NAMS Menopause Certification Exam 2024: Questions and 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+

The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of

menopause. ANSWER>>>> Climacteric phase

LMP before age 45 ANSWER>>>> Early menopause

LMP after age 54 ANSWER>>>> Late menopause

Menopause that occurs before age 40 ANSWER>>>> Primary ovarian insufficiency

Persistent difference of 7 days or more in the length of consecutive cycles. ANSWER>>>> Early

menopause transition (stage - 2)

60 or more consecutive days of amenorrhea ANSWER>>>> Late menopause transition (stage -

1)

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. ANSWER>>>> Luteal out of phase event (LOOP)

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) ANSWER>>>> Obese women

and estradiol levels during menopause

These ethnic groups have lower estradiol levels then white, black and hispanic women.

ANSWER>>>> Chinese and Japanese women

late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary

symptoms. ANSWER>>>> stage +

early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate.

ANSWER>>>> Stages +1a, +1b, +1c

Endocrine labs after menopause ANSWER>>>> Elevated FSH, LH

These hormones work during reproductive years to not deplete follicle pool too quickly.

ANSWER>>>> AMH, inhibin B

Menstrual cycle variable, persistent >7 day difference between difference in length of consecutive cycles. ANSWER>>>>Phases during menopause transition and PMS symptoms many pitfalls, variable depending on the day of the cycle you draw the lab, normal or low FSH is not

helpful. ANSWER>>>> How to respond if a patient requests FSH lab?

AMH ANSWER>>>> The potentially superior marker of menopause, a lab.

Adrenal androgens: precursor hromones produced by the adrenal gland that are enzymatically converted

to active androgens or estrogens in peripheral tissues. ANSWER>>>> DHEA

(dehydroepiandrosterone)

Vagina, vulva, urethra, trigone of the bladder ANSWER>>>> Location of estrogen receptors

maintain blood flow, the collagen, and HA within the epithelial surfaces. Supports microbiome which

supports acidity of vagina and protects tissue from pathogens. ANSWER>>>> Effects of estrogen

on tissue

Thinning, loss of elasticity, loss or absence or rugae. ANSWER>>>> Vaginal changes with

menopause

vagina narrows, urethra moves closer to the introitus. ANSWER>>>> Vagina and urethra in

menopause

Vaginal estrogen and urinary incontinence: what type does it help with? ANSWER>>>> Stress urinary

incontinence

Minoxidil, spironolactone, finasteride, estrogen therapy ANSWER>>>> Treatment for FPHL

- 3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin low.

• 3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin low. ANSWER>>>> Late

reporoductive years - 3b and - 3a. What happens with menstrual cycles, FSH, AMH,

AFC, inhibin?

Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level. ANSWER>>>> When

it is appropriate to check an FSH during the cycle if you check it? and why?

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. ANSWER>>>> AMH

produced by... used to test... Is it a screening tool for fertility? When does it peak? Antral follicle count

Number of follicles that are detectable with ultrasound. They are sensitive to FSH and considered to represent the availability pool of follicles.

ANSWER>>>> AFC

25 or higher ANSWER>>>> Late menopause transition (-1) FSH level on random draw

Higher ANSWER>>>> Black women have higher or lower FSH levels?

lower ANSWER>>>> Chinese and Japanese women have higher or lower estradiol

levels compared to white, black and hispanic women?

SHBG decreases

Testosterone/SHBG ratio increases by 80%. ANSWER>>>> Menopause transition-changes in

SHBG and testosterone? ratio?

The free androgen index ANSWER>>>> Testosterone/SHGB ratio is called what?

+1b (generally last 2 years) ANSWER>>>> What stage are VMS more likely?

Estrone-via aromatization. ANSWER>>>> What hormone is generally higher in obese

women?

testosterone and androstenedione ANSWER>>>> The postmenopausal ovary continues to

produce what two hormones?

testosterone. 40-50% lower than in women w/ intact ovaries. ANSWER>>>> Surgical menopause

causes women to have lower levels of what hormone?

inhibin and AMH decrease

therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished follicle

pool. ANSWER>>>> Driving piece of menopause is ovarian follicles depleting. What

does this do to the inhibin B and AMH?

