Menopause + MS

Question 1

Dx of menopause in pt with hysterectomy

Answer 1

High FSH and low estradiol

Question 2

Dx of menopause generally, when it is premature + when it is early

Answer 2

12mo after final period
Premature if <40
Early if <45

Question 3

Sx menopause

Answer 3

Sx:
Hot flashes
Libido change
Vaginal dryness
Dysuria
Incontinence
Sleep disturbance
Thinning skin + hair
Depression
Forgetfulness
Headache
Wt gain

Question 4

RF for early menopause

Answer 4

smoking, surgery, chemo, RT

Question 5

Lifestyle management of menopause

Answer 5

Diet (fruit, veg, grains, calcium)
Maintain healthy weight
Exercise
Stop smoking
BP control
Reduce alcohol

Question 6

HRT - when to give, CI, what to give if uterus vs no uterus

Answer 6

Recommended if <60, <10 yrs past menopause
CI: abn vaginal bleeding, breast/ ovarian/ endometrial cancer, CAD, CVA, VTE, liver disease
If uterus intact, progestin + estrogen
If uterus absent, only estrogen

Question 7

Oral vs transdermal HRT names

Answer 7

Oral:
Estrogen only: premarin or estrace
Progestin only: micronized progesterone, provera
Combined: activelle or angelique
Tissue selective estrogen complex + tibolone = progesterone free options for vasomotor sx
Transdermal (lower risk of VTE):
Estrogen only: Climara or Estradot patch or Estrogel
Combined: Estalis

Question 8

Rx For breast cancer pts

Answer 8

venlafaxine, gabapentin, clonidine, CBT

Question 9

Rx for Genitourinary sx

Answer 9

ospemifene (estrogen)
prasterone (steroid)
both topical

Question 10

Rx for Hyposexual desire

Answer 10

Flibanserin or transdermal testosterone

Question 11

Rx for hot flashes

Answer 11

Black Cohosh, Primrose Oil, SSRI/SNRIs (Venlafaxine), Clonidine, Gabapentin, Hormone Replacement Therapy

Question 12

Sx of MS

Answer 12

loss of vision in one eye
painful eye movements
diplopia
ascending sensory disturbance
weakness
imbalance
altered sensation down back
bladder + bowel dysfunction
sexual dysfunction

Question 13

patterns of MS

Answer 13

Relapsing remitting (periods of remission followed by exacerbations)
Secondary progressive (gradual accumulation of disability)
Primary progressive (sx gradually worsen over time)
Progressive relapsing (progressive w/ occasional attacks)

Question 14

What dx criteria to use for MS + what Ix to order

Answer 14

Dx:
McDonald criteria
Ix:
MRI
CBC, LFTs, Cr, lutes, Calcium, glucose, TSH, B12

Question 15

Management of MS: non-pharm

Answer 15

Education
MDT approach (neurologist, MS nurse, PT, OT, SLP, psychologist, RD)
Lifestyle
Exercise
Smoking cessation

Question 16

Annual review for MS - what to cover

Answer 16

Mobility, balance, falls
Spasticity, stiffness, tremors
Bladder, speech, swallowing, vision
Sensory sx + pain
Cognitive sx, depression, fatigue, sleep
Resp function
Weight, smoking, alcohol, SU, exercise

Question 17

what is Lhermitte’s sign?

Answer 17

electric shock sensation travelling down spine

Question 18

What is Uhthoff’s phenomenon?

Answer 18

Heat will precipitate a worsening of symptoms

Question 19

What meds for MS for:
a) relapse
b) maintenance

Answer 19

Relapse: methylprednisolone 0.5mg daily x 5/7
DMARDs

Question 20

Sx management for MS:
Fatigue
Spasticity
Emotional lability

Answer 20

Fatigue: amantadine, CBT
Spasticity: baclofen or gabapentin
Emotional lability: amitriptyline

Question 21

When do you test FSH for ?menopause?

Answer 21

Never!

Question 22

5 ways to rx menopause w/o meds

Answer 22

stop smoking, quit alcohol, stop caffeine, start exercise, weight loss

Question 23

When can you prescribe HRT safely?

Answer 23

Within 10 yrs of LMP, <60, safe for 5 years

Question 24

5 ways to rx vasomotor sx of menopause w/o meds

Answer 24

fan, layers, cool environment, no hot drinks, optimize sleep

Question 25

Rx for psych/ sex sx of menopause

Answer 25

treat sleep, relationship issues, genitourinary sx, SSRI

Question 26

Consequences of multimorbidity

Answer 26

increased mortality, complex critical care, polypharmacy