A 30-year-old woman presents with amenorrhea, hirsutism, and acne. She has gained 10kg over the past year. Ultrasound shows multiple ovarian cysts. Testosterone and LH are elevated, FSH is normal. What is the most likely diagnosis?
ACongenital adrenal hyperplasia
BPolycystic ovary syndrome
COvarian tumor
DCushing's syndrome
EHypothyroidism
A 35-year-old woman with a 16-month history of heavy menstrual bleeding reports that her periods last 9 days and she passes large clots. She has tried tranexamic acid and mefenamic acid with minimal improvement. She has two children and does not wish for future pregnancy. Examination is normal and transvaginal ultrasound shows a normal uterus (8 cm length) with no fibroids and endometrial thickness of 6 mm on day 5 of cycle. Full blood count shows haemoglobin 101 g/L. She declines hormonal treatment. What is the most appropriate next management option?
AOffer endometrial ablation
BPrescribe oral norethisterone for cycle regulation
CArrange hysterectomy
DIncrease dose of tranexamic acid and mefenamic acid
EOffer trial of levonorgestrel intrauterine system despite preferences
A 26-year-old woman presents to the emergency department with sudden onset severe left-sided pelvic pain, nausea, and one episode of syncope 2 hours ago. She has 7 weeks amenorrhoea. On examination, she is alert with heart rate 102 bpm, blood pressure 104/68 mmHg, and temperature 36.8°C. Abdominal examination reveals left iliac fossa tenderness with mild guarding but no rigidity. Transvaginal ultrasound shows an empty uterus, a 35 mm left adnexal mass with a hyperechoic ring, and a small amount of free fluid in the pouch of Douglas. Serum beta-hCG is 5600 IU/L. What is the most appropriate management?
AEmergency laparoscopy
BIntramuscular methotrexate
CAdmit for observation with 4-hourly observations and repeat ultrasound in 24 hours
DDiagnostic laparoscopy with decision for salpingectomy or salpingotomy at surgery
EArrange urgent MRI pelvis to better characterise the adnexal mass
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