NAMS Menopause Certification Exam 2024: Complete Study Guide with Verified Answers, Exams of Nursing

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NAMS MENOPAUSE CERTIFICATION EXAM 2024 ACTUAL EXAM COMPLETE 350 QUESTIONS WITH DETAILED VERIFIED ANSWERS (100% CORRECT ANSWERS) ALREADY GRADED A+ Which topical vaginal estrogen has the highest dose? - CORRECT ANSWER >>>>the vaginal rings FEMRING IS THE HIGHEST Most common cause of vulvovaginitis? - CORRECT ANSWER

BV post menopause burning and diffuse yellow/brown discharge and dyspareunia that does not respond to local ET? - CORRECT ANSWER >>>>desquamative inflammatory vaginitis. treat different with clindamycin or hydrocortisone+ET What hormones are associated with sexual desire in women? - CORRECT ANSWER >>>>circulating androgens

Women who have had a BSO experience an abrupt and persistent decline in what hormone? - CORRECT ANSWER

circulating androgen levels HSDD and FSAD were combined into a single dysrunction called

• CORRECT ANSWER >>>>female sexual interest/arousal disorder HSDD treatments - CORRECT ANSWER >>>>flibanserin and bremelanotide FGAD treatments (genital arousal disorder) - CORRECT ANSWER

L-arginine, topical alprostadil, wellbutrin, oxytosin. phosphodiesterase inhibitors-lacking in efficacy Eros therapy device $300- vaccum-like the penis pump FOD (orgasmic disorder) treatments - CORRECT ANSWER directed masturbation is most researched behavioral treatment. Does systemic ET cause fibroids to resume growth? - CORRECT ANSWER >>>>Rarely. They often shrink after menopause. What is true about cognition and menopause? - CORRECT ANSWER >>>>Difficulty concentrating and remembering are common. What is true about cognition and surgical menopause - CORRECT ANSWER >>>>memory for verbal information can be

compromised immediately after surgical menopause, especially if it is before the typical age of mesopause. Meta analysis of RCTs have shown small benefit of what diet/exercise for global cognition and memory? - CORRECT ANSWER >>>>Mediterranean diet with olive oil and tai chi exercise helps with global cognition Mediterranean diet with olive oil and isoflavone supplements helps with memory. effect of HRT on cognition - CORRECT ANSWER >>>>small or no overall effect on cognition What HRT can increase your risk for dementia based on the WHIMS study in 65+ year old healthy women? - CORRECT ANSWER >>>>EPT replacement was shown to double the risk of developing dementia. There was no significant increased risk in ET alone. this is why HRT is not recommended after 65 for primary prevention of dementia 3 reasons supporting the idea that HRT in early menopause may decrease a woman's chance of developing alzheimer's disease? - CORRECT ANSWER >>>>1. Observational studies imply it

2. Clinical trial of transdermal estradiol during the early postmenopause stage is associated with reductions in AD pathology.
3. 18 year cumulative follow up data from WHI found that women randomized to ET had significantly lower risk of dying from AD or dementia compared with women randomized to receive placebo. Migraine headache and pregnancy - CORRECT ANSWER

typically migraines improve-estrogen levels stabilize Migraine without aura after menopause - CORRECT ANSWER usually decrease with natural menopause menstrual migraine after menopause - CORRECT ANSWER should resolve completely When to consider preventative medication for migraines - CORRECT ANSWER >>>>>2 times per week or severe and effecting QOL Triptans are contraindicated in what? - CORRECT ANSWER patients with cardiovascular disease, as are NSAIDs Menstrual migraine treatment - CORRECT ANSWER >>>>NSAID or triptan 2 days before expected to get your period, and take for 5-7 days.

