APEA EXAM 220+ QUESTIONS WITH DETAILED ANSWERS BY EXPERT

APEA EXAM 220+ QUESTIONS WITH DETAILED ANSWERS BY EXPERT What medications are used in PCOS? - ANSWER o Treatment: o Low dose birth control pills will suppress ovaries o Spironolactone will decrease & control hirsutism o If pt denies birth control pills can use medroxyprogesterone (Provera) 5-10 mg for 10-14 days repeat q 1-2 months to induce menses What are PCOS patients at increased risk for? - ANSWER CHD, type 2 diabetes, metabolic syndrome, cancer of breast and endometrium, central obesity and infertility What is osteoporosis? What are the treatment options? - ANSWER loss of bone density due to estrogen deficiency and other metabolic disorders Most common in older, white or Asian petite women with positive family hx Treat postmenopausal women or men 50 years old who have a T-score of -2.5 or less or has a history of hip/vertebral fracture Treatment: weight-bearing exercises most days of the week -swimming and biking are not considered weight-bearing but are good for severe arthritis - no isometric exercises Calcium w/ vitamin D, Vitamin D2 once a week, & vit D3 What are the risk factors for osteoporosis? - ANSWER Most common in older, white or Asian petite women with positive family hx Treat postmenopausal women or men 50 years old who have a T-score of -2.5 or less or has a history of hip/vertebral fracture Other risk groups: Pts on chronic steroids (asthma, autoimmune) are at high risk rule it out in men or women on chronic steroids especially if they have risk factors Pts with anorexia nervosa and bulimia Long term use of PPIs like omeprazole Gastric bypass, celiac disease, hyperthyroidism, RA Lifestyle risk factors: Low calcium intake, vitamin D deficiency, inadequate exercise alcohol consumption, high caffeine intake, smoking Explain bone density test scores in relation to osteoporosis/osteopenia - ANSWER Use DXA to measure the bone mineral density of the hip and spine - start with a baseline if on treatment, retest every 1-2 years If no treatment, retest every 2-5 years Osteoporosis: T score of -2.5 or lower Osteopenia: T score of -1.5 to -2.4 Explain fibrocystic breasts and the treatment plan, when is a referral indicated? - ANSWER o Common to begin in women aged 30 o Breast tissue becomes engorged and painful up to 2 weeks before their menses (luteal phase) and are at their worst right before menses o Tenderness & lumps disappear after menstruation begins o Lumps should still be mobile and rubbery to touch o Treatment: stop caffeine intake, take Vitamin E & evening primrose daily o Wear bras with good support, referral indicated if the mass is dominant, skin changes or fixed massq Explain PCOS - what does it stand for? What are s/s? treatment plan? - ANSWER Polycystic Ovary Syndrome (PCOS) o Hormonal abnormality characterized by anovulation, infertility, excessive androgen production and insulin resistance o Higher risk for diabetes type 2, dyslipidemia, metabolic syndrome, endometrial hyperplasia, obesity, and OSA o Hirsutism 70% in cases, bad acne, amenorrhea, and infrequent periods o Diagnostic testing: o Transvaginal US: enlarged ovaries w/ multiple follicles o Testosterone, DHEA, and androstenedione are high o FSH is normal or low o Treatment: o Low dose birth control pills will suppress ovaries o Spironolactone will decrease & control hirsutism o If pt denies birth control pills can use medroxyprogesterone (Provera) 5-10 mg for 10-14 days repeat q 1-2 months to induce menses o Metformin will induce ovulation (if pregnancy is desired) § Warn reproductive diabetic patients to use birth control o Weight loss reduces androgen & insulin levels What is anovulation? - ANSWER when an egg does not release from your ovary during the menstrual cycle What does metformin do to the female reproductive system? - ANSWER Induces ovulation - warn diabetic patients to use birth control This is measured at the lumbar spine, femoral neck or total hip What does DXA stand for? - ANSWER dual-energy x-ray absorptiometry What are examples of isometric exercises? - ANSWER planking, wall sits, calf raises What meds are used to treat osteoporosis? What side effects should be warned about? - ANSWER 1st line: Bisphosphonates = Fosamax (alendronate) or Actonel (risedronate) ends in dronate Severe esophagus irritant can cause esophagitis, ulcers, and bleeding peptic ulcer disease Take med sitting or standing and wait 30 minutes before laying back down, don't take with coffee, juice, vitamins or other meds take with a full glass of water immediately upon waking Can take med daily or weekly Osteonecrosis of the jaw can happen with IV or IM bisphosphonates - signs are complaints of jaw heaviness, pain, swelling, and loose teeth SERM class: Evista (raloxifene) blocks estrogen receptors approved for use after menopause and helps with breast cancer prophylaxis -do not use to tx menopause symptoms -BBW: DVT or PE, stroke Tamoxifen (Noluadex) - what is it used for? risks? side effects? - ANSWER used for breast cancer that is hormone-receptor positive increase risk of DVT, endometrial cancer, stroke, PE side effects: causes hot flashes, white/brown vaginal discharge, weight gain or loss Teriparatide (forteo)- what is it used for? risks? side effects? - ANSWER an injection used to recombinant human parathyroid hormone for the treatment of osteoporosis