NAMS MENOPAUSE CERTIFICATION EXAM 2024, Exams of Nursing

Download NAMS MENOPAUSE CERTIFICATION EXAM 2024 and more Exams Nursing in PDF only on Docsity! 1 | P a g e NAMS MENOPAUSE CERTIFICATION EXAM 2024 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS|ALREADY GRADED A+|NEWEST|GUARANTEED PASS|LATEST UPDATE what is the most commonly sexually transmitted infection in the US? HPV What percentage of bone loss do women have from the menopause transition? 10-12% on average, about 1 t score What t score defines osteopenia -1.5 to -2.5 what t score defines osteoporosis less than -2.5 what z score defines osteoporosis before menopause? z score less than 2.0 and a history of a fragility fracture Who is at highest risk of osteoporosis? 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? 2 | P a g e 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? lower Black women have ____BMD than white people? higher Over 3 servings of alcohol daily and risk for fracture? 38% for osteoporotic fracture and 68% for hip fracture What 4 ethnic specific versions of FRAX are there? white, asiain, black, hispanic Dairy free diet amount of calicum. How much do they need to supplement? dairy free diet-300mg calcium daily. Needs 800-1200mg Tibolone and osteoporosis where is it approved? why wasn't it submitted for approval in the US and canada? approved in mexico decreased risk of vertebral and nonvertebral fracture increased risk of stroke Why was estrogen not approved for osteoporosis? 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? osteosarcoma caution using PTH receptor agonists in what condition? hypercalcemia when would you use PTH receptor agonists? someone incredibly high risk for vertebral fracture raloxifene helps with what kind of fractures? vertebral fractures raloxifene risk factors 5 | P a g e GnRH Selective progesterone receptor modulators Uterine artery embolization Hysteroscopic myomectomy is most suitable for fibroids smaller than 5cm in diameter Lichen Planus Pruritic, purple, polygonal planar papules and plaques (6 P's) Lichen sclerosis et atrophicus 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 Leukoplakia with thick, leathery vulvar skin associated with chronic irritation and scratching., hyperplasia of the vulvar squamous epithelium lichen planus treatment 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 topical steroid (clobetasol) Lichen Simplex Chronicus Treatment 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 Remove potential aggravators such as sleep deprivation, alcohol, exercise, caffeine, smoking Sleep hygiene, exercise, warm baths, leg vibration, massage, acupuncture, passive strestching 6 | P a g e PHarmo tx for RLS Parmipexole and ropinirole Red flags for headache 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 triptans, NSAIDs Preventative therapy for migraines Beta Blockers (propranolol) , Antiepileptic Drugs (divalproex), Tricyclic Antidepressants (amitriptyline) Hormone therapy for headache 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 2/2 to menopause 2/2 to arthritis 2/2 to other rheumatologic condition Causes of myalgia drug induced (statines, fibrates) endocrine (vit D deficiency, thyroid, cushings) Menopause plymyalgia rheumatica Causes of bone pain metagolic (pagets disease) neoplasia (multiple myeloma, metastatic infections fracture Perimenopause STRAW staging -2 to +1a; STRAW staging system 7 | P a g e POI Loss of ovarian follicular activity prior to the age of 40 Prevalence of POI in US 3% T/F Premature menopause is a risk factor for CAD True - higher risk for abdominal adiposity, dm, dyslipidemia Etiology of premature menopause 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 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 Genetic testing Autoimmune workup - TSH, thyroperoxidase antibody, 21-OH antibodies, fasting glucose, HbA1C - Ovarian antibodies lack sensitivity and specificity Estrogen therapy in premature menopause 10 | P a g e Roux-en-y bypass Sleeve gastrectomy Biliopancreatic diversion iwth duodenal switch Who is eligible for bariatric surgery? BMI >40 BMI >35 w/ 1 comorbid BMI 30-35 w/ T2DM, poor glycemic control despite lifestyle Non-scarring alopecia Disorders that reduce or slow hair growth without irreparably damaging the hair follicle -primarily affect the hair shaft scarring alopecia replacement of hair follicles with scar tissue examples of non-scarring alopecia Androgenetic alopecia Telogen Effluvium Alopecia Areata How to treat scarring alopecia Send to derm Androgenetic 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 Female pattern thinng: Who when what 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 11 | P a g e TSH, CBC, ferritin ?PCOS? Topical treatment for female pattern thinning minoxidil 5% once daily Systemic treatment for female pattern hair thinning Younger women - OCP w/ drospirenon - spironolactone 100-200 mg daily Minoxidil 2.5mg daily Finasteride 5mg daily Dutasteride .5mg daily Telogen effluvium Premature shedding of hair in the resting phase causes of 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 Testosterone estrogen level trend in menopause and impact on hair 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 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 12 | P a g e non-pharmacologic vaginal moisturizer 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? Can: Type I and II Carcinosarcoma Cannot: Leiomyosarcoma Stromal sarcoma Which ovarian cancer can you use topical estrogen? Which can you not? Can: HGSOC Germ cell Granulosa cell Cannot: Endometrioid Which types of cervical cancer can ou use topical estrogen All Dosing of vaginal estrogen daily for 2 weeks then 2x weekly Evaluation of incontinence Type: - provoking factord - sense of urgency - Frequency - Ability to defer Severity and Impact on QoL - Leak frequency - Pad use 15 | P a g e Women who have a low BMD (z-score < - 2) and have a history of fragility fracture FRAX score Used to predict the 10 year risk of fracture o Elements include • Age - 40-90 • Gender • BMI • Previous fracture • Previous hip fracture • Current smoking • Glucocorticoid use (3 months at more than 5mg / day) • Rheumatoid arthritis • Secondary osteoporosis • EtOH - more than 3 drinks a day • Bone mineral density Risk factors for low bone mineral density Age, thinness, genetics, smoking, hx of fracture, diseases and drugs (AI, steroids), excessive etoh, infertility FRAX score is ____ 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 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 