MCN 538 UPDATED EXAMS SCRIPT QUESTIONS AND
ANSWERS GRADED A+
✔✔this is a structural cause of AUB. Risk factors include long-term unopposed
estrogen; diagnosis via endometrial biopsy; all women with AUB >45 or risk factors
should have endometrial sampling. what is it and how do we treat it? -
✔✔malignancy/hyperplasia. Treatment is often hysterectomy
✔✔what are the Non-Structural Causes of abnormal uterine bleeding? - ✔✔COEIN:
Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified
✔✔this is a nonstructural cause of AUB. It is most common in adolescents; includes
VWB, platelet disorders, thrombocytopenia, factor deficiencies, rare leukemia/aplastic
anemia; assessment: hx, family hx, labs (PT, PTT, CBC, fibrinogen, LFTs, thyroid,
ferritin, VWB factors); what is it and how do we treat it? - ✔✔Coagulopathy. treatment:
identify cause, stop bleeding (COC, progestin, TXA), avoid NSAIDs until evaluated, iron
supplementation, maintain QOL
✔✔this is a nonstructural cause of AUB. Endocrine or functional causes: Anovulation,
immature HPO axis, thyroid disorders, PCOS, pregnancy, medications; assessment
includes menstrual hx, clots, hygiene, labs (B-HCG, CBC, thyroid, LFT, ferritin,
testosterone, prolactin, estradiol, progesterone, LH); what is it and how do we treat it? -
✔✔Ovulatory dysfunction. treatment: address underlying endocrine disorders,
dietary/lifestyle modification, hormonal contraception (COC, progestin-only, LNG-IUS),
NSAIDs, TXA
✔✔this is a nonstructural cause of AUB. Endometrial dysfunction: dysregulated
hemostasis due to inflammation, infection, or vasoconstriction disorders; regular cycles
but HMB; diagnosis of exclusion. what is it and how do we treat it? - ✔✔Endometrial
Causes. treatment: hormonal contraception, TXA, dietary changes (anti-inflammatory,
omega-3s)
✔✔this is a nonstructural cause of AUB. Medical or pharmacologic treatment disrupting
menstruation: chemo/radiation, hormonal contraception, tamoxifen, anticoagulants,
dopamine antagonists (tricyclics, antipsychotics), diuretics (spironolactone), opiates;
assessment: PMH, surgical hx, medications, social hx; what is it and how do we treat it?
- ✔✔Iatrogenic Causes. treatment: identify cause, adjust medications, TXA if needed
✔✔this is a nonstructural cause of AUB. endometritis, C-section scar defects;
assessment: PMH, surgical/menstrual hx; what is it and how do we treat it? - ✔✔Not
Yet Identified Causes. treat endometritis, surgical revision if fertility desired,
UAE/hysterectomy if fertility not desired
,✔✔[Topic: AUB Terminology] what is irregular menstrual bleeding? - ✔✔variation >20
days/year
✔✔what are labs to get in a patient with mental health concerns? - ✔✔Mental health lab
studies include: CBC to rule out anemia; TFTs especially during pregnancy and
postpartum in women with psych/thyroid hx; Glucose tolerance screening for
uncontrolled DM; Drug screening, liver, adrenocortical, renal tests as indicated; Serum
electrolytes, LFTs, bone density if eating disorder suspected; Check psychotropic drug
blood levels if on therapy.
✔✔what Erikson's Stage are Elderly Women in and what does it mean? - ✔✔Elderly
women are in Ego Integrity vs Despair stage. Ego integrity = sense of accomplishment
& creativity. Despair = perception of wasted life.
✔✔what is Late Adulthood Transition and what age does it occur? - ✔✔Occurs 60-65
yrs, involves profound reappraisal of past and shift to new era.
✔✔what is Menopause? - ✔✔Final menstrual period (FMP); permanent cessation of
menses due to loss of ovarian follicular function. Clinically confirmed by 12 months of
amenorrhea in women with uterus, or hx of bilateral oophorectomy, symptoms, or serial
endocrine markers.
