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NURP 501 - Ex 1 > 4: PALM-COEIN > Flashcards

4: PALM-COEIN Flashcards

1
Q

T/F Ovulatory abnormal bleeding tends to be cyclic and regular, although the bleeding patterns are often abnormal. The HPOA is intact and the steroid hormone profile is normal in ovulatory AUB.

A

True. This type of AUB is generally related to prolonged, heavy bleeding. It is commonly associated with AUB-P, AUB-A, and AUB-L. It can also be associated with AUB-C and AUB-E.

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2
Q

Women with PCOS often experience _____ bleeding because of chronic anovulation.

A

Women with PCOS often experience estrogen breakthrough bleeding because of chronic anovulation.

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3
Q

T/F There are no diagnostic tests that clinicians can use to confirm the presence of AUB-E; rather, it is a diagnosis of exclusion.

A

True

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4
Q

It usually occurs in a predictive and cyclical manner and includes heavy menstrual bleeding. It can also present with intermenstrual or prolonged bleeding patterns.

A

Endometrial (AUB-E)

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5
Q

What does PALM-COEIN stand for?

A
  • Polyps (AUB-P)
  • Adenomyosis (AUB-A)
  • Leiomyoma (AUB-L)
  • Malignancy and hyperplasia (AUB-M)
  • Coagulopathy (AUB-C)
  • Ovulatory dysfunction (AUB-O)
  • Endometrial (AUB-E)
  • Iatrogenic (AUB-I)
  • Not yet classified (AUB-N)
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6
Q

Estrogen levels increase the thickness of the endometrium; thus women with high sustained levels of estrogen tend to experience the _____ menstrual bleeding.

A

Estrogen levels increase the thickness of the endometrium; thus women with high sustained levels of estrogen tend to experience the heaviest menstrual bleeding.

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7
Q

3 months without a menses once menses has been established.

A

Secondary amenorrhea

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8
Q

Bleeding associated with these often occurs after sex.

A

Endocervical polyps (AUB-P)

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9
Q

This condition is generally caused by one of three hormonal imbalances: estrogen withdrawal, estrogen breakthrough, or progesterone breakthrough.

A

Anovulatory uterine bleeding (AUB-O)

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10
Q

The predominant predisposing factor for this condition is more than one pregnancy as well as history of miscarriage, curettage, endometrial resection, cesarean section, or tamoxifen use.

A

Adenomyosis (AUB-A)

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11
Q

In PALM-COEIN, which half describes structural criteria and which half is unrelated to structural criteria?

A
  • PALM = structural
  • COEIN = nonstructural
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12
Q

Rare in women of reproductive age and in women who have a normal body mass index (BMI) and who do not have polycystic ovarian syndrome (PCOS).

A

Malignancy and atypical hyperplasia (AUB-M)

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13
Q

T/F Ultrasonography and occasionally magnetic resonance imaging (MRI) have been used to detect the severity of the adenomyosis, which may include uterine enlargement. It is proposed that ultrasound evaluation meets the minimum requirements for diagnosis, as MRI diagnosis is not readily available worldwide.

A

True

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14
Q

How are polyps classified within the FIGO system?

A

Present or not present

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15
Q

Which women have the highest risk for amenorrhea?

A

Women with a low BMI and low percentage of body fat combined with a high level of intensive physical activity have the highest risk for amenorrhea.

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16
Q

This category encompasses many different presentations of AUB, including amenorrhea as well as light or heavy menses that can be more frequent, less frequent, or occurring in regular menstrual patterns.

A

Ovulatory dysfunction (AUB-O)

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17
Q

T/F Anovulation in PCOS can be caused by insulin resistance.

A

True. Diseases or syndromes causing insulin resistance, such as PCOS, increase circulating levels of insulin, which in turn leads to an elevation in androgen production and concomitant anovulation.

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18
Q

Caused by medications or devices that act on the endometrium.

A

Iatrogenic (AUB-I)

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19
Q

The Mirena, Skyla, Liletta, and Paragard intrauterine systems can cause irregular spotting and bleeding after placement, although this phenomenon usually resolves within 3 to 6 months after the device’s placement. What category is this?

A

Iatrogenic (AUB-I)

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20
Q

Antidepressant therapies including the _____ and _____ can cause AUB-I related to a disturbance in the HPOA.

