NU 665D EXAM 1 2024-2025 |ACTUAL COMPLETE QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS ) A GRADE.
Vulvo-Vaginal Atrophy: What do you see on examination? - ANSWER-
-Loss or diminishing of vaginal rugae
-Narrowing/Shortening of the vagina
-Shrinking clitoris & urethra
-Loss of subq fat in labia: may be flush to the wall
-Discharge
-Loss of pubic hair
-Fissures/vaginal tearing
-decreased introital moisture
Vulvo-Vaginal Atrophy: Patients complaints? - ANSWER--Vaginal
dryness -Discharge
-Itchiness
-pain during sex
-BV like s/s ( Vaginal ph becomes more alkaline)
-urethral discomfort
-Bleeding
Treatment options: Atrophic Vaginitis - ANSWER--Vaginal
Creams/Rings or suppository
-Premarin cream 0.625,
-Estrace 2-4 grQd x 2w, 1-2 gr qd x2w, then 1 gr 1-3 x week -Estring
vaginal ring continuous release for 90 days, needs replacement q
90 days - 7.5mcg/day estradiol
,-Caplet Vagifem 10mcg qd x 2wk then 2 x week
-Osphena - 60mg PO QD - estrogen receptor modulator - in the vagina
acts similarly to estrogen; in the breast tissue it acts as an estrogen
blocker *can increase risk of blood clots and hot flushes
-DHEA suppository (vaginal prasterone) - PV 1x/day * good option for
those who can't take estrogen
Patient Education: Vaginal Estrogen - ANSWER--A small amount is
absorbed into the bloodstream; 100x less than if you used an oral
estrogen medication
Alternative Treatment options: Atrophic Vaginitis - ANSWER--OTC
lubricants - Ky Jelly, Astroglide
-OTC vaginal moisturizers - Lubrin, KY longlasting, Replens. ----Allow
water to be retained in the tissues - not during sex.
-Vaseline, Aquaphor, Vit E oil - externally (can damage condoms)
-Mild soaps (Dove unscented bar soap), warm soaks with baking soda
-Sex - can keep vaginal tissues healthy, soft, elastic and prevent
stenosis
-Laser treatment - reduces vulvovaginal symptoms and restores
vaginal mucosa; 3 treatments every 4-6 weeks
Perimenopause - ANSWER--transition phase between regular
menstrual periods and no periods at all
-Usually occurs ~40 ( dependent on multiple factors)
-Many menstrual irregularities around this time
-This time last 2-8 yrs, average 5
, Risk factors for experiencing Menopause at an early age? - ANSWER--
Smokers
-Type 1 DM
-Increased altitude
-Undernourished/ newly vegetarians
-Cancer treatment
-Hysterectomy
Treatment for : Perimenopause - ANSWER--Catered towards
presenting symptoms
-Bleeding - after confirming bleeding is benign and from hormonal
instability: COC, POP, LNG-IUD, cycling progesterone, cryoablation
-Vaginal atrophy - OTC lubricants, vaginal estrogen RX
-Mood irritability - antidepressants - SSRI (fluoxetine 10mg), Effexor
37.5mg
-Menopausal symptoms - often relieved if you can stabilize hormones.
COC a good option. Gabapentin (neurontin) reduced HF/NS
Perimenopause: Education - ANSWER--Anticipatory guidance -
Should begin at age 40
-Vaginal dryness/Atrophy: Replens, Astroglide, KY jelly, lubrin,
Canola oil, Vit E 100-600/day, evening primrose oil 2-4 capsule/day
-Diet, Exercise for prevention of osteoporosis, Calcium 1000-
1200mg/day with 1000IU/day of Vit D
-Yearly mammogram and pelvic examination & BSE
-Need for contraception until 1 year of no menses
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