Clinical Gynecologic Endocrinology! Trivia Question Quiz

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| By Abdallah.a.aji
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Abdallah.a.aji
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Quizzes Created: 5 | Total Attempts: 14,244
Questions: 34 | Attempts: 224

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Clinical Gynecologic Endocrinology! Trivia Question Quiz - Quiz

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Questions and Answers
  • 1. 

    A 21-year-old athletic woman with diabetes on a low-dose oral contraceptive comes to your clinic with irregular menses and bilateral breast discharge. On examination, the discharge is expressed and galactorrhea is confirmed with fat globules seen microscopically. She currently takes metoclopramide (Reglan) for delayed gastric emptying. A random serum prolactin level is 65 ng/mL. Which of the following is most likely responsible for her hyperprolactinemia?

    • A.

      Metoclopramide

    • B.

      Pregnancy

    • C.

      Oral contraceptive

    • D.

      Pituitary adenoma

    • E.

      Exercise

    Correct Answer
    A. Metoclopramide
    Explanation
    The most likely cause of the patient's hyperprolactinemia is metoclopramide. Metoclopramide is known to increase prolactin levels by blocking dopamine receptors in the hypothalamus, which normally inhibit prolactin release from the pituitary gland. This leads to increased prolactin secretion and can result in symptoms such as irregular menses and breast discharge (galactorrhea). The patient's use of metoclopramide, along with the confirmation of galactorrhea and elevated serum prolactin level, strongly suggests that metoclopramide is the cause of her hyperprolactinemia.

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  • 2. 

    During pregnancy, the placenta and fetus actively contribute to the maternal hormone levels and impact the maternal-fetal unit physiology. Which of the following hormones decreases after the first trimester of pregnancy?

    • A.

      Progesterone

    • B.

      Prolactin

    • C.

      Human chorionic gonadotropin (hCG)

    • D.

      Human placental lactogen (hPL)

    • E.

      Estriol

    Correct Answer
    C. Human chorionic gonadotropin (hCG)
    Explanation
    Human chorionic gonadotropin (hCG) is a hormone that is produced by the placenta during pregnancy. Its levels are highest in the first trimester and gradually decrease as the pregnancy progresses. This hormone is responsible for maintaining the production of progesterone by the ovaries, which is essential for supporting the pregnancy. Once the placenta is fully developed, it takes over the production of progesterone, and the levels of hCG decrease. Therefore, hCG is the hormone that decreases after the first trimester of pregnancy.

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  • 3. 

    A 25-year-old woman who underwent menar-che at 11 years of age presents with a history of irregular menstrual cycles over the last 12 months, increased weight gain, and bilateral pelvic pain. Transvaginal ultrasound shows large cystic ad-nexa, with cysts measuring 7 to 9 cm in size. A urine pregnancy test is negative. Her thyroid-stimulating hormone (TSH) level is 17 mlU/mL, and prolactin level is 10 ng/mL. Which of the following is the treatment of choice for this patient to regain normal menstrual cycles?

    • A.

      Monophasic birth control pills

    • B.

      Triphasic birth control pills

    • C.

      Levothyroxine treatment

    • D.

      Bromocriptine treatment

    • E.

      Gonadotropin-releasing hormone (GnRH) agonist treatment

    Correct Answer
    C. Levothyroxine treatment
    Explanation
    The patient in this scenario presents with irregular menstrual cycles, increased weight gain, and bilateral pelvic pain. The ultrasound shows large cystic adnexa. The elevated TSH level indicates hypothyroidism, which can cause menstrual irregularities. Levothyroxine is the treatment of choice for hypothyroidism, and correcting the thyroid hormone levels can help regulate the menstrual cycles. The other options listed are not appropriate for this patient's presentation.

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  • 4. 

    A 22-year-old woman with amenorrhea of 6 weeks’ duration undergoes surgery for acute appendicitis. At the time of surgery, a 3-cm semisolid left ovarian cyst is discovered. It is vascular and appears to contain a blood-filled central cavity. A serum pregnancy test is positive. Which of the following is the most appropriate next step in this patient’s management?

    • A.

      Ovarian cystectomy

    • B.

      Ovarian wedge resection

    • C.

      Oophorectomy

    • D.

      Salpingo-oophorectomy

    • E.

