This page is dedicated to organizing various examples of standardized exam questions whose answer is adenomyosis. While this may seem a odd practice, it is useful to see multiple examples of how adenomyosis 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.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each condition has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for adenomyosis.
- Pain: both painful periods and intermittent pelvic pain are possible
- Heavy menses: may be noted
- Boggy, globular, tender, and/or enlarged uterus will be present on the physical exam
- Endometrial biopsy will be normal (can show secretory endometrium)
Question # 1
A 47 year old woman, G2P2, comes to the clinic with a 2 year history of heavy, painful periods, as well as pelvic pain between periods. She previously had regular 25-day cycles that lasted for 4 days. Currently her senses occur at 22 day intervals. She changes her pad every 2 hours during the the first 3 days of her menses, and the flow is much lighter on the last day. She has a past history of 2 cesarean sections. She does not take medications and denies having any allergies. Her temperature is 98.4° C. Physical exam shows a symmetrically enlarged uterus that is consistent with 10 weeks in size. The uterus is boggy, tender, globular and freely motile. The urine beta hCG is negative. What is the most likely explanation for this patient’s presentation?
Painful periods + pelvic pain + heavy menses + enlarged/boggy/tender/globular uterus = adenomyosis
A 44 year old female, G3P3, comes to her physician with complaints of heavy and painful menstrual bleeding. She has been experiencing these symptoms for the past 4 months. She explains that her last menstrual period was 20 days ago. Menarche was at age 11, and she has regular 29 day cycles. She is sexually active with her boyfriend, and denies any pain during intercourse. Her past history is notable for a bilateral tubal ligation 5 years ago. She does not take any medications and denies the usage of alcohol, tobacco, or any illicit substances. The patient’s vital signs are unremarkable. During a physical exam the physician notes that her uterus is uniformly enlarged. A urine beta-hCG is performed and is negative. The patient undergoes an endometrial biopsy, which revel as the presence of secretory endometrium. What is the most likely cause of this patient’s symptoms?
Painful periods + heavy menses + enlarged uterus + normal endometiral biopsy = adenomyosis
A 39 year old female, G3P2, comes to the clinic because she has been experiencing painful and irregular menses. She also complains of vaginal spotting of the past 4 months. Her menses occur every 27 days, and last for 3-5 days. She admits that she is not sexually active. An endometrial biopsy is conducted and shows secretory endometrium. During the physical exam the uterus is noted to be 12 cm in size, soft, and tender. No adenexal masses are present. A saline infusion ultrasound is performed and is notable for only an enlarged uterus. What is the likely diagnosis in this patient?
Painful periods + enlarged/tender uterus + normal endometrial biopsy = adenomyosis
TESTABLE FACTS ABOUT THIS CONDITION (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying condition. Often there are specific testable facts regarding some aspect of the disease’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
- What is it? presence of endometrial glandular tissues within the myometrium of the uterus.
Page Updated: 10.15.2016