zaki
Forum Guru
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A 65-year-old white woman is referred to you by her orthopedic surgeon for possible estrogen replacement therapy. She had her last menstrual period at the age of 50. She first noted back pain at age 51 and first suffered a right femoral neck fracture at age 54. She has had a left femoral neck fracture and several spinal compression fractures since then. Although she had hot flashes for several months after menopause, she has been asymptomatic for several years.
The patient currently is taking a thiazide diuretic twice daily for mild hypertension, and she had an anterior myocardial infarction at age 60. Other medications include acetaminophen with codeine for her back pain and intermittent oral calcium.
She tells you that her mother had breast cancer and severe hypertension and died of a cerebrovascular accident at age 61. The patient has smoked 1.5 packs of cigarettes each day for 35 years and admits to drinking approximately 1 gallon of sherry each week. Although she has attempted to stop smoking and curtail her drinking for over a decade, she has been unsuccessful.
Pertinent findings on physical examination include a blood pressure of 146/88 mm Hg, a pulse rate of 80/min, obvious kyphosis and scoliosis, an increased anterior-posterior diameter to the chest, decreased range of motion of the back and hips, significant varicosities in the lower extremities, and significant genital atrophy.
Laboratory studies:
Plasma cholesterol 257 mg/dL
Triglycerides 185 mg/dL
Serum calcium 9.8 mg/dL
Serum phosphorus 3.5 mg/dL
Serum parathyroid hormone (PTH) 50 pg/mL
Serum thyroid-stimulating hormone (TSH) 1.2 ľU/mL
Urinary calcium excretion 179 mg/24 hr
Creatinine clearance 82 mL/min/1.73m2
You order a mammogram, which is reported to be normal, and a serum protein electrophoresis study, which also is normal.
Which of the following is an absolute contraindication to estrogen replacement therapy in this patient?
(A) Cigarette smoking
(B) Hypertension with her current medical therapy
(C) Previous myocardial infarction
(D) Delayed time interval between age of menopause and possible estrogen replacement therapy
(E) None of the above
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Maverick
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| veri
Forum Newbie
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The answer is E.
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| helpful
Forum Junior
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Yes Veri is right here as non of these things is an absolute contraindication to estrogen replacement therapy in this patient and not even H/O her mother had breast cancer and drinking are not contraindication in this patient
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| mansun7177
Forum Newbie
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Are you all sure that F/H of breast cancer is not a contraindication esp. in this lady who has no menopausal symptoms.
Also the recent AHA recommend that HRT not be considered for both primary and secondary prevention of CAD.
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SSS
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| helpful
Forum Junior
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Dear ss
the question is not to give this lady HRT it is "Which of the following is an absolute contraindication to estrogen replacement therapy in this patient?"
so the answer is none of above that is E
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| helpful
Forum Junior
Topics: 4
Posts: 49
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Am are right Zaki?
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| zaki
Forum Guru
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absolutely the answer is E,
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Maverick
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| Moozy
Forum Guru
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thanks.. that was a good question
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Inability is a disaster; patience is bravery; abstinence is a treasure, self-restrain is a shield; and the best companion is submission to Divine Will
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