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Oral board studying Prep book > PCOS > Flashcards

PCOS Flashcards

1
Q

What is PCOS?

A

Endocrine disorder characterized by ovulatory dysfunction, hyperandrogenism and polycystic ovaries

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2
Q

How do you diagnose PCOS?

A

Diagnosis of exclusion
Rotterdam criteria need 2/3
Oligomenorrhea or amenorrhea
clinical or lab hyperandrogenism
polycystic ovaries (12 or more follicles)

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3
Q

What can PCOS increase your risk for?

A

Insulin resistance
nonalcoholic fatty liver disease
Slee apnea
Metabolic syndrome

Overall cardiovascular disease and diabetes

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4
Q

What is the evaluation for suspected PCOS?

A

Vitals
Weight
signs of hyperandrogenism
Labs showing hyperandrogenism
ruling out secondary causes of hyperandrogenism
Evaluation for metabolic dysfunction (diabetes and lipids)
Pelvic ultrasound (evaluate ovaries and endometrium)

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5
Q

What labs should be ordered to assess for hyperandrogenism in PCOS?

A

TSH
Prolactin
17OHP
Total and free testosterone ( if hirsutism)

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6
Q

How do you assess for diabetes in patients with PCOS

A

2hr glucose tolerance test
or
Fasting glucose with HbA1c

> 200= type 2 diabetes

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7
Q

What does 17OHP test for when obtaining the lab for PCOS evaluation?

A

nonclassical CAH due to 21 hydroxylase deficiency

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8
Q

What are clinical signs of hyperandrogenism?

A

Hirsuitism
Acne
Male pattern hair loss

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9
Q

How do you diagnose the metabolic syndrome?

A

Elevated BP (130/85)
Increased waist circumference (35+)
Elevated fasting glucose (>100)
Reduced HDL (<50)
Elevated triglycerides (>150)

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10
Q

What pregnancy things are women with PCOS at increased risk for?

A

Ovarian hyperstimulation
Multifetal pregnancy
GDM
Hypertensive disorders

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11
Q

Differential for PCOS?

A

PCOS
Thyroid disorders
Prolactin disorder
Primary ovarian failure
Hypothalamic dysfunction
NCCAH
Androgen secreting tumor
acromegaly

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12
Q

How do you test for non classical CAH?

A

Fasting 17OHP level in the follicular phase of menstrual cycle or random

Random level <4= normal
Fasting level <2= normal

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13
Q

If there is a elevated 17OHP level when testing for nonclassical CAH what is the next step?

A

ACTH stimulation test

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14
Q

How does weight loss impact PCOS?

A

As little as 5% weight loss can help to regular menstrual cycles and decrease metabolic abnormalities

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15
Q

What are lifestyle modifications for PCOS?

A

DIet and exercise

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16
Q

What type of diet modification is recommended for PCOS?

A

caloric restriction

17
Q

Management of PCOS to treat menstrual irregularities?

A

Combined hormonal contraceptives
Progestin contraceptives

18
Q

Management of PCOS to reduce risk of cardiovascular disease or diabetes?

A

Lifestyle modifications
Metformin

19
Q

Management of PCOS for ovulation induction?

A

Clomiphene
Letrozole

20
Q

What is letrozole and what is the dose used for ovulation induction?

A

Aromatase inhibitor
2.5mg/day starting on day 5 for 5 days

21
Q

What is clomiphene and what is the dose used for ovulation induction?

A

Antiestrogen
50mg/day starting on day 5 for 5 days

22
Q

Management of PCOS for hirsutism?

A

Antiandrogen + combination hormonal contraceptives

23
Q

What are the anitandrogens used for hirsutism treatment?

A

Spironolactone
Flutamide
Finesteride

24
Q

What medication has been FDA approved for treatment of hirsuitism?

A

Efluorthine

25
Q

What are nonpharmocologic treatments for hirsutism?

A

Mechanical hair removal
Laser hair removal

26
Q

What is spironolactone and what is the mechanism of action for hirsutism?

A

Diuretic and Androgen receptor antagonist

Mechanism of action= inhibition of ovarian and adrenal steroidogenesis, competes for androgen receptor in hair follicles, inhibits 5alpha reductase

27
Q

What is the dose of spironolactone for hirsutism and what are side effects?

A

25mg BID

Orthostatic hypotension
hyperkalemia
increased menstrual cycles

28
Q

What is flutamide and what is the mechanisms of action for hirsutism?

A

Androgen receptor agonist

29
Q

What is the dose for flutamide and side effects?

A

125mg/day
dry skin

30
Q

What is finasteride and what is the mechanism of action?

A

Antiandrogen that works by inhibiting 5 alpha reductase

31
Q

What is the dose for finasteride?

A

1mg daily

32
Q

What is efluorithine for hirsutism?

A

A cream applied twice daily to the face that works by inhibiting enzyme orthinine decarboxylase

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