A 34-Year-Old Woman Is Brought to the Emergency Department After

question 413

Multiple Choice

A 34-year-old woman is brought to the emergency department after a syncopal episode.  The patient was at work when she became lightheaded, started sweating, and then fell to the floor.  Now, she feels better and has no chest pain, dyspnea, or palpitations.  The patient is currently on day 10 of her menstrual cycle.  She reports that her menstrual periods still occur monthly but have become progressively heavier and longer over the past year, despite being on combination oral contraceptives.  Temperature is 36.7 C (98.1 F) , blood pressure is 100/60 mm Hg, and pulse is 112/min.  BMI is 27 kg/m².  On speculum examination, multiple blood clots are removed from the vaginal vault.  The cervix has no lesions, but there is active bleeding from the cervical os.  Bimanual examination shows a 12-week-size, irregularly shaped, enlarged uterus.  Hemoglobin is 4.9 g/dL.  Urine pregnancy test is negative.  Which of the following is the most likely cause of this patient's symptoms?

• A)Cyclic bleeding of ectopic endometrial glands
• B)Endometrial glands and stroma within the myometrium
• C)Endometrial hyperplasia with atypia
• D)Impaired platelet adhesion
• E)Proliferation of smooth muscle within the myometrium

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