Remembrances Flashcards
What prevents polyspermy?
- Capacitation
- Cortical reaction
- Acrosome reaction
Cortical reaction
(In the regulatory zone) What is the upstream DNA sequence that leads to increased transcription? (2021, 2022)
- Coactivator
- Coregulator
- Enhancer
- Inhibitor
Enhancer
- What do coactivators and corepressors bind to? (2007, 2011, 2012, 2018)
- C region/domain of receptor
- A/B region of receptor
- TAF
- E region of receptor
- 3COOH
- What is the function of corepressors & coactivators? (2018 NIH)
- How do promoters and repressors exert activity? (2011)
- Binding TAFs
- Binding zinc fingers
- Dimerizing hormones
- TAF
- Act on TAFs
- Binding TAFs
What is the binding site of corepressors and coactivators on hormone responsive genes? (2014, 2018 NIH)
- 3’ untranslated region
- CpG
- 5’ upstream region
- Hinge region
- DNA-binding domain
5’ upstream region
What mediates differences in estrogen receptor alpha (ER-alpha) and estrogen receptor beta (ER-beta)? (2013, 2016, 2017, 2018)
Coactivators and corepressors
Presence of TAF-1 on ER-alpha (A/B region)
Where does binding on DNA occur with the hormone response element? (2011)
- On mRNA
- Upstream to 5’ transcription
Upstream to 5’ transcription
What enzyme converts progesterone to dihydroprogesterone? (2017, 2018, 2022)
- 5-alpha-reductase
- 7-alpha-hydroxylase (7-alpha-OH)
5-alpha-reductase
- A mutation in DAX1 most likely results in what? (2003, 2007, 2011, 2012, 2014, 2018, 2018 NIH, 2019, 2021)
- Ovarian failure
- Adrenal hypoplasia/failure
- Delayed puberty
- Failed testicular development
- Failure to express SRY and SOX9
- Sulfatase deficiency
- What happens in males with DAX1 inactivating mutations? (2014, 2016, 2017, 2018)
- What happens in females with DAX1 inactivating mutations? (2014, 2016, 2017, 2018)
- Adrenal hypoplasia/failure
- Adrenal hypoplasia
- Delayed puberty
What enzyme is the rate limiting step of steroid hormone synthesis? (2018 NIH, 2020)
- StAR
- P450scc
- 17-beta-hydroxysteroid dehydrogenase (17-beta-HSD)
- Aromatase
StAR
What is the availability of gonadotropin beta subunits based on? (2020)
- GnRH pulse amplitude
- GnRH pulse frequency
GnRH pulse frequency
What is increasing sialic acid (residue) (silanization) content associated with? (2011, 2017, 2018, 2018 NIH, 2019)
- Diminished half-life
- Diminished clearance/excretion
- Increasing pH
- Decreased bioactivity
Diminished clearance/excretion
What is the biological effect of sialic acid residues? (2013, 2014)
- Increase urinary vs. recombinant hormone
- Increase pH
- Decrease half-life
- Increased during follicular phase
Increased during follicular phase
What setting do you see hyperglycosylated hCG? (2013)
- Pregnancy (first trimester)
- Male
Pregnancy (first trimester)
What setting do you see persistent hyperglycosylated hCG? (2018 NIH)
- Pregnancy
- Mole
- Pituitary small cell carcinoma
- Choriocarcinoma
Both mole and choriocarcinoma
What is the correct order of relative half-lives arranged from greatest to least? (2007, 2009, 2011, 2012, 2014, 2015, 2017, 2018, 2018 NIH)
- hCG>FSH>GnRH>LH
- LH>FSH>hCG>GnRH
- hCG>FSH>LH>GnRH
- FSH>hCG>LH>GnRH
hCG>FSH>LH>GnRH
What hormone receptor class uses phospholipase C (PLC)? (2007, 2011, 2018)
- FSH
- IGF
- TSH
- GnRH
GnRH
What is the least likely reason why hormones readily pass through the cell membrane? (2009, 2018, 2023 NIH)
- High polarity
- Protein binding
- Fat solubility
- Small size
High polarity
What causes failure to iodinate a new protein? (2001, 2007, 2018, 2018 NIH)
- Excess tyrosine residues
- Increased TSH
- No tyrosine residues available
- Abnormal receptor binding
No tyrosine residues available
Where does the TAF act? (2009, 2018, 2018 NIH)
- 5’ untranslated region
- Initiation codon
- 3’ end of DNA
- DNA-binding domain
5’ untranslated region
Which is most true about SHBG? (2018, 2018 NIH)
- Strongly binds progesterone
- Each molecule binds to a single steroid molecule
- Levels increased by IGF-1
Each molecule binds to a single steroid molecule
SHBG is best described by which of the following? (2011)
- Forms a homodimer with binding of a single hormone
- Binds estradiol in greater affinity than testosterone
Forms a homodimer with binding of a single hormone
What increases SHBG? (2003, 2018, 2018 NIH)
- Insulin
- Hyperthyroidism
- Obesity
- Growth hormone
Hyperthyroidism
What decreases SHBG? (2003, 2018, 2018 NIH)
- Estrogen
- T4
- IGF
- Anorexia
IGF
What is necessary for prostaglandin production? (2018, 2018 NIH)
- Lipolysis
- Protein synthesis
- Arachidonic acid
- PGE2
Arachidonic acid
Which has the highest affinity for the corticotropin receptor? (2010, 2011, 2012, 2018, 2018 NIH)
- Androstenedione
- Progesterone
- Mifepristone (RU-486)
- Estrogen
What is the most potent glucocorticoid antagonist? (2016, 2017, 2018, 2018 NIH)
- Mifepristone (RU-486)
- Mifepristone (RU-486)
Which inhibits the progesterone receptor (PR) the most? (2009, 2010, 2018, 2018 NIH)
- Estrogen
- Progesterone
- 17-hydroxyprogesterone (17-OHP)
- Mifepristone (RU-486)
- Danazol
Mifepristone (RU-486)
An orphan receptor (i.e. SF-1, DAX1) is defined by the lack of? (2011, 2018)
- Known gene
- Known ligand
- Known antibodies
- Known DNA-binding site
- Location of gene is unknown
Known ligand
Which of the following is least likely to be an orphan receptor? (2007, 2023 NIH)
- SF-1
- DAX1
- IGF-1
IGF-1
Somatic cell response to androgens is determined by the gene that is present on what chromosome? (2011, 2012, 2014, 2018)
- Xp
- Xq
- Y
- 22
- 13
Xq
What is the production rate of estradiol? (2018)
100-300ug/day
What is the production rate of androstenedione? (2018)
3 mg/day
How do nuclear receptors quickly exert actions? (2011)
- Transcription of mitochondrial DNA
- Duplication of DNA
- Activating transcription of genomic DNA
- Protein synthesis on ribosomes
Activating transcription of genomic DNA
What is the first event after insulin receptor binding? (2003, 2005, 2007, 2018, 2018 NIH)
- (Tyrosine) Auto-phosphorylation of receptor
- Conformational change of cytoplasmic domain of receptor
- Kinase activation of receptor
- Phosphatase activation of receptor
Conformational change of cytoplasmic domain of receptor
A nuclear receptor transmits its signal via? (2023 NIH)
- Translation
- Transcription
- Opening of calcium channels
- Protein kinase A (PKA)
Transcription
What does an insulin receptor defect cause? (2003)
Increased androgen secretion from the ovary
What is the immediate effect after a (steroid) hormone binds DNA? (2014, 2015, 2023 NIH)
- Dimerization
- Ribosomal DNA transcription
- Genomic DNA replication
- mRNA translation
- Genomic (mRNA) transcription
Genomic (mRNA) transcription
What does T3 use as its receptor? (2011, 2012)
- Phospholipase C (PLC)
- cAMP
- Steroid receptor
Steroid receptor
Which of the following has a nuclear receptor? (2009, 2011, 2012, 2018, 2018 NIH, 2022)
- T4
- T3
- FSH
- GnRH
- ACTH
- TRH
T4
T3*** both are correct
Which of the following has a nuclear receptor? (2018 NIH)
- Steroid hormones
- Peptide hormones
Steroid hormones
Which of the following has an intracellular receptor? (2003, 2012)
- T3
- TSH
- FSH
- LH
- hCG
- GnRH
T3
Which of the following has the least number of amino acids? (2007)
- GnRH
- GHRH
- Oxytocin
Oxytocin
The hormone binding domain is important for which of the following? (2007, 2023 NIH)
- HSP binding
- Dimerization
- Nuclear localization
- HSP binding
- Dimerization
*** both are correct
Where is the least likely place to find synthesis of steroids? (2007, 2023 NIH)
- Mitochondrial membrane
- Cytoplasm
- Nucleus
- Endoplasmic reticulum
Nucleus
Which of the following pairs do not act at the same type of receptor? (1999)
- Growth hormone and prolactin
- Insulin and IGF-1
- Progesterone and levonorgestrel
- Inhibin and TGF-alpha
Inhibin and TGF-alpha
Which of the following has a tyrosine kinase receptor? (1999)
- Growth hormone
- ACTH
- FSH
- GnRH
- IGF-1
IGF-1
Where is the steroid receptor DNA-binding domain located? (2012)
5’ upstream region
What initiates the DNA-binding of the hormone receptor? (2001)
Enhancer region
Progesterone action on stromal cell
Where does the most androgen production take place in women? (2010)
- Ovary
- Adrenal
Ovary
What is one of the first events after ligand binding to a tyrosine kinase receptor? (2007)
- G-protein activation
- Phosphorylation
- IP3
Phosphorylation
How are estrogen receptor alpha (ER-alpha) and estrogen receptor beta (ER-beta) different? (2013, 2015, 2017, 2018)
What is the difference in function of estrogen receptor alpha (ER-alpha) and estrogen receptor beta (ER-beta)? (2023 NIH)
- Methylation
- Dimerization
- Co-Binding
- Coregulator binding site
Co-regulators
Co-Binding
Coregulator binding site
The gene that binds to the steroid hormone receptor to cause transcription of the hormone-responsive gene is modulated by transcription factors that act where? (2003)
5’ upstream region
How is estrogen receptor beta (ER-beta) different from estrogen receptor alpha (ER-alpha)? (2019)
Estrogen receptor beta (ER-beta) lacks TAF-1
How are estrogen receptor alpha (ER-alpha) and estrogen receptor beta (ER-beta) the same (most homologous)? (2012, 2013, 2014, 2015, 2018)
- Regulatory
- DNA-binding domain
- Hinge
- Hormone binding domain
- F region
Which domain is most highly conserved in estrogen receptors? (2023 NIH)
- DNA-binding domain
- Hinge
- Ligand binding domain
Which part of the estrogen receptor alpha (ER-alpha) and estrogen receptor beta (ER-beta) are most homologous? (2018)
- A/B
- C
- D
- E
- F
DNA-binding domain
DNA-binding domain
C
Where are zinc fingers located? (2001, 2003, 2023 NIH)
- DNA-binding domain
- Hormone response element
- Ligand binding domain
DNA-binding domain
What type of receptor do growth hormone and prolactin bind to? (2003)
- Tyrosine kinase associated receptor
- JAK/STAT (aka cytokine receptor)
JAK/STAT (aka cytokine receptor)
Which of the following tissues has the highest ratio of estrogen receptor alpha (ER-alpha) to estrogen receptor beta (ER-beta)? (2001, 2003, 2005, 2023 NIH)
- Bone
- Brain
- Uterus
- Ovary
Uterus
Which androgen is most produced by peripheral conversion? (2003, 2005, 2023 NIH)
- Testosterone
- DHEAS
- Androstenedione
- DHEA
Testosterone
ACTH acts by binding to which type of receptor? (2007)
- G-protein, c-AMP
- G-protein, IP3
- Cytokine
G-protein, c-AMP
What does estrogen and progesterone priming lead to in progesterone receptor A (PR-A) and progesterone receptor B (PR-B) knockout mice? (2003, 2010, 2018, 2023 NIH)
- Lordosis
- Endometrial glandular hyperplasia
- Breast development
Endometrial glandular hyperplasia
What does not happen in a mouse model with a progesterone receptor (PR) knockout? (2018)
Decidualization
What is the mechanism of action of progesterone receptor B (PR-B)? (2005, 2007)
- Acts on progesterone elements
- Modulation of estrogen receptor (ER)
- Inhibition progesterone receptor A (PR-A) function by binding to progesterone receptor A (PR-A)
- Inhibiting homodimer formation
- Stimulate progestin-related actions
- Other
Stimulate progestin-related actions
What works though a G protein using phospholipase C (PLC)? (2007)
- GnRH
- Dopamine
- CRH
GnRH
Which is a decapeptide? (2023 NIH)
GnRH
What does CYP2R1 do in the liver? (2023 NIH)
Vitamin D conversion to 25-hydroxyvitamin D
What gene is associated with ovarian development (differentiation)? (2014, 2017, 2018, 2020)
- FOXL2
- HOXA 8/10 (HOX)
FOXL2
Which of the following genes are not involved in promoting ovarian development? (2018)
- WNT4
- RSPO1
- DAX1
- WT1
- FOXL2
WT1
What happens in oocyte meiotic arrest? (2013)
- Inhibiting factor from granulosa cells/functioning granulosa cells
- Gap junctions
Inhibiting factor from granulosa cells/functioning granulosa cells
What happens during embryo development? (2018)
- Demethylation of imprinted genes
- Demethylation of non-imprinted genes
Demethylation of non-imprinted genes
What enzyme is the granulosa cell missing? (2009, 2018, 2023 NIH)
- 3-beta-hydroxylase (3-beta-OH)
- 17-alpha-hydroxylase (17-alpha-OH)
- 17-beta-hydroxysteroid dehydrogenase (17-beta-HSD)
- Aromatase
17-alpha-hydroxylase (17-alpha-OH)
What other malignancy do you check for in a patient with uterine and cutaneous fibroids? (2014, 2015, 2017, 2018, 2019, 2021)
- Renal cell carcinoma
- Colon cancer
- Endometrial cancer
- Medullary thyroid cancer
- Ovarian cancer
Renal cell carcinoma
(HLRCC: Hereditary leiomyomatosis and renal cell cancer)
Patient has a 0.5cm fundal indentation and a 2cm portion of tissue extending from the interostial line into the cavity. What is the diagnosis? (2021)
- Septum
- Bicornuate
- Arcuate
- Didelphys
Septum
What is the least helpful in distinguishing a uterine septum from a bicornuate uterus? (2003, 2005, 2009, 2010, 011, 2012, 2018, 2023 NIH)
- Transvaginal ultrasound (US)
- Sonohysterogram
- HSG
- MRI
- Laparoscopy and hysteroscopy
HSG
What is the most helpful in distinguishing a uterine septum from a bicornuate uterus? (2023 NIH)
- Transvaginal ultrasound (US)
- Sonohysterogram
- HSG
- MRI
- Laparoscopy and hysteroscopy
MRI
What is the most common complication of a unicornuate uterus? (2001, 2018, 2023 NIH)
- First trimester pregnancy loss
- Second trimester pregnancy loss
- Preterm delivery
- Preeclampsia
First trimester pregnancy loss
A patient is found to have a longitudinal vaginal septum. What is the best next step? (2020)
MRI
Hysteroscopy
Laparoscopy
Ultrasound (US)
Ultrasound (US)
MRI
What is least likely to occur with progesterone resistance? (2014, 2016)
- Endometrial synechiae
- Endometrial hyperplasia
- Endometrial polyps
What is least likely to result from inadequate response to progesterone? (2023 NIH)
- Synechiae
- Polyps
- Endometritis
- Luteal defect
Which is the least likely to exhibit progesterone resistance? (2013, 2014)
- Endometriosis
- Endometritis
- Endometrial synechiae
Endometrial synechiae
Synechiae
Endometritis
Endometrial synechiae
What is true about leiomyosarcoma? (2015, 2023 NIH)
- > 10 mitoses per 10 high power fields
- Med 12 somatic mutation
- Some gene mutation that I had never heard of
> 10 mitoses per 10 high power fields
What is true about ethnic differences in fibroids? (2015)
- Black women have younger age of onset than white women
- More aneuploidy in fibroid cells
Black women have younger age of onset than white women
What do you give for fibroids in patients who have bleeding despite OCPs? (2015)
- Levonorgestrel IUD (Mirena)
- High dose progestin
- Uterine artery embolization (UAE)
- Rollerball ablation
Levonorgestrel IUD (Mirena)
What happens at menses? (2015, 2016)
- Vasoconstriction and coagulation
- Stromal breakdown
Stromal breakdown
(Lateral) Fusion defects are due to fusion abnormalities of which of the following? (2011, 2012, 2018, 2023 NIH)
- Mesonephric ducts
- Paramesonephric ducts
- Metanephric ducts
- Wolffian ducts
- Vaginal platea
- Metanephric ducts
- Urogenital sinus
Paramesonephric ducts
For which of the following conditions is an endometrial biopsy least useful for? (2007, 2012, 2023 NIH)
- Chronic endometritis
- RPL workup
- Test for ovulation
- PCOS
- Thickened endometrium >12mm
- Luteal phase deficiency
- Infertility workup
RPL workup
Luteal phase deficiency
Infertility workup
What is the most likely cause of bilateral (proximal) tubal occlusion on HSG? (2011)
- PID
- Tuberculosis
- Tubal spasm
- Salpingitis isthmica nodosa (SIN)
Tubal spasm
Salpingitis isthmica nodosa (SIN) causes which of the following? (2011)
- Hyperplasia of the mucosa
- Inflammation of the tubal epithelium
- Tubal scarring
Tubal scarring
Which of the following is the least useful test for salpingitis? (2010)
- HSG
- Mycoplasma
Mycoplasma
What is the mechanism of growth of fibroids? (2001, 2007, 2023 NIH)
- Acquired genetic abnormality
- TGF-beta dysregulation
- Others
TGF-beta dysregulation
What has uterus didelphys been associated with? (2022)
- Increased spontaneous miscarriage, increased preterm birth
- Increased infertility, increase in preterm birth
- Failure to progress, increase in preterm birth
- Decreased spontaneous abortion, increased preterm birth
Increased spontaneous miscarriage, increased preterm birth
Which of the following gene mutations is associated with mullerian anomalies in genetic females? (2022)
- HOXA13
- WNT4
- LIM1
- MIS
MIS
What is a consequence of an uncorrected vaginal septum in a sexually-active woman discovered incidentally on routine pap testing? (2022)
- Spontaneous miscarriage
- Infertility
- Endometriosis
- Labor dystocia
Labor dystocia
What is the most common finding in conjunction with Mullerian agenesis? (2003)
- Vertebral column abnormalities
- Foot deformity
- Pulmonary stenosis
Vertebral column abnormalities
Diethylstilbestrol (DES) exposure is least likely to cause which of the following? (2003, 2010)
- Cervical dysplasia
- Uterine septum
- Ectopic pregnancy
- Others
Uterine septum
What of the following has the highest likelihood of repair for the fallopian tubes? (2007)
- Extensive ovarian adhesions
- Hydrosalpinx involving 3cm of tube
- Salpingitis isthmica nodosa (SIN)
- Rugation of tubes on HSG
Extensive ovarian adhesions
What type of fallopian tube abnormality is easiest to correct? (2005)
- Bilateral hydrosalpinges
- Salpingitis isthmica nodosa (SIN)
- Tubal rugae on HSG
Bilateral hydrosalpinges
An infertility patient has an 8cm fibroid that is partially submucosal and Hct 22%. What is the best plan of management? (2005)
- Expectant management
- Hysteroscopic myomectomy
- GnRH agonist then abdominal myomectomy
- Others
GnRH agonist then abdominal myomectomy
Which of the following has the worst prognosis? (2023 NIH)
- Uterine septum
- Adenomyosis
- Unicornuate uterus
Uterine septum
Which receptor uses protein kinase C (PKC) as a second messenger? (2022, 2023 NIH)
- CRH
- GnRH
- Activin
GnRH
What activates phospholipase C (PLC)? (2011)
- Dopamine
- GnRH
- CRH
- Insulin
GnRH
What is the first action after GnRH binding? (2018)
- Autophosphorylation of the receptor
- Conformational change in the receptor
- GTP replaces GDP
- Activation of the adenylate cyclase
GTP replaces GDP
Which occurs first when GnRH binds to its receptor? (2011)
- Phospholipase C (PLC) activation
- G protein binding
- Others
G protein binding
What is the first action after GnRH binds its receptor? (2014, 2023 NIH)
- Protein kinase C (PKC)
- cAMP release
- Phospholipase C (PLC)
- IP3 and calcium release
What is initial action of GnRH binding to receptor (2015, 2018)
- Phospholipase C (PLC)
- Protein kinase C (PKC)
- Gq/G11
What is initial action of GnRH binding to receptor (2017)
- IP3/Ca
- Protein kinase C (PKC)
- Gq/G11
Phospholipase C (PLC)
Phospholipase C (PLC)
IP3/Ca vs Gq/G11
What is the intracellular immediate second messenger for GnRH? (2015, 2019)
- Phospholipase C (PLC)
- IP3
- DAG
- Protein kinase C (PKC)
- Protein kinase A (PKA)
Phospholipase C (PLC)
What mediates rapid response in GnRH receptor signaling? (2012)
- Protein kinase C (PKC)
- Protein kinase A (PKA)
- Calcium release
- DAG inhibition
Calcium release
How is GnRH able to exert immediate effects? (2011)
- cAMP
- Nuclear binding
- Calcium
- IP3
- Tyrosine kinase
Calcium
What is the immediate next step after GnRH binds its receptor? (2023 NIH)
Activation of Gq aka G11
What is most likely seen with LH pulses? (2009, 2010, 2011, 2012, 2018, 2023 NIH)
- Highest pulse frequency in the early follicular phase
- Lowest pulse frequency in the mid luteal phase
- Highest pulse amplitude in the early luteal phase
- Lowest pulse amplitude in the late luteal phase
Highest pulse amplitude in the early luteal phase
(Highest pulse frequency in late follicular phase)
What is the first action after FSH and LH bind to their receptor? (2003)
- Autophosphorylation of the receptor
- Conformational change in the receptor
- GTP replaces GDP
- Activation of the adenylate cyclase
Conformational change in the receptor
Speroff Ch 1 pg 39
Hormone-receptor interaction and binding change the a-subunit conformation
GTP replaces GDP on the a-subunit, freeing b- and gamma-subunits
Allows the GTP a-subunit to bind to the catalytic unit of adenylate cyclase, forming the active enzyme.
