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Nurse Practitioner:
doi: 10.1097/01.NPR.0000403258.16507.d9
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Treatment options for Dysfunctional uterine bleeding

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INSTRUCTIONS Treatment options for dysfunctional uterine bleeding

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Treatment options for dysfunctional uterine bleeding

General Purpose: To provide the NP with an overview of the diagnosis and treatment of DUB. Learning Objectives: After reading this article and taking this test, you should be able to: 1. Identify distinguishing characteristics of DUB. 2. Describe diagnostic testing for DUB. 3. Discuss treatment options for DUB.

1. DUB is best described as a health problem

a. that affects 30% of women ages 30 to 49.

b. that is diagnosed by exclusion.

c. associated with few emotional issues.

d. managed using comprehensive guidelines.

2. DUB is defined as abnormal uterine bleeding

a. associated with inflammation.

b. caused by declining ovarian function in teens.

c. in the absence of disease or pregnancy.

d. associated with use of IUDs.

3. Most cases of DUB are secondary to

a. anovulation during the menstrual cycle.

b. inadequate estradiol secretion.

c. unopposed progesterone.

d. impaired growth of the endometrium.

4. What should the NP rule out first in diagnosing the patient with DUB?

a. PCOS

b. pharmacological causes

c. systemic disease

d. pregnancy

5. Medications or supplements that can cause abnormal vaginal bleeding include

a. calcium channel blockers.

b. St. John's wort.

c. soy and ginseng.

d. ACE inhibitors.

6. Endometrial sampling in abnormal uterine bleeding is recommended

a. for women 35 years and older.

b. to rule out gonorrhea and chlamydia.

c. to quantify blood loss.

d. for women who have had tubal ligation.

7. The patient with abnormal vaginal bleeding needs LH, FSH, and LH/FSH ratio testing when

a. she exhibits hirsutism, acne, and metabolic syndrome.

b. DUB has been diagnosed.

c. endocrine dysfunction has been ruled out.

d. blood dyscrasias are suspected.

8. When diagnosing DUB, prolactin is tested to

a. test endometrial thickness.

b. diagnose PCOS.

c. confirm the patient is not pregnant.

d. rule out noncancerous pituitary tumor.

9. The purpose of saline infusion sonohysterography is to

a. perform dilation and curettage.

b. allow for polypectomy.

c. provide better visualization less invasively.

d. flush debris from the uterus.

10. Approximately 2% of women with inadequately managed anovulatory bleeding eventually develop

a. prolactinoma

b. uterine infection

c. endometrial adenocarcinoma

d. HPA axis disruption

11. A large component of the diagnostic process of DUB is

a. referring the patient for psychiatric management.

b. halting ovulation and preventing pregnancy.

c. performing interventions such as polypectomy.

d. reassuring the patient that every avenue is being explored.

12. Which patient is the best candidate for COC therapy for DUB?

a. 33-year-old with normal hematologic and endocrine profiles

b. 25-year-old with elevated prolactin levels and decreased LH

c. 35-year-old with a history of breast cancer and smoking

d. 30-year-old whose thyroid function panel is abnormal

13. A patient with hemorrhagic uterine bleeding can be treated with

a. bromocriptine.

b. high-dose conjugated estrogen.

c. COC therapy.

d. progestin.

14. What is the purpose of using estrogen in combination with progestin?

a. to stop bleeding while allowing for pregnancy

b. to prevent development of diabetes mellitus

c. to prevent later bleeding events after hemorrhage is controlled

d. to cease menstrual bleeding altogether

15. One treatment for women unable to tolerate systemic hormones is

a. levonorgestrel-releasing IUD.

b. tubal ligation.

c. micronized progestin for 10 to 12 days per month.

d. I.V. injection of factors IV and X.

16. Which statement best describes tranexamic acid?

a. hormonal medication taken daily to stabilize the fibrin matrix

b. drug approved for control of bleeding and pregnancy prevention

c. medication that induces formation of progesterone receptors

d. drug taken during menses to slow bleeding quickly by moderating plasmin activity

17. A disadvantage of endometrial ablation is

a. the procedure requires performing a hysterectomy.

b. patients who fail medical therapy are poor candidates.

c. patients unable to tolerate surgery are poor candidates.

d. younger women are more likely to resume heavy bleeding.

18. Which treatment option for DUB should be used as a last resort?

a. COC therapy

b. hysterectomy

c. endometrial ablation

d. D&C

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