Endometriosis

Question 1

Endometriosis is when there are endometrial cells growing outside of the womb. What terms is NOT used to describe when this is found outside of the endometrium?

1 - endometrioma
2 - chocolate cyst (on ovaries)
3 - endometriocarcinoma

Answer 1

3 - endometriocarcinoma

Question 2

What % of women in the UK are affected by endometriosis?

1 - 5%
2 - 10%
3 - 25%
4 - 50%

Answer 2

2 - 10%
- typically women in reproductive years

• 2nd most common gynaecological condition, behind fibroids

Question 2

What age does the incidence of endometriosis peak at?

1 - 15-25
2 - 20-30
3 - 30-40
4 - 35-45

Answer 2

3 - 30-40

Question 3

There are 3 layers of the uterus, which of the following is not one of these layers?

1- peritoneum
2 - perimetrium
3 - endometrium
4 - myometrium

Answer 3

1- peritoneum

• perimetrium = continuous layer of the peritoneum that covers the top part of the uterus

Question 4

Which ligament anchors the uterus to the sacrum?

1 - cardinal ligaments
2 - broad ligaments
3 - round ligaments
4 - utero-sacral ligaments

Answer 4

4 - utero-sacral ligaments

Question 5

Which ligament anchors the uterus laterally?

1 - cardinal/transverse ligaments
2 - broad ligaments
3 - round ligaments
4 - utero-sacral ligaments

Answer 5

1 - cardinal/transverse ligaments

Question 6

Which ligament anchors the uterus to the anterior body wall?

1 - cardinal/transverse ligaments
2 - broad ligaments
3 - round ligaments
4 - utero-sacral ligaments

Answer 6

3 - round ligaments

Question 7

Which ligament covers the uterus anteriorly and posteriorly, fallopian tubes and the ovaries and extends to the lateral walls providing stability?

1 - cardinal/transverse ligaments
2 - broad ligaments
3 - round ligaments
4 - utero-sacral ligaments

Answer 7

2 - broad ligament

Question 8

Which of the following is NOT a theory that has been associated with causing endometriosis?

1 - pelvic inflammatory disease
2 - retrograde menstruation
3 - lymphatic spread
4 - endometrium metaplasia

Answer 8

1 - pelvic inflammatory disease

• endometrium metaplasia = cells outside of uterus become endometrial cells
• also a genetic link, but no specific gene identified

Question 9

Endometrial tissue that grows outside of the uterus is responsive to which hormone?

1 - estrogen
2 - progesterone
3 - testosterone
4 - insulin

Answer 9

1 - estrogen
- estrogen levels increase in the menstrual cycle, cyclical pain is felt

• endometrial tissue thickens and then bleeds causing pain, bleeding and inflammation

Question 10

When patients have endometriosis, they typically experience all of the following cyclic symptoms, EXCEPT which one?

1 - sharp pain
2 - heavy pain
3 - dull pain
4 - burning and heavy feeling

Answer 10

1 - sharp pain
- pain is dull in nature

Question 11

Endometriosis can lead to localised bleeding and pain. Long term what can this also lead to?

1 - adhesions
2 - fistula development
3 - abscess
4 - all of the above

Answer 11

1 - adhesions
- inflammation and bleeding causes scar tissue and adhesions

• pain is cyclical in nature

Question 12

When patients have endometriosis, they can develop adhesions between organs that should be present. All of the following are non-cyclic symptoms that may present due to adhesions, EXCEPT which one?

1 - sharp pain
2 - dull pain
3 - chronic pain
4 - pulling/stretching in pelvic and/or abdomen
5 - sick and nausea feeling

Answer 12

2 - dull pain
- pain is far worse than a dull pain

• chronic pain = >6 months

Question 13

Can endometriosis cause abnormal bleeding?

Answer 13

• yes
• if endometrial tissue is present in bladder and/or rectum can cause bleeding

Question 14

Can endometriosis lead to fertility issues?

Answer 14

• yes
• may be due to adhesions blocking ovaries and/or fallopian tubes

Question 15

Can endometriosis lead to Dyspareunia?

Answer 15

• yes

Question 16

When trying to diagnose endometriosis we need to examine the patient. Which of the following is NOT a typical finding that would be present in someone with endometriosis?

1 - endometrioma in vagina
2 - fixed uterus and cervix
3 - mass in ovaries or abdomen
4 - tender with biannual and speculum (cervix, ovaires etc.)

