Endometrial cancer Rapid Review
Which of the following is the most common presenting symptom of endometrial cancer? And what are the risk factors?
A. Lower abdominal pain
B. Abnormal uterine bleeding
C. Pelvic pressure
D. Dysuria
Answer: B. Abnormal uterine bleeding
Especially postmenopausal bleeding, present in ~85% of cases diagnosed with endometrial cancer.
Risk factors:
These include unopposed estrogen states, such as polycystic ovary syndrome; estrogen-producing tumors; early menarche (younger than 12 years); nulliparity; late menopause (older than 55 years); tamoxifen therapy; and peripheral con- version of androgens to estrogen in adipose tissue (as occurs in obesit y).4
What is the definition of short stature in children?
A. Height below the 10th percentile for age
B. Height more than 2 standard deviations below the mean for age
C. Height below the 5th percentile and with delayed puberty
D. Height below average in children with small parents
B. Height more than 2 standard deviations below the mean for age
What is the primary conclusion of the Cochrane review regarding a lower BP target (130/80 mm Hg) in people with chronic kidney disease (CKD)?
A. It significantly reduces all-cause mortality
B. It increases the risk of serious adverse events
C. It shows little to no difference in mortality or cardiovascular outcomes
D. It should always be used as first-line therapy in CKD
Correct Answer: C. It shows little to no difference in mortality or cardiovascular outcomes
Rationale:
The Cochrane review concluded that using a lower BP target in people with CKD does not significantly reduce total mortality, cardiovascular events, cardiovascular mortality, or progression to end-stage renal disease compared to a higher BP target. This was based on moderate- to low-certainty evidence, and therefore, the overall recommendation strength was B.
Which of the following treatments has been shown to improve vaginal dryness and dyspareunia in menopausal women based on low-certainty evidence?
A) Oral estrogen therapy
B) Vaginal estrogen
C) Oral antibiotics
D) Vaginal progesterone
Correct Answer: B) Vaginal estrogen
Rationale: Vaginal estrogen (cream or ring) was shown to improve vaginal dryness and dyspareunia compared to placebo. Overall study was not great.
- sponsored by manufacturer
- researchers were not confident in the quality of the research
- too much variation in outcomes and population to make meta analysis and comparison
Which of the following preventive services is recommended with an “A” grade by the USPSTF for adults aged 50 to 75?
A. Screening for prostate cancer using PSA
B. Screening for colorectal cancer
C. Screening for skin cancer using full-body exam
D. Screening for pancreatic cancer using imaging
Answer: B. Screening for colorectal cancer
A 64-year-old postmenopausal woman presents with vaginal bleeding. What are the two first-line diagnostic evaluations recommended? What is the endometrial stripe thickness that can reliably rule out endometrial cancer? How would it differ for premenopausal women.
Answer:
• Transvaginal pelvic ultrasonography
• Endometrial biopsy
Either can be used as first-line, with Pipelle biopsy preferred due to convenience and cost unless imaging reveals a focal lesion.
Endometrial stripe <4mm can reliably rule out EC in post menopausal women but should not be used for premenopausal women because it has no diagnostic value
List three non-pathologic (normal variant) causes of short stature in children.
If pathological causes name some of the potential pathological cause.
Answer:
• Familial short stature
• Constitutional delay of growth and puberty
• Idiopathic short stature
Pathology is present in approximately 5% of children with short stature and includes endocrine disorders, gastrointestinal disorders, nutri- tional deiciencies, medication use, genetic abnormalities, systemic disease, and GH deiciencies.
True or false
When combined with adverse drug reaction reporting forms and reminder cards, educational interventions improve the overall reporting rate by health care professionals compared with standard spontaneous reporting
True
A recent trial compared abelacimab (a once-monthly Factor XI inhibitor) with rivaroxaban in patients ≥55 years old with atrial fibrillation and a CHA₂DS₂-VASc score of ≥4. The trial was stopped early due to lower bleeding rates in the abelacimab groups. Which of the following statements best reflects a limitation of this study that may impact the interpretation of abelacimab’s overall clinical benefit?
