KFP – Women’s health

Anna Green, aged 36, presents to your clinic with heavy, painful periods that have progressively worsened over the past 12 months. Her periods now last up to 8 days with flooding on days 2–4, requiring her to change super-absorbency pads hourly. She also reports deep dyspareunia and increasing pelvic pain unrelated to her cycle. She and her partner have been trying to conceive for the past 18 months without success.

Medications: Ibuprofen as needed for period pain

Allergies: Nil known

Past history: Appendicectomy aged 14

Family history: Mother had hysterectomy at age 42 for heavy periods

Social history: Non-smoker, occasional alcohol. Works full time as a school teacher

Examination findings: BMI 24. Bimanual examination reveals a tender, fixed retroverted uterus with nodularity in the posterior fornix

Investigations: Transvaginal ultrasound shows a retroverted uterus with a 3.5 cm heterogeneous lesion in the posterior myometrium. Both ovaries are visualised and appear normal

What is the most likely diagnosis and what are the most appropriate next steps in management? Select four (4) from the following list:

Emily Tran, a 27-year-old nulliparous woman, presents to your general practice clinic for contraceptive advice. She has been in a stable relationship for two years and does not wish to conceive for at least five years. She has a history of migraines without aura, occurring monthly around the time of her menses. Her periods are regular, every 28–30 days, lasting five days with moderate flow and mild dysmenorrhoea. She is a non-smoker and has no other significant medical history. Her BMI is 22. She takes paracetamol occasionally for migraines but no regular medications.

Past history: Nil significant

Family history: Mother had a DVT at age 50 following surgery

Social history: Works as a marketing manager; lives with her partner; no smoking, minimal alcohol

Examination findings: Normal pelvic examination

What are the most appropriate contraceptive options for Emily? Select three (3) from the following list:

Julia Sanderson, a 52-year-old woman, presents with a 6-month history of irregular per vaginal bleeding, including one episode of heavy bleeding with clots three weeks ago. She is otherwise well and has no menopausal symptoms. Her last cervical screening test was normal two years ago. She has not used any hormonal contraception for over 10 years and has no significant past medical history. There is no history of breast or ovarian cancer in the family.

Medications: Nil

Allergies: Nil known

Social history: Lives with her husband; no children. Non-smoker, drinks socially

Examination findings: BMI 28. Abdomen soft, non-tender. Bimanual exam shows a bulky but non-tender uterus. No adnexal masses palpable. Cervix appears normal

Investigations: FBC normal; transvaginal ultrasound shows endometrial thickness of 9 mm

What are the most appropriate next steps in Julia’s management? Select three (3) from the following list:

Aisha Mohamed, a 30-year-old G2P1 at 37+4 weeks gestation, presents to your rural general practice clinic complaining of a 24-hour history of reduced fetal movements. Her first pregnancy was uncomplicated and resulted in a spontaneous vaginal delivery at term. She reports no contractions, vaginal bleeding, or leakage of fluid. She is otherwise well and has had an uncomplicated antenatal course.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Social history: Lives with husband and 3-year-old son. Non-smoker. No alcohol. Lives 2.5 hours from nearest regional hospital with birthing facilities

Examination findings: BP 110/70 mmHg, HR 82 bpm, afebrile. Fundal height 37 cm. Fetal heart auscultated with Doppler at 132 bpm. Abdomen soft, non-tender. Cephalic presentation. No uterine activity

Investigations: CTG not available on site. You have access to handheld Doppler and basic ultrasound for fetal cardiac activity and amniotic fluid estimation

What are the most appropriate next steps in Aisha’s management? Select four (4) from the following list:

Rachel Lin, a 42-year-old woman, presents to discuss ongoing vasomotor symptoms including hot flushes and night sweats. These have persisted for over 12 months and significantly disrupt her sleep and daily functioning. Her last menstrual period was 15 months ago. She has no history of thromboembolic disease, cardiovascular disease, or breast cancer. She does not smoke and drinks occasionally. She is keen to explore treatment options and asks specifically about hormone therapy.

Past history: Iron deficiency anaemia, now resolved

Family history: Mother developed osteoporosis in her 60s

Social history: Married with two children, works in office administration

Examination findings: BMI 25, BP 128/82 mmHg, general examination unremarkable

Investigations: FBE, LFTs, and lipids are normal. DEXA scan shows osteopenia (T-score −1.9 at lumbar spine)

What are the most appropriate next steps in Rachel’s management? Select four (4) from the following list:

Amrita Singh, a 24-year-old woman, presents for review of her cervical screening test results. She is asymptomatic and attended for her first routine test two weeks ago. She is sexually active with one male partner, uses condoms inconsistently, and has no previous screening history. She does not smoke and is otherwise well.

