Snapshot A 45-year-old African American G2P2 woman presents with abnormal uterine bleeding. She reports irregular spotting between periods and pain with intercourse. Physical exam reveals a mobile, asymmetric, nontender uterus with multiple nodular abnormalities. A Transvaginal ultrasound shows hyperchoic masses within the uterine wall. She decides to undergo a hysterectomy because she does not want any more children. summary Otherwise known as fibroids Leiomyomas are smooth muscle growths of the uterine myometrium can be intramural submucosal subserosal Often present with multiple discrete tumors Epidemiology benign uterine tumor tumor in females seen in African Americans (5x more common) occurs in women 20-40 years of age Presentation Symptoms sensitive to estrogen levels tumor growth and increased symptoms during pregnancy decreased symptoms during menopause symptoms depend on location of leiomyoma intramural asymptomatic submucosal intermenstrual bleeding and menorrhagia subserosal compression of bladder, rectum, or ureter pelvic pain urinary or bowel issues Physical exam uterus is enlarged firm mobile asymmetric nontender multiple tumors IMAGING transvaginal ultrasound has high sensitivity (95-100%) hyperechoic, well-circumscribed round masses STUDIES Labs β-hCG to rule out pregnancy Histology whorled pattern of smooth muscle bundles Differential Diagnosis Leiomyosarcoma Adenomyosis Endometrial polyp Pregnancy Diagnosis Confirmed with sonogram Treatment If asymptomatic observation fibroids can shrink substantially postpartum and after menopause If symptomatic NSAIDs for dysmenorrhea OCPs for abnormal uterine bleeding GnRH analogs to shrink fibroids pre-surgery surgical management myomectomy preserves childbearing potential uterine artery embolization preserves childbearing potential if myomectomy is not an option hysterectomy definitive therapy Complications very rarely (if at all) transforms into leiomyosarcoma infertility iron deficiency anemia Prognosis having symptomatic fibroids decreases quality of life
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.GN.17.4754) A 37-year-old G1P000 presents to her obstetrician for her first prenatal visit. She states that her last menstrual period (LMP) was 11 weeks ago, though she is unsure of the exact date as her periods are sometimes irregular. She and her husband had 5 months of timed, unprotected intercourse before she had a positive home pregnancy test 2 weeks ago. She has been feeling generally well but notes some morning nausea and vomiting. She also mentions that for the last 6 months or so, she has felt increasing pelvic pressure and worsening urinary frequency but has not sought medical care for these symptoms. The patient has a history of obesity and hypertension but is not on any medications. Her mother had a hysterectomy at age 64 for fibroids, and her sister had a twin pregnancy after assisted reproduction. At this visit, the patient’s temperature is 98.3° F (36.8° C), blood pressure is 142/85 mmHg, pulse is 82/min, and respirations are 14/min. She has gained 4 pounds since the last time she weighed herself 4 months ago. On exam, the patient’s fundus is palpated at the umbilicus, her cervix is closed and firm, and there are no adnexal masses. Her lab results are shown below:ß-hCG: 81,324 mIU/mLThyroid stimulating hormone (TSH): 1.2 µIU/LWhich of the following is the most likely diagnosis? QID: 108706 Type & Select Correct Answer 1 Molar pregnancy 35% (14/40) 2 Dating error due to unreliable LMP 42% (17/40) 3 Leiomyomata 15% (6/40) 4 Multiple gestation pregnancy 5% (2/40) 5 Anteverted uterus 0% (0/40) M 6 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (M2.GN.13.254) A 32-year-old woman presents to clinic complaining of pelvic pain and heavy menstrual bleeding for the past 2 years. The patient reports that her last menstrual period was 1 week ago and she soaked through 1 tampon every 1-2 hours during that time. She does not take any medications and denies alcohol and cigarette use. She is currently trying to have a child with her husband. She works as a school teacher and exercises regularly. Her temperature is 97.0°F (36.1°C), blood pressure is 122/80 mmHg, pulse is 93/min, respirations are 16/min, and oxygen saturation is 99% on room air. Physical examination reveals an enlarged, irregularly-shaped uterus palpable at the level of the umbilicus. Laboratory studies are ordered as seen below.Hemoglobin: 9.0 g/dLHematocrit: 29%MCV: 70 fLLeukocyte count: 4,500/mm^3 with normal differentialPlatelet count: 188,000/mm^3Urine:hCG: NegativeBlood: NegativeLeukocytes: NegativeBacteria: NegativeWhich of the following is the most effective treatment for this patient? QID: 106210 Type & Select Correct Answer 1 Folate 2% (2/100) 2 Hysterectomy 8% (8/100) 3 Iron 69% (69/100) 4 Myomectomy 13% (13/100) 5 Oral contraceptive pills 5% (5/100) M 7 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
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