Luteal-more PMS symptoms, more frequent menstrual periods. ANSWER>>>>In the menopause transition, women spend more time in what phase? It is felt that the HPO axis may become less sensitive to estrogen, so even with good follicle growth and estradiol secretion, LH surges can fail which can lead to more cycle irregularity. ANSWER>>>>HPO axis theory and the menopause transition progesterone ANSWER>>>>In the first year after the FMP, there is no production of what hormone? zona reticularis ANSWER>>>>What region of the adrenal gland secretes the androgens? DHEA, DHEAS, Androstenedione. ANSWER>>>>what are considered the 'adrenal androgens'? Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted by the anterior pituitary. ANSWER>>>>Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors. Anterior pituitary. The posterior only secretes vasopressin and oxytosin. ANSWER>>>>What part of the pituitary gland secretes adrenocorticotropic hormone? Most serum cortisol circulates bound to cortisol binding globulin. 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. ANSWER>>>>Cortisol and HRT

No, cortisol levels have NOT been associated with more severe VMS. ANSWER>>>>Do cortisol levels associate with VMS severity? vaginal pain and dyspareunia ANSWER>>>>Local DHEA has been proven to help with what? Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months. AND elevated FSH over 25 on two occasions at least 4 weeks apart. ANSWER>>>>How to DX POI? prolactin FSH estradiol TSH pregnancy test ANSWER>>>>Anyone <40years old who misses 3+ consecutive cycles gets these labs 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. ANSWER>>>>treatment of POI

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. ANSWER>>>>Hair loss. Difference between FPHL and telogen effluvium? thinning at the crown of the head and widening of the hair part ANSWER>>>>FPHL pattern MINOXIDIL spironolactone finasteride ANSWER>>>>Treating FPHL Japanese ANSWER>>>>What ethnicity has the least likely chance of having bad hot flashes? black more frequent, longer duration. ANSWER>>>>What ethnicity is the most likely to have bad hot flashes? 10 years, early menopause transition women have them the longest. ANSWER>>>>Median length of hot flashes lower ovarian estradiol thermoregulation zone is narrowed neurokinins-regulate GnRH secretion. KNDy new meds serotonin cortisol and HPI axis dysregulation endothelial dysfunction. ANSWER>>>>Theories about etiology of hot flashes (6) low grade is not precancerous high grade is precancerous-GYN ONC differentiated-wide local excision-high risk of invasive carcinoma. ANSWER>>>>VIN low grade-what to do high grade-what to do

differentiated VIN-what to do squamous cell carcinoma ANSWER>>>>most common type of vulvar cancer 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. ANSWER>>>>Vulvar disorder commonly misdiagnosed as eczema or dermatitis? <100mL ANSWER>>>>Normal PVR will NOT help with stress incontinence. ANSWER>>>>systemic and vaginal estrogen will not help with this type of urinary incontinence? the vaginal rings FEMRING IS THE HIGHEST ANSWER>>>>Which topical vaginal estrogen has the highest dose? BV ANSWER>>>>Most common cause of vulvovaginitis? desquamative inflammatory vaginitis. treat different with clindamycin or hydrocortisone+ET ANSWER>>>>post menopause burning and diffuse yellow/brown discharge and dyspareunia that does not respond to local ET? circulating androgens ANSWER>>>>What hormones are associated with sexual desire in women? circulating androgen levels ANSWER>>>>Women who have had a BSO experience an abrupt and persistent decline in what hormone?

female sexual interest/arousal disorder ANSWER>>>>HSDD and FSAD were combined into a single dysrunction called flibanserin and bremelanotide ANSWER>>>>HSDD treatments L-arginine, topical alprostadil, wellbutrin, oxytosin. phosphodiesterase inhibitors-lacking in efficacy Eros therapy device $300- vaccum-like the penis pump ANSWER>>>>FGAD treatments (genital arousal disorder) directed masturbation is most researched behavioral treatment. ANSWER>>>>FOD (orgasmic disorder) treatments Rarely. They often shrink after menopause. ANSWER>>>>Does systemic ET cause fibroids to resume growth? Difficulty concentrating and remembering are common. ANSWER>>>>What is true about cognition and menopause? memory for verbal information can be compromised immediately after surgical menopause, especially if it is before the typical age of mesopause. ANSWER>>>>What is true about cognition and surgical menopause Mediterranean diet with olive oil and tai chi exercise helps with global cognition Mediterranean diet with olive oil and isoflavone supplements helps with memory. ANSWER>>>>Meta analysis of RCTs have shown small benefit of what diet/exercise for global cognition and memory? small or no overall effect on cognition ANSWER>>>>effect of HRT on cognition 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 ANSWER>>>>What HRT can increase your risk for dementia based on the WHIMS study in 65+ year old healthy women?

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. ANSWER>>>>3 reasons supporting the idea that HRT in early menopause may decrease a woman's chance of developing alzheimer's disease? typically migraines improve-estrogen levels stabilize ANSWER>>>>Migraine headache and pregnancy usually decrease with natural menopause ANSWER>>>>Migraine without aura after menopause should resolve completely ANSWER>>>>menstrual migraine after menopause

2 times per week or severe and effecting QOL ANSWER>>>>When to consider preventative medication for migraines patients with cardiovascular disease, as are NSAIDs ANSWER>>>>Triptans are contraindicated in what? NSAID or triptan 2 days before expected to get your period, and take for 5-7 days. ANSWER>>>>Menstrual migraine treatment migraine with aura-advise to not use combined hormone contraception caution in women with migraine without aura ANSWER>>>>cdc and who guidelines for migraine treatment

it can take several months. ANSWER>>>>How long can it take for arthralgia from vitamin d deficiency or hypothyroidism to fully resolve? osteoarthritis ANSWER>>>>what is th emost common form of arthritis? hippocampus and prefrontal cortex ANSWER>>>>what areas of th ebrain have th emost estrogen receptors? hashimoto thyroiditis ANSWER>>>>what is the most common thyroid disorder in women? 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. ANSWER>>>>if a patient on levothyroxine is started on estrogen, when do you recheck and what can you anticipate happening? when the TSH level is higher than 10. ANSWER>>>>when is treatment of subclinical hypothyroidism recommended? cold nodules ANSWER>>>>are hot or cold thyroid nodules typically most likely to be malignant? increases risk of gallstones with oral HRT, lower risk with transdermal. ANSWER>>>>how does HRT impact gallbladder disease? 1992, so women who have received blood products or organ transplants prior to 1992 may have acquired heptatitis c ANSWER>>>>when did they start screening blood for hep c? 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 ANSWER>>>>why do we screen for hep C?

1945 to 1965 ANSWER>>>>all adults born from what year to what year should recieve one time hep c testing? routine screening for all adults is not recommended, however baby boomers are at the highest risk. infection rates are 5x other birth cohorts. ANSWER>>>>routine screening of all adults for hepatitis c. is it reocmmended? 16 and 18 ANSWER>>>>what hpv is high risk? 80%-HPV is very common, but it is the high risk ones to worry about ANSWER>>>>by age 50 what percentage of US women will have acquired a genital HPV infection? HPV ANSWER>>>>what is the most commonly sexually transmitted infection in the US? 10 - 12% on average, about 1 t score ANSWER>>>>What percentage of bone loss do women have from the menopause transition?

