Menopause and Menstruation Disorders Flashcards
1
Q
- The medical management of should result in the relief of pelvic pain, an
improved quality of life, and a reduction in related lost school/work days.
A. Amenorrhea
B. Anovulatory bleeding
C. Dysmenorrhea
D. Menorrhagia
E. Polycystic ovary syndrome
A
C
2
Q
- Regardless of the cause of amenorrhea, which of the following lifestyle interventions is most appropriate?
A. Increase the level of exercise
B. Increase the intake of dietary calcium and vitamin D
C. Decrease the intake of alcohol
D. Decrease the level of exercise
E. Transition to a gluten-free diet
A
B
3
Q
- The primary goal of estrogen therapy in amenorrhea is to improve the patient’s
bone health. A progestin is added to:
A. Augment estrogen’s effects on bone
B. Improve overall quality of life
C. Prevent endometrial hyperplasia
D. Restore fertility
E. Counter estrogen’s negative effects on lipids
A
C
4
Q
- A 35-year-old woman presents with complaints of increasingly heavy menses that last approximately 7 days per month. A CBC shows a 2 g/dL (20 g/L; 1.24 mmol/L)
drop in hemoglobin over the past 15 months. A Pap smear and endometrial biopsy are performed, and are both negative. Her past medical history is significant for a deep vein thrombosis 3 years ago secondary to her oral contraceptive. Which of the following is most appropriate first-line therapy for this patient?
A. A combination oral contraceptive with 50 mcg of ethinyl estradiol plus desogestrel
B. Mefenamic acid 500 mg by mouth followed by 250 mg by mouth four times
daily during menses
C. Levonorgestrel IUD releasing 20 mcg of levonorgestrel daily
D. Medroxyprogesterone acetate 10 mg by mouth on days 5 through 26 of the
menstrual cycle
E. Acetaminophen 650 mg by mouth four times daily
A
B
5
Q
- Which of the following treatments for dysmenorrhea results in the most rapid
symptom improvement?
A. Acetaminophen
B. Levonorgestrel IUD
C. A standard (28-day) combination oral contraceptive
D. An extended cycle (91-day) combination oral contraceptive
E. NSAIDs
A
E
6
Q
- Which of the following statements is true regarding the use of NSAIDs and OCs in
patients with menorrhagia?
A. The reduction in blood loss is inversely proportional to pretreatment blood
loss.
B. The increase in blood loss is inversely proportional to pretreatment blood
loss.
C. The reduction in blood loss is proportional to pretreatment blood loss.
D. The increase in blood loss is proportional to pretreatment blood loss.
E. None of the above
A
C
7
Q
- A 32-year-old woman presents with complaints of irregular menses and difficulty becoming pregnant. She has been taking tetracycline for acne 8 years. She is
hirsute around the jaw line, her BMI is 32 kg/m2, and her waist circumference is 40
inches (102 cm). A pelvic ultrasound is performed that shows polycystic ovaries. In
addressing her infertility related to PCOS, in addition to recommending weight loss,
which of the following is most appropriate for this patient?
A. Clomiphene 50 by mouth daily for 5 days starting on day 5 of the menstrual
cycle
B. Medroxyprogesterone acetate 10 mg by mouth daily for 10 days
C. Metformin 850 mg by mouth twice daily
D. Pioglitazone 15 mg by mouth daily
E. A and D
A
A
8
Q
- Initially, the recommended treatment for acute bleeding episodes associated with
anovulation is:
A. Estrogen
B. Letrozole
C. Levonorgestrel IUD
D. Mefenamic acid
E. Naproxen
A
A
9
Q
- Which of the following agents is no longer recommended for the treatment of
anovulatory bleeding?
A. Estrogen via combination oral contraceptives
B. Letrozole
C. Depot medroxyprogesterone acetate
D. Metformin
E. Pioglitazone
A
E
10
Q
- Which of the following treatment options is most appropriate to control acute bleeding as well as prevent recurrent bleeding in a 25-year-old anovulatory woman with signs of high androgen levels?
