Exam 4 Random Info Flashcards
On the physiologic level, menopause is caused by a drop in (blank) which results in an increase in (blank)
a. FSH and progesterone; LH and estrogen
b. FSH and LH; estrogen and progesterone
c. Estrogen and FSH; progesterone and LH
d. Estrogen and progesterone; FSH and LH
d. Estrogen and progesterone; FSH and LH
Which of the following is an absolute contraindication to menopausal hormone therapy?
a. Stroke
b. Diabetes
c. Active seizure disorder
d. Hypertriglyceridemia
e. Family history of breast cancer
a. Stroke
why is estrogen monotherapy only reserved for women without a uterus?
estrogen alone increases the risk of endometriosis, endometrial hyperplasia, and endometrial cancer
Which of the following statements is false?
a. Oral estrogens have higher side effects compared to topical products
b. Topical vaginal products should be reserved for women experiencing vulvovaginal atrophy
c. Women with an intact uterus should be prescribed a progestin in addition to estrogen
d. Between the vaginal rings, only Estring can treat vasomotor symptoms
d. Between the vaginal rings, only Estring can treat vasomotor symptoms
(Estring is a low dose and only has a local effect, Femring can have high enough concentration systemically to treat vasomotor symptoms)
Based on the findings of the women’s health initiative study menopausal hormone therapy should be reserved to women who are…
a. Age < 60 or within 10 years of last period
b. Age < 60 or within 5 years of last period
c. Age < 55 or within 10 years of last period
d. Age < 55 or within 5 years of last period
a. Age < 60 or within 10 years of last period
Which method of combined estrogen and progestin offers the best long-term endometrial protection?
a. Continuous combined
b. Continuous long cycle
c. Continuous cyclic therapy
d. Intermittent combined
a. Continuous combined
Which of the following would be the best choice to treat hot flashes in a patient who can not tolerate hormonal therapy?
a. Black cohosh
b. Clonidine
c. Pregabalin
d. Escitalopram
e. Dong Quai
d. Escitalopram
(SSRIs/SNRIs are drugs of choice for hot flashes if there is no estrogen treatment, all the other options are for vasomotor symptoms )
Which of the following patients would be the WORST candidate to receive systemic menopausal hormonal therapy?
a. Patient with a 10-year CVD risk of 12% who has a moderate risk of developing breast cancer
b. Patient with a 10-year CVD risk of 8% whose last period was 6 years ago
c. Patient with a 10-year CVD risk of 4% whose last period was 4 years ago
d. Patient with a 10-year CVD risk of 10% who has a low risk of developing breast cancer
a. Patient with a 10-year CVD risk of 12% who has a moderate risk of developing breast cancer
(Avoid systemic MHT if patient’s 10 year CVD risk is >10% or if they have a moderate to high risk of developing breast cancer)
Prasterone (Intrarosa) is contraindicated in patients who have…
a. History of venous thromboembolism (VTE)
b. Undiagnosed vaginal bleeding
c. Endometrial hyperplasia
d. History of stroke
b. Undiagnosed vaginal bleeding
list contraindications to bisphosphonates
Hypocalcemia, renal insufficiency (CrCl < 30-35 mL/min), esophageal abnormalities unless IV, inability to sit or stand for at least 30 minutes, pregnancy or breast-feeding
Which bisphosphonate has the worst prevention efficacy?
a. Risedronate
b. Zoledronic acid
c. Ibandronate
d. Alendronate
c. Ibandronate
Which of the following is indicated for treatment of postmenopausal osteoporosis?
a. Premarin
b. Raloxifene
c. Prempro
d. Bazedoxifene + conjugated estrogens
e. None of the above
b. Raloxifene
Which medication has the potential for rebound osteoporosis following its discontinuation? How should it be addressed?
Denosumab is associated with increased risk of vertebral fracture after discontinuation, consider indefinite treatment of denosumab or adding a bisphosphonate after its discontinuation.
Describe parathyroid hormone’s place in therapy when treating osteoporosis.
Last line, reserved for very high fracture risk or patients who failed bisphosphonate treatment
Which medication has a black box warning for increased risk of myocardial infarction, stroke, and cardiovascular death?
a. Romosozumab
b. Denosumab
c. Teriparatide
d. Zoledronic Acid
a. Romosozumab
Which medication(s) are contraindicated in patients with chronic kidney disease whose eGFR is less than 35 mL/min/m2?
bisphosphonates
Which of the following is false regarding the effects of parathyroid hormone (PTH)?
a. Increased calcium in extracellular fluid
b. Decreased phosphate loss in the urine
c. Increased calcium resorption from collecting tubules
d. Increased 1,25 (OH)2 D3 production by the kidney
b. Decreased phosphate loss in the urine
(PTH results in inc PO4 loss in urine)
All of the following describe the actions of vitamin D EXCEPT…
a. Feedback inhibition of PTH
b. Increase absorption of calcium from the small intestine
c. Decrease calcium reabsorption in the kidney
d. Indirect effects on cells through calbindins, vitamin D binding protein
c. Decrease calcium reabsorption in the kidney
(increases)
When is fibroblast growth factor 23 (FGF23) secreted? How does it impact PO4, PTH, and 1,25(OH)2D?
- Secreted by osteocytes/blasts in response to elevated serum PO4
- Stimulates PO4 excretion
- Inhibits PTH secretion
- Inhibits 1,25(OH)2D synthesis
When is calcitonin secreted? What does it do?
- Stimulated by high serum calcium levels
- Inhibits osteoclastic bone resorption
- Increases calcium and phosphate loss in urine
Match the following to their mechanism of action: denosumab, romosozumab, raloxifene, and teriparatide.
a. Interacts with the PTH1 receptor to preferentially stimulate osteoblast activity
b. Monoclonal antibody against sclerostin
c. Selective estrogen receptor modulator
d. Binds to RANKL and prevents action of RANK on osteoclast precursors
a: teriperatide
b: romosozumab
c: raloxifene
d: denosumab
What is the mechanism of action of Cinacalcet? In which patient population is it typically used?
- Positive allosteric modulator of the calcium sensing receptor that works to decrease both serum PTH levels and serum calcium levels
- Used in patients with chronic kidney disease on dialysis
What is the necessary precursor besides dietary iodine required for the formation of thyroxine biosynthesis:
a) TBG
b) Tyrosine
c) T3
d) Threonine
e) TSH
b) tyrosine
Which of the following is not a physiological effect of thyroid hormone:
a) it promotes the production of protein.
b) increase basal metabolic rate.
c) Increase catecholamine sensitivity.
d) Increase production of insulin
e) All of them are physiological effects.
d) increase production of insulin
(insulin production is not one of the effects of the thyroid hormone. These effects are cardiovascular, Growth and development, metabolic, and thermoregulation)