• 1.5 to - 2.5 ANSWER>>>>What t score defines osteopenia less than - 2.5 ANSWER>>>>what t score defines osteoporosis z score less than 2.0 and a history of a fragility fracture ANSWER>>>>what z score defines osteoporosis before menopause? white and hispanic populations ANSWER>>>>Who is at highest risk of osteoporosis? 1 in 4 women (25%) require long term care 1 in 2 woemn (50%) have long term loss of mobility ANSWER>>>>What amount of women require long term care after hip fracture? What amount of women have long term loss of mobility after hip fracture?

lower ANSWER>>>>Asians have ____BMD than white people? higher ANSWER>>>>Black women have ____BMD than white people? 38% for osteoporotic fracture and 68% for hip fracture ANSWER>>>>Over 3 servings of alcohol daily and risk for fracture? white, asiain, black, hispanic ANSWER>>>>What 4 ethnic specific versions of FRAX are there? dairy free diet-300mg calcium daily. Needs 800-1200mg ANSWER>>>>Dairy free diet amount of calicum. How much do they need to supplement? approved in mexico decreased risk of vertebral and nonvertebral fracture increased risk of stroke ANSWER>>>>Tibolone and osteoporosis where is it approved? why wasn't it submitted for approval in the US and canada? 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. ANSWER>>>>Why was estrogen not approved for osteoporosis? osteosarcoma ANSWER>>>>Black box warning for PTH receptor agonists? hypercalcemia ANSWER>>>>caution using PTH receptor agonists in what condition? someone incredibly high risk for vertebral fracture ANSWER>>>>when would you use PTH receptor agonists?

vertebral fractures ANSWER>>>>raloxifene helps with what kind of fractures? increased risk of death from stroke in high risk patients, estrogen like risk of VTE, worsens hot flashes ANSWER>>>>raloxifene risk factors 1 in 1000 after 2-3 years. ANSWER>>>>atypical femur risk in women on bisphosphonate? small increase in spine BMD. daily SQ injections or nasal. ANSWER>>>>Salmon calcitonin and osteoporosis? 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 ANSWER>>>>Implications of estrogen drop on skin during menopause 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 ANSWER>>>>Definition of stress incontinence 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 ANSWER>>>>Definition of urgency incontinence

includes stress and urgency ANSWER>>>>Definition of mixed incontinence 100 or less, whereas >200 is abnormal, between 100-200 advised to repeat on different day ANSWER>>>>A postvoid residuals (w/in 15 minutes of emptying) of what volume is considered normal pyridium challenge ANSWER>>>>how to test for incontinence 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 ANSWER>>>>OAB Hypoactive sexual desire disorder Female genital arousal disorder Persistent genital arousal disorder Female orgasm disorder Femal orgasmic illness syndrome ANSWER>>>>ISSWSH Sexual Disorders in Menopause Levator ani superficial (transverse perineal, bulbospongiosus, ischiocavernosus) Deep (pubococcygeus, iliococcygeus, obturator internus, coccygeus( muscles ANSWER>>>>Pelvic floor muscles P: Polyp A: Adenomyosis L: Leiomyoma M: Malignancy/hyperplasia C: Coagulopathy O: ovulatory dysfunction E: Endometrial

I: Iatrogenic N: Not yet classified ANSWER>>>>PALM COEIN causes of AUB When <4mm ANSWER>>>>When is EMB not needed? Cocs decrease 7 to 4 days; IUD NSAID - reduce prostaglandin synthesiss which may have a role in aberrant neovasculariation ANSWER>>>>Management of AUB Mefenamic acid 500 mg TID for 5 days or Ibuprofen 600 mg Q6h or 800mg Q8 h for first 3 days ANSWER>>>>Dosing of NSAIDS for AUB 1300 mg TID for 5 days of menstrual cycle ; causes GI upset ANSWER>>>>Dosing of tranexamic acid for AUB Addback therapy can be used to protect against VMS and bone mineral density losss ANSWER>>>>GnRH therapy for fibroids Tranexamic acid and mefenamic acid mirena GnRH Selective progesterone receptor modulators Uterine artery embolization ANSWER>>>>Nonsurgical treatment of fibroids 5cm in diameter ANSWER>>>>Hysteroscopic myomectomy is most suitable for fibroids smaller than Pruritic, purple, polygonal planar papules and plaques (6 P's) ANSWER>>>>Lichen Planus