cdc and who guidelines for migraine treatment - CORRECT ANSWER >>>>migraine with aura-advise to not use combined hormone contraception caution in women with migraine without aura How long can it take for arthralgia from vitamin d deficiency or hypothyroidism to fully resolve? - CORRECT ANSWER >>>>it can take several months. what is th emost common form of arthritis? - CORRECT ANSWER >>>>osteoarthritis what areas of th ebrain have th emost estrogen receptors? - CORRECT ANSWER >>>>hippocampus and prefrontal cortex what is the most common thyroid disorder in women? - CORRECT ANSWER >>>>hashimoto thyroiditis if a patient on levothyroxine is started on estrogen, when do you recheck and what can you anticipate happening? - CORRECT ANSWER >>>>recheck 6-8 weeks later. anticipate that the dose of levothyroxine may need to be increased. oral estrogens increase thyroid binding globulin which in turn reduces the levels of free T4.

when is treatment of subclinical hypothyroidism recommended? - CORRECT ANSWER >>>>when the TSH level is higher than 10. are hot or cold thyroid nodules typically most likely to be malignant? - CORRECT ANSWER >>>>cold nodules how does HRT impact gallbladder disease? - CORRECT ANSWER

increases risk of gallstones with oral HRT, lower risk with transdermal. when did they start screening blood for hep c? - CORRECT ANSWER >>>>1992, so women who have received blood migraine with aura-advise to not use combined hormone contraception caution in women with migraine without aura How long can it take for arthralgia from vitamin d deficiency or hypothyroidism to fully resolve? - CORRECT ANSWER >>>>it can take several months. what is th emost common form of arthritis? - CORRECT ANSWER >>>>osteoarthritis what areas of th ebrain have th emost estrogen receptors? - CORRECT ANSWER >>>>hippocampus and prefrontal cortex what is the most common thyroid disorder in women? - CORRECT ANSWER >>>>hashimoto thyroiditis if a patient on levothyroxine is started on estrogen, when do you recheck and what can you anticipate happening? - CORRECT ANSWER >>>>recheck 6-8 weeks later. anticipate that the dose of levothyroxine may need to be increased. oral estrogens increase thyroid binding globulin which in turn reduces the levels of free T4. when is treatment of subclinical hypothyroidism recommended? - CORRECT ANSWER >>>>when the TSH level is higher than 10. are hot or cold thyroid nodules typically most likely to be malignant? - CORRECT ANSWER >>>>cold nodules how does HRT impact gallbladder disease? - CORRECT ANSWER >>>>increases risk of gallstones with oral HRT, lower risk with transdermal. when did they start screening blood for hep c? - CORRECT ANSWER >>>>1992, so women who have received blood products or organ transplants prior to 1992 may have acquired heptatitis c why do we screen for hep C? - CORRECT ANSWER >>>>most infections become chronic and most are asymptomatic until liver damage is detected years later. Our treatments are improving so if we catch this earlier in people, outcomes will be better all adults born from what year to what year should recieve one time hep c testing? - CORRECT ANSWER >>>>1945 to 1965 routine screening of all adults for hepatitis c. is it reocmmended? - CORRECT ANSWER >>>>routine screening for all adults is not recommended, however baby boomers are at the highest risk. infection rates are 5x other birth cohorts.

what hpv is high risk? - CORRECT ANSWER >>>>16 and 18 by age 50 what percentage of US women will have acquired a genital HPV infection? - CORRECT ANSWER >>>>80%-HPV is very common, but it is the high risk ones to worry about what is the most commonly sexually transmitted infection in the US? - CORRECT ANSWER >>>>HPV What percentage of bone loss do women have from the menopause transition? - CORRECT ANSWER >>>>10-12% on average, about 1 t score What t score defines osteopenia - CORRECT ANSWER >>>>-1. to - 2. what t score defines osteoporosis - CORRECT ANSWER >>>>less than - 2. what z score defines osteoporosis before menopause? - CORRECT ANSWER >>>>z score less than 2.0 and a history of a fragility fracture Who is at highest risk of osteoporosis? - CORRECT ANSWER

white and hispanic populations What amount of women require long term care after hip fracture?

