{
  "group": [
    {
      "group_id": "1",
      "questions": [
        {
          "question_id": "1_1",
          "question_text": "Which of the following statements about hormone therapy is <u>incorrect</u>?<sup>2</sup>",
          "type": "regular",
          "correct_answers": [
            -1,
            -1,
            0,
            -1
          ],
          "answers": [
            "The benefits to VMS from products that contain both estrogen and progestin are almost exclusively from the effects of estrogen.",
            "The addition of progestin to hormone therapy reduces the risk of endometrial cancer in women with a uterus that may occur when estrogen is used alone.",
            "Hormone therapy is used to decrease levels of natural hormones when the body produces them at a high level, such as during menopause.",
            "The hormones used as hormone therapy for menopause are similar to those produced by a woman’s body and can be natural or synthetic."
          ],
          "feedback": "",
          "guru_data": {}
        },
        {
          "question_id": "1_2",
          "question_text": "Which of the following correctly describes the patient population of the WHI clinical study?<sup>8</sup> (<i>Select all that apply.</i>)",
          "type": "regular",
          "correct_answers": [
            0,
            -1,
            -1,
            0
          ],
          "answers": [
            "Received CEE 0.625 mg/day if in the estrogen-alone arm",
            "Age 70 to 85 years",
            "Premenopausal",
            "Received CEE 0.625 mg/day plus MPA 2.5 mg/day if in the estrogen plus progestin arm"
          ],
          "feedback": "",
          "guru_data": {}
        },
        {
          "question_id": "1_3",
          "question_text": "Which of the following formulations is used as systemic therapy but can be prescribed in lower doses than oral products because the estrogen delivered is not dependent on liver metabolism and gastrointestinal absorption?<sup>5</sup>",
          "type": "regular",
          "correct_answers": [
            0,
            -1,
            -1,
            -1
          ],
          "answers": [
            "Transdermal",
            "Injectable",
            "Topical gel",
            "Vaginal ring"
          ],
          "feedback": "",
          "guru_data": {}
        },
        {
          "question_id": "1_4",
          "question_text": "Estrogen plus progestin products are available in which types of preparations?<sup>5</sup> <i>(Select all that apply.)</i>",
          "type": "regular",
          "correct_answers": [
            -1,
            -1,
            0,
            0
          ],
          "answers": [
            "Vaginal ring",
            "Vaginal cream",
            "Oral",
            "Transdermal"
          ],
          "feedback": "",
          "guru_data": {}
        },
        {
          "question_id": "1_5",
          "question_text": "<u>True</u> or <u>False</u>? A SERM is a drug that allows estrogen to act on some tissues but blocks the effect of estrogen on other tissues, such as the uterus.<sup>22</sup>",
          "type": "regular",
          "correct_answers": [
            0,
            -1
          ],
          "answers": [
            "True",
            "False"
          ],
          "feedback": "",
          "guru_data": {}
        }
      ]
    },
    {
      "group_id": "2",
      "questions": [
        {
          "question_id": "2_1",
          "question_text": "Results of randomized controlled trials support the use of which classes of agents for the treatment of VMS in healthy, nondepressed women?<sup>2</sup>",
          "type": "regular",
          "correct_answers": [
            -1,
            -1,
            -1,
            0
          ],
          "answers": [
            "SSRIs only",
            "SNRIs only",
            "Neither SSRIs nor SNRIs",
            "Both SSRIs and SNRIs"
          ],
          "feedback": "",
          "guru_data": {}
        },
        {
          "question_id": "2_2",
          "question_text": "Which of the following is an antihypertensive that is not US Food and Drug Administration (FDA)-approved for the treatment of VMS but is sometimes used in clinical practice?<sup>2</sup>",
          "type": "regular",
          "correct_answers": [
            -1,
            -1,
            -1,
            0
          ],
          "answers": [
            "Gabapentin",
            "Paroxetine",
            "Bazedoxifene",
            "Clonidine"
          ],
          "feedback": "",
          "guru_data": {}
        }
      ]
    },
    {
      "group_id": "3",
      "questions": [
        {
          "question_id": "3_1",
          "question_text": "Which of the following are lifestyle changes that a woman may use to potentially alleviate VMS?<sup>11,14,20,23</sup> <i>(Select all that apply.)</i>",
          "type": "regular",
          "correct_answers": [
            0,
            0,
            0,
            -1
          ],
          "answers": [
            "Using breathable, natural fiber clothing",
            "Refraining from smoking",
            "Dressing in layers",
            "Increasing caffeine consumption"
          ],
          "feedback": "",
          "guru_data": {}
        },
        {
          "question_id": "3_2",
          "question_text": "<u>True</u> or <u>False</u>? In addition to herbal therapies, other complementary therapies used by some women to alleviate VMS include acupuncture and yoga.<sup>14</sup>",
          "type": "regular",
          "correct_answers": [
            0,
            -1
          ],
          "answers": [
            "True",
            "False"
          ],
          "feedback": "",
          "guru_data": {}
        }
      ]
    },
    {
      "group_id": "4",
      "questions": [
        {
          "question_id": "4_1",
          "question_text": "<u>True</u>or <u>False</u>? According to ACOG guidelines for the management of menopausal symptoms, systemic hormone therapy with estrogen alone or in combination with progestin is the most effective therapy for VMS related to menopause.<sup>20</sup>",
          "type": "regular",
          "correct_answers": [
            0,
            -1
          ],
          "answers": [
            "True",
            "False"
          ],
          "feedback": "",
          "guru_data": {}
        },
        {
          "question_id": "4_2",
          "question_text": "<u>True</u> or <u>False</u>? According to the NAMS position statement on the use of hormone therapy as treatment for VMS, for symptomatic women with a uterus requesting hormone therapy, combination therapy protects against endometrial hyperplasia, either with a progestin or as a combination of CEE and bazedoxifene.<sup>26</sup>",
          "type": "regular",
          "correct_answers": [
            0,
            -1
          ],
          "answers": [
            "True",
            "False"
          ],
          "feedback": "",
          "guru_data": {}
        },
        {
          "question_id": "4_3",
          "question_text": "Which guideline states that menopausal hormone therapy must be individualized and tailored according to symptoms and the need for prevention, as well as personal and family history, results of relevant investigations, and the woman’s preferences and expectations?<sup>3</sup>",
          "type": "regular",
          "correct_answers": [
            -1,
            0,
            -1,
            -1
          ],
          "answers": [
            "ENDO",
            "IMS",
            "NAMS",
            "NICE"
          ],
          "feedback": "",
          "guru_data": {}
        }
      ]
    }
  ]
}