Posted: July 26th, 2016

Primary’ Care/Family’ Medicine Clerkship

For’ each’ of’ the’ following’ clinical’ situations,’ choose’ among:’ no’ additional’ treatment,’ treatment’ with’ estrogen’ replacement’ alone,’ combined’ estrogen/progestin,’ bisphosphonate’ or’ selectiveIestrogen’ receptor’ modulator’ (SERM).’ (Assume’ in’ each’ case’ that’ you’ have’ counseled’ the’ patient’ regarding’ exercise’ and’ calcium/vitamin’ D’ supplements,’ as’ such’ recommendations’ go’ without’ saying!)’ Defend’ your’ answers’with’ the’ literature;’ for’ each’case,’ elaborate’ on’how’ age,’ medical’coImorbidities,’and’family’history’affect’your’ultimate’choice. 1. 66%year%old! female! with! a! history! of! HTN,! Diabetes! Mellitus,! both! well! controlled,!but!has!no!cardiac!history.!!Patient!has!a!positive!family!history! of! osteoporosis! and! her!mother! also! had! breast! cancer! at! the! age! of! 62,! which! was! estrogen%receptor! positive.! ! Bone! DEXA:! Hip! T%score=! %1.6,! spine! T%score=! %2.2.! The! patient! also! had! a! vaginal! hysterectomy! (with! preservation!of!ovaries)!for!fibroids,!20!years!earlier. 2. 54! year! old! female! who! is! concerned! about! osteoporosis! because! her! mother,! who! has! Alzheimer’s! disease,! just! fell! and! broke! her! hip.! The! patient!is!2! years!post%menopausal!and!has!an!intact!uterus.!The!patient! also! has! a! strong! family! history! of! heart! disease,! but! no! personal! risk! factors!other!than!a!cholesterol!level!of!241!with!an!HDL!of!37.!There!is!no! family! history! of! breast! cancer.! Bone! DEXA:!Hip! T%score! =!%2.4,! spine! T% score!=!%2.6

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