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Endometriosis

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Endometriosis

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USMLE® Step 1 style questions USMLE

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A 28-year-old nulliparous woman comes to the office because of chronic intermittent dull pelvic pain for 7 months. The pain usually begins a day before menses and resolves 1-2 days after the menstruation stops. She also complains of crampy pain with defecation. Menarche was at age 13. Her cycles are regular but are associated with heavy bleeding for 5 days. She is not sexually active, and there is no history of sexually transmitted disease. Family history is remarkable for ovarian cancer in her maternal grandmother. Vitals are within normal limits. BMI is 33 kg/m2. Abdominal examination shows no abnormalities. Pelvic examination shows a fixed anteverted uterus and palpable right-sided adnexal mass. Transvaginal ultrasound of the right ovary is shown below.  


Reproduced from: radiopedia.org   

Which of the following is the most likely diagnosis?  

External References

First Aid

2024

2023

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2021

Danazol p. 676

endometriosis p. 658

Dysmenorrhea

endometriosis p. 658

Dyspareunia p. 584

endometriosis p. 658

Endometriosis p. 658

danazol for p. 676

endometriomas and p. 664

ovarian neoplasms and p. 664

Infertility

endometriosis p. 658

Nonsteroidal anti-inflammatory drugs (NSAIDs) p. 495

endometriosis p. 658

Oral contraceptives (OCPs)

endometriosis p. 658

Pelvic pain

endometrioma p. 658

endometriosis p. 658

Progestins p. 675

endometriosis p. 658

Vaginal bleeding

endometriosis p. 658

Transcript

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Endo- means internal and -metrium means womb, so endometrium is the innermost layer of the womb, and endometriosis is where these endometrial cells grow outside of the womb.

The female internal sex organs are the ovaries, which are the female gonads; the fallopian tubes, two muscular tubes that connect the ovaries to the uterus; and the uterus, which is the strong muscular sack that a fetus can develop in.

It’s a hollow organ that sits behind the urinary bladder and in front of the rectum.

The top of the uterus above the openings of the fallopian tubes is called the fundus, and the region below the openings is called the uterine body.

The uterus tapers down into the uterine isthmus and finally the cervix, which protrudes into the vagina.

It’s is anchored to the sacrum by utero-sacral ligaments, to the anterior body wall by round ligaments, and it’s supported laterally by cardinal ligaments as well as the mesometrium, which is part of the broad ligament.

The wall of the uterus has three layers: the perimetrium, which is a layer continuous with the lining of the peritoneal cavity, the myometrium, which is made of smooth muscle that contracts during childbirth to help push the baby out, and the endometrium, a mucosal layer, that undergoes monthly cyclic changes.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Endometriosis and Infertility: How and When to Treat?" Frontiers in Surgery (2014)
  6. "Medical Management of Endometriosis" Clinical Obstetrics & Gynecology (2017)
  7. "Endometriosis" Endocrine Reviews (2019)
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