A 25-year-old woman visits her doctor to discuss contraception options. She expresses interest in using the progesterone-only pill as her preferred method of birth control. During the consultation, the doctor informs her about the potential benefits and risks of this contraceptive method, including an elevated risk of ectopic pregnancy. What other factor is known to increase the likelihood of ectopic pregnancy?
A 42-year-old woman presents with a 2-month history of irregular periods and hot flashes. She experiences a few episodes during the day but sleeps well at night. She denies any mood disturbance and is generally healthy. This is her first visit, and she refuses hormone replacement therapy (HRT) due to concerns about increased risk of endometrial cancer as reported in the media. What is the most suitable course of action?
A 14-year-old girl has had apparently normal appearance of secondary sexual characteristics, except that she has not menstruated. A pelvic examination reveals a mobile mass in her left labium major and a shallow, blind-ending vagina without a cervix, but otherwise normal female external genitalia. Ultrasound reveals no cervix, uterus or ovaries. Karyotype analysis reveals 46,XY.
What is the most likely diagnosis?
A 32-year-old woman presents with a history of oligomenorrhoea and menstrual irregularity (menses every 32–38 days). She has a body mass index (BMI) of 28 kg/m2 and is hirsute. She has short hair distributed in a male pattern of baldness.
Examination reveals brown, hyperpigmented areas in the creases of the axillae and around the neck. A glucose tolerance test is performed and shows the following:
Investigation Result Normal value
Fasting plasma glucose 4.3 mmol/l 3.5–5.5 mmol/l
2-hour oral glucose tolerance test (OGTT) plasma glucose 9.2 mmol/l
What is the most appropriate monitoring plan for this patient?
A 21-year-old woman is experiencing amenorrhoea and has been referred for further investigation by her general practitioner. Her serum levels show a follicle-stimulating hormone (FSH) of 4 u/l (women: 2-8 u/l), luteinising hormone (LH) of 12 u/l (women: 2-10 u/l), and testosterone of 3.5 mmol/l (adult women: 0.5-2.5 mmol/l). What is the most likely diagnosis?
A 20-year-old woman is brought to the Emergency Department in a septic and drowsy state. According to her friend who accompanied her, she has no significant medical history. She has been feeling unwell for the past few days, coinciding with her monthly period. Upon examination, she has a temperature of 39.1 °C, a blood pressure of 80/60 mmHg, and a pulse rate of 110 bpm. Her respiratory examination is normal, but she groans when her lower abdomen is palpated.
Based on the following investigations, which of the following is the most likely diagnosis?
Haemoglobin: 109 g/l (normal value: 115–155 g/l)
White cell count (WCC): 16.1 × 109/l (normal value: 4–11 × 109/l)
Platelets: 85 × 109/l (normal value: 150–400 × 109/l)
Sodium (Na+): 140 mmol/l (normal value: 135–145 mmol/l)
Potassium (K+): 4.9 mmol/l (normal value: 3.5–5.0 mmol/l)
Creatinine: 175 μmol/l (normal value: 50–120 µmol/l)
Lumbar puncture: No white cells or organisms seen
MSU: White cells +, red cells +
A 30-year-old woman presents to the Emergency Department (ED) with sudden onset of severe abdominal pain. She had an appendicectomy 10 years ago. She denies any recent per-vaginal (PV) bleeding and her last menstrual period was six weeks ago. On examination, she has tenderness and guarding in the right iliac fossa. She also complains of right shoulder tip pain.
Observations:
Investigation Result Normal value
Heart rate 110 beats per minute 60–100 beats per minute
Blood pressure 120/80 mmHg <120/<80 mmHg
Respiratory rate (RR) 16 breaths per minute 12–20 breaths per minute
O2 saturation 98% 94–99%
Temperature 37.2°C 36.5–37.5°C
What is the likely diagnosis?
A 35-year-old teacher visits her General Practitioner (GP) with complaints of abnormal discharge and vaginal discomfort. She also reports experiencing dyspareunia. During a speculum examination, the GP observes a curdy, white discharge covering the vaginal walls with a non-offensive odour. The GP also notes some vulval excoriations. What infection is likely causing this woman’s discharge?
A 65-year-old retired librarian presents to her General Practitioner complaining of a feeling of fullness in her vagina. She states that this feeling is present at all times. On further questioning she also has a 1-year history of urinary frequency and has been treated for urinary tract infections in two instances in the past year. She has never smoked and is teetotal.
What is the most likely diagnosis?
A 70-year-old smoker presents to the Gynaecology clinic following a general practitioner’s referral. Her presenting complaint is long-standing vulval irritation and itching. She has a past medical history of lichen sclerosus. On examination, there is an obvious growth in the vulval area. A biopsy is taken and sent for pathological analysis.
What is the most common cause of vulval carcinoma?