✔✔what is the average Age of Menopause in western countries? - ✔✔51-52 years
✔✔What factors Influence Menopause? - ✔✔Smoking, higher parity, body mass,
malnourishment, vegetarianism, ethnicity
✔✔what are effects of menopause on CNS, Bones, GU, Metabolic system, and the
cardiovascular system? - ✔✔CNS: vasomotor instability, sleep disruption, cognitive
decline; Skin: loss of collagen (first 5 yrs); Bone: estrogen deficiency causes bone loss;
GU: vulvovaginal symptoms & urinary complaints; Metabolic: decreased carbohydrate
tolerance, increased insulin resistance; CVD risk rises
✔✔is postmenopausal Vaginal Bleeding acceptable? - ✔✔no! it is a Red flag; must be
investigated for endometrial cancer
✔✔what are some common General Health Concerns in Mature Women - ✔✔Age-
related physiologic changes affect disease processes; cognitive decline and dementia;
review adolescent & adult concerns for relevance
✔✔what is vaginitis? - ✔✔Inflammation or infection of the vagina; common presenting
complaints include itching, burning, irritation, dyspareunia, fishy odor, abnormal
discharge
, ✔✔what are common Causes of Vaginitis? - ✔✔Vulvovaginal candidiasis (17-39%),
bacterial vaginosis (22-50%), Trichomoniasis (4-35%); may remain undiagnosed in 7-
72% of patients
✔✔what is Estrogen's role in the vaginal environment? - ✔✔Estrogen increases
glycogen in epithelial cells → lactobacilli colonization → lactic acid → vaginal pH <4.5,
discouraging pathogenic growth. this is protective and good!
✔✔what bacterium is included in Normal Vaginal Flora? - ✔✔Gardnerella vaginalis, E.
coli, GBS, genital mycoplasma species, Candida albicans
✔✔what is BV Pathophysiology? - ✔✔Overgrowth of facultative anaerobes, lack of
H2O2-producing lactobacilli; not single pathogen STI; associated with aging, douching,
sexual activity; many asymptomatic
✔✔what are Symptoms of BV? - ✔✔Abnormal vaginal discharge, fishy odor after
intercourse or menses
✔✔what are the risk factors for and symptoms of trichomonas vaginalis? - ✔✔risk
factors: multiple sex partners, low SES, douching; associated with PID, post-
hysterectomy cuff cellulitis, HIV, other STIs; 50% asymptomatic; symptoms: discharge,
itching, burning, postcoital bleeding
✔✔what is Vulvovaginal Candidiasis? what are the symptoms? - ✔✔Inflammation &
infection with Candida spp.; second most common cause; range: asymptomatic to
severe (burning, itching, edema, dysuria, dyspareunia, abnormal discharge); uncommon
in prepubertal & postmenopausal women not on estrogen
✔✔Clinical Evaluation of Vaginitis should include what? - ✔✔History: sexual, OTC/Rx
use, hygiene, underlying conditions, relation to menstrual cycle; Physical: vulva &
vagina; Clinical testing: pH, KOH whiff, saline & KOH microscopy; FDA tests if needed
✔✔Normal Vaginal Discharge should be what colors, what ph, and what bacteria should
dominate? - ✔✔White & creamy or clear; pH 3.5-4.5; dominated by lactobacillus
✔✔how is BV diagnosed? - ✔✔Amsel criteria: 3 of 4 needed → homogenous thin
discharge, >20% clue cells, pH>4.5, positive KOH whiff; Gram stain with Nugent scoring
alternative
✔✔how is BV Treated? - ✔✔Metronidazole 500mg PO BID x7d or 2g single dose for
men; Metronidazole gel 0.75% intravaginally daily x5d; Clindamycin 2% cream
intravaginally x7d; Abstain from alcohol during & 24h after metronidazole; Treat partner,
retest at <3 months
ANSWERS GRADED A+
✔✔this is a structural cause of AUB. Risk factors include long-term unopposed
estrogen; diagnosis via endometrial biopsy; all women with AUB >45 or risk factors
should have endometrial sampling. what is it and how do we treat it? -
✔✔malignancy/hyperplasia. Treatment is often hysterectomy
✔✔what are the Non-Structural Causes of abnormal uterine bleeding? - ✔✔COEIN:
Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified
✔✔this is a nonstructural cause of AUB. It is most common in adolescents; includes
VWB, platelet disorders, thrombocytopenia, factor deficiencies, rare leukemia/aplastic
anemia; assessment: hx, family hx, labs (PT, PTT, CBC, fibrinogen, LFTs, thyroid,
ferritin, VWB factors); what is it and how do we treat it? - ✔✔Coagulopathy. treatment:
identify cause, stop bleeding (COC, progestin, TXA), avoid NSAIDs until evaluated, iron
supplementation, maintain QOL
✔✔this is a nonstructural cause of AUB. Endocrine or functional causes: Anovulation,
immature HPO axis, thyroid disorders, PCOS, pregnancy, medications; assessment
includes menstrual hx, clots, hygiene, labs (B-HCG, CBC, thyroid, LFT, ferritin,
testosterone, prolactin, estradiol, progesterone, LH); what is it and how do we treat it? -
✔✔Ovulatory dysfunction. treatment: address underlying endocrine disorders,
dietary/lifestyle modification, hormonal contraception (COC, progestin-only, LNG-IUS),
NSAIDs, TXA
✔✔this is a nonstructural cause of AUB. Endometrial dysfunction: dysregulated
hemostasis due to inflammation, infection, or vasoconstriction disorders; regular cycles
but HMB; diagnosis of exclusion. what is it and how do we treat it? - ✔✔Endometrial
Causes. treatment: hormonal contraception, TXA, dietary changes (anti-inflammatory,
omega-3s)
✔✔this is a nonstructural cause of AUB. Medical or pharmacologic treatment disrupting
menstruation: chemo/radiation, hormonal contraception, tamoxifen, anticoagulants,
dopamine antagonists (tricyclics, antipsychotics), diuretics (spironolactone), opiates;
assessment: PMH, surgical hx, medications, social hx; what is it and how do we treat it?
- ✔✔Iatrogenic Causes. treatment: identify cause, adjust medications, TXA if needed
✔✔this is a nonstructural cause of AUB. endometritis, C-section scar defects;
assessment: PMH, surgical/menstrual hx; what is it and how do we treat it? - ✔✔Not
Yet Identified Causes. treat endometritis, surgical revision if fertility desired,
UAE/hysterectomy if fertility not desired
,✔✔[Topic: AUB Terminology] what is irregular menstrual bleeding? - ✔✔variation >20
days/year
✔✔what are labs to get in a patient with mental health concerns? - ✔✔Mental health lab
studies include: CBC to rule out anemia; TFTs especially during pregnancy and
postpartum in women with psych/thyroid hx; Glucose tolerance screening for
uncontrolled DM; Drug screening, liver, adrenocortical, renal tests as indicated; Serum
electrolytes, LFTs, bone density if eating disorder suspected; Check psychotropic drug
blood levels if on therapy.
✔✔what Erikson's Stage are Elderly Women in and what does it mean? - ✔✔Elderly
women are in Ego Integrity vs Despair stage. Ego integrity = sense of accomplishment
& creativity. Despair = perception of wasted life.
✔✔what is Late Adulthood Transition and what age does it occur? - ✔✔Occurs 60-65
yrs, involves profound reappraisal of past and shift to new era.
✔✔what is Menopause? - ✔✔Final menstrual period (FMP); permanent cessation of
menses due to loss of ovarian follicular function. Clinically confirmed by 12 months of
amenorrhea in women with uterus, or hx of bilateral oophorectomy, symptoms, or serial
endocrine markers.