Which pattern of GnRH secretion is most likely to cause elevation in FSH? (2014, 2023 NIH)
- Low amplitude, low frequency
- Low amplitude, high frequency
- High amplitude, high frequency
- High amplitude, low frequency
High amplitude, low frequency
What is the pattern of GnRH frequency seen in the luteal phase? (2005, 2015, 2023 NIH)
- Low amplitude, low frequency
- Low amplitude, high frequency
- High amplitude, high frequency
- High amplitude, low frequency
High amplitude, low frequency
How does LH pulsatile secretion in the luteal phase compare to the follicular phase? (2003, 2005, 2007, 2009, 2010, 2011, 2012, 2018, 2023 NIH)
- Increased pulse frequency and increased amplitude
- Decreased pulse frequency and decreased amplitude
- Increased pulse frequency and decreased amplitude
- Decreased pulse frequency and increased amplitude
Decreased pulse frequency and increased amplitude
What controls FSH secretion? (2012, 2018, 2023 NIH)
- GnRH pulse amplitude
- GnRH pulse frequency
- Estradiol pulses
- GnRH-LH interaction
GnRH pulse frequency
How does the frequency of LH in the early follicular compare to the late follicular and early luteal? (2017)
Increase in late follicular, decrease in late luteal
What do you measure in a patient with a pituitary adenoma and large feet and hands? (2018)
- ACTH
- FSH
- IGF-1
- TSH
IGF-1
A woman presents with galactorrhea and is found to have a 2cm mass and prolactin 87ng/mL. What is most likely increased? (2023 NIH)
- Growth hormone
- IGF-1
- TSH
- DHEAS
GH
A patient presents with a 10mm adenoma and is found to have hyperprolactinemia. What test will you order next? (2009)
- IGF-1
- TSH
- Cortisol
- FSH
- Alpha subunit
A woman presents with a 2 cm adenoma and prolactin 40 ng/mL. What is an appropriate lab test to order? (2007)
- Growth hormone
- IGF-1
- Big prolactin
- Something with cortisol
IGF-1
Speroff: ~10% of adenomas that secrete prolactin also secrete GH, leading some to recommend measuring the serum IGF-1 concentration, even in women with microadenomas.
Women with pituitary macro-adenomas require additional evaluation (to hCG, TSH, prolactin, FSH, estradiol), including a serum FT4, IGF-1, and AM cortisol level.
What happens with hyperprolactinemia and hypothyroidism? (2016)
- Block GnRH release
- Modify sensitivity
Block GnRH release
What does hyperprolactinemia increase? (2003, 2011)
- Estrogen
- Testosterone
- DHEAS
- DHEA
DHEAS
A pregnant patient has a 7mm mass, bilateral peripheral vision loss, elevated prolactin, and severe headache. How do you manage these findings? (2007, 2011, 2015, 2016, 2017, 2018)
- Bromocriptine
- C-section and transsphenoidal surgery
- Transsphenoidal surgery now
Bromocriptine
A 32wk pregnant woman presents with a 7mm prolactinoma and visual disturbances. Steroids (dexamethasone) were given for fetal lung maturity. What is the next step? (2009, 2011, 2018, 2023 NIH)
- C-section and transphenoidal resection
- Transphenoidal resection
- Bromocriptine
- C-section and bromocriptine
Bromocriptine
A 28yoF who is not trying to conceive presents with amenorrhea, prolactin 45ng/mL, and no galactorrhea. What is the most appropriate treatment? (2007, 2011)
- Bromocriptine
- OCPs
- No treatment
- HRT
OCPs
What is the mechanism of action of metoclopramide? (1999)
- Aromatase inhibitor
- 18-hydroxylase (18-OH) (aldosterone synthase) inhibitor
- 17-hydroxylase (17-OH) inhibitor
- Dopamine antagonist
Dopamine antagonist
What medication does not increase prolactin? (2011)
- Valium
- Levothyroxine (Synthroid)
- Metoclopramide (Reglan)
- Methyldopa
What is least likely to be associated with hyperprolactinemia? (2011, 2023 NIH)
- Diazepam
- Chlorpromazine
- Estradiol
- Levothyroxine (Synthroid)
Levothyroxine (Synthroid)
What is the most potent glucocorticoid? (2013)
- Cortisone
- Progesterone
- Dexamethasone
- Prednisone
Dexamethasone
A woman presents with a pituitary adenoma. She has a normal TSH and prolactin 35ng/mL (normal 5-30ng/mL). What is the most likely diagnosis? (2014, 2015)
- Non-functioning pituitary adenoma
- Craniopharyngioma
Non-functioning pituitary adenoma
What happens if a large pituitary tumor that extends to the left to the cavernous sinus is resected? (2015)
- Hypopituitarism
- CSF rhinorrhea
- Cavernous sinus thrombosis
- Hyperprolactinemia
Hypopituitarism
Ablation of which nucleus causes hypernatremia? (2009, 2011, 2012, 2018, 2023 NIH)
- Optic nucleus
- Arcuate nucleus
- Supraoptic nucleus
- Paraventricular nucleus
- Preoptic nucleus
- Ventromedial nucleus
- Mediolateral nuclues
Supraoptic nucleus
GnRH secretion is most impacted with ablation of which nucleus? (2014)
- Preoptic nucleus
- Paraventricular nucleus
- Ventromedial nucleus
- Arcuate nucleus
Arcuate nucleus
What is least likely to be required to be replaced in panhypopituitarism? (2009, 2011, 2014, 2018, 2023 NIH)
- TSH
- Growth hormone
- Glucocorticoids
- Gonadotropins
- Estradiol
- Mineralocorticoids
Mineralocorticoids
A woman adopts a child and wants to breastfeed. Which of the following, along with nipple stimulation, is most likely to induce lactation? (2014, 2015)
Metoclopramide (Reglan)
What is pituitary feedback conducted via? (2015)
- Portal circulation
- Systemic circulation
Systemic circulation
A woman presents with a pituitary mass and is found to have elevated FSH 42mIU/mL, normal LH, and increased alpha subunits. What is the diagnosis? (2007, 2011, 2012)
- Prolactinoma
- Thyrotroph adenoma
- Gonadotroph adenoma/Non-functioning adenoma
- FSH-oma
- POI
- Pregnancy
Gonadotroph adenoma/Non-functioning adenoma
What is an increased FSH:LH ratio most likely due to? (2005, 2011)
- Increased GnRH pulse frequency
- Decreased GnRH pulse frequency
- Increased GnRH pulse amplitude
Decreased GnRH pulse frequency
A patient presents with a 12 mm adenoma, galactorrhea, normal cycles, and prolactin 35ng/mL. What is the most likely cause? (2007)
- Non-functioning adenoma
- Empty sella syndrome
- Craniopharyngioma
Non-functioning adenoma
A woman’s pituitary stalk is transected. What hormone will increase because of this? (2003, 2007)
Ablation of the median eminence (pituitary stalk) will create a rise in which hormone? (2007, 2023 NIH)
- TSH
- FSH
- Prolactin
- Oxytocin
Prolactin
The ultrashort feedback loop works because of which of the following? (2007, 2023 NIH)
- Retrograde flow
- Capillary fenestrations
- CSF fluid in 3rd ventricle
What is the explanation for the rapid feedback mechanism for pituitary hormones? (2023 NIH)
- Retrograde flow in the portal system
- Brain barrier
- Axo-neuronal transport of hormones
Retrograde flow
Retrograde flow in the portal system
How do pituitary hormones feedback on the hypothalamus? (2023 NIH)
- Systemic circulation
- Pituitary portal vessels
- Tanycytes
Pituitary portal vessels
Which of the following is a typical finding of craniopharyngioma on imaging? (1999)
- Intracranial calcifications
- Suprasellar extension
- Unilateral lesion
- Sellar erosion
Intracranial calcifications
Where is vasopressin made? (2007, 2023 NIH)
Supraoptic and paraventricular nuclei in hypothalamus
Which of the following is least likely to increase prolactin secretion? (2003)
- Sleep
- Exercise
- Suckling
- Others
Others
Ablation of which nucleus leads to changes in ADH? (2011)
- Preoptic nucleus
- Paraventricular nucleus
- Ventromedial nucleus
Paraventricular nucleus
Prolactin secretion is increased by which of the following? (2003)
- Estrogen
- Progesterone
- T4
- Others
Estrogen
IGF-1 works through which type of receptor? (2003)
Tyrosine kinase
Which of the following does not cause elevated prolactin? (2005)
- Hyperthyroidism
- Chronic renal failure
- Cushing disease
- Hypothyroidism
Hyperthyroidism
A 22yo F has an elevated prolactin level and an 8mm pituitary adenoma noted on MRI. What additional test should you order? (2007)
- Growth hormone
- IGF-1
- Cortisol
- TSH
Growth hormone
What causes histamine release? (1999, 2003)
- GnRH antagonists
- GnRH agonists
- Cyproterone acetate
- Spironolactone
- Insulin
GnRH antagonists
What is the most likely to cause hypernatremia if ablated? (2007)
- Amygdala
- Oxytocin cell
- Periventricular nucleus
Periventricular nucleus
What is the most likely to cause a decrease in gonadotropins if ablated? (2007)
- Amygdala
- Arcuate nucleus
Arcuate nucleus
Dopamine inhibits which of the following in vivo? (2003)
- GnRH
- FSH
- LH
- TSH
GnRH
What causes the transition from preantral/secondary to antral follicle? (What is required for antral progression (antrum progression)?) (2001, 2003, 2007, 2009, 2011, 2012, 2013, 2014, 2015, 2018, 2022, 2023 NIH)
- FSH
- GDF-9
- c-KIT
- Kit ligand
- Inhibin
- BMP15
- AMH
- LH
FSH
What directs development from the primary to preantral/secondary follicle? (2005, 2007, 2009, 2018, 2023 NIH)
- GDF-9
- FSH
- Inhibin
- AMH
- LH
GDF-9
What is the role of the granulosa cells in the primordial follicle? (2009, 2011, 2012, 2014, 2015, 2016, 2017, 2018, 2021, 2023 NIH)
- Secrete GDF-9
- Prevent atresia of the oocyte
- Secrete inhibin
- Secrete activin
- Secrete AMH
- To make kit ligand
Prevent atresia of the oocyte
In a primordial follicle, the oocyte is surrounded by which of the following? (2003)
- Single layer of granulosa cells
- Multiple layers of granulosa cells
- Others
Single layer of granulosa cells
What is connexin 37 used for communication between? (2020)
- Granulosa and oocyte
- Theca interna and externa
- Theca cell to granulosa cell
Granulosa and oocyte
When is peak estradiol in the menstrual cycle? (When is the ovary making the most estradiol?) (2019, 2023 NIH)
- Early follicular
- Late follicular
- Early luteal
- Midluteal
- Late luteal
- Menses
Late follicular
When is the maximum expression of the progesterone receptor (PR) during the menstrual cycle? (2023 NIH)
- Menses
- Late follicular
- Late luteal
Late follicular
What is a progesterone >5ng/mL most associated with? (2014)
- Ovulation
- Receptive endometrium
- Ectopic
Ovulation
What progesterone level is most consistent with ovulation? (2015)
- 1.5ng/mL
- 3 ng/mL
- 5 ng/mL
- 10 ng/mL
10 ng/mL
What phase of the menstrual cycle has the highest concentration (maximum expression) of progesterone receptors (PR)? (2001, 2011, 2012, 2013, 2014, 2015, 2016, 2018)
- Early follicular/proliferative
- Late follicular/proliferative
- Early luteal/secretory
- Mid luteal/secretory
- Late luteal/secretory
Late follicular/proliferative
What hormone decreases during luteolysis (regression of the corpus luteum)? (1999, 2003, 2005, 2007, 2009, 2011, 2012, 2013, 2014, 2018, 2023 NIH)
- FSH
- Inhibin A
- Inhibin B
- Activin
- PGF2-alpha
Inhibin A
What peaks in the luteal phase? (2015, 2016, 2018, 2023 NIH)
- Inhibin A
- Inhibin B
Inhibin A
What is least important for oocyte (follicular) development? (2011, 2013, 2014, 2023 NIH)
- BMP15
- GDF-9
- c-KIT
- Follistatin
Follistatin
What is the action of P4 on the endometrium at the start of menses? (2014, 2015)
Withdrawal leads to endometrial breakdown
What is the first event after IGF-1 binds to its receptor? (2007)
Tyrosine kinase phosphorylation
What is the most reliable marker of ovulation? (2016)
- Basal body temperature
- Urinary LH surge
- Progesterone > 3ng/mL 1wk before menses
Progesterone > 3ng/mL 1wk before menses
When does the zona pellucida first form? (2009, 2018, 2023 NIH)
- Primordial follicle
- Primary follicle
- Preantral follicle
- Antral follicle
Preantral follicle
What agent is responsible for theca interna development? (2007, 2018, 2023 NIH)
- GDF-9
- Inhibin
- Activin
- FOXL2
- FSH
- IGF-1
GDF-9
Which enzyme is lowest in theca cells? (2007, 2023 NIH)
- Aromatase
- All other enzymes in steroidogenesis
Aromatase
What enzyme is most likely involved with ovulation/follicular rupture? (2003, 2005, 2007, 2009, 2011, 2018, 2023 NIH)
- PIP2
- BMP15
- Collagenase
- Decrease in PGE2
- Decrease in PGF2-alpha
- Proteinase
- Cumulus hyaluronidase
Which of the following is most likely to cause of follicular rupture? (2007, 2023 NIH)
- Increase in proteoglycan
- Increase in collagenase
- Increase in follicular pressure
Collagenase
Increase in collagenase
What events occur at ovulation? (2018)
- Decrease in plasminogen activator
- Increase in plasminogen activator inhibitor
- Increase in plasminogen activator
- Decrease in matrix metalloproteinases
Increase in plasminogen activator
Granulosa cells in the follicular phase use which enzyme the least? (2007, 2023 NIH)
- Aromatase
- 17-hydroxylase (17-OH)
- P450scc
17-hydroxylase (17-OH)
At what stage does the follicle develop a blood supply? (2011)
- Primordial follicle
- Preantral follicle
- Antral follicle
- Atretic follicle
Preantral follicle
What happens to the follicle immediately prior to ovulation? (2014, 2015, 2016)
- Oocyte maturation inhibitor expressed
- Resumption of meiosis II
- Increase in prostaglandin
Increase in prostaglandin
At what stage does vascularization of the follicle start? (2009)
- Primary follicle
- Secondary follicle
- Antral follicle
Secondary follicle
What precursor must you have when going from cholesterol to estradiol? (2023 NIH)
- 17-hydroxyprogesterone (17-OHP)
- Testosterone
- Pregnenolone
- Progesterone
Testosterone
Which of the following is most likely in regard to the menstrual cycle? (2023 NIH)
- Progesterone in mid-cycle augments estradiol; feedback on LH
- Estradiol in early follicular phase increases GnRH receptors at pituitary
Progesterone in mid-cycle augments estradiol; feedback on LH
Where is the spindle most likely to be after extrusion of the 2nd polar body? (2021)
- Near 2nd polar body
- Opposite 2nd polar body
- Degraded
- Outside oocyte
- Near 2nd polar body
When does the cortical reaction occur? (2018)
- Sperm bind ZP2
- Sperm binds ZP3
- Sperm fusion to oocyte membrane
Sperm fusion to oocyte membrane
During implantation and uterine invasion, what cell gets replaced in trophoblast invasion? (2013, 2014, 2015, 2017, 2018)
- Vascular endothelium
- Endometrium
- Myometrium
Vascular endothelium
In pregnancy, trophoblast replaces which of the following? (2005, 2014, 2015)
- Glandular epithelium
- Luminal epithelium
- Stroma
- Endometrial glands
Luminal epithelium
What does the cytotrophoblast/trophoblast replace? (2007, 2009)
- Stroma
- Endothelium
- Decidua
- Myometrium
Endothelium
What is a progesterone receptor-regulated (PR-regulated) gene essential for implantation and decidualization? (2018)
HOXA8, HOXA10
How many chromosomes in an MI oocyte? (2009)
- 46 double chromatids
- 46 double chromosomes
How many chromosomes in an MI oocyte? (2009)
46 double chromosomes
How many chromosomes are there in prophase of meiosis I? (2003)
- 23 single-stranded chromosomes
- 23 double-stranded chromosomes
- 46 single-stranded chromosomes
- 46 double-stranded chromosomes
- 92 single-stranded chromosomes
46 double-stranded chromosomes
How many chromosomes are in an MI oocyte? (2018, 2023 NIH)
- 23
- 46
- 92
- Depends on which stage in meiosis I
46
How many chromatids are in an MII oocyte? (2007, 2010, 2023 NIH)
23
46
92
46
What is the number of chromatids present in a metaphase II oocyte? (2007)
- 23 single
- 46 single
- 23 double
- 46 double
46 single
What is the chromosome number of a euploid MII oocyte? (2007, 2023 NIH)
22
23
45
46
23
What is the number of chromosomes when an oocyte is arrested in meiosis I? (2009)
23 double stranded
46 double stranded
46 double stranded
What is the number of chromosomes in the primary oocyte? (2001)
- 23
- 46
- 92
46
What is the number of chromatids present in the oocyte immediately after ovulation? (2005, 2023 NIH)
- 23
- 46
46
What is the number of chromosomes present in the oocyte just prior to ovulation? (2005, 2023 NIH)
- 23 double
- 46 double
46 double
When does the oocyte complete meiosis II? (2018)
- Ovulation
- LH surge
- Fertilization
- Acrosome reaction
- Cortical granule reaction
Fertilization
What least characterizes the inner cell mass (ICM)? (2010, 2011, 2012, 2018)
- Proliferation
- Pluripotency
- Apoptosis
- Exponential growth
- hCG production
hCG production
Mesenchymal stem cells are? (2011, 2012, 2018, 2023 NIH)
- Totipotent
- Pluripotent
- Multipotent
- Unipotent
Multipotent
What sugar is used when the embryonic genome turns on (is activated)? (What is the preferred nutrient when the maternal genome is not longer governing the development of the oocyte) (2007, 2010, 2012)
- Glucose
- Lactate
- Pyruvate
Glucose
Precompaction (Day 1-3) prior to embryonic genome activation, primary energy source is anaerobic with lactate and pyruvate
Post compaction (Day 4-6) after embryonic genome activation, embryo switches to aerobic with increased glucose utilization
What is the first step in sex determination? (What is the first embryonic event leading to the development of a male phenotype?) (Which is the earliest requirement for normal male gonadal development?) (1999, 2003, 2005, 2010, 2012)
- Y chromosome
- SRY (TDF) gene expression/activation
- Testosterone production
- AMH
SRY (TDF) gene expression/activation
Which hormone most likely keeps immune suppression down for implantation? (2007, 2023 NIH)
- ACTH
- Cortisol
- Progesterone
- Estrogen
Progesterone
The oocyte is in which of the following stages just prior to fertilization? (2003, 2005, 2007, 2023 NIH)
- Prophase I
- Prophase II
- Metaphase I
- Metaphase II
Metaphase II
What is the first thing that happens in human embryos at implantation? (2023 NIH)
- Apposition
- Invasion
- Adhesion
Apposition
Which least accurately characterizes maternal thyroid physiology? (2003)
- Increased TSH secretion
- Decreased T4 secretion
Decreased T4 secretion
What enzyme does the fetus lack? (2013, 2015, 2017, 2019, 2022)
- 3-beta-hydroxysteroid dehydrogenase (3-beta-HSD)
- 17-alpha-hydroxylase (17-alpha-OH)
3-beta-hydroxysteroid dehydrogenase (3-beta-HSD)
What enzyme does the placenta lack?
