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What is a common risk factor for adenomyosis?
Which of the following is a characteristic of bleeding in ovulatory dysfunction?
What is the primary objective of endometrial sampling in women with abnormal uterine bleeding?
A 30-year-old woman presents with heavy menstrual bleeding. Which of the following laboratory tests should be ordered initially?
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What is the primary mechanism underlying abnormal uterine bleeding in ovulatory dysfunction?
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Which of the following is a risk factor for postmenopausal bleeding?
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What is the primary indication for imaging studies in women with abnormal uterine bleeding?
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Which of the following is a characteristic of bleeding in adenomyosis?
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What is the primary goal of initial therapy in managing AUB?
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What is the preferred treatment for managing acute episodes of heavy menstrual bleeding?
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What is the indication for saline infusion sonography?
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What is an alternative to endometrial biopsy in postmenopausal women?
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What is the purpose of TVUS in postmenopausal women?
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What is a risk factor for endometrial cancer?
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What is a benefit of hysteroscopy?
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What is a consideration for treatment of AUB in reproductive-aged individuals?
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A patient presents with heavy menstrual bleeding, frequent changes of pads/tampons throughout the night, and large blood clots. Which of the following conditions is most likely NOT a contributing factor?
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A 35-year-old woman reports irregular bleeding patterns, including prolonged periods and spotting between periods. She has been using a hormonal intrauterine device (IUD) for the past two years. Which of the following is the MOST likely cause of her irregular bleeding?
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A patient presents with postmenopausal bleeding. Which of the following is the MOST concerning potential cause?
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A 28-year-old woman with a history of heavy menstrual bleeding and pelvic pain is found to have a large uterine fibroid. Which of the following treatments is most likely to be recommended?
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A woman with a family history of endometrial cancer is concerned about her risk. Which of the following factors is the MOST significant risk factor for endometrial cancer?
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A patient reports heavy menstrual bleeding and is diagnosed with menorrhagia. Which of the following is a possible cause of menorrhagia?
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A woman is experiencing frequent and unpredictable bleeding patterns after starting a new contraceptive pill. Which of the following is the MOST likely cause?
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A patient presents with excessive bleeding during her menstrual cycle, lasting for over 7 days. Which of the following is a potential contributing factor?
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Which of the following is NOT a known risk factor for endometrial cancer?
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Which chronic medical disorder is specifically associated with the risk of developing secondary amenorrhea?
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What is a common symptom indicating the presence of a bleeding disorder?
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Which of the following medications is likely to cause oligomenorrhea due to hyperprolactinemia?
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Which scenario is most likely to lead to scarring of the endometrial lining?
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Which of the following risk factors is specifically associated with heavy menstrual bleeding?
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Which condition is linked to an increased risk of developing endometrial cancer due to unopposed estrogen exposure?
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What underlying condition may lead to a patient experiencing heavy menstrual bleeding?
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What is a common characteristic of heavy menstrual bleeding?
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Which of the following scenarios best suggests a potential cause of irregular vaginal bleeding?
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What factor may indicate a cervical origin for abnormal vaginal bleeding?
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How might the use of progestin-only contraceptives affect menstrual bleeding?
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Which symptom is commonly associated with endometrial cancer risk factors?
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Which of the following may indicate abnormal uterine bleeding due to hypothalamic dysfunction?
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What effect does the copper IUD have on menstrual bleeding?
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What bleeding pattern is considered abnormal for reproductive-aged individuals?
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Study Notes
Risk Factors for Endometrial Cancer
- Increasing age and nulliparity significantly elevate the risk.
- Polycystic Ovary Syndrome (PCOS) and obesity are notable contributors.
- Tamoxifen therapy and unopposed exogenous estrogen exposure are linked to higher incidence.
- Diabetes and a family history of endometrial cancer amplify the risk.
- Hereditary conditions like Lynch syndrome and Cowden syndrome are critical high-risk factors.
Risk Factors for Scarring of Endometrial Lining
- Obstetric catastrophes, severe bleeding, and dilation and curettage (D&C) procedures can lead to scarring.
- Endometritis and other infections pose a risk for damage to the endometrial lining.
Chronic Medical Disorders
- Thyroid, celiac disease, type 1 diabetes mellitus (T1DM), chronic kidney disease (CKD), and opioid use disorder (OUD) can result in secondary amenorrhea.
- Connective tissue disorders may cause heavy menstrual bleeding.
- Bleeding disorders present with symptoms like fatigue, shortness of breath, bruising, and petechiae. Key risk factors include anticoagulant therapy and thrombocytopenia.
Heavy Bleeding Characteristics
- Normal menstrual bleeding is defined as needing to change pads/tampons every 3 hours or empty menstrual cups every 10-12 hours.
- Heavy bleeding assessment includes frequency of changes during peak flow days and the size of passed clots (normal size is less than 1 inch).
- A Pictorial Blood Loss Assessment Chart (PBAC) score over 100 indicates heavy menstrual bleeding.
Associated Symptoms
- Hormonal issues: galactorrhea, intolerance to temperature, hirsutism, hot flashes.
- Reproductive issues: lower abdominal pain, fever, and vaginal discharge indicate potential pelvic inflammatory disease (PID) or endometritis.
- Neurological symptoms: headaches, visual field defects, fatigue, and polyuria indicate hypothalamic-pituitary disorders.
- Ovarian insufficiency and perimenopause symptoms include hot flashes, vaginal dryness, and decreased libido.
Physical Exam Findings
- Monitor vital signs, including Body Mass Index (BMI), hair, and body fat distribution.
- Look for systemic illness indicators: fever, ecchymosis, pallor, and lymphadenopathy (LAD).
- Examine optic fundi and visual fields if pituitary tumors are suspected.
- Assess for bruising, gingival bleeding, and endocrine symptoms (e.g., hirsutism, striae).
- Uterine examination should include size, contour, and presence of any masses or tenderness.
FIGO Classification (PALM-COEIN)
- Abnormal uterine bleeding can arise from structural (PALM) or nonstructural (COEIN) causes:
- PALM: Polyp, Adenomyosis, Leiomyoma, Malignancy.
- COEIN: Coagulopathy, Ovulatory dysfunction, Endometrial causes, Iatrogenic factors, Not yet classified.
Pathophysiology of AUB-O (Ovulatory Dysfunction)
- Abnormal secretion of sex steroids leads to continued endometrial proliferation without sufficient progesterone.
- Thickened endometrium may undergo necrosis leading to irregular and heavy bleeding.
Evaluation of Abnormal Uterine Bleeding (AUB)
- Initial evaluation should include urine hCG to rule out pregnancy, followed by serum hCG if negative but early pregnancy is suspected.
- Secondary evaluation includes laboratory tests (CBC, ferritin, thyroid function tests) and imaging for structural abnormalities.
- Endometrial sampling is critical for those at risk or showing suspicious symptoms.
Management of AUB
- Treatment is tailored based on etiology, severity of symptoms, and patient preference.
- High-dose combined oral contraceptives are the preferred method to manage acute heavy menstrual bleeding.
- Goals include normalizing bleeding, preventing anemia, and mitigating risks of endometrial hyperplasia/cancer.
- Preventive measures should be customized to individual patient circumstances and future pregnancy intentions.
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Description
This quiz covers the risk factors associated with endometrial cancer, including age, nulliparity, and certain medical conditions. It also touches on the risk factors for scarring of the endometrial lining.
