Polycystic ovarian syndrome
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Polycystic ovarian syndrome
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[ID] => 554929
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[post_date] => 2024-12-23 18:48:23
[post_date_gmt] => 2024-12-23 23:48:23
[post_content] => Practice Passage (Question 1-6)
*This passage is the property of Khan Academy and has been reformatted into an AAMC-style interface in their entirety by MedLife Mastery. MedLife Mastery does not endorse and is not an affiliate of Khan Academy.
Polycystic Ovary Syndrome (PCOS) is an endocrine disorder characterized by the presence of multiple small cysts on the ovaries and often accompanied by a variety of symptoms, including irregular menstrual cycles, hirsutism (excessive hair growth), acne, and obesity.
The hormonal imbalances associated with PCOS primarily involve elevated levels of androgens (male hormones). Androgens, such as testosterone, are typically present in low levels in women. However, in women with PCOS, the ovaries produce higher than normal amounts of androgens, which can lead to symptoms like hirsutism and acne. This excess androgen production can also interfere with the normal regulation of the menstrual cycle, resulting in the formation of ovarian cysts, irregular ovulation, or even amenorrhea (absence of menstruation).
Women with PCOS often exhibit an elevated LH to FSH ratio, as the elevated androgen levels can cause an increase in LH production, while FSH levels may decrease. The elevated LH levels also contribute to increased androgen production by the ovaries, creating a vicious cycle that further exacerbates the symptoms of PCOS.
Insulin resistance is another key feature of PCOS. In women with PCOS, the body's cells become less responsive to insulin, leading to higher insulin levels in the blood. This condition, known as hyperinsulinemia, can exacerbate the production of androgens by the ovaries. Insulin resistance is closely linked to obesity, which is prevalent in many women with PCOS and can further complicate the hormonal imbalance.
Given the complexity of PCOS, management often requires a multifaceted approach. Lifestyle modifications, such as weight loss and exercise, can improve insulin sensitivity and reduce symptoms. Medications like metformin, which enhances insulin sensitivity, and hormonal contraceptives, which regulate menstrual cycles, are commonly used in treatment.
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[question] => Which drug would most likely mimic the symptoms of PCOS in a healthy female of reproductive age?
[value] => Array
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[answer] => 2
[description] => Reason for Correct Answer:
Many of the observable side effects of PCOS are caused by elevated androgens, which lead to symptoms such as hirsutism (excessive hair growth), acne, and menstrual irregularities.
Exogenous steroids, and similar compounds, can cause the same symptoms as natural (endogenous) steroids in the body, because they mimic the actions of naturally produced steroids. So, in this problem, you’re looking for something with the structure of a steroid.
The core structure of a steroid consists of three six-membered cyclohexane rings and one five-membered cyclopentane ring. This core structure is shown here:
The molecule that matches this base structure is shown in answer choice B. This molecule is nandrolone, a synthetic steroid that could cause symptoms like those seen in PCOS.
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[answers] => Array
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[0] => Array
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[each_answer] => A.
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[1] => Array
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[each_answer] => B.
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[2] => Array
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[each_answer] => C.
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[3] => Array
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[each_answer] => D.
)
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[1] => Array
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[quiz_unique_key] => 1403770772
[question] => Which hormonal effect is most likely to contribute to the development of ovarian cysts in women with PCOS?
[value] => Array
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[answer] => 3
[description] => Reason for Correct Answer:
Here are the hormonal changes normally associated with the menstrual cycle:
https://commons.wikimedia.org/wiki/File:Menstrual_cycle.svg
The passage states that in PCOS, LH is increased and FSH can decrease. So you can eliminate answer choices A and B.
Decreased FSH levels alone would typically lead to lower, not higher, estrogen levels, because FSH is essential for stimulating follicle development and subsequent estrogen production during the follicular phase of the menstrual cycle.
In women with PCOS, elevated LH levels disrupt the normal LH surge, which is crucial for triggering ovulation. Without the proper LH surge, the dominant follicle fails to mature and release an egg. This leads to the accumulation of immature follicles or cysts in the ovaries. The increased androgen production associated with the increased LH/FSH ratio further disrupts the normal process of follicle maturation and ovulation.
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[answers] => Array
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[0] => Array
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[each_answer] => A. Increased FSH levels, leading to overstimulation of follicle development
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[1] => Array
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[each_answer] => B. Decreased LH levels, causing insufficient androgen production
)
[2] => Array
(
[each_answer] => C. Increased LH levels, causing disruption in ovulation and follicle development
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[3] => Array
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[each_answer] => D. Decreased FSH levels, leading to increased estrogen production
)
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[2] => Array
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[quiz_unique_key] => 1403770772
[question] => Which tumor is LEAST likely to mimic the effects of PCOS?
[value] => Array
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[answer] => 4
[description] => Reason for Correct Answer:
The pituitary gland produces LH and FSH, hormones that regulate the menstrual cycle and ovarian function. A pituitary tumor could disrupt the production of these hormones, potentially leading to symptoms similar to PCOS, such as menstrual irregularities and increased androgen production.