What amount of women have long term loss of mobility after hip fracture? - CORRECT ANSWER >>>>1 in 4 women (25%) require long term care 1 in 2 woemn (50%) have long term loss of mobility Asians have ____BMD than white people? - CORRECT ANSWER

lower Black women have ____BMD than white people? - CORRECT ANSWER >>>>higher Over 3 servings of alcohol daily and risk for fracture? - CORRECT ANSWER >>>>38% for osteoporotic fracture and 68% for hip fracture What 4 ethnic specific versions of FRAX are there? - CORRECT ANSWER >>>>white, asiain, black, hispanic Dairy free diet amount of calicum. How much do they need to supplement? - CORRECT ANSWER >>>>dairy free diet-300mg calcium daily. Needs 80 0 - 1200mg Tibolone and osteoporosis where is it approved? why wasn't it submitted for approval in the US and canada? - CORRECT ANSWER >>>>approved in mexico decreased risk of vertebral and nonvertebral fracture increased risk of stroke

Why was estrogen not approved for osteoporosis? - CORRECT ANSWER >>>>decreased risk of vertebral and hip fracture in low fracture risk population, but estrogen has not been shown to decrease fracture risk in women with osteoporosis. More prevention than treatment. Black box warning for PTH receptor agonists? - CORRECT ANSWER >>>>osteosarcoma caution using PTH receptor agonists in what condition? - CORRECT ANSWER >>>>hypercalcemia when would you use PTH receptor agonists? - CORRECT ANSWER >>>>someone incredibly high risk for vertebral fracture raloxifene helps with what kind of fractures? - CORRECT ANSWER >>>>vertebral fractures raloxifene risk factors - CORRECT ANSWER >>>>increased risk of death from stroke in high risk patients, estrogen like risk of VTE, worsens hot flashes atypical femur risk in women on bisphosphonate? - CORRECT ANSWER >>>>1 in 1000 after 2-3 years. Salmon calcitonin and osteoporosis? - CORRECT ANSWER

small increase in spine BMD. daily SQ injections or nasal.

Implications of estrogen drop on skin during menopause - CORRECT ANSWER >>>>Decreased fibroblast activity disrupted elastin decreased GAG production Disrupted melanocyte regulation Decreased blood flow and cellular oxygenation effects on keratinocytes Disruption of cellular growth factors and repair enzymes accelerated lipoatrophy Fat pad modification Bone resorptuon Definition of stress incontinence - CORRECT ANSWER

Involuntary loss of urine that occurs with an activity such as coughing or sneezing that increases intraabdominal pressure. Leakage is in drops, usually 2/2 to poor urethral support, urethral sphincter weakness, dysfunction of pelvic floor osteosarcoma caution using PTH receptor agonists in what condition? - CORRECT ANSWER >>>>hypercalcemia when would you use PTH receptor agonists? - CORRECT ANSWER >>>>someone incredibly high risk for vertebral fracture raloxifene helps with what kind of fractures? - CORRECT ANSWER >>>>vertebral fractures raloxifene risk factors - CORRECT ANSWER >>>>increased risk of death from stroke in high risk patients, estrogen like risk of VTE, worsens hot flashes atypical femur risk in women on bisphosphonate? - CORRECT ANSWER >>>>1 in 1000 after 2-3 years. Salmon calcitonin and osteoporosis? - CORRECT ANSWER >>>>small increase in spine BMD. daily SQ injections or nasal. Implications of estrogen drop on skin during menopause - CORRECT ANSWER >>>>Decreased fibroblast activity disrupted elastin decreased GAG production Disrupted melanocyte regulation Decreased blood flow and cellular oxygenation effects on keratinocytes Disruption of cellular growth factors and repair enzymes accelerated lipoatrophy Fat pad modification Bone resorptuon Definition of stress incontinence - CORRECT ANSWER >>>>Involuntary loss of urine that occurs with an activity such as coughing or sneezing that increases intraabdominal pressure. Leakage is in drops, usually 2/2 to poor urethral support, urethral sphincter weakness, dysfunction of pelvic floor Definition of urgency incontinence - CORRECT ANSWER Involuntary loss of urine preceded by sensation of urgency to urinate. Generally associated with losses of larger volumes of urine that soak through pads and clothing. Leakage results from detrusor (bladder) overactivity/uninhabited contractions of detrusser

