Reproductive and Endocrinology for the USMLE Step 1 Emma ...

Reproductive and Endocrinology for the USMLE Step 1Emma Holliday Ramahi1.) A 27 year old woman comes into her obstetrician-gynecologist distraught because of 2 consecutive 2 ndtrimester miscarriages. The physician performs a hysterosalpingogram revealing the following.Which of the following embryonic abnormalities occurred in this woman?A- failure of sinovaginal bulb to developB- failure of vaginal plate canalizationC- incomplete fusion of the mesonephric ductsD- incomplete fusion of the paramesonephric ductsE- agenesis of the paramesonephric ductsF- failure of medium septum to dissolve2.) A 37 y/o woman comes to a fertility specialist because she and her husband have been trying for 18 months toconceive. Her reproductive endocrinologist instructs her to keep a diary of her menstrual cycles for three months.Her menses are 40 days apart and regular. The patient comes back in for a follow up appointment on day 20 of hercycle.Assuming she is not anovulatory, which of the following would be most likely seen in this woman?A- LH>FSH and progesterone>estrogenB- accumulated glycogen in vacuoles w/in uterine glandsC- increased basal body temperatureD- elongated, coiled spiral arteriesE- thin, watery cervical mucus3.) A 23 y/o female is 30 weeks pregnant with her first child. On routine prenatal exam she is found to behypertensive with BP 170/110. She has also noticed her hands and face are more puffy and swollen. She has alsonoted her urine has a foamy appearance.What is a common complication occuring in patients with this condition?A- Liver failureB- SeizureC- Disseminated intravascular coagulopathyD- ChoriocarcinomaE- Severe intrapelvic hemorrhageF- Cervical incompetence

4.) A 21 year old patient comes to her gynecologist’s office for rapidly worsening pelvic pain and receives atransvaginal ultrasound. A solid 2cm mass is seen on her right ovary. A biopsy is taken and reveals the following:Which of the following is likely to be elevated in the patient’s serum?A- LH/FSH ratioB- hCGC- LDHD- AFPE-CA-125F- EstrogenG- Thyroid hormoneH- None of the above5.) A 17 year old girl gives birth to a full term child. When she asks the obstetrician whether the baby is a boy or agirl, the doctor hesitates. The doctor notes a small phallus with hypospadias and a small vaginal pouch.Genetic analysis performed on the child reveals XY genotype, normal testes in the inguinal canal with normalepididymis and vas defens in place, though the prostate is noted to be underdeveloped.What is true of this child’s condition?A- presence of a Barr bodyB- gonadal dysgenesisC- defective androgen receptorD- normal estrogen/testosterone ratioE- inability of the child to smellF- elevated 17-hydroxyprogesterone6.) A 45 y/o male house painter collapses while on the job. EMTs arrive on scene and measure his BP to be 85/40.His blood sugar is 55mg/dL.Labs are drawn and reveal Na = 128, K = 6.2, Cl = 100, HCO3 = 18, BUN = 30, Cr = 1.2.Which of the following findings is most likely to be found elevated upon further work up?A- blood glucose levelB- plasma reninC- plasma aldosteroneD- cortisol levels after low dose dexamethasoneE- cortisol levels after high dose dexamethasoneF-none of the above