A) The study failed to show a reduction in bleeding with abelacimab compared to rivaroxaban
B) The study excluded patients with chronic kidney disease, limiting generalizability
C) The use of apixaban instead of rivaroxaban would have resulted in more bleeding events
D) A trend toward higher ischemic stroke rates in the abelacimab groups raises safety concerns
E) The study had a small sample size and short follow-up, making bleeding results unreliable
Correct Answer:
D) A trend toward higher ischemic stroke rates in the abelacimab groups raises safety concerns
While abelacimab significantly reduced bleeding, the study was stopped early, and there was a nonsignificant but concerning trend toward increased ischemic strokes in the abelacimab groups compared to rivaroxaban (10 vs. 5 events). This raises questions about stroke prevention efficacy, especially since rivaroxaban, though associated with more bleeding, is proven to reduce stroke in AF
A 6-year-old child is brought in for a well-child visit. The parents report no concerns. According to USPSTF guidelines, which preventive service should be provided or offered at this visit as a Grade A recommendation?
A. Lipid screening
B. Lead level testing
C. Vision screening
D. Thyroid screening
Answer: C. Vision screening
Rationale: The USPSTF gives a Grade A recommendation for vision screening at least once in all children aged 3 to 5 years to detect amblyopia or its risk factors.
Lipid and lead screening are not recommended universally without specific risk factors; thyroid screening is not recommended in asymptomatic children
Name Some of the screening recommendation from the articles? What are intervention that can reduce the risk of endometrial adenocarcinoma?
• All individuals with a uterus should be counseled about signs of endometrial cancer and evaluated for abnormal and post- menopausal uterine bleeding.
• Based on consensus guidelines, patients with Lynch syn- drome should start receiving annual endometrial biopsy at 35 to 40 years of age a
• Atypical glandular cells on Papanicolaou test are reported in up to 50% of patients with endometrial cancer; this result should prompt colposcopy and endometrial biopsy.
Exogenous progesterone and keeping healthy weight with diet and excercise since obesity is a modifiable risk factor.
Which of the following findings is most suggestive of a pathologic cause of short stature rather than a normal variant?
A. Normal bone age with projected adult height within midparental height range
B. Advanced bone age and history of tall parents
C. Delayed bone age, low weight for height, and chronic abdominal pain
D. Delayed puberty and family history of similar growth patterns
C. Delayed bone age, low weight for height, and chronic abdominal pain
Rationale:
Delayed bone age:
Delayed bone age is associated with constitutional delay of growth and puberty, Males GH defieciency, hypothyroidism, celiac disease, anemia, other systemic illness, and malnutrition.
A 27-year-old man presented with a rash that was not painful or pruritic. During a haircut 4 days prior, clippers nicked the back of his neck. The first lesions appeared at this site. The rash then spread over the back of his neck and side of his face. Oral clindamycin, started 1 day prior, had not led to improvement. He did not have vision or hearing changes.
On examination, the patient was not in distress, and his vital signs were normal. A bullous, nonerythematous rash was present on his neck and face . The bullae were approximately 1 to 1.5 cm in diameter.
D. Primary herpes simplex virus infection.
A 55-year-old postmenopausal woman with no history of fracture has a femoral neck T-score of −1.8. She is reluctant to start yearly bisphosphonate therapy due to time and cost. Based on current evidence, which of the following is the most appropriate evidence-supported recommendation?
A) Recommend against zoledronate since fracture prevention is only shown in women with osteoporosis
B) Suggest a one-time infusion of zoledronate now and repeat it in 5 years to significantly reduce fracture risk
C) Suggest yearly zoledronate infusions for 10 years to maintain maximum benefit
D) Reassure her that no treatment is necessary as she is not at high risk for fracture
E) Prescribe calcium and vitamin D only, as bisphosphonates are ineffective in osteopenia
Correct Answer:
B) Suggest a one-time infusion of zoledronate now and repeat it in 5 years to significantly reduce fracture risk
Rationale:
This study demonstrated that even a single zoledronate infusion significantly reduced fracture risk (vertebra fracture) in women with normal bone density or osteopenia vs patient who received placebo. A second infusion at 5 years offered slightly more protection but was not significantly better than a single infusion. This option balances efficacy, cost, and convenience
What is the USPSTF recommendation for cervical cancer screening in a 30-year-old woman with a normal Pap test history?