inflammatory condition - autoimmune - antibodies against extracellular matrix. Affects males and females equally - but female genital and perineal region is most commonly affected. ANSWER>>>>Lichen sclerosis et atrophicus Leukoplakia with thick, leathery vulvar skin associated with chronic irritation and scratching., hyperplasia of the vulvar squamous epithelium ANSWER>>>>Lichen Simplex Chronicus only when it is symptomatic, these respond to topical corticosteroids. When it has a burning sensation, patients should be prescribed an antifungal ANSWER>>>>lichen planus treatment topical steroid (clobetasol) ANSWER>>>>lichen sclerosis tx Corticosteroid: Triamcinolone 0.1% (Alway start off with low potency then move if it gets worst) ANSWER>>>>Lichen Simplex Chronicus Treatment Remove potential aggravators such as sleep deprivation, alcohol, exercise, caffeine, smoking Sleep hygiene, exercise, warm baths, leg vibration, massage, acupuncture, passive strestching ANSWER>>>>Non-pharmo Tx for restless legs and periodic imb movements Parmipexole and ropinirole ANSWER>>>>PHarmo tx for RLS 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 ANSWER>>>>Red flags for headache triptans, NSAIDs ANSWER>>>>Abortive therapy for migraine

Beta Blockers (propranolol) , Antiepileptic Drugs (divalproex), Tricyclic Antidepressants (amitriptyline) ANSWER>>>>Preventative therapy for migraines 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 ANSWER>>>>Hormone therapy for headache 2/2 to menopause 2/2 to arthritis 2/2 to other rheumatologic condition ANSWER>>>>What to consider when evaluating women with arthralgia drug induced (statines, fibrates) endocrine (vit D deficiency, thyroid, cushings) Menopause plymyalgia rheumatica ANSWER>>>>Causes of myalgia metagolic (pagets disease) neoplasia (multiple myeloma, metastatic infections fracture ANSWER>>>>Causes of bone pain

• 2 to +1a; ANSWER>>>>Perimenopause STRAW staging ANSWER>>>>STRAW staging system Loss of ovarian follicular activity prior to the age of 40 ANSWER>>>>POI 3% ANSWER>>>>Prevalence of POI in US

True

• higher risk for abdominal adiposity, dm, dyslipidemia ANSWER>>>>T/F Premature menopause is a risk factor for CAD

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 ANSWER>>>>Etiology of premature menopause 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 ANSWER>>>>Diagnosis of POI Genetic testing Autoimmune workup
• TSH, thyroperoxidase antibody, 21-OH antibodies, fasting glucose, HbA1C
• Ovarian antibodies lack sensitivity and specificity ANSWER>>>>Assessment of etiology of POI Transdermal 17 (100 mcg/d patch or gel) Oral 17B estradiol 2mg/day vaginal ring: 17B .1mg/day Oral CEE: .9-`1.25mcg/day ANSWER>>>>Estrogen therapy in premature menopause

Can consider, adjust therapy to achieve goal range of 80-120 pg/ml ANSWER>>>>Should you check estradiol levels for prematures No studied General principle, use higher doses; micronized 200-400 mg/d (cont/cyclically) or IUD ANSWER>>>>Use of progestogen in premature menopause May be more socially acceptable; lower cost Better bone outcomes and lower blood pressure with replacement estradiol (limited evidence) ANSWER>>>>COCs vs estrogen in younger women Comes from zone retic and ovaries ANSWER>>>>Production of androgens yes ANSWER>>>>Consider testosterone replacement in POI and surgically postmenopausal women true ANSWER>>>>T/F Fat and lean mass increase prior to menopausal transition about 2 years after FMP ANSWER>>>>Rate of fat gain doubles and lean mass declines during menopausal transition; when do things stabilize? 2 - 4 fold increase in fat mass (6%, 1.6kg over 3.5 years .5% loss of lean muscle ANSWER>>>>Weight gain during menopausal transition Premenopaust weight increase,MT - stead increase, post meno no change ANSWER>>>>Changes in weight gain during peri/meno yes likely driven by decreased active energy expenditure ANSWER>>>>Should calorie intake decrease in post menopause