Investigation results: Cervical screening test: High-risk HPV (type 16) detected; reflex liquid-based cytology shows low-grade squamous intraepithelial lesion (LSIL)

What are the most appropriate next steps in Amrita’s management? Select three (3) from the following list:

Sarah O’Donnell, a 34-year-old woman, presents with a positive home pregnancy test. She is unsure of her exact dates but believes her last menstrual period was about seven weeks ago. This is her first pregnancy. She has been feeling well but reports some nausea and breast tenderness. She is taking folic acid and iodine supplements.

Past history: Nil significant

Social history: Lives with her partner, works as a graphic designer, non-smoker, no alcohol use since planning pregnancy

Examination findings: BP 110/70 mmHg, HR 78 bpm. Abdomen soft, non-tender. No vaginal bleeding or pain

Investigations: Urine pregnancy test confirmed in clinic. No imaging or bloods yet performed

What are the most appropriate next steps in Sarah’s antenatal care? Select four (4) from the following list:

Leila Haddad, a 29-year-old woman, presents with vulvar irritation and a thick, white vaginal discharge for the past five days. She reports vaginal itch and discomfort but no offensive odour. She denies dysuria or systemic symptoms. Her last menstrual period was two weeks ago and she is sexually active with her husband. She has had similar episodes in the past, especially after antibiotic use. She is otherwise well.

Past history: Recurrent vaginal candidiasis (diagnosed previously by swab)

Medications: Nil currently

Social history: Non-smoker, no recent travel, monogamous relationship

Examination findings: Vulva erythematous with excoriations. Thick, white, adherent discharge on vaginal walls. No cervical discharge or tenderness. No ulcers or vesicles

What are the most appropriate next steps in Leila’s management? Select three (3) from the following list:

Helen Bradbury, a 48-year-old perimenopausal woman, presents with worsening premenstrual symptoms including irritability, breast tenderness, abdominal bloating, and low mood in the week prior to her periods. These symptoms resolve within 2 days of menstruation commencing. Her cycles remain regular every 28–30 days. She is otherwise well and not on any medications. She does not wish to use hormonal contraception. She asks if anything can help her symptoms.

Past history: Nil significant

Family history: Mother with history of depression and breast cancer (postmenopausal, age 67)

Social history: Married, two teenage children, works full-time as a pharmacist. No smoking, minimal alcohol use

Examination findings: Normal BMI. Breast exam and pelvic exam normal

What are the most appropriate management options for Helen? Select three (3) from the following list:

Fatima Noor, a 38-year-old woman, presents with pelvic pain and difficulty conceiving. She has been trying to fall pregnant for over 18 months. Her cycles are regular, every 30 days, but she reports deep dyspareunia and increasing dysmenorrhoea over the past year. She has no previous pregnancies. She underwent a laparoscopy 4 years ago for ovarian cysts. Her BMI is 26 and she is otherwise well.

Medications: Nil

Past history: Laparoscopic cystectomy (benign endometrioma)

Social history: Married, no smoking or alcohol, works as a schoolteacher

Examination findings: Bimanual exam reveals a retroverted uterus with tenderness in the posterior fornix

Investigations: Day 21 progesterone confirms ovulation. Partner’s semen analysis is normal. Transvaginal ultrasound shows bilateral ovarian endometriomas (3 cm each)

What are the most appropriate next steps in her management? Select three (3) from the following list:

Emily Watson, a 19-year-old university student, presents for emergency contraception after unprotected intercourse 36 hours ago. She is otherwise healthy, not on any medications, and does not use regular contraception. Her last menstrual period was 10 days ago and is typically regular. She has no history of STI, pelvic surgery, or allergies. She is worried and seeks immediate advice.

Past history: Nil significant

Social history: Lives in student accommodation. Non-smoker, drinks alcohol occasionally. Sexually active with one partner. No current plans for pregnancy

Examination: Not required unless symptoms or concerns present. She reports no pain, discharge, or bleeding

What are the most appropriate next steps in Emily’s care? Select three (3) from the following list:

Jessica Moore, a 31-year-old woman, presents at 9 weeks gestation with her second pregnancy. She reports no vaginal bleeding or pain. Her previous pregnancy ended in miscarriage at 10 weeks. She is anxious and seeks reassurance that this pregnancy is progressing normally. She has not yet had any antenatal care in this pregnancy.