      No additional therapy indicated

    Correct Answer
    E. No additional therapy indicated
    Explanation
    Since the patient has a positive serum pregnancy test, the most appropriate next step in her management is to avoid any additional therapy. The presence of the ovarian cyst and the positive pregnancy test suggest a corpus luteum cyst, which is a normal finding in early pregnancy. These cysts usually resolve on their own and do not require any further intervention. Therefore, no additional therapy is indicated in this case.

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  • 5. 

    A 25-year-old woman is having a severe intrapartum hemorrhage with hypovolumic shock. Which of the following symptoms is evidence of pituitary infarction?

    • A.

      Infrequent urination

    • B.

      Diarrhea

    • C.

      Easy bruisability

    • D.

      Lactation failure

    • E.

      Perspiration

    • F.

      Perspiration

    Correct Answer
    D. Lactation failure
    Explanation
    Lactation failure is evidence of pituitary infarction because the pituitary gland is responsible for producing and releasing the hormone prolactin, which stimulates milk production in the breasts. If the pituitary gland is damaged or not functioning properly due to infarction, it can result in lactation failure. The other symptoms listed, such as infrequent urination, diarrhea, easy bruisability, and perspiration, are not specifically associated with pituitary infarction.

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  • 6. 

    A 16-year-old girl has not experienced menarche. Examination shows the absence of breast development and small but otherwise normal female pelvic organs. Which of the following diagnostic tests is most useful in determining the etiology of the amenorrhea?

    • A.

      Serum follicle-stimulating hormone (FSH)

    • B.

      Serum estradiol

    • C.

      Serum testosterone

    • D.

      Magnetic resonance imaging (MRI) of the head

    • E.

      Ovarian biopsy

    Correct Answer
    A. Serum follicle-stimulating hormone (FSH)
    Explanation
    The most useful diagnostic test in this scenario is serum follicle-stimulating hormone (FSH) level. FSH is responsible for stimulating the growth and development of ovarian follicles, which eventually leads to the release of an egg during ovulation. In this case, the absence of breast development and the presence of small but otherwise normal female pelvic organs suggest a problem with the ovaries or the hypothalamic-pituitary-ovarian axis. Measuring FSH levels can help differentiate between primary ovarian failure (high FSH levels) and hypothalamic-pituitary dysfunction (low FSH levels). The other options (serum estradiol, serum testosterone, MRI of the head, and ovarian biopsy) may be helpful in specific situations but are not the most useful initial test for determining the etiology of the amenorrhea.

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  • 7. 

    An 18-year-old patient has not experienced menarche. Examination shows normal breast development and the absence of a uterus. Which of the following diagnostic tests is most useful in determining the etiology of the amenorrhea?

    • A.

      Serum FSH

    • B.

      Serum estradiol

    • C.

      Serum testosterone

    • D.

      MRI of the head

    • E.

      Ovarian biopsy

    Correct Answer
    C. Serum testosterone
    Explanation
    In an 18-year-old patient who has not experienced menarche, the most useful diagnostic test in determining the etiology of the amenorrhea is serum testosterone. This is because the presence of normal breast development and the absence of a uterus suggests a potential androgen excess disorder, such as polycystic ovary syndrome (PCOS) or androgen-secreting tumors. Measuring serum testosterone levels can help differentiate between these conditions and guide further evaluation and management.

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  • 8. 

    If congenital androgen insensitivity syndrome (testicular feminization) is diagnosed, it is caused by a defect in what aspect of androgen function?

    • A.

      Synthesis

    • B.

      Metabolism

    • C.

      Receptor action

    • D.

      Excretion

    • E.

      Aromatization

    Correct Answer
    C. Receptor action
    Explanation
    Congenital androgen insensitivity syndrome, also known as testicular feminization, is caused by a defect in receptor action. This means that the body is unable to respond properly to androgens, which are male sex hormones. As a result, individuals with this syndrome may have male chromosomes and testes, but their bodies do not respond to androgens, leading to the development of female external genitalia and secondary sexual characteristics.

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  • 9. 

    An adult genetic male with 17-alpha-hydro-xylase deficiency would have which of the following findings?

    • A.

      No breast development, uterus present, hypertension

    • B.

      No breast development, uterus present, hypotension

    • C.

      Breast development, uterus absent, hypotension

    • D.

