NAMS CERTIFICATION LATEST 2026 EVALUATION
QUESTIONS AND ANSWERS GRADED A+
✔✔Ospemifene (Osphena) indications and MOA - ✔✔-for treatment of dyspareunia
-decreases vaginal pH
-improves vaginal dryness
-shifts vaginal maturational index to superficial cells
-estrogen agonist/antagonist
✔✔Ospemifene (Osphena) adverse effects - ✔✔-increase in uterine polyps
-proliferative endometrium
-slight increased risk of hemorrhagic stroke and VTE
-can increase VMS
✔✔treatment of urge incontinence - ✔✔-behavioral modifications
-overactivity of the detrusor muscle
-antimuscarinics: *oxybutynin*
-nerve stimulation
-botox
✔✔pelvic floor muscles - superficial - ✔✔-transverse perineal
-bulbospongiosus,
-ischiocavernosus
✔✔pelvic floor muscles - deep - ✔✔-pubococcygeus
-iliococcygeus
-obturator internus
-coccygeus
✔✔What is low-tone pelvic floor dysfunction? - ✔✔-weak, underactive and hypotonic
muscles that cannot maintain adequate contraction
✔✔What is high-tone Pelvic Floor Dysfunction? - ✔✔-weak pelvic floor muscles cannot
attain or maintain adequate relaxation
-muscles are overactive, hypertonic, spastic, shortened
✔✔What are the symptoms of low-tone PFD? - ✔✔-heaviness
-pressure
-pelvic organ prolapse
-incontinence
-altered sexual sensation
✔✔What are the symptoms of high-tone PFD? - ✔✔-urinary retention
-frequency
-urgency
, -dysuria
-fecal retention/constipation
-penetrative dyspareunia and/or vaginismus
✔✔Vaginal dilators for PFD - ✔✔-Choose size that does not cause pain
-Show how to insert with a mirror
-Apply lubricant to dilator, insert dilator as far as is comfortable, leave dilator in place
for 5-10 min 1-2 times daily
-Use each for 4 wk before progressing to a size similar to partner size
✔✔HRT and cognition - natural menopause - ✔✔In RCT, HRT has little or no overall
effect on short or long-term cognition
✔✔HRT and cognition - surgical menopause - ✔✔HRT may be beneficial in improving
verbal memory in the short term
✔✔In the SWANN survey, which groups of women were most likely to experience sleep
disturbance? - ✔✔-late perimenopause (45%)
-surgical menopause (47%)
✔✔non-menopausal causes of chronic myalgia - ✔✔-fibromyalgia
-arthritis
-statins
-biphosphonates
✔✔3 simple questions to dx arthritis - ✔✔1. Does pt have joint-based pain?
-single/multiple
-symmetrical
-episodic/progressive
-with activity
2. Is there early morning stiffness?
3. Can I see joint swelling?
-redness in joints
-tenderness in joints
-MCP joint swelling
✔✔Most common sites of osteoarthritis - ✔✔knee, hip, hand
✔✔onset of rheumatoid arthritis - ✔✔peak age of onset: women age 35-55
✔✔most common cause of hypothyroidism - ✔✔Hashimoto's thyroiditis
✔✔Gallbladder disease and HT - ✔✔-prescribe HT with caution in women with
gallstones or h/o gallbladder disease
-suggested that oral estrogen has a a greater risk of gallbladder disease vs transdermal
QUESTIONS AND ANSWERS GRADED A+
✔✔Ospemifene (Osphena) indications and MOA - ✔✔-for treatment of dyspareunia
-decreases vaginal pH
-improves vaginal dryness
-shifts vaginal maturational index to superficial cells
-estrogen agonist/antagonist
✔✔Ospemifene (Osphena) adverse effects - ✔✔-increase in uterine polyps
-proliferative endometrium
-slight increased risk of hemorrhagic stroke and VTE
-can increase VMS
✔✔treatment of urge incontinence - ✔✔-behavioral modifications
-overactivity of the detrusor muscle
-antimuscarinics: *oxybutynin*
-nerve stimulation
-botox
✔✔pelvic floor muscles - superficial - ✔✔-transverse perineal
-bulbospongiosus,
-ischiocavernosus
✔✔pelvic floor muscles - deep - ✔✔-pubococcygeus
-iliococcygeus
-obturator internus
-coccygeus
✔✔What is low-tone pelvic floor dysfunction? - ✔✔-weak, underactive and hypotonic
muscles that cannot maintain adequate contraction
✔✔What is high-tone Pelvic Floor Dysfunction? - ✔✔-weak pelvic floor muscles cannot
attain or maintain adequate relaxation
-muscles are overactive, hypertonic, spastic, shortened
✔✔What are the symptoms of low-tone PFD? - ✔✔-heaviness
-pressure
-pelvic organ prolapse
-incontinence
-altered sexual sensation
✔✔What are the symptoms of high-tone PFD? - ✔✔-urinary retention
-frequency
-urgency
, -dysuria
-fecal retention/constipation
-penetrative dyspareunia and/or vaginismus
✔✔Vaginal dilators for PFD - ✔✔-Choose size that does not cause pain
-Show how to insert with a mirror
-Apply lubricant to dilator, insert dilator as far as is comfortable, leave dilator in place
for 5-10 min 1-2 times daily
-Use each for 4 wk before progressing to a size similar to partner size
✔✔HRT and cognition - natural menopause - ✔✔In RCT, HRT has little or no overall
effect on short or long-term cognition
✔✔HRT and cognition - surgical menopause - ✔✔HRT may be beneficial in improving
verbal memory in the short term
✔✔In the SWANN survey, which groups of women were most likely to experience sleep
disturbance? - ✔✔-late perimenopause (45%)
-surgical menopause (47%)
✔✔non-menopausal causes of chronic myalgia - ✔✔-fibromyalgia
-arthritis
-statins
-biphosphonates
✔✔3 simple questions to dx arthritis - ✔✔1. Does pt have joint-based pain?
-single/multiple
-symmetrical
-episodic/progressive
-with activity
2. Is there early morning stiffness?
3. Can I see joint swelling?
-redness in joints
-tenderness in joints
-MCP joint swelling
✔✔Most common sites of osteoarthritis - ✔✔knee, hip, hand
✔✔onset of rheumatoid arthritis - ✔✔peak age of onset: women age 35-55
✔✔most common cause of hypothyroidism - ✔✔Hashimoto's thyroiditis
✔✔Gallbladder disease and HT - ✔✔-prescribe HT with caution in women with
gallstones or h/o gallbladder disease
-suggested that oral estrogen has a a greater risk of gallbladder disease vs transdermal
