PANCE Exam Practice Questions: Quiz 859

A 33-year-old female presents to your office with complaints of inability to become pregnant. She and her husband have been having regular intercourse for 10 years without contraception. Her husband has normal sperm count and motility. Her menses are irregular, occurring every 28 to 60 days. She has noticed some facial and upper back acne, as well as increased amount of pubic hair. On examination, her waist circumference is 36 in and she has cystic acne on her neck, forehead, and upper back. She also has acanthosis nigricans in her groin and posterior neck. Labs: fasting blood glucose: 106 Urine glucose: absent DHEAS: 360 µg/dL (follicular 32.2-308 µg/dL) (luteal 29.5-269 µg/dL) Total testosterone: 1.1 ng/mL (0.1-0.6 ng/mL) Pelvic sonogram: normal What is the best plan for the initial management of this patient?
- a. Weight loss through diet and exercise
- b. Metformin
- c. Isotretinoin
- d. OTC appetite suppressants

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