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Clinical Discipline(s)/Organ System(s)
Obstetrics & Gynaecology, Reproduction & Development, Endocrinology
Progress Test Topic(s)
Women's health
A 52 year old NZ European woman presents to her GP with hot flushes, night sweats, mood swings and lack of energy. These complaints have been present for the last 3 months and are increasing in intensity and severity. Her menstrual cycle is irregular with intervals between 1 and 3 months.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Biological and endocrinological changes during the menopausal transition phase
   - The process and staging of ovarian ageing
   - Changes in the female reproductive tract during menopausal transition
   - Changes in bone and lipid metabolism, vessel dynamics, thermoregulatory centre, hair and skin during menopausal transition
   - Differentiation between ageing and menopause
   - Mechanism of action of menopause-related drug therapy; complementary and alternative medicines
   - Finding reliable information about drugs
   - Legal aspects of prescribing, prescribing outside marketing authorisation
Clinical and Communication Skills 
   - Elicit a history from a menopausal woman
   - Clinical examination as appropriate (blood pressure measurement, thyroid, breast and pelvic exam if indicated by history)
   - Differential diagnosis for hot flushes
   - Awareness that gonadotrophin levels are not routinely indicated for diagnosis
   - Knowledge and causes of iatrogenic menopause and premature ovarian failure
   - Appropriate management plan including behavioural and lifestyle changes
   - Indications and contraindications for local and systemic hormone therapy; discussing prescribing options with patients
   - Risks related to the use of hormone therapy
   - Alternative therapy for management of hot flushes (lifestyle, paced breathing, cool environment, exercise, prescription and non-prescription medications)
   - Appropriate follow-up of women using hormone therapy
   - Assessing sexual health and refer for counselling if needed
   - Assessing bone health and indications for and interpretation of bone mineral density test
Personal and Professional Skills 
   - Empathetic and sensitive consulting style
   - Normalising the menopause transition and normal ageing
Hauora Māori 
   - Consideration of patient and whānau cultural and spiritual support needs
Population Health 
   - Cultural differences in the perception of menopause
   - Opportunity to assess health and discuss screening for chronic diseases relevant to older women
Conditions to be considered relating to this scenario
normal menopause and perimenopause, urogenital atrophy, thyroid disorders, anxiety, medications, alcohol, caffeine, osteopenia, osteoporosis, osteoarthritis
chemotherapy toxicity, radiotherapy toxicity, surgery, premature ovarian failure, carcinoid syndrome, pheochromocytoma, mastocytosis, fragile X syndrome
Related Scenarios
[Postmenopausal bleeding]