Past history: First trimester miscarriage 2 years ago. No other significant medical history

Medications: Prenatal vitamins

Social history: Lives with her partner, non-smoker, no alcohol

Examination: Vitals normal. Abdomen soft, non-tender. No bleeding or discharge on speculum exam

What are the most appropriate next steps in Jessica’s care? Select three (3) from the following list:

Clare Nguyen, a 41-year-old woman, presents with a three-month history of new-onset postcoital bleeding. Her last menstrual period was two weeks ago and her cycles are regular. She denies intermenstrual bleeding or pelvic pain. She has two children and is not currently sexually active aside from one new partner in the last four months. She had her last cervical screening test five years ago.

Past history: Vaginal deliveries × 2; nil gynaecological history

Medications: None

Social history: Works as a physiotherapist; non-smoker; drinks socially

Examination findings: Cervix appears erythematous with contact bleeding. No visible masses or ulcers. Bimanual exam reveals no adnexal masses or tenderness. Uterus normal in size

What are the most appropriate next steps in Clare’s care? Select three (3) from the following list:

Mary Ibrahim, a 45-year-old woman, presents with worsening urinary urgency, frequency, and occasional incontinence. She describes leaking urine when rushing to the toilet, but not with coughing or sneezing. These symptoms have gradually worsened over the past year. She has three children, all delivered vaginally. Her last cervical screening test was normal 2 years ago. She has no dysuria, haematuria, or pelvic pain.

Past history: Nil significant

Medications: None

Social history: Works in retail. Non-smoker. BMI 32

Examination findings: Abdomen soft, non-tender. No pelvic organ prolapse on bimanual exam. No stress leakage observed on coughing. Bladder not palpable. Post-void bladder scan: residual volume 30 mL

What are the most appropriate next steps in Mary’s management? Select three (3) from the following list:

Olivia Martin, a 32-year-old G3P1, presents at 30+2 weeks gestation with a 3-day history of pruritus, particularly affecting her palms and soles. She denies rash, fever, or systemic symptoms. She has felt normal fetal movements and no contractions. Her previous pregnancy was uncomplicated. She is otherwise well and takes only pregnancy multivitamins.

Past history: Nil significant

Medications: Elevit

Social history: Non-smoker, lives with partner and toddler

Examination: Normal BP 122/76 mmHg, no rash, uterus non-tender, fetal heart rate 142 bpm

What are the most appropriate next steps in her management? Select three (3) from the following list:

Angela Rossi, a 26-year-old woman, presents with a 2-week history of abnormal vaginal bleeding and a positive urine pregnancy test. She is unsure of her last menstrual period but estimates being around 8 weeks pregnant. She reports intermittent lower abdominal cramping and occasional light spotting. She denies shoulder pain, fever, or heavy bleeding. This is her first pregnancy. She is not using any contraception and has no history of sexually transmitted infections.

Past history: Nil significant

Medications: Nil

Social history: Non-smoker, lives with partner

Examination: Vitals stable. Abdomen soft with mild suprapubic tenderness. Speculum exam: small amount of old blood in the vault, closed cervical os

Investigations: Urine pregnancy test positive. No ultrasound or bloods yet performed

What are the most appropriate next steps in Angela’s care? Select three (3) from the following list:

Fiona Adams, a 35-year-old G4P3 woman, presents for contraceptive counselling six weeks after giving birth to her third child. She is fully breastfeeding and has not yet resumed menstruation. She and her partner are not planning any more children. She would prefer a long-term, low-maintenance option and is open to a procedure if needed.

Past history: Three normal vaginal deliveries, no complications. No other medical issues

Medications: Nil

Social history: Non-smoker, lives with partner and children

Examination: Routine postpartum exam normal. No concerns noted

What are the most appropriate contraceptive options for Fiona? Select three (3) from the following list:

Fiona Adams, a 35-year-old G4P3 woman, presents for contraceptive counselling six weeks after giving birth to her third child. She is fully breastfeeding and has not yet resumed menstruation. She and her partner are not planning any more children. She would prefer a long-term, low-maintenance option and is open to a procedure if needed.

