B8.064 Transgender Case Formative Question Stuff

Question 1

best way to prep transgender women for surgery

Answer 1

stop estrogen therapy
>estradiol can cause a hypercoagulable state
>spironolactone does NOT increase risk of VTE

Question 2

what % of transgender people experience homelessness?

Answer 2

1/5
frequently due to:
-fleeing intolerant family
-being forced out by a family
-losing a job due to discrimination
-not being able to be employed due to discrimination and disability

Question 3

which form of estrogen has the lowest risk of VTE

Answer 3

transdermal 17-beta estradiol
-bypassing hepatic metabolism results in more stable levels without high concentrations in the liver
-less pronounced effects on hepatic protein synthesis (CRP, markers of coagulation and fibrinolysis, steroid binding protein)
some studies show no increased risk with transdermal estrogen

Question 4

finasteride

Answer 4

5a-reductase inhibitor

inhibits conversion of T to the more potent DHT

Question 5

spironolactone

Answer 5

androgen blocker due to direct anti-androgen receptor activity
also a K+ sparing diuretic

Question 6

most serious side effect of spironolactone

Answer 6

hyperkalemia

Question 7

estrogen impact on lipid profile

Answer 7

LDL decreases
HDL increases
triglycerides increase

Question 8

effect of estrogen therapy on bone

Answer 8

induces apoptosis in osteoclasts
inhibits apoptosis in osteoblasts
needed for proper closure epiphyseal growth plates in females and males

Question 9

effects of estrogen deficiency on bone

Answer 9

increased cycles of remodeling and bone resorption leads to increased risk of osteoporosis

Question 10

what to do if a transgender woman presents to the ER < 72 hr after sexual assault

Answer 10

empirically treat for chlamydia, gonorrhea, and trichomonas

Question 11

why do transgender women have higher cardiovascular risk?

Answer 11

higher rates of tobaccos use, obesity, diabetes, and lipid disorders
reduced physical activity

Question 12

what are transgender men more likely to experience than cisgender peers

Answer 12

suicide

41% of trans people attempt suicide at least once (5% of general pop)

Question 13

aromatase

Answer 13

converts T to E

Question 14

what should you do if a patient is a victim of IPV?

Answer 14

make sure the patient has an emergency plan

Question 15

impact of ACA on transgender health care

Answer 15

prohibits most health insurers from discriminating based on transgender status

Question 16

selection bias

Answer 16

nonrandom sampling or treatment allocation of subjects so that the study population is not representative of the target population
most commonly a sampling bias

Question 17

function of PrEP with tenofovir disoproxil fumarate-emtricitabine (TDF-FTC)

Answer 17

acute HIV

risk of renal insufficiency

Question 18

danazol

Answer 18

synthetic androgen that acts as a partial agonist at androgen receptors

Question 19

letrazole

Answer 19

aromatase inhibitor, inhibits peripheral conversion of androgens to estrogen

Question 20

most common side effect of masculinizing hormone therapy

Answer 20

polycythemia

monitor Hct and keep below 50%

Question 21

greatest risks of feminizing therapy

Answer 21

VTE events (like stroke)

Question 22

best options for pregnancy prevention in transgender men

Answer 22

long acting reversible contraception
T use not reliable to prevent ovulation
OCPs not good bc they contain estrogen

Question 23

options other than spironolactone for androgen blockade

Answer 23

GnRH analog > downregulates GnRH receptor in pituitary causing a decrease in FSH/LH

Question 24

mesonephric duct

Answer 24

forms male genital structures

Question 25

paramesonephric duct

Answer 25

forms female genital structures