Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

Polycystic Ovarian Syndrome and Hyperandrogenism

17–1. Which of the following criteria for diagnosis of polycystic ovarian syndrome (PCOS) is not part of the Rotterdam criteria?

a. Oligo-/anovulation

b. Sonographic polycystic appearance of ovaries

c. Clinical or biochemical signs of hyperandrogenism

d. Peripheral distribution of follicles on sonography

17–2. In ovarian hyperthecosis, which of the following is LEAST likely to be seen?

a. Irregular menstrual cycles

b. Physical signs of hyperandrogenism

c. Biochemical evidence of hyperandrogenism

d. More than 12 follicles per ovary during sonography

17–3. First-degree male relatives of women with PCOS have been shown to have higher levels of which of the following circulating hormones?

a. Testosterone

b. Androstenedione

c. Dihydrotestosterone

d. Dehydroepiandrosterone sulfate

17–4. In PCOS, increased testosterone production from the ovaries is secondary to stimulation by which of the following hormones?

a. Inhibin

b. Estradiol

c. Luteinizing hormone (LH)

d. Follicle-stimulating hormone (FSH)

17–5. All EXCEPT which of the following hormones are increased in women with PCOS?

a. Luteinizing hormone (LH)

b. Follicle-stimulating hormone (FSH)

c. Estradiol

d. Testosterone

17–6. All EXCEPT which of the following are true regarding sex hormone-binding globulin (SHBG)?

a. It is a product of the liver.

b. Levels are increased by insulin.

c. Levels are increased by estradiol.

d. It binds most of the circulating testosterone.

17–7. Which of the following is NOT typical of PCOS?

a. Acne

b. Clitoromegaly

c. Androgenic alopecia

d. Increased facial hair

17–8. Of the following conditions, which is most likely associated with the following finding?


Photograph contributed by Dr. Ben Li. Reproduced, with permission, from Wilson EE: Polycystic ovarian syndrome and hyperandrogenism. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 17-11.


b. Endometriosis

c. Hyperprolactinemia

d. Ovarian androgen-producing tumor

17–9. Which of the following hormones is the most effective in converting vellus hairs to terminal hairs?

a. Testosterone

b. Androstenedione

c. Dihydrotestosterone

d. Dehydroepiandrosterone (DHEA)

17–10. Which of the following medications is NOT a cause of hypertrichosis or hirsutism?

a. Danazol

b. Minoxidil

c. Methyldopa

d. Ketoconazole

17–11. All EXCEPT which of the following is true of acanthosis nigricans?

a. It is limited to the nape of the neck.

b. It is a cutaneous sign of insulin resistance.

c. It is secondary to keratinocyte and skin fibroblast growth.

d. It is characterized by a thickened, velvety appearance of the skin.

17–12. Of the following laboratory test results, which is most closely associated with the following clinical finding?


Reproduced, with permission, from Wilson EE: Polycystic ovarian syndrome and hyperandrogenism. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 17-7.

a. Low progesterone level

b. Elevated estradiol level

c. Abnormal glucose tolerance test result

d. Elevated dehydroepiandrosterone (DHEA) level

17–13. A 22-year-old obese nulligravida presents with a long history of irregular cycles and amenorrhea. After appropriate evaluation, you diagnose her with PCOS. Which of the following findings is LEAST likely to be seen in her condition?

a. Abnormal glucose tolerance test results

b. Thickened, dark skin on the inner thighs

c. High serum levels of high density lipoprotein

d. Male-pattern hair growth on the lower abdomen

17–14. Which of the following is NOT characteristic of the metabolic syndrome?

a. Obesity

b. Hirsutism

c. Dyslipidemia

d. Insulin resistance

17–15. During evaluation for PCOS, a patient is noted to have a total testosterone level of 350 ng/dL. Which of the following endocrine glands most likely harbors the androgen-producing tumor?

