A 26-year-old woman visits her GP clinic with concerns about her chances of getting pregnant. She typically takes the combined contraceptive pill but missed her pills on days 2 and 3 of the first week of her current packet. On day 4, she engaged in unprotected sexual intercourse (UPSI). As a solution, you prescribe ulipristal acetate as an emergency contraceptive.
What is the appropriate time for her to resume her regular hormonal contraception?
A 29-year-old woman comes to the outpatients’ department for evaluation. She has a medical history of polycystic ovarian syndrome and has been trying to conceive for the past eight months without success. During the examination, she is found to be hirsute. Her height and weight measurements reveal a BMI of 24 kg/m². What is the best course of action for managing this patient?
A 14-year-old female presents with worries about not having started her periods yet. Her sisters all began menstruating at age 13. During the examination, it was observed that the patient is short, has not developed any secondary sexual characteristics, and has widely spaced nipples. Additionally, a systolic murmur was detected under the left clavicle. What finding is consistent with the most probable diagnosis for this patient?
A 52-year-old female visits her GP complaining of hot flashes, irritability, and a 7-month history of lighter periods that have become more irregular. The GP diagnoses her as perimenopausal and prescribes Elleste duet tablets (estradiol + norethisterone) as sequential combined HRT since she has not had a total abdominal hysterectomy. The GP discusses the potential risks with the patient. What is the most crucial risk to mention regarding the norethisterone component?
A 32-year-old woman visits her GP with complaints of left-sided pelvic pain and deep dyspareunia at 16 weeks of pregnancy. She has not experienced any vaginal bleeding, discharge, or dysuria. Her pregnancy has been uncomplicated so far, and she has a gravid uterus that is large for her gestational age. Her vital signs are stable, with a temperature of 37.1ºC, blood pressure of 110/70 mmHg, heart rate of 70 beats/min, and respiratory rate of 18 breaths/minute. She had an intrauterine system for menorrhagia before conception and has no other medical history. What is the most probable cause of her symptoms?
A 67-year-old postmenopausal woman comes to you with complaints of bloating, unintended weight loss, dyspareunia, and an elevated CA-125. What is the most appropriate term to describe the initial spread of this cancer, given the probable diagnosis?
A 16-year-old Ethiopian girl has come to the emergency department complaining of recurring urinary tract infections. During the examination, you and a chaperone observe that the girl may have undergone clitoridectomy, indicating that she may have been a victim of female genital mutilation (FGM). The girl requests antibiotics and that no one else be informed. In addition to treating the infection, what actions should you take?
A 25-year-old female presents to her GP with symptoms of vaginal candidiasis, including ‘cottage cheese’-like discharge, itching, and dyspareunia. She has had four previous presentations with similar symptoms in the past year. The patient is in good health and does not report any other symptoms. She is not taking any regular medications. What test would be most helpful in investigating a possible underlying cause for her recurrent vaginal candidiasis?
A 22-year-old female presents to her general practitioner seeking contraception. She has a past medical history of spina bifida, for which she uses a wheelchair. She has a family history of endometrial cancer, smokes 5 cigarettes a day and regularly drinks 20 units of alcohol per week. Her observations show:
Respiratory rate 18/min
Blood pressure 95/68 mmHg
Temperature 37.1ºC
Heart rate 92 bpm
Oxygen saturation 97% on room air
What would be a contraindication for starting the combined oral contraceptive pill for this patient?
A 25-year-old female visits her doctor for contraception. She has a medical history of depression and spina bifida, which requires her to use a wheelchair. Additionally, she has a family history of ovarian cancer and is a regular smoker, consuming 15 cigarettes per day. What would be a contraindication for initiating the use of the combined oral contraceptive pill (COCP) in this patient?