Polycystic Ovary Syndrome

Question 1

To diagnose PCOS, we need 2 out of 3 criteria, what are they?

Answer 1

Features of hyperandrogenism, Menstrual cycle disturbances, and Polycystic ovaries on US

Question 2

On Pelvic US we are looking for?

Answer 2

An ovary with over 20 follicles, 2-9mm in diameter

Question 3

Most accurate test of glycemic status

Answer 3

OGTT

Question 4

Which neuropeptide involved in regulating the HPO axis is the bio marker involved?

Answer 4

Kisspeptin

Question 5

Clinical manifestations of PCOS

Answer 5

Hirsutism, acne, hair loss, irregular menstrual cycles, so on

Question 6

Insulin resistance is a factor in PCOS?

Answer 6

Yes

Question 7

How do we reduce their metabolic risk of PCOS?

Answer 7

diet/lifestyle, 500mg Metformin, increase by 500mg every 2 weeks. Max is 2.5grams. Essentially don’t make them fat.

Question 8

What is the gold standard method for clinical evaluation of Hirsutism?

Answer 8

Modified Ferriman Gallwey Score.

Question 9

First line management for Hyperandrogenism?

Answer 9

COCP

Question 10

2nd line management for Hyperandrogenism?

Answer 10

Diane. Which is 35 ethinyl estradiol with 2mg cyproterone acetate

Question 11

The topical drug Eflornithine 13% does what? Why do we use it?

Answer 11

It inhibits hair growth, as such helpful with Hirsutism

Question 12

Principles of management for anovulatory infertility

Answer 12

Weight loss, 400mcg folic acid,

Question 13

First line medical treatment to induce ovulation?

Answer 13

Letrozole.

Question 14

Letrozole dosage

Answer 14

2.5-7.5mg for 5 days

Question 15

2nd line medical treatment to induce ovulation

Answer 15

Gonadotrophins, use low-dose step up regimen to optimize the follicular growth

Question 16

3rd line option if both first and second line ovulation induction therapies failed?

Answer 16

IVF

Question 17

A 30-year-old woman with PCOS and a BMI of 38 is planning pregnancy. She has failed lifestyle modifications. What is the most appropriate next step?
A) Letrozole ovulation induction
B) Bariatric surgery
C) Immediate IVF
D) Clomiphene citrate

Answer 17

Bariatric surgery

Question 18

A 25-year-old woman with PCOS is started on spironolactone for hirsutism. What is the most important counseling point?
A) Avoid pregnancy due to teratogenicity
B) Monitor liver enzymes monthly
C) Expect results within 1 month
D) Take with high-potassium foods

Answer 18

A

Question 19

Which of the following medications for PCOS-related hirsutism is contraindicated in pregnancy due to risk of undervirilization of a male fetus?
A) Spironolactone
B) Metformin
C) COCPs
D) Finasteride

Answer 19

D

Question 20

Which of the following is a late sequela of untreated PCOS?
A) Osteoporosis
B) Endometrial carcinoma
C) Hyperthyroidism
D) Autoimmune oophoritis

Answer 20

B