Past history: Three normal vaginal deliveries, no complications. No other medical issues

Medications: Nil

Social history: Non-smoker, lives with partner and children

Examination: Routine postpartum exam normal. No concerns noted

What are the most appropriate contraceptive options for Fiona? Select three (3) from the following list:

Katherine Brooks, a 50-year-old woman, presents with a 6-month history of postmenopausal bleeding. She reached menopause at age 48 and has had no bleeding since until recently. She describes several episodes of light vaginal bleeding, not associated with pain or other symptoms. She is otherwise well, takes no medications, and has no significant family history of cancer.

Past history: Nil significant

Medications: None

Social history: Lives with husband, non-smoker, BMI 29

Examination: Normal vitals. Speculum exam: atrophic vaginal mucosa, small amount of blood in vault. Cervix appears normal. Bimanual exam: uterus small, non-tender

What are the most appropriate next steps in Katherine’s management? Select three (3) from the following list:

Lucy Tran, a 17-year-old high school student, presents with concern about her lack of menstruation. She reports that she has never had a period. She is otherwise well and active in school sports. Her weight is appropriate for her height (BMI 21). She has normal secondary sexual characteristics including breast development and pubic hair. She denies any pelvic pain or systemic symptoms. She is not sexually active.

Past history: Nil

Medications: Nil

Family history: Mother had menarche at age 13

Social history: Lives with parents, non-smoker, no alcohol or drug use

Examination: Tanner stage V breast and pubic hair. External genitalia normal. No hirsutism or acne. Abdomen soft, no palpable masses

What are the most appropriate next steps in Lucy’s management? Select three (3) from the following list:

Joanna Ellis, a 33-year-old woman, presents at 12 weeks gestation (G2P1) requesting guidance on genetic screening options. She had a healthy first pregnancy and no known family history of genetic conditions. She is otherwise well and has commenced routine antenatal care. She is unsure about the differences between the available tests and wants to understand what’s right for her.

Past history: Uncomplicated first pregnancy with spontaneous vaginal delivery

Medications: Prenatal multivitamin with folate and iodine

Social history: Lives with partner, non-smoker, no alcohol since conception

Examination: BP 118/70 mmHg, BMI 23. Abdomen consistent with gestational age

What are the most appropriate next steps in Joanna’s care? Select three (3) from the following list:

Eliza Grant, a 36-year-old woman, presents with nipple discharge from the left breast for the past three weeks. She describes spontaneous clear-yellow discharge from a single duct. There is no associated mass, pain, or skin change. She is not pregnant or breastfeeding. Her last mammogram was 18 months ago and was normal. She has no personal or family history of breast cancer.

Past history: Nulliparous, regular menstrual cycles

Medications: Uses EziGest combined oral contraceptive

Social history: Works as a teacher, non-smoker, occasional alcohol use

Examination: No palpable breast mass or lymphadenopathy. Gentle expression elicits discharge from a single duct on the left nipple. No skin changes or erythema

What are the most appropriate next steps in Eliza’s management? Select three (3) from the following list:

Hannah Davis, a 28-year-old woman, presents with new onset lower abdominal pain and irregular vaginal bleeding. She had a medical termination of pregnancy (MTOP) 2 weeks ago at 8 weeks gestation. The procedure was performed through a community provider, and she was prescribed mifepristone followed by misoprostol. She experienced cramping and bleeding for several days afterward. However, her bleeding has continued and is now associated with mild suprapubic tenderness and occasional low-grade fever.

Past history: Nil significant

Medications: Nil

Social history: Non-smoker, lives with flatmates, no regular partner

Examination: Temp 37.8°C, HR 88 bpm. Abdomen: mild suprapubic tenderness. Bimanual: mild cervical motion tenderness, uterus slightly enlarged and tender. No adnexal masses

What are the most appropriate next steps in Hannah’s management? Select three (3) from the following list:

Rebecca Chen, a 30-year-old woman, presents with severe dysmenorrhoea that has progressively worsened over the past two years. She describes pain starting 1–2 days before her period and continuing through the first three days of bleeding. The pain is deep, crampy, and associated with bloating and occasional nausea. She takes over-the-counter NSAIDs with minimal relief. She has not been pregnant. Her cycles are regular every 28 days with moderate flow.

Past history: Nil significant

Medications: Ibuprofen as needed

Social history: Non-smoker, lives with partner, works in hospitality

Examination: BMI 24. Bimanual exam reveals tenderness in the posterior fornix and a fixed retroverted uterus. No adnexal masses

What are the most appropriate next steps in Rebecca’s management? Select three (3) from the following list:

Natalie Singh, a 40-year-old woman, presents with concerns about difficulty conceiving over the past 12 months. She has regular menstrual cycles every 30 days, no significant dysmenorrhoea, and has never been pregnant. Her partner is 42 and has no known medical issues. She works full-time in a corporate role and reports high stress. She has no significant past medical history and maintains a healthy lifestyle.

Past history: Nil significant

Medications: Multivitamin with folate

Social history: Non-smoker, occasional alcohol, BMI 23

Examination: Normal pelvic and speculum exam. No signs of hyperandrogenism or thyroid enlargement

What are the most appropriate initial investigations for Natalie? Select three (3) from the following list:

Tamara Blake, a 43-year-old woman, presents with bothersome heavy menstrual bleeding over the past 9 months. Her periods now last 8–10 days with passage of clots and soak-through episodes on days 2–4. She has no intermenstrual or postcoital bleeding. Her cycles are regular and she denies pelvic pain. She is otherwise healthy, has completed her family, and is not using contraception. She expresses a preference for non-hormonal management if possible.

Past history: Nil significant

Medications: Occasional ibuprofen

Social history: Lives with partner and two teenage children. Non-smoker, drinks occasionally

Examination: Vitals normal. Abdomen soft, non-tender. Bimanual exam: slightly enlarged, non-tender uterus. No adnexal masses

What are the most appropriate next steps in Tamara’s management? Select three (3) from the following list:

Isabella Romano, a 25-year-old woman, presents with a 5-month history of increasingly irregular periods and recent onset of facial acne and increased hair growth on her chin and lower abdomen. Her cycles were previously regular. She reports no weight change and denies galactorrhoea or visual symptoms. She is not sexually active and takes no medications. She is concerned about the cosmetic changes and impact on her fertility.

Past history: Nil significant

Medications: None

Social history: Lives with housemates, works in retail, non-smoker

Examination: BMI 26, normal BP. Mild hirsutism (Ferriman-Gallwey score 10). No virilisation. Pelvic exam: no masses

What are the most appropriate next steps in Isabella’s management? Select three (3) from the following list:

Mei Zhang, a 46-year-old perimenopausal woman, presents with increasing frequency of hot flushes and night sweats over the past 8 months. Her periods have become irregular, with skipped cycles and heavier bleeding. She also reports sleep disturbance and occasional mood swings. She has no significant medical history. Her mother was diagnosed with breast cancer at age 62. She is not currently on any medications.

Past history: Nil significant

Medications: None

Social history: Married, works as a manager, non-smoker, BMI 27

Examination: Normal vital signs and physical examination. No focal neurological or thyroid findings

What are the most appropriate next steps in managing Mei’s symptoms? Select three (3) from the following list:

Angela White, a 37-year-old woman, presents for preconception counselling. She and her partner are planning their first pregnancy. She has no chronic medical conditions. Her menstrual cycles are regular, and she is not on any medications apart from a daily multivitamin. She works as a school teacher and has no known allergies. She seeks advice on optimising her health before conception.

Past history: Nil significant

Medications: Multivitamin (no folate)

Social history: Non-smoker, no alcohol, BMI 22

Examination: BP 112/68 mmHg, HR 74 bpm, normal general examination

What are the most appropriate steps in Angela’s preconception care? Select three (3) from the following list:

Claudia Mendes, a 31-year-old woman, presents with sudden onset right-sided pelvic pain that began 6 hours ago while she was at work. She describes it as sharp and intermittent, with mild associated nausea but no vomiting. Her last menstrual period was 2 weeks ago. She is sexually active and uses condoms inconsistently. She has no history of pelvic surgery or gynaecological conditions. She is otherwise well.

Past history: Nil significant

Medications: Nil

Social history: Works in retail, non-smoker, drinks occasionally

Examination: Temp 37.2°C, HR 82 bpm, BP 120/72 mmHg. Abdomen: right lower quadrant tenderness without guarding. Speculum: no discharge. Bimanual: right adnexal tenderness, no cervical motion tenderness or palpable masses

What are the most appropriate next steps in her management? Select three (3) from the following list:

Fatemeh Rahimi, a 44-year-old woman, presents with complaints of recurrent urinary tract infections (UTIs) over the past 6 months. She has had four confirmed UTIs, each treated with oral antibiotics. She reports dysuria, urgency, and occasional suprapubic discomfort during episodes. She has no haematuria, incontinence, or fever. She is sexually active with her husband and reports increased vaginal dryness since her periods became irregular over the past year.

