Archives: Medical Student Finals

MSFinals-1882

A 54-year-old woman presents with a 2-year history of involuntary urine leakage when she sneezes or coughs. She has also had similar incidents while exercising in the gym, which has caused significant embarrassment and now wears pads whenever she goes out.

She denies urinary urgency or frequency and opens her bladder once at night. She has no bowel-related symptoms.

Despite trying pelvic floor exercises with support from a women’s health physiotherapist for the past 6 months, she still finds the symptoms very debilitating. However, she denies feeling depressed and is keen to try further treatment, although is frightened by the prospect of surgery and would prefer alternative measures.

Urinalysis is unremarkable, and on vaginal examination, there is no evidence of pelvic organ prolapse.

What is the next most appropriate treatment?

MSFinals-1883

A 32-year-old woman visits her doctor’s office with concerns about forgetting to change her combined contraceptive patch. She has missed the deadline by 12 hours and had sex during this time. She has never missed a patch before. What guidance would you offer her?

MSFinals-1884

A 26-year-old woman presents with cyclical pelvic pain that worsens around her periods. The pain begins 3 days before the period and continues for several days after. She experiences dyspareunia and painful bowel movements. Previously, paracetamol and ibuprofen provided relief, but they are no longer effective.

During the examination, the patient exhibits generalised tenderness, a fixed and retroverted uterus, and uterosacral ligament nodules. Her BMI is 29 kg/m². She plans to start a family next year but is willing to take contraceptives if necessary.

What is the most appropriate next step in managing her condition?

MSFinals-1885

A hairy 27-year-old woman visits the medical clinic with concerns about her missing menstrual cycles. What is one of the diagnostic criteria for polycystic ovarian syndrome (PCOS)?

MSFinals-1886

A pair of individuals in their mid-thirties visit their GP seeking guidance on fertility. They have been engaging in unprotected sexual activity thrice a week for a year. The GP recommends conducting a semen analysis and measuring serum progesterone levels. What is the optimal time to measure serum progesterone levels?

MSFinals-1887

A 28-year-old woman comes to her GP complaining of not having had a period for 7 months. She stopped taking the pill 9 months ago to try to conceive. She reports having always had irregular and heavy periods, which is why she started taking the pill at 16. She admits to gaining around 4 kg recently. She took a pregnancy test yesterday, which was negative. There is no other relevant medical or family history. What is the probable cause of this patient’s symptoms?

MSFinals-1888

A 35-year-old woman comes to her GP complaining of menorrhagia. She reports that her periods have been lasting for 10 days and are very heavy. She denies any recent weight loss and her recent sexual health screening was negative. On examination, there are no abnormalities. She has completed her family and has two children. What is the initial treatment option for this patient?

MSFinals-1889

A 30-year-old woman visits her GP complaining of vaginal itching and a change in discharge. She has been experiencing thick, white discharge for the past 3 days and the itching has become unbearable today. She is sexually active with her partner and takes the combined oral contraceptive pill. She denies having a fever, abdominal pain, painful intercourse, or any new sexual partners. What is the most suitable course of action for managing the probable diagnosis?

MSFinals-1890

A 49-year-old woman presents to her doctor with complaints of hot flashes, vaginal soreness, and decreased libido. She reports that her last menstrual period was 6 months ago and suspects that she is going through menopause. The patient is interested in starting hormone replacement therapy (HRT) but is worried about the risk of developing venous thromboembolism (VTE). What is the safest HRT option for her in terms of VTE risk?

MSFinals-1891

A 29-year-old female presents to the early pregnancy assessment unit at 7 weeks gestation with heavy vaginal bleeding. An ultrasound confirms an intra-uterine miscarriage. After 14 days of expectant management, the patient returns for a follow-up appointment. She reports experiencing light vaginal bleeding and is still haemodynamically stable without signs of ectopic pregnancy. An ultrasound scan confirms an incomplete miscarriage. What would be the most suitable course of action?