Chapter 38. Vaginal Bleeding
1. Your 16-year-old patient reports that she gets her period sometimes every month and sometimes she skips a month. If
menstrual periods are irregular, the term for this condition is:
A. Menorrhagia
B. Metrorrhagia
C. Dysmenorrhea
D. Amenorrhea
. ANS: B
The menstrual history includes any episodes of amenorrhea, menorrhagia (excessive bleeding at the time of the menstrual
cycle), metrorrhagia (bleeding at irregular noncyclic intervals), dysmenorrhea, and postmenopausal bleeding. Amenorrhea
has many causes, including pregnancy; anorexia nervosa; excessive exercise; low body fat; and disorders or tumors of the
hypothalamus, pituitary gland, ovary, uterus, and thyroid gland. Menorrhagia is most commonly caused by uterine fibroids,
but hematologic
disorders should be considered. Metrorrhagia can be caused by anovulation, intrauterine devices (IUDs), and ovarian and
uterine
tumors.
2. Your patient that has a uterine fibroid complains of bleeding through up to 10 tampons per day. Excessive bleeding at the
time of the menstrual cycle is termed:
A. Menorrhagia
B. Metrorrhagia
C. Dysmenorrhea
D. Premenstrual syndrome
The menstrual history includes any episodes of amenorrhea, menorrhagia (excessive bleeding at the time of the menstrual
cycle),
metrorrhagia (bleeding at irregular noncyclic intervals), dysmenorrhea, and postmenopausal bleeding.
3. When obtaining the health history of a 60-year-old female, it is important to ask:
A. The age of menopause
B. About any bleeding since menopause
C. Use of any hormone replacement treatment
D. All of the above
ANS: D
Bleeding that occurs after menopause has been established is cause for concern. It may indicate endometrial cancer, and
referral for endometrial biopsy or dilation and curettage (D&C) is warranted. If the patient is menopausal, ask about age of
menopause,
symptoms of menopause, and past or current use of hormone replacement therapy (HRT).
4.. Postmenopausal vaginal bleeding commonly indicates:
A. Hormonal imbalance
B. Endometrial cancer
C. Endometriosis
D. Atrophic vaginitis
PTS: 1
. ANS: B
Abnormal uterine bleeding is much more common in the younger population, especially during the teen years when
menstrual
patterns are becoming established. Also, during the early reproductive years, malignancies are much less likely to be the
cause. Most cases of dysfunctional uterine bleeding are due to organic causes and to dysfunction of the hypothalamic-
pituitary-ovarian
axis. Bleeding after menopause has been established is cause for concern, and referral for endometrial biopsy is a must.
5.. Your 45-year-old female patient complains of irregular menstrual cycles, severe pain with menses and heavy bleeding every
month for the last year. On examination, you palpate an enlarged uterus. Pregnancy test is negative. A recommended
diagnostic test for this patient is:
A. Abdominal CT scan
B. Kidney, ureter, bladder x-ray
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