Definition of mixed incontinence - CORRECT ANSWER

includes stress and urgency A postvoid residuals (w/in 15 minutes of emptying) of what volume is considered normal - CORRECT ANSWER >>>>100 or less, whereas >200 is abnormal, between 100-200 advised to repeat on different day how to test for incontinence - CORRECT ANSWER >>>>pyridium challenge OAB - CORRECT ANSWER >>>>Term used to describe idiopathic urinary urgency (w or w/o incontinennce) with urinary frequency (>8voids w/in 24h) adn sometimes nocturia (awakening to urinate more than 2x/night ISSWSH Sexual Disorders in Menopause - CORRECT ANSWER Hypoactive sexual desire disorder Female genital arousal disorder Persistent genital arousal disorder Female orgasm disorder Femal orgasmic illness syndrome Pelvic floor muscles - CORRECT ANSWER >>>>Levator ani superficial (transverse perineal, bulbospongiosus, ischiocavernosus) Deep (pubococcygeus, iliococcygeus, obturator internus, coccygeus( muscles

PALM COEIN causes of AUB - CORRECT ANSWER >>>>P: Polyp A: Adenomyosis L: Leiomyoma M: Malignancy/hyperplasia C: Coagulopathy O: ovulatory dysfunction E: Endometrial I: Iatrogenic N: Not yet classified When is EMB not needed? - CORRECT ANSWER >>>>When <4mm Management of AUB - CORRECT ANSWER >>>>Cocs decrease 7 to 4 days; IUD NSAID - reduce prostaglandin synthesiss which may have a role in aberrant neovasculariation Dosing of NSAIDS for AUB - CORRECT ANSWER >>>>Mefenamic acid 500 mg TID for 5 days or Ibuprofen 600 mg Q6h or 800mg Q8 h for first 3 days Dosing of tranexamic acid for AUB - CORRECT ANSWER

1300 mg TID for 5 days of menstrual cycle ; causes GI upset

GnRH therapy for fibroids - CORRECT ANSWER >>>>Addback therapy can be used to protect against VMS and bone mineral density losss Nonsurgical treatment of fibroids - CORRECT ANSWER

Tranexamic acid and mefenamic acid mirena GnRH Selective progesterone receptor modulators Uterine artery embolization Hypoactive sexual desire disorder Female genital arousal disorder Persistent genital arousal disorder Female orgasm disorder Femal orgasmic illness syndrome Pelvic floor muscles - CORRECT ANSWER >>>>Levator ani superficial (transverse perineal, bulbospongiosus, ischiocavernosus) Deep (pubococcygeus, iliococcygeus, obturator internus, coccygeus( muscles PALM COEIN causes of AUB - CORRECT ANSWER >>>>P: Polyp A: Adenomyosis L: Leiomyoma M: Malignancy/hyperplasia C: Coagulopathy O: ovulatory dysfunction E: Endometrial I: Iatrogenic N: Not yet classified When is EMB not needed? - CORRECT ANSWER >>>>When <4mm Management of AUB - CORRECT ANSWER >>>>Cocs decrease 7 to 4 days; IUD NSAID - reduce prostaglandin synthesiss which may have a role in aberrant neovasculariation Dosing of NSAIDS for AUB - CORRECT ANSWER >>>>Mefenamic acid 500 mg TID for 5 days or Ibuprofen 600 mg Q6h or 800mg Q8 h for first 3 days Dosing of tranexamic acid for AUB - CORRECT ANSWER >>>>1300 mg TID for 5 days of menstrual cycle ; causes GI upset GnRH therapy for fibroids - CORRECT ANSWER >>>>Addback therapy can be used to protect against VMS and bone mineral density losss Nonsurgical treatment of fibroids - CORRECT ANSWER >>>>Tranexamic acid and mefenamic acid mirena GnRH Selective progesterone receptor modulators Uterine artery embolization Hysteroscopic myomectomy is most suitable for fibroids smaller than - CORRECT ANSWER >>>>5cm in diameter Lichen Planus - CORRECT ANSWER >>>>Pruritic, purple, polygonal planar papules and plaques (6 P's) Lichen sclerosis et atrophicus - CORRECT ANSWER inflammatory condition - autoimmune - antibodies against extracellular matrix. Affects males and females equally - but female genital and perineal region is most commonly affected. Lichen Simplex Chronicus - CORRECT ANSWER >>>>Leukoplakia with thick, leathery vulvar skin associated with chronic irritation and scratching., hyperplasia of the vulvar squamous epithelium lichen planus treatment - CORRECT ANSWER >>>>only when it is symptomatic, these respond to topical corticosteroids. When

