NAMS MENOPAUSE CERTIFICATION EXAM
2024 | ACTUAL REAL EXAM TEST BANK
WITH 2 CURRENTLY TESTING VERSIONS
WITH 100 QUESTIONS EACH AND A STUDY
GUIDE
Red flags for headache - ANSWER>>Systemic symptoms (fever, weight loss,
rash)
Systemic illness malignancy, immunosupression
Neurologic symptoms and/or signs in consciousness
Sudden/abrupt onset
new onset or progressive
New/different from previoux headache hx
Abortive therapy for migraine - ANSWER>>triptans, NSAIDs
Preventative therapy for migraines - ANSWER>>Beta Blockers (propranolol) ,
Antiepileptic Drugs (divalproex), Tricyclic Antidepressants (amitriptyline)
Hormone therapy for headache - ANSWER>>CAn be used to mitigate falling
estrogen levels, no product FDA approved; can add lowdose estrogen
supplement during w/d phase of ocp, use continuous HT; if progesterogen
causes, switch to micronized
What to consider when evaluating women with arthralgia - ANSWER>>2/2 to
menopause
2/2 to arthritis
2/2 to other rheumatologic condition
Causes of myalgia - ANSWER>>drug induced (statines, fibrates)
endocrine (vit D deficiency, thyroid, cushings)
,Menopause
plymyalgia rheumatica
Causes of bone pain - ANSWER>>metagolic (pagets disease)
neoplasia (multiple myeloma, metastatic
infections
fracture
Perimenopause STRAW staging - ANSWER>>-2 to +1a;
POI - ANSWER>>Loss of ovarian follicular activity prior to the age of 40
Prevalence of POI in US - ANSWER>>3%
T/F Premature menopause is a risk factor for CAD - ANSWER>>True
- higher risk for abdominal adiposity, dm, dyslipidemia
Etiology of premature menopause - ANSWER>>1) Iatrogenic/Indused (surgery,
chemotherapy, cystectomy, hysterectomy, radiation)
2) spontaneous (genetic disorders, x-chromosome disorder (monosomy,
trisomy); specific mutations: POF1, POF2, FMR genes
3) autoimmune causes: polyendocrine syndromes, other endocrinopathies, non-
endocrine auto-immune conditions
4) idiopathic
Diagnosis of POI - ANSWER>>H&P
Labs:
- TSH
- Prolactin
- Pregnancy test
- Elevated FSH (>25 IU/L on 2 checks/4-6 weeks apart)
,- AMH
- E2 can fluctuate greatly
- Low AFC
Assessment of etiology of POI - ANSWER>>Genetic testing
Autoimmune workup
- TSH, thyroperoxidase antibody, 21-OH antibodies, fasting glucose, HbA1C
- Ovarian antibodies lack sensitivity and specificity
Estrogen therapy in premature menopause - ANSWER>>Transdermal 17 (100
mcg/d patch or gel)
Oral 17B estradiol 2mg/day
vaginal ring: 17B .1mg/day
Oral CEE: .9-`1.25mcg/day
Should you check estradiol levels for prematures - ANSWER>>Can consider,
adjust therapy to achieve goal range of 80-120 pg/ml
Use of progestogen in premature menopause - ANSWER>>No studied
General principle, use higher doses; micronized 200-400 mg/d (cont/cyclically)
or IUD
COCs vs estrogen in younger women - ANSWER>>May be more socially
acceptable; lower cost
Better bone outcomes and lower blood pressure with replacement estradiol
(limited evidence)
Production of androgens - ANSWER>>Comes from zone retic and ovaries
Consider testosterone replacement in POI and surgically postmenopausal women
- ANSWER>>yes
, T/F Fat and lean mass increase prior to menopausal transition - ANSWER>>true
Rate of fat gain doubles and lean mass declines during menopausal transition;
when do things stabilize? - ANSWER>>about 2 years after FMP
Weight gain during menopausal transition - ANSWER>>2-4 fold increase in fat
mass (6%, 1.6kg over 3.5 years
.5% loss of lean muscle
Changes in weight gain during peri/meno - ANSWER>>Premenopaust weight
increase,MT - stead increase, post meno no change
Should calorie intake decrease in post menopause - ANSWER>>yes likely driven
by decreased active energy expenditure
HRT on cardiovascular risk factors - ANSWER>>IN women w/o DM, HRT (oral or
transdermal E+/-P) improves lean body mass, reduces abdominal adiposity,
improves insulin resistance, improves lipids, decreases BP
When to add anti-obesity medication - ANSWER>>Initiate weight loss
medication as adjunct to lifestyle:
- if BMI (27-29.9 in presence of comorbid)
- If BMI >30 and failure of lifestyle
Weight loss w/ orlistat - ANSWER>>~8%
GI lipase inhibitor
poop in your pants
Climacteric phase - ANSWER>>The period of endrocrinologic, somatic, and
transitory psychologic changes that occur around the time of menopause.
Early menopause - ANSWER>>LMP before age 45