The hypothalamus controls the release of hormones from the pituitary gland by secreting gonadotropin-releasing hormone (GnRH). A tumor in this area could affect the regulation of LH and FSH, potentially mimicking some hormonal imbalances seen in PCOS.
https://commons.wikimedia.org/wiki/File:Hypothalamic%E2%80%93pituitary%E2%80%93gonadal_axis-La.svg
The adrenal cortex produces various steroids, including androgens. A tumor in the adrenal cortex could lead to excess androgen production, resulting in symptoms similar to those seen in PCOS, such as hirsutism and acne.
The adrenal medulla primarily produces catecholamines (epinephrine and norepinephrine) rather than androgens. Therefore, *a tumor in the adrenal medulla is least likely to produce symptoms that resemble PCOS, which are primarily due to androgen excess and menstrual irregularities.
Here is a summary of what is produced by the adrenal cortex and medulla:
https://commons.wikimedia.org/wiki/File:1818_The_Adrenal_Glands.jpg
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[answers] => Array
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[0] => Array
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[each_answer] => A. A pituitary tumor
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[1] => Array
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[each_answer] => B. A hypothalamic tumor
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[2] => Array
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[each_answer] => C. An adrenal cortical tumor
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[3] => Array
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[each_answer] => D. An adrenal medullary tumor
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[3] => Array
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[quiz_unique_key] => 1403770772
[question] => Which of the following explains why continuous use of estrogen and progesterone-containing birth control pills are helpful in treating the symptoms of PCOS?
[value] => Array
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[answer] => 2
[description] => Reason for Correct Answer:
To understand why birth control pills containing estrogen and progesterone are effective in treating PCOS, consider the roles these hormones play in the menstrual cycle and their feedback effects on other hormones.
During the follicular phase, estrogen is produced by the developing follicles. Low levels of estrogen provide negative feedback to the hypothalamus and pituitary to regulate the secretion of GnRH, LH, and FSH. High levels of estrogen before ovulation provide positive feedback, leading to the LH surge necessary for ovulation.
After ovulation, the corpus luteum produces progesterone, which stabilizes the endometrial lining and provides negative feedback to inhibit the secretion of GnRH, LH, and FSH, preventing further ovulation.
Birth control pills provide synthetic estrogen and progesterone, maintaining steady hormone levels.
The consistent presence of these hormones provides continuous negative feedback to the hypothalamus and pituitary gland, suppressing the release of GnRH, LH, and FSH. By suppressing LH production, the stimulation of ovarian theca cells, which produce androgens, is reduced. Lower androgen levels help alleviate PCOS symptoms such as hirsutism (excessive hair growth) and acne.
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[answers] => Array
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[0] => Array
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[each_answer] => A. Birth control pills increase the production of LH, leading to a reduction in androgen levels.
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[1] => Array
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[each_answer] => B. Birth control pills suppress LH production and reduce androgen levels by providing a steady level of estrogen and progesterone.
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[2] => Array
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[each_answer] => C. Birth control pills increase insulin sensitivity, thereby reducing androgen production.
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[3] => Array
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[each_answer] => D. Birth control pills stimulate the ovaries to produce more FSH, balancing the elevated LH to FSH ratio.
)
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[4] => Array
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[quiz_unique_key] => 1403770772
[question] => Which of the following correctly matches LH, FSH, and insulin with their respective types of hormones?
[value] => Array
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[answer] => 4
[description] => Reason for Correct Answer:
Peptide hormones are made up of chains of amino acids. They can range from small peptides with only a few amino acids to larger protein hormones. They bind to receptors on the surface of target cells, triggering a signaling cascade that leads to a cellular response. They generally do not enter the cell.
Steroid hormones are derived from cholesterol and have a characteristic structure consisting of four fused carbon rings. They diffuse through cell membranes and bind to intracellular receptors. The hormone-receptor complex then enters the nucleus and influences gene expression.
LH and FSH are peptide hormones produced by the pituitary gland.
Insulin is a peptide hormone produced by the pancreas.
)
[answers] => Array
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[0] => Array
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[each_answer] => A. LH – steroid hormone; FSH and insulin – peptide hormones
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[1] => Array
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[each_answer] => B. LH and FSH – steroid hormones; insulin – peptide hormone
)
[2] => Array
(
[each_answer] => C. LH and FSH – peptide hormones; insulin – steroid hormone
)
[3] => Array
(
[each_answer] => D. LH, FSH, and insulin – all peptide hormones
)
)
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[5] => Array
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[quiz_unique_key] => 1997864699
[question] => Which of the following changes would be expected in PCOS patients treated with metformin?
[value] => Array
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[answer] => 1
[description] => Reason for Correct Answer:
According to the passage, women with PCOS experience insulin resistance and hyperinsulinemia which also leads to higher androgen production.
Normally, insulin functions to decrease blood glucose by promoting its uptake and metabolism by cells and inhibiting its production.
Metformin improves insulin sensitivity, or the body’s response to insulin.
This would lower blood glucose.
This would also lower levels of insulin, which is released in response to blood glucose. This would also decrease androgen levels, as the passage states that increased insulin levels lead to higher androgen levels.
)
[answers] => Array
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[0] => Array
(
[each_answer] => A. Decreased insulin and decreased blood glucose
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[1] => Array
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[each_answer] => B. Increased insulin and decreased blood glucose
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[2] => Array
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[each_answer] => C. Decreased androgen production and increased blood glucose
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[3] => Array
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[each_answer] => D. Increased androgen production and increased insulin
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[554929|3] => D
[554929|4] => B
[554929|5] => D
[554929|6] => A
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