USMLE Forum Archives - USMLE Step 3 - CCS - Polycystic Ovarian Disease
CCS - Polycystic Ovarian Disease
meduploader - 01-02-09 13:22
PCOS is a spectrum of disorders accompanied by symptoms of obesity, insulin resistance, hirsutism, acne, oligomenorrhea, and infertility...
The Patient is a 31 yrs old graduate student...came to you with facial hair and absence of menstruation for last 2 months...she had irregular menstruation for last 4/5 years. Her BMI is 31.
At Office:
Complete Physical Examinations
Orders:
Pregnancy Test
CBC
BMP
UA
CXR
If not pregnant,
Medroxyprogesterone, po 5 days
Follow up on 10th day
If positive withdrawal bleeding,
Serum TSH
Serum LH - 45
Serum FSH - 15
Serum Prolactin
Serum Estrogen
Free Testosterone
DHEA
17-OH progesterone
UA
24 hr Urinary Cortisol
Abdominal USG – Shows pearl necklace appearance
Now Order :
Combined OCP
Lipid Profile
Fasting Blood Glucose
Follow up after 1 month
If pt want pregnancy,
Weight reduction
Clomiphene citrate
If does not want pregnancy,
Spironolactone for Hirsutism
Follow up 1 month
5 min screen:
RATED SEX
meduploader - 01-02-09 13:22
PCOS is a spectrum of disorders accompanied by symptoms of obesity, insulin resistance, hirsutism, acne, oligomenorrhea, and infertility...
The Patient is a 31 yrs old graduate student...came to you with facial hair and absence of menstruation for last 2 months...she had irregular menstruation for last 4/5 years. Her BMI is 31.
At Office:
Complete Physical Examinations
Orders:
Pregnancy Test
CBC
BMP
UA
CXR
If not pregnant,
Medroxyprogesterone, po 5 days
Follow up on 10th day
If positive withdrawal bleeding,
Serum TSH
Serum LH - 45
Serum FSH - 15
Serum Prolactin
Serum Estrogen
Free Testosterone
DHEA
17-OH progesterone
UA
24 hr Urinary Cortisol
Abdominal USG – Shows pearl necklace appearance
Now Order :
Combined OCP
Lipid Profile
Fasting Blood Glucose
Follow up after 1 month
If pt want pregnancy,
Weight reduction
Clomiphene citrate
If does not want pregnancy,
Spironolactone for Hirsutism
Follow up 1 month
5 min screen:
RATED SEX
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#1
Re: CCS - Polycystic Ovarian Disease bingousmle - 06-18-10 03:38 a nice summary for the CCS case of PCOD.. the patient should also be worked up for her lipid profile because it is a risk factor. Patient’s with LDL of more than 160 without risk factors, or >130 with risk factors, >100 with known CAD should be treated with HMG-CoA inhibitor
#2
Re: CCS - Polycystic Ovarian Disease babbu5508 - 06-18-10 15:04 Reducing insulin resistance by improving insulin sensitivity through medications such as metformin, and the newer thiazolidinedione is often needed.
#3
Re: CCS - Polycystic Ovarian Disease bingousmle - 06-18-10 15:14 from the point of view of CCS MANAGEMENT IN this case is these are the things to be remembered
-Weight reduction in obese females and use of drugs that decrease insulin resistance in both obese and non-obese reverse many abnormalities of PCOS. The drugs used for this purpose are metformin, troglitazone, and D-chiro-inositol.
-Unopposed estrogen action may result in endometrial hyperplasia and endometrial Ca. To decrease this risk, OCPs are given and progestin present in them antagonizes the effect of estrogen. Another benefit of this therapy is inhibition of androgen production and increase in sex-hormone binding globulin levels. OCPs are therefore the treatment of choice for women who don’t want to conceive.
- Patients with PCOS who have evidence of DM should be treated with metformin. Metformin is preferable over thiazolidinediones for possible teratogenicty. OCPs are indicated in conjunction with metformin if they do not want to become pregnant.
#7
Re: CCS - Polycystic Ovarian Disease bingousmle - 06-19-10 05:15 @ meduploader
for the 5 minutes screen in cases of females
Females: think if she neeeds to be PAPed.
Chlamydia screen for a sexualy active with many.
Elderly geriatic *Mamograph if older.
*osteoporosis screen.
*pneumovax and flu vax for elderly.
*elderly fall prevention.
*Hormone replacement.
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