NEET PG / USMLE – MCQ 24
A 58-year-old woman comes to the physician because of intermittent vaginal bleeding during the past 3 months. She has been treated with tamoxifen since having a partial mastectomy and radiation therapy for a stage II carcinoma of the left breast 4 years ago. Her last menstrual period was at the age of 48 years. She has never had an abnormal Pap smear. Speculum examination shows no abnormalities. Bimanual examination shows no abnormal masses. Which of the following structures is the most likely source of the bleeding?
A. Cervical canal
B. Fallopian tube
C. Ovary
D. Uterine endometrium
E. Vagina
Correct answer : D. Uterine endometrium
History of tamoxifen intake and the complaint of post menopausal bleeding suggests the diagnosis of endometrial carcinoma.Normal pap smear and speculum examination helps rule out cervical cancer.
Tamoxifen is a selective estrogen receptor modulator (SERM). It acts as an estrogen receptor antagonist in the breast tissue and a partial agonist in the endometrial tissue. It increases the risk for endometrial carcinoma.
d) uterine endometrium
cervical canal
the main source of bleeding is the uterine endometrium bcos pt is on tamoxifen tamoxifen is antagonistic at breast but not on the utrerus which results in endometrial hyperplasia and bleeding n also pt has a breast cancer which by itself is a hyperestrogenic state and precipitates endometrial cancer as a part of lynch syndrome
uterine endometrium.
true dr.,its endometrium…though cervical ca is commonest cause of pmbleed………pap smear negative and and no bimanual mass wid positive SERM history.
answer is (d), uterine endometrium.
D.uterine endometrium
d
uterine endometrium…….tamoxifen a risk factor for endometrial carcinoma which she has used for breasr ca and she is post menopausal and one of the common causes of post meno pausal bleed in west is endometrial ca though in asian countries cervical ca shud be the primary cause kept in mind
Ans.is uterine endometrium