Archives: Medical Student Finals

MSFinals-1976

A 29-year-old female patient visits her GP with complaints of vaginal soreness, itchiness, and discharge. During the examination, the doctor notices an inflamed vulva and thick, white, lumpy vaginal discharge. The cervix appears normal, but there is discomfort during bimanual examination. The patient has a medical history of asthma, which is well-controlled with salbutamol, and type one diabetes, and has no known allergies. What is the most suitable next step in her care, considering the most probable diagnosis?

MSFinals-1977

A 25-year-old woman visits her GP seeking advice regarding her current contraceptive method, microgynon 30. She recently went on a short trip and forgot to bring her pill pack, causing her to miss some pills. She last took a pill 76 hours ago and is uncertain about what to do next. The missed pills were from the third week of her pack, and she has not missed any other pills this month. She had unprotected sex in the past week. What guidance should you provide her?

MSFinals-1978

A 26-year-old woman visits her GP 10 days after giving birth and reports a continuous pink vaginal discharge with a foul odor. During the examination, the GP notes a pulse rate of 90 / min, a temperature of 38.2ºC, and diffuse suprapubic tenderness. The uterus feels generally tender upon vaginal examination, while the breast examination is unremarkable. The urine dipstick shows blood ++. What is the best course of action for management?

MSFinals-1979

A 27-year-old woman visits her doctor after missing her Micronor pill (progesterone-only) this morning and is uncertain about what to do. She typically takes the pill at approximately 08:30, and it is currently 10:00. What guidance should be provided?

MSFinals-1980

A 21-year-old patient who began taking desogestrel 50 hours ago reaches out to you to report that she took her second dose of medication 15 hours behind schedule yesterday and engaged in unprotected sexual activity on the same day. What is the recommended course of action?

MSFinals-1981

A 19-year-old female contacts her GP clinic with concerns about forgetting to take her combined oral contraceptive pill yesterday. She is currently in the second week of the packet and had unprotected sex the previous night. The patient is calling early in the morning, her usual pill-taking time, but has not taken today’s pill yet due to uncertainty about what to do. What guidance should be provided to this patient regarding the missed pill?

MSFinals-1982

A 26-year-old transgender male (assigned female at birth) patient presents to your clinic seeking advice on contraception. He is currently receiving testosterone therapy and is being monitored by the gender identity clinic. Although he plans to undergo surgery in the future, he has not done so yet. He is in good health overall.

During the consultation, he reveals that he is sexually active with a male partner and they do not use protection during vaginal intercourse. As he still has a uterus, he is worried about the possibility of pregnancy and wants to avoid it for the time being.

What recommendations would you provide to him?

MSFinals-1983

A young woman visits you to discuss contraception. She gave birth to a healthy baby girl through vaginal delivery nine months ago and is recovering well. To feed the baby, she uses a combination of breast milk and formula due to painful nipples. She was previously on the combined oral contraceptive pill (COCP) and wishes to resume it if possible. When asked about her menstrual cycle, she reveals that she had a period three weeks ago and has had unprotected sexual intercourse a few times since. What guidance should you provide her?

MSFinals-1984

A 42-year-old female smoker visits her GP seeking advice on contraception. She believes she has reached menopause as her last menstrual period was 15 months ago. What is the most suitable form of contraception for her?

The menopause is typically diagnosed retrospectively, 12 months after the last menstrual period. Women who experience menopause before the age of 50 require contraception for at least 2 years after their last menstrual period, while those over 50 require only 1 year of contraception. Given her age and smoking status, prescribing the combined oral contraceptive pill (COCP) for only 12 months would not be appropriate. Hormone replacement therapy (HRT) should not be used solely as a form of contraception, and barrier methods are less effective than other options. Therefore, the most suitable form of contraception for this patient would be the intrauterine system (IUS), which can be used for up to 7 years (off-licence) or 2 years after her last menstrual period.

MSFinals-1985

A 26-year-old female presents with a one day history of dysuria and urinary frequency. She was diagnosed with a simple urinary tract infection and prescribed a three day course of ciprofloxacin. She returns two weeks later with new onset vaginal discharge. A whiff test is negative and no clue cells are observed on microscopy.
What is the most probable cause of her symptoms?