NAMS MENOPAUSE CORRECT EXAMS SCRIPT
ANSWERS AND QUESTIONS SET A+
✔✔Black box warning for PTH receptor agonists - ✔✔Osteosarcoma.
✔✔Caution using PTH receptor agonists - ✔✔Hypercalcemia.
✔✔Use of PTH receptor agonists - ✔✔For someone incredibly high risk for vertebral
fracture.
✔✔Raloxifene and fractures - ✔✔Helps with vertebral fractures.
✔✔Raloxifene risk factors - ✔✔Increased risk of death from stroke in high risk patients,
estrogen-like risk of VTE, worsens hot flashes.
✔✔Atypical femur risk in women on bisphosphonate - ✔✔1 in 1000 after 2-3 years.
✔✔Salmon calcitonin and osteoporosis - ✔✔Small increase in spine BMD; administered
via daily SQ injections or nasal.
✔✔Implications of estrogen drop on skin during menopause - ✔✔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 resorption.
✔✔Definition of stress incontinence - ✔✔Involuntary loss of urine that occurs with an
activity such as coughing or sneezing that increases intraabdominal pressure.
✔✔Definition of urgency incontinence - ✔✔Involuntary loss of urine preceded by
sensation of urgency to urinate.
✔✔Definition of mixed incontinence - ✔✔Includes stress and urgency.
,✔✔Normal postvoid residual volume - ✔✔100 or less; >200 is abnormal, between 100-
200 advised to repeat on different day.
✔✔How to test for incontinence - ✔✔Pyridium challenge.
✔✔OAB - ✔✔Term used to describe idiopathic urinary urgency with urinary frequency
(>8 voids within 24h) and sometimes nocturia.
✔✔ISSWSH Sexual Disorders in Menopause - ✔✔Includes hypoactive sexual desire
disorder, female genital arousal disorder, persistent genital arousal disorder, female
orgasm disorder, female orgasmic illness syndrome.
✔✔Pelvic floor muscles - ✔✔Levator ani, superficial (transverse perineal,
bulbospongiosus, ischiocavernosus), deep (pubococcygeus, iliococcygeus, obturator
internus, coccygeus) muscles.
✔✔PALM COEIN causes of AUB - ✔✔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? - ✔✔When <4mm.
✔✔Management of AUB - ✔✔COCs decrease 7 to 4 days; IUD, NSAID reduce
prostaglandin synthesis.
✔✔Dosing of NSAIDs for AUB - ✔✔Mefenamic acid 500 mg TID for 5 days or Ibuprofen
600 mg Q6h or 800mg Q8h for first 3 days.
✔✔Dosing of tranexamic acid for AUB - ✔✔1300 mg TID for 5 days of menstrual cycle;
causes GI upset.
✔✔GnRH therapy for fibroids - ✔✔Addback therapy can be used to protect against
VMS and bone mineral density loss.
✔✔Nonsurgical treatment of fibroids - ✔✔Tranexamic acid, mefenamic acid, Mirena,
GnRH, selective progesterone receptor modulators, uterine artery embolization.
✔✔Hysteroscopic myomectomy suitability - ✔✔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; responds to topical
corticosteroids.
✔✔Antifungal - ✔✔When it has a burning sensation, patients should be prescribed an
antifungal.
✔✔Lichen Sclerosis Treatment - ✔✔Topical steroid (clobetasol).
✔✔Lichen Simplex Chronicus Treatment - ✔✔Corticosteroid: Triamcinolone 0.1%
(Always start off with low potency then move if it gets worse).
✔✔Non-pharmacological Treatment for Restless Legs - ✔✔Remove potential
aggravators such as sleep deprivation, alcohol, exercise, caffeine, smoking. Sleep
hygiene, exercise, warm baths, leg vibration, massage, acupuncture, passive stretching.
✔✔Pharmacological Treatment for Restless Legs - ✔✔Parmipexole and ropinirole.
✔✔Red Flags for Headache - ✔✔Systemic symptoms (fever, weight loss, rash),
systemic illness malignancy, immunosuppression, neurologic symptoms and/or signs in
consciousness, sudden/abrupt onset new onset or progressive, new/different from
previous headache history.
✔✔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 low-dose estrogen supplement during
withdrawal phase of oral contraceptive pill, use continuous hormone therapy; if
progestogen causes, switch to micronized.
✔✔Evaluation Considerations for Women with Arthralgia - ✔✔2/2 to menopause, 2/2 to
arthritis, 2/2 to other rheumatologic conditions.