      No breast development, uterus absent, hypertension

    • E.

      Breast development, uterus present, hypertension

    Correct Answer
    D. No breast development, uterus absent, hypertension
    Explanation
    An adult genetic male with 17-alpha-hydroxylase deficiency would have no breast development because this condition affects the production of certain hormones involved in breast development. Additionally, the individual would have an absent uterus because 17-alpha-hydroxylase deficiency can lead to the incomplete development of reproductive organs. Lastly, hypertension is a common finding in individuals with this condition due to the disruption of hormone regulation.

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  • 10. 

    A 28-year-old patient complains of amenorrhea after dilation and curettage (D&C) for postpartum bleeding. She denies any other complaints and did not require a blood transfusion at the time of her postpartum bleed. Which of the following is the most likely diagnosis?

    • A.

      Gonadal dysgenesis

    • B.

      Sheehan syndrome

    • C.

      Kallmann syndrome

    • D.

      Mayer-Rokitansky-Kiister-Hauser syndrome

    • E.

      Asherman syndrome

    Correct Answer
    E. Asherman syndrome
    Explanation
    Asherman syndrome is the most likely diagnosis in this case. Asherman syndrome is characterized by the formation of intrauterine adhesions, usually as a result of trauma to the endometrium, such as after a D&C procedure. This can lead to amenorrhea or decreased menstrual flow. The patient's lack of other complaints and absence of blood transfusion suggest that she did not have significant postpartum bleeding, making Asherman syndrome a more likely diagnosis than Sheehan syndrome or gonadal dysgenesis. Kallmann syndrome and Mayer-Rokitansky-Kiister-Hauser syndrome are not associated with postpartum bleeding.

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  • 11. 

    A 25-year-old woman experiences galactorrhea and amenorrhea of 8 weeks’ duration with irregular vaginal bleeding. Which of the following serum assays should initially be performed?

    • A.

      HCG

    • B.

      Progesterone

    • C.

      Prolactin

    • D.

      FSH

    • E.

      Luteinizing hormone (LH)

    Correct Answer
    A. HCG
    Explanation
    In a 25-year-old woman experiencing galactorrhea (abnormal milk production) and amenorrhea (absence of menstrual periods) with irregular vaginal bleeding, the initial serum assay that should be performed is hCG (human chorionic gonadotropin). This is because hCG is a hormone that is produced during pregnancy and can cause similar symptoms. By testing for hCG, it can help determine if the woman is pregnant, which could explain the symptoms she is experiencing.

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  • 12. 

    A 14-year-old girl complains of irregular vaginal bleeding. Her general examination and pelvic organs are normal. Which of the following is the most likely cause of anovulatory bleeding (dysfunctional uterine bleeding [DUB]) in this patient?

    • A.

      Hypothyroidism

    • B.

      Pituitary adenoma

    • C.

      Polycystic ovary syndrome (PCOS)

    • D.

      Congenital adrenal hyperplasia (CAH)

    • E.

      Hypothalamic immaturity

    Correct Answer
    E. Hypothalamic immaturity
    Explanation
    Hypothalamic immaturity is the most likely cause of anovulatory bleeding (dysfunctional uterine bleeding [DUB]) in a 14-year-old girl with normal general examination and pelvic organs. During puberty, the hypothalamus is still maturing and the hormonal feedback system may not be fully developed. This can lead to irregular menstrual cycles and anovulatory bleeding. Other causes such as hypothyroidism, pituitary adenoma, polycystic ovary syndrome (PCOS), and congenital adrenal hyperplasia (CAH) would typically present with additional symptoms or physical findings that are not mentioned in the question.

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  • 13. 

    A 15-year-old girl is seen in the emergency department. She has a sudden onset of heavy vaginal bleeding. She has noted irregular, painless vaginal bleeding of 6 months’ duration. Her medical history is unremarkable, and she is not sexually active. Physical and pelvic examinations are normal, but blood is coming through the cervical os. A serum pregnancy test is negative, and complete blood cell count has a hematocrit of 37% (normal 35% to 45%) and normal white blood cell and platelet counts. Which of the following is the best course of immediate action?

    • A.

      Observation

    • B.

      Estrogen therapy

    • C.

      Progesterone therapy

    • D.

      Nonsteroidal anti-inflammatory therapy

    • E.

