“Doc, Is This Endometriosis?”

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A drawing of the uterus and cervix.

“Doc, Is This Endometriosis?”

July 29, 2023 | Family Medicine Exam Prep Course | CCFP

We are excited to see so many of you join our fall FMEP courses. Several of you have requested we continue to post more practice SAMPs, so here you go!

Just a reminder… pay attention to the questions. Here are our general tips one more time:

1. Pay attention to the questions. Look carefully at how many items you are being asked to list. If the question asks for five items, you will not get more marks if you list eight items; the examiner will look at the first five and allocate marks only for the first five answers – so be careful. On a SAMP, if it is not clearly stated how many items you should list, look at the amount of points/marks being allocated for the question to get an idea of how many answers the examiner may be anticipating you write down.

2. Do not write lengthy answers. Most questions can be answered in 10 words or less!

3. Be specific when writing down investigations (hemoglobin instead of CBC; CT abdomen instead of CT).

4. Remember that trade names and generic names are both acceptable when writing down medications.

5. For more helpful tips, you can refer to CCFP’s SAMP instructions by clicking here.



Ashley is a 32 year old female who has had recurrent pelvic pain. This occurs during her menstrual cycle. She is otherwise healthy. She takes a multivitamin. She is married and sexually active. (7 points)

1. What initial investigation would you like to order? (1 point)

    • Transvaginal ultrasonography

2. How do you definitively diagnose endometriosis? (1 point)

    • Laparoscopy with biopsy is the gold standard for diagnosis

3. What are two risk factors for endometriosis? (2 points)

    • First-degree relative with endometriosis
    • Early menarche, heavy flows, short cycles
    • Müllerian anomaly
    • Nulliparity
    • Low birth weight
    • Low BMI

4. What are two physical exam findings you may find in a patient with endometriosis? (2 points)

    • Fixed retroverted uterus
    • Nodularity in the posterior vaginal fornix
    • Tender posterior and lateral vaginal fornices
    • Adnexal mass

5. List one first-line class/medication to treat endometriosis. (1 point)

    • NSAIDs
    • Combined hormonal contraceptives
    • Transdermal patch
    • Vaginal ring
    • Progestin-only methods
    • Gonadotropin-releasing hormone agonists/antagonists

Helpful CMAJ Resource: