AKT – Womens Health

Amber Wallace, aged 33, presents at 12 weeks’ gestation. She has a history of a previous pregnancy affected by neural tube defect. She is otherwise well and takes no regular medications. She has just commenced folic acid 500 mcg daily on discovering this pregnancy.

What is the MOST appropriate next step in her management?

Michelle Tran, aged 19, presents with primary amenorrhoea. She has no breast development and minimal axillary or pubic hair. She has a short stature and a webbed neck. On examination, there is a wide carrying angle and shield chest.

What is the MOST likely diagnosis?

Danica Miles, aged 43, presents with heavy menstrual bleeding and is found to have a thickened endometrium on ultrasound. She is overweight and has a family history of endometrial cancer. Endometrial biopsy reveals complex hyperplasia without atypia.

What is the MOST appropriate initial management?

Lauren Davis, aged 36, presents with mastalgia and a palpable lump in the right breast. She reports her symptoms fluctuate with her menstrual cycle. Ultrasound reveals a 2.5 cm anechoic, well-defined lesion.

What is the MOST appropriate next step?

Rachel Nguyen, aged 30, presents with secondary infertility. She has a history of chlamydia 5 years ago. Her cycles are regular. Partner’s semen analysis is normal. Pelvic ultrasound shows no abnormalities.

What is the MOST appropriate next step in investigation?

Maria Santoro, aged 37, presents at 11 weeks’ gestation for her first antenatal visit. She is concerned about toxoplasmosis as she owns a cat. She has no symptoms. She has been avoiding cleaning the litter tray but occasionally works in the garden without gloves.

What is the MOST appropriate advice to give?

Rachel Singh, aged 28, presents with a 2-day history of lower abdominal pain and fevers. She had a copper IUD inserted 2 weeks ago. She is sexually active with one partner. On examination, she is febrile at 38.5°C and has cervical motion tenderness. Pregnancy test is negative.

What is the MOST likely diagnosis?

Jessica Lu, aged 23, presents with pain during intercourse and superficial vaginal discomfort. She reports symptoms began after a new sexual relationship and are worse at initial penetration. There is no discharge or deep pelvic pain. Examination shows normal anatomy and erythema of the introitus.

What is the MOST likely diagnosis?

Fiona Lambert, aged 31, presents with persistent nausea and vomiting in early pregnancy. She is at 10 weeks’ gestation. She is unable to keep down solids or liquids and has lost 3 kg. She appears dehydrated. Urinalysis shows ketonuria and elevated specific gravity.

What is the MOST appropriate management?

Zara Patel, aged 41, presents requesting cervical screening. Her last CST was 2 years ago and was negative for HPV. She has had a new sexual partner in the past 6 months. She is otherwise well and has no symptoms.

What is the MOST appropriate management?

Yasmin Farouk, aged 35, presents at 18 weeks’ gestation for routine antenatal care. Her blood group is O negative. She has had no bleeding in this pregnancy. Her first pregnancy resulted in a term vaginal birth with no complications. Anti-D antibodies are not detected.

What is the MOST appropriate next step in her care?

Nikki Bright, aged 30, presents with concern about not feeling fetal movements. She is currently 19 weeks pregnant. This is her first pregnancy. She has no pain or bleeding and feels otherwise well. Fetal heart tones are detected with Doppler.

What is the MOST appropriate management?

Olivia Chan, aged 27, presents with a painless breast mass found during routine self-exam. It is 2 cm, smooth, and mobile. She is premenstrual. Ultrasound shows a well-circumscribed, solid lesion with posterior acoustic enhancement.

What is the MOST likely diagnosis?

Grace Lin, aged 44, presents with menopausal symptoms and irregular bleeding. She requests hormone therapy. Her past medical history includes a PE 5 years ago. She is normotensive and not on any regular medications. Cervical screening is up to date.

What is the MOST appropriate management?

Claire Dawson, aged 39, presents with new-onset pelvic pressure and urinary frequency. On examination, a firm midline mass is palpated arising from the pelvis. Pelvic ultrasound reveals a 9 cm intramural fibroid.

What is the MOST appropriate initial management?

Julia Weston, aged 30, presents for pre-conception counselling. She has type 1 diabetes diagnosed at age 14. Her last HbA1c was 8.5%. She takes insulin glargine and insulin aspart. She is otherwise healthy and keen to start trying for pregnancy in the next few months.

What is the MOST appropriate next step in management?

Alison Park, aged 27, presents with a positive pregnancy test. Her LMP was 7 weeks ago. She has experienced lower abdominal pain and light spotting. Her only medication is the COCP, which she stopped 2 months ago. A transvaginal ultrasound shows an empty uterus with a right adnexal mass and free fluid.

