266 Obstetrics and Gynecology Board Review •••
❍ What percentage of adolescents with heavy dysfunctional uterine bleeding will have a coagulation defect?
Although the most common cause is anovulation, as many as 20% of adolescents will have a coagulation defect—
the most common being von Willebrand disease. Bleeding is usually a heavy flow with regular, cyclic menses. This
is the same pattern seen in patients treated with anticoagulants.
❍ How much do oral contraceptive pills (OCPs) reduce menstrual flow?
In normal uteri, OCPs reduce flow by 50% to 60% by limiting maximal endometrial growth and allowing orderly
menses.
❍ What is adenomyosis?
Adenomyosis is the presence of endometrial glands and stroma within the myometrium. It occurs most commonly
in perimenopausal women and is present in approximately 15% of uteri. Some pathologists only use this term
when the lower border of the endometrium and the adenomyosis are separated by at least one-half of a low-power
field (about 2.5 mm).
❍ How is the diagnosis of adenomyosis made?
Adenomyosis is primarily diagnosed postoperatively, upon histologic review of the uterus. Clinical suspicion is
increased when a patient in her fourth or fifth decade presents with worsening dysmenorrhea and menorrhagia in
the presence of a symmetrically enlarged, firm and tender uterus. MRI can make this diagnosis preoperatively with
a high degree of accuracy. Curettage does not help in diagnosis or treatment.
❍ What is the embryological derivative of the hydatid cyst of Morgagni?
This is the most common paramesonephric (Mullerian) cyst. Other paratubal cysts can arise from mesonephric
(Wolffian) structures or mesothelial inclusions.
❍ What is salpingitis isthmica nodasa?
These are outpouchings or diverticula of tubal epithelium in the isthmic region. Involvement is often bilateral and
is associated with ectopic gestation and infertility. The etiology is unknown, although some evidence exists for a
noninflammatory adenomyosis-like origin.
❍ Following tubal sterilization procedures, what is the rate of hysterosalpingogram documented “leak”?
Hysterosalpingogram “leak rates” may reach 25% after Pomeroy or any of the other operations, but the actual
fertility “failure rate” is much lower. Additional surgery on a fallopian tube found to leak dye does not guarantee
permanent sterilization. Injection of dye under hydraulic pressure through the uterus may open a previously
occluded fallopian tube.
❍ What are nabothian cysts?
Nabothian cysts are retention cysts of endocervical columnar cells where a cleft has been covered by squamous
metaplasia.
❍ What is the size of a nabothian cyst?
It can vary from 3 mm to 3 cm.
❍ What are the symptoms of nabothian cysts?
Nabothian cysts are asymptomatic.