NMS Q&A Family Medicine

126 NMS Q&A Family Medicinecycle. Her apical rhythm is regular and the rate is 84.You proceed to entertain a differential diagnosis ofthis complaint. Which of the following diagnoses isthe least likely as a cause of this patient’s problem?(A) Neurotic depression(B) Thyrotoxicosis(C) Premenstrual syndrome(D) Incipient menopause(E) Hypoglycemic episodes5 Regarding the patient in Question 4, the doctornotices skin changes toward thinness and dryness.Which of the following levels of follicle-stimulatinghormone (FSH) is confirmatory of menopause as acause of her depression?(A) 20 IU(B) 30 IU(C) 40 IU(D) 50 IU(E) 60 IU6 Regarding the patient in Question 5, she asks about hormonetherapy. Which of the following is correct regardinghormone replacement therapy (whether estrogenalone, i.e., ERT, or estrogen/progesterone replacementtherapy, known as HRT) after menopause?(A) HRT is protective against cardiovascularatherosclerotic disease.(B) If progesterone is cycled in an overlappingfashion with estrogen cycling, HRT is protectiveagainst breast cancer.(C) Cycled estrogen with progesterone poses a riskof endometrial carcinoma.(D) Conjugated equine estrogen (CEE) given dailyat 0.625 mg is protective against osteoporosis.(E) HRT with 0.625 mg of CEE given daily protectsagainst senile dementia.7 What is the approximate lifetime risk of hip fracturein octogenarian women?(A) 5%(B) 10%(C) 20%(D) 33%(E) 50%8 Besides suddenness of onset, the way in whichsurgical menopause is most likely to differ fromphysiologic menopause is in which of the followingcharacteristics?(A) Depression is more of a problem in surgicalmenopause.(B) Atrophic vaginitis is more severe in surgicalmenopause.(C) Osteoporosis is a greater issue in physiologicmenopause.(D) Heart disease is a greater risk after surgicalmenopause.(E) Loss of libido is more likely after surgicalmenopause.9 A 65-year-old slightly built white woman who is acigarette smoker is brought to you by her daughter,who is a nurse. The daughter knows that her mother,as a small-boned person, is at high risk for hip fracture,as well as vertebral and radial fractures, as shegrows older. The daughter is aware that hip fracturecarries a 20% first-year mortality rate and is concernedthat if her mother is not placed on hormonereplacement therapy then she may suffer that fate.Despite acknowledging that HRT has lost favor andthat few physicians are prescribing it as a routine, shepresses for hormone replacement. You attempt toplace this information in perspective for the family ofthis woman. Thus, you point out that the rankingcause of death in postmenopausal females is which ofthe following?(A) Coronary artery disease (CAD)(B) Endometrial carcinoma(C) Carcinoma of the breast(D) Hip fracture mortality in the first year after theoccurrence(E) Stroke10 Regarding the patient osteoporotic, smoking patient,you feel the need to address the smoking issue withthe 65-year-old Caucasian woman and her daughter,who is a nurse. Which of the following is the mostcomplete and correct perspective?(A) Smoking’s detrimental effect is 10% as strong asestrogen’s beneficial effect and increases theCAD risk by 25%.(B) Smoking’s detrimental effect is 25% as strong asestrogen’s beneficial effect and increases theCAD risk by 25%.(C) Smoking’s detrimental effect is equal, negatesestrogen’s beneficial effect, and increases CADrisk by 50%.(D) Smoking is twice as detrimental to bone densityas estrogen is beneficial.(E) Smoking is irrelevant to bone density as long asthe patient is given HRT, but smoking increasesCAD risk.11 What is the best course of action to take if (mild)uterine bleeding occurs for longer than 6 monthsafter institution of HRT, whether estrogen and progesteroneare cycled with 25 days (estrogen) overlappingwith 10 days progesterone or each drug taken