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Abnormal Uterine Bleeding
Abnormal Uterine Bleeding
Which of the following is the most appropriate next step in management of this
patient?
A. Endometrial biopsy
B. Measure serum LH and FSH
C. Pelvic U/S
D. Oral contraceptives
Question 2: Answer
26 year old female presents with 4 days of history of light vaginal bleeding after
intercourse. Prior to this incident, she reports regular menstruation cycle and no vaginal
discharge. She is in a monogamous relationship with her husband.
Her physical exam was unremarkable. Her pelvic exam was unremarkable except small
amount of blood in the cervical os.
On physical exam she was afebrile, BP 134/86, HR 74, negative orthostasis. Pelvic exam
demonstrated slightly enlarged, globular uterus, with blood noted in cervical os. Pregnancy test is
negative.
Which of the following is the most appropriate next step in the evaluation of this patient?
A. Magnetic resonance imaging
B. Transvaginal ultrasound
C. Hysteroscopy
D. Reassurance and monitoring
Question 4: Answer
Which of the following is the most appropriate next step in the management of this
patient?
A. Estrogen-progestin oral contraceptive
B. Endometrial ablation
C. Levonorgestrel (Mirena) IUD
D. Hysterectomy
Question 5: Answer
A. Estrogen-progestin OCPs are effective in the treatment of
heavy menstrual bleeding, however this patient has several
risk factors for thrombosis
B. Endometrial ablation is a minimally invasive option in
patients in which medical therapy has failed. Medical
therapy should be initiated, also it is unknown whether the
patient wants to maintain fertility
C. Levonorgestrel IUDs are effective in the treatment of
heavy menstrual bleeding and would be an appropriate
choice in this patient with contraindications to estrogen use
D. Hysterectomy is curative in the treatment of uterine
bleeding, however medical therapy and less invasive
treatments are preferred initially