1. Which of the following is not a part of diagnostic criteria for polycystic ovarian syndrome (PCOS)?
a. Insulin resistance
b. Irregular ovulation
c. Hyperandrogenism
d. Presence of follicles in ovaries
2. Which of the following statements is not true?
a. Involvement of only one ovary is sufficient to make diagnosis of PCOS.
b. Presence of follicles in ovaries is necessary to make diagnosis of PCOS.
c. All women with polycystic ovaries have PCOS.
d. 50% of PCOS women are obese.
e. Androgen excess in PCOS may or may not occur with skin manifestations.
3. Which of the following is correct regarding gonadotropins in PCOS?
a. Luteinizing hormone (LH) to follicle stimulating hormone ratio < 2 rules out PCOS in obese PCOS.
b. Women with PCOS have high mean concentration and bioactivity of LH.
c. Follicle stimulating hormone levels are low in PCOS.
d. LH secretion in women with PCOS is unaltered by prolonged insulin infusion.
4. Select the incorrect answer in relation to inflammation and PCOS:
a. PCOS is a state of inflammation.
b. Levels of tumor necrosis factor-α increased in PCOS women as compared with controls.
c. Lean and obese PCOS women have higher tumor necrosis factor-α levels than normal lean women and obese controls respectively.
d. C-reactive protein levels and tissue plasminogen activator levels in PCOS women are increased as compared with healthy weight-matched controls.
e. Beneficial effect of thiazolidinediones (TZDs) in PCOS may be partly due to the decrease in inflammation.
5. PCOS is a state of insulin resistance. Which of the following statements best describes the correct relation between PCOS and abnormalities in glucose metabolism?
a. Ten percent of PCOS women have impaired glucose tolerance.
b. Prevalence of type 2 diabetes mellitus is 50% in PCOS women.
c. Lean PCOS women have lower rates of carbohydrate intolerance than obese PCOS women, but even lean PCOS women have higher rates than age and weight-matched controls.
d. Oral glucose tolerance test is recommended for all PCOS patients.
6. Choose the correct statement regarding spironolactone and metformin in PCOS:
a. Spironolactone acts by blocking androgen synthesis
b. Spironolactone is better than metformin in the treatment of hirsutism, menstrual cycle frequency and hormonal derangements in PCOS
c. Spironolactone improves insulin sensitivity better than metformin when used in PCOS
d. Metformin in PCOS improves ovulation only by inducing weight loss
7. Which is true regarding peroxisome proliferator-activated receptors (PPARs)?
a. They are a subfamily of the 90-member nuclear-receptor superfamily and regulate gene expression in response to ligand binding.
b. Four PPARs have been identified to date.
c. PPAR-α is expressed predominantly in adipose tissue.
d. PPAR activation enhances free fatty acid oxidation, controls expression of multiple genes regulating lipoprotein concentrations, and has anti-inflammatory effects.
8. Which is not the correct action of PPAR agonists?
a. PPAR-α agonists prevent or retard atherosclerosis in mice and humans.
b. Troglitazone was withdrawn from the market because of hepatotoxicity.
c. TZDs lower fasting and postprandial glucose concentrations as well as free fatty acid concentrations.
d. TZD treatment increases insulin concentration in PCOS.
9. TZDs are used in the treatment of PCOS. Which of the following best describes their use in PCOS?
a. They improve androgen levels and ovulation rates and enhance insulin sensitivity with reduction in the weight of subjects.
b. They may have a direct inhibitory effect on ovarian steroidogenesis.
c. There is a decrease in sex hormone binding globulin levels in PCOS with TZD use.
d. They are approved by the Food and Drug Administration for use in PCOS.
10. Which is the best statement regarding pioglitazone use in PCOS?
a. Pioglitazone in obese women with PCOS and severe insulin resistance is as effective as metformin in decreasing fasting blood serum insulin concentration and the insulin levels during a 2-hour oral glucose tolerance test without significantly changing fasting blood glucose concentration.
b. Pioglitazone is less effective in decreasing hirsutism and the serum concentrations of free testosterone and androstenedione as compared with metformin in PCOS.
c. Pioglitazone improves insulin sensitivity in PCOS with weight loss.
d. Long-term pioglitazone administration may lead to decreased hypothalamic dopaminergic tone and this can be the mechanism of amelioration of insulin resistance in obese insulin resistant patients.