American Board of Internal Medicine (ABIM) Certification Practice Exam

When is endometrial sampling unnecessary according to transvaginal ultrasonography findings?

1. When endometrial thickness is less than or equal to 4 mm

2. When there are symptoms of heavy bleeding

3. When lesions are detected

4. When the patient is under 50 years old

The correct answer is: When endometrial thickness is less than or equal to 4 mm

Endometrial sampling is considered unnecessary when transvaginal ultrasonography reveals that the endometrial thickness is less than or equal to 4 mm. This finding is significant because an endometrial thickness of 4 mm or less is generally associated with a low risk of endometrial pathology, including hyperplasia and cancer. In postmenopausal women, particularly, a thin endometrium is often interpreted as a reassuring sign that the endometrium is not likely to be the source of abnormal uterine bleeding. In contrast, other scenarios, such as the presence of heavy bleeding, the detection of lesions, or the patient's age being under 50 years, typically warrant further investigation through endometrial sampling. Heavy bleeding may suggest more complex underlying pathology that needs to be evaluated directly through biopsy, while lesions found on imaging could indicate the need for further diagnostic procedures, and age alone does not determine the necessity of endometrial sampling.