#128 Diagnosis of Abnormal Uterine Bleeding in Reproductive-Aged Women Flashcards

1
Q

How long does the normal menstrual cycle last (time between)

A

21 to 35 days

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2
Q

What is the definition of heavy menstrual bleeding

A

Great than 80mL (research), clinically based on patient perception

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3
Q

What is menorrhagia

A

heavy menstrual bleeding

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4
Q

What is metrorrhagia

A

Bleeding between periods

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5
Q

What is polymenorrhea

A

Bleeding that occurs more often than every 21 days

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6
Q

What is oligomenorrhea

A

Bleeding that occurs less frequently than every 35 days

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7
Q

What percentage of women presenting at any age with HMB will have an underlying bleeding disorder

A

up to 20%

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8
Q

What herbal remedies can cause AUB?

A

Ginkgo, ginseng, motherwort

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9
Q

Which patients w/ HMB should be tested for underlying disorder of hemostasis?

A

-HMB since menarche
- PP hemorrhage
- Surgery-related bleeding
- Bleeding associated with dental work
Two or more of the following:
- bruising 1-2x/mo
- epistaxis 1-2x/mo
- frequent gum bleeding
- FH of bleeding symptoms

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10
Q

What are physical exam findings suggestive of a bleeding disorder?

A

Petechiae, ecchymoses, skin pallor, swollen joints

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11
Q

What is the name of the test for von Willebrand disease?

A

von Willebrand-ristocetin cofactor activity, von Willebrand factor antigen, and factor VIII

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12
Q

Is hypothyroidsim or hyperthyroidism associated with AUB?

A

Both are, but hypothyroidism is more common

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13
Q

What are the imaging modalities used to evaluate AUB?

A

Primary imaging test TVUS. Then SIS of hysteroscopy to better evaluate uterine cavity. MRI is not a primary imaging modality for AUB.

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14
Q

How many adolescents with AUB who require hospitalization have an underlying coagulopathy?

A

As many as 19%

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15
Q

What is the sensitivity of TVUS for detecting intracavity pathology?

A

56%

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16
Q

What percentage of women with AUB have intrauterine abnormalities?

A

46.6%

17
Q

When should endometrial tissue sampling be performed in patients with AUB?

A

Patients with AUB who are older than 45 years, or younger than 45 years with a history of unopposed estrogen exposure, failed medical management, and persistent AUB.

18
Q

What is the concern of EMB with a focal lesion?

A

If the cancer occupies less than 50% of the surface area of the endometrial cavity, blind biopsy may miss it

19
Q

What is the chance of endometrial cancer with a negative EMB?

A

0.9%

20
Q

What does persistent bleeding after benign EMB necessitate?

A

Further work up

21
Q

What ultrasound findings support a diagnosis of adenomyosis?

A

Heterogeneous myometrium, myometrial cysts, asymmetric myometrial thickness, and subendometrial echogenic linear striations

22
Q

How is adenomyosis best visualized?

A

T2-weighted MRI

23
Q

Is ultrasound or MRI better at detecting adenomyosis?

A

MRI is equal to better than ultrasound. MRI performs better with coexisting myomas.

24
Q

When is treatment for AUB appropriate?

A

Trial of therapy is appropriate when risk for hyperplasia, neoplasia, or structural abnormalities is low. For those at increased risk, >45, initiation of therapy is appropriate after diagnostic evaluation