QUESTION: 105

A28-year-old woman presents for evaluation of primary infertility. She has had fewer than four periods per year since menarche at age 14, facial hirsutism, acne, and weight gain. On examination, she has a BP 150/100. Her body mass index (BMI) is 40. Acanthosis nigricans is noted along the posterior surface of her neck.
Which of the following would be her most likely fasting lipid profile?

high TGs, high HDL
low TGs, low HDL
high TGs, low HDL
high LDL cholesterol
normal lipid profile

Answer(s): C

Explanation:

The patient has the typical features of PCOS associated with insulin resistance and the metabolic syndrome. The presence of hyperandrogenism and oligomenorrhea, without other known causes (such as congenital adrenal hyperplasia), makes the diagnosis of PCOS. The hirsutism and acne are the result of the hyperandrogenism associated with PCOS. Thyroid disorders and hyperprolactinemia can contribute to menstrual disturbances but would not be expected to cause the signs of androgen excess or A. nigricans. A cosyntropin stimulation test would be used for the diagnosis of adrenal insufficiency. Growth hormone levels may be elevated in acromegaly or in some pituitary tumors. Women with PCOS have a high risk of glucose intolerance, diabetes, dyslipidemia, and hypertension. Individuals with insulin resistance syndromes typically exhibit hypertriglyceridemia with low HDLlevels. The key to management of PCOS is weight loss. Even modest weight loss (1020 lbs) can result in significant improvement in metabolic and physiologic parameters, such as blood pressure and insulin resistance, and improved fertility

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QUESTION: 106

The primary treatment for this problem is with medications.
Weight loss is key to her management.
Her hypertension would be best treated with a thiazide diuretic.
Regardless of her lipid panel result, she should be on a statin.
Her infertility is due to lack of estrogen production.

Answer(s): B

Explanation:

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QUESTION: 107

A 34-year-old female sex worker presents with a several week history of fatigue, malaise, fever, and a 10- lb weight loss. Over the last 2 weeks, the patient noted a rash on her face, torso, arms, legs, palms, and soles. The patient is HIV negative on a test 2 months ago, has had hepatitis B, gonorrhea, and chlamydia. The patient has an oral temperature of 100.6°F, and generalized lymphadenopathy. The patient does not have any lesions in the mucous membranes.

What is the diagnostic test most likely to explain this clinical presentation?

a hepatitis B surface antigen test
cervical smear for rapid tests for gonorrhea and chlamydiae
a skin biopsy
a rapid plasma reagin (RPR) and microhemagglutination assay for Treponema pallidum (MHA-TP) test
an HIV viral load by polymerase chain reaction (PCR)

Answer(s): D

Explanation:

The skin lesions as shown in Figures show erythematous maculopapular lesions. There are only a few conditions that cause a rash on the palms and soles. These include syphilis, gonorrhea, and Stevens- Johnson syndrome. Disseminated gonnorhea does not cause lesions on the face. This is not a potential presentation of hepatitis B or chlamydia. Askin biopsy is not indicated. RPR and MHA-TP tests will be positive in syphilis in a high titer. All patients with syphilis need to have HIV testing. The rash of primary HIV infection is a faint erythematous rash on the trunk and is not always present. Early in primary HIV infection, a PCR determination can be negative. In the absence of neurosyphilis, benzthine penicillin 2.4 million units IM weekly for 3 weeks is the treatment of choice for patients with syphilis of unknown duration or greater than a year. While azithromycin 1 g orally will treat gonorrhea and chlamydia, it will not treat syphilis. Aqueous penicillin 4 million units intravenously every 4 hours for 14 days is the treatment of choice for neurosyphilis. An alternate treatment for latent syphilis in patients who are penicillin allergic is doxycycline 100 mg twice daily for 30 days. Oral corticosteroids are not indicated in this case.

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QUESTION: 108

benzathine penicillin 2.4 million units IM weekly for 3 weeks
azythromycin 1 g orally
aqueous penicillin 4 million units intravenously every 4 hours for 14 days
doxycycline 100 mg twice a day for 2 weeks
oral corticosteroids over 5 days

Answer(s): A

Explanation:

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