HRT Question

[stronghold]

A 48 yo woman complains of hot flashes. Her mom, 78 yo, has osteoporosis. Her father DIED at age of 56 due to MI. We want to give her hormonal replacement therapy. What is the most likely indication?
1- Hot flashes
2- Osteoporosis
3- MI

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[Modeselektor]

1. hot flashes. You can no longer give HRT for osteoporosis partly because HRT is implicated in causing 3 so giving it for indication 3 would be going full ******.

 

[ninjasurgeron]

A 48 yo woman complains of hot flashes. Her mom, 78 yo, has osteoporosis. Her father DIED at age of 56 due to MI. We want to give her hormonal replacement therapy. What is the most likely indication?
1- Hot flashes
2- Osteoporosis
3- MI

Haven't had repro patho yet. But my guess is hot flashes based on her age. Osteoporosis would be due to low estrogen levels causing decreased bone density but appears later on (not immediate). Just tackled cardio patho and estrogen is cardioprotective and an increased risk of MI is only seen in menopausal women (>65y/o).

What's the answer and explanation given?

 

[Doctosanthewan]

Yup, hormonal replacement is used for post-menopausal symptoms, mostly hot flashes and atrophic vaginitis (although, I think estrogen creams or pessiaries are preferred for the latter.)
HRT not used for osteoporosis (bisphosphonates much much better)
Also, no cardio benefits with HRT and it increases the risk of thromboembolism. Plus remember that unopposed estrogen greatly increases the risks for endometrial cancer and estrogen-dependent breast cancer.

 

[ninjasurgeron]

Yup, hormonal replacement is used for post-menopausal symptoms, mostly hot flashes and atrophic vaginitis (although, I think estrogen creams or pessiaries are preferred for the latter.)
HRT not used for osteoporosis (bisphosphonates much much better)
Also, no cardio benefits with HRT and it increases the risk of thromboembolism. Plus remember that unopposed estrogen greatly increases the risks for endometrial cancer and estrogen-dependent breast cancer.

Damn, I just based it on the fact that the other symptoms wouldn't be there yet. I have an offtopic question: Would you recommend hitting hard on Robbin's hard while still on MS2 or would Pathoma be a more efficient method?

 

[Doctosanthewan]

Damn, I just based it on the fact that the other symptoms wouldn't be there yet. I have an offtopic question: Would you recommend hitting hard on Robbin's hard while still on MS2 or would Pathoma be a more efficient method?

Don't beat yourself up... I'm already an MD, so these clinical sort of scenarios are typical, everyday sort of things you deal with. It won't come right off the bat, it takes a little time and experience to start building those bridges and integrations. What I can tell you though is study hard but smart and start trying to make cross-system connections from early and things become a lot easier.
Btw I actually have been using Pathoma lately since I decided to sit Step 1 (exam next week.. lol). The guy is impressively good, but I'd also strongly advise having something else to back up his material when you're first learning the discipline because his main focus is to delve into the barebones high-yield and testable stuff for step 1.
Don't bother reading all of Robbin's though (except the first 6 or 7 chapters), its overkill and I doubt you'd retain much of it, if any. I gave Robbins away years ago and been using Rubin's Pathology ever since. Well written, compact, concise, all winning ingredients IMO, but it also depends on what kind of learning style fits you best. I think that right there is the biggest challenge.

 

[Phloston]

Apart from telling you it's hot flashes (which it is), I'll bring a little Step 2CK material to the table:

Master the Boards 2CK makes a point that even if a patient has a family member with CVD, he or she is NOT to considered to be at increased risk for CVD unless that family member is/was BOTH:

1) a PRIMARY relative (parent or sibling; that's it. No aunts, uncles, grandparents, cousins).

2) under the age of 65 IF FEMALE, or under age 55 IF MALE.

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In the vignette you've given, although the patient's father died of MI at age 56, in terms of USMLE questions, that is NOT considered to be a contraindication because he was not 55 or younger. It's borderline, I know, but was probably intentional on the question-writer's end.

 

[ninjasurgeron]

Don't beat yourself up... I'm already an MD, so these clinical sort of scenarios are typical, everyday sort of things you deal with. It won't come right off the bat, it takes a little time and experience to start building those bridges and integrations. What I can tell you though is study hard but smart and start trying to make cross-system connections from early and things become a lot easier.
Btw I actually have been using Pathoma lately since I decided to sit Step 1 (exam next week.. lol). The guy is impressively good, but I'd also strongly advise having something else to back up his material when you're first learning the discipline because his main focus is to delve into the barebones high-yield and testable stuff for step 1.
Don't bother reading all of Robbin's though (except the first 6 or 7 chapters), its overkill and I doubt you'd retain much of it, if any. I gave Robbins away years ago and been using Rubin's Pathology ever since. Well written, compact, concise, all winning ingredients IMO, but it also depends on what kind of learning style fits you best. I think that right there is the biggest challenge.

I've actually been reading whatever the syllabus prescribed so I've got the general patho down. We've just had heme/oncology and my favorite jump to another topic would be from follicular lymphoma to the caspases discussed early on in Robbin's. I'll check out Rubin's. Thanks for the advice.