Endometrial cancer — MCCQE Part 1 MCQ

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ModeratePost-menopausal BleedingEndometrial cancerMCCQE Part 1

A 58-year-old woman has vaginal bleeding 3 years after menopause; she has obesity and hypertension. Which of the following is the most appropriate next step?

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Correct answer: E — Arrange endometrial assessment with transvaginal ultrasound and/or biopsy

Arrange endometrial assessment with transvaginal ultrasound and/or biopsy is the single best answer because the age, timing, examination findings and investigations in the vignette fit Endometrial cancer better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to SOGC abnormal uterine bleeding guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: SOGC abnormal uterine bleeding guidance