17-alpha-hydroxylase (17-alpha-OH)
Rank corticosteroids in order of increasing potency
“Cold Hands Palpate My Dead Body”
Cortisone
Hydrocortisone
Prednisone
Methylprednisone
Dexamethasone
Betamethasone
Which hormone decreases mid-gestation/second trimester in a male fetus? (2009, 2010, 2011, 2012, 2013, 2015, 2017, 2018, 2019)
- LH
- TSH
- Prolactin
- Estrogen
- Testosterone
- ACTH
- Prolactin
- Growth hormone
- hPL
- E2
LH
Which hormone is least likely to decrease mid-gestation/second trimester? (2007)
- LH
- ACTH
- CRH
- Prolactin
Prolactin
All of the following will rise in pregnancy except? (1999, 2012, 2013, 2018, 2023 NIH)
- hPL
- CRH
- ACTH
- Estriol
- Progesterone
- Growth hormone
- Prolactin
- Cortisol
- T4
Growth hormone
Where is estetrol made? (2014, 2018)
- Fetal adrenal
- Fetal ovary
- Fetal liver
- Placenta
Fetal liver
Where is proopiomelanocortin (POMC) found? (2014, 2018)
Placenta
Placenta
What makes (increases) maternal (serum) CRH in pregnancy? (2003, 2005, 2007, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2018, 2023 NIH)
- Maternal hypothalamic activity
- Maternal pituitary activity
- Fetal hypothalamic activity
- Placental function
- Decidua
Placental function
What doesn’t come from POMC? (2015)
- Enkephalin
- Beta lipotropin
- Beta endorphin
- ACTH
- MSH
- Melatonin
Melatonin
What is the differential diagnosis of high estriol? (2018)
- Acute fetal hypoxia
- Multiple gestation
- Risk for preterm labor/pending labor
- CAH
Multiple gestation
CAH
What is the differential diagnosis of low estriol? (2018)
- Impending or present fetal demise
- Adrenal hypofunction
- ACTH deficiency
- Placental sulfatase deficiency
- Placental aromatase deficiency
- Drug-related effects (material corticoid therapy)
- Anencephaly
- Best answer per MFM: anencephaly
- Next best answer: present fetal demise
- 3rd best answer: placental sulfatase deficiency
What allows increased communication between cells at the time of delivery? (2014, 2017)
- Increased gap junctions
- Increased P4
Increased gap junctions
What happens at parturition? (2015)
- Functional depletion of progesterone receptors (PR)
- Increased estradiol in myometrium
- Decreased cortisol
Functional depletion of progesterone receptors (PR)
What triggers parturition? (2015)
- Fall in P4 and E2
- Depletion of progesterone receptor B (PR-B)
Depletion of progesterone receptor B (PR-B)
What causes virilization of a female fetus? (2023 NIH)
Danazol
What is the most common cause of maternal virilization in the first trimester? (2003, 2005, 2010, 2011, 2012, 2014, 2015, 2016, 2018, 2022)
- Sertoli-Leydig cell tumor
- Hyperreactio luteinalis (theca-lutein cysts)
- Luteoma of pregnancy
- Aromatase deficiency
- SHBG decrease
- PCOS
- Exogenous androgens
Luteoma of pregnancy
A pregnant woman has a testosterone (androgen) producing tumor. What is the most likely phenotype for a female fetus? (2005, 2011, 2012, 2015, 2018)
- Normal
- Virilized fetus
- Ambiguous genitalia
- Mixed gonadal dysgenesis
Normal
A woman has a twin pregnancy and develops hirsutism, what is the most likely cause? (2003, 2005, 2018)
- Nonclassical CAH
- Luteoma of pregnancy
- Hyperreactio luteinalis (theca-lutein cysts)
- Aromatase deficiency
Hyperreactio luteinalis (theca-lutein cysts)
A woman with hyperthecosis is least likely to have which of the following? (2009)
- Hypertension
- Dyslipidemia
- Acanthosis nigricans
- Virilization
Hypertension
The placenta synthesizes progesterone from what precursor? (2012, 2018)
- Maternal LDL
- Maternal HDL
- Acetate
- Fetal DHEAS
Maternal LDL
On a molar basis (In a molar pregnancy), what androgen does the theca cell produce the most? (2003, 2005, 2007, 2009, 2011, 2012, 2014, 2018, 2023 NIH)
- Androstenedione
- Testosterone
- DHEAS
- DHEA
Androstenedione
What is the least likely to cross placenta? (2005, 2018)
- T4
- TSH
- TRH
- Propylthiouracil (PTU)
- Thyroid antibody
TSH
What substances do not cross placenta? (2018)
- Glucose
- Amino acids
- Ketones
- Insulin
- IGF-1
Insulin
What is the best test to diagnose Addison disease in pregnancy? (2005, 2012, 2018)
- ACTH stimulation test
- Metyrapone test
- Insulin tolerance test (ITT)
- Glucose tolerance test (GTT)
ACTH stimulation test
What is the least likely mechanism of AIS at the receptor level? (2013, 2018)
Altered bioactivity of testosterone
What does a defect in the androgen receptor result in? (2015)
- AIS
- Klinefelter syndrome
- SMA
- 17-alpha-hydroxylase deficiency (17-alpha-OHD)
AIS
What is the inheritance pattern of AIS? (2013, 2020, 2021, 2022)
- Autosomal dominant
- Autosomal recessive
- X-linked dominant
- X-linked recessive
X-linked recessive
What is the most important requirement (principal determinant) for Wolffian duct differentiation? (2007, 2011, 2012, 2013, 2014, 2018)
- Testosterone
- SRY
- Y chromosome
- Androstenedione
- AMH
- DHT
Testosterone
What are the internal structures of a 46,XY individual with 17-alpha-hydroxylase deficiency (17-alpha-OHD)?
No internal structures (Unless testes is an option then pick that because these individuals will have some kind of cryptorchidism)
What is the pattern of Wolffian and Mullerian structures in complete AIS? (2014, 2015, 2017, 2018)
Normal Wolffian structures
Normal Mullerian structures
Both Wolffian and Mullerian structures
No Wolffian or Mullerian structures
No Wolffian or Mullerian structures
What is the gene loci responsible for androgen resistance? (2011)
- 46,XX
- 46,XY (13/15)
- 46,XY (11)
- 46,XY (t5)
46,XY (11)
Abnormality on which chromosome can cause (clinical features of AIS)? (2013, 2014)
- X
- Y
- 13
X
What chromosome is the androgen receptor gene located? (2014, 2018, 2023 NIH)
- Xq
- Xp
Xq
A 27yoF postpartum presents with fatigue and constipation, yellow coloring, TSH normal 1mIU/mL, T4 0.3mcg/dL. What is the best next step (2007)
- TRH stimulation test
- Prolactin
- Check T3 resin uptake
- MRI
Check T3 resin uptake
What causes most of insulin resistance in pregnancy? (2007)
hPL
What changes in fetal hormones in the third trimester? (2011)
- TSH can’t remember if it was increase or decrease
- Decreased FSH***
- Increased LH
- Cortisol can’t remember if it was increase or decrease
When is the soonest thyroid levels should be checked after an increase in levothyroxine (Synthroid) dose? (2012)
- 1wk
- 2wk
- 4wk
- 8wk
6-8 weeks
What is the earliest time to make a possible change in thyroid medication doses in pregnancy? (2014)
- 1wk
- 2wk
- 4wk
- 8wk
Should initiate as soon as pregnancy diagnosed, but increased need for T4 by 5 weeks
What are the normal changes to maternal thyroid function in the first trimester of pregnancy? (2010, 2012, 2014)
Increase in TSH, increase in T4
Increase in TSH, decrease in T4
Decrease in TSH, decrease in T4
Decrease in TSH, increase in T4
Decrease in TSH, increase in T4
(Due to mimicry of hCG)
What is the most likely cause of increased maternal urinary estriol? (2014)
- Placental sulfatase deficiency
- Fetal P450c17 deficiency
- Fetal 21-hydroxylase deficiency (21-OHD)
- Fetal 11-beta-hydroxylase deficiency (11-beta-OHD)
Fetal 21-hydroxylase deficiency (21-OHD)
What causes high estriol in pregnancy? (2013, 2014, 2015, 2016, 2017, 2018)
- Sulfatase
- Aromatase
- 21-hydroxylase deficiency (21-OHD)
21-hydroxylase deficiency (21-OHD)
What is the immediate precursor to estradiol in pregnancy? (2018)
- Testosterone
- DHEAS
- 16-hydroxy-dehydroepiandrosterone-sulfate (16-OH-DHEAS)
- 16-hydroxy-androstenedione (16-OH-androstenedione)
- Estriol
Testosterone
A pregnant woman at 16wk presents with low estriol levels on screening. What is the best next step? (2021)
- Check sulfated estriol
- Amnio for 17-hydroxyprogesterone (17-OHP) level
- cffDNA
- CVS
- Ultrasound (US)
Ultrasound (US)
What enzyme does the placenta lack? (1999, 2001, 2003, 2005, 2007, 2010, 2011, 2012, 2013, 2015, 2018, 2019, 2020, 2022)
- 17-alpha-hydroxylase (17-alpha-OH) and 17,20-lyase
- 17-beta-hydroxysteroid dehydrogenase (17-beta-HSD)
- 3-beta-hydroxysteroid dehydrogenase (3-beta-HSD)
- Aromatase
- Sulfatase
- 11-beta-hydroxylase (11-beta-OH)
17-alpha-hydroxylase (17-alpha-OH) and 17,20-lyase
Which is a fetal enzyme needed for production of estriol? (2018)
- 15-alpha-hydroxylase (15-alpha-OH)
- 16-alpha-hydroxylase (16-alpha-OH)
- 3-beta-hydroxysteroid dehydrogenase (3-beta-HSD)
- 17-beta-hydroxysteroid dehydrogenase (17-beta-HSD)
- 17-alpha-hydroxylase (17-alpha-OH) and 17,20-lyase
16-alpha-hydroxylase (16-alpha-OH)
What enzyme is exclusively produced by the fetal adrenal? (2018)
- 16-alpha-hydroxy-dehydroepiandrosterone-sulfate (16-alpha-OH-DHEAS)
- 16-alpha-hydroxy-dehydroepiandrosterone (16-alpha-OH-DHEA)
- Estriol
- Others
16-alpha-hydroxy-dehydroepiandrosterone-sulfate (16-alpha-OH-DHEAS)
What does a defect in the androgen receptor result in? (2015)
- AIS
- Klinefelter syndrome
- SMA
- 17-alpha-hydroxylase deficiency (17-alpha-OHD)
AIS
What is the least likely mechanism of AIS at the receptor level? (2013, 2018)
Altered bioactivity of testosterone
What is the likely mechanism of complete AIS? (2018)
- Mutation in androgen receptor gene
- Mutation in 5-alpha-reductase enzyme
- Failure of SF-1 to interact with SRY
- Dysgenesis of gonad
Mutation in androgen receptor gene
Translocation of the SRY from the Y to the X chromosome is due to the fact that the SRY is most closely located near which of the following? (2021, 2022)
- Pseudoautosomal region
- AZFa
- AZFb
- AZFc
Pseudoautosomal region
When should gonads be removed in AIS?
In patients with complete AIS, gonadectomy generally is best delayed until after puberty is completed (approximately age 16–18) because pubertal development generally proceeds more smoothly in response to endogenous hormone production and because the overall risk for tumor development is quite low (5–10%), particularly before puberty.
What is the pseudoautosomal region?
Where is it located?
Why is it significant?
The “pseudoautosomal” region constitutes only approximately 5% of the entire Y chromosome and is the only region that normally pairs and recombines during meiosis.
A single copy of the one gene most critical to testis differentiation, SRY (Sex-determining Region on Y), is located on the distal short arm of the Y (Yp11.3), immediately adjacent to the pseudoautosomal region.
Because it is so close to the SRY gene, translocation of SRY to the X chromosome is more likely
An infant presents with a 46,XX karyotype, (right) labioscrotal mass, and ambiguous genitalia. What is the MOST likely diagnosis? (2005, 2007, 2009, 2011, 2012, 2013, 2015, 2016, 2017, 2018, 2019, 2022)
- 46,XX, ovotesticular DSD (true hermaphroditism)
- 46,XX, testicular DSD (sex reversal; de la Chapelle syndrome)
- 46,XX, aromatase deficiency
- 46,XX, AMH deficiency
- Mixed gonadal dysgenesis
- Complete AIS
46,XX, ovotesticular DSD (true hermaphroditism)
An infant presents with ambiguous genitalia. There is no labioscrotal mass on exam. What is the MOST likely diagnosis if the karyotype is 46,XX? (2013, 2018)
- CAH
- Finasteride exposure during pregnancy
- Luteoma during pregnancy
- 46,XX, testicular DSD (sex reversal; de la Chapelle syndrome)
- 46,XX, ovotesticular DSD (true hermaphroditism)
CAH
An infant presents with ambiguous genitalia and a labioscrotal mass. What is the LEAST likely diagnosis if the karyotype is 46,XX? (2007, 2013, 2014, 2018)
- 5-alpha-reductase deficiency
- 46,XX male
- 46,XX, ovotesticular DSD (true hermaphroditism)
- CAH
CAH
A woman presents with fatigue, increased pigmentation, weight loss, and no androgen excess. What is the diagnosis? (2011, 2012, 2018)
- Autoimmune disease
- Diabetes
- Late onset 21-hydroxylase deficiency (21-OHD)
Autoimmune disease
A young man presents with hyperpigmentation, hyponatremia, and hyperkalemia. What is the most likely etiology? (2014, 2015)
- Autoimmune disease
- 3-beta-hydroxysteroid dehydrogenase deficiency (3-beta-HSDD)
- 11-beta-hydroxysteroid dehydrogenase deficiency (11-beta-HSDD)
- Sjogren disease
Autoimmune disease
What is the most likely phenotype in an activating LH receptor defect (LH receptor activating mutation, constitutive activation of the LH receptor)? (2003, 2005, 2009, 2011, 2012, 2014, 2015, 2016, 2017, 2018, 2020, 2021, 2022)
- Female with PCOS and elevated FSH
- Normal female
- Normal puberty
- Precocious puberty in a male (with low FSH and arrested spermatogenesis)
- Isosexual precocious puberty in female
- Precocious female puberty
Precocious puberty in a male (with low FSH and arrested spermatogenesis)
What is the risk of mortality from aortic dissection in pregnancy and postpartum in patients with Turner syndrome? (2018)
- 2/10
- 2/100
- 2/1000
- 2/10000
2/100 (2%)
What is the gene defect causing short stature in Turner syndrome (46,X, or 46,X/46,XX mosaic, or 46,X/46,XY mosaic)? (2018)
- SHOX
- SRY
- FMR1
- Anosmin-1
- AR (androgen receptor)
SHOX
A patient presents with primary amenorrhea and short stature. What is the most likely diagnosis? (2010)
Turner syndrome
An 18yoF with Tanner stage 5 breast development, pubic hair development, and primary amenorrhea. What is the best first test? (2005, 2020)
- Testosterone
- FSH
- 17-hydroxyprogesterone (17-OHP)
- Karyotype
FSH
What is the most likely phenotype in an AMH receptor defect? (2019)
- Persistence of Mullerian structures
- POI
- Precocious puberty
Persistence of Mullerian structures
An adolescent girl with primary amenorrhea is found to have Mullerian agenesis and a 1cm vaginal dimple. Which is the most appropriate treatment when she is ready to become sexually active? (2003, 2010)
- Frank dilators
- Ingram procedure
- McIndoe procedure
- Vecchietti procedure
Frank dilators
What is least likely with an 11beta-hydroxylase (11-OH) deficiency mutation? (2014)
- Hypertension
- Hyperkalemia
- Hypernatremia
Hyperkalemia
What do you find in male newborn with 21-hydroxylase deficiency (21-OHD)? (2012)
- Scrotal testes
- Hypospadias
- Café-au-lait spots
- Ambiguous genitalia
Scrotal testes
What is the mechanism of complete AIS? (2009, 2014, 2015)
- Hormone cannot bind receptor (decrease biologic activity)/Delta-5 androgens do not bind to receptor
- Receptor cannot bind to DNA?
- Other things about the receptor but nothing about a receptor defect
Hormone cannot bind receptor (decrease biologic activity)/Delta-5 androgens do not bind to receptor
What is an activating receptor mutation most likely to cause? (2012, 2018, 2023 NIH)
- Kallmann syndrome
- AIS
- CAH
- MEN2
- Myotonic dystrophy
MEN2
A 5yo African American girl presents with has pubic hair, Tanner stage 1 breasts, and growth 60th percentile. What do you do next? (2003, 2012, 2021)
- Estradiol level
- DHEA
- Testosterone
- Bone age
Bone age
A 5yoF presents with Tanner stage 3 pubic hair (pubarche). What is the next step? (2005, 2009, 2010, 2011, 2012, 2018)
- Depot medroxyprogesterone acetate (DMPA) (Depo-Provera)
- Depot GnRH
- Check testosterone level
- Check 17-hydroxyprogesterone (17-OHP)
- Pelvic ultrasound (US)
- Pituitary MRI
Check 17-hydroxyprogesterone (17-OHP)
A child presents with isolated precocious adrenarche. What is the best test to order? (2012)
17-hydroxyprogesterone (17-OHP)
17-hydroxyprogesterone (17-OHP)
What level do you need to optimize in the follicular phase of a patient with 21-hydroxylase deficiency (21-OHD)? (2021)
- Progesterone
- 17-hydroxyprogesterone (17-OHP)
- DHEAS
- Testosterone
Progesterone
What is most likely to cause a false positive 17-hydroxyprogesterone (17-OHP)? (2005, 2009, 2011, 2010, 2012, 2018)
- Not fasting/Postprandial
- Recent LH surge/Recent ovulation
- Pulsing of 17-hydroxyprogesterone (17-OHP)
- Luteal phase
Diurnal variation
Luteal phase
A 12yo presents with complete ovarian failure (POI). How do you supplement hormones? (2023 NIH)
- Slow incremental estrogen
- Estrogen and progesterone
- Growth hormone
Slow incremental estrogen
What is the cause of Turner mosaicism? (2020)
- Postzygotic mitotic error
- Oocyte mitotic error
- Maternal meiotic error
- Paternal meiotic error
Postzygotic mitotic error
Where does the error occur in mosaic Turner 46,X/46,XX? (2018, 2022)
- Meiosis II (paternal)
- Meiosis II (maternal)
- Mitosis after fertilization
Mitosis after fertilization
17yo presents with amenorrhea, normal electrolytes, and Tanner stage 3 breasts. Where is the most likely defect? (2007)
5-alpha-reductase
Androgen receptor
Androgen receptor
A young girl is found to have elevated FSH and progesterone. What else do you expect to find on evaluation? (2013)
A 17yo with primary amenorrhea and female external genitalia is found to have FSH 50mIU/mL, and progesterone 25ng/mL. What else do you expect to find on evaluation?
