True/False MCQ · Endometriosis and Adenomyosis
Concerning the clinical features of endometriosis, the following statements are correct:
- AEndometriosis in the rectovaginal septum is a recognised cause of dyschezia
- BA fixed retroverted uterus with adhesions can be caused by pelvic endometriosis
- CHaematuria is a common symptom of endometriosis
- DThe dysmenorrhoea characteristically starts before and continues throughout menstruation
- ESuperficial (introital) dyspareunia is the typical pattern
Show answers and explanation
- A. True
- B. True
- C. False: Haematuria is an unusual symptom, only with bladder deposits, not a common one.
- D. True
- E. False: Endometriosis causes deep, not superficial, dyspareunia.
Clinical features of endometriosis
Endometriosis produces symptoms according to the site of deposits, and the pain pattern is characteristic.
Deep deposits and bowel/rectovaginal disease
- Deposits in the rectovaginal septum cause dyschezia (pain on defaecation) and deep dyspareunia.
- Inflammation around deposits causes adhesions, producing a fixed retroverted uterus with thickened uterosacral ligaments and ovaries tethered in the pouch of Douglas.
Pain pattern
The dysmenorrhoea is secondary - it starts before the period and outlasts it - and the dyspareunia is deep, not superficial, because the deposits lie deep in the pelvis.
Unusual symptoms
Distant deposits give unusual symptoms - urinary frequency, haematuria, strangury, diarrhoea, tenesmus, PR bleeding - but these are unusual, not common.
Why A is true
Rectovaginal deposits classically cause dyschezia.
Why B is true
Adhesions from inflammation produce a fixed retroverted uterus.
Why C is false
Haematuria is an unusual, not common, symptom (only with bladder deposits).
Why D is true
The secondary dysmenorrhoea starts before and outlasts the period.
Why E is false
Endometriosis causes deep, not superficial, dyspareunia.
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