ACOG Practice Bulletins Verified Exam Questions and Answers Latest
update 2026/2027
Question:
When is endometrial evaluation indicated in women 13-18 years of age with AUB-O?
Answer:
Endometrial cancer is rare in <20 yo women; if it occurs, it usually presents with 2-3 years of
abnormal bleeding and obesity. Evaluation is needed when medical treatment has failed after thorough
investigation
Question:
When is endometrial evaluation indicated in women 19-39 years of age with AUB-O?
Answer:
risk of endometrial cancer in 20-34 is 1.6% risk in 35-44 is 6.2% assessment is needed in women who
do not respond to medical therapy or have prolonged periods of unopposed estrogen if biopsy is
non-diagnostic, hysteroscopy or saline sonohysterscope may be warranted
Question:
what are the risk factors for endometrial cancer in women <40 years old?
Answer:
nulliparity hypertension BMI >30 irregular menstruation family history
Question:
When is endometrial evaluation indicated in women 40+ years of age with AUB-O?
Answer:
between 40-50, incidence is 13-24/100,000 between 70-74, incidence is 87/100,000 Better prognosis
in women less than 45 yo therefore women 45+ with suspected anovulatory uterine bleeding should
received endometrial biopsy
Question:
in women with AUB-O, what is the treatment approach to guide therapy?
Answer:
Exogenous steroids
,Question:
1. progestin only - levonogestrel IUD, medroxyprogesterone acetate, megestrol acetate,
norethindrone acetate, depot medroxyprogesterone acetate
2. combined hormonal contraception
both will help thin endometrium and protect from hyperplastic transition; combined also induce
regular withdrawal bleeding when taken cyclically What are examples of progestin only medications?
Answer:
progestin only - levonogestrel IUD, medroxyprogesterone acetate, megestrol acetate, norethindrone
acetate, depot medroxyprogesterone acetate
Question:
what medical therapies are most appropriate for AUB-O in 13-18 yo age range?
Answer:
1. exogenous steroids
Question:
2. if clinically symptomatic or hemodynamically unstable --> ADMIT
3. can also prolong the interval of menstruation by skipping the placebo week, allowing anemia
to resolve
4. combined hormonal contraceptives also have the added benefit of increased factor VIII and
VWD levels, therefore combating coagulopathy what medical therapies are most appropriate for
AUB-O in 19-40 yo age range?
Answer:
1. low dose combined hormonal contraceptives or
Question:
2. progestin only
3. weight loss and exercise for obese, anovulatory women
what medical therapies are most appropriate for AUB-O in 40+ yo age range?`
Answer:
in Late perimenopausal women, cyclic progestin therapy, low dose oral contraceptives, levonorgestrel
IUD or cyclic hormone therapy It was found that perimenopausal symptoms were better managed with
cyclic hormone therapy
Question:
whats are the added benefit for younger patients who have a coagulopathy and AUB-O who take
combined oral contraceptives?
Answer:
combined hormonal contraceptives also have the added benefit of increased factor VIII and VWD
levels, therefore combating coagulopathy
,Question:
whats are the added benefit for younger patients who have PCOS and AUB-O who take combined oral
contraceptives?
Answer:
combined oral contraceptives suppress ovarian and adrenal androgen production and increase
hormone binding globulin, therefore decreasing androgens which in turn improve symptoms of
hirsuitism and acne in PCOS
Question:
In patients with AUB-O who have completed childbearing, what are the potential concerns of
endometrial ablation treatment?
Answer:
risk for endometrial cancer
- impeded future evaluation
- postablation asherman, cervical stenosis, endometrial distortion, strictures, synechiae
Question:
what is the suggested further investigation of women with AUB-O who have failed medical
management?
Answer:
1. hysteroscopy
Question:
2. TVUS (in pre-menopausal women, should be conducted when endometrium is thinnest at days
4-6)
3. saline infusion sonohysterography (high sensitivity and high NPV)
what method of contraception has been show to effectively treat AUB?
Answer:
levonorgestrel IUD
Question:
which women are candidates for hysterecomy without cervical preservation secondary to AUB?
Answer:
women who have completed child bearing women have failed medical therapy women with
contraindications
, Question:
What are the goal ranges of insulin therapy for women with pre-gestational diabetes mellitus (i.e. at
fasting, pre-meal, 1 hour postprandial, and 2 hour)
Answer:
fasting = <95 mg/dL pre meal = <100 1 hour = <140 2 hour = <120
Question:
when are the various insulins utilized during management of patient glucose levels?
Answer:
short/rapid acting = before meals intermediate acting = before breakfast and before dinner (with
short/rapid acting) longer acting = utilized to restrain hepatic glucose production during fasting states
Question:
what are the uses for magnesium sulfate during pregnancy?
Answer:
tocolysis during pre-term labor to provide time for steroid administration
- neuroprotection
Question:
What are the indications for treatment with magnesium sulfate for neuroprotection?
Answer:
PPROM
-PTL with intact membranes
-indicated Pre term delivery
- limited to pregnancies less than 32 weeks GA
Question:
What dose of magnesium sulfate is given for neuroprotection?
Answer:
loading dose 4 grams followed by 1 gram/hr for maintenance; discontinue after 24 hours if delivery
has not occurred
Question:
what are the side effects of magnesium sulfate?