Answer: Screen every 3 years with cervical cytology alone (Pap test), or every 5 years with high-risk HPV testing alone, or every 5 years with co-testing (cytology + HPV). (Grade A)
A 38-year-old nulliparous woman with Lynch syndrome has completed childbearing. What preventive strategy is recommended, and at what age should it be considered?
Answer:
• Prophylactic total abdominal hysterectomy with bilateral salpingo-oophorectomy
• **Recommended after childbearing is complete, often starting between 35 to 40 years
Annual endometrial biopsies are also started at that age if surgery is delayed
Describe the process and clinical significance of calculating midparental height and comparing it to projected adult height.
Answer:
Midparental height estimates genetic growth potential and helps differentiate familial short stature from pathologic causes.
• For boys: [(father’s height + 13 cm) + mother’s height] ÷ 2
• For girls: [(father’s height – 13 cm) + mother’s height] ÷ 2
If the child’s projected adult height (based on growth curve or bone age) is >2 SD (approx. 10 cm) below or above this midparental estimate, it suggests a pathologic cause may be present
*initial evaluation consist of : anthropometrics plotted on a growth chart, comparing predicted adult height with calculated midparental height, and performing radiography to determine bone age
A 58-year-old patient with CKD (GFR 45) and hypertension asks about his BP goal. Based on current guidelines and evidence, which is the most appropriate response?
A. All guidelines agree on targeting <120/80 mm Hg
B. Evidence strongly supports targeting <130/80 mm Hg in all CKD patients
C. A BP target <130/80 mm Hg is reasonable, but some guidelines accept <140/90 mm Hg depending on proteinuria and cardiovascular risk
D. Lower BP targets have been proven to improve renal outcomes in all CKD patients
Correct Answer: C. A BP target <130/80 mm Hg is reasonable, but some guidelines accept <140/90 mm Hg depending on proteinuria and cardiovascular risk
Rationale:
While KDIGO and ACC/AHA recommend <130/80 mm Hg, the Cochrane review didn’t find strong evidence that lower targets improve outcomes across the board. The ESH and NICE guidelines allow more flexibility depending on albuminuria, cardiovascular risk, and age. Therefore, individualized treatment is reasonable
A 58-year-old woman with genitourinary syndrome of menopause reports persistent dyspareunia and vaginal dryness despite 3 months of regular use of a vaginal moisturizer. She is not interested in hormone therapy due to concerns about systemic estrogen exposure. According to current evidence, which of the following would be the most evidence-supported next step in management?
A) Increase frequency of vaginal moisturizer use
B) Prescribe systemic estrogen therapy
C) Recommend vaginal estrogen cream
D) Initiate oral ospemifene therapy
E) Reassure the patient and continue current therapy
Correct Answer: D) Initiate oral ospemifene therapy
Rationale: Ospemifene is an oral nonhormonal selective estrogen receptor modulator (SERM) with high-certainty evidence for improving dyspareunia and dryness, especially for patients who do not respond to or prefer to avoid vaginal estrogen. Continuing a non-effective moisturizer or using systemic estrogen contradicts patient preference and available evidence
A 65-year-old man with a 35 pack-year smoking history quit 10 years ago. He has no current symptoms. According to USPSTF guidelines, what preventive screening is recommended for him?
Answer: Annual low-dose CT scan for lung cancer (Grade B).
(USPSTF recommends for adults aged 50–80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.
Which of the following treatment strategies is most appropriate for a patient with inoperable Stage IV endometrial cancer and poor performance status?
A. Total abdominal hysterectomy with bilateral salpingo-oophorectomy
B. Radiation therapy alone
C. Combination chemotherapy with carboplatin and paclitaxel
D. Hormone therapy with progestin
Answer: D. Hormone therapy with progestin
Used for distant metastases or when patients cannot tolerate standard regimens. Associated with 15–30% response rates
Stage I:
Minimally invasive total abdominal hysterectomy with bilateral salpingo-oophorectomy
Stage III and IV
Chemotherapy plus immunotherapy is typically used in stages III or IV disease and radiation.
A 12-year-old male presents with delayed growth. His bone age is 9 years. His father had late puberty and is 5’6”, and his mother is 5’1”. His projected adult height is within 1 SD of midparental height. He is otherwise healthy and shows no signs of systemic illness. What is the most likely diagnosis and next step?
