5.         Mrs Mak is a 51-year-old woman who has had irregular periods over the last 1 year. She has been troubled by hot flushes over the past 8 months.

a)         Name the physical examinations you would perform.

            Breast examination. Bimanual and pelvic examination. Pap smear.

b)            Besides a cervical smear, what is the most important investigation an gynaecologist must perform in this patient?

            Endometrial sampling. Urine HCG.

c)         Is a serum FSH level essential in this patient? No.

d)         List 2 conditions you must exclude before starting this patient on HRT?

            Breast cancer, pregnancy, DVT.

e)         What is the most serious potential problem of HRT?

            Breast cancer.

f)          Which HRT would not be appropriate for this patient?

            Estrogen therapy only as she still has a uterus.