[08.50] Polycystic Ovary Syndrome (PCOS) V2.pdf

5 to 10 percent

What is the global prevalence of Polycystic Ovary Syndrome among women of reproductive age

Stein 1935

Who provided the outdated definition of PCOS involving obesity and enlarged polycystic ovaries

Rotterdam Criteria

What is the name of the diagnostic criteria that requires 2 out of 3 findings to confirm PCOS

Menstrual irregularity, Hyperandrogenism, Polycystic ovaries on ultrasound

What are the three components of the Rotterdam Criteria

Phenotype A

Which phenotype is considered the classic form of PCOS and includes all three Rotterdam manifestations

Phenotype B

Which phenotype presents with anovulation and hyperandrogenism but anatomically normal ovaries

Phenotype C

Which phenotype presents with polycystic ovaries and hyperandrogenism but no anovulation

Phenotype D

Which phenotype presents with anovulation and polycystic ovaries but no hyperandrogenism

Alex

What is the mnemonic name for Phenotype A indicating all manifestations are present

Berta

What is the mnemonic name for Phenotype B indicating the ovaries are normal on ultrasound

Cary

What is the mnemonic name for Phenotype C indicating regular ovulation

Diana

What is the mnemonic name for Phenotype D indicating no hyperandrogenism

Insulin resistance

What is currently identified as the core problem and real culprit of PCOS

70 percent

Approximately what percentage of PCOS patients have insulin resistance or will develop it later

Hyperinsulinemia

What condition occurs when the body is less responsive to insulin and the pancreas produces more to compensate

Type 2 Diabetes

PCOS patients have a higher risk of developing which metabolic disease later in life due to insulin resistance

Androgens

High insulin levels disrupt normal ovarian function and stimulate the ovaries to produce more of which hormones

Testosterone

Which specific male hormone is typically elevated in PCOS

Hirsutism, acne, hair loss, and irregular periods

List four manifestations caused by excessive secretion of androgens

Anovulation

What term describes the failure to release a mature egg during a cycle leading to irregular menses

Corpus luteum

The absence of which structure in anovulation leads to a lack of progesterone

Progesterone

Which hormone normally opposes estrogen stabilizes the endometrial lining and triggers menstruation upon withdrawal

Unopposed estrogen

In anovulatory cycles the uterine lining thickens continuously due to what hormonal state

Endometrial cancer

Unopposed estrogen increases the long term risk for which specific malignancy

Basal layer

Severe focal ischemia in a thick endometrial lining can lead to the shedding of which deep uterine layer

Sex Hormone Binding Globulin or SHBG

Insulin resistance and high androgens inhibit the production of which protein in the liver

Increased free estradiol

Low levels of SHBG lead to what change in the level of biologically active estrogen

Estrone

Increased adipose tissue results in the peripheral conversion of androgens into which form of estrogen

Aromatase

Which enzyme in fat cells is responsible for the peripheral conversion of androgens to estrone

GnRH pulsatility Master regulator

Hyperestrogenic states in PCOS disrupt the frequency and amplitude of what master regulator of the cycle

Ovarian follicles

What are the polycystic structures seen on ultrasound actually composed of

Hypothyroidism

Which endocrine condition should be ruled out during the diagnosis of PCOS because of similar clinical features

Cyclic pelvic pain

What type of pain similar to dysmenorrhea can occur in PCOS due to estrogen dominance

30 to 35

At what age bracket does metabolism typically slow down making PCOS weight management more difficult

Modified Ferriman Gallwey Score

What is the name of the scoring tool used to assess the severity of hirsutism

Face, upper lip, chest, back, legs, and hypogastric area

Name the common areas for male pattern hair growth in hirsutism

Thick and coarse

How is the hair in hirsutism typically described compared to normal female hair

Acanthosis Nigricans

What is the term for thickened velvety and darker areas of skin found in intertriginous areas

Neck, armpits, umbilicus, elbows, and inguinal area

List the common sites for Acanthosis Nigricans

30 percent

Approximately what percentage of hyperandrogenic women exhibit Acanthosis Nigricans

Reversible

Is Acanthosis Nigricans considered a permanent or reversible skin condition

Spironolactone

Which medication is often given to address severe hirsutism and skin discoloration

Cortisol

Chronic work related stress can act as a trigger for PCOS by increasing the levels of which hormone

Diet, lack of sleep, and sedentary lifestyle

List three established lifestyle factors that can trigger PCOS symptoms

Environmental toxins

Chemicals in skin care and additives in meat fall under which category of PCOS causes

History taking and clinical evaluation

PCOS is diagnosed through which two methods rather than a single lab test

Insulin resistance

Diagnostic testing in PCOS is focused more on monitoring complications like what rather than the diagnosis itself

Individually sized follicles

How do follicles in a normal ovary appear on transvaginal ultrasound

Similarly sized follicles

How do follicles in a polycystic ovary appear on transvaginal ultrasound

12 or more

What was the classic follicle count required for a PCOM diagnosis on ultrasound

20 or more

According to the new definition how many follicles per ovary indicate polycystic ovarian morphology

10 mL or more

What is the minimum ovarian volume required for a PCOM diagnosis in the new definition

Rosary beads

What is the descriptive term for the peripheral distribution of small follicles in a polycystic ovary

PCOS is different from PCO morphology

What distinction must clinicians make to patients regarding ultrasound findings

Gestational Diabetes or GDM

PCOS patients are at a higher risk for which pregnancy complication involving blood sugar

Gestational hypertension

Besides diabetes what other pregnancy complication is a risk for those with a history of PCOS

75 gram OGTT

Which glucose test is preferred for monitoring sugar in PCOS patients over fasting blood sugar

Triglycerides and cholesterol

PCOS patients have a tendency to have increased levels of which lipid components

Lifestyle management

What is considered the mainstay of PCOS management across all phenotypes

Goal of the patient

Medical management of PCOS depends primarily on what factor

Ethynylestradiol

Which estrogen component is found in all combined oral contraceptive pills

Progesterone

The specific type of which hormone in the pill determines its therapeutic purpose such as treating acne

Yaz

Which brand of COCP contains Drospirenone and is used for hyperandrogenism

Diane 35

Which brand of COCP contains Cyproterone acetate and is used specifically for acne

Drospirenone

Which progesterone component can stimulate breast tissue enlargement and cause breast pain

Cyproterone acetate

Which progesterone in Diane 35 addresses acne without further stimulating breast tissue

Inositol or Mypicos

Which supplement addresses insulin resistance and endocrine problems in PCOS patients

Metformin

Which medication manages excess sugar and insulin resistance even in non diabetic patients

Cyclic progesterone

What is prescribed to regulate menses in PCOS patients trying to conceive to time ovulation induction

24 hours

How long is an egg valid for fertilization during the monthly cycle

Clomiphene citrate or Letrozole

Name two drugs used for medical ovulation induction

Letrozole

Which ovulation induction drug is generally preferred for PCOS patients in clinical trials

Ozempic

Which medication may be used for weight management in PCOS patients who are already diabetic

PCOS is a lifetime diagnosis

Why is it incorrect to say the birth control pill cures PCOS

Manage symptoms and prevent complications

What is the clinical goal of PCOS treatment if the syndrome cannot be cured

Manageable but not sterile

How is infertility in PCOS patients classified by Doc de Dios Ty

Anovulation

What state in PCOS is described as protective for ovarian cancer because it prevents regular ovulation

Hyperestrogenic

What state describes the predominance of estrogen in PCOS which stimulates breast tissues

Low carbs and low sugar

What are the specific dietary recommendations for PCOS patients to prevent rebound weight gain

Sustainable

Lifestyle modifications for PCOS must be something the patient can do how

SHBG

Which liver protein is inhibited by both insulin resistance and high androgens

Free estradiol

What is the term for estradiol that is not bound to SHBG and is biologically active

Aromatase

Which enzyme in fat cells converts androgens to estrone

Focal ischemia

What is the underlying cause of irregular spotting when the endometrial lining becomes too thick

Differently sized

How are follicles described in normal ovaries compared to polycystic ones

History and evaluation

Clinical diagnosis of PCOS is based on what

Metabolism slows down

Why is management difficult for patients who reach the age of 30 to 35

Thyroid function tests

Which tests are requested to rule out mimics like hypothyroidism

Lipid profile

Which test assesses triglycerides and cholesterol levels

Cardiovascular disease

Unhealthy cholesterol and metabolic syndrome in PCOS lead to a risk of what

Inositol

What is the active ingredient in the supplement Mypicos

Metformin

What is used for insulin resistance if weight cannot be shed through lifestyle alone

Spironolactone

What is added to the regimen for severe hirsutism that waxes or IPL cannot manage

Ozempic

Which weight management drug is used for diabetic PCOS patients

Berta

Which phenotype mnemonic refers to a patient with normal ovaries on ultrasound

Alex

Which phenotype mnemonic refers to the classic case with all manifestations

Cary

Which phenotype mnemonic refers to the patient who keri mag ovulate or has no anovulation

Diana

Which phenotype mnemonic refers to the patient with no hyperandrogenism symptoms

Phenotype B

Which phenotype is most likely to be misdiagnosed if ultrasound is the only criteria used

Phenotype D

Which phenotype is often not diagnosed because it lacks signs of hyperandrogenism