What is the MOST likely diagnosis?

Joanna Trinh, aged 21, presents with acne and hirsutism. Her periods are irregular and occur every 2–3 months. BMI is 34. Pelvic ultrasound shows polycystic ovarian morphology. Blood tests show elevated testosterone and normal prolactin and TSH.

What is the MOST appropriate first-line treatment?

Belinda Rogers, aged 40, presents with a 3-month history of persistent nipple discharge from the right breast. It is spontaneous, serous, and occurs from a single duct. There is no palpable mass. She is not pregnant and takes no medications.

What is the MOST appropriate next step?

Heather Knox, aged 31, presents with vulval discomfort and a white curd-like discharge. She has been on antibiotics for a recent sinus infection. She reports vulval itch and dyspareunia. Examination confirms thick white discharge and erythematous vulva. pH is normal.

What is the MOST appropriate treatment?

Samantha Boyd, aged 38, presents with persistent pelvic pain and dyspareunia. She has been previously investigated and diagnosed with endometriosis confirmed by laparoscopy. She has completed her family and is not currently using contraception. She is seeking effective long-term symptom relief.

What is the MOST appropriate management option?

Chloe Edwards, aged 22, presents requesting emergency contraception. She had unprotected intercourse 4 days ago. Her BMI is 36 and her cycles are regular, with last period 2 weeks ago. She is not using any regular contraception and has no contraindications to hormonal treatments.

What is the MOST effective option at this stage?

Danielle Fox, aged 47, presents with increasing fatigue and heavier periods over the last 6 months. She also reports occasional bloating and pelvic discomfort. Examination reveals a palpable pelvic mass arising from the pelvis. Ultrasound confirms a 10 cm subserosal fibroid.

What is the MOST appropriate next step in management?

Kate Monaghan, aged 34, presents with a new breast lump detected 1 week ago during self-examination. She is breastfeeding her 6-month-old infant. On examination, a firm, mobile 3 cm lump is noted in the upper outer quadrant of the right breast. No axillary nodes are palpable. She has no fever or signs of mastitis.

What is the MOST appropriate next step in management?

Felicity King, aged 26, presents with acute onset of lower abdominal pain on the right side. The pain began suddenly while exercising and has not resolved. She is sexually active with one partner, and her LMP was 2 weeks ago. On examination, she has right lower quadrant tenderness but no fever. Urine pregnancy test is negative.

What is the MOST likely diagnosis?

Nadia El-Sayed, aged 29, presents with amenorrhoea for 5 months. She stopped the oral contraceptive pill 6 months ago and has not had a period since. She has no hirsutism or acne and a BMI of 22. A urine pregnancy test is negative. TSH and prolactin are within normal limits.

What is the MOST appropriate next investigation?

Stephanie Rudd, aged 45, presents with painful lumps in her breasts that fluctuate with her menstrual cycle. The lumps are bilateral, mobile, and tender, especially premenstrually. No suspicious features are noted on examination.

What is the MOST likely diagnosis?

Karen McVeigh, aged 50, presents with a two-month history of vulval irritation and a white, thickened area on the labia. She has no vaginal discharge. Examination reveals a white, atrophic plaque with fissuring. A punch biopsy confirms lichen sclerosus.

What is the MOST important reason for ongoing surveillance?

Lisa Quade, aged 35, presents with irregular periods and has been trying to conceive for 12 months. Her BMI is 31. Pelvic ultrasound shows multiple small follicles in both ovaries. Serum LH is elevated compared to FSH. Testosterone is mildly elevated.

What is the MOST likely diagnosis?

Emily Zhang, aged 42, presents with abnormal uterine bleeding and an endometrial thickness of 13 mm on ultrasound. She is premenopausal and reports heavy, irregular periods. She has a family history of endometrial cancer. BMI is 34.

What is the MOST appropriate next step in management?

Emma Baldwin, aged 36, presents for contraceptive advice. She has a history of migraine with aura. She is in a stable relationship and not planning pregnancy. She prefers not to take a daily pill and is seeking a long-term solution.

What is the MOST appropriate contraceptive option?

Holly Nguyen, aged 32, presents in early pregnancy with spotting. She is 9 weeks pregnant by LMP and has no pain. A transvaginal ultrasound shows a live intrauterine pregnancy with crown-rump length consistent with dates and no subchorionic haemorrhage.

What is the MOST appropriate next step?

Melanie Brooks, aged 48, presents with a one-year history of progressively worsening vaginal dryness and discomfort during intercourse. She has had spontaneous menopause at 46 and takes no hormone replacement therapy.

