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A. MLA Map Obstetrics and Gynaecology > Endometriosis > Flashcards

Endometriosis Flashcards

1
Q

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

A

3 - endometriocarcinoma

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2
Q

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

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

A

2 - 10%
- typically women in reproductive years

  • 2nd most common gynaecological condition, behind fibroids
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2
Q

What age does the incidence of endometriosis peak at?

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

A

3 - 30-40

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3
Q

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

A

1- peritoneum

  • perimetrium = continuous layer of the peritoneum that covers the top part of the uterus
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4
Q

Which ligament anchors the uterus to the sacrum?

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

A

4 - utero-sacral ligaments

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5
Q

Which ligament anchors the uterus laterally?

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

A

1 - cardinal/transverse ligaments

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6
Q

Which ligament anchors the uterus to the anterior body wall?

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

A

3 - round ligaments

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7
Q

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

A

2 - broad ligament

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8
Q

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

A

1 - pelvic inflammatory disease

  • endometrium metaplasia = cells outside of uterus become endometrial cells
  • also a genetic link, but no specific gene identified
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9
Q

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

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

A

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

  • endometrial tissue thickens and then bleeds causing pain, bleeding and inflammation
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10
Q

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

A

1 - sharp pain
- pain is dull in nature

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11
Q

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

A

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

  • pain is cyclical in nature
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12
Q

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

A

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

  • chronic pain = >6 months
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13
Q

Can endometriosis cause abnormal bleeding?

A
  • yes
  • if endometrial tissue is present in bladder and/or rectum can cause bleeding
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14
Q

Can endometriosis lead to fertility issues?

A
  • yes
  • may be due to adhesions blocking ovaries and/or fallopian tubes
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15
Q

Can endometriosis lead to Dyspareunia?

A
  • yes
16
Q

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.)

A

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

17
Q

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

A

1 - chocolate ovarian cysts
4 - large endometrial masses

18
Q

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

A

3 - laparoscopy
- can remove or treat tissue if found

  • CA125 is not specific to endometriosis, but can be raised
19
Q

What is 1st line imaging technique used in endometriosis?

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

A

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

20
Q

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.

A

3 - characterised by isolated implants

21
Q

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.

A

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

22
Q

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.

A

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

23
Q

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.

A

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

24
Q

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

A

4 - Endometrial cancer

25
Q

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

A

1 - hormonal therapy
- COC or POP
- stop ovulation and thickening of endometrium

  • when medical management fails we use laparoscopy and in extreme cases hysterectomy
26
Q

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

A

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

27
Q

Does having endometriosis increase or decrease the risk of miscarriage?

A
  • increases risk of miscarriage

A. MLA Map Obstetrics and Gynaecology (29 decks)

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