      D&C

    Correct Answer
    B. Estrogen therapy
    Explanation
    The best course of immediate action in this case is estrogen therapy. The patient is experiencing heavy vaginal bleeding, which is likely due to anovulatory dysfunctional uterine bleeding (DUB). Estrogen therapy can help stabilize the endometrium and stop the bleeding. The negative pregnancy test and normal blood cell counts suggest that the bleeding is not due to pregnancy or a hematologic disorder. Observation alone may not be sufficient to control the bleeding, and progesterone therapy is not indicated in anovulatory DUB. Nonsteroidal anti-inflammatory therapy would not address the underlying cause of the bleeding. D&C (dilation and curettage) is not necessary at this time.

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  • 14. 

    An 18-year-old woman comes to your clinic with irregular cycles since menarche and mild hirsutism. She is not interested in pregnancy or contraception. Her serum TSH, prolactin, and dehydroepiandrosterone sulfate (DHEAS) levels are normal, with a slightly elevated serum testosterone level of 80 ng/dL. Which of the following is the most appropriate next step for this patient?

    • A.

      Oral contraceptive treatment

    • B.

      Endometrial biopsy

    • C.

      GnRH stimulation test

    • D.

      Clomiphene citrate

    • E.

      Bromocriptine

    • F.

      Bromocriptine

    Correct Answer
    A. Oral contraceptive treatment
    Explanation
    The most appropriate next step for this patient is oral contraceptive treatment. This is because she has irregular cycles and mild hirsutism, which are suggestive of polycystic ovary syndrome (PCOS). PCOS is a common cause of menstrual irregularities and excess androgen production. Oral contraceptive treatment can help regulate the menstrual cycle and reduce symptoms of hirsutism by suppressing ovarian androgen production. It is also a suitable option for this patient as she is not interested in pregnancy or contraception.

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  • 15. 

    A 24-year-old nulligravid patient presents with complaints of increasing dark coarse hair growth over upper lip and chin, on the abdomen, and on her chest. She denies any change in her voice, balding, or clitoral enlargement. Which of the following is she most likely experiencing?

    • A.

      Masculinization

    • B.

      Defeminization

    • C.

      Virilization

    • D.

      Hirsutism

    • E.

      Androgenization

    Correct Answer
    D. Hirsutism
    Explanation
    The patient is most likely experiencing hirsutism, which is characterized by the excessive growth of dark, coarse hair in areas typically seen in males, such as the upper lip, chin, abdomen, and chest. This condition is not accompanied by other signs of masculinization, such as voice changes, balding, or clitoral enlargement. Hirsutism can be caused by various factors, including hormonal imbalances, polycystic ovary syndrome, and certain medications.

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  • 16. 

    A 4-year-old girl is brought in by her mother for evaluation of clitoral enlargement. She is tall for her age, with no breast or axillary hair development. There is slight pubic hair growth on examination and an enlarged clitoris with a single perineal opening. A karyotype is 46, XX. The 17-OHP level is 108 ng/mL. What is the most likely diagnosis?

    • A.

      Androgen insensitivity syndrome

    • B.

      PCOS

    • C.

      CAH with 21-hydroxylase deficiency

    • D.

      Ovarian thecoma

    • E.

      Germ cell ovarian tumor

    • F.

      Germ cell ovarian tumor

    Correct Answer
    C. CAH with 21-hydroxylase deficiency
    Explanation
    The most likely diagnosis in this case is CAH with 21-hydroxylase deficiency. This condition is characterized by an enzyme deficiency that leads to impaired cortisol synthesis and excessive production of androgens. The clitoral enlargement, pubic hair growth, and single perineal opening are consistent with virilization of the external genitalia, which is a common feature of CAH. The elevated 17-OHP level further supports this diagnosis, as it is a marker of impaired cortisol synthesis. Androgen insensitivity syndrome is unlikely because the patient has virilization of the external genitalia. PCOS, ovarian thecoma, and germ cell ovarian tumors are also unlikely given the clinical presentation and laboratory findings.

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  • 17. 

    Female pseudohermaphroditism refers to individuals who have which of the following?

    • A.

      Ovaries, an XX karyotype, and varying degrees of masculinization

    • B.

      Testes, an XY karyotype, and varying degrees of masculinization failure

    • C.

