APEA EXAM 3 VERSIONS QUESTIONS WITH DETAILED ANSWERS VERIFIED BY EXPERT

APEA EXAM 3 VERSIONS QUESTIONS WITH
DETAILED ANSWERS VERIFIED 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
increases incidence of osteosarcoma in rats lol
Calcitriol - ANSWER A hormone produced from vitamin D that acts in essentially the same manner
as parathyroid hormone.
must be on a low calcium diet, monitor for hypercalcemia, hypercalciuria and renal insufficiency
What is the average age of menopause in women? - ANSWER 51
When do women use combined estrogen and progestin or unopposed estrogen? - ANSWER Does not
prevent chronic diseases
Helps with symptoms of menopause
recommended for women <60 in the first 10 years of menopause and for less than 5 years or at risk
for cancer
combined estrogen and progesterone = women with a uterus this decreases the risk of endometrial
cancer
unopposed estrogen = women without a uterus
What disease can estrogen or birth control pills exacerbate? - ANSWER
what is dyspareunia? What can alleviate it? - ANSWER painful intercourse - estrogen can help
When do you screen for ovarian cancer? - ANSWER Only in women with BRCA1 or BRCA 2 mutations
with high risk, starts at age 30 and every 5-10 years after or early based on first age diagnosis in
family
what is a bilateral salpingo-oophorectomy? - ANSWER removal of fallopian tubes and ovaries - used
to prevent ovarian cancer typically between age 35-40 in high risk women
bacterial vaginosis - ANSWER "fish like" odor that can be worse after sex - not itchy/vulva not red,
milk like or gray discharge
Lab results = clue cells no WBCs
NOT an STD - do not need to treat partner, those having sex are at high risk and those that douche
Pregnant women - at risk for intrauterine infection and premature labor
Tx: metronidazole (Flagyl) BID x 7 days
alternative: flagyl gel applied at bedtime for 5 days or clindamycin cream at HS x7 days
Abstain from sex until treatment is done