Answer 16

3 - mass in ovaries or abdomen
- not common to find masses due to endometriosis

Question 17

Pelvic ultrasounds can appear normal in patients with endometriosis. However, they can be useful for identifying which 2 of the following?

1 - chocolate ovarian cysts
2 - thickening of endometrium
3 - adhesions
4 - large endometrial masses

Answer 17

1 - chocolate ovarian cysts
4 - large endometrial masses

Question 18

What is the gold standard for diagnosing a patient with endometriosis?

1 - abdominal ultrasound
2 - transvaginal ultrasound
3 - laparoscopy
4 - open surgery
5 - raised CA125

Answer 18

3 - laparoscopy
- can remove or treat tissue if found

• CA125 is not specific to endometriosis, but can be raised

Question 19

What is 1st line imaging technique used in endometriosis?

1 - abdominal ultrasound
2 - transvaginal ultrasound
3 - X-ray
4 - CT scan

Answer 19

2 - transvaginal ultrasound
- abdominal if refuse or unable to have transvaginal ultrasound

Question 20

Which of the following is stage 1 of endometriosis?

1 - characterised by multiple implants, superficial and deeply invasive. Peritubal and periovarian adhesions may be evident.
2 - characterised by multiple superficial and deep implants, including large ovarian endometriomas. Filmy and dense adhesions are usually present.
3 - characterised by isolated implants
4 - characterised by superficial implants <5 cm in aggregate and are scattered on the peritoneum and ovaries.

Answer 20

3 - characterised by isolated implants

Question 21

Which of the following is stage 2 of endometriosis?

1 - characterised by multiple implants, superficial and deeply invasive. Peritubal and periovarian adhesions may be evident.
2 - characterised by multiple superficial and deep implants, including large ovarian endometriomas. Filmy and dense adhesions are usually present.
3 - characterised by isolated implants
4 - characterised by superficial implants <5 cm in aggregate and are scattered on the peritoneum and ovaries.

Answer 21

4 - characterised by superficial implants <5 cm in aggregate and are scattered on the peritoneum and ovaries.

Question 22

Which of the following is stage 3 of endometriosis?

1 - characterised by multiple implants, superficial and deeply invasive. Peritubal and periovarian adhesions may be evident.
2 - characterised by multiple superficial and deep implants, including large ovarian endometriomas. Filmy and dense adhesions are usually present.
3 - characterised by isolated implants
4 - characterised by superficial implants <5 cm in aggregate and are scattered on the peritoneum and ovaries.

Answer 22

1 - characterised by multiple implants, superficial and deeply invasive. Peritubal and periovarian adhesions may be evident.

Question 23

Which of the following is stage 4 of endometriosis?

1 - characterised by multiple implants, superficial and deeply invasive. Peritubal and periovarian adhesions may be evident.
2 - characterised by multiple superficial and deep implants, including large ovarian endometriomas. Filmy and dense adhesions are usually present.
3 - characterised by isolated implants
4 - characterised by superficial implants <5 cm in aggregate and are scattered on the peritoneum and ovaries.

Answer 23

2 - characterised by multiple superficial and deep implants, including large ovarian endometriomas. Filmy and dense adhesions are usually present.

Question 24

The key features of endometriosis are cyclical dysmenorrhoea, pelvic pain and subfertility. But which of the following differentials would NOT typically also be considered? 1 - adenomyosis 2 - Pelvic inflammatory disease 3 - Cervical stenosis 4 - Endometrial cancer 5 - Fibroids 6 - Ovarian cyst 7 - Endometrial polyps

Answer 24

4 - Endometrial cancer

Question 25

Analgesia )paracetamol and NSAID) is always given to patients with endometriosis and to work up the analgesia ladder. What is the 1st line treatment not including analgesia? 1 - hormonal therapy 2 - endometrial ablation 3 - laparoscopic surgery 4 - hysterectomy 5 - psychological support

Answer 25

1 - hormonal therapy - COC or POP - stop ovulation and thickening of endometrium - when medical management fails we use laparoscopy and in extreme cases hysterectomy

Question 26

Medical menopause can be used in extreme cases to relieve symptoms in a patient with endometriosis. What hormone is targeted here? 1 - LH 2 - FSH 3 - GnRH 4 - oestrogen

Answer 26

3 - GnRH - low or no GnRH reduces all other hormones - essentially causes menopause

Question 27

Does having endometriosis increase or decrease the risk of miscarriage?

Answer 27

- increases risk of miscarriage