A. An oral contraceptive containing at least 35 mcg of ethinyl estradiol in combination with the progesterone, drospirenone; one tablet taken by mouth three times daily for 1 week followed by one tablet daily for 3 weeks
B. An oral contraceptive containing at least 35 mcg of ethinyl estradiol in
combination with norethindrone acetate; one tablet taken by mouth daily for
4 weeks
C. Medroxyprogesterone acetate 5 mg taken by mouth daily for 1 week
followed by 2.5 mg daily for 3 weeks
D. Medroxyprogesterone acetate 5 mg taken by mouth daily for 4 weeks
E. None of the above
A
A
11
Q
- Which of the following agents is most appropriate for the management of
dysmenorrhea when nonpharmacologic options have failed?
A. Depot medroxyprogesterone acetate 150 mg intramuscularly every 12 weeks
B. Ibuprofen 800 mg by mouth three times daily during menses
C. Levonorgestrel IUD releasing 20 mcg of levonorgestrel daily
D. Medroxyprogesterone acetate 5 mg by mouth daily
E. Oral contraceptive with 35 mcg of ethinyl estradiol plus norgestimate daily
A
B
12
Q
- When using an OC for the management of dysmenorrhea in an adolescent,
additional benefit(s), dependent on the specific option chosen, may include:
A. Reduced endometrial cancer risk
B. Pregnancy prevention
C. Improved acne
D. None of the above
E. A, B, and C
A
E
13
Q
- The treatment goals of include preserving bone density,
preventing bone loss, improving quality of life, and restoring menstruation.
A. Amenorrhea
B. Dysmenorrhea
C. Menorrhagia
D. Polycystic ovary syndrome
E. None of the above
A
A
14
Q
- Which of the following menorrhagia treatment options have been shown to reduce menstrual blood flow by 75% to 95% and result in up to 80% of treated women experiencing amenorrhea after 12 months?
A. Combination oral contraceptives
B. Ibuprofen
C. Levonogestrel IUD
D. Medroxyprogesterone acetate
E. All of the above
A
C
15
Q
- Which of the following non-hormonal treatment options is well tolerated from a
gastrointestinal standpoint and is recommended for patients with vonWillebrand disease as a cause of menorrhagia?
A. Ibuprofen
B. Mefenamic acid
C. Naproxen
D. Tranexamic acid
E. None of the above
A
D
16
Q
- All of the following are the functional phases of the menstrual cycle except:
A. Follicular
B. Ovulatory
C. Implantation
D. Menstruation
A
C
17
Q
- Which of the following contraceptives is not recommended in women with a body mass index of ≥ 30 kg/m 2 due to an increased risk of developing a VTE?
A. EluRyng
B. Depo-Provera
C. Kyleena
D. Xulane
A
D
18
Q
- With typical use, the most effective method of hormonal contraception is:
A. Intrauterine device
B. Vaginal ring
C. Transdermal patch
D. Progestin-only pill
A
A
19
Q
- Potential risks associated with the use of oral contraceptives include all of the following except:
A. Venous thromboembolism
B. Hypertension
C. Ovarian cancer
D. Gallbladder disease
A
C
20
Q
- Which of the following CHCs is FDA-approved for the treatment of PMDD?
A. Estrostep FE
B. Yasmin
C. Beyaz
D. TriNessa
A
C
21
Q
- Which of the following adverse reactions/events has been associated with progestin-only pills?
A. Hypotension
B. Venous thromboembolism
C. Wilson Disease
D. Acne
A
D
22
Q
- Which medication can interact with CHCs by inducing the CYP450 3A4 enzyme and has a recommendation to use a back-up method of contraception during coadministration and for at least 28 days after discontinuation?
