NAMS CERTIFICATION LATEST 2026 MAIN FINAL EXAM
QUESTIONS AND ANSWERS GRADED A+
✔✔adenocarcinoma of vulva with itchy well demarcated erythematous lesion on labia
major not improving with corticosteroids - ✔✔extramammary paget = intraepithelial
adenocarcinoma
coexisting adenocarcinoma of breast, GItract, or GU tract 20-30% of time
✔✔do you need to treat epidermal inclusion cysts? - ✔✔no
✔✔when do you biopsy bartholin? - ✔✔menopause
✔✔RF for postmenopausal UTIs - ✔✔increased vaginal pH
use ET to restore microbiome
✔✔abnormal PVR - ✔✔200mL or more
✔✔any FDA approved meds for SUI? - ✔✔no
✔✔Does systemic HT or local ET help SUI? - ✔✔no
✔✔treatment of SUI - ✔✔midurethral sling
✔✔tx of urge incontinence - ✔✔antimuscarinic agents
MOA stop detrusor contractions
AE: dry mouth constipation
✔✔if urge incontinence does not respond to basic treatments what can you use? -
✔✔botulinum A injections via cystoscopic injections
✔✔OAB managmeent - ✔✔anticholinergic agents
vaginal ET
acupuncture
sacral neuromodulation
✔✔RF POP - ✔✔age
parity
obesity
hysterectomy
✔✔asymptomatic POP - ✔✔no treatment
✔✔mild prlapse - ✔✔pelvic floor PT
, ✔✔bothersome POP sxs - ✔✔pessary
surgery
✔✔what % women have fecal incontinence - ✔✔9%
✔✔structural causes of fecal incontinence - ✔✔incompletely healed anal sphincter tears
denervation of sphincter
✔✔treatment of anal incontinence - ✔✔dietary changes - stool bulking agents, fiber
meds: antidiarrheal
Pelvic floor PT
✔✔primary treatment for anal fissure - ✔✔manage constipation
topical analgesics
topical vasodilators
ointment
✔✔internal hemorrhoid - ✔✔proximal to dentate line
✔✔external hemorrhoid - ✔✔distal to dentate line
✔✔decline in fertility accelerates after what age? - ✔✔35
✔✔if women in their 40s still menstruate why don't they get pregnant? - ✔✔aging
oocyte
✔✔what is the production theory? - ✔✔oocytes that entered meiosis I first in
development are the ones that activate first in life
the later and poorer quality oocytes progressively move through the line of production
with aging
✔✔What is the compromised microcirculation hypothesis? - ✔✔abnormal oocytes arise
from poor development of the microvasculature that may be because of a number of
factors like oxidative stress
✔✔what is a strong predictor of fertility? - ✔✔age
✔✔day 3 labs are predictive of? - ✔✔response to ovarian stim, not a measure of fertility
✔✔Name 3 inhibitory hormones for sex function - ✔✔Signal satiety - 5
hydroxytryptamine and serotonin
Sex reward - opioid
Sedation - endocannabinoid
QUESTIONS AND ANSWERS GRADED A+
✔✔adenocarcinoma of vulva with itchy well demarcated erythematous lesion on labia
major not improving with corticosteroids - ✔✔extramammary paget = intraepithelial
adenocarcinoma
coexisting adenocarcinoma of breast, GItract, or GU tract 20-30% of time
✔✔do you need to treat epidermal inclusion cysts? - ✔✔no
✔✔when do you biopsy bartholin? - ✔✔menopause
✔✔RF for postmenopausal UTIs - ✔✔increased vaginal pH
use ET to restore microbiome
✔✔abnormal PVR - ✔✔200mL or more
✔✔any FDA approved meds for SUI? - ✔✔no
✔✔Does systemic HT or local ET help SUI? - ✔✔no
✔✔treatment of SUI - ✔✔midurethral sling
✔✔tx of urge incontinence - ✔✔antimuscarinic agents
MOA stop detrusor contractions
AE: dry mouth constipation
✔✔if urge incontinence does not respond to basic treatments what can you use? -
✔✔botulinum A injections via cystoscopic injections
✔✔OAB managmeent - ✔✔anticholinergic agents
vaginal ET
acupuncture
sacral neuromodulation
✔✔RF POP - ✔✔age
parity
obesity
hysterectomy
✔✔asymptomatic POP - ✔✔no treatment
✔✔mild prlapse - ✔✔pelvic floor PT
, ✔✔bothersome POP sxs - ✔✔pessary
surgery
✔✔what % women have fecal incontinence - ✔✔9%
✔✔structural causes of fecal incontinence - ✔✔incompletely healed anal sphincter tears
denervation of sphincter
✔✔treatment of anal incontinence - ✔✔dietary changes - stool bulking agents, fiber
meds: antidiarrheal
Pelvic floor PT
✔✔primary treatment for anal fissure - ✔✔manage constipation
topical analgesics
topical vasodilators
ointment
✔✔internal hemorrhoid - ✔✔proximal to dentate line
✔✔external hemorrhoid - ✔✔distal to dentate line
✔✔decline in fertility accelerates after what age? - ✔✔35
✔✔if women in their 40s still menstruate why don't they get pregnant? - ✔✔aging
oocyte
✔✔what is the production theory? - ✔✔oocytes that entered meiosis I first in
development are the ones that activate first in life
the later and poorer quality oocytes progressively move through the line of production
with aging
✔✔What is the compromised microcirculation hypothesis? - ✔✔abnormal oocytes arise
from poor development of the microvasculature that may be because of a number of
factors like oxidative stress
✔✔what is a strong predictor of fertility? - ✔✔age
✔✔day 3 labs are predictive of? - ✔✔response to ovarian stim, not a measure of fertility
✔✔Name 3 inhibitory hormones for sex function - ✔✔Signal satiety - 5
hydroxytryptamine and serotonin
Sex reward - opioid
Sedation - endocannabinoid
