A 28-year-old nulligravid patient complains of bleeding between her periods and increasingly heavy menses. Over the past 9 months she has had two dilation and curettages (D&Cs), which have failed to resolve her symptoms, and oral contraceptives and antiprostaglandins have not decreased the abnormal bleeding. Which of the following options is most appropriate at this time?
a. Perform a hysterectomy
b. Perform hysteroscopy
c. Perform endometrial ablation
d. Treat with a GnRH agonist
e. Start the patient on a high-dose progestational agent
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is b; Perform hysteroscopy.
In patients with abnormal bleeding who are not responding to standard therapy, hysteroscopy should be performed. Hysteroscopy can rule out endometrial polyps or small fibroids, which, if present, can be resected. In patients with heavy abnormal bleeding who no longer desire fertility, an endometrial ablation can be performed. If a patient has completed childbearing and is having significant abnormal bleeding, a hysteroscopy, rather than a hysterectomy, would still be the procedure of choice to rule out easily treatable disease. Treatment with a GnRH agonist would only temporarily relieve symptoms.