Exam 4 Random Info

Question 1

On the physiologic level, menopause is caused by a drop in (blank) which results in an increase in (blank)

a. FSH and progesterone; LH and estrogen
b. FSH and LH; estrogen and progesterone
c. Estrogen and FSH; progesterone and LH
d. Estrogen and progesterone; FSH and LH

Answer 1

d. Estrogen and progesterone; FSH and LH

Question 2

Which of the following is an absolute contraindication to menopausal hormone therapy?

a. Stroke
b. Diabetes
c. Active seizure disorder
d. Hypertriglyceridemia
e. Family history of breast cancer

Answer 2

a. Stroke

Question 3

why is estrogen monotherapy only reserved for women without a uterus?

Answer 3

estrogen alone increases the risk of endometriosis, endometrial hyperplasia, and endometrial cancer

Question 4

Which of the following statements is false?

a. Oral estrogens have higher side effects compared to topical products
b. Topical vaginal products should be reserved for women experiencing vulvovaginal atrophy
c. Women with an intact uterus should be prescribed a progestin in addition to estrogen
d. Between the vaginal rings, only Estring can treat vasomotor symptoms

Answer 4

d. Between the vaginal rings, only Estring can treat vasomotor symptoms

(Estring is a low dose and only has a local effect, Femring can have high enough concentration systemically to treat vasomotor symptoms)

Question 5

Based on the findings of the women’s health initiative study menopausal hormone therapy should be reserved to women who are…

a. Age < 60 or within 10 years of last period
b. Age < 60 or within 5 years of last period
c. Age < 55 or within 10 years of last period
d. Age < 55 or within 5 years of last period

Answer 5

a. Age < 60 or within 10 years of last period

Question 6

Which method of combined estrogen and progestin offers the best long-term endometrial protection?

a. Continuous combined
b. Continuous long cycle
c. Continuous cyclic therapy
d. Intermittent combined

Answer 6

a. Continuous combined

Question 7

Which of the following would be the best choice to treat hot flashes in a patient who can not tolerate hormonal therapy?

a. Black cohosh
b. Clonidine
c. Pregabalin
d. Escitalopram
e. Dong Quai

Answer 7

d. Escitalopram

(SSRIs/SNRIs are drugs of choice for hot flashes if there is no estrogen treatment, all the other options are for vasomotor symptoms )

Question 8

Which of the following patients would be the WORST candidate to receive systemic menopausal hormonal therapy?

a. Patient with a 10-year CVD risk of 12% who has a moderate risk of developing breast cancer
b. Patient with a 10-year CVD risk of 8% whose last period was 6 years ago
c. Patient with a 10-year CVD risk of 4% whose last period was 4 years ago
d. Patient with a 10-year CVD risk of 10% who has a low risk of developing breast cancer

Answer 8

a. Patient with a 10-year CVD risk of 12% who has a moderate risk of developing breast cancer

(Avoid systemic MHT if patient’s 10 year CVD risk is >10% or if they have a moderate to high risk of developing breast cancer)

Question 9

Prasterone (Intrarosa) is contraindicated in patients who have…

a. History of venous thromboembolism (VTE)
b. Undiagnosed vaginal bleeding
c. Endometrial hyperplasia
d. History of stroke

Answer 9

b. Undiagnosed vaginal bleeding

Question 10

list contraindications to bisphosphonates

Answer 10

Hypocalcemia, renal insufficiency (CrCl < 30-35 mL/min), esophageal abnormalities unless IV, inability to sit or stand for at least 30 minutes, pregnancy or breast-feeding

Question 11

Which bisphosphonate has the worst prevention efficacy?

a. Risedronate
b. Zoledronic acid
c. Ibandronate
d. Alendronate

Answer 11

c. Ibandronate

Question 12

Which of the following is indicated for treatment of postmenopausal osteoporosis?

a. Premarin
b. Raloxifene
c. Prempro
d. Bazedoxifene + conjugated estrogens
e. None of the above

Answer 12

b. Raloxifene

Question 13

Which medication has the potential for rebound osteoporosis following its discontinuation? How should it be addressed?

Answer 13

Denosumab is associated with increased risk of vertebral fracture after discontinuation, consider indefinite treatment of denosumab or adding a bisphosphonate after its discontinuation.

Question 14

Describe parathyroid hormone’s place in therapy when treating osteoporosis.

Answer 14

Last line, reserved for very high fracture risk or patients who failed bisphosphonate treatment

Question 15

Which medication has a black box warning for increased risk of myocardial infarction, stroke, and cardiovascular death?

a. Romosozumab
b. Denosumab
c. Teriparatide
d. Zoledronic Acid

Answer 15

a. Romosozumab

Question 16

Which medication(s) are contraindicated in patients with chronic kidney disease whose eGFR is less than 35 mL/min/m2?