A

Antidepressant therapies including the tricyclics and phenothiazines can cause AUB-I related to a disturbance in the HPOA.

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21
Q

Primary classification is present or not. Secondary classification gives location within the uterus.

A

Leiomyomas (AUB-L)

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22
Q

Infections, such as _____ and _____, may cause irregular spotting due to irritation and inflammation of the tissues of the cervix or endometrium.

A

Infections, such as gonorrhea and endometritis, may cause irregular spotting due to irritation and inflammation of the tissues of the cervix or endometrium.

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23
Q

Which inheritable clotting disorder is more commonly found in coagulopathies?

A

von Willebrand’s disease

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24
Q

It can involve a premature release of blood from the endometrium or disorders of local endometrial hemostasis.

A

Endometrium (AUB-E)

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25
Q

What is the pathophysiology of exercise-induced amenorrhea?

A

The pathophysiology of exercise-induced amenorrhea is complex and most likely due to the combination of low body fat and diminished secretion of GnRH. Lower GnRH levels result in fewer luteinizing hormone (LH) and follicle-stimulating hormone (FSH) pulses, which in turn decreases the amount of estrogen produced by the ovaries. The critical weight theory hypothesizes that some critical weight and amount of body fat exist that must be maintained for women to experience regular menstrual cycles.

26
Q

Absence of menses.

A

Amenorrhea (AUB-O)

27
Q

Normal menstrual function requires that what four anatomic and structural components are in working order?

A
  1. Uterus
  2. Ovary
  3. Pituitary
  4. Hypothalamus
28
Q

It is important to determine if the leiomyoma interferes with the _____ (submucosal), because this type is most likely to cause AUB. The “other” category includes subserosal and intramural leiomyomas.

A

It is important to determine if the leiomyoma interferes with the endometrium (submucosal), because this type is most likely to cause AUB. The “other” category includes subserosal and intramural leiomyomas.

29
Q

Commonly occurring, benign growths on the endocervix.

A

Endocervical polyps (AUB-P)

30
Q

Smooth, deep to bright red growths that are fragile and bleed with little encouragement during examination.

A

Endocervical polyps (AUB-P)

31
Q

T/F Tertiary classification of leiomyomas includes size.

A

False. There is currently not a tertiary system and size is not included elsewhere.

32
Q

New name for a category that used to be called dysfunctional uterine bleeding.

A

Ovulatory dysfunction (AUB-O)

33
Q

Amenorrhea associated with elevated prolactin levels is due to prolactin inhibition of the pulsatile secretion of _____.

A

Amenorrhea associated with elevated prolactin levels is due to prolactin inhibition of the pulsatile secretion of gonadotropin-releasing hormone (GnRH).

34
Q

Encompass a wide range of blood clotting disorders that can potentially cause AUB.

A

Coagulopathies (AUB-C)

35
Q

Would anticoag meds that contribute to bleeding be considered AUB-I or AUB-C?

A

Although this type of bleeding could be considered iatrogenic in nature, it is still termed AUB-C because of the rationale (coagulopathy disorder) for the drug therapy.

36
Q

This type of AUB is sometimes seen in women using progestin-only pills or other forms of progestin-only contraception. Heavy and/or irregular bleeding results from an imbalance in both the vasoconstricting and vasodilating properties of prostaglandins and platelet aggregation and inhibition. The abnormal microvasculature is probably the cause of the abnormal bleeding that results from this phenomenon.

A

Progesterone breakthrough bleeding

37
Q

When does ovulatory dysfunction bleeding (AUB-O) typically occur?

A

It is typically observed in the post-adolescent years and during the premenopausal years.

38
Q

In contrast to the typically regular, predictable bleeding experienced with ovulatory cycles, this frequently leads to abnormal cycle intervals, excessively heavy bleeding, or lighter than normal amounts of bleeding.

A

Anovulatory uterine bleeding (AUB-O)

39
Q

By definition, the anovulatory woman is always in the _____ phase of the ovarian cycle and in the _____ phase of the endometrial cycle.

A

By definition, the anovulatory woman is always in the follicular phase of the ovarian cycle and in the proliferative phase of the endometrial cycle.

