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Most beautiful girl in the world
When doves cry
Purple Rain
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Lemonade
100
What is Late Onset Congenital Adrenal Hyperplasia?
1. Adult women with anovulation and hirsutism 2. Due to genetic defects in CYP21 enzyme 3. Prevalent amongst Ashkenazi Jews, Hispanics 4. Screen with a fasting 17-OHP level (<2 is normal)--(High levels of 17-OHP should prompt an ACTH stimulation test)
100
What is the first-line treatment for ovulation induction in PCOS women trying to conceive?
Clomiphene citrate 2nd line is exogenous gonadotropins, used if clomiphene fails
100
1) What NOT to order as a work-up for PCOS:  LH FSH Estradiol  OGTT Fasting Insulin Lipid panel Testosterone Dexamethasone challenge test
Estradiol Dexamethasone challenge test 
100
List the disorders one needs to rule out to diagnose PCOS?
CAH, Cushing's, Hypothyroidism, Premature ovarian failure, ovarian/adrenal neoplasm, drug-related condition
100
True or False: LH regulates aromatase activity in granulosa cells, FSH regulates androgen synthesis in theca cells?
False. LH --> theca cells FSH --> granulosa cells
200
What are some of the effects of weight loss on PCOS patients?
1. ↓ circulating androgen levels due to ↑ SHBG, causing resumption of menses 2. Improved pregnancy rates 3. ↓ hirsutism 4. Improved glucose and lipid levels 5. Weight loss agents (e.g. Orlistat, which inhibits lipid absorption in intestine) noted to show similar improvement in ovarian fxn 6. Gastric bypass surgery helps restore normal ovarian function 7. Weight loss effects in normal weight women with PCOS unknown
200
What risks are associated with clomiphene citrate?
1)  Multiple births (10% increased risk of twin gestation) 2)  Preterm birth 3)  Hypertensive disorders
200
What is the role of Insulin in PCOS pathogenesis?
Insulin synergizes with LH to increase androgens, decreases synthesis of SHBG (thus increasing Testosterone)
200
Is GnRH pulsatility increased or decreased in PCOS?
Increased
200
What is the role of Progesterone in pathogenesis of PCOS?
Infrequent ovulation --> low progesterone --> increased GnRH pulsatility increased
300
Who warrants screening for cardiovascular disease? What tests and how frequently? How do you decrease the risk?
1. All PCOS patients 2. Screen BMI, fasting lipid and lipoprotein levels, metabolic syndrome 3. Screen periodically because 20% of PCOS women convert to impaired glucose tolerance per year 4. Exercise and weight control 5. Studies show an increased prevalence of subclinical atherosclerosis compared to controls
300
True or false, ovarian drilling is a recommended treatment for PCOS?
False. Benefits undetermined, long term effects unclear.
300
List 5 criteria to diagnose metabolic syndrome:
1) waist circumference > 35in 2) triglyceride >150 3) HDL <40 4) BP >130/85 5) Fasting sugar >100
300
True or False: PCOS is a heritable syndrome
True
400
How do OCPs help treat menstrual disorders of PCOS?
Increase circulating SHBG Suppression of pituitary LH secretion Suppression of ovarian androgen secretion
400
What are the benefits to using Letrozole (aromatase inhibitor) compared to clomiphene?
Oral administration Shorter half life Higher implantation rates Lower multiple pregnancy rates
400
How many % of PCOS women have impaired glucose tolerance?
30-40%
400
Name the systemic sequelae of PCOS:
Diabetes, HTN, CAD, Sleep apnea, endometrial cancer
400
What percent of women with PCOS are obese?
80%
500
How does Metformin help treat PCOS?
Improves insulin sensitivity and lowers circulating insulin levels Insulin sensitivity helps decrease circulating androgen levels, thus ↑ ovulation rate
500
How do aromatase inhibitors work to induce ovulation in PCOS?
Prevent conversion of testosterone to estrogen. The testosterone build up causes increase of gonadotropin release to stimulate ovulation
500
What are the Rotterdam Criteria (2003) for diagnosing PCOS?
1. Hyperandrogenism 2. Oligomenorrhea or amenorrhea 3. Polycystic ovaries by ultrasound diagnosis (Must have 2 out of 3 for diagnosis)
500
What is the theorized mechanism of insulin resistance on hyperandrogenism in PCOS?
Hyperinsulinemia may result in decreased levels of sex-hormone binding globulin causing increased circulating androgen as well as stimulation of androgen production in the adrenal glands and ovaries
500
What complications of pregnancy are associated with maternal PCOS?
Gestational diabetes, pre-eclampsia and chronic hypertension