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As part of the evaluation of PCOS, which of these conditions does NOT need to be ruled out in all patients prior to making this diagnosis of exclusion?
What is the best screening test for dysglycemia in patients with PCOS?
Which of these statements regarding the management of PCOS is inaccurate?
A 42-year-old woman is diagnosed with early menopause, there is evidence of hypogonadotropic hypogonadism on biochemical evaluation. Which of these tests is indicated in this setting?
A 34-year-old female with polycystic ovary syndrome, who initially presented with hirsutism, acne, and oligomenorrhea has been on oral contraceptive therapy since diagnosis, 10 years prior. Her current regimen includes a once-daily OCP, metformin, and spironolactone. She is not interested in fertility at this time and is happy with her physical appearance at this time. Physical exam shows hair stubs over areas of male pattern hair distribution. Her Ferriman-Gallwey score is increased at 11 (should be less than 8). Her current A1C is 5.5% with a normal lipid panel. What should be done next?
Which of these is NOT a contraindication to hormone replacement therapy in the postmenopausal period?
A 53-year-old man is admitted to the medicine service for Clostridium difficile colitis. He had a prolonged hospital course requiring rehabilitation. He reports to his primary care doctor’s office two weeks after discharge from the rehabilitation center. The patient complains of fatigue and poor concentration. He feels tired on most days and has no sexual desire. Physical exam is remarkable for reduced power and proximal muscle strength. There is a lack of fullness of his bitemporal fossae. Testicular volume is 25cc measured with an orchidometer. His testosterone drawn at 8 a.m is low at 150 ng/dL (reference range, 280-800 ng/dL). A repeat level is 162ng/dL. LH is close to the lower limit of normal. What should be done next?
A 21-year-old woman with recently diagnosed polycystic ovary syndrome presents to your office to review options for oral contraceptive therapy. She has a long-standing history of hirsutism, acne and impaired glucose tolerance. She is currently on metformin.
Which oral contraceptive option is preferred in this patient?
A couple is being evaluated for infertility. You are evaluating a 26-year-old man with no significant past medical history. He is not on any medications or supplements. He endorses a normal libido and has early morning tumescence. Physical examination is unremarkable. His testes are 15cc bilaterally with no masses. His bilateral vas deferens are both palpable.
Laboratory tests are significant for mid normal testosterone, mid normal LH and a moderately elevated FSH. His seminal fluid analysis was remarkable for azoospermia despite an optimal seminal fluid volume, pH and fructose. Karyotype analysis is 46, XY and he has no Y chromosome anomalies.
What should be done next?
A 19year old female presents with primary amenorrhea. She has tanner stage 4 pubic hair and breast development. Her height and weight is at the 90th percentile for age and gender.
Serum Beta HCG is negative TSH is in the mid-normal range LH and FSH are both below the normal reference range. Estradiol <20pg/mL (pre-pubertal estradiol is <20pg/mL) Normal serum prolactin level.
What should be done next?
An 18-year-old woman with no past medical history presents with primary amenorrhea. She is noted to have Tanner stage 4 breast development. She is noted to have a short vagina and an absent cervix on pelvic examination. Her serum testosterone is more than 5 times the upper limit of normal for a woman.
What would you recommend now?
A 62-year-old woman is having distressing menopausal symptoms and is interested in hormone replacement therapy. Which of these statements about HRT is inaccurate?
Which of these conditions is a contraindication to starting testosterone replacement therapy in hypogonadal men?
A 54-year-old woman who had her last menstrual period 2 years ago is referred to you for management of distressing menopausal symptoms. She has excessive vaginal dryness, hot flashes, night sweats, and an irritable mood. She smokes 6 packs of cigarettes per day. Biochemical evaluation is consistent with menopause. A baseline DEXA scan is remarkable for osteopenia. What would you recommend?
Which of these nonhormonal therapies is FDA approved for relief of menopausal symptoms?
A 38-year-old woman presents with a 4-month history of amenorrhea, vaginal dryness, hot flashes, and insomnia. She is noted to have vaginal atrophy on clinical exam, suggestive of hypoestrogenism. Her initial workup is negative for pregnancy. The patient is diagnosed with hypergonodatropic hypogonadism. Which of these genetic conditions is NOT a cause of premature ovarian failure?
A 24-year-old woman is diagnosed with polycystic ovary syndrome. She endorses less than 6 menstrual cycles per year over the past 3 years. A transvaginal ultrasound is significant for a multiple antral follicles meeting criteria for polycystic ovary morphology. What is the next best step in the management of this patient?