it has a burning sensation, patients should be prescribed an antifungal lichen sclerosis tx - CORRECT ANSWER >>>>topical steroid (clobetasol) Lichen Simplex Chronicus Treatment - CORRECT ANSWER

Corticosteroid: Triamcinolone 0.1% (Alway start off with low potency then move if it gets worst) Non-pharmo Tx for restless legs and periodic imb movements - CORRECT ANSWER >>>>Remove potential aggravators such as sleep deprivation, alcohol, exercise, caffeine, smoking Tranexamic acid and mefenamic acid mirena GnRH Selective progesterone receptor modulators Uterine artery embolization Hysteroscopic myomectomy is most suitable for fibroids smaller than - CORRECT ANSWER >>>>5cm in diameter Lichen Planus - CORRECT ANSWER >>>>Pruritic, purple, polygonal planar papules and plaques (6 P's) Lichen sclerosis et atrophicus - CORRECT ANSWER >>>>inflammatory condition - autoimmune - antibodies against extracellular matrix. Affects males and females equally - but female genital and perineal region is most commonly affected. Lichen Simplex Chronicus - CORRECT ANSWER >>>>Leukoplakia with thick, leathery vulvar skin associated with chronic irritation and scratching., hyperplasia of the vulvar squamous epithelium lichen planus treatment - CORRECT ANSWER >>>>only when it is symptomatic, these respond to topical corticosteroids. When it has a burning sensation, patients should be prescribed an antifungal lichen sclerosis tx - CORRECT ANSWER >>>>topical steroid (clobetasol) Lichen Simplex Chronicus Treatment - CORRECT ANSWER >>>>Corticosteroid: Triamcinolone 0.1% (Alway start off with low potency then move if it gets worst) Non-pharmo Tx for restless legs and periodic imb movements - CORRECT ANSWER >>>>Remove potential aggravators such as sleep deprivation, alcohol, exercise, caffeine, smoking Sleep hygiene, exercise, warm baths, leg vibration, massage, acupuncture, passive strestching PHarmo tx for RLS - CORRECT ANSWER >>>>Parmipexole and ropinirole Red flags for headache - CORRECT ANSWER >>>>Systemic symptoms (fever, weight loss, rash) Systemic illness malignancy, immunosupression Neurologic symptoms and/or signs in consciousness Sudden/abrupt onset new onset or progressive New/different from previoux headache hx Abortive therapy for migraine - CORRECT ANSWER triptans, NSAIDs

