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A new look at abnormal uterine bleeding

doi: 10.1097/01.NPR.0000439075.30883.ed
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INSTRUCTIONS A new look at abnormal uterine bleeding


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A new look at abnormal uterine bleeding

General Purpose: The purpose of this learning activity is to provide information about abnormal uterine bleeding (AUB) and its management. Learning Objectives: After reading this article and taking the test, you should be able to: 1. Define AUB and identify its causes. 2. Identify assessment and management strategies for AUB.

  1. The highest incidence of AUB is in perimenopausal women and in
    1. adolescents just beginning to menstruate.
    2. prenatal women at risk for spontaneous abortion.
    3. women during the 6 to 12 week period after delivery.
    4. postmenopausal women.
  2. AUB is defined as
    1. new terminology for menorrhagia and oligomenorrhea.
    2. abnormally heavy bleeding related to vasodilation of the endometrium.
    3. abnormally heavy bleeding that occurs intermittently over at least 6 months.
    4. any change within normal menstruation or the normal menstrual cycle pattern.
  3. The PALM-COEIN classification system identifies abnormalities by bleeding pattern and
    1. etiology.
    2. duration.
    3. frequency.
    4. anatomical structures.
  4. The patient with AUB-O has abnormal uterine bleeding caused by
    1. oligomenorrhea.
    2. pituitary dysfunction.
    3. ovulatory dysfunction.
    4. hypothalamic dysfunction
  5. The normal parameter for blood loss during a menstrual cycle is defined as
    1. 5 to 20 ml.
    2. 5 to 80 ml.
    3. 10 to 120 ml.
    4. 30 to 150 ml.
  6. The secretory phase of the uterine cycle is under the influence of
    1. estrogen.
    2. progesterone.
    3. luteinizing hormone.
    4. prostaglandins.
  7. In contrast to anovulatory bleeding, ovulatory bleeding is characterized by
    1. normal cervical mucus changes.
    2. monophasic temperature records.
    3. non-anatomic or functional causes.
    4. abnormal estradiol hormone levels.
  8. Endometrial polyps are
    1. the most common benign neoplasms.
    2. related to inherited coagulopathies.
    3. benign clumps of tissue stemming from follicles.
    4. pedunculated masses of stromal and endometrial glands.
  9. Heavy menstrual bleeding in up to a third of adolescents is frequently associated with
    1. leiomyomas.
    2. adenomyosis.
    3. endocervical polyps.
    4. von Willebrand disease.
  10. Which of the following is associated with anovulatory bleeding?
    1. prostaglandin surges stimulating patchwork vasodilation.
    2. endometrial proliferation of abnormal heights and fragility.
    3. abnormally low levels of plasminogen activator enzymes.
    4. a luteinizing hormone surge and a dysfunctional corpus luteum.
  11. In anovulatory bleeding, the expected serum progesterone on day 20 is
    1. less than 1 ng/ml.
    2. 1 to 3 ng/ml.
    3. 4 to 6 ng/ml.
    4. 7 to 10 ng/ml.
  12. The menopausal transition is associated with all of the following except
    1. hypothalamic-pituitary-ovarian (HPO) axis dysfunction.
    2. anovulatory bleeding.
    3. luteal out-of phase events.
    4. high levels of follicle development.
  13. Extreme exercise can cause
    1. menorrhagia.
    2. ovarian dysfunction.
    3. platelet dysfunction.
    4. endometrial disorders.
  14. Which blood test(s) does the American College of Obstetricians and Gynecologists (ACOG) recommend in evaluating all women with AUB?
    1. bleeding time
    2. serum ferritin
    3. CBC with differential and thyroid stimulating hormone
    4. CBC with prothrombin and partial thromboplastin times
  15. Which diagnostic tool is not recommended as a primary tool for AUB evaluation?
    1. endometrial biopsy
    2. magnetic resonance imaging
    3. transvaginal ultrasonography
    4. saline infused sonohysterography
  16. The first line of treatment for a non-pregnant woman with AUB is
    1. single hormone therapy with estrogen.
    2. single hormone therapy with progestin.
    3. combined estrogen/progestin therapy.
    4. the levonogestrel intrauterine contraceptive system (LNG-IUS).
  17. What is the mechanism of action of LNG-IUS?
    1. decreases endometrial proliferation
    2. blocks vasodilator prostaglandins
    3. stabilizes the uterine fibrin matrix
    4. stabilizes the hypothalamus-pituitary-ovarian axis
  18. Women with irregular frequency or duration patterns may benefit from treatment with
    1. prostaglandins.
    2. tranexamic acid.
    3. conjugated estrogen.
    4. NSAIDs.


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