(2007, 2011, 2012, 2018, 2023 NIH)
- Hypercortisolism
- Hypertension
- Absent uterus
Hypertension
What is the most likely way to diagnose 17-alpha-hydroxylase deficiency (17-alpha-OHD) in a child? (2019)
- Hyponatremia
- Hypokalemia
- Premature adrenarche
- Salt wasting
Hypokalemia
What is most likely to be seen in a teenager with 17-alpha-hydroxylase deficiency (17-alpha-OHD)? (2011)
- Hypertension
- Hyperkalemia
- Hirsutism
Hypertension
What is the least likely way to diagnose 17-alpha-hydroxylase deficiency (17-alpha-OHD) in a child? (2005, 2011)
- Hyponatremia
- Hypokalemia
- Hypertension
- Premature adrenarche
- Salt wasting
Hyponatremia/salt wasting
What enzyme deficit will not cause salt wasting? (2014, 2015, 2018)
- 17-alpha-hydroxylase (17-alpha-OH)
- 11-beta-hydroxylase deficiency (11-beta-OHD)
17-alpha-hydroxylase (17-alpha-OH)
What enzyme deficiency is least likely to cause precocious puberty? (2013, 2014, 2023 NIH)
- 17-hydroxylase deficiency (17-OHD)
- 3-beta-hydroxysteroid dehydrogenase deficiency (3-beta-HSDD)
- 17-beta-hydroxysteroid dehydrogenase deficiency (13-beta-HSDD)
- Aromatase deficiency
17-hydroxylase deficiency (17-OHD)
What is the best management of long-term amenorrhea in nonclassical CAH? (2016, 2017, 2018)
- OCPs
- Hydrocortisone
OCPs
What is the order of hormone repletion in thyroid and adrenal disorders? (2007, 2009, 2013, 2015, 2016, 2018)
- Glucocorticoid then mineralocorticoid and last thyroid replacement
- Mineralocorticoids and glucocorticoids; then thyroid
- Thyroid, then mineralocorticoids and glucocorticoids
- Glucocorticoids, then thyroid, then mineralocorticoids
- Only glucocorticoids and mineralocorticoids
What do you first treat in a patient with both adrenal insufficiency and hypothyroidism? (A patient is diagnosed with both Addison disease and Hashimoto thyroiditis. What is the next best step in treatment?) (2003, 2005, 2007, 2011, 2012, 2014, 2023 NIH)
- Replace all three at once
- Thyroid and cortisol then watch see if mineralocorticoid replacement is needed
- Thyroid then watch and see if others require replacement
- Replace glucocorticoids and mineralocorticoids then thyroid
Glucocorticoid
then mineralocorticoid
and last thyroid replacement
How do you monitor mineralocorticoid activity? (2015, 2017)
How do you monitor and titrate someone on mineralocorticoid replacement (for adrenal insufficiency)? (2011, 2013, 2014)
- Plasma renin level
- Sodium
- Potassium
- 17-hydroxyprogesterone (17-OHP)
Plasma renin level
What are patients with 46,XY complete gonadal dysgenesis (Swyer syndrome) most likely to have? (2014)
- Normal breast development
- Vagina
- Low FSH
- Normal sperm
- High P4
Vagina
What is the most likely etiology of a 46,XX male? (2005, 2009, 2011, 2012, 2014, 2015, 2017)
- Recombination or translocation
- Inversion
- Nondisjunction
- Deletion
What type of event causes a 46,XX male? (2018)
- Chromosomal substitution
- Abnormal recombination event during embryonic development
- Abnormal recombination/translocation during male meiosis
- Developmental mutation
Recombination or translocation
Abnormal recombination/translocation during male meiosis
What region on the Y chromosome is most likely affected by crossover? (2013, 2014, 2018)
- Pseudoautosomal region
- SRY
- Yp
- AZF region
Pseudoautosomal region
A patient presents with hirsutism and 17-hydroxyprogesterone (17-OHP) >800. What test would you do next? (2016, 2017)
- Cosyntropin stimulation test
- 24-hour urinary cortisol
- CRH stimulation
Cosyntropin stimulation test
What is the effect of flutamide in pregnancy? (2018)
- Teratogen – abnormalities in male fetus
- Teratogen – decreased estrogens in female fetus
- No effect
- Teratogen – abnormal prostate function later in life
Teratogen – abnormalities in male fetus
What is the first determinant of male development? (2009, 2018)
- Differentiation of Leydig cells
- Sertoli cell development from SF-1 and SRY
- Peritubular myoid cell development
- Testicular formation
Sertoli cell development from SF-1 and SRY
What is the next step when streak gonads are found during an appendectomy? (2018)
- Removal
- Sequence AR gene
- Sequence SRY gene
- Karyotype
Karyotype
What is the most common chromosomal abnormality in gonadal dysgenesis? (2003, 2018)
- 46,XY complete gonadal dysgenesis (Swyer syndrome)
- 46,X, Turner syndrome
- 46,XXY, Klinefelter syndrome
- 46,X, 46,XY Turner mosaic
46,X Turner syndrome
Which has the highest risk for tumor formation? (2018)
- Mixed gonadal dysgenesis
- 46,XY complete gonadal dysgenesis (Swyer syndrome)
- 45,X/46,XY (Turner mosaic)
- AIS
- 45,X
46,XY complete gonadal dysgenesis (Swyer syndrome)
What genetic mutation can cause abnormal female structures in 46,XX? (2012, 2018)
- SRY
- SOX9
- FGF-9
- GDF-15
- FOXL2
FOXL2
How do you clinically define 46,XX DSD? (2018)
- SRY and cell expression
- Absence of Mullerian ducts and presence of Wolffian ducts
- Presence of ovarian tissue (follicles) and testicular tissue (seminiferous tubules)
Presence of ovarian tissue (follicles) and testicular tissue (seminiferous tubules)
Picture of ambiguous genitalia, with a 46,XY karyotype. What is the least likely diagnosis? (2018)
- 46,XY complete gonadal dysgenesis (Swyer syndrome)
- CAH
- AMH deficiency
- AIS
- 5-alpha-reductase deficiency
- Testicular regression syndrome
- 17-hydroxylase deficiency (17-OHD)
- 17-beta-hydroxysteroid dehydrogenase deficiency (17-beta-HSDD)
CAH
Usually normal male at birth
What do you find in male newborn with 21-hydroxylase deficiency (21-OHD)? (2012)
- Scrotal testes
- Hypospadias
- Café-au-lait spots
- Ambiguous genitalia
Scrotal testes
What are you most likely to see with 21-hydroxylase deficiency (21-OHD)? (2012, 2018, 2023 NIH)
- Decreased progesterone and 17-hydroxyprogesterone (17-OHP)
- Decreased deoxycorticosterone (DOC) and 11-deoxycortisol
- Increased aldosterone
- Low cortisol
Decreased deoxycorticosterone (DOC) and 11-deoxycortisol
Low cortisol
What test is best for diagnosing nonclassical 21-hydroxylase deficiency (21-OHD)? (2015)
- ACTH stimulated 17-hydroxyprogesterone (17-OHP)
- ACTH stimulated 17-hydroxypregnenolone
- 17-hydroxypregnenolone
ACTH stimulated 17-hydroxyprogesterone (17-OHP)
What is most important for testosterone production in the male fetus after 20wk? (2014, 2018)
- Maternal androstenedione production
- Fetal LH
Fetal LH
What is least likely to be seen in 11-beta-hydroxylase deficiency (11-beta-OHD)? (1999, 2003, 2011, 2012, 2014, 2015, 2018)
- Hypertension
- Elevated 11-deoxycortisol
- Elevated ACTH
- Salt wasting
- Hypokalemia
- Precocious puberty
- Virilization
- Anovulation
- Irregular cavity with adhesions
Salt wasting
What is the inheritance pattern in 17-alpha-hydroxylase deficiency (17-alpha-OHD)? (2018)
Autosomal recessive (AR)
Why is ACTH elevated (in 17 alpha hydroxlase deficiency)? (2018)
Cortisol is a much stronger glucocorticoid than corticosterone or deoxycorticosterone (DOC)
What class of steroids are produced in excess in 17-alpha-hydroxylase deficiency (17-alpha-OHD)? (2018)
- Mineralocorticoids
- Glucocorticoids
Mineralocorticoids
A 17 yo patient presents with primary amenorrhea, 95th percentile growth, Tanner stage 1 breasts, and Tanner stage 1 pubic hair. What is the enzyme defect ? (2018, 2023 NIH)
17-alpha-hydroxylase deficiency (17-alpha-OHD)
A 16yo presents with Tanner stage 1 hair and breasts, FSH 35 mIU/mL, progesterone 23 ng/mL. What is the most likely etiology? (2011)
- Isolated gonadotropin deficiency
- FSH receptor defect
- Turner syndrome
- 17-hydroxylase deficiency (17-OHD)
17-hydroxylase deficiency (17-OHD)
A 17 yo F presents with Tanner stage 1 everything, 90th percentile height and weight, a small uterus, and no adnexal masses. What is the most likely diagnosis? (2010, 2023 NIH)
- Isolated gonadotropin deficiency
- DAX1 mutation
- AIS
DAX1 mutation
A 16 yo presents with Tanner stage 1 everything, 90th percentile height, a uterus, and a cervix. What is the most likely diagnosis? (2023 NIH)
46,XY complete gonadal dysgenesis (Swyer’s)
A 16yo presents with primary amenorrhea, 90th percentile height, Tanner stage 1 pubic hair and Tanner stage 1 breasts, cervix, and small uterus. What is the enzyme deficiency? (2007, 2011, 2012, 2018)
- CYP17
- CYP21
- 3-beta-hydroxysteroid dehydrogenase deficiency (3-beta-HSDD)
CYP17
- AR inheritance
- Chromosome 10
- Delayed puberty, primary amenorrhea, hyper hypo, HTN (increased mineralocorticoids)
A 16yo presents with primary amenorrhea, elevated FSH, and elevated progesterone 25ng/mL? What condition does she have? (2012, 2018)
- 45,X
- 46,XY, complete gonadal dysgenesis
- CYP21 deficiency
- CYP17 deficiency
CYP17 deficiency
Where is the CYP17A1 enzyme located? (2015)
- Mitochondria
- Endoplasmic Reticulum
Endoplasmic Reticulum
How is CYP21 inherited? (2018)
- Chromosome 6
- Autosomal Recessive (CYP21A1 pseudogene, CYP21A2 gene)
What is 17-hydroxylase deficiency (17-OHD) most associated with? (2020)
- Hyponatremia
- Hypotension
- Hyperkalemia
- Ambiguous genitalia
Ambiguous genitalia
List the CAH enzyme deficiencies in order of most common to least common. (2018)
- 21-hydroxylase (21-OH)
- 11-hydroxylase (11-OH)
- 3-beta-hydroxysteroid dehydrogenase (3-beta-HSD)
46,XX, ambiguous genitalia most common condition? (2018)
- Ovotesticular DSD (true hermaphroditism)
- Testicular DSD (sex reversal; de la Chapelle syndrome)
- CAH
CAH
(Image of an infant with a small phallus, opening on underside of phallus, scrotal mass on the right) Karyotype is 46,XX. What is the most likely diagnosis? (2014, 2015)
- Ovotesticular DSD (true hermaphroditism)
- 5-alpha-reductase deficiency
- Mixed gonadal dysgenesis
- AIS
- CAH
Ovotesticular DSD (true hermaphroditism)
(Image of an infant with a small phallus, opening on underside of phallus, scrotal mass on the right) Karyotype is 46,XY. What is the least likely diagnosis? (2014, 2015)
CAH
A baby is born with ambiguous genitalia including a phallus with a urogenital sinus at its base and a unilateral palpable inguinal mass. Karyotype 46,XX. What is the most likely diagnosis? (1999, 2003, 2010)
- CAH
- 46,XX male
- 5-alpha-reductase deficiency
- Mixed gonadal dysgenesis
46,XX male
What is least likely with an 11beta-hydroxylase (11-OH) deficiency mutation? (2014)
- Hypertension
- Hyperkalemia
- Hypernatremia
Hyperkalemia
All but which of the following will not result in ambiguous genitalia? (2012)
- CYP11 deficiency
- CYP17 deficiency
- CYP21 deficiency
- 3-beta-hydroxysteroid dehydrogenase deficiency (3-beta-HSDD)
CYP17 deficiency
How do you monitor a 14yo on glucocorticoid and mineralocorticoid replacement? (2007)
- Cortisol
- ACTH
- ACTH stimulation test
- ACTH after CRH stimulation test
- Renin/angiotensin
Renin/angiotensin
An adolescent girl with primary amenorrhea is found to have Mullerian agenesis and a 1cm vaginal dimple. Which is the most appropriate treatment when she is ready to become sexually active? (2003, 2010)
- Frank dilators
- Ingram procedure
- McIndoe procedure
- Vecchietti procedure
Frank dilators
What is the least common finding in Turner syndrome? (2003)
- Hypothyroidism
- Diabetes
- Fragment of Y chromosome
Fragment of Y chromosome
What excludes the diagnosis of 21-hydroxylase deficiency (21-OHD) in a patient with new onset hirsutism at puberty? (2005)
- ACTH stimulation test
- 17-hydroxyprogesterone (17-OHP)
17-hydroxyprogesterone (17-OHP)
A 22yo is 60in tall with a broad/wide/shield chest, breast development, and menstrual irregularities. What is the most likely diagnosis? (2005, 2007, 2023 NIH)
- 45,X
- 45,X/46,XX
- 45,X/46,XY
- 46,XX
45,X/46,XX
What is the most likely karyotype for a patient with gonadal dysgenesis? (2003, 2007)
- 45,X
- 45,X/46,XX
- 47,XYY
45,X/46,XX
What is the most likely phenotype in an AMH receptor defect? (2019)
- Persistence of Mullerian structures
- POI
- Precocious puberty
Persistence of Mullerian structures
How do you calculate the expected adult height of a child based on parental heights in centimeters? (2010)
Add height of both parents +/-5 depending on sex / 2
What is the correct order of pubertal events in girls? (2010, 2012, 2013, 2014, 2016, 2018)
- Maximal growth, thelarche, pubarche, menarche
- Thelarche, menarche, pubarche, maximal growth
- Thelarche, pubarche, maximal growth, menarche
- Pubarche, thelarche, maximal growth, menarche
Thelarche, pubarche, maximal growth, menarche
AG-BPM
Adrenarche
Growth spurt
Breast
Pubarche
*final growth spurt
Menarche
What is the first hormone to rise during adrenarche? (2011, 2018)
- DHEAS
- Androstenedione
- Testosterone
- Estradiol
- ACTH
What is the first hormone to rise during puberty? (2018)
- Estrogen
- LH
- FSH
- Androstenedione
LH
What is the change in LH seen as the first sign of puberty? (2009, 2012, 2018)
- LH in daytime
- LH in nighttime
- LH while asleep
LH in nighttime
What test do you order from isolated precocious adrenarche? (2011, 2018)
- DHEAS
- Androstenedione
- 17-hydroxyprogesterone (17-OHP)
- FSH
- E2
17-hydroxyprogesterone (17-OHP)
What is the first change seen in adrenarche? (2018)
- Increase in testosterone
- Increase in DHEA
- Increase in androstenedione
- Increase in ACTH proportional to reticularis growth
Increase in DHEA
What hormone is highest in adrenarche? (2018)
- DHEA
- Androstenedione
- Total testosterone
DHEA
What best describes adrenarche? (2011)
- Increased ACTH with enlargement of the zona reticularis
- Increased DHEAS at 6-7 yo
Increased DHEAS at 6-7 yo
What is the first sign of male puberty? (2007, 2018)
- Hair growth around testicles
- Testicle enlargement
- Phallus enlargement
Testicle enlargement
What is the most common presentation in the setting of an inactivated alpha subunit GPCR? (2021)
- Delayed puberty
- Precocious puberty
- Ambiguous genitalia in a male
- Ambiguous genitalia in a female
Delayed puberty
What is the most common cause of delayed puberty and primary amenorrhea in females? (2011, 2012, 2017, 2018, 2022)
- (Stress induced) Hypergonadotropic hypogonadism (hyper-hypo)
- Hypogonadotropic hypogonadism (hypo-hypo)
- MRKH
- Constitutional delay
- Cushing syndrome
- Craniopharyngioma (CNS tumors)
- Turner syndrome
- Prolactinoma
(Stress induced) Hypergonadotropic hypogonadism (hyper-hypo)
What is the most common cause of delayed puberty in females? (2015, 2021)
- Eugonadal/Constitutional
- Hypergonadotropic hypogonadism (hyper-hypo))
- Hypogonadotropic hypogonadism (hypo-hypo)
Hypergonadotropic hypogonadism (hyper-hypo))
What is the most common cause of primary amenorrhea? (2003, 2010, 2011, 2014, 2015, 2023 NIH)
- Hypergonadotrophic hypogonadism (hyper-hypo)
- Hypogonadotropic hypogonadism (hypo-hypo)
- Mullerian agenesis
- 46,XY, complete gonadal dysgenesis
- CAH
- AIS
- Hyperprolactinemia
Hypergonadotrophic hypogonadism (hyper-hypo) per 2003, 2010, 2014, 2023 NIH
A patient presents with anosmia and amenorrhea. Where is the defect most likely located? (2007, 2023 NIH)
KAL
What gene causes autosomal dominant Kallman syndrome? (2013, 2014, 2015, 2017, 2018, 2022, 2023 NIH)
- FGFR1
- KAL1
- KAL2
- PROK
- KISS
FGFR 1 = KAL2
What is the inheritance pattern of Kallmann syndrome with KAL1? (2021)
- X-linked recessive
- Autosomal dominant
- Autosomal recessive
X-linked recessive
All of the following are associated with the KAL1 gene except? (1999)
- Guides gonadotroph cell migration
- Is found on the distal end of the X chromosome
- Is sometimes associated with congenital short stature
- Is adjacent to region encoding for congenital ichthyosis
Is sometimes associated with congenital short stature
In a woman with Kallmann syndrome picture (hypo-hypo and anosmia) what is the most likely mutation? (2021)
- KAL1
- KAL2
- FGFR1
- PROK2
KAL2 = FGFR1
What is the most likely inheritance of KAL2? (2015, 2018)
- Autosomal dominant
- Autosomal recessive
- X-linked
Autosomal dominant
What is the most common transmission of Kallmann syndrome? (2011, 2012, 2013, 2018, 2023 NIH)
- X-linked
- Autosomal recessive
- Autosomal dominant
- Sporadic mutation
X-linked (anosmin, KAL1)
Kallmann syndrome is a disorder of what? (2005, 2018, 2023 NIH)
- Neuronal synthesis
- Neuronal migration
- Olfactory placode tumor
- GnRH synthesis
Neuronal migration
A 16yo F presents with delayed puberty. What is the best first test? (2021)
- FSH
- E2
- Testosterone
A 16yo F presents with delayed puberty. Thyroid testing and prolactin are normal. What is the best next test? (2003)
- FSH
- E2
- Testosterone
FSH
A 15yo F with male build, new onset clitoromegaly. Most likely diagnosis? (2019, 2021)
5-alpha-reductase deficiency
A 15yo presents with primary amenorrhea, has Tanner stage 1 breasts, clitoromegaly, no uterus, and a male body habitus. What test is most likely elevated? (2016, 2017, 2022)
- 17-hydroxyprogesterone (17-OHP)
- T/DHT ratio
- 11-deoxycorticosterone (11-DOC)
- FSH
- DHEAS/androstenedione ratio
T/DHT ratio (5 alpha reductase deficiency)
What are the internal and external structures of a patient who is 46,XY with 17-hydroxylase deficiency (17-OHD)? (2013, 2016, 2018)
- Internal male, external male
- Internal male, external female
- Internal female, external male
- Internal female, external female
Internal male, external female
A 5yoF with a pigmented lesion that does not cross the midline presents with vaginal bleeding. What is the most likely cause? (2011, 2021)
- GnRH pulsatility
- CAH
- Ovarian cysts
A 5yoF with skin spots that don’t cross the midline presents with precocious puberty and 90th percentile for height. What is the most likely cause? (2003, 2007)
- GnRH pulsatility
- CAH
- Ovarian cysts
Ovarian cysts (McCune Albright)
What is likely seen in a GNAS activating mutation? (2023 NIH)
What does an error in the GNAS gene lead to? (2018)
Increase in protein kinase A (PKA)
McCune-Albright syndrome
What is being overproduced in McCune-Albright syndrome? (2009, 2010, 2015)
- Protein kinase C (PKC)
- Protein kinase A (PKA)
- DAG
Protein kinase A (PKA)
What occurs in McCune-Albright syndrome? (2011)
- Cytochrome P450 enzyme activation
- Protein kinase A (PKA) activation
- Others
Protein kinase A (PKA) activation
What is the most effective treatment of McCune-Albright syndrome? (1999)
- GnRH analog
- GnRH agonist
- Testolactone
- Ketoconazole
- Spironolactone
- Testolactone is no longer available
- Use anastrozole, though loses effect over time
- GnRH agonist may work if GnRH independent > dependent
- Other: tamoxifen
A patient presents with café-au-lait spots, bone lesions, and precocious puberty. Which of the following is most likely to be activated? (2005)
Protein kinase A (PKA)
Cytochrome P450
Others
Protein kinase A (PKA)
A young girl presents with precocious puberty, café au lait spots, and polyostotic fibrous dysplasia. These findings are most likely caused by which of the following? (2003)
- Hypersecretion in multiple endocrine organs
- A lesion leading to constitutive activation of adenylate cyclase
A lesion leading to constitutive activation of adenylate cyclase
What is AMH in patients with hypogonadotropic hypogonadism (hypo-hypo)? (2020)
- High
- Low
- Normal
Normal
What is the most common autosomal dominant genetic defect for hypogonadotropic hypogonadism (hypo-hypo)? (2014, 2018, 2023 NIH)
- KAL1 mutation
- FGFR1 mutation
- Androgen receptor mutation
- SRY mutation
- AZF mutation
FGFR1 or KAL2 for Kallman
What is the best way to establish a diagnosis in a patient with hypogonadotropic hypogonadism (hypo-hypo) and anosmia? (2020)
- MRI
- Gene sequencing
Gene sequencing
A female patient has Kallman syndrome. What mutation is most likely to affect 50% of her offspring? (2019)
- KAL2
- FGFR2
KAL2 or FGFR1 (AD)
What hormone “turns on” the HPO axis in puberty? (2019)
- Kisspeptin
- Leptin
- GABA
Kisspeptin
What is the most important signal for the initiation of GnRH pulses to start puberty? (2023 NIH)
- Leptin
- Kisspeptin
Kisspeptin
Which substance is not responsible for the rise in GnRH with puberty? (2012, 2014, 2018)
- GABA
- Leptin
- Kisspeptin
- Endogenous opioids
- Glutamate
GABA
What will a mutation in the kisspeptin receptor most likely cause? (2015, 2023 NIH)
- Decreased LH/Failure of LH release
- Elevated TSH
- Elevated LH
