Mary L
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bleeding/endocrine disorders

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Mary L
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Abnormal Uterine Bleeding/ Amenorrhea/ Hyperandrogenic Disorders

Question 1 of 18

1

Select from the dropdown lists to complete the text.

The normal cycle length is ( 21 to 35 days, 20 to 30 days, 21 to 30, 18 to 35 ). The normal length of menstrual flow is ( 2 to 8 days, 1 to 8 days, 3 to 9 days, 4 to 7 days ). The normal amount of menstrual blood loss is ( 20 - 80 ml, 10 - 90 ml, 20 - 40 ml, 10 - 100 ml ).

Explanation

Question 2 of 18

1

Abnormal uterine bleeding is defined as any of the following except

Select one of the following:

  • frequency of menses

  • duration of flow

  • amount of blood loss

  • pain with menstruation

  • bleeding between periods

Explanation

Question 3 of 18

1

Broad classifications of Abnormal Uterine Bleeding include Ovulatory and Anovulatory. Accurate terminology includes the following terms: check all that apply

Select one or more of the following:

  • acute uterine bleeding

  • menorrhagia

  • heavy menstrual bleeding

  • polymenorrhea

  • prolonged menstrual bleeding

  • oligomenorrhea

  • menometrorhagia

Explanation

Question 4 of 18

1

All of the following complaints may be classified as Abnormal Uterine Bleeding except:

Select one or more of the following:

  • 16 yo dancer who is concerned because she only gets her period every 60 days

  • 49 yo who reports reports heavy uterine bleeding and that her last period before this episode was 18 months ago

  • 25 year old who complains that she has spotting requiring the use of a light pad usually for 1-2 days between periods most months

  • 29 yo who has severe cramps with regular menstrual cycle and menses lasting for 9 days each month

Explanation

Question 5 of 18

1

When the etiology of AUB is structural, the most common cause is

Select one of the following:

  • polyps

  • fibroids

  • ectopic pregnancy

  • traumatic injury

Explanation

Question 6 of 18

1

Choose all of the risk factors for endometrial cancer:

Select one or more of the following:

  • Age > 35

  • anovulation

  • PCOS

  • family hx of endometrial cancer

  • grandmultiparity

  • new onset of heavy, irregular bleeding, particularly after menopause

  • BMI <25

  • tamoxifen

Explanation

Question 7 of 18

1

In the PALM-COEIN classification, PALM stands for:

Select one of the following:

  • Polymenorrhea, amenorrhea, Leukorrhea, and Metrorrhagia

  • Polymenorrhea, amenorrhea, Leukorrhea, and Menorrhagia

  • Polyps, Adenomyosis, Leiomyoma, Malignant and Premalignant

  • Polyps, Adenomyosis, Leiomyoma, Menorrhagia

Explanation

Question 8 of 18

1

In the PALM-COEIN classification, COIEN stands for:

Select one of the following:

  • Coagulapathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not classified

  • Coagulapathy, Ovulatory dysfunction, Endometrial, Immunologic, Neoplasia

  • Coagulapathy, Ovulatory dysfunction, Endemic, Iatrogenic, Neoplasia

  • Coagulapathy, Ovulatory dysfunction, Endometrial, Immunologic, Not classified

Explanation

Question 9 of 18

1

AUB that is ovulatory is likely the result of endocrine process in which estrogen is stimulating endometrial growth without progesterone opposition, then is sloughed only once the endometrium outgrows its blood supply/loses nutrients.

Select one of the following:

  • True
  • False

Explanation

Question 10 of 18

1

A 41 yo female presents with a complaint of heavy but regular periods occuring at her usual 29-30 intervals. She states that her last period was very heavy and lasted for 8 days. She has had no problems with abdominal pain, menstrual cramping or pain with sex. She does occasionally feel some pressure in her pubic area. Expected pelvic examination findings with this client would include:

Select one of the following:

  • diffusely enlarged uterus

  • irregularly enlarged uterus

  • fixed retroverted uterus

  • prolapsed uterus

Explanation

Question 11 of 18

1

You have prescribed your patient the first line therapy for her AUB, you tell her that you are prescribing

Select one of the following:

  • continuous COCs and that it can take up to 3 months to be effective.

  • Cyclic COCs and that she should results after 1 month treatment.

  • NSAIDS which will help reverse the prostglandin imbalance and be effective within the first 12 hours.

  • Estrogen therapy to calm the hyperactive growth of her uterine lining.

Explanation

Question 12 of 18

1

Progestins are the first line of treatment for an acute bleeding episode due to a denuded endometrium because it will stimulate the synthesis of PgF2 alpha which is vasoconstrictive.

Select one of the following:

  • True
  • False

Explanation

Question 13 of 18

1

A woman brings her daughter in to see you because she is not menstruating. You would evaluate her for all of the following except:

Select one of the following:

  • primary amenorrhea because she is 16 years, 7 months old and has never menstruated

  • primary amenorrhea because she is 14, has no breast budding, no pubic and has never menstruated

  • nothing because she is a 17 year old with previous regular periods, but they stopped after joining cross country team six months ago. this is secondary amenorrhea and you know that this is not uncommon for athletes

  • nothing because she is a 17 year old and had regular periods, but she started taking depo and her periods stopped. Secondary amenorrhea is a normal side effect of depo.

Explanation

Question 14 of 18

1

You suspect that your patient's AUB is annovulatory so you order _________ to confirm the diagnosis.

Select one of the following:

  • serum progesterone on day 1 of her cycle

  • serum progesterone on day 22 of her cycle

  • prolactin

  • quantitative serum hCG

Explanation

Question 15 of 18

1

The following pts present for AUB. Match their complaints with the supplemental labs you would order:
- hair loss, cold intolerance
- headaches and peripheral vision changes
- easy bruising, heavy periods
- irregular bleeding

Drag and drop to complete the text.

    Prolactin
    TSH
    Progesterone
    PTT/PT

Explanation

Question 16 of 18

1

A client comes in asking more about GnRH agonists, you could tell her all of the following except:

Select one of the following:

  • They are appropriate for short term use while a woman is awaiting surgical treatment for her heavy bleeding.

  • They should not be used long term because of menopausal side effects including negative impact on bone density

  • They are a first line therapy for women who are anemic

  • There is an estridiol "flare" that occurs around day 5, accompanied by heavy bleeding that lasts for several days.

Explanation

Question 17 of 18

1

In evaluating a client for primary amenorrhea, you administer a progesterone challenge test. Check off all the following things that are true for this test

Select one or more of the following:

  • You administer micronized progesterone 400mg daily X10 days, medroxyprogesterone acetate 5-10mg daily for 5-10 days, or progesterone in oil 200mg IM

  • If the challenge is positive, should should observe a withdrawal bleed while taking the progesterone.

  • If the challenge is positive, it confirms that the client has functioning ovaries which produce enough circulating endogenous estrogen

  • If the challenge is positive, it confirms rules out an obstruction of the genital tract

  • If the challenge is negative, it confirms exercise induced annovulation.

Explanation

Question 18 of 18

1

The Rotterdam PCOS Consensus Group requires 2 of the following 3 criteria to diagnose PCOS EXCEPT:

Select one of the following:

  • oligo- or annovulation

  • Clinical and/or biochemical signs of hyperandrogenism

  • polycystic ovaries

  • exclusion of other androgen excess or related disorders

Explanation

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