During your work in the Gynaecology outpatient department, you come across a 59 year old patient who has been referred to you for abnormal vaginal bleeding. The patient informs you that she underwent menopause at the age of 54. As a medical professional, you know that postmenopausal bleeding (PMB) is a common issue. What is the leading cause of PMB?
A 55-year-old woman undergoes a smear test, which reveals an ulcerated lesion on her cervix. The lesion was confirmed to be squamous cell carcinoma.
With which virus is this patient most likely infected?
A woman aged 57 presents with a unilateral ovarian cyst accompanied by a large omental metastasis. What is the preferred surgical treatment in this case?
A 32-year-old woman presents to the Emergency Department at midnight with sudden and severe lower abdominal pain. The pain is sharp and constant, with a rating of 10/10, and is spreading to her lower back. She is unable to lie still due to the pain. She is experiencing nausea but has not vomited. Her last menstrual period was two weeks ago and was normal, and her menstrual cycle is always regular.
During the examination, her blood pressure is 110/70 mmHg, pulse rate is 110 bpm, respiratory rate is 18 breaths/min, and temperature is 37.3 °C. There is tenderness in the periumbilical and right lower quadrant upon palpation. Abdominal ultrasound reveals a significant amount of free pelvic fluid.
What is the most likely organ or structure that is injured in this patient?
A 30-year-old woman comes to the Emergency Department complaining of sudden onset of right-sided iliac fossa pain, right tip shoulder pain and a scanty brown per vaginum (PV) bleed. She missed her last menstrual period which was due eight weeks ago. She has an intrauterine device (IUD) in place.
What is the most probable diagnosis?
A 32-year-old mother of two presents to her general practitioner with depression. She explains that for the last 4 months, she has been unable to leave her house or socialize with friends due to an embarrassing and uncomfortable incontinence problem.
What is the most common type of urinary incontinence in women?
A 28-year-old woman presents with a history of oligomenorrhoea and menstrual irregularity (menses every 35–45 days). She has a body mass index (BMI) of 32 kg/m2 and has had persistent acne since being a teenager.
During examination, brown, hyperpigmented areas are observed in the creases of the axillae and around the neck.
Hormone levels have been tested, as shown below:
Investigation Result Normal value
Total testosterone 7 nmol/l 0.5–3.5 nmol/l
Follicle-stimulating hormone (FSH) 15 IU/l 1–25 IU/l
Luteinising hormone (LH) 78 U/l 1–70 U/l
Which of the following ultrasound findings will confirm the diagnosis?
A 28-year-old woman with menorrhagia and dysmenorrhoea attends the clinic with her mother. She tells you that her mother has had a hysterectomy to treat menorrhagia, which found growths in the uterus. She is worried that the condition is hereditary, how this will affect her fertility and whether she is at risk of cancer.
Which of the following is most suitable for a definitive diagnosis of the condition described in this scenario?
A 25-year-old woman presents to the Emergency Department with lower abdominal pain. She also reports experiencing pain in her right shoulder. What investigation would be the most helpful in managing this patient further?
A 22-year-old law student, with a history of cyclical pelvic pain and dysmenorrhoea not responding to paracetamol is attending her follow-up appointment to receive the histology results of her diagnostic laparoscopy. She does not want to conceive at present and uses barrier methods of contraception. She has asthma, which is well controlled with inhalers but was made worse in the past when she took some painkillers.
The histology report concludes that: ‘The peritoneal deposits, submitted in their entirety, contain evidence of endometrial glands and stroma surrounded by red blood cells and a mixed chronic inflammatory cell infiltrate’. The operation notes say that all deposits seen were removed.
Which of the following is the most appropriate treatment for this patient?