Deck 18: Abnormal Uterine Bleeding

Question 1

A 48-year-old woman presents to the clinic with a complaint of irregular vaginal bleeding for the last 12 months. Currently, she has been bleeding for the last 10 days, the bleeding is light, one to two pads per day. She is not sexually active and is followed at the clinic for hypertension. After a detailed history and exam you diagnose this patient with ovulatory dysfunction. The most appropriate pharmacological treatment to regulate her bleeding in this case is:

A) Antifibrinolytic agents
B) Monophasic oral contraceptives
C) Antiprostaglandins
D) Medroxyprogesterone acetate

Answer 1

D

Question 2

You are following up a 45-year-old woman for heavy bleeding. You initiated treatment, and her bleeding has subsided. She presented a week ago with a 2-week history of heavy vaginal bleeding with blood clots. Her gynecological history revealed 1-year history of irregular bleeding, characterized by several months of no bleeding followed by 1-2 weeks of "heavy menstrual bleeding." Her physical exam, including pelvic exam, was benign. At this follow-up visit, which of the following diagnostic tests is most appropriately ordered for the investigation of this abnormal bleeding pattern?

A) MRI of the pelvic organs
B) Endometrial biopsy
C) Saline infusion sonography
D) Blood serum CA 125

Answer 2

B

Question 3

An 18-year-old woman presents with a 2-month history of intermenstrual bleeding, increased vaginal discharge, and mild lower abdominal pain. Her last menstrual period (LMP) was 1 week ago, and her cycles are regular. Sexual debut was 1 year ago; she is sexually active with the same partner (her only partner) and has taken oral contraception pills for 1 year. She reports taking her oral contraceptives consistently with no side effects. The most likely cause of this bleeding is:

A) Chlamydia infection
B) Endometriosis
C) Cervical polyps
D) Missing oral contraceptive (OC) pills

Answer 3

A

Question 4

A 28-year-old woman reports a 10-day history of vaginal spotting. Her past medical, family, and social histories are noncontributory. She is sexually active and uses condoms for contraception. Prior to this event, she had no complaints; her menses were regular before this episode. Which of the following laboratory tests is most important in her initial workup?

A) Follicle-stimulating hormone (FSH)
B) Prolactin
C) Estradiol
D) Pregnancy test

Question 5

A 15-year-old, sexually active woman, using condoms for contraception, presents with a history of irregular bleeding since the onset of menses at age 13. She started bleeding 2 weeks ago after a prolonged period of no bleeding. She has been changing three to four soaked pads per day. Her history and physical leads you to believe she has ovulatory dysfunction. Her urine pregnancy test is negative. What is the most appropriate medication regimen to prescribe for this woman?

A) Medroxyprogesterone acetate 20 mg 2 pills TID X 7 days followed by 1 pill daily X 2 weeks
B) A monophasic 35 mcg oral contraceptive ,1 pill PO TID X 7 days, f/u by a 1, 20 mcg OC pill, daily X 21 days
C) Nonsteroidal anti-inflammatory medication,
D) Medroxyprogesterone acetate 150 mg intramuscular (IM), at the time of the visit
E)g., Ibuprofen 800 mg TID for 5 to 7 days

Question 6

A 35-year-old, G1 P1 (gravida 1 para 1) woman presents to the clinic with a 5-month history of heavy menstrual bleeding and frequent dysmenorrhea. You find that the uterus is enlarged and irregular. What is the most likely explanation for this bleeding?

A) Endometriosis
B) Adenomyosis
C) Leiomyomatosis
D) Endometrial polyps

Question 7

A 43-year-old woman presents with a 12-month history of irregular menses, mostly infrequent menses followed by prolonged episodes of bleeding (up to 2 weeks). Her past medical, family, and social histories are noncontributory. Her review of systems is negative for hot flushes, weight changes, galactorrhea, headaches, changes in bowel movements, or skin problems. She is not sexually active. Her physical exam, including her pelvic exam, is normal. The bleeding pattern in this case is most likely due to:

A) Ovulatory dysfunction
B) Coagulation disorder
C) Endometrial polyps
D) Thyroid disease

Question 8

What advice will you give a woman diagnosed with heavy menstrual bleeding who is being treated with combined oral contraceptives?

A) Bleeding should stop or greatly decrease 24 to 48 hours after initiation of therapy.
B) Normal menstrual bleeding will resume 1 month after the medication therapy is discontinued.
C) Tranexamic acid can be added to oral contraceptives if bleeding does not subside.
D) She is at risk of ovarian cancer if she does not follow the advised therapy.