Preventative therapy for migraines - CORRECT ANSWER

Beta Blockers (propranolol) , Antiepileptic Drugs (divalproex), Tricyclic Antidepressants (amitriptyline) Hormone therapy for headache - CORRECT ANSWER >>>>CAn be used to mitigate falling estrogen levels, no product FDA approved; can add lowdose estrogen supplement during w/d phase of ocp, use continuous HT; if progesterogen causes, switch to micronized What to consider when evaluating women with arthralgia - CORRECT ANSWER >>>>2/2 to menopause 2/2 to arthritis 2/2 to other rheumatologic condition Causes of myalgia - CORRECT ANSWER >>>>drug induced (statines, fibrates) endocrine (vit D deficiency, thyroid, cushings) Menopause plymyalgia rheumatica Causes of bone pain - CORRECT ANSWER >>>>metagolic (pagets disease) neoplasia (multiple myeloma, metastatic infections fracture

Perimenopause STRAW staging - CORRECT ANSWER >>>>-2 to +1a; STRAW staging system - CORRECT ANSWER >>>> POI - CORRECT ANSWER >>>>Loss of ovarian follicular activity prior to the age of 40 Prevalence of POI in US - CORRECT ANSWER >>>>3% T/F Premature menopause is a risk factor for CAD - CORRECT ANSWER >>>>True

• higher risk for abdominal adiposity, dm, dyslipidemia Etiology of premature menopause - CORRECT ANSWER >>>>1) Iatrogenic/Indused (surgery, chemotherapy, cystectomy, hysterectomy, radiation)

2. spontaneous (genetic disorders, x-chromosome disorder (monosomy, trisomy); specific mutations: POF1, POF2, FMR genes
3. autoimmune causes: polyendocrine syndromes, other endocrinopathies, non-endocrine auto-immune conditions
4. idiopathic Diagnosis of POI - CORRECT ANSWER >>>>H&P Labs:

• TSH
• Prolactin
• Pregnancy test

• Elevated FSH (>25 IU/L on 2 checks/4-6 weeks apart)
• AMH
• E2 can fluctuate greatly
• Low AFC Assessment of etiology of POI - CORRECT ANSWER >>>>Genetic testing Autoimmune workup
• TSH, thyroperoxidase antibody, 21-OH antibodies, fasting glucose, HbA1C
• Ovarian antibodies lack sensitivity and specificity Estrogen therapy in premature menopause - CORRECT ANSWER

Transdermal 17 (100 mcg/d patch or gel) Oral 17B estradiol 2mg/day vaginal ring: 17B .1mg/day Oral CEE: .9-1.25mcg/day Should you check estradiol levels for prematures - CORRECT ANSWER >>>>Can consider, adjust therapy to achieve goal POI - CORRECT ANSWER >>>>Loss of ovarian follicular activity prior to the age of 40 Prevalence of POI in US - CORRECT ANSWER >>>>3% T/F Premature menopause is a risk factor for CAD - CORRECT ANSWER >>>>True - higher risk for abdominal adiposity, dm, dyslipidemia Etiology of premature menopause - CORRECT ANSWER >>>>1) Iatrogenic/Indused (surgery, chemotherapy, cystectomy, hysterectomy, radiation) 2) spontaneous (genetic disorders, x-chromosome disorder (monosomy, trisomy); specific mutations: POF1, POF2, FMR genes 3) autoimmune causes: polyendocrine syndromes, other endocrinopathies, non-endocrine auto-immune conditions 4) idiopathic Diagnosis of POI - CORRECT ANSWER >>>>H&P Labs: - TSH - Prolactin - Pregnancy test - Elevated FSH (>25 IU/L on 2 checks/4-6 weeks apart) - AMH - E2 can fluctuate greatly - Low AFC Assessment of etiology of POI - CORRECT ANSWER >>>>Genetic testing Autoimmune workup - TSH, thyroperoxidase antibody, 21-OH antibodies, fasting glucose, HbA1C - Ovarian antibodies lack sensitivity and specificity Estrogen therapy in premature menopause - CORRECT ANSWER >>>>Transdermal 17 (100 mcg/d patch or gel) Oral 17B estradiol 2mg/day vaginal ring: 17B .1mg/day Oral CEE: .9-1.25mcg/day Should you check estradiol levels for prematures - CORRECT ANSWER >>>>Can consider, adjust therapy to achieve goal range of 80-120 pg/ml Use of progestogen in premature menopause - CORRECT ANSWER >>>>No studied General principle, use higher doses; micronized 200-400 mg/d (cont/cyclically) or IUD

