NAMS MENOPAUSE CERTIFICATION EXAM 2024 | ACTUAL REAL EXAM TEST BANK WITH 2 CURRENTLY TES, Exams of Nursing

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NAMS MENOPAUSE CERTIFICATION EXAM 2024 | ACTUAL REAL EXAM TEST BANK WITH 2 CURRENTLY TESTING VERSIONS WITH 100 QUESTIONS EACH AND A STUDY GUIDE Red flags for headache - 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 - ANSWER>>triptans, NSAIDs Preventative therapy for migraines - ANSWER>>Beta Blockers (propranolol) , Antiepileptic Drugs (divalproex), Tricyclic Antidepressants (amitriptyline) Hormone therapy for headache - 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 - ANSWER>>2/2 to menopause 2/2 to arthritis 2/2 to other rheumatologic condition Causes of myalgia - ANSWER>>drug induced (statines, fibrates) endocrine (vit D deficiency, thyroid, cushings) Menopause plymyalgia rheumatica Causes of bone pain - ANSWER>>metagolic (pagets disease) neoplasia (multiple myeloma, metastatic infections fracture Perimenopause STRAW staging - ANSWER>>-2 to +1a; POI - ANSWER>>Loss of ovarian follicular activity prior to the age of 40 Prevalence of POI in US - ANSWER>>3% T/F Premature menopause is a risk factor for CAD - ANSWER>>True - higher risk for abdominal adiposity, dm, dyslipidemia Etiology of premature menopause - 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 - ANSWER>>H&P Labs: - TSH - Prolactin - Pregnancy test - Elevated FSH (>25 IU/L on 2 checks/4-6 weeks apart) Late menopause - ANSWER>>LMP after age 54 Primary ovarian insufficiency - ANSWER>>Menopause that occurs before age 40 Early menopause transition (stage -2) - ANSWER>>Persistent difference of 7 days or more in the length of consecutive cycles. Late menopause transition (stage -1) - ANSWER>>60 or more consecutive days of amenorrhea Luteal out of phase event (LOOP) - ANSWER>>Explains why some perimenopausal women have elevated estrogen level sometimes...In the early menopause transition, elevated FSH levels are adequate to recruit a second follicle which results in a follicular phase-like rise in estradiol secretion superimposed on the mid-to-late luteal phase of the ongoing ovulatory cycle. Obese women and estradiol levels during menopause - ANSWER>>Obese women are more likely to have anovulatory cycles with high estradiol levels. They are also more likely to have lower premenopause yet higher postmenopause estradiol levels compared with women of normal weight. (why they are at higher risk of endometrial cancer) Chinese and Japanese women - ANSWER>>These ethnic groups have lower estradiol levels then white, black and hispanic women. stage +2 - ANSWER>>late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary symptoms. Stages +1a, +1b, +1c - ANSWER>>early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate. Elevated FSH, LH - ANSWER>>Endocrine labs after menopause AMH, inhibin B - ANSWER>>These hormones work during reproductive years to not deplete follicle pool too quickly. Phases during menopause transition and PMS symptoms - ANSWER>>Menstrual cycle variable, persistent >7 day difference between difference in length of consecutive cycles. How to respond if a patient requests FSH lab? - ANSWER>>many pitfalls, variable depending on the day of the cycle you draw the lab, normal or low FSH is not helpful. The potentially superior marker of menopause, a lab. - ANSWER>>AMH DHEA (dehydroepiandrosterone) - ANSWER>>Adrenal androgens: precursor hromones produced by the adrenal gland that are enzymatically converted to active androgens or estrogens in peripheral tissues. Location of estrogen receptors - ANSWER>>Vagina, vulva, urethra, trigone of the bladder Effects of estrogen on tissue - ANSWER>>maintain blood flow, the collagen, and HA within the epithelial surfaces. Supports microbiome which supports acidity of vagina and protects tissue from pathogens. Vaginal changes with menopause - ANSWER>>Thinning, loss of elasticity, loss or absence or rugae. Vagina and urethra in menopause - ANSWER>>vagina narrows, urethra moves closer to the introitus. Stress urinary incontinence - ANSWER>>Vaginal estrogen and urinary incontinence: what type does it help with? Treatment for FPHL - ANSWER>>Minoxidil, spironolactone, finasteride, estrogen therapy Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? - ANSWER>>-3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin