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The patient is 5' 1" (155 cm) and weighs 165 lbs (75 kg). Upgrade to PEAK L 2
Snapshot: A 25-year-old woman presents with excessive hair growth and abnormal menses.

Non-classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency (NCAH) is a milder and later onset form of a genetic condition known as congenital adrenal hyperplasia.Some people affected by the condition have no associated signs and symptoms while others experience symptoms of androgen (male hormone) excess.Women with NCAH are generally born with normal female genitalia. Ascites is the abnormal accumulation of fluid in the peritoneal cavity and a common complication of diseases presenting with portal hypertension (e.g., liver cirrhosis, acute liver failure) and/or hypoalbuminemia (e.g., nephrotic syndrome).Other conditions resulting in ascites include chronic heart failure, visceral inflammation (e.g., pancreatitis), and malignant tumors. L1\L2 Evidence







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Upgrade to PEAK E Although there are few studies on the emotional effects of precocious puberty, it's possible that feeling different can cause social and emotional problems, including early sexual experimenting. (M2.GN.13.255) QID:
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Monoclonal antibody against TNF-alpha (infliximab, adalimumab, certolizumab)Disease modifying drug for Crohn's, psoriasis, rheumatoid arthritis, ankylosing spondylitis  Opportunistic infection, in particular mycobacterial infection due to TNF destabilization of granulomas Must monitor pregnancy status, extremely toxic to fetus including neural tube defects Decreases calcium release from the sarcomplasmic reticulumMixed metabolic acidosis and respiratory alkalosis Increased risk of MI, thrombosis in at-risk individuals

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She is not on any medications. There is also acanthosis nigricans in the posterior neck.patients may present for hirsutism, irregularities in their menses, obesity, and acanthosis nigricansfor obese patients, weight loss is the first-line of treatmentfirst-line of treatment for the insulin resistance associated with PCOSalso known to improve ovulation and assist in reducing androgen levels to improve regular menstrual cyclescan be considered in patients who are refractory to clomiphene citrate (M2.PH.14.35) A 58-year-old man presents to the emergency department with a chief complaint of ringing in his ears that started several hours previously that has progressed to confusion. Question Complexity

Date A 25-year-old woman presents with excessive hair growth and abnormal menses.

- Polycystic Ovarian Syndrome

Metformin And Spironolactone: Concomitant Use In Polycystic Ovary Syndrome.



Metformin taken at adequate doses (500 mg or 850 mg three times a day) has an anti-inflammatory action, partially reduces the production of androgens and is able to improve the rate of ovulation and reduce the risk of early abortion in pregnant women. Upgrade to PEAK

104309 She reports shaving mulitple times to remove hair from her chin and chest, states that her menses has been irregular, and is currently sexually active and only uses condoms as a form of contraception. Question Complexity On physical examination, there is hair in the periareolar and linea alba region. Question Importance (M2.PH.14.35)

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