Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

CHAPTER 10
Endometriosis

10–1. With endometriosis, as shown here, which of the following is ectopically located?

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Reproduced, with permission, from Carr BR, Beshay VE: Endometriosis. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 10-10.

a. Myometrial cells

b. Ectocervical cells

c. Endometrial glands and stroma

d. Endocervical glands and stroma

10–2. The prevalence of endometriosis is higher in women with which of the following characteristic?

a. Pelvic pain

b. Infertility

c. Affected family member

d. All of the above

10–3. Which of the following theories is the most widely accepted as the cause of endometriosis?

a. Lymphatic spread

b. Hormonal induction

c. Coelomic metaplasia

d. Retrograde menstruation

10–4. Persistence of endometriosis is directly dependent on which of the following hormones?

a. Estrogen

b. Testosterone

c. Progesterone

d. Androstenedione

10–5. An enzyme important in creating a unique hormonal environment within endometriotic implants includes which of the following?

a. Aromatase

b. Cyclooxygenase type 2

c. 17β-Hydroxysteroid dehydrogenase type 1

d. All of the above

10–6. Which of the following conditions is a risk factor for developing endometriosis?

a. Multiparity

b. Transverse vaginal septum

c. Prior chemotherapy exposure

d. Autoimmune connective tissue disorders

10–7. Which of the following environmental toxins has been implicated in the development of endometriosis?

a. Arsenic

b. Asbestos

c. DEHP—bis(2-ethylhexyl)phthalate

d. TCDD—tetrachlorodibenzo-p-dioxin

10–8. Which of the following is the focus of the classification system developed by the American Society for Reproductive Medicine (ASRM)?

a. Degree of pelvic pain

b. Degree of infertility

c. Anatomic extent of endometriosis

d. All of the above

10–9. In the ASRM classification system, mild endometriosis found during laparoscopy is described as which of the following?

a. Stage 1

b. Grade 1

c. Stage A

d. Grade A

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Photograph contributed by Dr. Karen Bradshaw.

10–10. At the time of laparoscopy, this patient was noted to have endometriotic surface lesions limited to the locations shown below. According to the ASRM classification, which of the following stages is assigned?

a. Stage 1

b. Stage 2

c. Stage 3

d. Stage 4

10–11. At the time of laparoscopy, your patient was noted to have bilateral adnexal cysts. Incision of one of the surgical specimens is seen here. Prior to laparoscopy, the ovarian cysts were measured by sonography and found to be 4 cm (right), 7 cm (left). According to the ASRM classification, this degree of endometriosis would be assigned which stage?

Image

Reproduced, with permission, from Carr BR, Beshay VE: Endometriosis. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 10-4B.

a. Stage 1

b. Stage 2

c. Stage 3

d. Stage 4

10–12. In which of the following locations is endometriosis LEAST likely to be found?

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Reproduced, with permission, from Carr BR: Endometriosis. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 10-3.

a. Ovary

b. Bladder

c. Posterior cul-de sac

d. Uterosacral ligaments

10–13. Which of the following locations is endometriosis MOST likely to be found?

a. Bladder

b. Small bowel

c. Large bowel

d. Posterior cul-de sac

10–14. Which of the following patient complaints is LEAST likely to be encountered in women with endometriosis?

a. Dysuria

b. Dyschezia

c. Dyspareunia

d. Dysmenorrhea

10–15. Which of the following statements is true regarding endometriosis?

a. Depth of disease invasion correlates with degree of pain

b. Severity of disease correlates with degree of infertility

c. Severity of disease correlates with degree of dyspareunia

d. All of the above

10–16. In women presenting with chronic pelvic pain, what percentage of women are expected to have endometriosis at the time of laparoscopy?

a. 1–5

b. 10–30

c. 40–60

d. 80–90

10–17. Which of the following is the most likely etiology for infertility in women with endometriosis?

a. Tubal obstruction

b. Implantation defect

c. Ovulatory dysfunction

d. Abnormalities of the endocervical mucus

10–18. Compared with women without endometriosis, women with endometriosis undergoing in vitro fertilization (IVF) treatment for infertility will have which of the following?

