NAMS MENOPAUSE CERTIFICATION
UPDATED ACTUAL EXAM QUESTIONS AND
CORRECT ANSWERS
●● Off label rx for VMS
Answer: SSRIs, SNRIs, Gabapentinoids, Clonidine, Oxybutynin.
●● Studies on Fractional Co2 Laser for GSM
Answer: not FDA approved; vaginal symptoms and sexual function
scores increased significantly at 3 months; noted continued improvement
at 1 year.
●● Ospemifene (Osphena) indications and MOA
Answer: for treatment of dyspareunia; decreases vaginal pH; improves
vaginal dryness; shifts vaginal maturational index to superficial cells;
estrogen agonist/antagonist.
●● Ospemifene (Osphena) adverse effects
Answer: increase in uterine polyps; proliferative endometrium; slight
increased risk of hemorrhagic stroke and VTE; can increase VMS.
●● treatment of urge incontinence
,Answer: behavioral modifications; overactivity of the detrusor muscle;
antimuscarinics: oxybutynin; nerve stimulation; botox.
●● pelvic floor muscles - superficial
Answer: transverse perineal, bulbospongiosus, ischiocavernosus.
●● pelvic floor muscles - deep
Answer: pubococcygeus, iliococcygeus, obturator internus, coccygeus.
●● What is low-tone pelvic floor dysfunction?
Answer: weak, underactive and hypotonic muscles that cannot maintain
adequate contraction.
●● What is high-tone Pelvic Floor Dysfunction?
Answer: weak pelvic floor muscles cannot attain or maintain adequate
relaxation; muscles are overactive, hypertonic, spastic, shortened.
●● What are the symptoms of low-tone PFD?
Answer: heaviness, pressure, pelvic organ prolapse, incontinence,
altered sexual sensation.
●● What are the symptoms of high-tone PFD?
,Answer: urinary retention, frequency, urgency, dysuria, fecal
retention/constipation, penetrative dyspareunia and/or vaginismus.
●● Vaginal dilators for PFD
Answer: 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 weeks
before progressing to a size similar to partner size.
●● HRT and cognition - natural menopause
Answer: In RCT, HRT has little or no overall effect on short or long-
term cognition.
●● HRT and cognition - surgical menopause
Answer: 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?
Answer: late perimenopause (45%), surgical menopause (47%).
●● non-menopausal causes of chronic myalgia
Answer: fibromyalgia, arthritis, statins, biphosphonates.
, ●● 3 simple questions to dx arthritis
Answer: 1
●● SWANN survey sleep disturbance
Answer: Late perimenopause (45%); surgical menopause (47%).
●● Most common sites of osteoarthritis
Answer: Knee, hip, hand.
●● Onset of rheumatoid arthritis
Answer: Peak age of onset: women age 35-55.
●● Most common cause of hypothyroidism
Answer: Hashimoto's thyroiditis.
●● Gallbladder disease and HT
Answer: Prescribe HT with caution in women with gallstones or h/o
gallbladder disease; suggested that oral estrogen has a greater risk of
gallbladder disease vs transdermal; CHCs and HT increase risk of
cholelithiasis, cholecystitis, and cholecystectomy.
●● Who to screen for hepatitis C
Answer: All patients born between 1945 and 1965.
UPDATED ACTUAL EXAM QUESTIONS AND
CORRECT ANSWERS
●● Off label rx for VMS
Answer: SSRIs, SNRIs, Gabapentinoids, Clonidine, Oxybutynin.
●● Studies on Fractional Co2 Laser for GSM
Answer: not FDA approved; vaginal symptoms and sexual function
scores increased significantly at 3 months; noted continued improvement
at 1 year.
●● Ospemifene (Osphena) indications and MOA
Answer: for treatment of dyspareunia; decreases vaginal pH; improves
vaginal dryness; shifts vaginal maturational index to superficial cells;
estrogen agonist/antagonist.
●● Ospemifene (Osphena) adverse effects
Answer: increase in uterine polyps; proliferative endometrium; slight
increased risk of hemorrhagic stroke and VTE; can increase VMS.
●● treatment of urge incontinence
,Answer: behavioral modifications; overactivity of the detrusor muscle;
antimuscarinics: oxybutynin; nerve stimulation; botox.
●● pelvic floor muscles - superficial
Answer: transverse perineal, bulbospongiosus, ischiocavernosus.
●● pelvic floor muscles - deep
Answer: pubococcygeus, iliococcygeus, obturator internus, coccygeus.
●● What is low-tone pelvic floor dysfunction?
Answer: weak, underactive and hypotonic muscles that cannot maintain
adequate contraction.
●● What is high-tone Pelvic Floor Dysfunction?
Answer: weak pelvic floor muscles cannot attain or maintain adequate
relaxation; muscles are overactive, hypertonic, spastic, shortened.
●● What are the symptoms of low-tone PFD?
Answer: heaviness, pressure, pelvic organ prolapse, incontinence,
altered sexual sensation.
●● What are the symptoms of high-tone PFD?
,Answer: urinary retention, frequency, urgency, dysuria, fecal
retention/constipation, penetrative dyspareunia and/or vaginismus.
●● Vaginal dilators for PFD
Answer: 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 weeks
before progressing to a size similar to partner size.
●● HRT and cognition - natural menopause
Answer: In RCT, HRT has little or no overall effect on short or long-
term cognition.
●● HRT and cognition - surgical menopause
Answer: 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?
Answer: late perimenopause (45%), surgical menopause (47%).
●● non-menopausal causes of chronic myalgia
Answer: fibromyalgia, arthritis, statins, biphosphonates.
, ●● 3 simple questions to dx arthritis
Answer: 1
●● SWANN survey sleep disturbance
Answer: Late perimenopause (45%); surgical menopause (47%).
●● Most common sites of osteoarthritis
Answer: Knee, hip, hand.
●● Onset of rheumatoid arthritis
Answer: Peak age of onset: women age 35-55.
●● Most common cause of hypothyroidism
Answer: Hashimoto's thyroiditis.
●● Gallbladder disease and HT
Answer: Prescribe HT with caution in women with gallstones or h/o
gallbladder disease; suggested that oral estrogen has a greater risk of
gallbladder disease vs transdermal; CHCs and HT increase risk of
cholelithiasis, cholecystitis, and cholecystectomy.
●● Who to screen for hepatitis C
Answer: All patients born between 1945 and 1965.