A. Lamotrigine
B. Modafinil
C. Theophylline
D. Griseofulvin
A
B
23
Q
- Which of the following emergency contraceptives is recommended to be taken within 120 hours of unprotected sex?
A. Aftera
B. My Way
C. Ella
D. Preventeza
A
C
24
Q
- Which of the following is an example of a progestin-only contraceptive?
A. Seasonique
B. Natazia
C. Aviane
D. Slynd
A
D
25
10. The most effective fertility awareness–based contraceptive method is thought to be the:
A. Calendar (rhythm) method
B. Temperature method
C. Cervical mucus method
D. Symptothermal method
D
26
11. A 26-year-old woman smoker who is 14 days postpartum is seen in the family medicine clinic today for follow-up and is requesting to be prescribed a hormonal contraceptive. Her BP is 112/74 mm Hg. She has a history of migraine headache disorder (without aura), exercise-induced
asthma, and uterine fibroids that were surgically removed 3 years ago. She smokes one-half pack of cigarettes per day but does not drink alcohol or use illicit drugs. She has no prior personal or
family history of cancer or cardiovascular disease. The use of a CHC in this patient is:
A. No restriction (method can be used).
B. Unacceptable health risk (method not to be used) due to her smoking history.
C. Unacceptable health risk (method not to be used) due to her migraine headache disorder.
D. Unacceptable health risk (method not to be used) due to her current postpartum status.
D
27
12. A 28-year-old woman who is taking Junel 1/20 presented to clinic today with a chief complaint of bloating and constipation. The patient denies breakthrough bleeding and headaches,
has normal blood pressure (which has remained unchanged since her last examination), and she is otherwise tolerating the Junel 1/20. What would be the best course of action to address her
complaint?
A. Increase progestin dose
B. Decrease progestin dose
C. Increase estrogen dose
D. Decrease estrogen dose
B
28
13. A 32-year-old sexually active woman presents to your clinic today requesting to be prescribed hormonal contraception. She has a history of seizures and anxiety disorder, for which she is prescribed phenytoin and alprazolam. Which of the following statements is correct regarding potential for drug interactions with CHCs?
A. Phenytoin and alprazolam may decrease metabolism of CHCs.
B. Phenytoin and alprazolam will have no effect on metabolism of CHCs.
C. Phenytoin may increase metabolism of CHCs, while alprazolam’s metabolism may be decreased by CHCs.
D. Phenytoin and alprazolam may increase the metabolism of CHCs.
C
29
14. A 23-year-old graduate student came to clinic today after a recent family reunion where she found out that she has a family history of endometrial as well as cervical cancer (two of her second cousins on her mother’s side of the family). The patient has been taking Aviane for the past 6 months and is now concerned that the contraceptive she is taking may increase her risk for this type of cancer. What counseling would be most appropriate for you to provide to her at this time?
A. There is evidence to suggest that women who take oral contraceptives for 1 year have a reduced risk of developing endometrial cancer.
B. There is evidence to suggest that women who take oral contraceptives for 1 year have a
reduced risk of developing cervical cancer.
C. There is evidence to suggest that women who take oral contraceptives for 1 year have an increased risk of developing endometrial cancer.
D. There is evidence to suggest that women who take oral contraceptives for 1 year have an increased risk of developing cervical cancer.
A
30
15. An 18-year-old college freshman has started to become sexually active and is seeking your advice regarding contraceptive options that protect against both pregnancy and STIs. She has no medical history and no contraindications to the use of hormonal contraceptives. She is open to all forms of contraception. Which of the following options protects against both pregnancy and STIs?
A. Diaphragms, when used with spermicide
B. Male condoms made from latex
C. Intrauterine devices
D. CHCs
B
31
1. Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line therapy for dysmenorrhea because they do all of the following except:
A. Decrease uterine contractions
B. Exert analgesic properties
C. Decrease endometrial lining
D. Reduce menstrual blood flow
C
32
2. A 17-year-old woman presents with symptoms of dysmenorrhea. She is already taking high- dose scheduled naproxen during menses but would like to know if there are any nonmedication options to help reduce the pain. Which of the following nonpharmacologic therapies are associated with the most benefit?
