18 February 2016.
The materials to be used for Julie's tutorial are in the Dropbox folder "materials for the tutorials". There is preliminary work to be done before listening to the podcast so make sure you check it out.
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69
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Tutorial. Julie Morris.
Medical statistics
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70
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SBA. Taxoxifen
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71
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SBA. Menopause diagnosis and definitions
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70. SBA. Tamoxifen.
Question 1.
Lead-in
What kind
of drug is Taxoxifen?
Option List
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A.
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aromatase inhibitor
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B.
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GnRH analogue
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C.
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selective
anti-oestrogen
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D.
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selective oestrogen-receptor blocker
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E.
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selective oestrogen receptor modulator.
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Question 2.
Lead-in
Which of
the following are current indications for using tamoxifen?
Option List
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A.
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reducing risk of development of breast cancer in women
+ve for BRCA1 & 2
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B.
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treatment
of oestrogen receptor –ve breast cancer
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C.
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treatment of oestrogen receptor +ve breast cancer
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D.
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treatment of HER2 –ve breast cancer
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E.
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treatment of HER2 +ve breast cancer
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Question 3.
Lead-in
How do
aromatase inhibitors work?
Option List
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A.
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negate the olfactory-ovarian feedback loop’s effects
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B.
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reduce DNA replication and cell division
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C.
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reduce
FSH production and oestrogen levels in premenopausal women
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D.
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reduce production of oestrogen from androgen
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E.
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none of the above
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Question 4.
Lead-in
How do
SERMS work?
Option List
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A.
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competitive
binding to oestrogen-receptors
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B.
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competitive binding to oestrogen-receptors in granulosa
cells
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C.
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competitive binding to oestrogen-receptors in the
anterior pituitary
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D.
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increased oestrogen receptor apoptosis
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E.
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none of the above
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Question 5.
Lead-in
What have
been the main uses of tamoxifen in gynaecology?
Option List
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A.
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peri and
postmenopausal oestrogen replacement therapy
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B.
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contraception, though no longer used
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C.
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ovulation induction as an alternative to clomifene
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D.
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osteoporosis prevention in premature ovarian
insufficiency
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E.
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none of the above
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Question 6.
Lead-in
Which, if
any, of the following are recognised
side-effects of tamoxifen?
Option List
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A.
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↑ risk
of cataract and retinopathy
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B.
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↑ risk
of endometrial pathology, including cancer
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C.
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↑ risk
of thrombocytopenia
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D.
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↑ risk
of thrombosis and VTE by a factor of 2-3
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E.
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menopausal
symptoms: hot flushes & sweats
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Question 7.
Lead-in
Which, if
any, of the following statements are true in relation to the risk of uterine
cancer in women using Tamoxifen?
Option List
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A.
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the
overall risk of endometrial cancer is
increased by a factor of 2-3
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B.
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the overall risk of endometrial cancer is increased by
a factor of 5-10
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C.
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the risk
of endometrial cancer is not
increased in postmenopausal women
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D.
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the risk of endometrial cancer is increased by 50% in premenopausal
women
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E.
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the risk is endometrial cancer is increased, but the
risk of sarcoma is not
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Question 8.
Lead-in
Which, if
any, of the following statements are true in relation to the risk of thrombosis
and VTE in women using Tamoxifen?
Option List
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A.
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the risk
is increased by a factor of 1.5-2
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B.
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the risk is increased by a factor of 2-3
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C.
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the risk is increased by a factor of 5-10
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D.
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the risk increases with age
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E.
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the risk increases if chemotherapy is given at the same
time
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71 SBA. Menopause definitions and diagnosis.
Abbreviations.
AMH: anti-Müllerian hormone.
FSH: follicle-stimulating hormone.
LH: luteinising hormone.
NG23: NICE Guideline 23. “Menopause: diagnosis and
management.” November 2015.
POF: premature ovarian failure.
POI: premature ovarian insufficiency.
Some of
the questions have no option list to make them harder.
Question 1.
Lead-in
Which
adjective did NICE use in relation to ideal care in recommendation 1.1.1 of
NG23?
Option List
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F.
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best
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G.
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holistic
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H.
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individualised
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I.
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personalised
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J.
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privatised
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Question 2.
Lead-in
What is
the average age at the menopause?
Option List
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F.
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49 years
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G.
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50 years
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H.
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51 years
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I.
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52 years
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J.
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53 years
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Question 3.
Lead-in
What age limit is used for the diagnosis of premature
ovarian insufficiency?
Option List
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A.
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30 years
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B.
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35 years
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C.
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37 years
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D.
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40 years
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E.
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45 years
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Question 4.
Lead-in
What is the approximate incidence of premature ovarian
insufficiency?
Option List
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A.
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0.1%
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B.
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0.5%
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C.
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1%
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D.
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2%
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E.
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5%
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Question 5.
Lead-in
What is the definition of the perimenopause?
Option List
There is
none.
Question 6.
Lead-in
What is
the definition of the postmenopause?
Option List
There is
none.
Question 7.
Lead-in
What is
the definition of premature ovarian insufficiency?
Option List
There is
none.
Question 8.
Lead-in
A healthy physics
teacher of 35 is diagnosed as menopausal. There is no obvious explanation.
Which of the following conditions could be the undiagnosed hereditary cause?
Option List
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F.
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Cystic
fibrosis carrier status
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G.
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Elliptocytosis
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H.
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Fragile X carrier status
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I.
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Galactosaemia
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J.
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Polycythaemia vera
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Question 9.
Lead-in
A healthy
woman of 52 presents with amenorrhoea for 15 months and vasomotor symptoms. She
is not taking any drugs. What tests should be done to confirm the diagnosis of
the menopause.
Option List.
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F.
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FSH
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G.
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FSH & LH
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H.
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FSH & oestradiol
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I.
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AMH
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J.
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None of the above
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Question 10.
Lead-in
A healthy
woman of 46 presents with vasomotor symptoms and irregular periods. She is not
taking any drugs. What tests should be done to confirm the diagnosis of the
menopause?
Option List.
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A.
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FSH
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B.
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FSH & LH
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C.
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FSH & oestradiol
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D.
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AMH
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E.
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None of the above
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Question 11.
Lead-in
Which
tests does NICE say should not be used to diagnose the menopause and
perimenopause in women > 45 years?
List of possible investigations.
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A.
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AFCA
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B.
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MH
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C.
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CT scan of pituitary fossa
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D.
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inhibin A
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E.
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inhibin B
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F.
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oestradiol
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G.
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ovarian volume
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H.
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prolactin
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I.
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thyroid function tests
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Question 12.
Lead-in
What does
NICE recommend with regard to the use of FSH in relation to diagnosis of the
menopause?
Question 13.
Lead-in
What does
NICE recommend with regard to the use of FSH in relation to diagnosis of the
perimenopause?
Option List
There is
none.
Question 14.
Lead-in
What does
NICE say about the cost of FSH assay?
Option List
There is
none.
Question 15
Lead-in
What does
NICE recommend with regard to the use of oestradiol assay in relation to
diagnosis of the menopause and perimenopause?
Option List
There is
none.
Question 16.
Lead-in
What does
NICE recommend in relation to the diagnosis of POI?
Option List
There is
none.
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