HY USMLE Q#3 OBS GY Concept Step 1 and 2CK

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Step 2ck/ 3 level (inspired from UWORLD)

A 41 year-old-woman g4p4 presents due to heavy bleeding for the past 3 months. She had bilateral tubal ligation 3 years ago after her last delivery. Her BMI is 24 kg/m2. The uterus is uniformly enlarged and tender. What is the UNDERLYING pathology?

A. Benign Proliferation of the smooth muscle cell proliferation

B. Local overgrowth of endometrium into the uterine cavity

C. Unreg endometrial proliferation w/increased gland-to-stroma ratio

D. Endometrial glands and stroma in the myometrium

E Blastocyst in the ampulla of the fallopian tube

Explanation:

✅D. Endometrial glands and stroma in the myometrium --> Tenderness and uniformly enlarged uterus and sort of manipulation of the uterus through surgery like C sec or myomectomy can cause adenomyosis and also multiparity during pregnancy there is an increase of estrogen and progesterone can lead to abnormal growth into the myometrium.

Estrogen and progesterone levels increase during pregnancy which maintain the endometrium, inhibit uterine contractions and support the developing fetus. During early pregnancy beta-hcg from synciotrophoblast cells which stimulate the corpus luteum which stimulates the corpus luteum in the ovary to produce progesterone and also some estradiol which is specifically produced by the granulosa-lutein cells of the corpus luteum.

During Mid to late pregnancy from 10 to 12 weeks onward. The placenta takes over hormone production ( this is called luteal-placental shift). Specifically, the syncytiotrophoblast of the placenta becomes the source of estrogen mainly estriol which is derived from fetal adrenal precursors.

❌ A. Benign Proliferation of the smooth muscle cell proliferation --> Lieomyom or fibroids this will be an irregular uterus.

❌ B. Local overgrowth of the endometrium into the uterine cavity --> polyps which will present as Intermittent bleeding.

❌ C. Unregulated endometrial proliferation with increased gland-to-stroma ratio --> thickened endometrial lining may slightly increase uterine size and cause heavy menses. However, endometrial hyperplasia does not typically cause dysmenorrhea or uterine tenderness. In addition, the most common risk factor is unopposed estrogen from chronic anovulation and/or obesity; this patient has regular menses and a normal BMI.

❌ E. Blastocyst in the ampulla of the fallopian tube --> Refers to ectopic pregnancy. "infundibulum" specifically referred to a funnel."infundere" (to pour in). The ampulla is the widest and longest segment of the fallopian tube, providing a larger surface area and a more hospitable environment for the fertilized egg to implant and develop.