A. Fish oil supplementation
B. Topical heat therapy
C. Acupuncture
D. Zinc oxide supplementation
B
33
3. Which of the following is best to recommend for a woman with amenorrhea secondary to hyperprolactinemia?
A. Ethinyl estradiol patch 50 mcg/24 hours
B. Cabergoline 0.25 mg twice weekly
C. Oral medroxyprogesterone 10 mg on cycle days 14–26
D. Ibuprofen 800 mg three times daily
B
34
4. The medical management of ______________ should result in the reduction in menstrual blood flow, prevention of iron-deficiency anemia, and improvement of quality of life.
A. Amenorrhea
B. Anovulatory bleeding
C. Dysmenorrhea
D. Heavy menstrual bleeding
D
35
6. The recommended initial treatment for acute bleeding episodes associated with anovulation is:
A. Estrogen
B. Letrozole
C. Levonorgestrel IUD
D. Naproxen
A
36
5. A 26-year-old woman presents with concerns of heavy menses and containment flow problems lasting approximately 9 days per month and increased fatigue. Her lab results indicate
a 1.8 g/dL (18 g/L; 1.12 mmol/L) drop in hemoglobin over the past 12 months. A Pap smear and endometrial biopsy were normal. She is currently trying to conceive for the first time with her husband of 2 years. Which of the following is the most appropriate first-line therapy for this patient?
A. Combination oral contraceptive with an extended cycle dosing
B. Levonorgestrel IUD releasing 20 mcg of levonorgestrel daily
C. Diclofenac 50 mg three times daily with onset of menses
D. Tranexamic acid 1300 mg three times daily
C
37
7. A 19-year-old woman presents with concerns for amenorrhea. She reports her last period was 4 months ago. She reports previously her cycle has been regular, occurring every 28–30 days. She started a new healthy lifestyle 6 months ago, and joined a high-intensity workout gym. She
has lost 55 pounds (24.9 kg), and currently works out 7 days a week. She is currently sexually active with one partner and reports using condoms for contraception. She has taken several urine pregnancy tests at home, all of which have been negative. She does not desire pregnancy at this time. Her past medical history is unremarkable. She currently takes famotidine for occasional heartburn and a daily multivitamin. She is a nonsmoker and nondrinker. She is 5’6’’ (168 cm) and currently weighs 122 pounds (55.3 kg) (BMI 19.4 kg/m 2 ). Patient’s urine pregnancy test in clinic was negative. Which of the following is most appropriate to recommend?
A. Start bromocriptine
B. Start an oral CHC
C. Start metformin
D. Start ethinyl estradiol patch
B
38
8. A 27-year-old woman returns for a follow-up appointment after 3 months of CHC therapy for heavy menstrual bleeding. She is feeling much better and for the first time in 2 years, her menstrual cycles are lighter, and no longer has issues with flow containment. She still notices fatigue that lasts throughout her cycle but is worse during menses. What is the best
recommendation for the patient at this time?
A. Complete blood count and ferritin levels
B. Testing to identify coagulation disorder
C. Endometrial biopsy
D. Pelvic ultrasound
A
Option A: Correct. The patient has had heavy bleeding for a prolonged period of time and is at increased risk for iron deficiency anemia. A CBC and ferritin levels will give a better assessment of the patient’s current situation.
38
9. A healthy 43-year-old woman had a hysterectomy and bilateral salpingo-oophrectomy 6 months ago due to fibroids and has been using an estrogen transdermal patch to control menopausal symptoms with success. She does not have a personal or family history of breast cancer or clotting disorders, but there is a history of heart disease in the family. When asked about continuing the estrogen patch in this patient, which one of the following recommendations is best at this time?
