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Flashcards in BC Menopause Deck (32):
1

Premature ovarian failure is associated with a persistently elevated FSH level
And is further defined as cessation of menses before what age?


A- 40 years
B- 45 years
C- 52 years
D- 35 years
E- 50 years

40y

2

During menopausal transition, erractic fluctuation in female reproductive
Hormones lead to an array of physical and psychological symptoms.
These symptoms include all of the following except

A- Poor memory G)fatigue
B- Headache H)decrease libido
C- urinary incontinence I)skin thinning
D- vision changes J)dyspareunia
E- Hot flashes K)Sleep disturbance
F- decrease breast size L)formication
M-back /joint pain

Vision changes

3

Age and race are nonmodifiable risk factors for osteoporosis.
Menopausal Osteoporosis is most common in which race group?

A- White
B- Asian
C- Aboriginal
D- African Canadian
E- Pacific Islander

White

4

What T- score value is associated with osteopenia?




A- T- score greater -1
B- T -score between -1 to -2.5
C- T-score = -2.5
D- T- score between + 1.0 and -1.0
E- T-score between + 1.0 and – 2.5

T score betewen -1 to - 2.5


CONTENT
Normal BMD; +2.5 to -1.0
Osteopenia -1.0 and -2.5
Osteoporosis -2.5
Severe or established osteoporosis at or below -2.5 with fractures

5

What are secondary causes of osteoporosis?

Primary hyperparathyroidism, secondary hyperparathyroidism from chronic renal failure, hyperthyroidism or excess thyroid hormone, increased calcium excretion, hypercortisolism, alcohol abuse, and metastatic cancer, osteomalacia.

6

A 57 years old woman has been amenorrheic for 4 years and asks whether hormone therapy will lead to heart attack. You explain that results from Women’s Health Initiative (WHI ) suggest which of the following regarding coronary heart disease risk?

It is decreased among older users (70-79 years)
It is increased among younger users (50-59 years)
It is increased among all postmenopausal users of combined estrogen and progestin hormone therapy.
It is likely decreased among women who initiate combined hormone therapy within 10 years of the menopause.
All of the above statements are true

D.It is likely decreased among women who initiate combined hormone therapy within 10 years of the menopause.

7

What drugs are used to tx osteoporosis?

Bisphosphonates (alendronate, risendfronate,etc), Denosumab (RankL inhibitor), Parathyroid hormone, Hormone Medications (estrogen/progesterone therapy), SERMS (estrogen like medicines (

8

What is a SE of bisphosphonates

Jaw pain (osteonecrosis of the jaw)

9

What are hormones good for (tx)?

Vulvovaginal and vasomotor sx)

10

What is Denosumab and when do you use it?

RankL inhibitor to help prevent bone loss in prostate ca and breast ca

11

What is the MOA of Denosumab?


Binds to RankL, blocks interaction between RANKL and RANK and prevents osteoclast
Formation, leading to decreased bone resportion and increased bone mass in
Osteoporosis.

12

Estrogen replacement therapy is contraindicated in women with all of the
following except:

Vasomotor symptoms
Active liver disease
Known or suspected breast carcinoma
Abnormal genital bleeding of unknown etiology
Known cardiovascular disease
Known or suspected uterine cancer
Acute or history of thromboembolic disease

Vasomotor Sx

13

For treatment of vasomotor symptoms, currently suggested alternatives to hormones includes all of the following EXCEPT:


Bellergal
Clonidine
Gabapentin
Selective serotonin-reuptake inhibitors
Venlafaxine (SNRI)

Bellergal

14

Which of the following does NOT have an indication for osteoporosis treatment?

Denosumab
Calcitonin
Bisphosphonates
Estrogen replacement
Parathyroid hormone

estrogen replacement

15

Which of the following is true of raloxifene (SERM)?

It is a potent bisphosphonate.
It increases breast cancer risk
It increases thromboembolism risk.
It significantly decreases nonvertebral fracture rick.
Decreases stroke mortality and hot flashes

Increases thromboembolism risk

16

A 57 year old non smoking Caucasian multigravida reports reaching menopause at the age 52. She has no family history of osteoporosis, no history of prolonged corticosteroid use, no hyperparathyroidism, or malabsorption syndrome. An evaluation for severe back pain reveals an anterior wedge fracture. Bone mineral density screening was preformed and gives a T-score of -1.7. Which of the following is the most effective and appropriate intervention intervention?

-Limit physical activity
-Initiate oral calcium 1000mg daily
-Initiate physical therapy and analgesia
-Initiate an oral bisphosphonate therapy for bone fracture prevention and treatment.
-PTH replacement

D-Initiate an oral bisphosphonate therapy for bone fracture prevention and treatment.

17

What is Raloxifine selective to?

Estrogen receptors.

18

Which of these products is an acidic hydrophilic insoluble polymer that can hold water and act as a sustained moisturizer to the vagina?

Replens
K-Y Jelly
Astroglide
Slippery Stuff
None of the above

Replens

19

What vitamin deficiency do you think about in malabsorption?

ADEK (think about D for osteoporosis)

20

Is prolonged corticosteroid use a RF for osteoporosis?

Yes

21

A 57 year old woman who is six years post menopausal, c/o a six month history of vaginal irritation and itching. Examination reveals an erythematous and thinned vaginal mucosa without lesion or a discharge. Vaginal cultures and Pap smear are negative.

Which of the following would be the most appropriate initial management?

a)Estrogen cream
b)Sulfa cream
c)Miconazole cream
d)Oral amoxicilin
e)Biopsy

Biopsy

22

What do you have to do for a patient who is over 50 with point tenderness over her spine?

XR (with point tenderness)

23

What is the most common # in osteoporosis?

T12/L1

24

A 58 yo postmenopausal woman comes to your
clinic with complaints of backache. X ray of the
lower spine reveals a fractured lumbar vertebra.
Which of the following tests would best quantify
her risk for osteoporosis?

a)Urinary calcium
b)Serum estradiol
c)Serum calcium
d)Bone densitometry (DEXA)
e)X ray of wrist

DEXA

25

A 60 year old woman wishes to discontinue using
her estrogen replacement therapy. Which of the
Following supports the best reason to continue
her current regimen of low-dose estrogen?

a)A family history of myocardial infarction
b)Persistent hot flashes and insomnia when off hormones
c)A family history of cerebrovascular accidents
d)A family history of osteoporosis
e)A personal history of heart disease

b)Persistent hot flashes and insomnia when off hormones

26

The presence of pyometra in a postmenopausal patient is suspicious for which of the following?

a)Pelvic tuberculosis
b)Endometrial carcinoma
c)Atrophic endometritis
d)An endocervical polyp
e)Chronic cervicitis

Endometrial Ca

27

A 46 y.o. female presents to your office with an 18 month history of hot flashes, insomnia and vaginal dryness. She has no other complaints and is hemodynamically stable.
1)What are your differential Diagnoses.
Select as many as appropriate

i)Pregnancy
ii)Menopause
iii)Hyperthyroidism
iv)Hyperprolactinemia

Menopause

28

What is the most appropriate investigation when diagnosed with menopause?

fasting lipid profile

29

What about If the patient was <45 years old and presented with irregular menses and menopausal symptoms: Choose as many appropriate?

1)HCG
2)TSH
3)FSH
4)Prolactin

All Hcg, TSH, FSH, Prolactin

30

When do you do a workup for someone presenting with menopause

young age

31

biggest mortality for post menopausal women

MI

32

biggest morbidity for post menopausal women

fracture