The Sella turcica is composed of three parts:
1. The tuberculum sellae (horn of saddle): a variable slight to prominent median elevation forming the posterior
boundary of the prechiasmatic sulcus and the anterior boundary of the hypophysial fossa.
2. The hypophysial fossa (pituitary fossa): a median depression (seat of saddle) in the body of the sphenoid that accommodates the pituitary gland (L. hypophysis).
3. The dorsum sellae (back of saddle): a square plate of bone projecting superiorly from the body of the sphenoid.
It forms the posterior boundary of the Sella turcica, and its prominent superolateral angles make up the posterior clinoid processes.

Premenstrual dysphoric disorder (PMDD) is a more serious form of premenstrual syndrome (PMS). PMS causes bloating, headaches, and breast tenderness a week or two before your period.

With PMDD, you might have PMS symptoms along with extreme irritability, anxiety, or depression. These symptoms improve within a few days after your period starts, but they can be severe enough to interfere with your life.

PMDD symptoms appear a week or two before menstruation and go away within a few days after your period starts. In addition to PMS symptoms, you may have:

Anger or irritability.
Anxiety and panic attacks.
Depression and suicidal thoughts.
Difficulty concentrating.
Fatigue and low energy.
Food cravings or binge eating.
Headaches.
Insomnia.
Mood swings.

The following treatments have been shown to relieve symptoms:

Sertraline, escitalopram, paroxetine, and fluoxetine are SSRIs (selective serotonin reuptake inhibitors). SSRIs are the first-line treatment and are extremely effective.
The second line of defence is alprazolam (a short course recommended due to its addictive potential).
The use of temazepam has little advantage because it only aids with sleep and is relatively short-acting.
Lifestyle modifications-weight loss, exercise, quitting smoking, and relaxation therapies for less severe PMS.
Danazol-suppresses the ovulation and helps with mastalgias associated with PMS.

The most probable cause of her presentation is a mixed infection with Chlamydia trachoma and vaginal pathogens.

Her most likely diagnosis is pelvic inflammatory disease (PID) as suggested by a purulent vaginal discharge alongside a fever which indicates a systemic infection.

The most common causative organisms in PID after sexual activity are chlamydia and gonorrhoea, of which chlamydia has a much higher prevalence.

Chlamydia has also been shown to be present in about 15% of subjects who underwent pregnancy termination with no constant sexual partner.

PID occurring after a gynaecologic surgical procedure is most commonly a result of mycoplasma or vaginal pathogens.

Oral progestogen therapy for 21 days (day 5-26) is considered effective but is only a short-term therapy for menorrhagia. Myomectomy should only be considered if the woman would like to conceive later on. Due to the recurrent nature of fibroids, it is likely that the woman would need more surgeries in the future, which is not ideal. Furthermore, if there is a large number of fibroids or the size of the fibroids are large, myomectomy would not be an option for reasons such as the feasibility. If myomectomy for multiple fibroids prove to be unsuccessful, the ultimate outcome would still have to be a hysterectomy.

In cases where there is significant enlargement of the uterus, endometrial ablation would be difficult and the long-term cure rate of symptoms would be considerably low. The best next step would be a total abdominal hysterectomy since it would solve her menorrhagia and within a few years’ time, she would be expected to attain menopause anyway. Ponstan or mefenamic acid has been found to be superior to tranexamic acid for menorrhagia. However, it can still prove to be ineffective in some cases and also not a long term solution.

In hyperemesis gravidarum, IV corticosteroids can be given to reduce vomiting, if the patient is not responding to standard anti emetics.

Trigeminal nerve has three divisions, the first is the ophthalmic division that does not originate from any of the pharyngeal arches, the second and third divisions, namely, the maxillary and the mandibular region develop from the first pharyngeal arch.
Pharyngeal Arches:
1st = Trigeminal V2 & V3 (CN V)
2nd = Facial (CN VII)
3rd = Glossopharyngeal (CN IX)
4th and 6th = Vagus (CN X)

Warfarin can be useful for management of thromboembolism. The target INR range for this medication is between 2.0-3.0 in patients with venous thromboembolism, pulmonary embolism etc. The INR range may increase to 3.0-4.0 in patients with mechanical valves. However, warfarin is not recommended in pregnancy, and Low Molecular Weight Heparin should be used for thromboprophylaxis instead.

Red degeneration of fibroids is one of 4 methods of fibroid degeneration. Although uncommon outside pregnancy it is thought to be the most common form of fibroid degeneration during pregnancy and typically occurs in the 2nd trimester. It is thought to arise from the fibroid outgrowing its blood supply and haemorrhagic infarction occurs. Ultrasound will typically show a localised fluid collection (blood) within the fibroid.

Anaemia in pregnancy is defined by the British Committee for Standards in Haematology (BCSH) guidance: 1st trimester Hb < 110 g/l 2nd and 3rd trimester Hb < 105 g/l Postpartum Hb less than 100 g/l

The life time risk of breast cancer in BRCA 1 gene is 70% and of ovarian cancer is 40%.