00:00 / 00:00








0 / 20 complete

USMLE® Step 1 questions

0 / 2 complete

High Yield Notes

9 pages



of complete


USMLE® Step 1 style questions USMLE

of complete

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








Danazol p. 682

endometriosis p. 665


endometriosis p. 665

Dyspareunia p. 590

endometriosis p. 665

Endometriosis p. 665

danazol for p. 682

endometriomas and p. 670

ovarian neoplasms and p. 670


endometriosis p. 665

Nonsteroidal anti-inflammatory drugs (NSAIDs) p. 499

endometriosis p. 665

Oral contraceptives (OCPs)

endometriosis p. 665

Pelvic pain

endometrioma p. 665

endometriosis p. 665

Progestins p. 681

endometriosis p. 665

Vaginal bleeding

endometriosis p. 665


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.


  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)

Copyright © 2023 Elsevier, its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Cookies are used by this site.

USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.