DPOTMH DEPT OF OB-

GYN ORAL EXAM 2021

CASE
• A 23 year old woman G0P0 comes to the clinic for the 12 months amenorrhea.
• Her menarche was at 12yo, and menses have always been irregular occurring every 3-4 months.
BMI of 28, Height 5’2”, she has been unsuccessful with weight loss efforts. No history of previous
admissions or surgery.
 
• Her physical examination shows an obese woman who has sparse hair above upper lip, areas of
alopecia and abundant hair on her legs. She has acne and dark lines around neck area. There is
no galactorrhea, no neck mass, and the rest of physical exam and pelvic exam is unremarkable.

• BP 140/90 HR 82/min LMP- 4 months PTC. She has a sexual partner and will get married in a few
months.
A transvaginal ultrasound was requested which showed the following images of the ovaries,
uterus and endometrium:

1. Describe the images of the:

OVARIES
UTERUS
ENDOMETRIUM
THE OFFICIAL MEASUREMENTS OF HER TRANSVAGINAL ULTRASOUND RESULT
SHOWED:

UTERUS: 6 x 4 x 5 cm
ENDOMETRIUM: 1.5 cm
Both OVARIES: 5 x 3 x 3 cm with >20 peripheral cystic structures 4-6mm in sizes.
2. Give your CLINICAL diagnosis

3. Give your basis for the diagnosis

4.
• How does Rotterdam differ from Androgen Excess and Polycystic
Ovary Syndrome (AEPCOS) Society and NIH Consensus’ definition of
PCOS?
5. Describe the typical ovarian morphology in
PCOS
6. What is the pathophysiology in PCOS
7. Enumerate the typical endocrine findings in PCOS
with regards to
 
- FSH and LH
- Androgens
- Estrogens
- Insulin
8. The patient is extremely disturbed about her hirsutism.
Explain the presence of hirsutism in PCOS and what is the serum marker
reflective of this pathology.
9. The patient is likewise conscious of the dark velvety skin commonly
seen around the neck area?
She asks what is causing it?
What do you call the resultant syndrome and its components?
10. What are the theories as to possible cause of PCOS
11. Give the laboratory work up you will request for this patient and
the expected result?
SCENARIO
Her lab results came out as follows
• Elevated total cholesterol, LDL & triglycerides, FBS
140, 75 gm OGTT elevated values, Hb1 Ac 6.5
• Serum testosterone- elevated; DHEAS within normal
• FSH 4 mIU/ml; LH 13 mIU/ml, TSH –normal
12. Identify the problems that needs to be addressed in this patient so
as to decrease risk for long term consequences and give your
management for each
SCENARIO:
One year after getting married this patient has lost weight with BMI now 24.
She is on Metformin 500 mg BID with controlled blood sugar levels, BP now
120/80.
Her menses comes every 35-40 days. She now wants to get pregnant.
13. What will be your management?
14. What are other options if pregnancy is not achieved after
6 cycles of oral ovulation induction?
END OF EXAM