APEA EXAM 220+ QUESTIONS WITH DETAILED ANSWERS BY EXPERT

APEA EXAM 220+ QUESTIONS WITH DETAILED ANSWERS BY EXPERT

What medications are used in PCOS? - ANSWER o Treatment:
o Low dose birth control pills will suppress ovaries
o Spironolactone will decrease & control hirsutism
o If pt denies birth control pills can use medroxyprogesterone (Provera) 5-10 mg for 10-14 days
repeat q 1-2 months to induce menses
What are PCOS patients at increased risk for? - ANSWER CHD, type 2 diabetes, metabolic
syndrome, cancer of breast and endometrium, central obesity and infertility
What is osteoporosis? What are the treatment options? - ANSWER loss of bone density due to
estrogen deficiency and other metabolic disorders
Most common in older, white or Asian petite women with positive family hx
Treat postmenopausal women or men >50 years old who have a T-score of -2.5 or less or has a
history of hip/vertebral fracture
Treatment: weight-bearing exercises most days of the week
-swimming and biking are not considered weight-bearing but are good for severe arthritis - no
isometric exercises
Calcium w/ vitamin D, Vitamin D2 once a week, & vit D3
What are the risk factors for osteoporosis? - ANSWER Most common in older, white or Asian
petite women with positive family hx
Treat postmenopausal women or men >50 years old who have a T-score of -2.5 or less or has a
history of hip/vertebral fracture
Other risk groups:
Pts on chronic steroids (asthma, autoimmune) are at high risk
rule it out in men or women on chronic steroids especially if they have risk factors
Pts with anorexia nervosa and bulimia
Long term use of PPIs like omeprazole
Gastric bypass, celiac disease, hyperthyroidism, RA
Lifestyle risk factors:
Low calcium intake, vitamin D deficiency, inadequate exercise
alcohol consumption, high caffeine intake, smoking
Explain bone density test scores in relation to osteoporosis/osteopenia - ANSWER Use DXA to
measure the bone mineral density of the hip and spine - start with a baseline
if on treatment, retest every 1-2 years
If no treatment, retest every 2-5 years
Osteoporosis: T score of -2.5 or lower
Osteopenia: T score of -1.5 to -2.4
Explain fibrocystic breasts and the treatment plan, when is a referral indicated? - ANSWER o
Common to begin in women aged >30
o Breast tissue becomes engorged and painful up to 2 weeks before their menses (luteal phase)
and are at their worst right before menses
o Tenderness & lumps disappear after menstruation begins
o Lumps should still be mobile and rubbery to touch
o Treatment: stop caffeine intake, take Vitamin E & evening primrose daily
o Wear bras with good support, referral indicated if the mass is dominant, skin changes or fixed
massq
Explain PCOS - what does it stand for? What are s/s? treatment plan? - ANSWER Polycystic Ovary
Syndrome (PCOS)
o Hormonal abnormality characterized by anovulation, infertility, excessive androgen production
and insulin resistance
o Higher risk for diabetes type 2, dyslipidemia, metabolic syndrome, endometrial hyperplasia,
obesity, and OSA
o Hirsutism 70% in cases, bad acne, amenorrhea, and infrequent periods
o Diagnostic testing:
o Transvaginal US: enlarged ovaries w/ multiple follicles
o Testosterone, DHEA, and androstenedione are high
o FSH is normal or low
o Treatment:
o Low dose birth control pills will suppress ovaries
o Spironolactone will decrease & control hirsutism
o If pt denies birth control pills can use medroxyprogesterone (Provera) 5-10 mg for 10-14 days
repeat q 1-2 months to induce menses
o Metformin will induce ovulation (if pregnancy is desired)
§ Warn reproductive diabetic patients to use birth control
o Weight loss reduces androgen & insulin levels
What is anovulation? - ANSWER when an egg does not release from your ovary during the
menstrual cycle
What does metformin do to the female reproductive system? - ANSWER Induces ovulation - warn
diabetic patients to use birth control
This is measured at the lumbar spine, femoral neck or total hip
What does DXA stand for? - ANSWER dual-energy x-ray absorptiometry
What are examples of isometric exercises? - ANSWER planking, wall sits, calf raises
What meds are used to treat osteoporosis? What side effects should be warned about? - ANSWER
1st line: Bisphosphonates = Fosamax (alendronate) or Actonel (risedronate) ends in dronate
Severe esophagus irritant can cause esophagitis, ulcers, and bleeding peptic ulcer disease
Take med sitting or standing and wait 30 minutes before laying back down, don't take with coffee,
juice, vitamins or other meds
take with a full glass of water immediately upon waking
Can take med daily or weekly
Osteonecrosis of the jaw can happen with IV or IM bisphosphonates - signs are complaints of jaw
heaviness, pain, swelling, and loose teeth
SERM class: Evista (raloxifene) blocks estrogen receptors
approved for use after menopause and helps with breast cancer prophylaxis
-do not use to tx menopause symptoms
-BBW: DVT or PE, stroke
Tamoxifen (Noluadex) - what is it used for? risks? side effects? - ANSWER used for breast cancer
that is hormone-receptor positive
increase risk of DVT, endometrial cancer, stroke, PE
side effects: causes hot flashes, white/brown vaginal discharge, weight gain or loss
Teriparatide (forteo)- what is it used for? risks? side effects? - ANSWER an injection used to
recombinant human parathyroid hormone for the treatment of osteoporosis