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 ANSWER>>>>HRT on cardiovascular risk factors Initiate weight loss medication as adjunct to lifestyle:

• if BMI (27-29.9 in presence of comorbid)
• If BMI >30 and failure of lifestyle ANSWER>>>>When to add anti-obesity medication ~8% GI lipase inhibitor poop in your pants ANSWER>>>>Weight loss w/ orlistat 8 - 12% C/I: glaucoma, hyperthyroid, MAOI SE: insomnia, dry mouth, paresthesias, metabolic acidocis, anxiety, tachy ANSWER>>>>Weight loss with phentermine/topiramate ER ~5-6.4% Dopamine and norepinephrine reuptake inhibitor and u-opioid receptor antagonist C/I: htn, seizures, eating disorder, opioid use, SE: nausea, headache ANSWER>>>>Weight loss with Naltrexone SR/Bupropion SR (Contrave) 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 ANSWER>>>>Weight loss with liraglutide ~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 ANSWER>>>>Weight loss with semaglutide GLP-1s help the pancreas release more insulin, delay stomach emptying, and reduce appetite. ANSWER>>>>How do GLP-1 receptor agonists work? 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 ANSWER>>>>Weight loss with pentermine monotherapy Roux-en-y bypass Sleeve gastrectomy Biliopancreatic diversion iwth duodenal switch ANSWER>>>>Surgical management of obesity BMI >40 BMI >35 w/ 1 comorbid BMI 30-35 w/ T2DM, poor glycemic control despite lifestyle ANSWER>>>>Who is eligible for bariatric surgery? Disorders that reduce or slow hair growth without irreparably damaging the hair follicle

• primarily affect the hair shaft ANSWER>>>>Non-scarring alopecia replacement of hair follicles with scar tissue ANSWER>>>>scarring alopecia Androgenetic alopecia Telogen Effluvium Alopecia Areata ANSWER>>>>examples of non-scarring alopecia

Send to derm ANSWER>>>>How to treat scarring alopecia 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 ANSWER>>>>Androgenetic alopecia 50+% of women Can begin in teens Usually NOT androgen excess What did you first notice (ponytail smaller, part wider, see scalp ANSWER>>>>Female pattern thinng: Who when what TSH, CBC, ferritin ?PCOS? ANSWER>>>>What labs to obtain in fmale pattern thinning minoxidil 5% once daily ANSWER>>>>Topical treatment for female pattern thinning Younger women
• OCP w/ drospirenon
• spironolactone 100-200 mg daily Minoxidil 2.5mg daily Finasteride 5mg daily Dutasteride .5mg daily ANSWER>>>>Systemic treatment for female pattern hair thinning

Premature shedding of hair in the resting phase ANSWER>>>>Telogen effluvium Thyroid Rapid weight loss Significant illness Anesthesia Malnutrition Pregnancy Heparin, β-blockers, IFN, lithium, retinoids, OCP discontinuation, antidepressants, anticonvulsants, ACE inhibitors, colchicine, NSAIDs ANSWER>>>>causes of telogen effluvium 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 ANSWER>>>>Testosterone estrogen level trend in menopause and impact on hair 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 ANSWER>>>>The role of estrogen on urogenital health 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 ANSWER>>>>non-pharmacologic vaginal moisturizer Can: Type I and II Carcinosarcoma Cannot: Leiomyosarcoma Stromal sarcoma ANSWER>>>>What uterine cancer can you use topical estrogen? Which to not? Can: HGSOC Germ cell Granulosa cell Cannot: Endometrioid ANSWER>>>>Which ovarian cancer can you use topical estrogen? Which can you not? All ANSWER>>>>Which types of cervical cancer can ou use topical estrogen daily for 2 weeks then 2x weekly ANSWER>>>>Dosing of vaginal estrogen Type:

• provoking factord
• sense of urgency
• Frequency