40
Q

Rarely, these polyps can resemble atypical or cancerous cells.

A

Endometrial polyps (AUB-P)

41
Q

Fibroids or fibromuscular benign tumors in the myometrium.

A

Leiomyomas (AUB-L)

42
Q

Approximately one-third of women with elevated prolactin levels will also have _____.

A

Approximately one-third of women with elevated prolactin levels will also have galactorrhea.

43
Q

Name the 3 subcategories for AUB-O.

A
  1. Anovulatory uterine bleeding
  2. Amenorrhea
  3. Ovulatory uterine bleeding
44
Q

Common condition that rarely affects women who are multiparous and older than age 40.

A

Adenomyosis (AUB-A)

45
Q

The most common benign pelvic tumors in women and the leading indication for hysterectomy.

A

Leiomyomas (AUB-L)

46
Q

T/F the PALM-COEIN AUB system is meant to replace the oncology staging system only within conditions that relate to abnormal uterine bleeding.

A

False. It is not meant to replace the system at all, but to work with it. Oncology ratings are subclassifications of the PALM-COEIN rating.

47
Q

Evidence from histologic and molecular studies suggests that this is the result of an increased density of abnormal vessels that have a fragile structure prone to focal rupture, which is then followed by the release of lysosomes (proteolytic enzymes) from surrounding epithelial and stromal cells and migratory leukocytes and macrophages

A

Anovulatory uterine bleeding (AUB-O)

48
Q

3 most common causes of amenorrhea.

A
  1. Pregnancy
  2. Hypothalmic amenorrhea
  3. PCOS
49
Q

Small areas of endometrial tissue within the myometrium.

A

Adenomyosis (AUB-A)

50
Q

Although infection is not thoroughly discussed, _____ has been found to be associated with endometritis, which can produce intermenstrual bleeding as observed with AUB-E.

A

Although infection is not thoroughly discussed, Chlamydia trachomatis has been found to be associated with endometritis, which can produce intermenstrual bleeding as observed with AUB-E.

51
Q

If you see any of these 3 criteria, you should evaluate for amenorrhea.

A
  1. No menses by age 14 in the absence of growth or development of secondary sexual characteristics
  2. No menses by age 16 regardless of the presence of normal growth and development of secondary sexual characteristics
  3. In women who have menstruated previously, no menses for an interval of time equivalent to a total of at least three previous cycles, or 6 months
52
Q

The failure to begin menses by the age of 16.

A

Primary amenorrhea

53
Q

Benign growths of the endometrium consisting of connective, glandular, or muscular tissue; they are usually asymptomatic, but are generally thought to contribute to AUB in some women.

A

Endometrial polyps (AUB-P)

54
Q

_____, one of the disorders of AUB-O, occurs significantly less often than abnormal bleeding due to anovulation.

A

Ovulatory AUB, one of the disorders of AUB-O, occurs significantly less often than abnormal bleeding due to anovulation.

55
Q

This type of bleeding tends to be heavy secondary to the high and sustained levels of unopposed estrogen that can result in endometrial hyperplasia.

A

Anovulatory uterine bleeding (AUB-O)

56
Q

T/F Women who have leiomyomas generally have no symptoms and do not require treatment, although depending on their locations within the uterus the fibroids may have the potential to contribute to AUB.

A

True

57
Q

A unique tissue that releases blood as a part of normal physiology.

A

Endometrium

58
Q

T/F White blood cells are involved in endometrial hemostasis very marginally at the time of menstruation.

A

False. Platelets are involved in endometrial hemostasis very marginally at the time of menstruation.

59
Q

This category may be used when possible causes of AUB, other than those previously mentioned, are being explored.

A

Not yet classified (AUB-N)

60
Q

Women presenting with complaint of heavy menstrual bleeding who have history of easy bruising and prolonged bleeding following dental work or surgery warrant further follow-up for _____.

A

Women presenting with complaint of heavy menstrual bleeding who have history of easy bruising and prolonged bleeding following dental work or surgery warrant further follow-up for von Willebrand’s disease.

61
Q

T/F Many cases of AUB-O stem from endocrinopathies including thyroid disorders, polycystic ovarian syndrome, excessive exercise, or extreme mental distress.

A

True

NURP 501 - Ex 1 (63 decks)

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