A. Growth hormone deficiency – order GH stimulation test
B. Familial short stature – refer to endocrinology
C. Constitutional delay of growth and puberty – reassure and monitor
D. Idiopathic short stature – start GH therapy
C. Constitutional delay of growth and puberty – reassure and monitor
This child presents with delayed growth and a bone age that is behind chronological age, which is a hallmark of constitutional delay of growth and puberty (CDGP). Additional clues include:
• Positive family history of delayed puberty (his father).
• Projected adult height within 1 standard deviation of mid-parental height, which suggests normal potential height.
• Otherwise healthy child, with no signs of systemic illness or chronic disease.
CDGP is a normal variant, not a pathologic condition. These children tend to have a temporary delay in skeletal growth and puberty but eventually reach a normal adult height consistent with genetic potential
A 62-year-old patient with stage 3b CKD (GFR 38 mL/min/1.73 m²), albumin-creatinine ratio of 350 mg/g, and a history of myocardial infarction is being considered for BP target adjustment. Based on the Cochrane review findings and guideline recommendations, what is the most appropriate approach?
A. Target BP <140/90 mm Hg, as lower targets have no proven benefit
B. Target BP <130/80 mm Hg, due to high proteinuria and cardiovascular risk
C. Target BP <120/80 mm Hg, following Eighth Joint National Committee guidelines
D. Use BP target of <130/80 mm Hg only if patient has diabetes
Correct Answer: B. Target BP <130/80 mm Hg, due to high proteinuria and cardiovascular risk
Rationale:
Although the Cochrane review showed limited benefit from lower BP targets, certain patients with severe albuminuria (≥300 mg/g) and increased cardiovascular risk may still benefit. The 2023 ESH and 2021 NICE guidelines recommend <130/80 mm Hg for such individuals. This patient fits those criteria, even if the overall evidence base is not definitive. This reflects a tailored, risk-based approach, rather than a universal target
An RCT evaluated the efficacy of an early invasive strategy versus a conservative strategy for NSTEMI management in adults ≥75 years. Despite a significant reduction in nonfatal MI (11.7% vs 15.0%), the composite primary outcome (cardiovascular death or nonfatal MI) showed no significant difference (25.6% vs 26.3%; HR 0.94; 95% CI, 0.77–1.14), and cardiovascular mortality was slightly higher in the invasive group (15.8% vs 14.2%, HR 1.11; 95% CI, 0.86–1.44).
Which of the following most accurately explains why the trial concluded that an early invasive strategy did not improve overall outcomes, despite fewer nonfatal MIs?
A) The reduction in nonfatal MIs was offset by a statistically significant increase in all-cause mortality in the invasive group.
B) The invasive strategy increased the rate of frailty-related complications, leading to higher cardiovascular mortality.
C) The observed reduction in nonfatal MI did not translate into a statistically or clinically meaningful benefit in the composite outcome or mortality.
D) The conservative strategy included revascularization in most patients later during follow-up, minimizing differences between groups.
E) The confidence interval for the primary outcome was wide and included clinically significant benefit, invalidating the conclusion
C) The observed reduction in nonfatal MI did not translate into a statistically or clinically meaningful benefit in the composite outcome or mortality.
Although the invasive group had fewer nonfatal MIs, this did not result in improved outcomes in the composite primary outcome or all-cause mortality. The hazard ratio for the primary endpoint (0.94; 95% CI, 0.77–1.14) shows no statistical significance, and the reduction in nonfatal MI was counterbalanced by a slight (though not significant) increase in cardiovascular deaths. Thus, the overall clinical impact was neutral, leading to the conclusion that the invasive approach did not improve outcomes overall
A 28-year-old woman comes to establish care. She is sexually active with multiple partners and does not use condoms consistently. She is not pregnant. She has no symptoms and no known exposures. Which USPSTF-recommended screenings should you consider offering her at this visit? (List at least 3)
Answer:
• Chlamydia and gonorrhea screening (Grade B, for sexually active women <25 or at increased risk)
• HIV screening (Grade A, one-time screening for all aged 15–65 and at-risk patients)
• Syphilis screening (Grade A, for high-risk populations)
• Cervical cancer screening (if not done within appropriate interval)
• Depression screening (Grade B)
• Tobacco use screening and counseling (Grade A