      Ovaries, an XY karyotype, and varying degrees of masculinization failure

    • D.

      Testes, an XX karyotype, and severe masculinization

    • E.

      Both ovarian and testicular tissue

    Correct Answer
    A. Ovaries, an XX karyotype, and varying degrees of masculinization
    Explanation
    Female pseudohermaphroditism refers to individuals who have ovaries, an XX karyotype, and varying degrees of masculinization. This means that despite having female reproductive organs (ovaries), their genetic makeup is typically XX, which is associated with females. However, due to certain hormonal imbalances or abnormalities, these individuals may exhibit varying degrees of masculinization in terms of physical characteristics and/or hormone levels. It is important to note that the other options are not correct as they do not accurately represent the characteristics of female pseudohermaphroditism.

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  • 18. 

    An infant with ambiguous genitalia is found to have testes and an XY karyotype. Seminal vesicles, ejaculatory ducts, epididymis, and vas deferens (Wolffian duct derivatives) are present. There is no uterus, fallopian tubes, or upper vagina. The ratio of circulating testosterone to dihydrotestosterone (DHT) is elevated compared to normal male infants. What is the most likely diagnosis?

    • A.

      20,22 desmolase deficiency

    • B.

      21-hydroxylase deficiency

    • C.

      Testicular feminization

    • D.

      5-alpha-reductase deficiency

    • E.

      Embryonic testicular regression

    Correct Answer
    D. 5-alpha-reductase deficiency
    Explanation
    The most likely diagnosis for an infant with ambiguous genitalia, testes, an XY karyotype, and the presence of Wolffian duct derivatives (seminal vesicles, ejaculatory ducts, epididymis, and vas deferens) but the absence of uterus, fallopian tubes, or upper vagina is 5-alpha-reductase deficiency. This condition is characterized by a defect in the enzyme 5-alpha-reductase, which converts testosterone to dihydrotestosterone (DHT). The elevated ratio of circulating testosterone to DHT suggests a deficiency in this enzyme, leading to incomplete masculinization of the external genitalia despite normal internal male structures.

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  • 19. 

    A 17-year-old boy presents for delayed sexual development. He is 6 ft 5 in. tall with a weight of 152 lb. There is a reduced amount of pubic hair with a small phallus and small testicles. Endocrine testing reveals increased FSH and LH levels and a low testosterone level. What is the most likely diagnosis?

    • A.

      Kallmann syndrome

    • B.

      Klinefelter syndrome

    • C.

      Savage syndrome

    • D.

      Beckwith-Wiedemann syndrome

    • E.

      Turner syndrome

    Correct Answer
    B. Klinefelter syndrome
    Explanation
    The most likely diagnosis for this 17-year-old boy with delayed sexual development, reduced pubic hair, small phallus, small testicles, increased FSH and LH levels, and low testosterone level is Klinefelter syndrome. Klinefelter syndrome is a genetic disorder characterized by the presence of an extra X chromosome in males (XXY). This condition leads to underdeveloped testicles, resulting in low testosterone levels and delayed or absent secondary sexual characteristics. Additionally, individuals with Klinefelter syndrome tend to have tall stature, as seen in this patient's height of 6 ft 5 in.

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  • 20. 

    During pregnancy, the most likely change in maternal levels of thyroxine-binding globulin (TBG), total thyroxine (T4), and total triiodothyronine (T3) are which of the following?

    • A.

      TBG levels, total thyroxine (T4), and total triiodothyronine (T3) all rise.

    • B.

      TBG levels rise, but total thyroxine (T4) and total triiodothyronine (T3) fall.

    • C.

      TBG levels and total thyroxine (T4) rise while total triiodothyronine (T3) remains unchanged.

    • D.

      TBG levels fall, while total thyroxine (T4) and total triiodothyronine (T3) both rise.

    • E.

      TBG levels, total thyroxine (T4), and total triiodothyronine (T3) all remain unchanged

    Correct Answer
    A. TBG levels, total thyroxine (T4), and total triiodothyronine (T3) all rise.
    Explanation
    During pregnancy, the levels of thyroxine-binding globulin (TBG), total thyroxine (T4), and total triiodothyronine (T3) all rise. This is because pregnancy leads to an increase in estrogen, which stimulates the liver to produce more TBG. TBG is a protein that binds to thyroid hormones, including T4 and T3. As a result, the levels of TBG-bound T4 and T3 increase during pregnancy. This rise in TBG levels and bound thyroid hormones is a normal physiological adaptation to support the increased metabolic demands of the mother and fetus during pregnancy.