Past history: Nil major medical history. No history of urological procedures

Medications: None

Social history: Non-smoker, BMI 25, two adult children

Examination: Normal vital signs. Abdomen soft. External genitalia: atrophic changes noted. No prolapse on pelvic exam

What are the most appropriate next steps in Fatemeh’s management? Select three (3) from the following list:

Layla Ibrahim, a 21-year-old university student, presents with a 2-day history of lower abdominal cramping, low-grade fever, and new onset of malodorous vaginal discharge. She is sexually active with multiple partners and does not consistently use barrier protection. Her last menstrual period was 10 days ago. She has no significant past medical history.

Past history: Nil significant

Medications: None

Social history: Lives in student housing, non-smoker, drinks occasionally

Examination: Temp 38.1°C, HR 92 bpm. Lower abdominal tenderness present. Speculum exam: purulent cervical discharge. Bimanual: cervical motion tenderness and mild right adnexal tenderness. No palpable masses

What are the most appropriate next steps in Layla’s management? Select three (3) from the following list:

Georgia Milne, a 39-year-old woman, presents with concerns about early menopause. She reports that her periods have stopped suddenly 5 months ago and she now experiences daily hot flushes, night sweats, mood lability, and fatigue. She has no vasomotor symptoms prior to this. There is no history of recent stress, weight loss, or excessive exercise. She has not been pregnant and does not use contraception.

Past history: Nil significant. No chemotherapy or radiation exposure

Medications: None

Family history: Mother underwent menopause at 53

Social history: Non-smoker, occasional alcohol, BMI 22

Examination: Normal general exam. No goitre. No signs of androgen excess. Pelvic exam unremarkable

What are the most appropriate next steps in Georgia’s assessment and management? Select three (3) from the following list:

Priya Nair, a 34-year-old woman, presents with persistent vaginal discharge for the past 3 weeks. She describes it as thin, grey-white in colour, with a fishy odour, particularly after intercourse. She denies pruritus, pain, dysuria, or systemic symptoms. She is sexually active with her male partner and uses condoms inconsistently. No recent change in sexual partners.

Past history: Recurrent bacterial vaginosis (BV)

Medications: Nil

Social history: Works in hospitality, non-smoker, BMI 23

Examination: Speculum exam: thin homogenous grey discharge coating vaginal walls. No erythema or ulceration. No cervical discharge

What are the most appropriate next steps in Priya’s management? Select three (3) from the following list:

Monique James, a 29-year-old G1P0 woman at 36+5 weeks gestation, presents for a routine antenatal appointment. She feels well and reports good fetal movements. Her pregnancy has been uncomplicated. Her blood group is O negative, and she received routine anti-D at 28 weeks. She is unsure whether she needs another dose before delivery.

Past history: Nil significant

Medications: Pregnancy multivitamin

Social history: Non-smoker, no alcohol, lives with partner

Examination: BP 116/72 mmHg, symphysis-fundal height appropriate, fetal heart rate 140 bpm

What are the most appropriate next steps in Monique’s care? Select three (3) from the following list:

Emily Harper, a 45-year-old woman, presents with fatigue and irregular vaginal bleeding over the past 3 months. She reports bleeding between periods and occasional heavier menstrual flow. She is otherwise well and has no significant medical history. Her cervical screening test was normal 2 years ago. She has not experienced any vasomotor symptoms. She is not on any medications and has two children.

Past history: Nil significant

Medications: None

Social history: Non-smoker, works part-time, BMI 24

Examination: BP 118/72 mmHg, abdomen soft, no palpable masses. Bimanual exam: uterus slightly bulky, no adnexal tenderness

What are the most appropriate next steps in her assessment? Select three (3) from the following list:

Rina Patel, a 26-year-old woman, presents with a positive home pregnancy test. She is uncertain of her last menstrual period but estimates she is around 6 weeks pregnant. She reports occasional mild lower abdominal cramping but no vaginal bleeding, nausea, or other symptoms. This is her first pregnancy. She has not yet had any medical review in this pregnancy and is seeking confirmation and advice on next steps.

