NUR 660 EXAM 1 2025
Menstruation QUESTIONS AND
ANSWERS
GRADED A+
What is the most important differential to rule out in postmenopausal bleeding?
Cancer (especially endometrial)
An average cycle is how many days?
28 days
Range 21-35 days/3-5 weeks
,How long does an average cycle last and how much blood is typically lost?
4-6 days
30 mL (not typically measured, upper limit of normal 6-80)
Amenorrhea is defined as
Absence of menses >6 months
If <6 months, this is just irregular menstrual bleeding and not actual amenorrhea
Define oligomenorrhea
Bleeding at an interval >35 days
Define menorrhagia
Excessive or prolonged menstural bleeding occurring at regular intervals
>80 cc or >7 days
Define polymenorrhea
Bleeding at an interval <21 days
Differentiate between ovulatory and anovulatory bleeding.
Ovulatory bleeding is cyclic bleeding accompanied by cyclic signs of ovulation (tender breasts,
cramping, pain) aka typical menstrual bleeding
Anovulatory bleeding is unpredictable, non-cyclic bleeding that is variable in flow and duration.
There are no signs of ovulation.
What age groups are anovulatory bleeding not uncommon in?
Perimenopausal
Pre-teen
,What are some differentials to consider with pregnancy related AUB?
Spontaneous abortion, ectopic pregnancy, placental previa (not attached to the fundus),
placenta abruptio (detaching, emergency), trophoblastic disease, childbirth complications
What are some medications that can cause irregular bleeding? Herbals?
Anticoagulants, SSRIs/antipsychotics (especially Lexapro), corticosteroids, hormonal
medications, IUD, tamoxifen
Also some herbals like ginseng, gingko, soy, black cohosh
Tamoxifen has what effects on estrogen?
Blocks estrogen at the breast but has a positive effect on uterus which can increase
endometrial cancer risk and therefore create AUB
Name some systemic diseases that can cause AUB.
thyroid disease (both hypo and hyper)
PCOS
Coagulopathies
Hepatic disease
Pituitary adenoma
Hypothalamic suppression (common in athletes due to low adipose)
In a woman who is not menopausal, what needs to be ruled out before investigating other
causes of AUB?
pregnancy always
Why is it important to assess the size, contour, and tenderness of the uterus when doing a
physical exam for someone with AUB?
, rule out ectopic pregnancy, fibroids that you may be able to palpate
What lab are you going to make sure to add for a woman who reports she is reporting she is
changing her pad or tampon multiple times in an hour?
Bleeding studies: H/H, platelet count, PT, PTT
May want to consider factor VIII, von Willebrand factor antigen (referral)
A patient with AUB is also reporting nipple discharge. What is your top differential and what
lab do you want to order?
Prolactinoma
Order prolactin level
Who requires an endometrial biopsy if experiencing AUB?
All women over age 35 or with risk factors of endometrial cancer
What is the initial pharmacologic management of SEVERE AUB in reproductive-age women?
High dose of estrogen during severe acute bleeding
Oral: 35 mcg 1-4x/day for 7 days and then daily
IV prn
What is something to consider when a patient is interested in endometrial ablation as
treatment for their AUB?
Fertility
Will not be able to have children after this procedure so it is not recommended in the case that
she wants to reproduce
For a patient who is having chronic or less severe ANOVULATORY AUB, what would the
pharmacologic management be?
OCPs can help by increasing the predictability of cycles as well as decreasing blood loss per
cycle
Menstruation QUESTIONS AND
ANSWERS
GRADED A+
What is the most important differential to rule out in postmenopausal bleeding?
Cancer (especially endometrial)
An average cycle is how many days?
28 days
Range 21-35 days/3-5 weeks
,How long does an average cycle last and how much blood is typically lost?
4-6 days
30 mL (not typically measured, upper limit of normal 6-80)
Amenorrhea is defined as
Absence of menses >6 months
If <6 months, this is just irregular menstrual bleeding and not actual amenorrhea
Define oligomenorrhea
Bleeding at an interval >35 days
Define menorrhagia
Excessive or prolonged menstural bleeding occurring at regular intervals
>80 cc or >7 days
Define polymenorrhea
Bleeding at an interval <21 days
Differentiate between ovulatory and anovulatory bleeding.
Ovulatory bleeding is cyclic bleeding accompanied by cyclic signs of ovulation (tender breasts,
cramping, pain) aka typical menstrual bleeding
Anovulatory bleeding is unpredictable, non-cyclic bleeding that is variable in flow and duration.
There are no signs of ovulation.
What age groups are anovulatory bleeding not uncommon in?
Perimenopausal
Pre-teen
,What are some differentials to consider with pregnancy related AUB?
Spontaneous abortion, ectopic pregnancy, placental previa (not attached to the fundus),
placenta abruptio (detaching, emergency), trophoblastic disease, childbirth complications
What are some medications that can cause irregular bleeding? Herbals?
Anticoagulants, SSRIs/antipsychotics (especially Lexapro), corticosteroids, hormonal
medications, IUD, tamoxifen
Also some herbals like ginseng, gingko, soy, black cohosh
Tamoxifen has what effects on estrogen?
Blocks estrogen at the breast but has a positive effect on uterus which can increase
endometrial cancer risk and therefore create AUB
Name some systemic diseases that can cause AUB.
thyroid disease (both hypo and hyper)
PCOS
Coagulopathies
Hepatic disease
Pituitary adenoma
Hypothalamic suppression (common in athletes due to low adipose)
In a woman who is not menopausal, what needs to be ruled out before investigating other
causes of AUB?
pregnancy always
Why is it important to assess the size, contour, and tenderness of the uterus when doing a
physical exam for someone with AUB?
, rule out ectopic pregnancy, fibroids that you may be able to palpate
What lab are you going to make sure to add for a woman who reports she is reporting she is
changing her pad or tampon multiple times in an hour?
Bleeding studies: H/H, platelet count, PT, PTT
May want to consider factor VIII, von Willebrand factor antigen (referral)
A patient with AUB is also reporting nipple discharge. What is your top differential and what
lab do you want to order?
Prolactinoma
Order prolactin level
Who requires an endometrial biopsy if experiencing AUB?
All women over age 35 or with risk factors of endometrial cancer
What is the initial pharmacologic management of SEVERE AUB in reproductive-age women?
High dose of estrogen during severe acute bleeding
Oral: 35 mcg 1-4x/day for 7 days and then daily
IV prn
What is something to consider when a patient is interested in endometrial ablation as
treatment for their AUB?
Fertility
Will not be able to have children after this procedure so it is not recommended in the case that
she wants to reproduce
For a patient who is having chronic or less severe ANOVULATORY AUB, what would the
pharmacologic management be?
OCPs can help by increasing the predictability of cycles as well as decreasing blood loss per
cycle