7.) A 28 y/o woman presents complaining of a “lump on her neck” that moves when she swallows. A biopsy wastaken and further analysis revealed apple green birefringence between crossed polars that had been stained withcongo red.Which of the following findings on medical history or physical is most likely to be found in this woman?A- constipation, fatigue, mental slowingB- proptosis, irregularly irregular heart beatC- history of cough, coryza and fever 2 weeks agoD- history of radiation for Hodgkin’s lymphoma 20 years agoE- episodic pounding headaches and hypertensionF- recurrent duodenal ulcers8.) A 75 year old man with a 30 year history of type 2 diabetes mellitus presents to his doctor for follow up. Hecomplains of a tingling sensation around his mouth. The physician induces a carpal spasm when inflating the bloodpressure cuff.Laboratory work up reveals the following:Ca = 7.5, Alb = 4.0, PO4 = 5.5, high PTH, high AlkPhosWhich of the following is the most likely diagnosis?A- decreased vitamin D intakeB- parathyroid adenomaC- accidental surgical excision of the parathyroidsD- Albright’s hereditary osteodystrophyE- diabetic nephropathyF- prostate adenocarcinoma metastatic to the bones9.) A women presents to her gynecologist because she has not yet resumed her menses 12 months after havingher baby. The pregnancy was complicated by placenta previa and 1500cc blood loss during delivery. Her bloodsugar is found to be 65mg/dL at the office visit.Which of the following is true of her condition?A- a trial of estrogen & progesterone will cause uterine bleedingB- a trial of bromocriptine or somatostatin will likely reverse her symptomsC- prolactin is elevatedD- serum K is decreasedE- serum IGF-1 is elevatedF- serum osmolarity is decreased10.) A 17 y/o female presents to the ER after fainting at school. She currently complains of heart palpitations,sweating and tremor. She has no known medical problems but has a strong family history of diabetes. Her littlesister has type 1 diabetes and takes glargine and lispro insulin. Her mother has type 2 diabetes and takesmetformin and glipizide.A blood glucose level is obtained in the ER and is 40mg/dL. Serum insulin and C-peptide levels are both found to beelevated.Which is the most likely mechanism causing the patient’s hypoglycemia?A- amyloid deposition in the islets of LangerhanB- autoimmune destruction of β-cellsC- anion gap metabolic acidosisD- mutation in the ret oncogeneE- closure of the β-cell K+ channelF- an exogenous agent binding the insulin receptor and increased GLUT4 expression in adipose tissue & muscleG- decreasing gluconeogenesis and increasing tissue sensitivity to insulin

Question 10-A 17 y/o female presents to the ER after fainting at school. She currently complains of heartpalpitations, sweating and tremor. She has no known medical problems but has a strong family historyof diabetes. Her little sister has type 1 diabetes and takes glargine and lispro insulin. Her mother hastype 2 diabetes and takes metformin and glipizide.A blood glucose level is obtained in the ER and is 40mg/dL. Serum insulin and C-peptide levels are bothfound to be elevated.Which is the most likely mechanism causing the patient’s hypoglycemia?Since the insulin AND C-peptide are high, this indicates that the hypoglycemia is coming from an increasein endogenous insulin (ie- the patient is not stealing her sister's glargine or lispo and shooting up thatwould give high insulin and low/normal C-peptide). The two main causes of hypoglycemia in the settingof high insulin and C-peptide are insulinoma and surreptitiously taking sulfonylureas. Sulfonylureas cancause hyperinsulinemic hypoglycemia b/c they close the K+-ATP channel in the pancreatic beta-cellswhich hyperpolarizes them and increases exocytosis of insulin in secretory vesicles.A- amyloid deposition in the islets of LangerhanNo. This is a pathologic finding in type 2 diabetes.B- autoimmune destruction of β-cellsNo. This is a pathologic finding in type 1 diabetes.C- anion gap metabolic acidosisNo. This is a finding in diabetic ketoacidosisD- mutation in the ret oncogeneNo. This is found in MEN2a or 2b. Not in MEN1 which is assoc. w/ insulinomaE- closure of the β-cell K+ channelYes! This is the mechanism of action of sulfonylureas. The girl likely took some.F- an exogenous agent binding the insulin receptor and increased GLUT4 expression in adipose tissueand skeletal muscleNo. This is the mechanism of action of insulin (lispro or glargine). Normal C-peptideG- decreasing gluconeogenesis and increasing tissue sensitivity to insulinNo. This is the mechanism of action for metformin. Would not increase Insulin and rarely causeshypoglycemia