Past history: Nil significant

Medications: None

Social history: Non-smoker, lives with partner, works full-time

Examination: Vitals normal. Abdomen soft and non-tender. No adnexal or cervical tenderness on bimanual examination

What are the most appropriate next steps in her care? Select three (3) from the following list:

Helen Murphy, a 55-year-old postmenopausal woman, presents with vaginal dryness and discomfort during intercourse that has progressively worsened over the past year. She also reports mild urinary urgency but no dysuria or haematuria. She has not had any vaginal bleeding since menopause at age 51. She is otherwise well and not on any medications. Her last cervical screening test was normal at age 53.

Past history: Two normal vaginal deliveries, no significant gynaecological history

Medications: None

Social history: Lives with partner, non-smoker, no alcohol

Examination: Vulvovaginal mucosa appears pale and thin. Introital narrowing noted. No masses, discharge or lesions. Urinalysis normal

What are the most appropriate management options for Helen? Select three (3) from the following list:

Rachael Long, a 32-year-old G2P1 woman, presents at 18 weeks gestation with a recent positive syphilis screening result. She has had no symptoms and is surprised by the result. Her first pregnancy was uncomplicated. She reports being in a stable monogamous relationship. She is otherwise well and has no history of STI. Her partner has not yet been tested.

Past history: Nil significant

Medications: Pregnancy multivitamin

Social history: Married, works as a dental hygienist, non-smoker

Investigations: Syphilis EIA positive, RPR titre 1:16

What are the most appropriate next steps in her care? Select three (3) from the following list:

Tanya Blake, a 30-year-old woman, presents requesting advice on postpartum contraception. She delivered her second child 8 weeks ago via uncomplicated vaginal birth and is currently fully breastfeeding. She has not resumed menstruation. She and her partner do not plan any further children but are unsure about permanent contraception. She would prefer something long-term and forgettable.

Past history: Two normal pregnancies and births. No chronic illnesses

Medications: None

Social history: Lives with partner, non-smoker, BMI 24

Examination: General exam unremarkable. No concerns raised during postnatal review

What are the most appropriate contraceptive options for Tanya at this time? Select three (3) from the following list:

Anna Deluca, a 23-year-old woman, presents with a painless vulvar lump that she noticed one week ago. It has gradually increased in size but is not associated with itching, discharge, or bleeding. She denies systemic symptoms or recent trauma. She is sexually active with one partner and uses condoms inconsistently. She has no significant medical history.

Past history: Nil significant

Medications: None

Social history: Lives with partner, non-smoker, university student

Examination: A 3 cm soft, fluctuant, non-tender mass is palpated at the 5 o’clock position on the right labia majora. No overlying skin changes or erythema. No inguinal lymphadenopathy. No other lesions or discharge

What are the most appropriate next steps in her management? Select three (3) from the following list:

Sophie Adams, a 35-year-old woman, presents with ongoing fatigue, difficulty conceiving, and a history of irregular menstrual cycles for over a year. Her periods occur every 35–60 days, with some cycles skipped entirely. She reports increased facial hair and mild acne. She has been trying to conceive with her partner for 12 months without success. She is otherwise well and has no known chronic conditions.

Past history: Nil significant

Medications: None

Social history: BMI 31, non-smoker, works as an accountant, moderate physical activity

Examination: BP 124/82 mmHg, normal thyroid exam, mild hirsutism (chin and upper lip). No palpable masses

What are the most appropriate next steps in Sophie’s assessment and management? Select three (3) from the following list:

Naomi Foster, a 48-year-old woman, presents with a six-month history of cyclical breast tenderness, bloating, mood swings, and fatigue. Her menstrual cycles remain regular but are slightly shorter than usual (every 24–26 days). She has not noticed any intermenstrual bleeding or postcoital bleeding. She describes worsening irritability and low mood in the week before her period, which improves once menstruation starts. She is concerned about hormone imbalance and asks if she is perimenopausal.

Past history: Nil significant

Medications: None

Social history: Married, two children, works full time, non-smoker

Examination: Normal BMI and BP. General and breast exam unremarkable. No pelvic tenderness or masses on bimanual examination

What are the most appropriate next steps in her care? Select three (3) from the following list:

Laura Stevens, a 27-year-old woman, presents with concerns about primary dysmenorrhoea. She reports cramping pelvic pain during menstruation since her teenage years, which begins a few hours before bleeding and lasts for the first 2–3 days. The pain is severe enough to affect her ability to work and requires regular ibuprofen. Her cycles are regular, and there is no intermenstrual bleeding, dyspareunia, or abnormal discharge. She has not been sexually active for 2 years.