- Elevated GnRH
Decreased LH/Failure of LH release
What is most likely associated with the onset of puberty? (2011, 2014, 2015, 2017, 2018)
- Kisspeptin
- Leptin
- Neuropeptide Y (NPY)
Kisspeptin
What is the most likely mechanism of precocious puberty at 6yo with pigmented skin lesions? (2019)
Constitutively active GPCR
What is the treatment for McCune-Albright syndrome? (2007, 2009, 2011, 2012, 2018, 2019)
- Aromatase inhibitor
- OCPs
- Progesterone
- Estradiol
Aromatase inhibitor
A patient presents with precocious puberty and is found to have bone and hyperpigmented skin lesions. What would you treat this patient with? (2003, 2007, 2009, 2011, 2012)
- Anastrozole
- Flutamide
- GnRH agonist
- Ketoconazole
- Progestin
- Testolactone
Testolactone (no longer available)
Anastrozole
A young female presents with advanced bone age. What is the single best test to determine activation of the HPO axis? (2015)
- LH
- Estrogen
LH (GnRH stim testing)
What is the most common cause of hypogonadotropic hypogonadism (hypo-hypo) boys? (2017)
- Constitutional delay
- Kallmann syndrome
Constitutional delay
What is the most common mutation in familial hypogonadotropic hypogonadism (hypo-hypo)? (2016, 2018)
Kisspeptin loss of function
A male patient presents with signs of hypogonadism. What is the best test for evaluation? (2015)
- Serum total testosterone
- Serum total free testosterone
- FSH
- LH
Serum total testosterone
What is the most common cause of GnRH dependent precocious puberty? (2015)
- Idiopathic
- McCune-Albright syndrome
Idiopathic
A patient presents with precocious puberty and elevated gonadotropins. How is this treated? (2018)
- Aromatase inhibitors
- Danazol
- GnRH antagonists, daily preparations
- GnRH agonists, depot preparations
- GnRH agonists, depot preparations
This is GnRH-dependent precocious puberty (McCune Albright has low gonadotropins due to elevated sex steroids)
What are the indications for treatment of precocious puberty? (2018)
- Thelarche
- Pubarche
- Progression to the next stage in 3-6 months
- Current isolation from friends
Progression to the next stage in 3-6 months
A 5yoF presents with precocious puberty and an ovarian cyst. What is the most likely diagnosis? (2014, 2018)
- Granulosa cell tumor
- Theca cell tumor (thecoma)
Granulosa cell tumor
Which of the following can be used to monitor for recurrence of a granulosa cell tumor? (2003)
- Inhibin B
Inhibin B
What is the best tumor marker for a granulosa cell tumor? (2003, 2005, 2023 NIH)
- Estradiol
- Inhibin B
- AFP
- hCG
- CA125
Inhibin B
What is the most likely diagnosis of a patient presenting with precocious puberty and delayed bone age? (2009, 2013, 2014, 2015, 2016, 2017)
- Hypothyroidism
- McCune-Albright syndrome
Hypothyroidism
A patient presents with isolated precocious pubarche. What lab should be ordered next? (2007)
17-hydroxyprogesterone (17-OHP)
What is the mechanism of action of McCune-Albright syndrome? (2009, 2012, 2015, 2016, 2018)
- Constitutive protein kinase A (PKA)
- Phospholipase C (PLC)
- IP3/DAG
Constitutive protein kinase A (PKA)
What is the mechanism of action of McCune-Albright syndrome? (2011, 2012)
- G inhibitory stimulation
- GsAlpha stimulation
- GPR40 mutation
- Gq stimulation
- PLC
GsAlpha stimulation
What is responsible for McCune-Albright syndrome symptoms? (2009, 2012)
- Increased cytochrome P450 enzyme activities
- Increased protein kinase A (PKA)
- Decreased protein kinase C (PKC)
Increased protein kinase A (PKA)
What is the mechanism of McCune-Albright syndrome? (2007, 2018)
- Inactivating mutation of the LH receptor
- Activating mutation of the beta subunit of the G-protein
- Constitutively active adenylate cyclase due to somatic mutation alpha subunit of the G-protein GNAS1 gene
- Inactivating mutation of the alpha subunit of the G-protein
Constitutively active adenylate cyclase due to somatic mutation alpha subunit of the G-protein GNAS1 gene
What is the best (most sensitive) test for growth hormone deficiency? (2014, 2015, 2017, 2023 NIH)
- Insulin tolerance test (ITT)
- Glucose stimulation test
- IGF-1 level
IGF-1 level
What is the best hormonal evaluation in puberty? (2016)
- LH:FSH ratio <1 in a prepubertal patient
- LH <1 during GnRH stimulation test
- AMH undetectable in a prepubertal patient
- Inhibin undetectable in a prepubertal patient
LH <1 during GnRH stimulation test
What does the presence of breasts indicate? (2016, 2018)
- Estrogen exposure at some point
- Testosterone
Estrogen exposure at some point
Children with sexual precocious puberty at most risk for which of the following? (2016)
- Sexual molestation
- Depression and behavior disorders
- Short stature
Depression and behavior disorders
Why has the age at puberty decreased in the United States? (2014, 2015)
- Increased health
- Increased fat mass
Increased fat mass
How do you give HRT to patients with delayed puberty? (2015, 2016, 2017)
- E2 slowly increase over 1-2yr
- E2 and P4
- E2 plus growth hormone
E2 slowly increase over 1-2 yr
What condition can be seen as virilization at puberty? (2005, 2007, 2009, 2011, 2012, 2018)
- 5-alpha-reductase deficiency
- Complete AIS
- 46,XY complete gonadal dysgenesis (Swyer syndrome)
- 17-beta-hydroxylase deficiency (17-beta-OHD)
- FSH activating receptor
5-alpha-reductase deficiency
What adrenal enzyme deficiency is least likely to cause virilization at puberty? (2011)
- 17-beta-hydroxysteroid dehydrogenase deficiency (17-beta-HSD)
- 17-hydroxylase deficiency (17-OHD)
- Aromatase deficiency
17-hydroxylase deficiency (17-OHD)
A 14 yo presents with primary amenorrhea, Tanner stage 4 pubic hair, Tanner stage 5 breasts, 2 cm blind vagina with dimple, normal hymen, no bulging, and no pain. What is the most likely diagnosis? (2012, 2018)
- Androgen insensitivity
- Imperforate hymen
- Transverse vaginal septum
- Mullerian aplasia
Mullerian aplasia
A 14yo presents with amenorrhea, Tanner stage 4 breasts, Tanner stage 5 pubic hair, 2cm vaginal dimple, no bulge, no pain, and 63in height. What is the most likely diagnosis? (2023 NIH)
- Mullerian anomaly
- AIS
- Imperforate hymen
Mullerian anomaly
A 14 yo presents with primary amenorrhea, Tanner stage 4 breasts, 2cm vaginal dimple, no bulge, no pain, and 63in height. What is the best test to make the diagnosis? (2023 NIH)
- MRI
- Serum testosterone level
Serum testosterone (to distinguish from AIS)
A 17yo presents with amenorrhea, Tanner stage 4 breasts, Tanner stage 5 pubic hair, normal external genitalia, intact hymen, and 2cm vaginal pouch (vaginal dimple). What is the best next step? (2011, 2012, 2018, 2023 NIH)
- Vaginoscopy
- Exam under anesthesia
- Pelvic ultrasound (US)
- CT scan of pelvis
Pelvic ultrasound (US)
A patient presents with labs consistent with hypogonadotropic hypogonadism (hypo-hypo). What is the least likely cause? (2009)
- DAX1
- FMR1
- Leptin
FMR1
An 18 yo 46,XY female presents with new onset breast (and pubic hair) development. What is the most likely cause? (2009, 2011, 2018)
- Dysgerminoma
- Gonadoblastoma
- Activating LH mutation
- Sertoli-Leydig cell tumor
- Seminoma
- Granulosa cell tumor
- Theca-lutein cyst
Gonadoblastoma
A 30yo 46,XY female presents with new onset breast and pubic hair development. What is the most likely diagnosis? (2011)
- Gonadoblastoma
- Seminoma
- Granulosa cell tumor
Gonadoblastoma
What is the most likely cause of cancer before 30yo in a phenotypic female with a genotype of 47,XY? (2009)
- Mixed gonadal dysgenesis
- 46,XY, complete gonadal dysgenesis (Swyer syndrome)
- 46,XX, ovotesticular DSD (true hermaphroditism)
- 46,XY, gonadal dysgenesis
- Complete AIS
- Incomplete AIS
46,XY, complete gonadal dysgenesis (Swyer syndrome)
Which of the following is the most likely to develop a gonadoblastoma (before 30yo)? (2005, 2011)
- Mixed gonadal dysgenesis
- 46,XX, ovotesticular DSD (true hermaphroditism)
- 46,XY, gonadal dysgenesis
- Complete AIS
- Incomplete AIS
46,XY, gonadal dysgenesis
Which of the following is the most likely to develop gonadal cancer? (2009)
- 46,XY complete gonadal dysgenesis (Swyer syndrome)
- Mixed gonadal dysgenesis
- AIS
- 45,X
46,XY complete gonadal dysgenesis (Swyer syndrome)
What is the least important in the work-up of small testes? (2018)
- Karyotype
- Prolactin
- LH/FSH
- Testosterone
- DHEAS
DHEAS
A patient presents with labs consistent with hypogonadotropic hypogonadism (hypo-hypo). What is the most common cause? (2011)
- Increased endogenous opioids leading to GnRH suppression
- Hyperprolactinemia
- Increased cortisol
Hyperprolactinemia
A 2yo has a bone age of 4.5 yo and breast development. What is the best test to determine if there has been premature activation of the HPO axis? (2014, 2015)
- LH
- GnRH
- Estradiol
LH
A young girl presents with vaginal bleeding, Tanner stage 3 breasts, and 90th percentile for height and weight. What is the most likely diagnosis? (2011, 2014, 2015)
- Exogenous hormone ingestion
- Ovarian cyst
Ovarian cyst
A 23 yo F presents with new onset of hypogonadotropic hypogonadism (hypo-hypo). What is the most likely etiology? (2011, 2015)
- Pituitary tumor
- Hyperprolactinemia
- Hypothalamic tumor
- Idiopathic
Hyperprolactinemia
A woman is found to have hypogonadotropic hypogonadism (hypo-hypo) with a normal prolactin and TSH. What do you do next? (2011, 2012, 2023 NIH)
- GnRH stimulation test
- MRI
- ACTH stimulation test
MRI
A woman recently finished tuberculosis treatment and now has weight loss, hyper-pigmented lesions, and fatigue. What is the best next test? (2011)
- 24hr urine free cortisol
- ACTH stimulation test
- Dexamethasone suppression test
ACTH stimulation test (for adrenal insufficiency)
A patient recently had transsphenoidal surgery for a growth hormone tumor. She now has weight loss, hyperpigmented lesions, and fatigue with a normal TSH and ACTH. What do you do next? (2009)
- IGF with cortisol
- ACTH stimulation test
- Dexamethasone suppression test
ACTH stimulation test
A patient presents with bilateral adrenal cysts and an elevated ACTH after high dose dexamethasone suppression test. What is the most likely diagnosis? (2011)
- Pituitary tumor
- Adrenal tumor
- Ectopic ACTH production
Ectopic ACTH production
What is the most common location of ectopic ACTH production? (2009)
- Lung
- Liver
- Ovary
- Kidney
Lung
A (receptor inactivating) mutation in which of the following is most likely to have increased ovarian androgen production? (2009, 2023 NIH)
- Insulin receptor
- IGF-1 receptor
- Leptin
- 21-hydroxylase (21-OH)
Insulin receptor
(IGF-1 promotes androgen production, Leptin inhibits, 21-hydroxylase does not exist in ovary)
Primary pathology in women with HAIR-AN and hyperthecosis is severe insulin resistance, resulting in grossly elevated insulin levels that stimulate ovarian androgen production in theca cells (via insulin, IGF-1, and hybrid receptors) and markedly decrease hepatic SHBG production, thereby greatly increasing the amount of circulating free androgen.
What causes abnormal puberty? (2009)
- Craniopharyngioma
- Prolactinoma
- Hamartoma
Hamartoma
Craniopharyngioma > hypo hypo > delayed puberty
Prolactinoma > hypo hypo > delayed puberty
Hypothalamic hamartomas, congenital malformations composed of a heterotropic mass of nerve tissue usually located on the floor of the 3rd ventricle or attached to the tuber cinereum, are a common etiology of precocious gonadarche.
An 18yoF comes to the office prior to going to college. While she has had normal breast development, she has never had a period. She has been a swimmer throughout middle and high school and was told this prevented her periods from starting. Given she swims every day, she hasn’t cared about not having a period but her mother wants this evaluated prior to her starting college. Which of the following is least likely to be the etiology of her amenorrhea? (2022)
- Hypothalamic dysfunction
- POI
- Mullerian agenesis
- AIS
- Delayed puberty
Delayed puberty
A physical exam on the 18yoF with primary amenorrhea after being a competitive swimmer through middle and high school reveals normal breast development but no uterus. Which lab evaluations would be the most appropriate next step? (2022)
- FSH, LH, estradiol
- FSH, TSH, prolactin
- TSH, prolactin, testosterone
- Testosterone, karyotype
Testosterone, karyotype
A 30yoF comes to the office to begin treatment for infertility. She had menarche at 14yo and regular menstrual cycles until starting OCPs at 21yo. She has continued OCPs until 6mo ago and has not had menses since. What is the least likely diagnosis? (2022)
- Post-pill amenorrhea
- POI
- PCOS
- Hypothyroidism
- Hyperprolactinemia
Post-pill amenorrhea
In a patient with amenorrhea, presence of breasts and a uterus, with a normal laboratory evaluation (FSH, TSH, prolactin), which of the following would be most helpful in determining the etiology? (2022)
- Presence of PCOS on ultrasound (US)
- Estrogen status
- History of bleeding while on OCPs
- Patient weight
Estrogen status
A 17yoF presents with normal thelarche and adrenarche and primary amenorrhea. What will serum estradiol levels most likely reveal? (2022)
- Elevated levels of estradiol due to tissue resistance
- Very low (menopausal) levels of estradiol
- Levels in the normal range for a 17yoF
- Undetectable levels due to inhibitor antibodies
Levels in the normal range for a 17 yo F (Mullerian agenesis)
A 17 yo F presents with normal thelarche and adrenarche and primary amenorrhea. What will serum testosterone levels most likely reveal? (2022)
- Levels in the normal range for a 17yoF
- Levels in the normal range for a 17yoM
- Elevated levels due to mutation of the androgen receptor
- Low levels due to increased aromatase
- Low levels due to gonadal failure
Levels in the normal range for a 17 yo F (Mullerian agenesis)
A 17yo presents with primary amenorrhea, normal secondary sexual characteristics, and a blind vaginal pouch on pelvic exam. What is the most appropriate next step? (2022)
- Office cystoscopy
- CT scan of the pelvis
- Serum testosterone
- MRI of the olfactory bulbs
- Office hysteroscopy
Serum testosterone (to distinguish between AIS and Mullerian anomaly)
A 17 yo presents with primary amenorrhea, normal secondary sexual characteristics, a blind vaginal pouch, and a uterus but no cervical tissue on MRI. What is the most appropriate surgical procedure? (2022)
- Laparoscopic resection of the non-functioning uterine remnants
- Robotic resection of the non-functioning uterine remnants
- Laparoscopic resection of all uterine and ovarian structures to avoid neoplasia
- Laparoscopic resection of any functional uterine remnants
Laparoscopic resection of any functional uterine remnants
What is the first steroid hormone to increase in a pubertal girl? (2003)
DHEAS
17-beta-estradiol
DHEAS
Which is least likely to be seen in the ovaries of a prepubertal girl? (2003)
- Antral follicles
- Corpus albicans
Corpus albicans
A 15yo F presents with primary amenorrhea and is phenotypically prepubertal on exam. What do you evaluate first? (2003, 2023 NIH)
- FSH
- Prolactin
- MRI
- Bone age
Bone age
A 6yoF has growth hormone deficiency. She would be most expected to have which of the following additional consequences (2003)
Pubertal delay
A 16 yo F has primary amenorrhea and anosmia. What is the most likely cause of her problem? (2003)
Mutation of the X chromosome Interfering with migration of neurons
Which null mutation is most likely to result in hypergonadotropic hypogonadism (hyper-hypo)? (2005)
- LH receptor
- FSH receptor
LH receptor
A young patient presents with Tanner stage 1 adrenarche, Tanner stage 3 breasts, and a blind vagina. What is the most likely genetic defect? (2005)
- AMH
- Androgen receptor
androgen receptor
18yo boy presents with delayed puberty and hypothalamic hypogonadism. What intra-cellular effect would likely be found in his GnRH neurons? (2024)
- Increased cAMP activity
- Decreased Ca
- Decreased protein kinase A (PKA)
- Decreased tyrosine phosphorylation
Decreased Ca
A 5 yo African American girl presents with has pubic hair, Tanner stage 1 breasts, and growth 60th percentile. What do you do next? (2003, 2012, 2021)
- Estradiol level
- DHEA
- Testosterone
- Bone age
Bone age
What is the least likely to cause amenorrhea? (2023 NIH)
- Hypothyroid
- Elevated prolactin
- PCOS
- Hypopituitarism
Hypothyroid
What percentage of adolescents with POI and secondary amenorrhea have an abnormal karyotype? (2023 NIH)
- 50%
- 13%
13%
Patients with Sheehan syndrome or pituitary apoplexy are most likely to have which hormone is affected? (2018, 2022)
- FSH/LH
- ACTH
- Growth hormone
- TSH
GH
*Anterior pituitary defect: Prolactin, GH, and GnRH deficiencies are most common with Sheehan, but ACTH and TSH also possible.
Oxytocin and vasopressin (ADH) are not compromised
Sheehan syndrome least associated with deficiency in? (2011, 2018, 2023 NIH)
- Oxytocin
- Growth hormone
- Prolactin
- ACTH
- TSH
- Estrogen
- FSH
- LH
Oxytocin
What is least likely to be affected in Sheehan syndrome? (2011)
- Growth hormone
- Prolactin
- TSH
- ACTH
TSH
Most common deficiencies in Sheehan: GH, prolactin
Less common deficiencies: ACTH > TSH (corticotrophs are more sensitive to ischemia)
What is the first sign of postpartum pituitary apoplexy? (2013, 2015)
Severe headaches
How will a woman with Sheehan syndrome present? (2015)
- Decreased breastfeeding with little pubic hair
- Decreased breastfeeding with hypercalcemia
Decreased breastfeeding with little pubic hair
*Sheehan a/w hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, and hypophosphatemia
How will a woman with Sheehan syndrome present? (2015)
- Galactorrhea and hypermenorrhea
- Amenorrhea, difficulty nursing, and hypercalcemia
- Amenorrhea, difficulty nursing, and decreased pubic hair
Amenorrhea, difficulty nursing, and decreased pubic hair
Described large postpartum hemorrhage. What would you expect to see as a consequence? (2023 NIH)
- Failed lactation
- Failed nursing, amenorrhea, loss of pubic hair
- Failed nursing alone
- Galactorrhea, amenorrhea, HTN
Failed nursing, amenorrhea, loss of pubic hair
What is least likely to cause bilateral hemianopsia 3wk postpartum? (2003, 2010, 2012, 2023 NIH)
- Sheehan syndrome
- Lymphocytic hypophysitis
- Rathke pouch cyst
- Craniopharyngioma
Sheehan syndrome
A 32wk pregnant patient with prolactinoma and visual changes, how do you treat? (2014, 2019, 2021)
- Bromocriptine
- Transsphenoidal surgery
- Deliver then transsphenoidal surgery
Bromocriptine
A 32wk pregnant woman gestation with a known 12mm prolactinoma from before pregnancy. Her prolactin is 35ng/dL and she now has headache and bitemporal hemianopsia. What is the best course of action? (2014)
- Delivery and then transsphenoidal surgery
- Transsphenoidal surgery
- Bromocriptine
Bromocriptine
When you give bromocriptine to a pregnant woman what happens to prolactin? (2003, 2005, 2009, 2011, 2018, 2023 NIH)
- Increased maternal prolactin
- Increased fetal prolactin
- Decreased fetal prolactin
- Altered/Decreased in amniotic fluid
- Decreased maternal TSH
- Decreased placental prolactin
Decreased fetal (and maternal) prolactin
(Amniotic fluid prolactin is not altered)
What is the most common side effect of cabergoline? (2021, 2022, 2023 NIH)
- GI upset
- Headache
- Cardiac valvulopathy
GI upset
What steroid is most likely to be increased with elevated prolactin? (2005, 2014, 2015)
- DHEAS
- Androstenedione
DHEAS
*Some women with hirsutism also have mild hyperprolactinemia. Elevated serum prolactin concentrations can be associated with increased serum DHEA-S levels. Prolactin receptors have been identified in the human adrenal, and prolactin can increase adrenal DHEA production in vitro. Although DHEA-S is a weak androgen, it can be converted in the periphery to potent androgens such as testosterone and DHT. Prolactin stimulation of adrenal androgen production, excessive ovarian androgen production due to the chronic anovulation that often results from hyperprolactinemia (discussed in Chapter 4), and increased free testosterone levels consequent to anovulation may all be relevant to causation of hirsutism in women with chronic hyperprolactinemia.
