Case 425

Medical history

Case description

A 42-year-old female patient, G7P1A6, presenting dysmenorrhea (10/10 intensity), menorrhagia, polymenorrhea, and pollakiuria for over the past 5 years, has been  feeling indisposed recently. Denies dyspareunia. She also reports having one alive child and 6 abortions, with two being in vitro fertilizations, both unsuccessful. Despite that, it is not her desire to get pregnant again. Negative familiar history of uterine cancer. On physical exam: bleached patient, palpable pelvic masses present. Transvaginal ultrasound was requested (TVS).


Based on the patient’s clinical condition and the image exam, which is the most likely diagnosis and the main course of action to take? 

Test question

(UNIFESP - SP - 2010 - R1 - 1) A patient presents to the hospital with hematocrit of 24%. The transvaginal ultrasound indicates the presence of a 14 cm pedunculated myoma in the uterine fundus, with numerous smaller submucous myomas. The initial approach should be: