Structured cases and ACOG readings UPDATED ACTUAL Questions and
CORRECT Answers
1. Risk reducing 1. Explore entire abdomen
BSO (5) 2. Pelvic washings
3. Examine course of ureter
4. Dissect IP 2 cm lateral to ovary
5. Inform pathology
2. Salpingectomy 1. Ensure it is her wish, not being imposed
counseling 2. Other forms of contraception (LARCs, vasectomy)
3. Surgical risks
4. Menstrual hx; will not help bleeding
3. AUB medical 1. cOCP
treatments 2. Progestins (oral, Depo Provera, LNG IUD)
3. Tranexamic acid
4. GnRH modulators (suppress LH and FSH)
a. Lupron: GnRH modulator (agonist); Norethrindrone add back therapy to help
reduce bone loss and hot flashes
b. Elagolix, Rolugolix, Linzagolix: GnRH antagonists (need add back, esp if higher
doses for fibroid treatment)
4. PID antibiotics Ceftriaxone 1g q24 hrs
Doxycycline 100 mg BID
Flagyl 500 mg BID
Home on Doxy/Flagyl for total of 14 days
IR if no improvement in about 24 hrs
Laparoscopy if concern for rupture
5. Layers abdomi- Skin
nal wall Fat (camper's fascia)
Scarpa's fascia (membranous)
External oblique
,Internal oblique
, Transverse abdominal
Transversalis fascia
Preperitoneal fat
Peritoneum
6. Causes of AUB Structural-
(PALM-COEIN) Polyps
Adenomyosis
Leiomyoma
Malignancy/ Hyperplasia
Coagulopathy
Ovulatory dysfuction
Endometrial
Iatrogenic
Not yet classified
7. Acute AUB med- 1. IV Estrogen 25 mg q 4-6 hrs for 24 hrs
ical treatment 2. Medroxprogesterone acetate 20 mg TID for 7 days
3. cOCP 35 micorgrams estradiol TID x7 days
4. Tranexamic acid 1.3 g TID x 5 days
8. When to evalu- 1. Heavy menses since menarche
ate for underly- 2. ONE of the following: PPH, surgery related bleeding, bleeding with dental work
ing bleeding dis- 3. TWO or more: Epistaxis or bruising twice monthly, frequent gum bleeds, FH
order with AUB bleeding disorders
9. Fetal risks VAVD Scalp lacerations
Cephalohematoma
Subgaleal hematoma (30-40/1000)
CORRECT Answers
1. Risk reducing 1. Explore entire abdomen
BSO (5) 2. Pelvic washings
3. Examine course of ureter
4. Dissect IP 2 cm lateral to ovary
5. Inform pathology
2. Salpingectomy 1. Ensure it is her wish, not being imposed
counseling 2. Other forms of contraception (LARCs, vasectomy)
3. Surgical risks
4. Menstrual hx; will not help bleeding
3. AUB medical 1. cOCP
treatments 2. Progestins (oral, Depo Provera, LNG IUD)
3. Tranexamic acid
4. GnRH modulators (suppress LH and FSH)
a. Lupron: GnRH modulator (agonist); Norethrindrone add back therapy to help
reduce bone loss and hot flashes
b. Elagolix, Rolugolix, Linzagolix: GnRH antagonists (need add back, esp if higher
doses for fibroid treatment)
4. PID antibiotics Ceftriaxone 1g q24 hrs
Doxycycline 100 mg BID
Flagyl 500 mg BID
Home on Doxy/Flagyl for total of 14 days
IR if no improvement in about 24 hrs
Laparoscopy if concern for rupture
5. Layers abdomi- Skin
nal wall Fat (camper's fascia)
Scarpa's fascia (membranous)
External oblique
,Internal oblique
, Transverse abdominal
Transversalis fascia
Preperitoneal fat
Peritoneum
6. Causes of AUB Structural-
(PALM-COEIN) Polyps
Adenomyosis
Leiomyoma
Malignancy/ Hyperplasia
Coagulopathy
Ovulatory dysfuction
Endometrial
Iatrogenic
Not yet classified
7. Acute AUB med- 1. IV Estrogen 25 mg q 4-6 hrs for 24 hrs
ical treatment 2. Medroxprogesterone acetate 20 mg TID for 7 days
3. cOCP 35 micorgrams estradiol TID x7 days
4. Tranexamic acid 1.3 g TID x 5 days
8. When to evalu- 1. Heavy menses since menarche
ate for underly- 2. ONE of the following: PPH, surgery related bleeding, bleeding with dental work
ing bleeding dis- 3. TWO or more: Epistaxis or bruising twice monthly, frequent gum bleeds, FH
order with AUB bleeding disorders
9. Fetal risks VAVD Scalp lacerations
Cephalohematoma
Subgaleal hematoma (30-40/1000)
