A 61-year-old female presents to the physician with a chief complaint of vaginal spotting … — USMLE Step 2 CK

A $61$ -year-old female presents to the physician with a chief complaint of vaginal spotting that began $2$ days ago. She experienced menopause at age $51$ . Her medical history includes hypertension, obesity, and type 2 diabetes mellitus. A speculum examination demonstrates a normal-appearing vagina and cervix, with a small amount of blood exiting the external cervical os. Pelvic sonography is performed and reveals an endometrial stripe thickness of $9 \text{ mm}$ . Which of the following is the most appropriate next step in management?

Endometrial samplingCevap
B
Observation with a repeat ultrasound in 6 months
C
Initiation of oral progesterone therapy
D
Measurement of serum CA-125 concentration
E
Total abdominal hysterectomy

Cevap

Endometrial sampling

Endometrial sampling is the definitive and most appropriate next step for this patient. She presents with postmenopausal bleeding and has multiple risk factors for endometrial cancer, including obesity and type 2 diabetes mellitus (which contribute to a hyperestrogenic state). Furthermore, her pelvic sonography reveals an endometrial stripe of

9 \text{ mm}

. In postmenopausal women, an endometrial thickness

>4 \text{ mm}

requires tissue diagnosis to rule out endometrial hyperplasia and carcinoma.

Adım Adım Çözüm

Identify the primary clinical problem and patient demographic.

The patient is a

61

-year-old postmenopausal female presenting with new-onset vaginal bleeding (postmenopausal bleeding).

Recognizing postmenopausal bleeding is critical because it is a cardinal sign of endometrial cancer until proven otherwise.

Evaluate the results of the initial diagnostic imaging.

Pelvic sonography demonstrates an endometrial thickness of

9 \text{ mm}

In a postmenopausal woman, an endometrial stripe thickness greater than

4 \text{ mm}

is considered abnormal and highly suspicious for hyperplasia or malignancy.

Determine the definitive next step in management based on imaging findings.

Tissue diagnosis via endometrial sampling is indicated.

Because the endometrium is abnormally thickened, direct tissue evaluation is required to rule out endometrial carcinoma before initiating any treatment or electing observation.

Anahtar Kavram

Postmenopausal bleeding with an endometrial stripe

>4 \text{ mm}

on ultrasound requires immediate endometrial sampling to rule out malignancy.

Soru

Cevap

Adım Adım Çözüm

Anahtar Kavram

Sık Yapılan Hatalar

Konular

Bu konudan daha fazla soru