Endometriosis And Adenomyosis

Question 1

Clinical features of Endometriosis

Answer 1

Severe non-colicky pelvic pain, deep pain with intercourse

Question 2

A TVUS can detect endometriosis involving what?

Answer 2

The ovaries

Question 3

A finding on TVUS called kissing ovaries means what?

Answer 3

It’s when the ovaries are fixed together, such findings add strength to the diagnosis

Question 4

Is endometriosis treatable?

Answer 4

Generally no, but symptom reliefs are indicated, like COCP to remove sex pain (dyspareunia), NSAIDS to remove pelvic pain.

Question 5

Progestogens are indicated to endometriosis patients when?

Answer 5

When COCP is contraindicated

Question 6

What is the only possible surgical treatment that spares fertility

Answer 6

Laparoscopy

Question 7

Investigation of choice for Adenomyosis?

Answer 7

MRI

Question 8

Treatment options for Adenomyosis?

Answer 8

Any treatment that induces amenorrhea, because it then relives the pain. As such LNG-IUS and depo porvera are used together

Question 9

Definitive treatment option for adenomyosis?

Answer 9

Hysterectomy

Question 10

A 32-year-old woman presents with worsening dysmenorrhea and deep dyspareunia. Pelvic exam reveals tender uterosacral nodules. TVUS shows a 4 cm ovarian cyst with “ground-glass” echogenicity. What is the most likely diagnosis?

Answer 10

Endometriosis

Question 11

A 28-year-old with chronic pelvic pain and infertility undergoes laparoscopy. Multiple superficial peritoneal “powder-burn” lesions are seen. What is the best initial treatment if she desires fertility?

Answer 11

Laparoscopic ablation

Question 12

First-line therapy for Adenomyosis?

Answer 12

LNG-IUS + depo porvera

Question 13

Which hormonal therapy is most likely to cause irreversible voice changes?
a) Levonorgestrel-IUS
b) Danazol
c) GnRH agonists
d) Aromatase inhibitors

Answer 13

Danazol

Question 14

A 30-year-old with endometriosis has severe dyspareunia. Exam reveals a fixed, retroverted uterus. What is the most likely anatomic site involved?
a) Uterosacral ligaments
b) Bladder dome
c) Round ligaments
d) Fallopian tubes

Answer 14

Uterosacral ligaments

Question 15

A “chocolate cyst” is most commonly found in which organ?

a) Uterus
b) Ovary
c) Fallopian tube
d) Bladder

Answer 15

Ovary

Question 16

Which symptom is most specific for deep infiltrating endometriosis?

a) Dysmenorrhea
b) Dyspareunia
c) Dyschezia
d) Chronic pelvic pain

Answer 16

Dyschezia

Question 17

The gold standard for diagnosing endometriosis is:

a) Transvaginal ultrasound
b) MRI
c) Laparoscopy with biopsy
d) CA-125 levels

Answer 17

Laparoscopy with biopsy

Question 18

Which medication is avoided in endometriosis due to androgenic side effects?

a) Progestogens
b) Danazol
c) NSAIDs
d) COCPs

Answer 18

Danazol