A High-Yield UKMLA/PLAB Scenario (February 2025 Exam Question) - Chronic Pelvic Pain and Infertility π©Ί
Essential Insights for Medical Licensing Exams: Diagnosing Endometriosis and Endometrioma
This article highlights a real-world clinical scenario from the February 2025 PLAB 1 exam, focusing on a classic presentation of endometrioma β a crucial topic for UKMLA, PLAB, and other medical licensing exams.
π PLAB 1 Exam Case Scenario
A 30-year-old woman visits her GP surgery with progressive lower abdominal pain over the past 9 months. Her pain worsens just before and during her periods and is occasionally associated with deep dyspareunia. She has been trying to conceive for 1 year without success. She has no history of pelvic inflammatory disease and no changes in her bowel or urinary habits.
A transvaginal ultrasound reveals a 5 cm left ovarian cyst with homogeneous ground-glass echogenicity.
What is the most likely diagnosis?
A) Functional ovarian cyst
B) Endometrioma
C) Mature cystic teratoma (dermoid cyst)
D) Polycystic ovary syndrome (PCOS)
E) Ovarian epithelial carcinoma
Answer with an explanation is provided below.
Our content is updated to align with the MLA content map
γ°οΈ
Our content is updated to align with the MLA content map γ°οΈ
Resources for PLAB/UKMLA
Recent Updates to PLAB 1 Exam Format: Is the exam tougher post-MLA content map changes? Find out here.
MedRevisions Success Stories: Hear from past candidates who passed on their first attempt. Learn more.
Free PLAB/UKMLA Sample Questions: Sign up today for 20 free questions with revision notes.
Preparation groups for exams
Find the 10% discount referral links in the groups
All about the UKMLA or PLAB exam:
Important update to the PLAB exam: Is the PLAB exam based on the MLA content map from August 2024 onward? Find out more about the change and how to prepare for it here.
Evolving Nature of PLAB 1 Exam Questions: Is the exam getting tougher? A Closer Look with examples
What Past PLAB 1 candidates say about us (with exam results)
β Correct Answer: B) Endometrioma (Chocolate Cyst)
Check out these updated study notes in the demo questions and in the library section and get access to the contraception note for FREE. These new study notes will soon replace the existing revision notes entirely.
Clinical Reasoning and Explanation
π Key Diagnosis β Endometrioma Linked to Endometriosis
This patientβs symptoms β progressive pelvic pain, dysmenorrhoea, deep dyspareunia, and subfertility β form a classic presentation of endometriosis, a chronic inflammatory condition where endometrial-like tissue grows outside the uterus.
The ultrasound finding of a 5 cm cyst with homogeneous "ground-glass" echogenicity is highly characteristic of an endometrioma, a blood-filled ovarian cyst (chocolate cyst) caused by ovarian endometriosis.
π¬ Hallmark Clinical Features of Endometriosis
Chronic pelvic pain: Cyclical or constant, worsens premenstrually and during periods
Dysmenorrhoea: Severe period pain, often starting before menstruation
Deep dyspareunia: Pain with deep penetration
Subfertility: A common complication
Cyclical bowel or bladder symptoms: May occur if lesions affect the bowel or bladder
π₯οΈ Interpreting the Ultrasound Findings β Ground-Glass Cyst
Ground-glass echogenicity refers to a cyst filled with thick, old blood, which is highly suggestive of an endometrioma.
Functional cysts tend to be simple and thin-walled, without internal echoes.
Dermoid cysts typically have mixed echogenicity due to fat, hair, and calcification.
PCOS presents with multiple small follicles (string of pearls) rather than a single cyst.
Ovarian carcinoma would more likely show solid areas, septations, and vascularity on Doppler.
β Why the Other Options Are Incorrect
A) Functional ovarian cyst
Functional cysts (follicular or corpus luteum cysts) are simple, thin-walled, and usually asymptomatic or cause mild pain, not chronic pelvic pain with dysmenorrhoea.
C) Mature cystic teratoma (dermoid cyst)
Typically shows heterogeneous echogenicity, often with fat-fluid levels and calcifications. Not linked with chronic pelvic pain or dysmenorrhoea.
D) Polycystic ovary syndrome (PCOS)
Characterised by multiple small follicles (2-9 mm) and ovarian volume >10 mL, not a solitary cyst. PCOS does not cause severe dysmenorrhoea.
E) Ovarian epithelial carcinoma
Ovarian cancer in a 30-year-old woman would be rare and typically presents with complex solid-cystic masses, not isolated ground-glass cysts.
Management
β
Refer to gynaecology for further assessment.
β
Laparoscopy is the gold standard for diagnosing and treating endometriosis.
β
Consider management options including:
Analgesia (NSAIDs)
Hormonal suppression (combined oral contraceptive pill, progestogens, GnRH analogues)
Surgical excision for severe disease or fertility preservation.
Key Learning Points for PLAB 1 / UKMLA:
Endometriosis is a chronic inflammatory condition where endometrial-like tissue is found outside the uterus.
Symptoms typically start in the reproductive years.
The most common sites include the ovaries, pelvic peritoneum, uterosacral ligaments, and rectovaginal septum.
Endometriomas (chocolate cysts) are ovarian cysts filled with old, altered blood, giving the characteristic ground-glass appearance.
Endometriosis is a leading cause of chronic pelvic pain and subfertility.
This topic was tested in the February 2025 exam.
Prepare Smarter for PLAB 1 & UKMLA with MedRevisions
To excel in UKMLA and PLAB 1 and master more high-yield scenarios like this:
β Join our free study group β Connect with 50,000+ medical students for exam strategies and discussions.
β Get MedRevisions materials β 5,000+ exam-style questions, updated notes, and exam mocks tailored to UKMLA/PLAB 1 format.
β Stay Updated β Learn about recent PLAB 1 recalls, NICE guideline updates, and focused study tools.
π New Study Essential Mode For PLAB 1/UKMLA exam
For Focused, efficient, targeted learning for PLAB and UKMLA exam
This update gives you the freedom to prepare for your exam in a short time and cover the syllabus with around 1800+ questions and our updated notes. Then leverage the remaining 3000+ exam-style questions and solidify your concepts. Know how to use it from the link below and get access to the most updated and reliable exam-like materials. Learn more about the Study Essential Mode
This is a high-yield exam PLAB 1/ UKMLA question-style question. At MedRevisions, We provide questions and not only explain the correct answer, we also explain the wrong answer so you will have a comprehensive understanding of the concepts that is commonly tested in the exam. On top of that, we also provide you PLAB 1 / UKMLA exam curated notes with no additional cost.
To discuss to more PLAB or UK-MLA exam questions, Join: PLAB 1 /UKMLA exam study group
At MedRevisions, we strive hard to provide the most up-to-date content available for PLAB Part 1. We constantly add exam-style questions derived from the most recent exam and also update the content to align with the latest NICE/CKS guidelines to ensure doctors pass PLAB Part 1 or UKMLA exam with ease in ONE attempt.
Past PLAB 1 candidates reviews about MedRevisions
How to use MedRevisions effectively for the PLAB 1 exam/ UKMLA exam preparation
Previous PLAB 1 or UKMLA exam guideline update
All MedRevisions recent updates
What we provide:
β 5000+ exam style questions
β Perfectly tailored exam style notes
β 30+ exam mocks
β
Spaced repetition learning tool
Nephrology, Dermatology and Emergency Medicine Notes. Just Got Better! PLAB & UKMLA Exam update