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  • 21. 

    Successful lactation is initiated by which of the following?

    • A.

      Estrogen stimulation during pregnancy

    • B.

      Progesterone stimulation during pregnancy

    • C.

      Elevated levels of hCG

    • D.

      Elevated levels of prolactin near term

    • E.

      The postpartum decline in circulating sex steroid levels

    Correct Answer
    E. The postpartum decline in circulating sex steroid levels
    Explanation
    Successful lactation is initiated by the postpartum decline in circulating sex steroid levels. During pregnancy, high levels of estrogen and progesterone inhibit milk production. After childbirth, these hormone levels decrease, allowing for the production of prolactin, which stimulates milk production. Therefore, it is the postpartum decline in sex steroid levels that triggers lactation.

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  • 22. 

    Amenorrhea, estrogen deficiency, and elevated circulating gonadotropin levels are noted in a normal- appearing 27-year-old woman. Which of the following conditions is most closely associated with these findings?

    • A.

      X chromosome abnormalities

    • B.

      Polyglandular autoimmune syndrome

    • C.

      Kallmann syndrome

    • D.

      Alkylating antineoplastic drugs

    • E.

      Pelvic irradiation

    Correct Answer
    B. Polyglandular autoimmune syndrome
    Explanation
    Polyglandular autoimmune syndrome is the most closely associated condition with the findings of amenorrhea, estrogen deficiency, and elevated circulating gonadotropin levels. This syndrome is characterized by the autoimmune destruction of multiple endocrine glands, leading to hormonal deficiencies. In this case, the autoimmune destruction of the ovaries is causing the estrogen deficiency and resulting in amenorrhea. The elevated levels of gonadotropins (FSH and LH) are a compensatory response by the pituitary gland to try to stimulate the ovaries to produce estrogen.

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  • 23. 

    A 33-year-old woman who underwent normal puberty describes an 18-month history of secondary amenorrhea and hot flashes. A pregnancy test was negative. A progesterone withdrawal challenge test revealed no bleeding. Her FSH was 94 mlU/mL, and her LH level was 68 mlU/mL. She desires to be pregnant with her current partner. Which of the following is the most appropriate next step in the management of this individual?

    • A.

      Karyotype

    • B.

      Measurement of serum prolactin

    • C.

      Clomiphene citrate therapy

    • D.

      Gonadotropin stimulation therapy

    • E.

      Estrogen replacement therapy

    Correct Answer
    E. Estrogen replacement therapy
    Explanation
    The patient's history of normal puberty followed by secondary amenorrhea and hot flashes, along with a negative pregnancy test and a progesterone withdrawal challenge test that revealed no bleeding, suggests a diagnosis of premature ovarian insufficiency (POI). The elevated levels of FSH and LH confirm the diagnosis. Estrogen replacement therapy is the most appropriate next step in the management of this individual to relieve her symptoms and prevent long-term complications of estrogen deficiency.

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  • 24. 

    What is the principal androgen used for placental estrogen synthesis?

    • A.

      Androstenedione

    • B.

      Testosterone

    • C.

      DHEAS

    • D.

      Aldosterone

    • E.

      Cortisol

    Correct Answer
    C. DHEAS
    Explanation
    DHEAS, or dehydroepiandrosterone sulfate, is the principal androgen used for placental estrogen synthesis. It is produced by the fetal adrenal glands and is converted into estrogens by the placenta. This conversion is important for maintaining a healthy pregnancy and supporting fetal development. Androstenedione and testosterone are also androgens, but they are not the primary ones used for placental estrogen synthesis. Aldosterone and cortisol are not androgens and are not involved in placental estrogen synthesis.

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  • 25. 

    What is the principal hormone produced by the maternal zona glomerulosa?

    • A.

      Estriol

    • B.

      Androstenedione

    • C.

      Testosterone

    • D.

      DHEAS

    • E.

