A 56year old nulliparous woman with a BMI of 37 has a four–‐month history of blood stained discharge. She is otherwise normal. What is the single most likely diagnosis?
a. Atrophic Vaginitis
b. Bacterial Vaginosis
c. Endometrial Carcinoma
d. Candidiasis
e. Chlamydia
Ans. The key is C. Endometrial Carcinoma. [Post menopausal blood stained discharge is highly suggestive of endometrial carcinoma]. [a. Atrophic vaginitis- causes post coital bleeding, not blood stained discharge. B. Bacterial vaginosis- fishy odour (particularly postcoital odour) and increased vaginal discharge but bleeding is not a feature. d. Candidiasis- it causes vaginal erythema and curd-like or cheesy discharge, itching and dyspareunia, but bleeding is not a feature. e. Chlamydia- postcoital usually when there is ectropion. otherwise no bleeding].