✔✔what is the average Age of Menopause in western countries? - ✔✔51-52 years
✔✔What factors Influence Menopause? - ✔✔Smoking, higher parity, body mass,
malnourishment, vegetarianism, ethnicity
✔✔what are effects of menopause on CNS, Bones, GU, Metabolic system, and the
cardiovascular system? - ✔✔CNS: vasomotor instability, sleep disruption, cognitive
decline; Skin: loss of collagen (first 5 yrs); Bone: estrogen deficiency causes bone loss;
GU: vulvovaginal symptoms & urinary complaints; Metabolic: decreased carbohydrate
tolerance, increased insulin resistance; CVD risk rises
✔✔is postmenopausal Vaginal Bleeding acceptable? - ✔✔no! it is a Red flag; must be
investigated for endometrial cancer
✔✔what are some common General Health Concerns in Mature Women - ✔✔Age-
related physiologic changes affect disease processes; cognitive decline and dementia;
review adolescent & adult concerns for relevance
✔✔what is vaginitis? - ✔✔Inflammation or infection of the vagina; common presenting
complaints include itching, burning, irritation, dyspareunia, fishy odor, abnormal
discharge
, ✔✔what are common Causes of Vaginitis? - ✔✔Vulvovaginal candidiasis (17-39%),
bacterial vaginosis (22-50%), Trichomoniasis (4-35%); may remain undiagnosed in 7-
72% of patients
✔✔what is Estrogen's role in the vaginal environment? - ✔✔Estrogen increases
glycogen in epithelial cells → lactobacilli colonization → lactic acid → vaginal pH <4.5,
discouraging pathogenic growth. this is protective and good!
✔✔what bacterium is included in Normal Vaginal Flora? - ✔✔Gardnerella vaginalis, E.
coli, GBS, genital mycoplasma species, Candida albicans
✔✔what is BV Pathophysiology? - ✔✔Overgrowth of facultative anaerobes, lack of
H2O2-producing lactobacilli; not single pathogen STI; associated with aging, douching,
sexual activity; many asymptomatic
✔✔what are Symptoms of BV? - ✔✔Abnormal vaginal discharge, fishy odor after
intercourse or menses
✔✔what are the risk factors for and symptoms of trichomonas vaginalis? - ✔✔risk
factors: multiple sex partners, low SES, douching; associated with PID, post-
hysterectomy cuff cellulitis, HIV, other STIs; 50% asymptomatic; symptoms: discharge,
itching, burning, postcoital bleeding
✔✔what is Vulvovaginal Candidiasis? what are the symptoms? - ✔✔Inflammation &
infection with Candida spp.; second most common cause; range: asymptomatic to
severe (burning, itching, edema, dysuria, dyspareunia, abnormal discharge); uncommon
in prepubertal & postmenopausal women not on estrogen
✔✔Clinical Evaluation of Vaginitis should include what? - ✔✔History: sexual, OTC/Rx
use, hygiene, underlying conditions, relation to menstrual cycle; Physical: vulva &
vagina; Clinical testing: pH, KOH whiff, saline & KOH microscopy; FDA tests if needed
✔✔Normal Vaginal Discharge should be what colors, what ph, and what bacteria should
dominate? - ✔✔White & creamy or clear; pH 3.5-4.5; dominated by lactobacillus
✔✔how is BV diagnosed? - ✔✔Amsel criteria: 3 of 4 needed → homogenous thin
discharge, >20% clue cells, pH>4.5, positive KOH whiff; Gram stain with Nugent scoring
alternative
✔✔how is BV Treated? - ✔✔Metronidazole 500mg PO BID x7d or 2g single dose for
men; Metronidazole gel 0.75% intravaginally daily x5d; Clindamycin 2% cream
intravaginally x7d; Abstain from alcohol during & 24h after metronidazole; Treat partner,
retest at <3 months
