FINAL CMN 572 EXAM QUESTIONS
WITH VERIFIED ANSWERS
DIAGNOSTIC TEST IS DEXAMETHASONE SUPPRESSION TEST (take
dexamethasone at night and test cortisol levels in am)
tx: prevention by limiting long term high dose steroid use, taper doses appropriately
(most patients on steroids for >2-4 wks will dev adrenal suppression)
calicium and vitamin D
surgical resection of tumor
addison's disease - Answer-chronic adrenocortical insufficiency
80% are due to autoimmune adrenal destruction (TB is common cause in areas where
TB is prevalent)
secondary adrenal insufficiency can occur after abrupt DC of cortisosteroids
sx: increased skin pigmentation, weakness, fatigue, anorexia, weight loss, NV, diarrhea,
amenorrhea, sparse axillary hair, hypotension, small heart
TREATMENT OF CHOICE IS HYDROCORTISONE 15-30 MG/DAY (prednisone is alt)-
dose will need to be increased with infection, trauma, surgery, stress
menopause - Answer-diagnosis is made with absence of menstruation for 12
consecutive months (due to normal aging or removal of ovaries)
premature menopause occurs before 40 yrs (risk factors for early menopause are
smoking, hysterectomy, oophorectomy, autoimmune disorders, living at high altitude,
chemo/radiation)
average age of menopause is 51 yrs
FSH: 25.8-134 (increased)
estrogen decreases
LH, progesterone, DHEAS, testosterone, beta hcg, TSH, lipids, CBC, CMP
estrogen - Answer-e1: estrone; converted by aromatization in adrenals
e2: estradiol; produced by ovaries and testes
,e3: only of clinical value in pregnant women
levels after menopause: 0-40- decreased
luteinizing hormone (LH) - Answer-FSH stimulates follicular activity (egg production and
growht) which increases estrogen , the pituitary notes increased estrogen then stops
FSH and increases LH
LH releases the egg: empty follicles are filled with cellular activity (corpus luteum) which
releases progesterone to support pregnancy
postmenopause: 15-54
progesterone - Answer-prepares the uterus to receive fertilized egg and supports
pregnancy
higher level indicate successful ovulation
HRT: used alone or with estrogen in pts with intact uterus; SE: breast tenderness,
weight gain, fatigue, vaginal bleeding, menses resumption
DHEA - Answer-created by the adrenal gland and brain
leads to production of estrogen and androgens
may contribute to ovarian, prostate, and breast CA
testosterone - Answer-produced by the ovaries; contributes to estrogen production
production will continue even after estrogen production ceases
helpful for libido, bone, and muscle mass
high levels are associated with polycystic ovaries
summary of menopause hormones - Answer-FSH: increased (accompanied by
decreased estrogen)
LH: increased with ovulation; levels NOT required for dx of menopaise
estrogen: considerably decreased with menopause
progesterone: considerably decreased with menopause
testosterone: may be decreased (decreased libido)
sx of menopause - Answer-hot flashes (#1)
, insomnia, vaginal atrophy, weight gain/bloating, mood changes, irregular menses,
mastodynia, depression, HA
hot flashes - Answer-intense heat associated with sweating and flushing
can occur 6 yrs before and up to 7 yrs after menstruation ceases
african american women report longer vasomotor sx
vaginal atrophy - Answer-in early menopause, the vaginal epithelium is bright red due to
thinning
in late menopause, vaginal walls are pale and smooth due to loss of rugation; ovaries
are no longer palpable (fibroids shrink), intercourse may be painful (dyspareunia);
possible bladder and uterus prolapse due to loss of muscle tone
endometrium changes with menopause - Answer-usually thins and atrophies
hypertrophic/thickened endometrium could be due to estrogen therapy or may be a sign
of endometrial CA- do bx! (>5 mm)
benefits of HRT - Answer-womens health initiative suggests that women in their 50s
benefit in regards to heart disease protection
women >/9 yrs post menopause face increased risk of colorectal CA, CAD, MI, total
mortality and chronic illness with HRT
provides vasomotor relief, decreases unwanted pregnancy, avoids irregular
menstruation, preserves bone health, decreases risk of disease, improves quality of life
contraindications of HRT - Answer-pregnancy
undiagnosed vaginal bleeding
severe liver dx
venous thromboembolism
personal hx of breast CA
may consider HRT in pt who has been sucessfull treated for well differentiated
endometrial CA
treatment options of HRT - Answer-estrogen (conjugaed or estradiol)
progesterone (micronized progesterone, progestin, medroxyprogesterone,
norethindrone)
patch: estrogen, estrogen/progestin, estrogen/testosterone; change once a week