low. -3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin low. When it is appropriate to check an FSH during the cycle if you check it? and why? - ANSWER>>Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level. AMH produced by... used to test... Is it a screening tool for fertility? When does it peak? - ANSWER>>produced by granulosa cells used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low ovarian reserve. not recommended as a screening tool to predict fertility. Peaks at around 25 years old. So before age 25, this test is not helpful. It is influenced by exogenous hormones. Lower in hormonal contraception users, but increases after d/cing. Oral estrogen increases the cortisol binding globulin, which increases total cortisol concentration. Oral tamoxifen acts similarly. Transdermal does not increase it, so it has a minimal effect on serum cortisol concentration. Do cortisol levels associate with VMS severity? - ANSWER>>No, cortisol levels have NOT been associated with more severe VMS. Local DHEA has been proven to help with what? - ANSWER>>vaginal pain and dyspareunia How to DX POI? - ANSWER>>Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months. AND elevated FSH over 25 on two occasions at least 4 weeks apart. Anyone <40years old who misses 3+ consecutive cycles gets these labs - ANSWER>>prolactin FSH estradiol TSH pregnancy test treatment of POI - ANSWER>>100 microgram estradiol patch 1.25 mg CEE 2mg oral estradiol If intact uterus-progesterone for 12 days of the month. Physiologic is better than continuous hormonal contractption, but if menorrhagia-IUD plus estrogen patch, or if really not wanting to risk pregnancy, continuous HRT can be used. Hair loss. Difference between FPHL and telogen effluvium? - ANSWER>>FPHL is gradual, telogen effluvium is sudden and usually precipitated by a life stressor, chronic illness, beta blockers or anticoagulants-usually more patchy hair loss. FPHL pattern - ANSWER>>thinning at the crown of the head and widening of the hair part Treating FPHL - ANSWER>>MINOXIDIL spironolactone finasteride What ethnicity has the least likely chance of having bad hot flashes? - ANSWER>>Japanese What ethnicity is the most likely to have bad hot flashes? - ANSWER>>black more frequent, longer duration. Median length of hot flashes - ANSWER>>10 years, early menopause transition women have them the longest. Theories about etiology of hot flashes (6) - ANSWER>>lower ovarian estradiol thermoregulation zone is narrowed neurokinins-regulate GnRH secretion. KNDy new meds serotonin cortisol and HPI axis dysregulation endothelial dysfunction. VIN low grade-what to do high grade-what to do differentiated VIN-what to do - ANSWER>>low grade is not precancerous high grade is precancerous-GYN ONC differentiated-wide local excision-high risk of invasive carcinoma. most common type of vulvar cancer - ANSWER>>squamous cell carcinoma Vulvar disorder commonly misdiagnosed as eczema or dermatitis? - ANSWER>>paget's disease will not improve on steroids screen for co-existing breast, GI or GU cancer. They are present 20-30% of the time. Normal PVR - ANSWER>><100mL systemic and vaginal estrogen will not help with this type of urinary incontinence? - ANSWER>>will NOT help with stress incontinence. Which topical vaginal estrogen has the highest dose? - ANSWER>>the vaginal rings FEMRING IS THE HIGHEST Most common cause of vulvovaginitis? - ANSWER>>BV post menopause burning and diffuse yellow/brown discharge and dyspareunia that does not respond to local ET? - ANSWER>>desquamative inflammatory vaginitis. treat different with clindamycin or hydrocortisone+ET When to consider preventative medication for migraines - ANSWER>>>2 times per week or severe and effecting QOL Triptans are contraindicated in what? - ANSWER>>patients with cardiovascular disease, as are NSAIDs Menstrual migraine treatment - 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 - 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? - ANSWER>>it can take several months. what is th emost common form of arthritis? - ANSWER>>osteoarthritis what areas of th ebrain have th emost estrogen receptors? - ANSWER>>hippocampus and prefrontal cortex what is the most common thyroid disorder in women? - ANSWER>>hashimoto thyroiditis if a patient on levothyroxine is started on estrogen, when do you recheck and what can you anticipate happening? - 