American Board of Internal Medicine (ABIM) Certification Practice Exam

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What must patients report during yearly pelvic examinations while on tamoxifen?

Change in appetite
Abnormal vaginal bleeding
Skin rashes
Joint pain

The correct answer is: Abnormal vaginal bleeding

Patients taking tamoxifen need to report any abnormal vaginal bleeding during their yearly pelvic examinations because tamoxifen can influence the endometrial lining. This medication is a selective estrogen receptor modulator and can lead to changes in the endometrium, increasing the risk for endometrial hyperplasia and even endometrial cancer over time. Reporting abnormal vaginal bleeding is crucial as it may be an early sign of these complications. Regular monitoring and evaluation are essential for these patients to ensure any potential issues can be detected and addressed promptly. While changes in appetite, skin rashes, and joint pain are important symptoms for patients to be aware of and report during health evaluations, they are not specifically linked to the risks associated with tamoxifen in the same way that abnormal vaginal bleeding is. Thus, abnormal vaginal bleeding is particularly significant and should be closely monitored.