Uterine fibroids
Uterine Fibroids are abnormal growth of uterine smooth muscles. Risk factors include previous history, family history, early menarche, late menopause, nulliparity, obesity, blacks, genetics and hereditary. How they present include preterm labor, dysmenorrhea, infertility, mass, HMB, pressure symptoms like constipation, DVT, edema, urine retention, hydroureters, hydronephrosis. Types are p...
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Question 1
Multiple choiceA 34-year-old woman presents with heavy menstrual bleeding and pelvic pressure symptoms. Upon examination, she is diagnosed with uterine fibroids. Which risk factor is NOT commonly associated with the development of uterine fibroids?
Explanation
Previous history of ectopic pregnancy is not a commonly recognized risk factor for uterine fibroids.
Question 2
Multiple choiceWhich type of uterine fibroid is located inside the uterine cavity and often leads to menstrual irregularities?
Explanation
Submucosal fibroids are located within the uterine cavity and can cause heavy menstrual bleeding and other symptoms.
Question 3
Multiple choiceA 28-year-old nulliparous woman with a family history of uterine fibroids presents complaining of severe dysmenorrhea and pelvic pain. Which of the following diagnostic modalities would be the most suitable first-line investigation?
Explanation
Transvaginal ultrasound is often the first-line investigation to assess for uterine fibroids due to its effectiveness in visualizing the uterus.
Question 4
Multiple choiceIn a patient diagnosed with hydroureters secondary to uterine fibroids, which of the following treatment options should be prioritized to relieve her urinary symptoms?
Explanation
Myomectomy may be indicated to relieve urinary symptoms caused by fibroids that obstruct urinary flow.
Question 5
Multiple choiceA 40-year-old woman with a history of uterine fibroids experiences recurrent episodes of venous thromboembolism. What is the most likely complication of fibroids contributing to this condition?
Explanation
Chronic edema from venous obstruction due to bulk effect of fibroids may increase risk for venous thromboembolism.
Question 6
Multiple choiceRegarding the management options for uterine fibroids, which statement is true regarding hormonal treatment?
Explanation
Hormonal treatments can help manage symptoms by temporarily reducing fibroid size but are not definitive cures.
Question 7
Multiple choiceA 36-year-old woman is planning to conceive but has been informed that she has submucosal fibroids. What is an appropriate management plan prior to attempting to conceive?
Explanation
Myomectomy is advisable prior to conception to improve chances of implantation and reduce risk of pregnancy complications.
Question 8
Multiple choiceIn evaluating a patient with suspected uterine fibroids, which of the following supportive diagnostic tests would be least relevant?
Explanation
While FBC can help assess for anemia due to heavy menstrual bleeding, it is less directly relevant for diagnosing fibroids compared to imaging studies.
Question 9
Multiple choiceA patient with large pedunculated fibroids presents at 30 weeks of gestation with preterm labor. What is the most critical management step in this scenario?
Explanation
Administering tocolytics is essential for managing preterm labor while carefully monitoring both maternal and fetal status.
Question 10
Multiple choiceA 39-year-old woman with a history of DVT and obesity is diagnosed with subserosal uterine fibroids. Which treatment option presents the highest risk of exacerbating her underlying conditions?
Explanation
Use of GNRH analogues can increase thromboembolic risk in patients with a history of DVT and obesity.
Question 11
Multiple choiceWhen considering the complications of untreated uterine fibroids, which of the following scenarios illustrates possible hydronephrosis development?
Explanation
Fibroids can compress ureters, leading to obstructive uropathy and subsequent hydronephrosis.
Question 12
Multiple choiceConsidering the genetic predispositions associated with uterine fibroids, what is the most influential genetic finding relevant to their development?
Explanation
Mutations in smooth muscle cells have been noted in the pathogenesis of uterine fibroids.
Question 13
Multiple choiceA 31-year-old patient being treated for heavy menstrual bleeding due to uterine fibroids is prescribed mefenamic acid. What is the primary mechanism by which it alleviates her symptoms?
Explanation
Mefenamic acid works by inhibiting prostaglandin production, leading to decreased menstrual bleeding.
Question 14
Multiple choiceA 35-year-old nulliparous woman presents with heavy menstrual bleeding and severe dysmenorrhea. Imaging reveals a large intramural uterine fibroid. Given her presentation and desired fertility, what is the most appropriate management option?
Explanation
Myomectomy is indicated in women with fibroids who wish to preserve their fertility, especially when they present with heavy menstrual bleeding and dysmenorrhea.
Question 15
Multiple choiceAn African-American patient in her early 40s with a family history of uterine fibroids presents with urinary retention and significant bilateral edema. Upon assessment, it’s determined she has several subserosal and one pedunculated submucosal fibroid. Considering the possible complications, which of the following should be prioritized in her management plan?
Explanation
Due to her significant urinary retention caused by the fibroids, a urological evaluation should be prioritized to assess and address any obstructions.