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NBME 17 Answers

nbme17/Block 2/Question#20 (8.0 difficulty score)
A 38-year-old woman comes to the physician ...
Proliferative endometrial tissue🔍
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submitted by cassdawg(580),

This woman likely has endometriosis, characterized by cyclic pelvic pain, bleeding, and associated with infertility (FA2020 p648). It is associated with "chocolate cysts" on the ovaries. Proliferative endometrial tissue would be found on biopsy

Endometriosis scar tissue/adhesions can cause the uterus to stick in a backwards position (retroverted) according to https://www.healthline.com/health/womens-health/tilted-uterus

Polycystic ovarian syndrome is associated with obesity would also likely have symptoms of hisutism and acne as well as infertility. It also presents with amenorrhea or oligomenorrhea. [FA2020 p645]

waitingonprometric  Also, rule out cancers because no weight loss, symptoms are not constant throughout month, and symptoms are not getting progressively worse over the 2-yr history of pain +4  
cheesetouch  FA2018 P630 +1