Answer 16

bisphosphonates

Question 17

Which of the following is false regarding the effects of parathyroid hormone (PTH)?

a. Increased calcium in extracellular fluid
b. Decreased phosphate loss in the urine
c. Increased calcium resorption from collecting tubules
d. Increased 1,25 (OH)2 D3 production by the kidney

Answer 17

b. Decreased phosphate loss in the urine

(PTH results in inc PO4 loss in urine)

Question 18

All of the following describe the actions of vitamin D EXCEPT…

a. Feedback inhibition of PTH
b. Increase absorption of calcium from the small intestine
c. Decrease calcium reabsorption in the kidney
d. Indirect effects on cells through calbindins, vitamin D binding protein

Answer 18

c. Decrease calcium reabsorption in the kidney

(increases)

Question 19

When is fibroblast growth factor 23 (FGF23) secreted? How does it impact PO4, PTH, and 1,25(OH)2D?

Answer 19

• Secreted by osteocytes/blasts in response to elevated serum PO4
• Stimulates PO4 excretion
• Inhibits PTH secretion
• Inhibits 1,25(OH)2D synthesis

Question 20

When is calcitonin secreted? What does it do?

Answer 20

• Stimulated by high serum calcium levels
• Inhibits osteoclastic bone resorption
• Increases calcium and phosphate loss in urine

Question 21

Match the following to their mechanism of action: denosumab, romosozumab, raloxifene, and teriparatide.

a. Interacts with the PTH1 receptor to preferentially stimulate osteoblast activity
b. Monoclonal antibody against sclerostin
c. Selective estrogen receptor modulator
d. Binds to RANKL and prevents action of RANK on osteoclast precursors

Answer 21

a: teriperatide
b: romosozumab
c: raloxifene
d: denosumab

Question 22

What is the mechanism of action of Cinacalcet? In which patient population is it typically used?

Answer 22

• Positive allosteric modulator of the calcium sensing receptor that works to decrease both serum PTH levels and serum calcium levels
• Used in patients with chronic kidney disease on dialysis

Question 23

What is the necessary precursor besides dietary iodine required for the formation of thyroxine biosynthesis:
a) TBG
b) Tyrosine
c) T3
d) Threonine
e) TSH

Answer 23

b) tyrosine

Question 24

Which of the following is not a physiological effect of thyroid hormone:
a) it promotes the production of protein.
b) increase basal metabolic rate.
c) Increase catecholamine sensitivity.
d) Increase production of insulin
e) All of them are physiological effects.

Answer 24

d) increase production of insulin

(insulin production is not one of the effects of the thyroid hormone. These effects are cardiovascular, Growth and development, metabolic, and thermoregulation)

Question 25

All of the following conditions are caused by hyperthyroidism except:
a) Graves disease
b) Hashimoto’s thyroiditis
c) Toxic multinodular goiter
d) triiodothyronine toxicosis
e) Plummer disease

Answer 25

b) Hashimoto’s thyroiditis

Question 26

BT is a 45 yom diagnosed with hypothyroidism. You are in your IPPE rotation and during the round, your preceptor asks you to assist the consulting team in the treatment of this patient. the team is looking for a drug that will rapidly correct the patient’s disease and ask you for any recommendations.

a) Liotrix
b) Methimazole
c) Levothyroxine
d) Liothyronine
e) Propylthiouracil

Answer 26

d) Liothyronine

(has faster effect but a relatively short life also)

Question 27

ST is a 40 YOM present to the ED and diagnosed with hyperthyroidism. The medical team asks you to complete the medical reconciliation for this patient. after assessing the patient’s different medications, you found that one of his medications could be the origin of the patient’s disease. Which medication is most likely associated with it?

a) Lisinopril is used by the patient for his Hypertension.
b) Atorvastatin, which he used as his lipid-modifying agent.
c) Lithium, which he used for his bipolar depression.
d) Ibuprofen used for his pain PRN.

Answer 27

c) Lithium, which he used for his bipolar depression.

(Lithium can cause an inc level of iodine which can lead to hyperthyroidism)

Question 28

What is the average replacement dose of levothyroxine for an otherwise healthy adult?
a) 25 to 50 mcg/day
b) 50 to 100 mcg/day
c) 75 to 150 mcg/day
d) 100 to 200 mcg/day
e) 200 to 400 mcg/day

Answer 28

c) 75 to 150 mcg/day

Question 29

CT is a 35yof has just been diagnosed with hypothyroidism. She has no significant PMH and weighs 56 kg. what drug would you recommend to the patient?

a) Levothyroxine 100 mg PO QD
b) Levothyroxine 88 mcg PO QD
c) Liothyronine 100 mcg PO QD
d) Levothyroxine 200 mcg PO QD

Answer 29

b) Levothyroxine 88 mcg PO QD