a. Ovary

b. Adrenal

c. Pancreas

d. Pituitary

17–16. During evaluation for PCOS, a serum 17-hydroxyprogesterone level is obtained to exclude which of the following conditions?

a. Cushing syndrome

b. Insulin resistance

c. Congenital adrenal hyperplasia

d. Androgen-producing adrenal tumor

17–17. Which of the following conditions can result in a false positive elevation in serum 17-hydroxyprogesterone level results?

a. Obesity

b. Ovulation

c. Insulin resistance

d. Endometrial hyperplasia

17–18. A 23-year-old G1P1 female presents with a recent history of irregular cycles and a desire to conceive. She reports recent weight gain. During examination, she is noted to have facial hirsutism as well as purple stria on the abdomen. Which of the following test is most likely to be helpful in making the diagnosis?

a. Serum progesterone level

b. Serum total testosterone level

c. 24-hour urinary cortisol measurement

d. Abdominal computed tomography (CT) scanning

17–19. Several patients undergo 2-hour glucose tolerance testing. Which of the following results is specifically equated with the term impaired glucose tolerance?

a. 2-hour blood glucose is 80 mg/dL.

b. 2-hour blood glucose is 150 mg/dL.

c. Fasting blood glucose is 80 mg/dL.

d. Fasting blood glucose is 150 mg/dL.

17–20. A 29-year-old female with irregular cycles presents for evaluation. A sonogram of her ovaries reveals the following findings. The ovarian follicles seen are which type?


a. Antral follicles

b. Primary follicles

c. Apoptotic follicles

d. Preantral follicles

17–21. According to the Rotterdam criteria, which of the following is NOT a criterion for sonographic findings in PCOS?

a. Ovarian volume > 10 mL

b. At least 10 follicles per ovary

c. Follicles 2–9 mm in mean diameter

d. Only one ovary with findings is sufficient to define PCOS

17–22. A 25-year-old nulligravida presents for infertility evaluation. She reports monthly cyclic menses. During pelvic sonography, she has 15 follicles measuring 2–9 mm in diameter per ovary. What percentage of young women without PCOS will exhibit polycystic-appearing ovaries during sonographic evaluation?

a. 25

b. 45

c. 65

d. 85

17–23. In treatment of PCOS with combination oral contraceptives, ethinyl estradiol has which of the following effects?

a. Reduces luteinizing hormone (LH) production

b. Increases sex hormone-binding globulin (SHBG) production

c. Reverses endometrial hyperplasia

d. Increases angiotensinogen production

17–24. In treatment of PCOS with combination oral contraceptives, what is one effect of the progesterone component?

a. Reduces follicle-stimulating hormone (FSH) production

b. Increases luteinizing hormone (LH) production

c. Antagonizes androgen receptors

d. Reduces ovarian androgen production

17–25. Which of the following medications can be added to improve the clomiphene citrate (Clomid) response in women with PCOS?

a. Dehydroepiandrosterone (DHEA)

b. Insulin

c. Metformin

d. Progesterone

17–26. Which of the following enzymes necessary for hair follicle division and development is the target of eflornithine hydrochloride (Vaniqa)?

a. Pyrroline carboxylate

b. Pyruvate dehydrogenase

c. Ornithine decarboxylase

d. Glucose-6-phosphate dehydrogenase

17–27. Which of the following statements is LEAST likely to be true regarding spironolactone?

a. It reduces luteinizing hormone (LH) production.

b. Is an androgen-receptor blocker.

c. It is a potassium-sparing diuretic.

d. It lowers dihydrotestosterone production.

17–28. Which of the following is true of the procedure shown here?


Reproduced, with permission, from Hoffman BL: Surgeries for benign gynecologic conditions. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 41-32.1.

a. Is used now mainly to treat severe hirsutism

b. Is a first-line treatment of women with PCOS seeking fertility

c. Is performed less frequently than ovarian wedge resection in suitable candidates

d. None of the above

Chapter 17 ANSWER KEY