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 35-year-old woman seeks treatment for severe dysmenorrhea and heavy menstrual bleeding (HMB). Upon ultrasound, uterine fibroids are identified. Which risk factor is least likely to be associated with her condition?
Explanation
Early menopause is not typically a recognized risk factor for the development of uterine fibroids, whereas obesity, family history, and nulliparity are established risk factors.
Question 2
Multiple choiceA 28-year-old nulliparous woman presents with abdominal swelling and urinary retention. An ultrasound shows multiple subserosal fibroids. Which of the following is the most appropriate first-line treatment option?
Explanation
The COCP can help manage symptoms associated with fibroids, such as heavy menstrual bleeding, making it the most appropriate first-line treatment in this case.
Question 3
Multiple choiceA patient with a previously diagnosed pedunculated submucosal fibroid presents with acute pelvic pain and heavy menstrual bleeding. Which complication should be most concerning in her case?
Explanation
Uterine torsion, particularly with pedunculated fibroids, is a serious concern due to its potential to cause necrosis of the fibroid and severe pain.
Question 4
Multiple choiceIn managing fibroids, which class of drugs is primarily used for short-term management of heavy menstrual bleeding (HMB)?
Explanation
Tranexamic acid is specifically indicated for short-term control of heavy menstrual bleeding and is effective in this clinical scenario.
Question 5
Multiple choiceA 40-year-old woman with a history of fibroids is being evaluated for infertility. Which underlying mechanism may contribute to her difficulty conceiving?
Explanation
Intramural or submucosal fibroids can alter the endometrial receptivity or the uterine cavity's shape, affecting implantation and fertility.
Question 6
Multiple choiceAn ultrasound in a patient with suspected uterine fibroids also indicates hydronephrosis. Which underlying pathophysiological mechanism is most likely responsible for this condition?
Explanation
Uterine fibroids can compress the ureters, leading to obstruction and subsequent hydronephrosis, particularly if fibroids are located near the ureteral insertion points.
Question 7
Multiple choiceA 50-year-old woman presents with a history of late menopause and is found to have multiple intramural fibroids. Which surgical intervention is most justified if she opts for surgery due to severe symptoms?
Explanation
Given her age and severe symptoms, a total abdominal hysterectomy would resolve the issue effectively, especially since she is likely done with childbearing.
Question 8
Multiple choiceA patient diagnosed with adenomyosis is also found to have fibroids. Considering the overlap of these conditions, which of the following statements is most accurate?
Explanation
Adenomyosis often coexists with uterine fibroids and can aggravate menstrual bleeding and pain, thus understanding their relationship is critical in management.
Question 9
Multiple choiceA 32-year-old female patient presents with symptoms of severe lower abdominal pain and heavy menstrual bleeding. Imaging reveals a large submucosal fibroid impacting the uterine cavity. In this case, what would be the most appropriate course of action?
Explanation
A hysteroscopic myomectomy is appropriate for submucosal fibroids as it allows for direct removal and can improve her symptoms significantly.
Question 10
Multiple choiceAn analysis of a study group of women undergoing treatment for uterine fibroids reveals a significant association between the size of fibroids and the incidence of DVT. Which of the following underlying mechanisms may explain this correlation?
Explanation
Immobility resulting from pelvic discomfort caused by larger fibroids contributes to an increased risk of DVT, emphasizing the need for early intervention.