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OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is endometriosis. While this may seem a odd practice, it is useful to see multiple examples of how endometriosis will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for endometriosis.
- Pelvic pain: that is often cyclic
- Abnormal uterine bleeding:
- Dysmenorrhea
- Dyspareunia especially with deep intercourse
QUESTION EXAMPLES
Question # 1
A 27 year old nulliparous woman comes to the clinic because of experiencing severe pain during sexual intercourse. She explains that the pain is particularly severe with deep penetration. She is in a monogamous relationship with her husband of 3 years. She admits that she has been avoiding sexual intimacy due to the pain she is experiencing. The patient’s husband is her first sexual partner, and her pain has put a significant strain on their relationship. Her menses are painful, and they occur every 30 days and last for about 5 days. The patent explains that she also has pain when passing stool, and sometimes even experiences sporadic pelvic pain at random times during the day. Transvaginal ultrasound shows no remarkable findings. What is the most likely cause of this patient’s symptoms?
Explanation # 1
Dysmenorrhea + deep dyspareunia + dyschezia = endometriosis
Question # 2
A 26 year old GOPO woman comes to the clinic because of pelvic pain. She explains that her pain has gotten worse over the past year, and it intensifies a few days before mensuration. She explains that she ahs also noticed that the pain improves slightly during the end of her period. She has been taking ibuprofen to control the pain, however this only helps minimally. She denies having any fever or abnormal vaginal discharge. The patient is in a committed relationship with her boyfriend of 5 years. They have been using both condoms and oral contraceptives for birth control. Her temperature in the office is 98.6 F, blood pressure is 120/80 mm Hg. Physical exam shows tenderness in the posterior vaginal fornix, decreased uterine mobility, and thickening of the uterosacral ligaments. There are no adnexal masses palpated on the exam. The patient’s urine beta-hCG is negative, her hemoglobin si 12.3 g/Dl and leukocyte count is 8,000/mm³. Transvaginal ultrasound shows normal pelvic anatomy. What is the likely cause of this patient’s symptoms?
Explanation # 2
Question # 3
A 28 year old G0P0 woman comes tot he office for the evaluation of intermittent left pelvic pain over the past 9 months. She has noticed that when she exercises this makes her pain worse. She is sexually active with her husband, and has stopped taking her oral contraceptives about 2 years ago with the intention of having children. The patient has menstrual cycles every 27 days, with bleeding that lasts 5 days. She has had trichomoniasis in the past as a child. Her temperature is 98.2°F, blood pressure is 120/70 mm Hg. Physical examination shows a normal sized uterus, and there is an enlarged right adnexa. Ultrasonography shows a homogenous cystic-appearing mass on the right ovary, however there are no other remarkable findings. What is the most likely diagnosis in this patient?
Explanation # 3
Infertility + pelvic pain + adnexal enlargement/mass + homogenous cystic appearing mass on ovary = endometriosis
Question # 4
A 29 year old woman comes to the clinic for infertility evaluation. She has had unprotected intercourse with her husband every other day for the past year, but has yet to become pregnant. Her last menstrual period was 3 weeks ago. Her menses occur every 28 days, and last for 4 days, with significant pain the day before her period begins. She explains feeling severe pelvic and back pain that is only partially relieved with taking ibuprofen. She does not take any medications, and denies smoking or drinking alcohol. Her husband is 38 years old, and does not have any children. He has an appointment scheduled for infertility, however has yet to be evaluated. The patient’s blood pressure is 130/70 mm Hg, and her pulse is 80/min. Her BMI is 32 kg/m². Physical examination shows a uterus adherent to the right, and there is tenderness when the uterus is mobilized. What is the likely cause of this patent’s inability to conceive?
Explanation # 4
Pelvic/back pain + dysmenorrhea + fixed, immobile uterus + pain with mobilizing uterus = endometriosis
Question # 5
A 30 year old woman, G0P0, comes to the clinic with with dysmenorrhea that she has been experiencing for the past 2 years. She also complains of dyspareneuria and pain with defecation, both of which she has been experiencing for the past 5 months. She has been unable to conceive for the past 2 years. Physical examination shows a firm, tender uterus. Nodularity of the uterosacral ligaments and adnexal tenderness are also appreciated. There is a 5 cm, cystic right adnexal mass. A pregnancy test is negative. What is the likely diagnosis?
Explanation # 5
Question # 6
A 32 year old nillkigravid woman comes to the clinic because of difficulty conceiving. She has never become pregnant despite having unprotected intercourse with her male parter for the past year and half. She explains that she has a history of pelvic pain, which becomes more severe with menses. Her pain has persisted despite medical therapy. Exploratory laparoscopy is performed, and multiple flesh colored nodules are visualized on the pelvic organs, along with thin, filmy adhesions. Biopsies of these nodules reveal the presence of simple columnar cells as well as hemosiderin pigment. What is the patient’s likely diagnosis?
Explanation # 6
Infertility + pelvic pain + flesh colored nodules on pelvic organs + presence of simple columnar cells (endometrium) in nodule biopsy + presence of hemosiderin on biopsy = endometriosis
Question # 7
Explanation # 7
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
- Cause: non-neoplastic endometrium like glands/stroma found outside the endometrial cavity.
- Common locations of tissue: ovary
Page Updated: 10.02.2016