800 - 1200 mg; excessive intake (>2000) should be avoided ecause this is associated with renal stones Normal vitamin D >20 ng/ml Systemic estrogen is approved for osteoporosis prevention correct Systemic estrogen is NOT approved for osteoporosis treatment Stupid, but true The benefits fo estrogen abate within a few months after stopping therapy 16 | P a g e correct What are estrogen agonists/antagonists SERMS (selective estrogen receptor modulators, have weak estrogen agonist properties in bone whil functioning as antiestrogen in female reproductive tissues Raloxifene (Evista) 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: younger postmenopausal women with osteoporosis at risk for vertebral but not hip fracture w/o significant vasomotor symptoms Bazedoxifene 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 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) 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) Biphosphate. Taken daily, weekly, or monthly. Zoledronic acid (Reclast, Zometa) Biphosphate. IV annually. 17 | P a g e After 5 years fo treatment in women with high risk of osteoporosiss, consider switching to denosumab Results in additional gains Denosumab (Prolia) Monoclonal antibody for postmenopausal women Subcutaneous injection every 6 months salmon calcitonin Reduces bone loss in osteoporosis potent inhibitor of bone resorption STI screening in <25 annual genital chlamy and gonn treatment for gonorrhea 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? 3 months Contraindications to HRT 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 Climacteric phase The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of menopause. Early menopause LMP before age 45 Late menopause LMP after age 54 Primary ovarian insufficiency Menopause that occurs before age 40 20 | P a g e It is influenced by exogenous hormones. Lower in hormonal contraception users, but increases after d/cing. AFC 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. Late menopause transition (-1) FSH level on random draw 25 or higher Black women have higher or lower FSH levels? Higher Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic women? lower Menopause transition-changes in SHBG and testosterone? ratio? SHBG decreases Testosterone/SHBG ratio increases by 80%. Testosterone/SHGB ratio is called what? The free androgen index What stage are VMS more likely? +1b (generally last 2 years) What hormone is generally higher in obese women? Estrone-via aromatization. The postmenopausal ovary continues to produce what two hormones? testosterone and androstenedione Surgical menopause causes women to have lower levels of what hormone? testosterone. 40-50% lower than in women w/ intact ovaries. Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin B and AMH? inhibin and AMH decrease therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished follicle pool. 21 | P a g e In the menopause transition, women spend more time in what phase? Luteal-more PMS symptoms, more frequent menstrual periods. HPO axis theory and the menopause transition 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. In the first year after the FMP, there is no production of what hormone? progesterone What region of the adrenal gland secretes the androgens? zona reticularis what are considered the 'adrenal androgens'? DHEA, DHEAS, Androstenedione. Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors. Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted by the anterior pituitary. What part of the pituitary gland secretes adrenocorticotropic hormone? Anterior pituitary. The posterior only secretes vasopressin and oxytosin. Cortisol and HRT 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. Do cortisol levels associate with VMS severity? No, cortisol levels have NOT been associated with more severe VMS. Local DHEA has been proven to help with what? vaginal pain and dyspareunia How to DX POI? Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months. AND 22 | P a g e elevated FSH over 25 on two occasions at least 4 weeks apart. Anyone <40years old who misses 3+ consecutive cycles gets these labs prolactin FSH estradiol TSH pregnancy test treatment of POI 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? 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 thinning at the crown of the head and widening of the hair part Treating FPHL MINOXIDIL spironolactone finasteride What ethnicity has the least likely chance of having bad hot flashes? Japanese What ethnicity is the most likely to have bad hot flashes? black more frequent, longer duration. Median length of hot flashes 10 years, early menopause transition women have them the longest. Theories about etiology of hot flashes (6) 25 | P a g e 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? 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 typically migraines improve-estrogen levels stabilize Migraine without aura after menopause usually decrease with natural menopause menstrual migraine after menopause should resolve completely When to consider preventative medication for migraines >2 times per week or severe and effecting QOL Triptans are contraindicated in what? patients with cardiovascular disease, as are NSAIDs Menstrual migraine treatment NSAID or triptan 2 days before expected to get your period, and take for 5-7 days. cdc and who guidelines for migraine treatment 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? it can take several months. what is th emost common form of arthritis? osteoarthritis what areas of th ebrain have th emost estrogen receptors? hippocampus and prefrontal cortex what is the most common thyroid disorder in women? 26 | P a g e hashimoto thyroiditis if a patient on levothyroxine is started on estrogen, when do you recheck and what can you anticipate happening? 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? when the TSH level is higher than 10. are hot or cold thyroid nodules typically most likely to be malignant? cold nodules how does HRT impact gallbladder disease? increases risk of gallstones with oral HRT, lower risk with transdermal. when did they start screening blood for hep c? 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? 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? 1945 to 1965 routine screening of all adults for hepatitis c. is it reocmmended? 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? 16 and 18 by age 50 what percentage of US women will have acquired a genital HPV infection? 80%-HPV is very common, but it is the high risk ones to worry about