A mother attends her general practice surgery with her 14-year-old daughter. She is concerned, as her daughter is yet to start menstruating and has not shown any signs of starting puberty. The mother says that her first period was around the age of 17. On examination, the general practitioner notes a lack of physical manifestations of puberty. She is not underweight.
What is the most likely cause of delayed puberty in this case?
A 16-year-old woman is admitted surgically with acute-onset lower abdominal pain. On examination, she has a tender left iliac fossa.
Which of the following is the most appropriate next test?
A 21-year-old woman was worried about the possibility of being pregnant after having unprotected sex two weeks after the end of her last menstrual cycle. She skipped her next period, and now, two months after the sexual encounter, she purchases a home pregnancy test kit.
What is the hormone in the urine that the colorimetric assay in these test kits identifies?
A 19-year-old woman visits your GP clinic with her mother to discuss contraceptive options. She reports heavy periods and prefers non-invasive methods. She also has a history of migraine with aura. What would be the most suitable option for her?
A 42-year-old woman, who has completed her family, visits the Gynaecology Clinic following the detection of abnormal cervical cytology on a cervical smear screen. A biopsy is taken from a lesion found on the ectocervix during clinical examination under anaesthesia. Further investigations and histology confirm stage 1b cervical cancer.
What treatment option would be most suitable for this patient, taking into account the stage of the cancer?
A 50-year-old woman visits the Menopause Clinic with complaints of severe vasomotor symptoms such as hot flashes and night sweats. Despite experiencing light periods, she is worried about undergoing hormone replacement therapy (HRT) due to a past deep vein thrombosis (DVT) during pregnancy 18 years ago. Although she has not required any long-term treatment since then, she is anxious about the increased risk of clotting associated with HRT. without other risk factors, what is the most suitable form of HRT for her?
A 47-year-old woman with a history of breast cancer, requiring a lumpectomy two years ago, is currently on tamoxifen therapy and presents to her follow-up clinic with her partner.
She is feeling down, has a low mood and reports difficulty sleeping due to hot flashes. She is seeking assistance in improving her mood.
What is the most appropriate course of action for this patient?
A 23-year-old woman student presents to her general practitioner (GP) with menstrual irregularity. Her last menstrual period was 5 months ago. On examination, the GP notes an increased body mass index (BMI) and coarse dark hair over her stomach. There are no other relevant findings. The GP makes a referral to a gynaecologist.
What is the most probable reason for this patient’s menstrual irregularity?
A 50-year-old obese woman presents with a gradual onset of severe hirsutism and clitoral enlargement. Her voice is deepened, and she has recently noted abnormal vaginal bleeding. Her last menses was three years ago. Her medical history is remarkable for type II diabetes mellitus diagnosed at the age of 45. She is being treated with metformin and glibenclamide. Serum androstenedione and testosterone concentrations are elevated. Ultrasound shows bilaterally enlarged, solid-appearing ovaries without cyst. A simple endometrial hyperplasia without atypia is found on biopsy.
Which one of the following is the most likely diagnosis?
A 27-year-old nulliparous woman presents to the Emergency Department with severe nausea and vomiting, as well as a 3-hour history of spotting. Her last menstrual period was approximately ten weeks ago. She denies any abdominal pain, focal neurological deficits and headaches. She has had normal cervical screening results, denies any history of sexually transmitted infections and had her Mirena® coil removed one year ago. She has been having regular unprotected sex with a new partner for the past month. Her menstrual cycle length is normally 28 days, for which her period lasts five days, without bleeding in between periods.
She reports being previously fit and well, without regular medication. She is a non-smoker and drinks heavily once a week.
On examination, her heart rate is 81 bpm, blood pressure 115/80 mmHg and temperature 37.2 °C, and her fundal height was consistent with a 16-week-old pregnancy. A bimanual examination with a speculum revealed a closed cervical os. A full blood count reveals all normal results. A human chorionic gonadotrophin (hCG) level and a vaginal ultrasound scan are also carried out in the department, which reveal the following:
Serum hCG:
Investigation Result Impression
hCG 100,295 iu/l Grossly elevated
Transvaginal ultrasound:
Comment Anteverted, enlarged uterus. No fetal parts observed. Intrauterine mass with cystic components observed
What is the most likely diagnosis for this patient?