POLYCYSTIC OVARIAN SYNDROME
EXAM QUESTIONS AND ANSWERS
Hirsutism: def - ANSWER-excessive sexual hair that appears in a male pattern
Hirsutism: grading - ANSWER-Ferriman-Gallwey system for women
<8= normal
8-15= mild
>15= severe
Hyperandrog hair locations - ANSWER-1. Upper lip
2. Sideburn area
3. Chin
4. Low jaw & neck
5. Upper back
6. Lower back
7. Upper arm
8. Thigh
9. Chest
10. Upper abdomen
11. Perineum
hypertichosis - ANSWER-excessive hair distributed in a nonsexual pattern (generalized
& more prominent on forehead & shoulders
-NOT caused by excess androgen
Hyperandrogenism: when to suspect - ANSWER-all adolescent females who have
inflammatory acne that is unusual in its age of onset (before puberty), severity,
persistence, or unresponsiveness to 1st line derm tx
Ovarian findings - ANSWER-1. Lack of ovulatory sx
2. Irregular menstrual cycles
-secondary amenorrhea
-oligomenorrhea
-dysfunctional uterine bleeding
Primary amenorrhea - ANSWER-lack of menarche by 15 y.o. or >3 years after onset of
breast development
Oligomenorrhea - ANSWER-missing >4 periods/year
-<8 periods/year
->45 days b/t periods
-secondary amenorrhea (>90 days w/out periods) after initially menstruating
, Dysfunctional uterine bleeding - ANSWER-bleeding intervals <21 days, bleeding lasting
>7 days, or bleeding requiring a pad or tampon change >q 1-2 hours
Does normal menstrual activity signify ovulatory cycles? - ANSWER-NO
-1/2 of regular menstrual cycles are anovulatory during 1st 2 years of menarche
What signifies anovulatory cycles? - ANSWER-lack of moliminal sx
-breast tenderness
-dysmenorrhea
When do sx of hyperandrogenism & PCOS often present - ANSWER-near the age of
menarche
-high androgen level w/ irregular menses
-often not documented until later b/c of absence of other clinical features
Chronic anovulation is a/w increased risk of: - ANSWER-endometrial hyperplasia &
carcinoma
Ovarian abnormalities - ANSWER-1. Thickened sclerotic cortex
2. Multiple follicles in peripheral location
-80% of women w/ PCOS have classic cysts
Infertility - ANSWER-1. Intermittent ovulation or anovulation
2. Inherent ovarian disorder
DD (conditions of exclusion) - ANSWER-1. Cushing syndrome
-HTN, striae, easy bruising
-elevated 24-hr urinary free cortisol level
2. Primary hypothyroidism
-goiter
-increased thyrotropin & subnormal thyroxine level; prolactin may be increased
3. Hyperprolactinemia
-galactorrhea
-elevated plasma prolactin level
4. Premature ovarian failure
-autoimmune endocrinopathies
-elevated FSH & normal estradiol
5. Obesity
-dx by exclusion
6. Ovarian neoplasm
-clitorimegaly, extreme hirsutism, male pattern alopecia
-extremely elevated androgen
7. Drug related
8. Nonclassic congenital adrenal hyperplasia d/t deficiency of 21-hydroxylase
-family hx of infertility, hirsutism, Jew
-elevated 17-hydroxyprogesterone in AM or w/ stimulation
EXAM QUESTIONS AND ANSWERS
Hirsutism: def - ANSWER-excessive sexual hair that appears in a male pattern
Hirsutism: grading - ANSWER-Ferriman-Gallwey system for women
<8= normal
8-15= mild
>15= severe
Hyperandrog hair locations - ANSWER-1. Upper lip
2. Sideburn area
3. Chin
4. Low jaw & neck
5. Upper back
6. Lower back
7. Upper arm
8. Thigh
9. Chest
10. Upper abdomen
11. Perineum
hypertichosis - ANSWER-excessive hair distributed in a nonsexual pattern (generalized
& more prominent on forehead & shoulders
-NOT caused by excess androgen
Hyperandrogenism: when to suspect - ANSWER-all adolescent females who have
inflammatory acne that is unusual in its age of onset (before puberty), severity,
persistence, or unresponsiveness to 1st line derm tx
Ovarian findings - ANSWER-1. Lack of ovulatory sx
2. Irregular menstrual cycles
-secondary amenorrhea
-oligomenorrhea
-dysfunctional uterine bleeding
Primary amenorrhea - ANSWER-lack of menarche by 15 y.o. or >3 years after onset of
breast development
Oligomenorrhea - ANSWER-missing >4 periods/year
-<8 periods/year
->45 days b/t periods
-secondary amenorrhea (>90 days w/out periods) after initially menstruating
, Dysfunctional uterine bleeding - ANSWER-bleeding intervals <21 days, bleeding lasting
>7 days, or bleeding requiring a pad or tampon change >q 1-2 hours
Does normal menstrual activity signify ovulatory cycles? - ANSWER-NO
-1/2 of regular menstrual cycles are anovulatory during 1st 2 years of menarche
What signifies anovulatory cycles? - ANSWER-lack of moliminal sx
-breast tenderness
-dysmenorrhea
When do sx of hyperandrogenism & PCOS often present - ANSWER-near the age of
menarche
-high androgen level w/ irregular menses
-often not documented until later b/c of absence of other clinical features
Chronic anovulation is a/w increased risk of: - ANSWER-endometrial hyperplasia &
carcinoma
Ovarian abnormalities - ANSWER-1. Thickened sclerotic cortex
2. Multiple follicles in peripheral location
-80% of women w/ PCOS have classic cysts
Infertility - ANSWER-1. Intermittent ovulation or anovulation
2. Inherent ovarian disorder
DD (conditions of exclusion) - ANSWER-1. Cushing syndrome
-HTN, striae, easy bruising
-elevated 24-hr urinary free cortisol level
2. Primary hypothyroidism
-goiter
-increased thyrotropin & subnormal thyroxine level; prolactin may be increased
3. Hyperprolactinemia
-galactorrhea
-elevated plasma prolactin level
4. Premature ovarian failure
-autoimmune endocrinopathies
-elevated FSH & normal estradiol
5. Obesity
-dx by exclusion
6. Ovarian neoplasm
-clitorimegaly, extreme hirsutism, male pattern alopecia
-extremely elevated androgen
7. Drug related
8. Nonclassic congenital adrenal hyperplasia d/t deficiency of 21-hydroxylase
-family hx of infertility, hirsutism, Jew
-elevated 17-hydroxyprogesterone in AM or w/ stimulation
