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Endometrial cancer — MCCQE Part 1 MCQ

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ModerateAbnormal BleedingEndometrial cancerMCCQE Part 1

62-year-old woman presents with post-menopausal bleeding. She is obese and has not used hormone therapy. Which of the following is the most appropriate next step?

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Correct answer: E — Arrange transvaginal ultrasound and endometrial sampling when indicated

Arrange transvaginal ultrasound and endometrial sampling when indicated is best because post-menopausal bleeding requires endometrial cancer evaluation. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Any post-menopausal bleeding warrants assessment.

Reference: SOGC abnormal uterine bleeding guidance