A. Continue treatment until the average age of menopause onset
B. Continue treatment but switch to an oral estrogen
C. Continue treatment but add a progestogen 12 to 14 days/month
D. Discontinue treatment
A
39
10. A 55-year-old woman with a history of hysterectomy is suffering from dyspareunia and urinary incontinence over the past year. Her LMP was 2 years ago. PMH is significant for hypertension being treated with losartan 100 mg daily. She smokes 1 ppd and has one glass of
wine daily. What is the most appropriate treatment recommendation for this patient?
A. CEE 0.3 mg oral daily
B. CEE 0.3 mg oral daily + MPA 1.5 mg oral daily
C. Venlafaxine 75 mg oral daily
D. Estradiol 2 mg vaginal ring, insert vaginally every 90 days
D
40
11. A 55-year-old postmenopausal woman presents to the clinic complaining of hot flashes. Her PMH is significant for current tobacco use at ½ ppd for the past 40 years and CHD. Her LMP was approximately 16 months ago. She states she suffers from about five hot flashes per day that
significantly interfere with her concentration at work and two per night that wake her from sleep. What is the most appropriate treatment recommendation for this patient?
A. CEE 0.6 mg daily plus MPA 1.5 mg oral daily
B. CEE/bazedoxifene 0.45 mg/20 mg oral daily
C. Ospemifene 60 mg oral daily
D. Paroxetine CR 7.5 mg oral daily
D
41
12. A 55-year-old woman has taken CEE 0.3/MPA 2.5 mg once daily for the past 4 years for moderate-to-severe VMS. Her symptoms have been well controlled and she does not report any adverse effects. Her PMH includes no surgeries. She has become more concerned about the use
of estrogens and would like to discontinue. What would be the best recommendation for discontinuing therapy?
A. Discontinue oral MHT and initiate a topical vaginal product.
B. Continue CEE 0.3 mg once daily, discontinue MPA as it is no longer needed and will reduce risks.
C. Discontinue oral MHT by slowly tapering the regimen over 3 to 6 months.
D. Continue oral MHT as the benefits she is receiving outweigh her risks.
C
42
13. A 51-year-old woman presents to her health care provider with complaints of vaginal dryness and dyspareunia. She states she has been experiencing these symptoms for over 3 months, and it
is significantly affecting her sexual relationship with her partner. Her past medical history is significant for hypertension. Her past surgical history is significant for a right knee replacement
and hysterectomy. What is the most appropriate treatment recommendation for this patient?
A. CEE 0.625 mg oral daily
B. Soy isoflavones 80 mg oral daily
C. Paroxetine CR 25 mg oral daily
D. Ospemifene 60 mg oral daily
D
43
14. A 50-year-old newly menopausal woman is experiencing mild vaginal burning and irritation. Her LMP was 13 months ago. She has not experienced any other symptoms associated with menopause and has an intact uterus. Her past medical history is significant for asthma. What is the most appropriate treatment recommendation for this patient?
A. Vaginal estrogen cream + oral progestogen
B. Vaginal lubricants
C. Vaginal estrogen tablets
D. Oral CEE + MPA
B
44
15. A 51-year-old woman with a PMH significant for hypothyroidism, HTN, and GERD has been suffering from severe hot flashes that wake her up every night. Her LMP was 3 years ago. She has a past surgical history significant for cesarean section × 2 and a hysterectomy 15 years
ago for dysfunctional uterine bleeding (no salpingo-oophorectomy performed). She has been receiving CEE 0.3 mg oral daily for the last 2 years but her symptoms have continued to be severe. What is the most appropriate treatment recommendation for this patient?
A. Discontinue CEE and initiate bazedoxifene/CEE
B. Increase daily oral estrogen dose
C. Decrease daily oral estrogen dose
D. Discontinue CEE and initiate gabapentin
B