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? - ANSWER>>when the TSH level is higher than 10. are hot or cold thyroid nodules typically most likely to be malignant? - ANSWER>>cold nodules how does HRT impact gallbladder disease? - ANSWER>>increases risk of gallstones with oral HRT, lower risk with transdermal. when did they start screening blood for hep c? - 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? - 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? - ANSWER>>1945 to 1965 routine screening of all adults for hepatitis c. is it reocmmended? - 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? - ANSWER>>16 and 18 by age 50 what percentage of US women will have acquired a genital HPV infection? - 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? - ANSWER>>HPV What percentage of bone loss do women have from the menopause transition? - ANSWER>>10-12% on average, about 1 t score What t score defines osteopenia - ANSWER>>-1.5 to -2.5 what t score defines osteoporosis - ANSWER>>less than -2.5 what z score defines osteoporosis before menopause? - ANSWER>>z score less than 2.0 and a history of a fragility fracture Who is at highest risk of osteoporosis? - 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? - 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? - ANSWER>>lower Black women have ____BMD than white people? - ANSWER>>higher Over 3 servings of alcohol daily and risk for fracture? - ANSWER>>38% for osteoporotic fracture and 68% for hip fracture What 4 ethnic specific versions of FRAX are there? - ANSWER>>white, asiain, black, hispanic how to test for incontinence - ANSWER>>pyridium challenge OAB - 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 - ANSWER>>Hypoactive sexual desire disorder Female genital arousal disorder Persistent genital arousal disorder Female orgasm disorder Femal orgasmic illness syndrome Pelvic floor muscles - ANSWER>>Levator ani superficial (transverse perineal, bulbospongiosus, ischiocavernosus) Deep (pubococcygeus, iliococcygeus, obturator internus, coccygeus( muscles PALM COEIN causes of AUB - 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? - ANSWER>>When <4mm Management of AUB - 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 - 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 - ANSWER>>1300 mg TID for 5 days of menstrual cycle ; causes GI upset GnRH therapy for fibroids - ANSWER>>Addback therapy can be used to protect against VMS and bone mineral density losss Nonsurgical treatment of fibroids - ANSWER>>Tranexamic acid and mefenamic acid mirena GnRH Selective progesterone receptor modulators Uterine artery embolization Hysteroscopic myomectomy is most suitable for fibroids smaller than - ANSWER>>5cm in diameter Lichen Planus - ANSWER>>Pruritic, purple, polygonal planar papules and plaques (6 P's) Lichen sclerosis et atrophicus - 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 - ANSWER>>Leukoplakia with thick, leathery vulvar skin associated with chronic irritation and scratching., hyperplasia of the vulvar squamous epithelium lichen planus treatment - 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 - ANSWER>>topical steroid (clobetasol) Lichen Simplex Chronicus Treatment - 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 - 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 - ANSWER>>Parmipexole and ropinirole Weight loss with phentermine/topiramate ER - 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) - 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 - OCP w/ drospirenon - spironolactone 100-200 mg daily Minoxidil 2.5mg daily Finasteride 5mg daily Dutasteride .5mg daily Telogen effluvium - ANSWER>>Premature shedding of hair in the resting phase causes of telogen effluvium - 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 - 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 - 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 - 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? - ANSWER>>Can: Type I and II Carcinosarcoma Cannot: Leiomyosarcoma Stromal sarcoma Which ovarian cancer can you use topical estrogen? Which can you not? - ANSWER>>Can: HGSOC Germ cell Granulosa cell Cannot: Endometrioid Which types of cervical cancer can ou use topical estrogen - ANSWER>>All Dosing of vaginal estrogen - ANSWER>>daily for 2 weeks then 2x weekly Evaluation of incontinence - 