
fetal hypoxia that is secondary to placental insufficiency
What causes accelerations?
Fetal movements are related to accelerations.
You are asked to assess a woman who is receiving magnesium sulphate infusions for severe pre-eclampsia. They have passed only 5 ml urine in the last 2 hours. Tests demonstrate that their deep tendon reflexes are absent. What other observation should you take?
The answer is respiratory rate. This woman has signs of magnesium toxicity (absent deep tendon reflexes), which is probably secondary to renal impairment. Respiratory depression is a sign of increasing magnesium toxicity.
Polyglactin sutures are used extensively in surgical procedures, particularly to ligate vessels. What are the key features of polyglactin sutures?
Braided, absorbable and synthetic
Polyglactin sutures are used to ligate pedicles and close the uterus during a caesarean section.
A 68-year-old woman presents with two episodes of postmenopausal bleeding. She has a BMI of 23 and is otherwise healthy. An ultrasound shows that her endometrial cavity is 4 mm thick, and an endometrial pipelle sample is taken that yields a small volume of tissue. The pathology report suggests a neoplasm. What is the most likely diagnosis?
The answer is serous carcinoma. Serous carcinomas are typically seen in postmenopausal women. The development of these carcinomas is not associated with a raised BMI, diabetes or hypertension.