a. Higher pregnancy rates

b. Fewer blastomeres per embryo

c. Higher oocyte yields at oocyte retrieval

d. Lower embryonic developmental arrest rates

10–19. When considering the diagnosis of endometriosis, which of the following gynecologic conditions should be considered in the differential diagnosis?

a. Tubo-ovarian abscess

b. Interstitial cystitis

c. Degenerating leiomyoma

d. All of the above

10–20. Which of the following manifestations is most likely encountered during the physical examination of a patient with endometriosis?

a. Tenderness to lower abdominal palpation

b. Endocervical polyp during speculum examination

c. Powder burn lesions on the cervix during speculum examination

d. Uterosacral ligament nodularity during bimanual examination

10–21. Which of the following is true regarding laboratory testing during evaluation of suspected endometriosis?

a. It should rarely be performed.

b. It identifies most cases of endometriosis.

c. It is used mainly to exclude other conditions.

d. Reference ranges vary widely among laboratories that perform endometriosis-specific assays.

10–22. Which of the following methods can reliably assist in making the diagnosis of endometriosis?

a. Sonography

b. Laparoscopy

c. Computed tomography

d. Magnetic resonance imaging

10–23. Sonographically, endometriomas are typically described as which of the following?

a. Solid with intracystic blood flow

b. Cystic with hyperechoic internal echoes

c. Solid with diffuse internal low level echoes

d. Cystic with diffuse internal low level echoes

10–24. The following pelvic sonogram image signifies which of the following conditions?

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a. Ovarian torsion

b. Mature teratoma

c. Tubo-ovarian abscess

d. Ovarian endometrioma

10–25. Which of the following peritoneal implant colorings most commonly correlates with histologic findings of endometriosis?

a. Red

b. Blue

c. Black

d. Clear

10–26. Medical treatment for endometriosis may include all EXCEPT which of the following?

a. Progestins

b. Oral contraceptives

c. Aromatase inhibitors

d. Androgen-receptor blockers

10–27. Which of the following combination oral contraceptive formulations is most effective in the management of endometriosis?

a. Monophasic

b. Multiphasic

c. Low dose (20 μg ethinyl estradiol)

d. All are equally effective

10–28. The treatment effect of progestins on endometriosis is secondary to which of the following?

a. Estrogen antagonism

b. Androgen antagonism

c. Aromatase inhibition

d. Glucocorticoid stimulation

10–29. Women seeking immediate fertility and who suffer from endometriosis would most likely benefit from which of the following treatments?

a. Danazol

b. Aromatase inhibitors

c. Laparoscopic ablation of lesions

d. Gonadotropin-releasing hormone (GnRH) agonists

10–30. All EXCEPT which of the following are danazol side effects?

a. Hirsutism

b. Hot flashes

c. Voice deepening

d. Breast hypertrophy

10–31. The most troublesome side effects of GnRH agonist use stem from which of the following?

a. Hypoestrogenism

b. Hypoandrogenism

c. Hyperestrogenism

d. Hyperandrogenism

10–32. When should add-back therapy be considered during the course of GnRH agonist treatment?

a. At 1 month

b. At 6 months

c. Not necessary

d. At initiation of therapy

10–33. With deeply infiltrating endometriosis, which of the following surgical approaches may most likely benefit the patient?

a. Laser ablation

b. Radical excision

c. Bipolar electrosurgical ablation

d. Monopolar electrosurgical ablation

10–34. For surgical treatment of endometriomas, which of the following approaches is superior?

a. Drainage

b. Cystectomy

c. Cyst wall ablation

d. None of the above

10–35. Which of the following statements is most likely true regarding presacral neurectomy?

a. It may be performed laparoscopically.

b. It effectively treats lateral adnexal pain.

c. It is a procedure that excises the uterosacral ligaments.

d. It should commonly be used for most women with endometriosis.

10–36. Which of the following is a concern with the use of estrogen replacement therapy following bilateral salpingo-oophorectomy for endometriosis?

a. Recurrence of endometriotic lesions

b. Persistence of endometriotic lesions

c. Cancer development within endometriotic lesions

d. All of the above

Chapter 10 ANSWER KEY

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