MLA Domain 5 · Presentation

Amenorrhoea

14 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 4

Eating disorders

Anorexia red flags: BMI <13, rapid weight loss, bradycardia <40, hypotension, hypoglycaemia, prolonged QTc, hypokalaemia

Ectopic pregnancy

Haemodynamic instability/collapse, shoulder-tip pain, peritonism → rupture → resuscitate + emergency surgery

Menopause / perimenopause

Postmenopausal bleeding (PMB) → urgent exclusion of endometrial cancer

Turner syndrome

Coarctation of the aorta / bicuspid aortic valve; aortic dissection risk; renal anomalies

recognised feature · 7

Autoimmune hepatitis

Acute liver failure presentation (coagulopathy/encephalopathy) → urgent specialist

Contraceptive implant (Nexplanon)

Current breast cancer (UKMEC 4). Enzyme-inducing drugs reduce efficacy (a rare LARC limitation)

Depot injection (DMPA)

UKMEC: caution if multiple osteoporosis risk factors; age <18 (peak bone mass) and >45 are relative cautions; current br

Hyperprolactinaemia / prolactinoma

Visual field loss from a macroprolactinoma → urgent

Hypopituitarism

Pituitary APOPLEXY (sudden severe headache, visual loss, ophthalmoplegia, hypotension) → emergency (steroids + neurosurg

Pituitary tumours

Pituitary apoplexy → emergency (steroids + neurosurgery)

Polycystic ovary syndrome (PCOS)

Prolonged amenorrhoea → unopposed oestrogen → endometrial hyperplasia/cancer risk

differential of the above · 3

Appendicitis

Generalised peritonitis (perforation) → emergency

Depression

Active suicidal intent/plan, psychotic features, severe self-neglect → urgent specialist/crisis referral

Noonan syndrome

Significant cardiac disease (pulmonary stenosis/HCM); bleeding tendency before surgery