OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is leiomyoma uteri. While this may seem a odd practice, it is useful to see multiple examples of how leiomyoma uteri will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
QUESTION EXAMPLES
Question # 1
A 34 year old woman comes to the clinic with pelvic paint act has been going on for the past 2 days since her last menstrual period has ended. The painter says that her pain “feels like I am in labor” and she has been taking ibuprofen with little relief. She does have a history of regular, but heavy, menstrual cycles and will on occasion pass clots. She is sexually active and uses the rhythm method for contraception. 4 years ago she had a spontaneous abortion, and was treated with a suction dilation and curettage. A Papanicolau test was normal 2 years ago. Her blood pressure is 140/90 mmHg and her pulse is 114/min. A pelvic exam reveals an irregular enlarge uterus. Her cervix is dilated 5 cm and there is a spherical mass that is visible through the os. The mass is firm and smooth, and the physician notices some bleeding around the mass. What is the most likely diagnosis?
Question # 2
A 37 year old nulliparous woman comes to the emergency room after she experiences a syncopal episode at work. She works as a surgical technician, and spends many hours on her feet. Her colleagues administered 1 L of normal saline to her before she arrived. The patient explains that she is currently on day 9 of her menses, which have become significantly heavier and longer over the past year. She is always regular, at 28 day intervals. A review of systems reveals frequent lightheadedness and heart palpitations experienced by the patient. She is sexually active with her boyfriend, and uses a combined hormonal contraceptive. Her temperature is 98.7 °F, blood pressure is 100/60 mm Hg, and her pulse is 115/min. A pelvic exam shows an irregularly enlarged uterus that is estimated to be 12 weeks in size. Her hemoglobin is 5.0 g/dL, and MCV is 75 fL. A urine pregnancy test is negative. What is the most likely cause of this patients anemia?
Explanation: heavy menstrual bleeding + enlarged uterus = leiomyoma uteri
Question # 3
A 26 year old woman, G1P0, comes to the clinic for her first prenatal visit. She took a at home pregnancy test that was positive. Her last menstrual period was 9 weeks ago. Before conceiving, she had regular 28 day cycles. She experienced heavier and longer periods after stopping oral contraceptives 9 months ago. She explains that she is experiencing some nausea and vomiting, but denies any cramps or vaginal bleeding. She explains that voiding is uncomfortable, and she often does not feel like she can fully “empty” her bladder. She explains that this has been happening for many months prior to the pregnancy, and that she had gotten used to it the past. She elaborates that these symptoms have been getting worse since she became pregnant. She has no past medical history. She takes a daily prenatal vitamin but no other medications. A bimanual pelvic exam reveals a 14 week size mobile irregular with an irregular contour. What is the most likely cause for this patient’s presentation?
Explanation: urinary issues + irregular shaped uterus + larger then expected uterus = leiomyoma uteri
Question # 4
A 39 year old nulliparous woman complains of lower abdominal discomfort and constipation. She has cramping with her menses, and this results in her having to stay home from work 1 day each month. Menses occur at regular 28-day cycles, and there is no bleeding/spotting in between her cycles. Her medical history is significant for asthma. Her family history is notable for a mother who had breast cancer at age 57, and a maternal grandmother who died of ovarian cancer at age 69. Her vital signs are unremarkable. A helpful examination shows an enlarged uterus that is irregular, and mobile. A prominent posterior mass is palpated. What is the most likely diagnosis?
Explanation: constipation + irregular shaped uterus + larger then expected uterus + posterior mass = leiomyoma uteri
Question # 5
A 37 year old woman, G2P0, comes to the clinic with complaints of “feeling something heavy” in her lower abdomen this past year. Her menses occur at regular 28-day intervals, and last 10 days with no bleeding/spotting in between cycles. She has had cramping with her senses that cause her to miss a day of work each month. Her last menstrual period was 4 days ago. She has had 2 first trimester miscarriages in the last year, but is hoping to try to conceive again. Examination shows a mobile, globular mass under the umbilicus that has severe protuberances. A urine pregnancy test is negative. What is the most likely cause of this patient’s symptoms?
Question # 6
A 40 year old woman comes to the clinic complaining of constipation and pelvic pressure. She explains that these symptoms have worsened over the past year. She finds it easer to defecate when she pushes her vaginal canal with her fingers to get the stool out. Even upon doing this, she still feels as though she has not completely evacuated her bowels. Her menses occur very 28 days and she does not have heavy flow or severe pain . She does not have pain with intercourse. Her BMI is 22 kg/m². Physical examination shows an irregularly enlarged uterus and normal rectal tone. What is the most likely cause of this patient’s constipation?
Explanation: constipation + pelvic pressure + irregularly enlarged uterus = leiomyoma uteri (posterior part of the uterus that impinges the colon)
Page Updated: 10.02.2016