Endometriosis & Adenomyosis Knowledge Test

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This brief test is intended to check your knowledge as an allied health professional in the diagnosis and overall management of endometriosis and adenomyosis. The goal of this process is to ensure that patients will receive consistent, evidence-based, unbiased, optimal care and education from all providers on their team. You are allotted three opportunities to complete it, and there is no designated timeline. If you don't pass after three attempts, you are welcome to retake the test after 7 days.

A passing score is considered 16/20 (80%). After you complete the exam, choose "view score" to see if you have received a passing score. If you have scored <80%, please go back and elect the option "submit another response."

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Q1. What is the gold standard for the diagnosis of endometriosis? (Johnson 2013) *

1 point

Transvaginal ultrasound

Diagnostic laparoscopy with histological confirmation

Pelvic MRI

All of the above

Q2. A hysterectomy has traditionally been offered to patients with endometriosis and adenomyosis as a treatment option to cure these diseases. When is a hysterectomy potentially indicated as a way to treat the disease itself? (Vannuccini 2019, Di Spiezio 2017, Roman 2018, Johnson 2013) *

1 point

Adenomyosis

Endometriosis

Both adenomyosis and endometriosis

Adenomyosis IF the patient does not desire a future pregnancy and fully understands the implications of the surgery

Q3. Which of the following are potential symptoms of endometriosis? (Johnson 2013, Nezhat 2019) *

1 point

Dysmenorrhea

Dyspareunia

Ovulatory pain

Bowel dysfunction

Dysuria

A & B only

All of the above

Q4. Laparoscopic surgery for excision or ablation of endometriosis nearly doubles the spontaneous pregnancy rate in those with mild endometriosis, and still significantly improves pregnancy rates in those with moderate to severe endometriosis. (Rizk 2015) *

1 point

True

False

Q5. Pregnancy has been demonstrated to decrease the number and size of endometriosis lesions, thereby treating the disease. (Leeners 2018) *

1 point

True

False

Q6. Symptoms of endometriosis in adolescents can present as: (Jansenn 2013) *

1 point

Bowel dysfunction

Urinary urgency

Cyclical or acyclical pain

A & B only

All of the above

Q7. Your patient with endometriosis had an excision surgery four months prior, and is now complaining of chronic abdominal bloating and cramping. What should be part of your differential diagnosis? (Achufusi 2020, Hao 2009, Marziali 2012, Mathias 1998, Parker 2005, Soares 2018) *

1 point

Small Intestinal Bacterial Overgrowth (SIBO)

Non-celiac gluten sensitivity

Intra-abdominal postoperative adhesion formation

A & B only

All of the above

Q8. What is the origin of endometriosis? (Giudice 2010) *

1 point

Retrograde menstruation

Muleriosis

Genetic

All of the above. The origin of endometriosis is a debated topic and yet to be fully known.

Q9. Endometriosis is a disease where the lining of the uterus, the endometrium, grows outside of the uterus. (Giudice 2010) *

1 point

True

False

Q10. A patient with deep infiltrating and/or more widespread endometriosis discovered during laparoscopy will always present with more severe symptoms than someone with less lesions and a lower stage of disease. (Fauconnier 2005) *

1 point

True

False

Q11. Perri, a 21 year old cisgender female (she/her/hers) with dyspareunia and dysmenorrhea indicating a potential diagnosis of endometriosis, comes to your clinic seeking conservative care for her pain. She has tried various progestin birth control medications (medroxyprogesterone acetate and dienogest) but found that her symptoms actually worsened while using them. What is the most likely reason that this occurred? (Donnez 2021, Bernardi 2017) *

1 point

She has primary dysmenorrhea, which is not alleviated by progestin therapy.

She is simply extremely stressed by her life as a junior in college and should see a psychologist.

She is demonstrating drug-seeking behavior and should be monitored for opioid abuse.

She is one of the ⅓ of individuals with endometriosis who demonstrates progesterone resistance.

Q12. What factors have been demonstrated in the literature to increase the risk of central sensitization of pain in individuals with endometriosis? (Stratton 2015) *

1 point

Anxiety and depression

Anxiety and use of oral contraceptives

Hypothyroidism and inflammatory diet

Low FODMAP diet and stress

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