COCs vs estrogen in younger women - CORRECT ANSWER

May be more socially acceptable; lower cost Better bone outcomes and lower blood pressure with replacement estradiol (limited evidence) Production of androgens - CORRECT ANSWER >>>>Comes from zone retic and ovaries Consider testosterone replacement in POI and surgically postmenopausal women - CORRECT ANSWER >>>>yes T/F Fat and lean mass increase prior to menopausal transition - CORRECT ANSWER >>>>true Rate of fat gain doubles and lean mass declines during menopausal transition; when do things stabilize? - CORRECT ANSWER >>>>about 2 years after FMP Weight gain during menopausal transition - CORRECT ANSWER 2-4 fold increase in fat mass (6%, 1.6kg over 3.5 years .5% loss of lean muscle Changes in weight gain during peri/meno - CORRECT ANSWER Premenopaust weight increase,MT - stead increase, post meno no change Should calorie intake decrease in post menopause - CORRECT ANSWER >>>>yes likely driven by decreased active energy expenditure

HRT on cardiovascular risk factors - CORRECT ANSWER >>>>IN women w/o DM, HRT (oral or transdermal E+/-P) improves lean body mass, reduces abdominal adiposity, improves insulin resistance, improves lipids, decreases BP When to add anti-obesity medication - CORRECT ANSWER

Initiate weight loss medication as adjunct to lifestyle:

• if BMI (27-29.9 in presence of comorbid)
• If BMI >30 and failure of lifestyle Weight loss w/ orlistat - CORRECT ANSWER >>>>~8% GI lipase inhibitor poop in your pants Weight loss with phentermine/topiramate ER - CORRECT ANSWER >>>>8-12% C/I: glaucoma, hyperthyroid, MAOI SE: insomnia, dry mouth, paresthesias, metabolic acidocis, anxiety, tachy Weight loss with Naltrexone SR/Bupropion SR (Contrave) - CORRECT ANSWER >>>>~5-6.4% Dopamine and norepinephrine reuptake inhibitor and u-opioid receptor antagonist C/I: htn, seizures, eating disorder, opioid use, SE: nausea, headache

Weight loss with liraglutide - CORRECT ANSWER >>>>GLP- 1 receptor agonist Dose up to 3mg daily in .6mg steps Weight loss ~7-10% C/I: pancreatitis, fam hx of medullary thyroid, multiple endocrine neoplasia S/E: nausea, diarrhea, vomiting constipation Weight loss with semaglutide - CORRECT ANSWER >>>>~14- 16% GLP-1 receptor agonist Dose up yo 2.4mg daily in slow weekly dose titration C/I: pancreatitis, fam hx of medullary thyroid, multiple endocrine neoplasia S/E: nausea, diarrhea, vomiting constipation How do GLP-1 receptor agonists work? - CORRECT ANSWER

GLP-1s help the pancreas release more insulin, delay stomach emptying, and reduce appetite. Weight loss with pentermine monotherapy - CORRECT ANSWER Short term, FDA approved for shortterm use (<12 weeks); common practice to prescribe for longer; retrospective data suggests; better weight loss iwth longer use >6m; no increase in AE cardiovascular; no addiction potential I do not believe any of theis Surgical management of obesity - CORRECT ANSWER >>>>Roux- en-y bypass

Sleeve gastrectomy Biliopancreatic diversion iwth duodenal switch Who is eligible for bariatric surgery? - CORRECT ANSWER