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 - ANSWER>>Stress incontinence Overactive bladder Oveflow incontinence Screening for thyroid disease - ANSWER>>Every 5 years starting at age 35 Most common thyroid disease - ANSWER>>Hypothyroidism caused by hashimoto thyroiditis Normal range of serum TSH - ANSWER>>.4 mIU/L to 4.5 mIU/L; if TSH level is elevated, free T4 and antithyroperoxidase antibodies should be measured Levo dosing - ANSWER>>1.6ug per KG Over 50 start w/ 25ug to 50 with progression every 2-3 weeks until euthyroid is reached • Secondary osteoporosis • EtOH - more than 3 drinks a day • Bone mineral density Risk factors for low bone mineral density - ANSWER>>Age, thinness, genetics, smoking, hx of fracture, diseases and drugs (AI, steroids), excessive etoh, infertility FRAX score is ____ - ANSWER>>screening tool for osteoporosis tells 10 year probability of hip fx or major osteoporotic fracture (hip, proximal humerus, distal radium, symptomatic spine fracture) DEXA screening recommendations - ANSWER>>All women aged 65 and older, younger postmenopausal women wiht one other important risk factor of low BMD (personal family hx of fracture, low body weight) REcommended daily intake of calcium - ANSWER>>800 - 1200 mg; excessive intake (>2000) should be avoided ecause this is associated with renal stones Normal vitamin D - ANSWER>>>20 ng/ml Systemic estrogen is approved for osteoporosis prevention - ANSWER>>correct Systemic estrogen is NOT approved for osteoporosis treatment - ANSWER>>Stupid, but true The benefits fo estrogen abate within a few months after stopping therapy - ANSWER>>correct What are estrogen agonists/antagonists - ANSWER>>SERMS (selective estrogen receptor modulators, have weak estrogen agonist properties in bone whil functioning as antiestrogen in female reproductive tissues Raloxifene (Evista) - ANSWER>>Selective Estrogen Receptor Modulator (SERM) Induces small increases in BMD 60 mg daily for 3 years reduced vertebral fractures by 30% Risk of VTE in elderly women Reduced risk of invasive breast cancer Raloxifene is an appealing treatment options for: - ANSWER>>younger postmenopausal women with osteoporosis at risk for vertebral but not hip fracture w/o significant vasomotor symptoms Bazedoxifene - ANSWER>>Selective Estrogen Receptor Modulator (SERM) vertebral fracture risk reduced by 42% over 3 years no effect on nonvertebral risk, no effect on reast cancer irsk proven Combo of bazedoxifene 20 mg and .45 mg CEE daily improves VMS and prevents bone loss in young postmenopausal women Bisphosphonates - ANSWER>>Fosamax: inhibit bone resorption used in osteoporosis. AE: dysphagia, esophageal ulcer. Nursing: take 1st thing in the morning w/o food, 8oz of water, remain upright for 30mins after taking, if dose missed-skip Fosamax (alendronate) - ANSWER>>Classification: Bone resorption inhibitor. Bisphosphonate Therapeutic Effects: TX and prevention of post-menopausal and cortico-steroid- induced osteoporosis, Adverse Reactions & side effects: Altered taste, photosensitivity, rash, musculoskeletal pain, fluid overload, esophagitis. Common upset stomach & heartburn, GI effects Nursing Implications & teaching:Take first thing in the AM, before eating anything; then pt MUST remain upright for at least 30 mins! Take only with plain water. Monitor for GI side effects. Use sunscreen to prevent photosensitivity reactions. Risedronate (Actonel) - ANSWER>>Biphosphate. Taken daily, weekly, or monthly. Zoledronic acid (Reclast, Zometa) - ANSWER>>Biphosphate. IV annually. After 5 years fo treatment in women with high risk of osteoporosiss, consider switching to denosumab - ANSWER>>Results in additional gains Denosumab (Prolia) - ANSWER>>Monoclonal antibody for postmenopausal women Subcutaneous injection every 6 months salmon calcitonin - ANSWER>>Reduces bone loss in osteoporosis potent inhibitor of bone resorption STI screening in <25 - ANSWER>>annual genital chlamy and gonn treatment for gonorrhea - ANSWER>>2021 guidelines: ceftriaxone 500 mg IM x1 or ceftriaxone 1g IM x1 if > 150kg If chlamydia not ruled out; doxy 100 BID 7 days when to repeat testing for Chlamydia? - ANSWER>>3 months Contraindications to HRT - ANSWER>>History of endometrial cancer Personal history of breast cancer History of thromboembolic disorders Acute or chronic liver disease Coronary artery disease Elevated triglyc Undiagnosed vaginal bleeding