MLA Domain 5 · Presentation

Menopause/ perimenopause

8 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 · 1

Osteoporosis

New vertebral fracture / hip fracture → high imminent re-fracture risk; consider underlying malignancy in atypical fract

recognised feature · 6

Adenomyosis

Severe anaemia from heavy bleeding

Breast cancer

≥30 with an unexplained breast lump → suspected-cancer pathway (2-week-wait); ≥50 with unilateral nipple changes (discha

Endometrial cancer

Any postmenopausal bleeding → urgent 2-week-wait referral

Endometrial hyperplasia

Postmenopausal bleeding → 2-week-wait referral; atypical hyperplasia → high cancer risk/coexisting cancer

Osteoporosis & fragility fractures

Vertebral fracture with neurology, or hip fracture → acute orthopaedic/surgical pathway (cross-ref acute_care)

Urinary incontinence (women)

Visible haematuria, recurrent UTI, pain, palpable bladder/mass, or new symptoms >50y → exclude malignancy/retention befo

differential of the above · 1

Paget's disease of bone

New severe pain/soft-tissue mass in Pagetic bone → exclude osteosarcoma