A newly registered couple comes to see you as they have been trying to have a baby for 4 months. She is 32 years old and was previously taking the oral contraceptive pill for 8 years. Her body mass index (BMI) is 27 and she is a non-smoker. She reports regular periods. He is 36 years old without medical history. His BMI 25 and he smokes five cigarettes per day.
What would you suggest next?
A 28-year-old investment banker has been experiencing challenges in getting pregnant after trying for a baby for more than a year. She and her partner have been directed to the Fertility Clinic for additional assessments by their General Practitioner.
Regarding the female reproductive system, which of the following statements is accurate?
A 48-year-old woman comes to her General Practitioner complaining of pelvic pain that has been present for 4 months and worsens during her menstrual cycle. She has never experienced painful periods before. Additionally, she has lost 7 kg in weight over the past 5 months but feels that her abdomen has become unusually distended. She denies any changes in bowel movements.
What blood tests should be ordered in primary care for this patient?
A 21-year-old woman comes to the clinic complaining of abdominal pain that started yesterday. She had her last period 2 weeks ago, and her menstrual cycle is usually regular. She has had multiple sexual partners in the past 6 months and has been experiencing deep dyspareunia lately. She has noticed an increase in vaginal discharge over the past few days, and the pain is not relieved by paracetamol. During the examination, her temperature is 37.8 °C, and she is otherwise stable within the normal range. Her abdomen is soft but tender, and a cervical exam reveals cervical excitation +++ with right adnexal tenderness and thick yellow/green discharge from the cervical os. Swabs are taken, and there is no bleeding. A urine β-HCG test is negative. What would be your next step?
A 16-year-old girl comes to her GP with a complaint of never having had a menstrual period. During the examination, the GP observes normal external female genitalia and a vagina that terminates as a blind pouch. The absence of a uterus or ovaries is palpable, and there is no growth of pubic or axillary hair. What karyotype abnormality is likely to be present in this patient?
A 17-year-old girl presents with a 48-hour history of increasing abdominal pain and vomiting.
What is the next most appropriate step in the management of this patient?
A 25-year-old woman presents with vaginal discharge. She describes it as a thin, greyish, watery discharge. It is painless and has a fishy odour.
Which is the appropriate treatment?
A 42-year-old woman presents to the Menstrual Disturbance Clinic with a complaint of abnormal pain and heavy menstrual bleeding for the past 5 years. She reports that the pain is most severe just before and during the first day of her period and that she has been passing clots. During the examination, the physician notes thickening of the uterosacral ligament and enlargement of the ovaries. Laparoscopic examination reveals the presence of ‘chocolate cysts’.
What is the probable diagnosis?
A 16-year-old girl presents to the Emergency Department accompanied by her mother. She complains of a 3-day history of right iliac fossa and suprapubic pain. She does not complain of vomiting, although she does mention that she has lost her appetite. Her bowel habit is regular and she describes no urinary symptoms. Her last menstrual period was 4 weeks ago and she should be starting her period soon. On asking, she states that she has never been sexually active.
Examination reveals suprapubic tenderness and some right iliac fossa tenderness, inferior to McBurney’s point. Her vitals are normal otherwise. Her blood test results are as follows:
Investigation Result Normal value
Haemoglobin 123 g/l 115–155 g/l
White cell count (WCC) 11.1 × 109/l 4–11 × 109/l
Platelets 290 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.3 mmol/l 3.5–5.0 mmol/l
Urea 4.5 mmol/l 2.5–6.5 mmol/l
Creatinine 35 mmol/l 50–120 mmol/l
Amylase 35 U/l < 200 U/l
LFTs Normal
Her urine dipstick shows 1+ of leukocytes, 1+ of proteins and a trace of blood, but is otherwise normal.
Which of the following tests is the next step in investigating this girl?
A 25-year-old patient is worried about her amenorrhea for the past 3 months. She has a body mass index of 33 kg/m² and severe acne. A pregnancy test came back negative. Upon testing, her results are as follows:
Investigation Result Normal value
Testosterone 3.5 nmol/l 0.21-2.98 nmol/l
Luteinizing hormone (LH) 31 u/l 3-16 u/l
Follicle-stimulating hormone (FSH) 5 u/l 2-8 u/l
What is the most probable diagnosis?