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Menopause -General Gynaecology module part2

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1) What is the mode of action of bisphosphonates?

2)

A 49-year-old woman approaches you in the clinic as she has been having regular,
troublesome hot flushes for past 6 months. Her last period was 2 weeks ago and they are
regular.
Which is the most suitable type of HRT to start her on?

3)

A 70-year-old woman undergoes a dual-energy X-ray absorptiom- etry (DXA) scan to
assess her bone mineral density.
What T score is diagnostic of osteoporosis?

4)

A 35-year-old para 3 underwent a TAH+BSO for severe pelvic endometriosis that had
not responded to medical and conservative surgical treatment. She attends for her followup appointment complaining of hot ushes and sweating.
Which HRT regime should you consider?
Options

5)

A 52-year-old woman presents with severe hot flushes. She takes tablets for
hypertension that has been well managed for the past 6 years. She had a hysterectomy
when she was 49.

6)

A 56-year-old woman presents to the urogynaecology clinic with dysuria and vaginal
irritation. This has been a problem for many months. Urine routine and culture are
negative for bacterial presence. Local examination shows a urethral caruncle.

7)

A 55-year-old patient presents with severely debilitating vasomotor symptoms. She
was declined HRT treatment by her general practitioner as her mother had had a PE while
taking the combined oral contraceptive pills. She is otherwise t and well with no signi cant
previous medical or surgical history and has never had any gynaecologic surgery.
Which HRT would give her the lowest risk of VTE?

8)

A woman opts to take oral continuous combined HRT for 5 years after the
menopause.
In which year of HRT use will her risk of venous thromboembolism (VTE) be greatest?

9)

Which of the following statements regarding osteoperosis management in
menopausal women is true?

10)

A 50-year-old patient is due to have a major abdominal surgery. She is currently
taking combined continuous HRT for vasomotor symptoms.
When should she stop HRT before surgery?
Options

11)

A 58-year-old postmenopausal woman presents for HRT counselling. While
questioning her about her health, you ask her about the risk factors for osteoporosis from
the fracture risk assessment (FRAX) tool, which is used to determine which individuals
warrant further evaluation for osteoporosis by bone mineral density testing.
Which of the following is not part of the FRAX tool?

12)

A 55-year-old patient presents with severely debilitating vasomotor symptoms. She
was declined HRT treatment by her general practitioner as her mother had had a PE while
taking the combined oral contraceptive pills. She is otherwise t and well with no signi cant
previous medical or surgical history and has never had any gynaecologic surgery.
Which HRT would give her the lowest risk of VTE?
Options

13)

A 48-year-old woman presents with amenorrhoea for 10 months. She is concerned
about her family history of osteoporosis and a recent DEXA scan showed a low T score
with osteopenia globally. Her mum and aunt have been operated for breast cancer

14)

A 52-year-old woman presents with complaints of low libido. She attained
menopause 5 years ago and is taking estrogen and progesterone HRT.

15)

A 52-year-old woman is referred by her GP to the menopause clinic with hot flushes
and night sweats. She is concerned about the risk of breast cancer following the use of
HRT.
Which of the following statements regarding HRT and breast cancer is true?

16)

What proportion of epithelial ovarian cancers are diagnosed in women who are not
postmenopausal?

17) What is the most common side effect of bisphosphonates?

18)

A 55-year-old woman attends the gynaecology clinic. She is suffer- ing with terrible
menopausal symptoms and cannot sleep because of the frequency of hot flushes.She is
requesting hormone replacement therapy (HRT) for symptom relief. She is currently
healthy but has a history of a deep venous thrombosis in her calf following a fractured
femur as a result of an accident 10 years ago.
Her last menstrual period was 2 years ago and her uterus is intact. What would you
recommend?

19) Q18. Which of the following statements regarding premature ovarian failure (POF) is true?

20)

A 50-year-old patient is due to have a major abdominal surgery. She is currently
taking combined continuous HRT for vasomotor symptoms.
When should she stop HRT before surgery?
Options

21)

You are seeing a 62-year-old patient for a follow-up visit. You evaluated her for
fracture risk 2 weeks ago and, given that she has high risk for fracture, you sent her for a
DEXA scan. Her T score for bone mineral density in the hip was less than −2.5 and the
thoracic spine less than −2.0. She has no secondary causes of osteoporosis, has not
been on glucocorticoids recently, is a nonsmoker, and does not drink alcohol.
ere is no dysphagia, and she is able to sit upright for 1 hour a er taking medications. It is
determined that she should be placed on a bisphosphonate for treatment of her
osteoporosis of the hip.
Which of the following does not affect the risk of fracture of hip?

22)

A 56-year-old woman with a BMI of 38 and type 2 diabetes mellitus presents with
daily dark brown staining on her underwear for the past week. She underwent menopause
at age 53 and has had no further bleeding or discharge since that time. ere has been no
vaginal or vulval trauma, and her cervical smear test 6 months previously was normal. On
examination her cervix appears normal and there is no evidence of external
haemorrhoids. A urine dipstick test is negative for blood.
What is the next best step in the management of this patient?

23)

A 45-year-old woman approaches you in the menopause clinic. Her mother died at
the age of 48 from acute myocardial infarction.
She wants more information on the use of HRT and other medications to prevent coronary
heart disease (CHD).
Which of the following statements is correct?

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