An increased prolactin is associated with which of the following? (2019, 2020)
- DHT
- Testosterone
- Androstenedione
- DHEA
- DHEAS
DHEA-S
What do you check next in a patient who has prolactin 30ng/dL (upper limit of normal 24ng/dL)? (2021)
- Repeat prolactin
- TSH
- FSH
- LH
Repeat prolactin
What hormone is most likely to be also elevated with a prolactinoma? (1999, 2003, 2005, 2007, 2009, 2010, 2012, 2019, 2021)
- Cortisol
- FSH
- Inhibin
- Growth hormone
- ACTH
- T4
- TRH
Growth hormone
What hormone is most likely to be affected after a pituitary infarction? (2016, 2019, 2021)
- Growth hormone
- TSH
- ACTH
- FSH
- Gonadotropins
GH
What type of WBC most commonly infiltrates the ovary in autoimmune oophoritis? (2021)
- Lymphocyte
- Neutrophil
- Eosinophil
- Macrophage
Lymphocyte
What is the most important test in suspected autoimmune oophoritis? (2014, 2015)
- Anti-21-hydroxylase (21-OH) antibodies
- Antithyroid antibodies
- Antiovarian antibodies
Anti-21-hydroxylase (21-OH) antibodies
Most important test in suspected autoimmune oophoritis? (2023 NIH)
- Adrenal antibodies
- Ovarian antibodies
- Thyroid antibodies
Adrenal antibodies
What antibody is most highly associated with POI? (2003, 2005, 2007, 2009, 2010, 2014, 2018, 2023 NIH)
- Antithyroid antibodies
- Antiadrenal antibodies
- Antiovarian antibodies
- Antinuclear antibodies
Anti-thyroid abs (more common)
Anti-adrenal abs (help confirm diagnosis)
Having a positive finding of which of the following antibodies would be most related to autoimmune POI? (2011, 2012)
- Antithyroid antibodies
- Antiadrenal antibodies
- Antiovarian antibodies
Anti-adrenal antibodies
The most likely cause of POI? (2021)
- 45,X
- 45,X/46,XX
- FGFR1
- FMR1
45,X/46,XX
What is most likely to be found on evaluation of a 22 yo F with POI? (2014, 2015)
- Increased number of CGG repeats in FMR1
- Antiovarian antibodies
- Karyotype 46,XX
- Karyotype 46,X
Karyotype 46,XX
*Idiopathic POI is most common
A 22 yo F presents with POI. What is the most likely cause? (2014, 2020)
- FOXL2 mutation
- FMR1 premutation
- FSH receptor mutation
- LH receptor mutation
FMR1 pre-mutation
What is the most common abnormality with POI? (2007, 2011, 2023 NIH)
- Adrenal crisis
- Hypothyroidism
- Insulin resistance
- Ovarian antibodies
Hypothyroidism
What is most likely to be abnormal in a female with galactosemia? (2012, 2014, 2015, 2018, 2019)
- AMH
- TSH
- Prolactin
- Glucose
AMH
Galactosemia:
- Very rare
- Autosomal recessive
- Deficiency of galactose 1-phosphate uridyl transferase
- Toxicity of galactose metabolites in primordial follicles (decreased)
A 30 yo F presents with galactosemia. What else is she at risk for? (2023 NIH)
POI
What is the least likely cause of amenorrhea? (2013, 2014, 2015, 2023 NIH)
- Swimming
- Biking
- Running
- Ballet
- Gymnastics
Swimming
What is the most likely to cause anovulation? (2013)
PCOS
What is the most likely to cause anovulation? (2011)
- Hyperprolactinemia
- Hyperandrogenism
- Hypogonadotropic hypogonadism (hypo-hypo)
- Hypothyroidism
Hyperprolactinemia
What hormone do you measure in a patient with a prolactin secreting macroadenoma? (2013, 2018, 2023 NIH)
- TSH
- Cortisol
- IGF-1
- Alpha subunit
- FSH
IGF-1
What hormone level is most important to check after transsphenoidal surgery for a macroadenoma? (2016, 2022)
- Cortisol
- ACTH
- TSH
- FSH
Cortisol
Which test is least useful in evaluation of a macroadenoma? (2009, 2018, 2023 NIH)
- Prolactin
- FSH
- Alpha subunit
- IGF-1
- Cortisol
FSH
Gonadotrophs may secrete alpha-subunit instead of undetectable FSH
What do you expect to happen if polyethylene glycol (PEG) is added to a pretreatment serum sample of a patient with macroprolactinemia? (2023 NIH)
- Monomer
- Monomer <40%
- Polyethylene glycol (PEG) not the appropriate test
- Others
Precipitation of macroprolactin to allow appropriate measurement of free prolactin
A G2P0020 presents following two D&Cs with new onset hypomenorrhea. TVUS with a sagittal view of the uterus shows adhesions. What is the best next step? (2023 NIH)
- HSG
- Hysteroscopy
- Serum hCG
Hysteroscopy
How do you diagnose macroprolactinemia? (2023 NIH)
Pretreat the serum with polyethylene glycol (PEG)
A woman has experienced 9 mo of amenorrhea while nursing. What is the most likely diagnosis? (2005, 2023 NIH)
- Lactational amenorrhea
- Sheehan syndrome
- Prolactinoma
Lactational amenorrhea
What is the most likely karyotype in a patient with Turner syndrome presenting with secondary amenorrhea? (2005)
- 45,X
- 46,XX/45,X
46,XX/45,X
What antibody is most associated with POI? (2013, 2014, 2017)
- 21-hydroxylase (21-OH)
- Anti-TPO
Anti-TPO (commonly associated but not diagnostic)
21-hydroxylase (diagnostic)
What is most diagnostic of immune mediated POI? (2018)
- 21-hydroxylase (21-OH)
21-hydroxylase (21-OH)
A woman is found to have a mutation in a gene. What gene would her father need to be concerned about in terms of delayed disease? (2011)
- FMR1
- CFTR
- NCQV
- GnRH
FMR1
How many repeats are in Fragile X premutations? (2017)
- 5-36
- 38-54
- 55-200
- > 200
55-200
A woman has a brother with Fragile X syndrome. She has 100 CGG repeats on testing. What are the chances of her having POI? (2018)
- 0%
- 10%
- 20%
- 50%
- 100%
If a woman has a son or brother with mental retardation and negative work-up for Fragile X but she herself has 100 CGG repeats on FMR1 testing. What are the chances of her having POI? (2007, 2011)
- 10%
- 20%
- 40%
- 90-100%
20%
15% have pre-mutations in familial POI
1-7% have pre-mutations in sporadic POI
25 yo F has a son with mental retardation and a negative work-up for Fragile X. She gets screened and has 100 triplet repeats. What does this mean clinically? (2007, 2023 NIH)
- The son does have Fragile X
- The patient is at risk for POI
The patient is at risk for POI
A female patient is found to have a Fragile X pre-mutation. Which of the following is most likely to be true? (2011)
- 20% risk of POI
- Mental retardation
- Skeletal abnormalities
- Renal aplasia
20% risk of POI
What is the least common product in a hormonally active pituitary adenoma? (2014, 2015, 2023 NIH)
- Growth hormone
- ACTH
- Alpha subunit
- TSH
TSH
What genes are not involved with pituitary development? (2015)
- PIT-1
- PROP-1
- HESX1
- PTX (LHX)
- BMP15
BMP15
What gene is most associated with pituitary development? (2016, 2017)
- PIT-1
- PROP-1
- HESX1
- PTX (LHX)
- BMP15
PROP-1
What is the least likely congenital malformation in pituitary disease (2015)
- PROP-1
- PIT-1
- HOX genes
- BMP15
- Others
BMP15
What is most associated with POI/gonadal failure? (2003, 2014, 2015, 2016, 2017, 2018, 2023 NIH)
- Galactosemia
- Blepharophimosis inversus syndrome (FOXL2)
Galactosemia
A woman presents with elevated FSH, normal LH, increased alpha subunit, and a pituitary mass. What is the diagnosis? (2018)
- Prolactinoma
- TSH secreting adenoma
- Non-functional pituitary tumor
- FSH secreting adenoma
Non-functional pituitary tumor
80-90% of nonfunctional pituitary tumors derive from gonadotrophs.
FSH tumors are rare (high FSH, low LH)
Gonadotroph tumors may secrete large amounts of the a subunit
Gonadotroph tumors affect HPO axis via stalk compression
- interrupting GnRH
- blocking dopamine > increasing prolactin
LH/FSH secreted by same cell
Common a subunit (LH, FSH, TSH, hCG), different b subunit
GnRH stimulates common a and different b subunits vi g protein second messenger, calcium dependent system
Rate limiting step is synthesis of b subunits of each gonadotropin (prior question; remember, alpha subunits are common and secreted with non-functional tumors)
A patient presents in the third trimester of pregnancy with a new onset headache and prolactin 126ng/mL. What is the next step? (2005, 2012, 2018)
- Bromocriptine
- Neurosurgery consult
- MRI brain
- TSH level
MRI brain
Which is least likely to cause hypothalamic amenorrhea? (2003)
- Weight training
- Aerobic exercise
- Eating disorders
Weight training
A 25yoF is 9mo postpartum and breastfeeding. She has not had a menstrual cycle since before pregnancy. What is the least likely cause of her secondary amenorrhea? (2003)
- POI
- Sheehan syndrome
Sheehan syndrome
Which of the following is most likely to lead to amenorrhea with long term use? (2003)
- Fluoxetine
- Chlorpromazine
Chlorpromazine (anti-psychotic causing hyperprolactinemia)
A 30yoF presents with 3mo amenorrhea, FSH 35mIU/mL, LH 3mIU/mL, prolactin 15ng/mL, TSH 4mIU/L, and excess alpha subunit. What is the most likely diagnosis? (2007, 2023 NIH)
- POI
- Gonadotroph adenoma
Gonadotroph adenoma
How is bleeding induced in secondary amenorrhea? (2010)
Medroxyprogesterone (Provera)
A 37yoF presents with secondary amenorrhea for 3mo. She is found to have FSH 3mIU/mL, LH 54mIU/mL, and prolactin 18ng/mL. What do you check next? (2007
Pregnancy test
Which substance inhibits prolactin? (2018, 2023 NIH)
- GABA***
- TRH
- Glutamate
- VIP
- Angiotensin II
- Estrogen
GABA
Which of the following will increase prolactin? (2005, 2007, 2023 NIH)
- GABA
- CRH
- Angiotensin II per 2023 NIH
- Neuropeptide Y (NPY)
- Vasopressin
Angiotensin II
Which of the following most inhibits (most potent inhibitor of) prolactin release? (2011, 2012, 2014, 2015, 2017, 2018, 2019, 2023 NIH)
- VIP
- Angiotensin
- TRH
- Oxytocin
- GABA
GABA
A 30yoF has secondary amenorrhea after using OCPs for the past 9yrs and discontinuing them 6mo ago. Her exam revealed the presence of a normal uterus and breasts but low local estrogen in the vagina. Which lab evaluations would be the most appropriate diagnostic evaluation? (2022)
- FSH, LH, estradiol
- FSH, TSH, prolactin
- TSH, prolactin, testosterone
- Testosterone, karyotype
FSH, TSH, prolactin
A 30yoF has secondary amenorrhea after using OCPs for the past 9 yrs and discontinuing them 6mo ago. Her exam revealed the presence of a normal uterus and breasts but low local estrogen in the vagina. Labs demonstrate FSH 68mIU/mL, TSH 5.2mIU/L, and prolactin 2.5 ng/mL. What is the most appropriate next step? (2022)
- Repeat FSH and TSH in 4 wk
- Pituitary MRI
- Begin treatment of hypothyroidism
- Discuss oocyte donation
Repeat FSH and TSH in 4 weeks
A 30yo F has secondary amenorrhea after using OCPs for the past 9 yrs and discontinuing them 6 mo ago. Her exam revealed the presence of a normal uterus and breasts but low local estrogen in the vagina. Labs demonstrate FSH 68mIU/mL, TSH 5.2mIU/L, and prolactin 2.5ng/mL. Repeat FSH 4wk later is 75mIU/mL.
Which of the following is inappropriate to perform at this time? (2022)
- Antiadrenal and antiadrenal antibodies
- TSH, free T4, calcium, phosphate, CBC, fasting blood sugar
- Fragile X screening
- Ovarian biopsy
Ovarian biopsy
A 30yoF comes to the office to begin treatment for infertility. She had menarche at 14yo and regular cycles until starting OCPs at 21yo. She continued OCPs until 6mo prior to today’s visit. She has had no menses since. Lab evaluations reveal FSH 2.5mIU/mL, TSH 13mIU/L, and prolactin 52ug/L. What is the most appropriate next step in the evaluation? (2022)
- Repeat prolactin mid-morning
- Pituitary MRI
- Medroxyprogesterone acetate (MPA) (Provera) withdrawal
- Treatment with thyroid replacement
- Treatment with bromocriptine
Treat with thyroid replacement
Which of the following has the lowest risk for a young patient with POI treated with estrogen replacement, compared to women her age who are still cycling regularly? (2022)
- Breast cancer
- Endometrial cancer with unopposed estrogen
- Infertility
- Depression
Breast cancer
What is the best treatment for an infertile patient with hypothalamic amenorrhea with normal prolactin levels? (2003)
- Bromocriptine
- Clomiphene citrate (Clomid)
- hMG
hMG
What is the most common cause of oligo-ovulation? (2016, 2023 NIH)
- Weight loss/anorexia
- Hypothyroidism
- Hyperprolactinemia
Hyperprolactinemia
A 24 yo F with PCOS and a BMI 24 kg/m2 wants to get pregnant. What is the best way to do this? (2007, 2011)
- Clomiphene citrate (Clomid)
- Clomiphene citrate (Clomid) and metformin
- Metformin
- IVF
Clomiphene citrate (Clomid)
A 30 yo F with PCOS has infertility. What is the most appropriate therapy? (2011)
- Gonadotropins
- Metformin
- IVF
- Clomiphene citrate (Clomid)
- Letrozole
Letrozole
A woman with PCOS desiring fertility, fails clomiphene citrate (Clomid) therapy. What is the best next step? (2018)
- Ovarian drilling
- Gonadotropins
- Clomiphene citrate (Clomid) and -metformin
- Extended clomiphene citrate (Clomid)
Clomid + metformin
What test is least accurate for assessing insulin resistance? (2007)
- Fasting glucose:fasting insulin ratio
- HbA1c
- Euglycemic clamp
- 2hr oral glucose tolerance test (GTT)
- Fasting glucose
Fasting glucose
What is the best test to screen for insulin resistance? (2005, 2018)
- Frequently sampled IV glucose tolerance test
- Insulin tolerance test (ITT)
- Oral glucose tolerance test (GTT)
- HOMA-IR
- QUICKI
OGTT
What is the best/most accurate clinical test for glucose tolerance? (2003, 2005, 2010, 2011)
- Euglycemic clamp
- 2 hr oral glucose tolerance test (GTT)
- Fasting insulin:glucose ratio
Euglycemic clamp
What is the most accurate way to diagnose insulin resistance in PCOS? (2011)
- Insulin:glucose ratio
- HbA1c
- Oral glucose tolerance test (GTT)
- Fasting insulin
OGTT
What is the best test to evaluate glucose intolerance in PCOS? (2011)
- Fasting glucose
- 1hr glucose tolerance test (GTT)
- 2hr glucose tolerance test (GTT)
- HbA1c
2 hour GTT
What is the best screening for insulin resistance in PCOS? (2023 NIH)
- 2hr oral glucose tolerance test (GTT)
- Fasting glucose:insulin ratio
- HbA1c
2 hour OGTT
What causes increased insulin resistance in theca cells in women with PCOS? (2012, 2018)
- Decreased serine phosphorylation of insulin receptor
- Increased serine phosphorylation of the insulin receptor
- Increased tyrosine phosphorylation of the insulin receptor
- Decreased number of insulin receptors
Increased serine phosphorylation of the insulin receptor
What causes increased insulin with insulin resistance? (2012, 2014, 2015)
- Decreased number of insulin receptors
- Abnormality in insulin receptor
- Serine phosphorylation of insulin receptor cascade
Serine phosphorylation of insulin receptor cascade
What is the mechanism of hyperinsulinemia in PCOS? (2013, 2015, 2017, 2018)
- Increased serine phosphorylation of insulin receptor
- Insulin receptor polymorphism
- Insulin receptor defect
Increased serine phosphorylation of insulin receptor
A patient is on metformin. Which of the following is the best reason to stop it 24hr in advance? (2009, 2011, 2012, 2014, 2015, 2018, 2023 NIH)
- MRI
- HSG
- Intravenous pyelogram (IVP)
- VOR
IVP
Contrast dye can cause renal failure, which results in build up of lactic acidosis (restart metformin 48 hours after dye)
What is least likely to occur if ovarian drilling is performed on a patient with PCOS? (2014, 2015)
- Drop androstenedione
- Decrease dopaminergic inputs
- Decrease LH
- Decrease LH/FSH ratio
Decrease dopaminergic inputs
How does insulin primarily increase androgen production in the ovary? (2010, 2012, 2018)
- Insulin action on IGF-1 receptors of theca cells
- Insulin action on insulin receptors in theca cells
- Insulin action on androgen receptor
- Insulin upregulates CYP17 enzymes
Insulin acts via which of the following to increase androgen production in theca cells? (2023 NIH)
- Insulin receptor
- Stimulation of CYP17 transcription
- IGF-1 receptor
Insulin receptor
What causes hyperinsulinemia with insulin resistance in PCOS? (2018)
- Less insulin receptors
- Intrinsic abnormality in the receptor
- Defects in the post-receptor signaling pathway
Defects in the post-receptor signaling pathway
What is least useful in diagnosis of PCOS? (2007, 2011, 2012, 2018)
- LH:FSH ratio
- Ultrasound (US)
- Ovarian volume
- Serum androgen levels
- Ferriman-Gallwey scores
- Menstrual history
LH:FSH ratio
PCOS patients are at increased risk for which of the following? (2012, 2018)
- Ovarian cancer
- Breast cancer
- Colon cancer
- Renal cancer
Breast cancer
What is the most common abnormality in PCOS? (2014)
- Elevated free testosterone
- Elevated total testosterone
- Elevated DHEA
- LH:FSH ratio >3
Elevated free testosterone
A college student has PCOS. What is the most appropriate therapy? (2011)
- Progestins
- Dexamethasone
- Metformin
- OCPs
OCPs
A first year college student has BMI 34, oligomenorrhea, and hirsutism. What is the best first treatment? (2023 NIH)
- OCPs
- Metformin
- Cyclic progesterone
OCPs
What is metformin least likely to do? (2003, 2007)
- Increase triglycerides
- Decrease HDL
- Increase insulin sensitivity
- Decrease serum testosterone
- Increase testosterone clearance
- Decrease serum insulin
Increase testosterone clearance
What circulating androgen has the biggest impact on hair growth? (2018)
DHT
Which of the following drugs is most likely to result in abnormal liver function tests? (2013, 2014, 2015, 2018, 2021, 2023 NIH)
- Finasteride
- Flutamide
- OCPs
- Spironolactone
- Cyproterone acetate
- Fulvestrant
Which antiandrogen therapy has the greatest risk of affecting liver enzymes (hepatotoxicity)? (2003, 2013, 2014, 2016, 2017, 2018, 2023 NIH)
- Finasteride
- Flutamide
- OCPs
- Spironolactone
Flutamide
What is the weakest antiandrogen therapy? (2010)
- Finasteride
- Flutamide
- Cimetidine
- Spironolactone
- Cyproterone acetate
Cimetidine
What is the most potent antiandrogen? (2023 NIH)
- Levonorgestrel
- Drospirenone
- Norethindrone
Drospirenone
What drug inhibits 5-alpha-reductase? (2005, 2013, 2019)
- Spironolactone
- Cyproterone acetate
- Flutamide
- Finasteride
Finasteride
Which drug does not inhibit the androgen receptor? (1999, 2009, 2011, 2023 NIH)
- Flutamide
- Spironolactone
- Finasteride
- Cyproterone acetate
- Danazol
Which of the following is least likely to bind the androgen receptor? (2023 NIH)
- Flutamide
- Cyproterone acetate
- Spironolactone
- Finasteride
Finasteride
What is the mechanism of action of finasteride? (1999, 2009)
- Androgen receptor antagonist
- Aromatase inhibitor
- 5-alpha-reductase inhibitor
- 17-beta-hydroxysteroid dehydrogenase (17-beta-HSD) inhibitor
5-alpha-reductase inhibitor
What is not a mechanism of spironolactone? (2003, 2005, 2011, 2012, 2018)
- Aldosterone antagonist
- Androgen receptor antagonist
- Inhibits ovarian and adrenal androgen synthesis
- Inhibits 5-alpha-reductase activity
- Decrease aromatase activity
- Increase aromatase activity
Increase aromatase activity
Decrease aromatase activity
Which is the least effect of spironolactone? (2007, 2023 NIH)
- Androgen receptor complete inhibition
- Increased aromatase
- Decreased P450scc
increased aromatase
Which has the greatest binding affinity for the androgen receptor? (2015, 2023 NIH)
- Flutamide
- Finasteride
- Danazol
- Drospirenone
Flutamide
(Danazol also picked)
What binds the androgen receptor best? (2012, 2015, 2016)
- Flutamide
- Testosterone
- DHEA
Testosterone
What has the strongest affinity for the androgen receptor? (2023 NIH)
- Flutamide
- DHT
- Testosterone
- DHEAS
DHT
A 50yoF with new onset hirsutism is suspicious for an androgen secreting tumor. What do you check? (2014, 2015, 2018)
- Testosterone
- Free testosterone
- Androstenedione
- DHT
- DHEAS
Testosterone
What pattern of hair growth would make you most suspicious for an androgen secreting tumor? (2017)
- Areolar hair
- Pubic hair extending up to the umbilicus
- Chin, upper and lower lip
- Balding
Balding
A 60 yo F presents with male pattern balding and a deepening voice. What is happening to hormones? (2013, 2018)
- Testosterone
- Free testosterone
- 17-hydroxyprogesterone (17-OHP)
- Androstenedione
- DHT
Testosterone
A 60yoF presents with male pattern balding and a deepening voice. What test do you order next? (2014)
- Testosterone
- 17-hydroxyprogesterone (17-OHP)
- Androstenedione