      Aldosterone

    Correct Answer
    E. Aldosterone
    Explanation
    Aldosterone is the principal hormone produced by the maternal zona glomerulosa. It is a steroid hormone that is responsible for regulating the balance of salt and water in the body. It acts on the kidneys to increase the reabsorption of sodium and the excretion of potassium. This helps to maintain blood pressure and electrolyte balance during pregnancy. Estriol, androstenedione, testosterone, and DHEAS are other hormones produced during pregnancy, but they are not primarily produced by the maternal zona glomerulosa.

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  • 26. 

    What is the principal hormone responsible for 1,25-dihydroxy vitamin D3 synthesis?

    • A.

      Aldosterone

    • B.

      Cortisol

    • C.

      Thyroxine

    • D.

      Parathyroid hormone (PTH)

    • E.

      Insulin

    Correct Answer
    D. Parathyroid hormone (PTH)
    Explanation
    Parathyroid hormone (PTH) is the principal hormone responsible for the synthesis of 1,25-dihydroxy vitamin D3. PTH stimulates the conversion of 25-hydroxy vitamin D3 to its active form, 1,25-dihydroxy vitamin D3, in the kidneys. This active form of vitamin D3 plays a crucial role in regulating calcium and phosphate levels in the body, promoting their absorption from the intestines and reabsorption from the kidneys. Therefore, PTH is essential for maintaining proper calcium and phosphate homeostasis in the body.

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  • 27. 

    A patient with hirsutism, ovarian androgen excess, and elevated serum LH levels is most likely to have which of the following?

    • A.

      11-beta-hydroxylase deficiency

    • B.

      Cushing syndrome

    • C.

      Adrenal tumor

    • D.

      Polycystic ovarian syndrome (PCOS)

    • E.

      Arrhenoblastoma

    Correct Answer
    D. Polycystic ovarian syndrome (PCOS)
    Explanation
    A patient with hirsutism, ovarian androgen excess, and elevated serum LH levels is most likely to have polycystic ovarian syndrome (PCOS). PCOS is a common endocrine disorder in women of reproductive age, characterized by hormonal imbalances that lead to the development of cysts on the ovaries. This condition often presents with symptoms such as hirsutism (excessive hair growth), elevated levels of androgens (male hormones), and increased LH levels. Other options such as 11-beta-hydroxylase deficiency, Cushing syndrome, adrenal tumor, and arrhenoblastoma do not typically present with the same combination of symptoms seen in PCOS.

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  • 28. 

    Which of the following is the most common adrenal cause for hirsutism, adrenal androgen excess, and elevated 17-OHP?

    • A.

      20,22-desmolase deficiency

    • B.

      3-beta-hydroxysteroid dehydrogenase (3-n HSD) deficiency

    • C.

      21-hydroxylase deficiency

    • D.

      11-beta-hydroxylase deficiency

    • E.

      Cushing syndrome

    Correct Answer
    C. 21-hydroxylase deficiency
    Explanation
    21-hydroxylase deficiency is the most common adrenal cause for hirsutism, adrenal androgen excess, and elevated 17-OHP. This condition is a genetic disorder that affects the production of cortisol and aldosterone in the adrenal glands. It leads to an excess production of androgens, which can cause symptoms such as hirsutism (excessive hair growth), acne, and menstrual irregularities. Elevated levels of 17-OHP (17-hydroxyprogesterone) are often seen in individuals with 21-hydroxylase deficiency. This condition is commonly associated with congenital adrenal hyperplasia (CAH) and can be diagnosed through genetic testing and hormone level measurements.

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  • 29. 

    Sexual differentiation of the male internal and external genitalia is most dependent on the action of which of the following?

    • A.

      Anti-müllerian hormone (AMH)

    • B.

      Sex-determining region of the Y chromosome (SRY)

    • C.

      Testosterone

    • D.

      DHEAS

    • E.

      Cortisol

    Correct Answer
    B. Sex-determining region of the Y chromosome (SRY)
    Explanation
    The sexual differentiation of the male internal and external genitalia is most dependent on the action of the sex-determining region of the Y chromosome (SRY). This gene is responsible for initiating the development of male characteristics during embryonic development. It triggers the production of testosterone, which plays a crucial role in the development of male genitalia. Anti-müllerian hormone (AMH) is involved in the regression of female reproductive structures, while DHEAS and cortisol are not directly involved in sexual differentiation.

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  • 30. 

    For most girls, the onset of puberty is heralded by which of the following?

    • A.

      Growth acceleration

    • B.

