nbme3 4 lab tets q - quansar

[ArchivalUser]

42. A 32-year-old nulligravid woman comes to the physician because she has been unable to conceive for 3 years. Menarche was at the age of 13 years. Menses occur at irregular 1- to 6-month intervals and often last more than 2 weeks. She has been sexually active since the age of 17 years and has never used contraception. She weighs 100 kg (220 lb) and is 168 cm (66 in) tall. Examination shows increased facial and abdominal hair, excessive sebum production, and facial acne vulgaris. Pelvic examination shows normal external genitalia, a well-estrogenized vagina, and a normal cervix and uterus. Bimanual examination shows enlarged (5 x 5 cm) ovaries bilaterally, they are mildly tender and multicystic on palpation. Which of the following is the most appropriate next step in management?

O A) Measurement of early morning serum cortisol level
O B) Measurement of serum testosterone and dehydroepiandrosterone sulfate levels
O C) Dexamethasone suppression test
O D) Pituitary stimulation test
O E) Exploratory operation

Sounds like PCOS, so maybe BB. but the best should be FSH/LH testing.... I wonder why they do not include it here..

[ArchivalUser]

bbbb...out of the choices given...u need to find out the source of androgen....DHEAS means adrenal...testosterone...most likely ovary

[ArchivalUser]

Out of all the options I will also go with B for the same reason.
This does not look like cushings, so C is r/o.
I think a is a distracter for those who might think it is cushings
D and E are irrelevant here.

[ArchivalUser]

BBB

[ArchivalUser]

quansar>>b
begiin from down going to up

[ArchivalUser]

i didnt understand this . she is not able to conceive because she is not able to ovulate. can some one please explain

[ArchivalUser]

B, to differenciate btw PCOS and some kind of adrenal androgen (testosterone)hyperproduction.

[ArchivalUser]

its clear from the question that it is PCOS . obesity + hirsutism + cystic mass

[ArchivalUser]

Syndromes of Adrenal androgen excess result from excess production of DHEA and androstenedione wich are converted to testosterone in extraglandular tissues. Clinical signs and symptoms iclude: hirsutism, oligo-amenorrhea, acne and virilization.
Etiology: congenital adrenal hyperplasia, adrenal adenomas or adrenal carcinomas.
So...there's reason to dd of PCOS.

[ArchivalUser]

I don't know, I sort of disagree with B. It's clear she has PCOS. There are multicystic bilateral ovaries. She's trying to conceive. What she needs is clomiphene which decreases negative feedback of estrogen receptors in the pituitary so she can ovulate--> CHOICE D