NAMS MENOPAUSE FINAL PAPER EXAM 2025/2026
QUESTIONS WITH ANSWERS GRADED A+
✔✔patients with cardiovascular disease, as are NSAIDs - ✔✔Triptans are
contraindicated in what?
✔✔NSAID or triptan 2 days before expected to get your period, and take for 5-7 days. -
✔✔Menstrual migraine treatment
✔✔migraine with aura-advise to not use combined hormone contraception
caution in women with migraine without aura - ✔✔cdc and who guidelines for migraine
treatment
✔✔it can take several months. - ✔✔How long can it take for arthralgia from vitamin d
deficiency or hypothyroidism to fully resolve?
✔✔osteoarthritis - ✔✔what is th emost common form of arthritis?
✔✔hippocampus and prefrontal cortex - ✔✔what areas of th ebrain have th emost
estrogen receptors?
✔✔hashimoto thyroiditis - ✔✔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. - ✔✔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. - ✔✔when is treatment of subclinical
hypothyroidism recommended?
✔✔cold nodules - ✔✔are hot or cold thyroid nodules typically most likely to be
malignant?
✔✔increases risk of gallstones with oral HRT, lower risk with transdermal. - ✔✔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 - ✔✔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 - ✔✔why do we screen for hep C?
✔✔1945 to 1965 - ✔✔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. - ✔✔routine screening of all
adults for hepatitis c. is it reocmmended?
✔✔16 and 18 - ✔✔what hpv is high risk?
✔✔80%-HPV is very common, but it is the high risk ones to worry about - ✔✔by age 50
what percentage of US women will have acquired a genital HPV infection?
✔✔HPV - ✔✔what is the most commonly sexually transmitted infection in the US?
✔✔10-12% on average, about 1 t score - ✔✔What percentage of bone loss do women
have from the menopause transition?
✔✔-1.5 to -2.5 - ✔✔What t score defines osteopenia
✔✔less than -2.5 - ✔✔what t score defines osteoporosis
✔✔z score less than 2.0 and a history of a fragility fracture - ✔✔what z score defines
osteoporosis before menopause?
✔✔white and hispanic populations - ✔✔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 - ✔✔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 - ✔✔Asians have ____BMD than white people?
✔✔higher - ✔✔Black women have ____BMD than white people?
✔✔38% for osteoporotic fracture and 68% for hip fracture - ✔✔Over 3 servings of
alcohol daily and risk for fracture?
, ✔✔white, asiain, black, hispanic - ✔✔What 4 ethnic specific versions of FRAX are
there?
✔✔dairy free diet-300mg calcium daily.
Needs 800-1200mg - ✔✔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 - ✔✔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. - ✔✔Why was estrogen not approved for
osteoporosis?
✔✔osteosarcoma - ✔✔Black box warning for PTH receptor agonists?
✔✔hypercalcemia - ✔✔caution using PTH receptor agonists in what condition?
✔✔someone incredibly high risk for vertebral fracture - ✔✔when would you use PTH
receptor agonists?
✔✔vertebral fractures - ✔✔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 - ✔✔raloxifene risk factors
✔✔1 in 1000 after 2-3 years. - ✔✔atypical femur risk in women on bisphosphonate?
✔✔small increase in spine BMD. daily SQ injections or nasal. - ✔✔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 - ✔✔Implications of estrogen drop on skin during menopause
QUESTIONS WITH ANSWERS GRADED A+
✔✔patients with cardiovascular disease, as are NSAIDs - ✔✔Triptans are
contraindicated in what?
✔✔NSAID or triptan 2 days before expected to get your period, and take for 5-7 days. -
✔✔Menstrual migraine treatment
✔✔migraine with aura-advise to not use combined hormone contraception
caution in women with migraine without aura - ✔✔cdc and who guidelines for migraine
treatment
✔✔it can take several months. - ✔✔How long can it take for arthralgia from vitamin d
deficiency or hypothyroidism to fully resolve?
✔✔osteoarthritis - ✔✔what is th emost common form of arthritis?
✔✔hippocampus and prefrontal cortex - ✔✔what areas of th ebrain have th emost
estrogen receptors?
✔✔hashimoto thyroiditis - ✔✔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. - ✔✔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. - ✔✔when is treatment of subclinical
hypothyroidism recommended?
✔✔cold nodules - ✔✔are hot or cold thyroid nodules typically most likely to be
malignant?
✔✔increases risk of gallstones with oral HRT, lower risk with transdermal. - ✔✔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 - ✔✔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 - ✔✔why do we screen for hep C?
✔✔1945 to 1965 - ✔✔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. - ✔✔routine screening of all
adults for hepatitis c. is it reocmmended?
✔✔16 and 18 - ✔✔what hpv is high risk?
✔✔80%-HPV is very common, but it is the high risk ones to worry about - ✔✔by age 50
what percentage of US women will have acquired a genital HPV infection?
✔✔HPV - ✔✔what is the most commonly sexually transmitted infection in the US?
✔✔10-12% on average, about 1 t score - ✔✔What percentage of bone loss do women
have from the menopause transition?
✔✔-1.5 to -2.5 - ✔✔What t score defines osteopenia
✔✔less than -2.5 - ✔✔what t score defines osteoporosis
✔✔z score less than 2.0 and a history of a fragility fracture - ✔✔what z score defines
osteoporosis before menopause?
✔✔white and hispanic populations - ✔✔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 - ✔✔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 - ✔✔Asians have ____BMD than white people?
✔✔higher - ✔✔Black women have ____BMD than white people?
✔✔38% for osteoporotic fracture and 68% for hip fracture - ✔✔Over 3 servings of
alcohol daily and risk for fracture?
, ✔✔white, asiain, black, hispanic - ✔✔What 4 ethnic specific versions of FRAX are
there?
✔✔dairy free diet-300mg calcium daily.
Needs 800-1200mg - ✔✔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 - ✔✔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. - ✔✔Why was estrogen not approved for
osteoporosis?
✔✔osteosarcoma - ✔✔Black box warning for PTH receptor agonists?
✔✔hypercalcemia - ✔✔caution using PTH receptor agonists in what condition?
✔✔someone incredibly high risk for vertebral fracture - ✔✔when would you use PTH
receptor agonists?
✔✔vertebral fractures - ✔✔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 - ✔✔raloxifene risk factors
✔✔1 in 1000 after 2-3 years. - ✔✔atypical femur risk in women on bisphosphonate?
✔✔small increase in spine BMD. daily SQ injections or nasal. - ✔✔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 - ✔✔Implications of estrogen drop on skin during menopause