What is the MOST appropriate initial treatment?

Ava Karam, aged 29, presents with a 3-month history of intermenstrual bleeding and postcoital spotting. Cervical screening test 2 years ago was negative for HPV. She is otherwise well and takes no medications.

On speculum examination, there is an erythematous, friable area on the ectocervix that bleeds on contact.

What is the MOST appropriate next step?

Natalie Samuels, aged 41, presents with lower abdominal pain and a positive pregnancy test. She has a history of tubal surgery for ectopic pregnancy 3 years ago. She is unsure of her LMP. Transvaginal ultrasound shows no intrauterine pregnancy and no adnexal mass. Beta-hCG is 1600 IU/L.

What is the MOST appropriate next step?

Margaret O’Neill, aged 67, presents with vulval itching and irritation. She has noticed whitening and thinning of the skin in the vulval region. There is no vaginal discharge or bleeding. On examination, the labia minora appear fused and there is parchment-like skin with fissuring.

What is the MOST appropriate next step in management?

Judith Reynolds, aged 72, presents with postmenopausal bleeding. She has been menopausal for 20 years and is not on HRT. She has no associated pain. Examination is unremarkable. Pelvic ultrasound shows an endometrial thickness of 6 mm.

What is the MOST appropriate next step in management?

Barbara Thomas, aged 69, presents with urinary urgency and incontinence. She voids small amounts frequently and occasionally does not make it to the toilet in time. She has no dysuria or haematuria. Examination is unremarkable and urinalysis is negative.

What is the MOST likely diagnosis?

Elaine Morrison, aged 75, presents with vaginal spotting. She is sexually active with a new partner. She has not used HRT. Speculum examination reveals a pale, dry vaginal mucosa with petechiae but no lesions or discharge. Swabs are negative.

What is the MOST appropriate initial management?

Nancy Bell, aged 70, presents with pelvic organ prolapse symptoms. She reports a sensation of vaginal pressure and difficulty with bowel movements. She is not sexually active. On examination, she has a stage 2 uterine prolapse with no ulceration.

What is the MOST appropriate initial management?

Tahlia Browne, aged 15, presents with primary amenorrhoea. She has not yet had a period. She has normal breast development and pubic hair. She is active in school sports. BMI is 17 and she reports significant exercise and dietary restriction.

What is the MOST likely diagnosis?

Keira Simmons, aged 17, presents with painful periods since menarche. The pain occurs on the first day of menstruation and is relieved with ibuprofen. Her cycles are regular, and she is otherwise well.

What is the MOST likely diagnosis?

Sophie Taylor, aged 16, presents with concerns about acne and irregular periods. Her menses occur every 2–3 months and she has noticed increased facial hair. BMI is 30. Ultrasound shows polycystic ovarian morphology.

What is the MOST appropriate initial management?

Isla Kennedy, aged 14, presents with vulval itch and discomfort. She has been using fragranced soaps and bubble bath daily. There is no discharge, dysuria, or systemic symptoms. Examination reveals mild erythema of the vulva but no ulceration or discharge.

What is the MOST appropriate initial management?

Zara Morrison, aged 19, presents requesting contraception. She has never used hormonal contraception before. She is a university student, smokes 5 cigarettes per day, and prefers not to take daily pills. BMI is 24 and cervical screening is not yet due.

What is the MOST appropriate option?

Claire Young, aged 24, presents with vaginal discharge and mild pelvic discomfort. She is sexually active with a new partner. Examination reveals mucopurulent cervical discharge and cervical motion tenderness. Cervical swabs are taken.

What is the MOST appropriate next step?

Alana Petros, aged 44, presents with 6 months of heavy, irregular periods and pelvic pressure. She is not planning further pregnancies. Pelvic ultrasound shows an 8 cm submucosal fibroid.

What is the MOST appropriate initial management?

Alicia Ramsey, aged 55, presents with new-onset dyspareunia and vaginal dryness. She is postmenopausal and not on any HRT. She has no bleeding or discharge. On exam, the vaginal mucosa appears pale, dry, and thin.

What is the MOST appropriate management?

Lily Harris, aged 29, presents 3 weeks postpartum with fever, breast tenderness, and erythema of the left breast. She reports difficulty breastfeeding on that side. Temperature is 38.3°C, and there is a 4 cm area of warmth and tenderness laterally on the left breast.

What is the MOST appropriate management?

Natalie Lowe, aged 39, presents requesting fertility advice. She has been trying to conceive for 14 months. Her cycles are regular, and day 21 progesterone is 38 nmol/L. Her partner’s semen analysis is normal. Pelvic ultrasound is normal.

What is the MOST appropriate next step?