Fam Med - Aquifer

Question 1

Hormone Therapy - Benefits and risks

Answer 1

(+) => reduce hot flashes and delay bone loss

(-) => increase the risk of breast cancer, heart attack, stroke, DVT, and incontinence.

Question 2

Signs and symptoms of atrophic vaginitis

Answer 2

Symptoms: Vaginal dryness, dyspareunia, urinary symptoms (Recurrent urinary tract infections, urinary frequency, and dysuria), and vaginal pruritis.

Question 3

Risk factors for endometrial cancer

Answer 3

Hypertension, hypothyroidism, and obesity
History of breast or colon cancer
Diabetes

Estrogen therapy without progesterone
Tamoxifen (Nolvadex)—Often used in patients with breast cancer or are at high risk for breast cancer and has an estrogenic effect on the genital tract.

Obesity
Anovulatory cycles
Estrogen-secreting neoplasms
Early menarche (before age 12)
Late menopause (after age 52)
Menstrual cycle irregularities
Nulliparity

Question 4

Post-menopausal bleeding evaluation

Answer 4

Transvaginal US => if ≥ 4mm, endometrial biopsy

CBC

TSH level

Question 5

Strategies to prevent osteoporosis

Answer 5

Adequate Vitamin D and Calcium intake
Smoking cessation
weight bearing exercise

Question 6

Osteoporosis treatments

Answer 6

Biphosphonates (inhibitor of bone resorption)

• Alendronate (Fosamax) and risedronate (Actonel)
• Ibandronate (Boniva)
• Zoledronic acid => IV, given annually (for who can’t tolerate oral form)

PTH analog = Teriparatide (Forteo)

Raloxifene (SERM) and Calcitonin = prevent vertebral fractures

Denosumab = 2nd line = IV every 6 months, costly => inhibit osteoclast formation

Question 7

Risk and protective factors for endometrial cancer

Answer 7

Risk: increases exposure to unopposed estrogen => tamoxifen therapy, obesity, anovulatory cycles, nulliparity, early menarche (before age 12), and late menopause (after age 52)

Decrease risk: smoking??? - oral contraceptives with progesterone