ANSWERS AND QUESTIONS SET A+
✔✔Black box warning for PTH receptor agonists - ✔✔Osteosarcoma.
✔✔Caution using PTH receptor agonists - ✔✔Hypercalcemia.
✔✔Use of PTH receptor agonists - ✔✔For someone incredibly high risk for vertebral
fracture.
✔✔Raloxifene and fractures - ✔✔Helps with vertebral fractures.
✔✔Raloxifene risk factors - ✔✔Increased risk of death from stroke in high risk patients,
estrogen-like risk of VTE, worsens hot flashes.
✔✔Atypical femur risk in women on bisphosphonate - ✔✔1 in 1000 after 2-3 years.
✔✔Salmon calcitonin and osteoporosis - ✔✔Small increase in spine BMD; administered
via daily SQ injections or nasal.
✔✔Implications of estrogen drop on skin during menopause - ✔✔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 resorption.
✔✔Definition of stress incontinence - ✔✔Involuntary loss of urine that occurs with an
activity such as coughing or sneezing that increases intraabdominal pressure.
✔✔Definition of urgency incontinence - ✔✔Involuntary loss of urine preceded by
sensation of urgency to urinate.
✔✔Definition of mixed incontinence - ✔✔Includes stress and urgency.
,✔✔Normal postvoid residual volume - ✔✔100 or less; >200 is abnormal, between 100-
200 advised to repeat on different day.
✔✔How to test for incontinence - ✔✔Pyridium challenge.
✔✔OAB - ✔✔Term used to describe idiopathic urinary urgency with urinary frequency
(>8 voids within 24h) and sometimes nocturia.
✔✔ISSWSH Sexual Disorders in Menopause - ✔✔Includes hypoactive sexual desire
disorder, female genital arousal disorder, persistent genital arousal disorder, female
orgasm disorder, female orgasmic illness syndrome.
✔✔Pelvic floor muscles - ✔✔Levator ani, superficial (transverse perineal,
bulbospongiosus, ischiocavernosus), deep (pubococcygeus, iliococcygeus, obturator
internus, coccygeus) muscles.
✔✔PALM COEIN causes of AUB - ✔✔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? - ✔✔When <4mm.
✔✔Management of AUB - ✔✔COCs decrease 7 to 4 days; IUD, NSAID reduce
prostaglandin synthesis.
✔✔Dosing of NSAIDs for AUB - ✔✔Mefenamic acid 500 mg TID for 5 days or Ibuprofen
600 mg Q6h or 800mg Q8h for first 3 days.
✔✔Dosing of tranexamic acid for AUB - ✔✔1300 mg TID for 5 days of menstrual cycle;
causes GI upset.
✔✔GnRH therapy for fibroids - ✔✔Addback therapy can be used to protect against
VMS and bone mineral density loss.
✔✔Nonsurgical treatment of fibroids - ✔✔Tranexamic acid, mefenamic acid, Mirena,
GnRH, selective progesterone receptor modulators, uterine artery embolization.
✔✔Hysteroscopic myomectomy suitability - ✔✔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; responds to topical
corticosteroids.
✔✔Antifungal - ✔✔When it has a burning sensation, patients should be prescribed an
antifungal.
✔✔Lichen Sclerosis Treatment - ✔✔Topical steroid (clobetasol).
✔✔Lichen Simplex Chronicus Treatment - ✔✔Corticosteroid: Triamcinolone 0.1%
(Always start off with low potency then move if it gets worse).
✔✔Non-pharmacological Treatment for Restless Legs - ✔✔Remove potential
aggravators such as sleep deprivation, alcohol, exercise, caffeine, smoking. Sleep
hygiene, exercise, warm baths, leg vibration, massage, acupuncture, passive stretching.
✔✔Pharmacological Treatment for Restless Legs - ✔✔Parmipexole and ropinirole.
✔✔Red Flags for Headache - ✔✔Systemic symptoms (fever, weight loss, rash),
systemic illness malignancy, immunosuppression, neurologic symptoms and/or signs in
consciousness, sudden/abrupt onset new onset or progressive, new/different from
previous headache history.
✔✔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 low-dose estrogen supplement during
withdrawal phase of oral contraceptive pill, use continuous hormone therapy; if
progestogen causes, switch to micronized.
✔✔Evaluation Considerations for Women with Arthralgia - ✔✔2/2 to menopause, 2/2 to
arthritis, 2/2 to other rheumatologic conditions.
