BHRT Part 2 Post test and Evaluation April 9-11, 2010
 

1. Default Section

 

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1. Please fill out the following information for the permanent record of your certificate.

Please type in N/A in sections that are not pertinent.

FCM does not sell or share our participant database information lists.

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2. Medical Designation

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3. How many credit hours did you attend?
(60 minutes = 1 credit hour)

Maxiumum Credit Day 1: 5.0
Maxiumum Credit Day 2: 9.0
Maxiumum Credit Day 3: 6.0

Maximum Credit for all 3 days is 20

The healthcare provider should only claim credit
commensurate with the extent of their participation in the activity.

POST TEST
CASE STUDY #1: A 30 y/o woman presents with symptoms of polysystic ovary syndrome, acne, hair loss, and irregular periods.

4. Of the following therapies, which one has been proven beneficial in the treatment of PCOS?

5. Which therapy is safe to take throughout pregnancy?

6. Hair loss in men can be treated with all of the following therapies EXCEPT:

7. Hair loss in menopausal women has been successfully treated with which therapy?

8. Hirsutism in women can be treated with which therapy?

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9. CASE STUDY #2: A 57 y/o menopausal patient who has taken hormones for 5 years, reports to you that her primary care physician took her off all hormones because of recent media reports that hormones increase risk of breast cancer and heart disease. She reports that her doctor stated that you were trying to kill her. You try to educate your patient that all hormones are not the same and that some are safe and some are not.

Understanding this how would you answer the following?

A 57 y/o woman with HTN and DM should NOT be treated with oral estrogen.

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10. Transdermal estrogen increases CRP (C-reactive protein), Triglycerides, Prothrombin II.

11. Transdermal estrogen effectively lowers SHBG (Sex hormone binding globulin).

12. Case Study #3: A 65 y/o woman who has never taken hormones desires to take menopausal hormones. She has no cardiac risk factors and plays tennis everyday.

Which Estrogen is best for cardiovascular protection?

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13. Testosterone negates (lowers) the increase in CRP and triglycerides seen with oral estrogen.

14. Oral estrogen improves libido better than transdermal.

15. Transdermal estrogen is contraindicated in any woman with a personal or family history of blood clots.

16. CASE STUDY #4: Your menopausal patient reports back to you that her physician took her off hormones because the hormones increase the risk of breast cancer as per the WHI Study. Your patient has stopped her hormones after researching that her physicain was indeed correct. You also agree to stop hormones due to this concern that all hormones are the same.

Micronized progesterone has been shown to decrease the incidence of breast cancer.

17. CASE STUDY #5: A 55 y/o male with heart disease can not tolerate any statin due to side effects. This patient is now asking for something natural to take instead of drugs.

Nicotinic acid has been proven to lower Lipoprotein A, Apo-Lipoprotein A, triglycerides,
LDL cholesterol.

18. CASE STUDY #6: A 40 y/o woman presents with sever fatigue. She has tried multiple medications without success and has seen multiple doctors without relief. She inquires about hormones.

Cortisol and thyroid hormones have demonstrated clinical efficacy in the treatment of Chronic Fatigue Syndrome.

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19. Case Study #7: A 65 y/o woman who has taken HRT for 15 years is concerned about her need to continue HRT. She read where estrogen can cause heart attacks and should be stopped as recommended by experts. You recommend resuming hormone treatment for bone and cardiovascular protection. Besides monitoring hormone levels, you monitor other parameters.

Elevated leveal of 2-OH hydroxyestrone are beneficial.

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20. The goal of osteoporosis therapy is to keep the NTX (N-telopeptide of type I collagen) levels high.

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21. Women over 65 who have been taking menopausal hormones should stop taking them due to increased incidence of heart attacks.

COURSE EVALUATION

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22. How would you rate the overall course?

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23. How would your rate the impact of this course on your practice?

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24. Please rate the following faculty:

Neal Rouzier, MD

Knowledge of the subject:

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25. Neal Rouzier, MD

Ability to respond to questions:

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26. Neal Rouzier, MD

Did the speaker present, without bias, a balanced discussion of competing therapeutic options or treatment strategies?