Past history: Nil significant

Medications: Ibuprofen during menses

Social history: Works as a nurse, non-smoker, drinks socially

Examination: General examination unremarkable. Pelvic exam deferred at patient request. No systemic signs

What are the most appropriate next steps in managing Laura’s symptoms? Select three (3) from the following list:

Olga Ivanov, a 62-year-old postmenopausal woman, presents with a 2-week history of vaginal spotting. She reached menopause at age 52 and has had no bleeding until now. She is otherwise well, with no abdominal pain or systemic symptoms. Her last cervical screening test was normal at age 60. She has never used hormone replacement therapy and takes no regular medications.

Past history: Nil significant

Medications: None

Social history: Retired teacher, non-smoker, BMI 27

Examination: Speculum exam shows pale atrophic vaginal mucosa with minimal spotting. Cervix appears normal. No masses or discharge. Bimanual exam: uterus small, non-tender

What are the most appropriate next steps in Olga’s assessment and management? Select three (3) from the following list:

Grace Thompson, a 19-year-old woman, presents requesting the oral contraceptive pill. This is her first visit to discuss contraception. She has no significant past medical history and is otherwise well. Her periods are regular, she is not currently sexually active but anticipates becoming sexually active in the near future. She has no history of migraine, clotting disorders, or smoking.

Past history: Nil

Medications: None

Social history: Lives with parents, university student, BMI 22, non-smoker, no alcohol or drug use

Examination: BP 110/70 mmHg, general examination unremarkable

What are the most appropriate steps in providing contraception to Grace? Select three (3) from the following list:

Caroline West, a 52-year-old woman, presents with worsening urinary urgency and frequency over the past 6 months. She reports waking twice per night to void and has experienced occasional incontinence before reaching the toilet. She denies dysuria or haematuria. She reached menopause at age 50 and is not on hormone replacement therapy. Her symptoms have progressively impacted her confidence and daily activities.

Past history: Two vaginal births, no history of UTIs or pelvic surgery

Medications: None

Social history: Works as a librarian, non-smoker, BMI 26

Examination: Abdomen soft, no masses. No pelvic organ prolapse. Post-void residual bladder scan: 40 mL

What are the most appropriate next steps in Caroline’s management? Select three (3) from the following list:

Elinor Jacobs, a 36-year-old woman, presents with concerns about pelvic heaviness and a sensation of ‘something coming down’ in her vagina. Symptoms are worse at the end of the day or after standing for long periods. She has had three vaginal births, the last 4 years ago. She denies urinary incontinence, bleeding, or pain. She is otherwise healthy and not sexually active currently.

Past history: Three uncomplicated vaginal deliveries

Medications: None

Social history: Works as a teacher, non-smoker, BMI 29

Examination: Pelvic exam reveals stage 2 anterior vaginal wall prolapse. No ulceration or masses. No signs of infection. Pelvic floor tone reduced

What are the most appropriate next steps in Elinor’s management? Select three (3) from the following list:

Sara Mahmoud, a 25-year-old woman, presents with a 3-month history of vulvar itching and occasional burning sensation. The symptoms are worse at night. She has tried over-the-counter antifungal creams without improvement. She is sexually active with one partner and uses condoms inconsistently. She denies discharge, dysuria, or systemic symptoms. This is her first presentation for these symptoms.

Past history: Nil significant

Medications: Nil

Social history: Works as a retail assistant, non-smoker

Examination: Pale, thin vulvar skin with areas of whitening and slight fissuring near the perineum. No discharge or ulceration. No lymphadenopathy

What are the most appropriate next steps in Sara’s care? Select three (3) from the following list:

Jacinta Moore, a 33-year-old woman, presents with deep dyspareunia and progressive dysmenorrhoea over the past 12 months. Her periods are regular but increasingly painful, with the pain often extending into her lower back. She reports fatigue but no abnormal bleeding or bowel/bladder symptoms. She is trying to conceive and has been unsuccessful after 10 months of unprotected intercourse. She has no significant past medical history.

Past history: Nil significant

Medications: Ibuprofen for pain during periods

Social history: Married, non-smoker, no alcohol use, works as a graphic designer

Examination: Normal BMI. Pelvic exam reveals tenderness in the posterior fornix and reduced uterine mobility. No palpable masses

What are the most appropriate next steps in Jacinta’s care? Select three (3) from the following list: