q10..wade through the words to get your prize.. - samomcos

[ArchivalUser]

A 45-year old woman of normal habitus with no prior medical history during her schedule OB/GYN exam mentions to her doctor that she has not had her period recently although she has been abstinent. She has also noticed increased facial hair and oily skin. Concerned that she might be going through menopause, she mentions that she has taken a herbal preparation of black cohosh that her friend gave to her two days ago. Upon searching the medical literature you discover that the active ingredient in black coohosh belongs to the saponin group, a group of amphipathic glycosides with properties similar to flutamide and surfactant. Assuming that this preparation has therapeutic efficacy, what is the mechanism by which the patient's self-medication could augment the indicated medication for the condition defined by her presumptive diagnosis?

A. Suppression of insulin release
B. Decrease in androgens
C. Increase in progestins
D. Decrease in GnRH pulses
E. Increase in FSH levels

[ArchivalUser]

B?????

[ArchivalUser]

D

[ArchivalUser]

the rationale i used is that indicated treatment for Menopause is hormone replacement therapy and the purpose of HRT is to decrease the gonadotrophin hormones which are raised in menupausal patients causing hot flashes etc. So any herb that acts by this mechanism could augument the effects of therapy

[ArchivalUser]

or using the same rationale it could be C increase in progestins

[ArchivalUser]

will go wid D

[ArchivalUser]

c??????????

[ArchivalUser]

Can't understand the concept behind this q ........... Very difficult one

please explain samo ......... and thanks for the qs today

[ArchivalUser]

Hi guys...sorry for the delay..
like i titled the question, the big thing in this question is just wordplay. All u gotta know is the action of Flutamide...

here's the explanation..


The patient is presenting with symptoms suggestive of PCOS, caused by an excessive LH/FSH ratio. Most treatments, herbal or not, for menopause aim to supplement and regulate the bodies estrogen and progesterone levels. The question stem indicates that the herbal remedy functions like flutamide, an anti-androgen. The observation that black cohosh also has similar properties to surfactant may have pharmacological ramifications but functions here as a distraction. The patient is exhibiting signs of androgen excess (hirsutism, acne) that would normally be treated by anti-androgens. Although she did not take black cohosh for this purpose, and should be counseled as to its proper use, the herbal remedy has a similar enough efficacy and mechanism of action to the indicated therapy that it would be expected that this herbal remedy could help given a controlled administration of longer than two days.

For answer choice A: The patient is of normal habitus and has no history of insulin resistance. Furthermore, her main complains are adrogenic symptoms not insulin-related syndromes.

For answer choice C: It is possible that this therapy could cause an increase in progestins, but the only research the doctor found related black cohosh to estrogen levels.

For answer choice D: There is no data to support an inference about the frequency of decreased GnRH pulses. Although lower frequencies favors FSH (implying less LH release) this is a very subtle mechanisms not directly mentioned in the question stem.

For answer choice E: Like answer choice D, this is a possible mechanism of action but there is not data in the question stem to support this.

[ArchivalUser]

whoa, I got it right. What's the prize?? ....