- DHT
Testosterone
What is the best test to discriminate to determine if a 60yoF has an ovarian androgen secreting tumor? (2018)
- Testosterone
- Free testosterone
- 17-hydroxyprogesterone (17-OHP)
- Androstenedione
- DHT
Testosterone
A 60 yo F presents with hyperandrogenism. What test do you order? (2013, 2014, 2016, 2018)
- 17-hydroxyprogesterone (17-OHP)
- Total testosterone
- Free testosterone
- Androstenedione
Total T
A 60 yo F presents with new onset hirsutism. What is the best test to order? (2014)
- Ultrasound (US) of ovaries
- MRI
US of ovaries
A 60 yo with presents with virilization, acanthosis, and other symptoms suggestive of hyperthecosis versus androgen secreting tumor. What is the best test to confirm ovarian androgen source? (2023 NIH)
- Free T4
- Total T4
- Androstenedione
- DHEAS
Total T4
What is the best test for an ovarian tumor found in 50yoF? (2014, 2015, 2016, 2018)
- Total testosterone
- DHT
- Free testosterone
- Androstenedione
- DHEAS
Total T
What is most associated with peripheral testosterone? (2011, 2014, 2015, 2016)
- 3-alpha-androstanediol glucuronide (3-alpha-AG)
- DHT
- Testosterone
- Androstenedione
How is androgen activity measured in the periphery? (2007, 2018)
What is the best measure of peripheral testosterone activity? (2018)
- Androstenedione
- DHT
- Testosterone
- 3-alpha-androstanediol (3-alpha-A)
- 3-alpha-androstanediol glucuronide (3-alpha-AG)
What is the best measure of peripheral androgen activity? (2007, 2010, 2023 NIH)
- DHEA
- DHT
- Testosterone
- Androstenedione
- 3-alpha-androstanediol glucuronide (3-alpha-AG)
3-alpha-androstanediol glucuronide (3-alpha-AG)
Density of hair follicles is based on which of the following? (2018)
- Number of follicles at birth
- Testosterone concentration at puberty
- Testosterone concentration at birth
- DHT concentration at birth
Number of follicles at birth
Density of hair follicles is based on which of the following? (2011, 2012, 2023 NIH)
- Gender
- Ethnicity
- Age
Ethnicity
What is the best marker of androgen receptors at the skin? (2023 NIH)
- DHEA
- DHT
- Testosterone
- Androstenedione
- 3-alpha-androstanediol glucuronide (3-alpha-AG)
3-alpha-androstanediol glucuronide (3-alpha-AG)
Which androgen is produced by the ovary in the greatest quantity? (2012, 2014, 2018)
- Androstenedione
- DHEA
- DHEAS
- Testosterone
Androstenedione
Which of the following enzyme deficiencies does not result in hirsutism? (2018)
- 21-hydroxylase deficiency (21-OHD)
- 11-hydroxylase (11-OH)
- 5-alpha-reductase
5 alpha reductase
An 18yoF who presents with moderate to severe hirsutism. What is the next step? (2018)
- Serum 17-hydroxyprogesterone (17-OHP)
- Adrenal CT
- 3-alpha-androstanediol glucuronide (3-alpha-AG)
- Free testosterone
- Total testosterone
- No lab or imaging studies
Total testosterone
Which is least likely in ovarian thecosis? (2007, 2023 NIH)
- Virilization
- Insulin resistance
- Acanthosis nigricans
- Hirsutism
- Hypertension
Hypertension
A patient with a 5cm mass and testosterone 300ng/ml is subsequently found to have a cystadenoma. What is the cell type responsible for the elevated androgen level? (1999)
- Capsule
- Stromal
- Granulosa cell
- Glandular cells of the cystadenoma
- Hilar
Stromal
Most common genetic mechanism defect for CYP21A2? (2021)
- Point mutation
- Pseudogene replacement
Pseudogene replacement
What is the best initial treatment for adrenal crisis? (2019, 2021)
- Prednisone 5mg
- Hydrocortisone 100mg
- Dexamethasone 25mg
Hydrocortisone 100 mg
What is the most potent glucocorticoid? (2013)
- Cortisone
- Progesterone
- Dexamethasone
- Prednisone
Dexamethasone
What hormone is made in the fasciculate layer of adrenal? (2019)
- Aldosterone
- Cortisol
- DHEA
Cortisol
What is the next step after confirmation of positive antiadrenal antibodies? (2018)
AM cortisol level
(>18 ug/dL excludes adrenal insufficiency)
What is the next step after positive antiadrenal antibodies are confirmed and AM cortisol level is low? (2018)
ACTH stimulation test (stimulated cortisol > 18 is a normal response)
Which enzyme deficiency is most likely to require glucocorticoids? (2005, 2011, 2018, 2023 NIH)
- Nonclassical 21-hydroxylase deficiency (21-OHD)
- 17-hydroxylase deficiency (17-OHD)
- 3-beta-hydroxysteroid dehydrogenase deficiency (3-beta-HSDD)
- Classical 21-hydroxylase deficiency (21-OHD)
Classical 21-hydroxylase deficiency (21-OHD)
What is a dexamethasone suppression test used to diagnose? (2016, 2017)
- Cushing syndrome
- 21-hydroxylase deficiency (21-OHD)
Cushing syndrome
What is the best initial test to DIAGNOSE Cushing syndrome? (2007, 2010, 2011, 2023 NIH)
- 24hr urine free cortisol
- AM serum cortisol
- Cosyntropin stimulation test
- Late night serum cortisol
24 hour urine free cortisol
You suspect adrenal insufficiency. What is the best initial diagnostic test? (2023 NIH)
- ACTH stimulation test
- ACTH
- AM serum cortisol
- 24hr urine free cortisol
AM serum cortisol
A patient is diagnosed with Cushing syndrome based on a 24hr urine free cortisol. What is the next test? (2009, 2011, 2023 NIH)
- ACTH
- Adrenal sampling
- High dose dexamethasone suppression test
- CT scan of the adrenals
ACTH
A patient is found to have elevated 17-hydroxyprogesterone (17-OHP). What is the next step? (2020)
- Overnight dexamethasone suppression
- 24hr urine free cortisol
- 2d suppression
- ACTH stimulation test
ACTH stim test
You do an overnight dexamethasone suppression test on a patient with Cushing syndrome. What is the most likely to cause a false positive? (2007)
- Depot medroxyprogesterone acetate (DMPA) (Depo-Provera)
- OCPs
- Obesity
OCPs
A pregnant patient is found to have very elevated 24hr urine free cortisol. What is the next step? (2010)
- Morning cortisol
- PM cortisol
- CBG
- ACTH
ACTH
How do you determine the cause of Cushing syndrome? (2018)
Measure ACTH
What is the least accurate test for Cushing disease? (2018)
- High dose dexamethasone suppression test
- Low dose dexamethasone suppression test
- Random serum cortisol
- 24 hour urinary cortisol
- Late night salivary cortisol
Late night salivary cortisol
What is the most common symptom of Cushing syndrome? (2017, 2018, 2021, 2022)
- Centripetal obesity/adiposity
- Moon facies
- Fatigue
- Amenorrhea
- Hirsutism
Central obesity/adiposity
What is the difference between iatrogenic and endogenous Cushing? (2001, 2003, 2005, 2007, 2009, 2011, 2012, 2014, 2015, 2017, 2018, 2023 NIH)
- Moon facies
- Buffalo hump
- Hypertension
- Hyperandrogenism/Hirsutism
- Glucose intolerance
- Psychosis
What is seen with endogenous but not exogenous steroid excess? (2003)
- Hypertension
- Hyperglycemia
- Obesity
- Hyperandrogenism
Hyperandrogenism/Hirsutism
(Iatrogenic Cushing due to exogenous steroids not hirsuit)
What finding distinguishes 17-hydroxylase deficiency (17-OHD) from Cushing syndrome? (2007)
- Hypertension
- Others
Hypertension
What treatment reduces the synthesis of cortisol in refractory Cushing disease? (2014, 2019, 2021, 2023 NIH)
- Ketoconazole
- Octreotide
Ketoconazole
In resistant Cushing disease, which of the following treatment options stops cortisol production best? (2023 NIH)
- Mifepristone (RU-486)
- Hydrocortisone
- Prednisone
- Others
Mifepristone
What is the most common cause of primary adrenal insufficiency? (2018)
- Idiopathic
- Autoimmune
- Mineralocorticoid administration
- Exogenous steroids
Autoimmune
What is the most common cause of secondary adrenal insufficiency? (2011, 2012, 2018, 2023 NIH)
- Idiopathic
- Auto-immune
- Mineralocorticoid administration
- Exogenous steroids/Iatrogenic
- Tuberculosis
- Pituitary tumor
Exogenous steroids/Iatrogenic
How do you monitor adequacy of fludrocortisone replacement? (2012, 2018)
- 17-hydroxyprogesterone (17-OHP)
- Serum testosterone
- Plasma renin
- 11-deoxycorticosterone (11-DOC) levels
Plasma renin
What layer of adrenals has CYP21? (2009, 2018, 2023 NIH)
- Granulosa
- Fasciculata
- Reticularis
- Medulla
Fasciculata (Glomerulosa which makes mineralocorticoids has it also)
Where is CYP11B2 located (most active in the adrenal)? (2007, 2009, 2023 NIH)
- Glomerulosa
- Fasciculata
- Reticularis
- Medulla
Glomerulosa
CYP11B1 - 11 beta hydroxylase
CYP11B2 - 11 beta hydroxylase and aldosterone synthase (for mineralocorticoid production)
What adrenal hormone is most likely to decrease with aging? (2011, 2012, 2014, 2015, 2023 NIH)
- Androstenedione
- DHEAS
- Testosterone
- Cortisol
DHEAS
All the androgens decrease with age, but cortisol increases. DHEAS decreases the most (70%)
A patient has bilateral adrenal enlargement with the same ACTH level after 2d of treatment with 2mg dexamethasone q6hr. What is the most likely diagnosis? (2011)
- ACTH-secreting small cell tumor of the lung
- ACTH-secreting adenoma of the pituitary
- Adrenal adenoma
- CRH-secreting tumor of the lung
Adrenal adenoma
Which of the following is most likely to mean there is an adrenal secreting tumor? (2010)
- Testosterone >200ng/dL
- DHEA(S)? >700mcg/mL
- Virilization
What is the best marker for an adrenal androgen producing tumor? (2003)
- Testosterone > 200ng/dL
- DHEAS >700ug/dL
- Rapid-onset virilization
DHEAS
A patient presents with hypotension, fatigue, and low AM cortisol. After giving them metyrapone you see an increased CRH and ACTH but no change in cortisol. What is the most likely diagnosis? (2022)
- Pituitary failure
- Addison disease
- Chronic steroids
Addison disease
Metapyrone blocks 11-beta hydroxylase (so cant make cortisol via 11-DOC or corticosterone). After giving metapyrone, people with adrenal failure have increased CRH and ACTH and stably low cortisol. If secondary adrenal failure, CRH will increase but ACTH will not and cortisol will stay low.
Note: is a tx for Cushing’s syndrome!
Note- chronic steroid user would have rise in cortisol!
What is the most common cause of secondary Addison disease in the United States? (2003, 2010)
- Sheehan syndrome
- Corticosteroid therapy
- Radiation therapy
Corticosteroid therapy
Which of the following is least compatible with Addison disease in a 25yoF with fatigue? (1999, 2003)
- Nausea and vomiting
- Hyperpigmentation in the buccal mucosa
- Alopecia
- Antiadrenal antibodies
- Hyponatremia
- Hyperkalemia
Alopecia
Anti-adrenal abs present in 60-70% of those with Addison
Which enzyme deficiency is not associated with hypocortisolism? (2003)
- 20,22-desmolase
- 7-alpha-hydroxylase (7-alpha-hydroxylase)
- 3-beta-hydroxysteroid dehydrogenase (3-beta-HSD)
- 18-hydroxylase (18-OH) (aldosterone synthase)
18-hydroxylase (18-OH) (aldosterone synthase)
What is most associated with adrenal failure? (2005, 2023 NIH)
- Thyroiditis
- Ovarian
Ovarian
What is most likely to cause a false positive cortisol elevation? (2005, 2023 NIH)
Obesity
What does low aldosterone result in? (2013)
Hyponatremia and hypercalcemia
A patient presents with hyperpigmentation, fatigue, and electrolyte abnormalities. What do you check next? (2021)
- Cortisol
- ACTH stimulation test
- Urine metanephrines
Cortisol
A woman presents with fatigue, increased pigmentation, weight loss, and no androgen excess. What is the diagnosis? (2011, 2012, 2018)
- Autoimmune disease
- Diabetes
- Late onset 21-hydroxylase deficiency (21-OHD)
Autoimmune disease
A young man presents with hyperpigmentation, hyponatremia, and hyperkalemia. What is the most likely etiology? (2014, 2015)
- Autoimmune disease
- 3-beta-hydroxysteroid dehydrogenase deficiency (3-beta-HSDD)
- 11-beta-hydroxysteroid dehydrogenase deficiency (11-beta-HSDD)
- Sjogren disease
Autoimmune disease
What is the order of hormone repletion in thyroid and adrenal disorders? (2007, 2009, 2013, 2015, 2016, 2018, 2023 NIH)
- Glucocorticoid then mineralocorticoid and last thyroid replacement
- Mineralocorticoids and glucocorticoids; then thyroid
- Thyroid, then mineralocorticoids and glucocorticoids
- Glucocorticoids, then thyroid, then mineralocorticoids
- Only glucocorticoids and mineralocorticoids
What do you first treat in a patient with both adrenal insufficiency and hypothyroidism? (A patient is diagnosed with both Addison disease and Hashimoto thyroiditis. What is the next best step in treatment?) (2003, 2005, 2007, 2011, 2012, 2014, 2023 NIH)
- Replace all three at once
- Thyroid and cortisol then watch see if mineralocorticoid replacement is needed
- Thyroid then watch and see if others require replacement
- Replace glucocorticoids and mineralocorticoids then thyroid
GC > MC > thyroid
Replace glucocorticoids and mineralocorticoids then thyroid
*Thyroid first will increase metabolism and worsen crisis
How do you monitor mineralocorticoid activity? (2015, 2017, 2023 NIH)
How do you monitor and titrate someone on mineralocorticoid replacement (for adrenal insufficiency)? (2011, 2013, 2014, 2023 NIH)
- Plasma renin level
- Sodium
- Potassium
- 17-hydroxyprogesterone (17-OHP)
Plasma renin level
A patient with clinical signs of Cushing syndrome undergoes a 2d dexamethasone suppression test and is found to still have elevated ACTH afterwards. What is the most likely cause? (2023 NIH)
- Small cell lung tumor
- CRH bronchial tumor
- ACTH pituitary adenoma
- Adrenal adenoma
Small cell lung tumor
Small cell lung tumor – ectopic, basal ACTH high, does NOT suppress
CRH bronchiole tumor – basal ACTH high, but suppresses with Dexa
ACTH pituitary adenoma – basal ACTH high, but suppresses with Dexa
Adrenal adenoma – basal ACTH LOW
Low dose dexa suppression test is used to differentiate Cushing’s from those who do not have Cushing’s.
High dose tests are used after the diagnosis of CS is made to distinguish patients with pituitary hyper-secretion from those with ectopic ACTH secretion (pituitary ACTH will suppress, ectopic won’t).
A patient presents with excessive hair growth, hypertension, and moon facies. What is the diagnosis? (2023 NIH)
- Hirsutism
- PCOS
- Cushing syndrome
Cushing syndrome
A pregnant patient presents with yellow skin, malaise, and. buccal pigmentation. A 24hr urine free cortisol is elevated to 700. What is the best next best step? (2023 NIH)
- ACTH stimulation test
- Serum ACTH
Serum ACTH
*Cushing’s syndrome - elevated cortisol, suspect elevated ACTH –> buccal pigmentation (acts via direct ACTH action on MSH receptors, most common in ectopic and less often in pituitary overproduction of ACTH) but confirm ACTH- dependence with serum ACTH. Next step would be to do a CRH stim test or high dose dexa suppression test to distinguish pituitary from ectopic.
What is the most common cause of secondary Cushing syndrome? (2023 NIH)
Iatrogenic
What is the most common complaint of a Cushing syndrome patient? (2023 NIH)
Generalized weakness
Centripetal obesity
Hypertension
Centripetal obesity
How do you monitor a 14yo on glucocorticoid and mineralocorticoid replacement? (2007, 2023 NIH)
- Cortisol
- ACTH
- ACTH stimulation test
- ACTH after CRH stimulation test
- Renin/angiotensin
Renin/angiotensin
A 30yoF presents with primary adrenal failure with new onset hypotension, fatigue, and hyperpigmentation. What is the most likely enzyme deficiency? (2023 NIH)
21-hydroxylase deficiency (21-OHD)
What is the best treatment for PMDD? (2019)
- SSRI
- Benzo
What is the most effective treatment for PMS? (2003, 2012)
- SSRI
- OCPs
SSRI
What receptor does danazol bind least to? (2001, 2003, 2005, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2018, 2023 NIH)
- Androgen receptor
- Progesterone receptor (PR)
- Glucocorticoid receptor
- Estrogen receptor (ER)
- Prolactin receptor
ER
The most common cause of irregular vaginal bleeding is which of the following? (2003)
Pregnancy
What is the definition of abnormal uterine bleeding (AUB)? (2011, 2012, 2018)
- Increased bleeding volume to >95th percentile
- Menorrhagia
- Bleeding for >8d
- Bleeding >80mL
Previous years answered: - Increased bleeding volume to >95th percentile
vs
Bleeding > 80 mL
What is the least likely definition of AUB? (2011, 2023 NIH)
Bleeding >7d
Preferred name for DUB
Same as menorrhagia
Bleeding >80mL
Bleeding volume >95th percentile
Same as menorrhagia (regular, but heavy)
(DUB = dysfunctional uterine bleeding)
What is the most likely cause of AUB in a teenager? (2005, 2019, 2021)
Anovulation
Inherited coagulopathy
Pregnancy complication
Cervical polyp
Anovulation
A 16yoF presents with profuse, heavy vaginal bleeding. Hemodynamically stable with Hct 26%. What is the best next step in management? (2021)
- One tab of combined oral contraceptive today and then one pill daily x30d
- IV estrogen q4h x24hr
- Tranexamic acid (TXA)
- D&C
What is the best treatment for a 13yoF with profuse vaginal bleeding but is hemodynamically stable with Hct 26%? (2020)
- IV estrogen
- OCPs
- D&C
- Endometrial biopsy then progesterone treatment
IV estrogen Q4H x 24H
IV estrogen
What marker is highest in patients with menorrhagia? (2021)
- Thromboxane
- PGI2
- PGE2
- Something else
PGI2 = prostacyclin
Which of the following is most commonly associated with endometrial cancer due to unopposed estrogen? (2020, 2021)
- PTEN mutation
- Smoking
- Advanced age
- MSH2
PTEN mutation
vs
Age
What is the most sensitive finding for adenomyosis? (2021)
- Increased thickness of the junctional zone
- Myometrial cysts and hyper (or hypo?) echogenic opacities on ultrasound (US)
- Diffusely thickened myometrial layer on MRI
- Abnormally soft uterine tone on laparoscopy
Increased thickness of the junctional zone
What is vasodilation after IV estrogen due to? (Why do coronary arteries dilate within 25sec of IV infusion of estradiol?) (1999, 2020)
- Genomic effects of estrogen
- Non-genomic effects of estrogen
- Effect of the estrogen response unit
- Release of endothelin-1
- Formation of estrogen receptor (ER) dimer
- Other
Non-genomic effects of estrogen
Estrogen increases NO synthesis (vasodilator)
What is the mechanism by which IV estrogen stops acute bleeding? (2005)
- Clotting
- Re-epithelialization
- Others
Clotting
Re-epithelialization
Both, but probably pick re-epithelialization for denuded endometrium
What is not a good treatment for a perimenopausal woman with menorrhagia? (2013)
Copper IUD (ParaGard)
A 14 yo F presents with persistent severe and heavy bleeding with menses. What do you do? (2018)
- Check a CBC
- TSH
- Wait 6 mo re-evaluate
Check a CBC
What is a contraindication for tranexamic acid (TXA) use? (2016)
Smoking
Retinal artery thrombosis
Uterine artery embolization (UAE)
AVM
Uterine septum
Infertile patient with intramural fibroids
Submucosal fibroids
Retinal artery thrombosis
What is the best treatment for heavy bleeding and anemia? (2016)
- Levonorgestrel IUD (Mirena)
- Tranexamic acid (TXA)
Mirena
A 16yoF girl has AUB. What is the most likely finding? (2003)
- Von Willebrand
- Others
Von Willebrand
A healthy 46yoF has AUB with Hgb 10g/dL. What is the best treatment? (2003)
Prostaglandin synthesis inhibitor
Endometrial ablation
OCPs
OCPs
*Prostaglandin synthesis inhibitor = NSAIDs
An 18yoF has abnormally heavy menses. What is the most likely etiology of her AUB? (2005)
Coagulopathy
A 35yoF presents with persistent AUB for 1yr. What is the most likely etiology? (2003, 2005, 2007, 2023 NIH)
Coagulopathy
Endometrial polyp
Increase in prostacyclin production
Fibroids
Fibroids
A 25/35yoF has AUB. What is the least likely cause? (2007)
Endometrial polyp
Fibroids
Factor V Leiden
IInsufficient luteal phase progesterone secretion
Factor V Leiden
*Clotting disorder, not bleeding
What is least likely to cause AUB (menorrhagia) from endometrial overgrowth (a thickened endometrium)? (2007, 2023 NIH)
- Conjugated estrogen
- Mifepristone (RU-486)
- Raloxifene
Raloxifene
*Acts as antagonist on endometrium
What is the best way to quantitate menses if doing a research trial on the menstrual cycle? (2013)
- Pictorial
- Diary
- Hgb
Diary
What is the best treatment for decreasing bleeding in women with fibroids distorting the uterine cavity?