Answer:
diaphoresis flushing nausea headache magnesium toxicity (cardiac arrest, respiratory depression)
update 2026/2027
Question:
When is endometrial evaluation indicated in women 13-18 years of age with AUB-O?
Answer:
Endometrial cancer is rare in <20 yo women; if it occurs, it usually presents with 2-3 years of
abnormal bleeding and obesity. Evaluation is needed when medical treatment has failed after thorough
investigation
Question:
When is endometrial evaluation indicated in women 19-39 years of age with AUB-O?
Answer:
risk of endometrial cancer in 20-34 is 1.6% risk in 35-44 is 6.2% assessment is needed in women who
do not respond to medical therapy or have prolonged periods of unopposed estrogen if biopsy is
non-diagnostic, hysteroscopy or saline sonohysterscope may be warranted
Question:
what are the risk factors for endometrial cancer in women <40 years old?
Answer:
nulliparity hypertension BMI >30 irregular menstruation family history
Question:
When is endometrial evaluation indicated in women 40+ years of age with AUB-O?
Answer:
between 40-50, incidence is 13-24/100,000 between 70-74, incidence is 87/100,000 Better prognosis
in women less than 45 yo therefore women 45+ with suspected anovulatory uterine bleeding should
received endometrial biopsy
Question:
in women with AUB-O, what is the treatment approach to guide therapy?
Answer:
Exogenous steroids
,Question:
1. progestin only - levonogestrel IUD, medroxyprogesterone acetate, megestrol acetate,
norethindrone acetate, depot medroxyprogesterone acetate
2. combined hormonal contraception
both will help thin endometrium and protect from hyperplastic transition; combined also induce
regular withdrawal bleeding when taken cyclically What are examples of progestin only medications?
Answer:
progestin only - levonogestrel IUD, medroxyprogesterone acetate, megestrol acetate, norethindrone
acetate, depot medroxyprogesterone acetate
Question:
what medical therapies are most appropriate for AUB-O in 13-18 yo age range?
Answer:
1. exogenous steroids
Question:
2. if clinically symptomatic or hemodynamically unstable --> ADMIT
3. can also prolong the interval of menstruation by skipping the placebo week, allowing anemia
to resolve
4. combined hormonal contraceptives also have the added benefit of increased factor VIII and
VWD levels, therefore combating coagulopathy what medical therapies are most appropriate for
AUB-O in 19-40 yo age range?
Answer:
1. low dose combined hormonal contraceptives or
Question:
2. progestin only
3. weight loss and exercise for obese, anovulatory women
what medical therapies are most appropriate for AUB-O in 40+ yo age range?`
Answer:
in Late perimenopausal women, cyclic progestin therapy, low dose oral contraceptives, levonorgestrel
IUD or cyclic hormone therapy It was found that perimenopausal symptoms were better managed with
cyclic hormone therapy
Question:
whats are the added benefit for younger patients who have a coagulopathy and AUB-O who take
combined oral contraceptives?
Answer:
combined hormonal contraceptives also have the added benefit of increased factor VIII and VWD
levels, therefore combating coagulopathy
,Question:
whats are the added benefit for younger patients who have PCOS and AUB-O who take combined oral
contraceptives?
Answer:
combined oral contraceptives suppress ovarian and adrenal androgen production and increase
hormone binding globulin, therefore decreasing androgens which in turn improve symptoms of
hirsuitism and acne in PCOS
Question:
In patients with AUB-O who have completed childbearing, what are the potential concerns of
endometrial ablation treatment?
Answer:
risk for endometrial cancer
- impeded future evaluation
- postablation asherman, cervical stenosis, endometrial distortion, strictures, synechiae
Question:
what is the suggested further investigation of women with AUB-O who have failed medical
management?
Answer:
1. hysteroscopy
Question:
2. TVUS (in pre-menopausal women, should be conducted when endometrium is thinnest at days
4-6)
3. saline infusion sonohysterography (high sensitivity and high NPV)
what method of contraception has been show to effectively treat AUB?
Answer:
levonorgestrel IUD
Question:
which women are candidates for hysterecomy without cervical preservation secondary to AUB?
Answer:
women who have completed child bearing women have failed medical therapy women with
contraindications
, Question:
What are the goal ranges of insulin therapy for women with pre-gestational diabetes mellitus (i.e. at
fasting, pre-meal, 1 hour postprandial, and 2 hour)
Answer:
fasting = <95 mg/dL pre meal = <100 1 hour = <140 2 hour = <120
Question:
when are the various insulins utilized during management of patient glucose levels?
Answer:
short/rapid acting = before meals intermediate acting = before breakfast and before dinner (with
short/rapid acting) longer acting = utilized to restrain hepatic glucose production during fasting states
Question:
what are the uses for magnesium sulfate during pregnancy?
Answer:
tocolysis during pre-term labor to provide time for steroid administration
- neuroprotection
Question:
What are the indications for treatment with magnesium sulfate for neuroprotection?
Answer:
PPROM
-PTL with intact membranes
-indicated Pre term delivery
- limited to pregnancies less than 32 weeks GA
Question:
What dose of magnesium sulfate is given for neuroprotection?
Answer:
loading dose 4 grams followed by 1 gram/hr for maintenance; discontinue after 24 hours if delivery
has not occurred
Question:
what are the side effects of magnesium sulfate?
Answer:
diaphoresis flushing nausea headache magnesium toxicity (cardiac arrest, respiratory depression)
