Exam Questions PCOS/Infertility

Case 1
PL is a 24 yowf who presents to the clinic with complaints of irregular
periods, worsening facial hair, and bothersome acne. She provides the
following HPI.
Menstrual Cycles: Period every 4 to 6 months, sometimes less. States
that this has been ongoing since puberty.
Facial Hair: Dark upper lip hair that is becoming more and more
bothersome. She waxes very frequently and is now starting to notice
more dark hair on her neck and chin.
Acne: Severe acne since onset of puberty. Has tried several
prescription and OTC products without success.
No current medications.
You gather the following information from the visit:
PE Findings:
Thick, dark upper lip/chin hair
Acne Severe acne on her face and back
Dark patches of skin along underarms, backs of knees
SH:
Smokes PPD, attributes to stress at work
Not married.
No children.
Height: 62 inches
140/95

Weight: 215 lbs

BMI: 39.3

BP

1. PLs physician suspects that she is suffering from PCOS. He

orders lab work in order to confirm this diagnosis. Which of the
following lab results would you expect in a positive PCOS
diagnosis? Select all that apply.
a. High testosterone
b. Low testosterone
c. A1c >7%
d. Elevated fasting blood glucose
e. Elevated random blood glucose
f. Low TSH
g. LH:FSH ratio >2
h. LH:FSH ratio <2

2. After reviewing the lab work, PL is diagnosed with PCOS. Before

starting medication, PL would like to try a non-pharmacologic
approach. Which of the following is the most important
recommendation for PL?
a. Smoking cessation
b. Weight loss
c. Stress reduction
d. Blood pressure control
3. Which of the following would be the best pharmacologic
treatment option for PLs diagnosis of PCOS?
a. Metformin
b. Clomiphene
c. Oral contraceptives
d. Spironolactone
4. PLs physical exam shows several common characteristics of
PCOS. Which of the following is most commonly seen among
women diagnosed with PCOS?
a. Irregular menstrual cycle
b. Obesity
c. Polycystic ovaries
d. Acanthosis nigricans
ML is a 30 yowf who presents to a family medicine clinic for a follow up
visit. She was diagnosed with PCOS 6 years ago. She and her husband
do not have any children, but have been trying to conceive for the past
2 years. She is currently being treated for infertility with Clomid. She
completed 3 cycles, but still has not had success in getting pregnant.
Today, she presents with complaints of hot flashes.
5. Which of the following best describes the couples current
infertility status?
a. The couple is suffering from primary infertility
b. The couple is suffering from secondary infertility
c. The couple is suffering from unexplained infertility
6. Which of the following statements best describes the probable
mechanism behind this MLs hot flashes? Select all that apply.
a. Clomid causes an increase in estrogen
b. Clomid commonly causes hot flashes
c. Clomid causes a decrease in LH
d. Clomid causes a decrease in estrogen

e. Clomid does not usually cause hot flashes

f. Clomid causes a decrease in testosterone
7. Because of the bothersome hot flashes, ML asks to switch to
another agent to treat her infertility. Which of the following is the
next best option for her?
a. Metformin
b. Letrozole
c. hCG
d. Spironolactone
8. What is the generic name of Clomid?
a. Clomipramine
b. Clomiphene
c. Clomiphate
d. Clozaril
A patient presents to a family medicine clinic with concerns about her
inability to get pregnant. She denies any chronic medical conditions.
PE: Unremarkable
Height 56
Weight 45 kg
BMI 16.1
SH: Married, no children
9. What would your initial recommendation be for this patient?
a. Start treatment with Clomid
b. Start treatment with letrozole
c. Start treatment with metformin
d. Counsel patient on the benefits of weight gain
10. Which of the following induces ovulation by inhibiting the
aromatase enzyme, resulting in increased secretion of LH and FSH?
Select all that apply.
a. Anastrozole
b. hCG
c. Letrozole
d. Clomid