      Thelarche

    • C.

      Pubarche

    • D.

      Menarche

    • E.

      Ovulation

    Correct Answer
    A. Growth acceleration
    Explanation
    The onset of puberty in most girls is typically marked by a growth acceleration. During this time, girls experience a rapid increase in height and weight as their bodies undergo various hormonal changes and development. This growth spurt is one of the first signs of puberty and is often followed by other physical changes such as breast development (thelarche), the appearance of pubic hair (pubarche), the onset of menstruation (menarche), and eventually ovulation. However, growth acceleration is usually the earliest and most noticeable indication that puberty has begun.

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  • 31. 

    The physical stigmata of Turner syndrome are due to loss of chromosomal material from which chromosome?

    • A.

      Chromosome 21

    • B.

      chromosome 18

    • C.

      Chromosome 6

    • D.

      The short arm of the X chromosome

    • E.

      The Y chromosome

    Correct Answer
    D. The short arm of the X chromosome
    Explanation
    The physical stigmata of Turner syndrome are due to the loss of chromosomal material from the short arm of the X chromosome. Turner syndrome is a genetic disorder that affects females and is characterized by short stature, webbed neck, low hairline at the back of the neck, and other physical abnormalities. The loss of genetic material from the X chromosome leads to the development of these physical features.

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  • 32. 

    A 14-year-old girl is brought to you for evaluation of lower abdominal pain that has been progressive over the preceding 4 months. History indicates that she experienced a growth spurt at age 11 and has had normal breast and pubic hair growth that began approximately 2 years ago. She appears to be of appropriate height. She has no other medical conditions and takes no medications. She has not had a menstrual period and is not sexually active. What is the most appropriate next step in the evaluation of this patient?

    • A.

      Measurement of serum hCG

    • B.

      Measurement of serum FSH

    • C.

      Imaging of the pituitary and sella turcica

    • D.

      Pelvic ultrasonography

    • E.

      Pelvic examination

    Correct Answer
    E. Pelvic examination
    Explanation
    The most appropriate next step in the evaluation of this patient is a pelvic examination. This is because the patient is a 14-year-old girl who has not had a menstrual period and is not sexually active. A pelvic examination can help assess the development of the reproductive organs, check for any abnormalities, and determine if there are any signs of a gynecological condition causing the lower abdominal pain. This is the first step in evaluating the patient's condition before considering other diagnostic tests or imaging.

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  • 33. 

    A 25-year-old G4P0040 presents for evaluation of recurrent documented pregnancy losses that have occurred between the 10th and 14th weeks of gestation. The patient has no ongoing medical conditions and takes no medications. Pubertal events and menstrual history are unremarkable. A pelvic examination is normal. What is the most appropriate next step in the evaluation of this patient?

    • A.

      Measurement of serum FSH on cycle day 3

    • B.

      Hysterosalpingography

    • C.

      Imaging of the pituitary and sella turcica

    • D.

      Pelvic ultrasonography

    • E.

      Measurement of mid-cycle LH

    Correct Answer
    B. Hysterosalpingography
    Explanation
    Hysterosalpingography is the most appropriate next step in the evaluation of this patient because it can help determine if there are any abnormalities in the uterus or fallopian tubes that may be causing the recurrent pregnancy losses. This procedure involves injecting a contrast dye into the uterus and taking X-ray images to visualize the uterine cavity and fallopian tubes. It can identify any structural abnormalities, such as uterine fibroids or blocked fallopian tubes, which could be contributing to the pregnancy losses.

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  • 34. 

    Which of the following ovarian tumors is most likely to result in virilization of a 35-year-old woman?

    • A.

      Brenner (transitional cell) tumor

    • B.

      Dysgerminoma

    • C.

      Sertoli-Leydic cell tumor

    • D.

      Mucinous cystademoma

    • E.

      Thecoma

    Correct Answer
    C. Sertoli-Leydic cell tumor
    Explanation
    A Sertoli-Leydic cell tumor is the most likely ovarian tumor to result in virilization of a 35-year-old woman. Sertoli-Leydic cell tumors are rare and typically produce androgens, which can cause masculinization symptoms such as deepening of the voice, hirsutism (excessive hair growth), and clitoromegaly (enlarged clitoris). The other listed tumors are less likely to cause virilization symptoms.

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