A 20-year-old female comes in for a follow-up appointment. She had a Nexplanon implanted six months ago but has been experiencing light spotting on approximately 50% of days. Her medical history includes a first trimester abortion two years ago, but otherwise, she has no significant medical issues. A vaginal examination reveals no abnormalities, and she recently tested negative for sexually transmitted infections. What is the best course of action to take?
A 28-year-old lady seeks your advice on contraception. She has recently entered a new relationship and wants to protect herself against pregnancy. She is in good health, doesn’t experience migraines, and is a non-smoker. Her mother had breast cancer a decade ago, but has since been declared cancer-free. The patient has a confirmed BRCA1 gene mutation. Her BMI is 23 and her blood pressure is 124/82. Based on this information, what form of contraception would you recommend for her?
A 25-year-old woman is interested in beginning the combined oral contraceptive pill (COCP) but is concerned about the potential risk of breast cancer due to her maternal grandmother’s diagnosis in her 60s. What UK Medical Eligibility Criteria (UKMEC) should be considered for her?
A 50-year-old diabetic lady presents to you for advice on contraception. She reports having regular periods lasting 5 days, which are not heavy. She is a smoker of 10 cigarettes per day and has hypertension, which is managed with ramipril. Her most recent blood pressure reading was 120/82, and her BMI is 28. She has no history of migraines, breast cancer, or venous thromboembolism in herself or her family. She recently had a lipid check and has an upcoming appointment with another provider to discuss her dyslipidemia. What would be the safest form of contraception for her?
A 25-year-old woman presents with complaints of coarse hair on her lip, chin, chest and abdomen. She reports moderate menstrual irregularity and long periods of amenorrhoea. Upon examination, her body mass index is 40 kg/m2. What is the most probable diagnosis?
A mother comes to the clinic with her 15-year-old son and she is worried as her son’s voice has not yet deepened. Her son is also of short stature when compared to his calculated expected height.
Which one of the following should you keep in mind when evaluating him?
A 50-year-old lady presents to you seeking advice on how to manage her possible menopause. Her periods have been light and infrequent for a few years and stopped about three months ago. She has no significant medical or surgical history. Her family history doesn’t reveal any significant cardiovascular or thromboembolic disease, and she has never smoked. She has had two pregnancies, both resulting in healthy children. Currently, she feels well, and on further questioning, she reports experiencing mild flashes that are not bothersome. On examination, her blood pressure is 120/80, and her BMI is 23. What advice should you give her regarding her possible menopause?
A 35-year-old woman is experiencing constant fatigue, sadness, and tearfulness. She is also having trouble sleeping. These symptoms have been present for the past six months. The woman gave birth to her second child eight months ago and recently lost her mother, which has made things worse. Her older child is two years old. Despite having two healthy children, she has no interest in socializing, returning to work, or engaging in sexual activity. She feels guilty about not being able to snap out of it. What is the most likely diagnosis?
An 80-year-old woman is referred by a GP colleague to the hospital with a breast lump.
She is asymptomatic but her investigations reveal:
Corrected calcium 2.75 mmol/L (2.2-2.6)
Phosphate 0.81 mmol/L (0.8-1.4)
Alkaline phosphatase 115 U/L (45-105)
PTH concentration 5.7 pmol/L (0.9-5.4)
Whilst your colleague is away, you are shown these results by one of the receptionists.
What is the most likely diagnosis?
A 28-year-old woman presents to your clinic seeking emergency contraception after having unprotected sex the day before. She expresses her reluctance to use intrauterine methods and is prescribed Levonelle. Additionally, she is interested in starting a combined contraceptive pill.
What advice would you give regarding the need for supplementary contraception when initiating a combined contraceptive pill?