27. Comments about Dr. Neal Rouzier

OBJECTIVES

1. Outline key elements in HRT presented in Part One: Mastering the Protocols for Optimization of Hormone Replacement Therapy.
2. Identify important issues in the relationship between hormones and cancer: cause, provocation or protection?
3. Outline problem-solving techniques for difficult cases presenting with multiple disease processes and the potential benefits of hormones.
4. Discuss literature citing new indications, risks, benefits and complications of estrogen, progesterone and testosterone therapy.
5. Determine advanced treatment modalities and dosing strategies for estrogen and progesterone, including new and specific approaches to these therapies.
6. Describe important aspects of the WHI findings: identify the experts that refute this study, and other factors not included in the trials that would change the conclusions.
7. Determine advanced treatment modalities, including new and specific approaches to HGH, thyroid and testosterone in age management and disease prevention.
8. Discuss over 40 articles that demonstrate thyroid replacement does not cause osteoporosis, even in TSH suppressive doses.
9. Distinguish various new therapies for erectile/sexual dysfunction in men and women.
10. Describe the epidemiology of cardiovascular disease and diabetes and the various treatment strategies as they pertain to medication, diet, exercise, lifestyle change and nutritional supplements.
11. Explore the role of omega 3 fatty acids, antioxidants and glucose and their influence on insulin, inflammation, disease progression and atherosclerosis.
12. Describe the strategies for using the new cardiovascular risk markers, inflammation markers, new lipid parameters and how to make sense of all the new lipid fractionation components.
13. Explore the role of niacin and EFA in diabetes and atherosclerosis.
14. Identify rational approaches to vitamins and supplements with a review of the medical literature supporting their use in wellness as well as citing any harmful effects and interactions.
15. Determine current screening methods and management strategies of the most common pre-menopausal hormone disorder, Polycystic Ovary Syndrome (PCOS).
16. Implement diagnostic and treatment strategies for PCOS.
17. Apply diagnostic and treatment strategies for hirsutism and hair loss.
18. Implement strategies for treating osteoporosis using hormone replacement therapy.
19. Discuss interesting cases in bioidentical hormone replacement therapy.
20. Identify current indications, risks and benefits of using cortisol for the treatment of chronic fatigue.
21. Determine rational approaches for the evaluation of fatigue with emphasis on cellular hypofunction as it pertains to thyroid hormone.
23. Describe, based on the literature, when to use oral vs. saliva testing.
24. Utilize the knowledge gained to improve patient outcomes in BHRT.

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28. Were the objectives met?

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29. Did this CME Workshop provide you with additional tools to manage your patients using Bio Identical Hormone Replacement Therapy in the prevention and treatment of disease?

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30. Will you make any changes in your practice/patient care as a result of this activity?

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31. If you answered "Yes", which changes will you make? (choose all that apply)

32. If you answered "No", please describe why:

33. If Barriers prevent you from making a change in your practice/patient care (Describe the barriers)

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34. Please identify topics on BHRT you would like to see presented in future workshops?

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35. Please identify 1 practice gap that needs to be addressed for each topic you identified in question #33.

Thank you for taking the time to answer all of our questions. Your feedback will empower us to continue to provide quality and important continuing medical education programs.

You will now be directed to your statement of credit which can be filled out and printed for your records.

After your certificate appears please fill out top section by clicking above first, last name and your medical designation and typing in the appropriate information in each of those sections.

Please also fill out the hours you ACTUALLY attended by clicking in that section and typing the # of credit hours you attended.

Then place your curser and click in the section that is appropriate to the credit you will be requesting (physician, nursing, pharmacy, or other)and a check mark will appear.

You can than print the certificate for your records.

After the certificate has printed you will need to sign your certificate on the signature line and if you are a pharmacist you will additionally need to fill in the date you printed the certificate.

Again we THANK YOU for your time and for attending this workshop.

Should you have any problems/issues please contact FCM at 425-821-9917 or email us at www.fcm.cme@verizon.net