MCN 538 MODULE 1 ACTUAL PAPER 2026
COMPLETE QUESTIONS AND SOLUTIONS
◉ AUB frequencies includes amenorrhea, frequent, and infrequent -
what does each frequency mean?
Answer: · Amenorrhea - no period
· Frequent - Less than 24 days
· Infrequent - Greater than 38 days
◉ [Topic: AUB Duration] abnormal duration of bleeding would be
how many days?
Answer: Menstrual bleeding lasting more than 8 days
◉ [Topic: AUB Volume] abnormal volume of bleeding is determined
by what?
Answer: the patient. includes Light or Heavy bleeding. (is the
bleeding interfering with physical, social, emotional, or material
quality of life)
◉ [Topic: Medications & AUB] what supplements can increase
vaginal bleeding by disrupting platelet aggregation?
Answer: ginkgo biloba, ginseng, soy
,◉ [Topic: AUB Classification] what pneumonic can bc used to
identify most common structural problems or nonstructral
problems?
Answer: PALM (structural) = Polyp, Adenomyosis,
Leiomyoma/Fibroid, Malignancy. COEIN (nonstructural) =
Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not
yet classified
◉ true or false: structural causes of abnormal uterine bleeding
(PALM) often causes ovulatory bleeding despite normal ovulation,
can be heavy menstrual bleeding or intermenstrual bleeding, and be
imaged or defined histopathologically
Answer: true
◉ this is a structural cause of AUB. Prevalence 8-35%; risk increases
with age, obesity, HTN, HRT, tamoxifen; intermenstrual bleeding is
presenting symptom; 95% benign; diagnosed via transvaginal US.
What is it and how do we treat it?
Answer: polyp. treated with hysteroscopic polypectomy.
◉ this is a structural cause of AUB. Endometrial tissue in
myometrium; risk factors include multiparity, C-section, endometrial
curettage; most common age 40-50; heavy, painful, prolonged cycles;
diffuse uterine enlargement; diagnosed via US or MRI. what is it and
how do we treat it?
,Answer: Adenomyosis. Treated non-surgically with NSAIDs, LNG-IUS
(Mirena/Liletta), DNG, COCs, GnRH agonists/antagonists; surgical
options: endomyometrial resection (limited), uterine artery
embolization (not fertility-sparing), HIFU (fertility-sparing)
◉ this is a structural cause of AUB. _____ is a benign uterine smooth
muscle tumors; submucous type often cause intermenstrual
bleeding; prevalence increases with age; heavy, painful, prolonged
cycles; enlarged or irregular uterus; diagnosed with US. what is it
and how do we treat it?
Answer: Leiomyoma. treated non-surgically with COCs, progestin-
only pills, GnRH agonists (Depot Lupron), Elagolix, Relugolix;
surgical: myomectomy (fertility-sparing), uterine artery
embolization, endometrial ablation, hysterectomy
◉ 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?
Answer: malignancy/hyperplasia. Treatment is often hysterectomy
◉ what are the Non-Structural Causes of abnormal uterine bleeding?
Answer: 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?
Answer: 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?
Answer: 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?
Answer: Endometrial Causes. treatment: hormonal contraception,
TXA, dietary changes (anti-inflammatory, omega-3s)
COMPLETE QUESTIONS AND SOLUTIONS
◉ AUB frequencies includes amenorrhea, frequent, and infrequent -
what does each frequency mean?
Answer: · Amenorrhea - no period
· Frequent - Less than 24 days
· Infrequent - Greater than 38 days
◉ [Topic: AUB Duration] abnormal duration of bleeding would be
how many days?
Answer: Menstrual bleeding lasting more than 8 days
◉ [Topic: AUB Volume] abnormal volume of bleeding is determined
by what?
Answer: the patient. includes Light or Heavy bleeding. (is the
bleeding interfering with physical, social, emotional, or material
quality of life)
◉ [Topic: Medications & AUB] what supplements can increase
vaginal bleeding by disrupting platelet aggregation?
Answer: ginkgo biloba, ginseng, soy
,◉ [Topic: AUB Classification] what pneumonic can bc used to
identify most common structural problems or nonstructral
problems?
Answer: PALM (structural) = Polyp, Adenomyosis,
Leiomyoma/Fibroid, Malignancy. COEIN (nonstructural) =
Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not
yet classified
◉ true or false: structural causes of abnormal uterine bleeding
(PALM) often causes ovulatory bleeding despite normal ovulation,
can be heavy menstrual bleeding or intermenstrual bleeding, and be
imaged or defined histopathologically
Answer: true
◉ this is a structural cause of AUB. Prevalence 8-35%; risk increases
with age, obesity, HTN, HRT, tamoxifen; intermenstrual bleeding is
presenting symptom; 95% benign; diagnosed via transvaginal US.
What is it and how do we treat it?
Answer: polyp. treated with hysteroscopic polypectomy.
◉ this is a structural cause of AUB. Endometrial tissue in
myometrium; risk factors include multiparity, C-section, endometrial
curettage; most common age 40-50; heavy, painful, prolonged cycles;
diffuse uterine enlargement; diagnosed via US or MRI. what is it and
how do we treat it?
,Answer: Adenomyosis. Treated non-surgically with NSAIDs, LNG-IUS
(Mirena/Liletta), DNG, COCs, GnRH agonists/antagonists; surgical
options: endomyometrial resection (limited), uterine artery
embolization (not fertility-sparing), HIFU (fertility-sparing)
◉ this is a structural cause of AUB. _____ is a benign uterine smooth
muscle tumors; submucous type often cause intermenstrual
bleeding; prevalence increases with age; heavy, painful, prolonged
cycles; enlarged or irregular uterus; diagnosed with US. what is it
and how do we treat it?
Answer: Leiomyoma. treated non-surgically with COCs, progestin-
only pills, GnRH agonists (Depot Lupron), Elagolix, Relugolix;
surgical: myomectomy (fertility-sparing), uterine artery
embolization, endometrial ablation, hysterectomy
◉ 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?
Answer: malignancy/hyperplasia. Treatment is often hysterectomy
◉ what are the Non-Structural Causes of abnormal uterine bleeding?
Answer: 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?
Answer: 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?
Answer: 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?
Answer: Endometrial Causes. treatment: hormonal contraception,
TXA, dietary changes (anti-inflammatory, omega-3s)
