MCCQE - OBGYN block study cards-
with complete solutions
ovulatory abnormal pre-menopausal menstrual bleeding
- definition correct answer: normal cycle length (28 days +/- 7)
but abnormal (excessive) volume of blood loss:
a) menses >7days
b) blood loss >80mL
-soak through menstrual products q1-2 hours
-passage of clots larger than a dime
-self reported 'very heavy' periods
shorter luteal phase & increased fibrinolysis contributes to
menorrhagia
anovulatory pre-menopausal menstrual bleeding
- DDx (3 categories) correct answer: 1. HPO issues
- Immature HPO axis (young)
- aging ovarian follicles (older)
- premature ovarian failure (e.g. chemo/rads to pelvis)
- stress, weight loss, exercise
2. Diseases
a) Hypothyroid
b) PCOS (androgen excess)
c) Cushing's (androgen excess)
3. Tumors/masses
a) Prolactinoma
,b) STRUCTURAL --> fibroids, tumors pushing into the cavity
can cause sketchy bleeding!ova
abnormal pre-menopausal menstrual bleeding
- DDx correct answer: PALM COEIN
Structural:
Polyp
Adenomyosis
Leiomyoma (fibroids)
Malignancy
Non-structural
Coagulopathy
- e.g. VWD
Ovulatory
- weight loss/exercise, PCOS, etc.
Endometrial
- hyperplasia/cancer
- endometritis
Iatrogenic
- e.g. anticoagulation, IUD, FB, trauma
Not otherwise classified:
- chronic disease: hypothyroidism, liver disease, CKD, obesity
- pregnancy
- infection: STI
,pre-menopausal menstrual bleeding
- pregnancy related causes (4) correct answer: 1. Implantation
bleed
2. Miscarriage
3. Ectopic pregnancy
4. Gestational trophoblastic disease
PCOS
- risks with anovulatory cycles (3)
- Tx causing infertility (2)
- Tx for those desiring fertility (2) correct answer: Risks
1. Infertility
2. Dysfunctional uterine bleeding (DUB)
- Can be VERY heavy
- Obesity = increased peripheral E ("fertilizer") for the
lining**Impt to use OCP or IUD with these pts
3. Endometrial hyperplasia/endometrial cancer
Tx -
1. OCP
2. IUD
Fertility Tx:
1. Weight loss
2. Metformin
Abnormal ovulatory premenstrual bleeding
- Px (3 things to look for)
- Ix - blood (4)
- Ix - imaging (3 lines) correct answer: Px:
1. Thyroid dysfunction - clinical exam signs
, 2. Abdo/Pelvic exam - bimanual, assess uterine size/masses
3. Anemia - pallor, fatigue, overall appearance
Ix:
1. b-hCG
2. CBC, ferritin
3. INR, PT, PTT
4. TSH
Ix - imaging:
- 1º: U/S
- 2º: sonohystogram (SIS)
- 3º: hysteroscopy
*other as indicated --> pap smear, endometrial Bx
sonohysterogram
- what can be visualized? (2)
- indications (2) correct answer: sterile saline infused through
the cervix into the endometrial cavity
visualize:
1. Intra-cavitary masses (e.g. polyps, fibroids)
2. Tubes (assess patency of tubes)
indications
1. Abnormal bleeding (look for masses)
2. Infertility (assess patency of tubes)
Indications for endometrial Bx (3) correct answer: 1. any post
menopausal bleeding
with complete solutions
ovulatory abnormal pre-menopausal menstrual bleeding
- definition correct answer: normal cycle length (28 days +/- 7)
but abnormal (excessive) volume of blood loss:
a) menses >7days
b) blood loss >80mL
-soak through menstrual products q1-2 hours
-passage of clots larger than a dime
-self reported 'very heavy' periods
shorter luteal phase & increased fibrinolysis contributes to
menorrhagia
anovulatory pre-menopausal menstrual bleeding
- DDx (3 categories) correct answer: 1. HPO issues
- Immature HPO axis (young)
- aging ovarian follicles (older)
- premature ovarian failure (e.g. chemo/rads to pelvis)
- stress, weight loss, exercise
2. Diseases
a) Hypothyroid
b) PCOS (androgen excess)
c) Cushing's (androgen excess)
3. Tumors/masses
a) Prolactinoma
,b) STRUCTURAL --> fibroids, tumors pushing into the cavity
can cause sketchy bleeding!ova
abnormal pre-menopausal menstrual bleeding
- DDx correct answer: PALM COEIN
Structural:
Polyp
Adenomyosis
Leiomyoma (fibroids)
Malignancy
Non-structural
Coagulopathy
- e.g. VWD
Ovulatory
- weight loss/exercise, PCOS, etc.
Endometrial
- hyperplasia/cancer
- endometritis
Iatrogenic
- e.g. anticoagulation, IUD, FB, trauma
Not otherwise classified:
- chronic disease: hypothyroidism, liver disease, CKD, obesity
- pregnancy
- infection: STI
,pre-menopausal menstrual bleeding
- pregnancy related causes (4) correct answer: 1. Implantation
bleed
2. Miscarriage
3. Ectopic pregnancy
4. Gestational trophoblastic disease
PCOS
- risks with anovulatory cycles (3)
- Tx causing infertility (2)
- Tx for those desiring fertility (2) correct answer: Risks
1. Infertility
2. Dysfunctional uterine bleeding (DUB)
- Can be VERY heavy
- Obesity = increased peripheral E ("fertilizer") for the
lining**Impt to use OCP or IUD with these pts
3. Endometrial hyperplasia/endometrial cancer
Tx -
1. OCP
2. IUD
Fertility Tx:
1. Weight loss
2. Metformin
Abnormal ovulatory premenstrual bleeding
- Px (3 things to look for)
- Ix - blood (4)
- Ix - imaging (3 lines) correct answer: Px:
1. Thyroid dysfunction - clinical exam signs
, 2. Abdo/Pelvic exam - bimanual, assess uterine size/masses
3. Anemia - pallor, fatigue, overall appearance
Ix:
1. b-hCG
2. CBC, ferritin
3. INR, PT, PTT
4. TSH
Ix - imaging:
- 1º: U/S
- 2º: sonohystogram (SIS)
- 3º: hysteroscopy
*other as indicated --> pap smear, endometrial Bx
sonohysterogram
- what can be visualized? (2)
- indications (2) correct answer: sterile saline infused through
the cervix into the endometrial cavity
visualize:
1. Intra-cavitary masses (e.g. polyps, fibroids)
2. Tubes (assess patency of tubes)
indications
1. Abnormal bleeding (look for masses)
2. Infertility (assess patency of tubes)
Indications for endometrial Bx (3) correct answer: 1. any post
menopausal bleeding
