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OBG · Gynaecological endocrinology: adenomyosis
Sample itemA 42-year-old multiparous woman has progressive dysmenorrhoea, heavy menses and a uniformly enlarged, globular tender uterus. What is the most likely diagnosis and best imaging modality?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Adenomyosis; MRI or transvaginal ultrasound
Adenomyosis is the presence of endometrial glands within the myometrium, producing a symmetrically enlarged boggy uterus. MRI shows a thickened junctional zone (above 12 mm). Definitive treatment is hysterectomy, with LNG-IUS or GnRH analogues as medical options.
Option by option
A. Endometrial carcinoma; X-ray
Endometrial carcinoma is diagnosed by biopsy.
B. Ovarian cyst; HSG
HSG does not diagnose ovarian cysts.
C. Fibroid uterus; CT scan
Fibroids give an irregular, nodular enlargement.
D. Adenomyosis; MRI or transvaginal ultrasound (correct)
Correct. A globular uterus with dysmenorrhoea is characteristic.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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