BMI >40 BMI >35 w/ 1 comorbid BMI 30-35 w/ T2DM, poor glycemic control despite lifestyle Non-scarring alopecia - CORRECT ANSWER >>>>Disorders that reduce or slow hair growth without irreparably damaging the hair follicle

• primarily affect the hair shaft scarring alopecia - CORRECT ANSWER >>>>replacement of hair follicles with scar tissue examples of non-scarring alopecia - CORRECT ANSWER

Androgenetic alopecia Telogen Effluvium Alopecia Areata How to treat scarring alopecia - CORRECT ANSWER >>>>Send to derm Androgenetic alopecia - CORRECT ANSWER >>>>Female pattern thinning Genetic predisposition Hromonal factors A slow minaturization over time

• follicular miniturization - finer hair
• shorter growth cycle - shorter hair
• longer latent period - delay before new hair starts NOT AN ABRUPT SHED Female pattern thinng: Who when what - CORRECT ANSWER >>>>50+% of women Can begin in teens Usually NOT androgen excess What did you first notice (ponytail smaller, part wider, see scalp What labs to obtain in fmale pattern thinning - CORRECT ANSWER >>>>TSH, CBC, ferritin ?PCOS? Topical treatment for female pattern thinning - CORRECT ANSWER >>>>minoxidil 5% once daily Systemic treatment for female pattern hair thinning - CORRECT ANSWER >>>>Younger women
• OCP w/ drospirenon
• spironolactone 100-200 mg daily Minoxidil 2.5mg daily Finasteride 5mg daily Dutasteride .5mg daily Telogen effluvium - CORRECT ANSWER >>>>Premature shedding of hair in the resting phase

causes of telogen effluvium - CORRECT ANSWER >>>>Thyroid Rapid weight loss Significant illness Anesthesia Malnutrition Pregnancy Heparin, β-blockers, IFN, lithium, retinoids, OCP discontinuation, antidepressants, anticonvulsants, ACE inhibitors, colchicine, NSAIDs Testosterone estrogen level trend in menopause and impact on hair - CORRECT ANSWER >>>>testosterone levels decrease but not as significantly as estrogen levels therefore leading to a hypoestrogenemic and relative hyerandrogenic state that may lead to patterned hair loss The role of estrogen on urogenital health - CORRECT ANSWER

Vasoactive hormone

Increase blood flow, increases transductive lubrication Supplies glyogen to superficial and intermediate layers maintaining acidic pH Supports collagen content of the vagina, maintains thickenss and elasticity of the vaginal walls

Supports epithelium , connective tissue, and smooth muscle of the vulva agina, uretrha and bladder trigone non-pharmacologic vaginal moisturizer - CORRECT ANSWER

long term aid to vaginal dryness attaches to mucin and epithelial cells on vaginal wall Carries up to 60x its weight in water HOlds water in place requires maintenance 2-3x week What uterine cancer can you use topical estrogen? Which to not? - CORRECT ANSWER >>>>Can: Type I and II Carcinosarcoma Cannot: Leiomyosarcoma Stromal sarcoma Which ovarian cancer can you use topical estrogen? Which can you not? - CORRECT ANSWER >>>>Can: HGSOC Germ cell Granulosa cell Cannot: Endometrioid

Which types of cervical cancer can ou use topical estrogen - CORRECT ANSWER >>>>All Dosing of vaginal estrogen - CORRECT ANSWER >>>>daily for 2 weeks then 2x weekly Evaluation of incontinence - CORRECT ANSWER >>>>Type:

• provoking factord
• sense of urgency
• Frequency
• Ability to defer Severity and Impact on QoL
• Leak frequency
• Pad use
• Impact on ADL Complexity & Safety
• Bladder emptying
• Blood, stones
• Pain
• Comorbidities Main types of incontinence - CORRECT ANSWER >>>>Stress incontinence Overactive bladder Oveflow incontinence