View source for WBR0350

 {{WBRQuestion
|QuestionAuthor=Neeraja Danda M.B.B.S
|ExamType=USMLE Step 2 CK
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|Prompt=A  50 year old  female with a history of hypertension for the last 5 years presents to her physician’s office for  an annual physical examination. In the history her last menstrual period was 8 months ago, and she shows interest in knowing about menopause and its effects. Further questioning reveals that her father died of Myocardial Infarction at the age of 60 and mother is hypertensive. She says she has been researching about menopause recently and asks “Can I take estrogen replacement to decrease my risk of coronary artery disease”. Administration of estrogen replacement  leads to which of the following?
|Explanation=Menopause is caused by decreased production of estrogen and progesterone from  oocytes in females and usually between the age of 48 to 52 years. It is diagnosed by elevated levels of gonadotropins (FSH and LH) . Decreased estrogen in menopause may lead to Osteoporosis, Hot flashes, vaginal dryness, and increased LDL levels, Decreased HDL levels. Until the onset of menopause women are considered to be at lower risk for coronary artery disease than men because of the protective effect of estrogen. But Hormone replacement therapy can never be given to prevent risk of Coronary artery disease. Studies say hormone replacement therapy may decrease the levels of low density lipoproteins but cannot decrease the risk of coronary artery disease.

'''Educational Objective''': After menopause the protective effect of estrogen over coronary artery disease risk in females Is lost. While administration of estrogen to post-menopausal women decreases LDL, it does not decrease the risk of coronary artery disease

'''References''': Page 50, 482  Master the Boards Step 2 CK  Second edition, Page 445 Master the boards Step 3 2009 edition
|AnswerA=50% decrease in the risk of Coronary artery disease in this patient
|AnswerAExp='''Incorrect''' Estrogen does not decrease risk of coronary artery disease
|AnswerB=20% decrease in the risk of coronary artery disease in this patient
|AnswerBExp='''Incorrect''' Estrogen does not decrease the risk of coronary artery disease
|AnswerC=25% decrease in the risk of coronary artery disease and 25% decrease in low density lipoprotein levels
|AnswerCExp='''Incorrect''' Estrogen may decrease low density lipoprotein levels but may not help coronary artery disease
|AnswerD=No decrease in low density lipoprotein levels
|AnswerDExp='''Incorrect''' Estrogen may decrease Low density lipoprotein levels
|AnswerE=Decreased low density lipoprotein level but may not help in Coronary artery disease
|AnswerEExp=Administration of estrogen to post-menopausal women decreases LDL, it does not decrease the risk of coronary artery disease
|RightAnswer=E
|Approved=Yes
}}