Mehl. dysmenorrhea/endometriosis/adenomyosis 03-24 (1)

Question 1

M. Primary dysmenorrhea.
What is dysmenorrhea?

Answer 1

Dysmenorrhea = period pain.

Question 2

M. Primary dysmenorrhea. what is it?

Answer 2

Primary dysmenorrhea = “normal period pain”; benign.

Question 3

M. Primary dysmenorrhea. mechanism?

Answer 3

Mechanism is prostaglandin PGF2a hypersecretion.

Question 4

M. Primary dysmenorrhea.

During menstruation, the endometrial cells release high levels of prostaglandins, which cause uterine contractions and pain. The prostaglandins can also make their way into the systemic circulation, leading to headache and nausea.

Answer 4

.

Question 5

M. This is the answer on USMLE for period pain under the age of 20. The Q can say, girl who is 17 has menstrual pain so bad she has to miss class + physical exam shows no abnormalities, Dx?

Answer 5

primary dysmenorrhea

Question 6

M. Primary dysmenorrhea.

the answer can also be written simply as “prostaglandin secretion.”

Answer 6

.

Question 7

M. Primary dysmenorrhea.
The key detail regarding primary dysmenorrhea is that ?

Answer 7

the physical exam is normal

Question 8

M. Primary dysmenorrhea. VS In endometriosis, the physical exam is??????

Answer 8

the physical exam is abnormal + is always over age 20.

Question 9

M. Primary dysmenorrhea. Tx?

Answer 9

Treatment is NSAID.
OCP is wrong answer if listed alongside NSAID (on NBME).

Question 10

M. Endometriosis. definition?

Answer 10

Growth of endometrial tissue outside the uterus.

Question 11

M. Endometriosis. most common location?

Answer 11

Most common location is the ovary, but can also grow in other locations like the pouch of Douglas.

Question 12

M. Endometriosis. mechanism?

Answer 12

Mechanism is thought to be retrograde menstrual flow through the Fallopian tubes + seeding onto the ovaries or peritoneum.

Question 13

M. Endometriosis. CP?

Answer 13

Causes severe menstrual pain over age 20 + an ABNORMAL physical exam.

Question 14

M. Endometriosis.

The abnormal physical exam can be any miscellaneous finding – i.e., there is no specific finding you have to memorize. They can say findings such as nodularity of the uterosacral ligaments, a fixed retroverted uterus (due to adhesions from lesions), or pelvic tenderness.

Answer 14

.

Question 15

M. In contrast, severe period pain + normal physical exam = Dx?

Answer 15

primary dysmenorrhea.

NOT ENDOMETRIOSIS

Question 16

M. 3F + period pain so bad she has to miss work + normal physical exam = answer?

Answer 16

answer = prostaglandin secretion / primary dysmenorrhea.

Question 17

M. 23F + period pain so bad she has to miss work + physical exam shows nodularity of the uterosacral ligaments = Dx?

Answer 17

answer = endometriosis.

Question 18

M. Endometriosis.
Descriptors such as pain with defecation (due to pouch of Douglas lesions) or dyspareunia (pain during sex) are highly buzzy and pass-level but too easy, so are often omitted from NBME questions, as per my observation.

Answer 18

.

Question 19

M. Endometriosis. next best step?

Answer 19

USMLE wants diagnostic laparoscopy as next best step.

Question 20

M. Endometriosis. Dx = short term?

Answer 20

NSAIDs and OCPs are short-term measures

Question 21

M. Endometriosis. definitive Tx?

Answer 21

definitive Tx is laparoscopic removal of lesions.

Question 22

M. Adenomyosis. definition?

Answer 22

Growth of endometrial tissue within the myometrium.

Question 23

M. Adenomyosis. CP?

Answer 23

Presents as a diffusely enlarged uterus + vaginal bleeding in woman 30s-50s.

Question 24

M. Adenomyosis. Pain?

Answer 24

May or may not be painful.

Question 25

M. Adenomyosis. Q will say woman had tubule ligation two years ago + now has uterus that is 8 weeks’ gestation in size + vaginal bleeding. Answer = adenomyosis. Student is confused and says “how can she be pregnant if she had tubule ligation?” She’s not. Use your head. It’s just how the Q can describe the incr.­ size.

Answer 25

.

Question 26

M. Adenomyosis. Tx?

Answer 26

NSAIDs + OCPs.

Question 27

M. Adenomyosis. What can be used for Tx in theory?

Answer 27

Leuprolide can be used in theory, but I haven’t seen it assessed.

Question 28

M. Ovulatory pain; can present as sharp adnexal pain mid-cycle. Dx?

Answer 28

Mittelschmerz

Question 29

M. Mittelschmerz?

Answer 29

Ovulatory pain; can present as sharp adnexal pain mid-cycle.

Question 30

M. Heavy periods (>80 mL; can present with clots); and/or menses lasting >7 days?

Answer 30

Menorrhagia

Question 31

M. Menorrhagia?

Answer 31

Heavy periods (>80 mL; can present with clots); and/or menses lasting >7 days

Question 32

M. Mid-cycle bleeding (i.e., any bleeding between periods). Slightly different from “breakthrough bleeding,” which refers to mid-cycle bleeding in women using hormonal contraception.??

Answer 32

Metrorrhagia

Question 33

M. Metrorrhagia?

Answer 33

Mid-cycle bleeding (i.e., any bleeding between periods). Slightly different from “breakthrough bleeding,” which refers to mid-cycle bleeding in women using hormonal contraception.

Question 34

M. Persistent or recurrent pain during sex; no one specific etiology.?

Answer 34

Dyspareunia

Question 35

M. Dyspareunia?

Answer 35

Persistent or recurrent pain during sex; no one specific etiology.

Question 36

M. Dyspareunia specifically caused by involuntary contraction of the pelvic floor muscles, especially the pubococcygeus (PC), presenting as spasmodic pain during sex.?

Answer 36

Vaginismus

Question 37

M. Vaginismus?

Answer 37

Dyspareunia specifically caused by involuntary contraction of the pelvic floor muscles, especially the pubococcygeus (PC), presenting as spasmodic pain during sex.