This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Gynaecology & Obstetrics
[{'content': 'A teenage girl presented in OPD with moderate acne and history of irregular menses. What treatment will you give? \nSelect and explain. \nA. Oral isotretinoin, B. Oral acitretin, C. Oral minocycline, D. Cyproterone acetate', 'role': 'user'}, {'content': 'Answer: D \nExplanation: A teenage Girl is presenting with H/O irregular menses and acne both of which could mean excessive androgen production in females\nExcessive androgen production in females leads to:\ni. Hirsutism\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0 ii. Irregular Menses\niii. Acne\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0 iv. Seborrhea\nv. Temporal Balding\xa0 \xa0 \xa0 \xa0 \xa0vi. Clitoromegaly\n“The physical manifestations of androgen excess generally reflect the extent to which androgen levels are elevated. Hirsutism is the most common complaint associated with androgen excess and essentially all women with hirsutism have an increased production rate of testosterone and androstenedione.”\xa0\nThe management of excessive androgen production is -\ni. Oral contraceptive pills-\nPrinciple for using OCP’s\nEstrogen component of OCP’s\nIncreases sex hormone binding globulin (SHBG) resulting in decreased free testosterone.\nProgesterone suppresses LH resulting in decreased ovarian androgens.\nThe best oral contraceptives should be those which utilize a progestin with minimal androgenicity i.e. pills containing desogestrel, gestodene e.g. femilon and novelon.\nOCP’s are effective in 60 — 100% patients with hirsutism, acne and seborrhea.\nRemember: Hormone therapy must be continued for 6 months before judging its effectiveness.\nAnti-androgens Cyproterone acetate: It is an antiandrogen which inhibits gonadotropin secretion and interferes with androgen action on the target organs by competing for the androgen receptors.\nIt should be administered along with ethinyl-estradiol to prevent menstrual irregularities and ovulation. it is available as combined estrogen — progestin oral contraceptive (2 mg cyproterone acetate and 35 ig ethinyl estrodiol as (Ginette or Diane 35)\n“A combined pill containing 35 mcg ethinyl estrodiol and 2 mg of an ant-i-androgen cyproterone acetate (Diane 35 or Ginette) is the drug of choice in teenagers with irregular period and hirsulism. The effect on acne and seborrhea is evident shortly after starting treatment but 6-12 cycles are needed for a demonstrable effect on hirsutism.', 'role': 'assistant'}]