- Levonorgestrel IUD (Mirena)
- Depot medroxyprogesterone acetate (DMPA) (Depo-Provera)
- UAE
- Ablation
UAE
What is increased in menstrual fluid in women with menorrhagia? (2023 NIH)
Prostacyclin
Thromboxane
PGE2
Both prostacyclin, PGE2
Which of the following is the best indication for a UAE? (2023 NIH)
- AV malformation
- Multiple submucosal fibroids
- Intramural fibroids with infertility
AV malformation
What is the most likely outcome after an endometrial ablation? (2023 NIH)
- Future hysterectomy
- Light vaginal bleeding with the menstrual cycle
- Amenorrhea
Light vaginal bleeding with the menstrual cycle
A patient presents with irregular cycles and a 12mm homogenous stripe. What is the best next step? (2023 NIH)
- Endometrial biopsy
- Combined OCPs
- Saline sonogram (SIS)
COCs
What is the effect of tamoxifen on bone density (BMD)? (2007)
Increases BMD in post-meno women but decreases BMD in pre-meno women
What is the effect of raloxifene on bone density (BMD)? (2007)
Increases
What is the effect of tamoxifen on cholesterol? (2007)
Increase: HDL, SHBG (–> lower free E2)
Decrease: LDL, cholesterol, ATIII
What is the effect of raloxifene on cholesterol? (2007)
lowers LDL
What should you not give someone for vasomotor symptoms who is taking tamoxifen for breast cancer? (2021, 2022)
Paroxetine
Citalopram
Escitalopram
Sertraline
Paroxetine
*In order to be fully effective, tamoxifen must be metabolized to an active metabolite, endoxifen, by the liver enzyme cytochrome P450 2D6 (CYP2D6). Consequently, any co-administered agent (e.g. paroxetine, fluoxetine, bupropion) that inhibits this enzyme will reduce the conversion of tamoxifen to endoxifen, thereby potentially reducing the efficacy of tamoxifen as a breast cancer therapy.
A patient with hot flashes is on tamoxifen to reduce risk of breast cancer recurrence. What do you add? (2017, 2021)
Paroxetine
Norethindrone
Venlafaxine
Citalopram
Escitalopram
Gabapentin
Valerian root
Gabapentin
*Paroxetine, Venlafaxine, Citalopram, Escitalopram are all contraindicated as they would reduce effectiveness of tamoxifen
Which of the following drugs is most likely to interfere with the action of tamoxifen? (2021)
- SSRI can’t remember which one
- Benzodiazepine of some kind
- Clonazepam
- OCPs
OCPS (but why would someone on tamoxifen be on OCPs)
SSRIs also interfere
What hormonal changes do you see in a premenopausal woman on tamoxifen? (2018, 2023 NIH)
- Increased FSH
- Increased inhibin
- Decreased estrogen
Increased FSH
Which of the following has the least effect on endometrial thickness? (2012, 2014, 2015, 2023 NIH)
Raloxifene
Tamoxifen
Mifepristone (RU-486)
Clomiphene citrate (Clomid)
Estriol
Which of the following is least likely to lead to (vaginal bleeding from) endometrial hyperplasia? (2009, 2011, 2012, 2014, 2015, 2018)
Raloxifene
Tamoxifen
Mifepristone (RU-486)
Clomiphene citrate (Clomid)
Estradiol
Which one of the following does not lead to vaginal bleeding with endometrial side effects? (2023 NIH)
Tamoxifen
Raloxifene
Estradiol
Mifepristone (RU-486)
Raloxifene
What is the least likely effect of raloxifene? (2001, 2007, 2014, 2015, 2023 NIH)
- HDL (up or down)
- Triglycerides (up or down)
- Hot flashes
- VTE
No effect on HDL
What is the least likely effect of raloxifene? (2001, 2007, 2011)
DVT
Increased LDL
Decreased HDL
Increased cholesterol
Hot flashes
Fracture
Fracture
What is the most common side effect of tamoxifen? (2007, 2013, 2014)
Hot flashes
Arthralgias
Hot flashes
What is the most common side effect of aromatase inhibitors? (2007, 2009, 2013, 2014)
Hot flashes
Arthralgias
Fractures
Arthralgias
What risk is associated with raloxifene? (2003, 2007, 2009, 2011, 2012, 2015, 2016, 2017, 2018, 2019, 2023 NIH)
Endometrial hyperplasia
Weight loss
Increases DVT risk
Stroke
Reduced hot flashes
Increased total cholesterol
Increased LDL
Increases DVT risk
How does a risk reducing BSO affect the cancer risk of a patient with a BRCA? (2017, 2018)
Decreases ovarian cancer by 90%
Decreases breast cancer by 90%
No change
Decreases ovarian cancer by 90%
Mechanism of action of tamoxifen
TAF-1 and TAF-2 areas can both activate transcription, but TAF-2 activates transcription only when it is bound by estrogen. The individual transactivating abilities of TAF-1 and TAF-2 depend on the promoter and cell context. Tamoxifen’s agonistic ability is due to activation of TAF-1; its antagonistic activity is due to competitive inhibition of the estrogen-dependent activation of TAF-2 (Figure 1.25).
Tamoxifen (SERM): Agonist or antagonist at estrogen receptor
a. Agonist due to TAF-1 activation
i. Estrogen agonist effect – TAF-1 too weak to activate transcription when TAF-2 inactivated in most cell types EXCEPT endometrium, bone, liver (due to overcoming competitive inhibition of TAF-2)
b. Antagonist activity due to competitive inhibition of TAF-2 action
i. Anti-estrogen effect occurs in tissues when response to estrogens is mediated by TAF-2
Each of the following is an established risk factor for breast cancer except? (Which of the following does not increase breast cancer risk?) (1999, 2005, 2023 NIH)
First pregnancy after age 30yo
Nulliparity
OCPs
First degree relative with breast cancer
Cigarette smoking
OCPs
How is testosterone replacement managed in a woman? (2011, 2012, 2018)
Keep testosterone levels in normal range
Keep giving testosterone until patient feels better
Increased libido
Give as much testosterone as needed, even if blood levels are high
Keep testosterone levels in normal range
What does testosterone replacement in postmenopausal women most likely result in? (2011, 2012, 2018, 2023 NIH)
Improvement in UTI
Increased ovarian androstenedione production
Improved sense of wellbeing
Improved lipid panel
Increased skin elasticity
Increased thrombotic events
Improved sense of wellbeing
What is the mechanism of hot flashes in postmenopausal women? (2017, 2018, 2020, 2021, 2022)
Decreased endorphins
Narrowing of the central thermoregulatory zone
Increased catecholamines
Narrowing of the central thermoregulatory zone
What medication increases osteoblast activity? (2013, 2014, 2015, 2016, 2018, 2022, 2023 NIH)
Teriparatide
Raloxifene
Bisphosphonates
E2
SERMs
Denosumab
Calicitonin
Which of the following increases osteoblast activity? (2011, 2023 NIH)
Estrogen
Calcium
Calcitonin
Bisphosphonates
PTH
What directly stimulates osteoblast activity? (2012, 2014, 2018)
Vitamin D
Estrogen
Tamoxifen
Raloxifene
Bazedoxifene
Teriparatide*** is a recombinant PTH
PTH
Estrogen
Which one is least associated with osteoporosis? (2003, 2009, 2012, 2014, 2018, 2023 NIH)
Steroids
Hypothyroidism
Hyperparathyroidism
Renal failure
Smoking
Hypothyroidism
*Hyperthyroidism causes osteoporosis
A 75yoF with coronary heart disease (CHD) and TSH 10mU/mL. What therapy do you initiate? (2007, 2021, 2022, 2023 NIH)
15mg desiccated thyroid (Armour)
20mg desiccated thyroid (Armour)
25ug levothyroxine (Synthroid)
50ug levothyroxine (Synthroid)
25ug levothyroxine (Synthroid)
What should the starting levothyroxine (Synthroid) dose be for a 60yoF with hypertension when her needed dose is 150ug? (2023 NIH)
12.5ug
25ug
100ug
150ug
25ug
What does transdermal HRT do differently compared to oral HRT? (2021)
Decreases triglycerides
Decreases triglycerides
Postmenopausal woman with known cardiovascular disease (CVD) and hot flashes. What will provide the best relief of symptoms? (2021)
Some specific SSRI (paroxetine maybe)
Vaginal E2
Transdermal E2
Black cohosh
Transdermal E2
What is least likely to be elevated with a transdermal estrogen patch? (2009)
SHBG
LDL
Triglycerides
HDL
Triglycerides
What is the least effect of estrogen (HRT) on cardiovascular disease (CVD)? (2003, 2005, 2007, 2009, 2011, 2012, 2018, 2023 NIH)
Increase in NO synthase
Decrease in NO synthase
Inhibits oxidation of LDL
Increase in HDL
Increase in prostacyclin
Decrease in NO synthase
(*E2 increases NO, which is anti-atherogenic)
What will most effectively reduce hot flashes in a perimenopausal woman? (2021)
Vaginal E2
Systemic E2
Some SSRI
Clonazepam
Systemic E2
What is an absolute contraindication to initiation of testosterone therapy in a hypogonadal male? (2021, 2023 NIH)
PSA 2.5ng/mL
Hct 45%
Breast cancer
Obesity
CHF Class 1
Breast cancer
What is absolutely contraindicated for men with breast cancer? (2018)
Testosterone therapy
What complication is bisphosphonate treatment associated with? (2012, 2014, 2015, 2018, 2021)
Increased serum calcium levels
Osteonecrosis of the mandible
Atypical fractures of the femoral head
Something else about bones
Osteonecrosis of the mandible
What is the best treatment for vasomotor symptoms when HRT is contraindicated? (2019)
Paroxetine
Neurontin
Black cohosh
Paroxetine
Which of the following is the best treatment for vasomotor symptoms? (2014, 2015)
Venlafaxine
Clonidine
Black cohosh
Venlafaxine
What is the best way to protect bones (prevent bone loss) of a 35yoF patient with POI? (2018, 2019)
OCPs
Transdermal HRT
Calcium and vitamin D
Weight-bearing exercise
OCPs
How do you treat hot flashes and vaginal dryness in a 52yoF with prior hysterectomy? (2017, 2018)
Systemic estrogen
Vaginal estrogen
Systemic estrogen and progesterone
Systemic estrogen
A 63yoF presents with a T-score of -3 and Z-score of -2.5. What is the least likely cause? (2009, 2011, 2012, 2013, 2014, 2015, 2018, 2023 NIH)
Normal menopause
Chronic renal disease
Multiple myeloma
Hyperparathyroidism
Hyperthyroidism
Hypothyroidism
Vitamin D deficiency
Normal menopause
A 65yoF has a T-Score of -3 and Z-Score of -2.5. What is the least likely reason? (2023 NIH)
Menopause
Vitamin D deficiency
Hypoparathyroidism
Menopause
A 60yoF has a T-score of -2, normal PTH, normal calcium, and vitamin D 9ng/dL (low). What is the best initial treatment? (2011)
Bisphosphonates
Calcium
Vitamin D
DEXA in 2yr
Vitamin D
What is least effective at treating osteoporosis? (2013)
Vitamin D supplementation
Calcitonin
Bisphosphonates
HRT
Vit D supplementation
What is the highest food source of vitamin D? (2016, 2023 NIH)
Raw milk
Hard cheese
Cod liver oil
Spinach
Cod liver oil
What is least effective at treating osteoporosis? (2013, 2014, 2015, 2018)
High dose calcium
Calcitonin
Bisphosphonates
HRT
What treatment will not increase bone density (BMD)? (2011, 2013, 2014, 2015)
High dose calcium
Calcitonin
Risedronate
HRT
What is least likely to increase bone density (BMD)? (2023 NIH)
High dose calcium
Calcitonin
Estradiol
Bisphosphonates
High dose calcium
What is least likely to improve bone density (BMD)? (2005, 2007, 2009)
Calcitonin
Raloxifene
Tamoxifen
Calcitonin
What is the best way to determine bone loss? (2010)
Vitamin D
TFTs
Renal function tests
DEXA
DEXA
What is most likely to result in negative calcium balance? (2023 NIH)
Hyperprolactinemia
Renal insufficiency
Hyperthyroidism
Progesterone treatment
Hyperparathyroidism
Renal insufficiency
What is most likely to have a negative calcium balance? (2013, 2014, 2017)
Hypercortisolism
Hyperprolactinemia
Hyperparathyroidism
Hypercortisolism
What is the best predictor of perimenopause within 10yr? (2014, 2018, 2023 NIH)
AMH
FSH
Inhibin
AMH
What does HRT do to cardiovascular disease (CVD)? (2015)
Primary and secondary prevention of cardiovascular disease (CVD)
Primary prevention only
Primary prevention only
When is HRT most likely to have a protective effect? (2015)
Obesity
PCOS
Hyperlipidemia
Perimenopause
Perimenopause
What hormone decreases in menopause? (2015, 2016, 2017, 2018)
DHEAS
Androstenedione
Testosterone
3-alpha-androstanediol glucuronide (3-alpha-AG)
DHEAS
Measured at any time during the menstrual cycle, which is most likely to predict menopausal status? (2014, 2015)
FSH
LH
AMH
Inhibin
AMH
A 50yoF with prior TAH-BSO wants medications for hot flashes but does not want to take anything that increases her risk of breast cancer. What do you give her? (2014, 2015, 2023 NIH, 2023 NIH)
Gabapentin
Venlafaxine
Conjugated equine estrogens (CEE) (Premarin)
Venlafaxine
Who is most likely to have hot flashes? (2017)
African American
Asian Pacific Islander
Hispanic
African American
Which route of HRT gives the most constant levels? (2012, 2015, 2017, 2018)
Transdermal
Oral
IM
Transdermal
Compared to placebo, which was increased in the estrogen only arm of the Women’s Health Initiative (WHI)? (2015, 2016)
Breast cancer
Stroke
DVT
Lung cancer
Urinary incontinence
Vertebral Fraction
Stroke
C-EE and E-P arms:
- Increased CVA
- Decreased hip fracture
E-P arm:
- Increased VTE > increased BC > inc CHD
- Decreased colon ca
Compared to the increased risk seen in the estrogen only arm, what differed in the estrogen and progestin arm of the Women’s Health Initiative (WHI)? (2005, 2007, 2010, 2023 NIH)
Breast cancer risk
Cardiovascular disease (CVD) risk
VTE risk
Breast cancer risk
A postmenopausal woman has been on estrogen HRT for years. If she continues, her risk of which of the following will continue to increase? (2012)
Stroke
VTE
Stroke
Why is hirsutism common after menopause? (2018)
Change in androgen/estrogen ratio
What is least likely to affect circulating estrone levels? (2012, 2018)
- Liver disease
- Hypothyroidism
- Aging
- Obesity
Hypothyroidism
What is least likely to cause osteoporosis? (2023 NIH)
Hyperprolactinemia
How do you monitor response to treatment of osteoporosis after 3mo of treatment? (2007, 2010, 2012)
Serum C-telopeptide
Procollagen
Osteocalcin
DEXA scan
Serum C-telopeptide
What is the worst marker of bone resorption? (2010, 2011, 2012, 2018, 2023 NIH)
Urinary N-telopeptide
Serum N-telopeptide
Serum C-telopeptide
Serum hydroxyproline
Urinary hydroxyproline
Hydroxypyridine
Urinary C-phosphatidylcholine
Urinary N-phosphatidylcholine
What is the least useful test for measuring the efficacy of osteoporosis treatment? (2023 NIH)
N-telopeptide
C-telopeptide
Hydroxyproline
Serum hydroxyproline
What is least likely to reflect bone resorption? (2011)
N-telopeptide
C-telopeptide
Urinary hydroxyproline
Serum N-terminal propeptide of type 1 collagen
Serum N-terminal propeptide of type 1 collagen
A patient begins treatment for osteopenia. How can you best assess if the regimen is preserving bone density (BMD) 3mo later? (2003)
DEXA of spine
DEXA of hip
Osteocalcin:creatinine ratio
C-telopeptide:creatinine ratio
C-telopeptide:creatinine ratio
Adiponectin is secreted by ___
Increased/decreased adiponectin is assoc w metabolic syndrome, insulin resistance and obesity. (2023 NIH)
Adipose
Decreased
Which of the following scenarios would be most appropriate to initiate treatment with metformin? (2021)
Obesity
Abnormal glucose tolerance test (GTT)
Insulin resistance
PCOS
IR
What is least likely to have a negative calcium balance? (2003, 2011, 2012, 2013, 2014, 2018, 2023 NIH)
Hypercortisolism
Hyperprolactinemia
Hyperthyroidism
Progesterone therapy
Hyperparathyroidism
Alcohol
Anorexia
Hyperparathyroidism
What is the best way to check bone density (BMD) 3mo post treatment? (2023 NIH)
DEXA spine
DEXA hip
Telopeptides
Serum hydroxyproline
What is the best test after 3mo of osteoporosis therapy? (2023 NIH)
DEXA spine
DEXA hip
C-telopeptide
Urinary CTX/creatinine ratio
Telopeptides
If a teenager is getting a DEXA scan as there is a concern for bone mass. What score do you use? (2007, 2011, 2012, 2014, 2017, 2018, 2022, 2023 NIH)
T-score
Z-score
Age adjusted tables
Growth chart
Telopeptide
Single ray photon
Z-score
What is the best test for bone density (BMD) in a 16yo girl? (2023 NIH)
DEXA scan with T-Score
DEXA scan with Z-Score
Heel ultrasound (US)
Telopeptide
DEXA scan with Z-Score
An 18yoF college student gets a DEXA and her T-score of -2.5. What is the most likely cause? (2009, 2018, 2023 NIH)
Low BMI
Age
Exercise
OCPs
Age
T-score compares against healthy 30 year old female (bone mass peaks in 20s)
Z-score compares against sex, age, weight matched controls
What is the least likely to help a 61yo postmenopausal woman with severe osteopenia? (2005, 2012, 2018)
Estradiol
Alendronate
High dose calcium
Raloxifene
Calcitonin
Risedronate
High dose calcium
A 58yoF presents with osteopenia. What is the least likely cause? (2011)
Chronic renal insufficiency
Smoking
Hyperparathyroidism
Hyperthyroidism
Hyperparathyroidism
What occurs less with aromatase inhibitors compared to tamoxifen? (2011, 2012, 2013, 2014, 2018, 2023 NIH)
Hot flashes
Nausea and vomiting
Thromboembolism
Arthralgias
Fractures
Thromboembolism
What occurs less with aromatase inhibitors compared to tamoxifen? (2023 NIH)
Hot flashes
Arthralgias
Fractures
Hot flashes
What occurs more with aromatase inhibitors compared to tamoxifen? (2011)
Hot flashes
Myalgias
Bone density (BMD)
DVT risk
Myalgias
What is the earliest sign of perimenopause? (2007)
Increasing FSH
Decreasing inhibin
What is the earliest sign of perimenopause? (2023 NIH)
Increasing FSH
Decreasing inhibin
Decreasing AMH
Decreasing inhibin (if AMH is not an answer)
Decreasing AMH
Which is least likely to occur during the perimenopause? (2005, 2018, 2023 NIH)
Amenorrhea
Oligomenorrhea
Menorrhagia
Regular cycles
Regular cycles
Which of the following hormonal changes is most likely found in a perimenopausal woman? (1999)
Increased estradiol
Increased androstenedione
Decreased post-ovulatory progesterone
Decreased FSH
Decreased post-ovulatory progesterone
A patient wants HRT but wants the least amount of variability in dosing as she has night sweats and hot flashes in the evening. Which of the following would be best? (2012, 2015)
- Transdermal patch
- IM
- Oral cyclic
- Oral continuous
Transdermal patch
What do you check to diagnose vitamin D deficiency? (2012)
25 Vitamin D
1,25 Vitamin D
25 vit D
Which hormone is least likely to decrease with age? (2007)
Insulin
DHEA
Growth hormone
Insulin
What is the most important risk factor for stroke in women? (1999)
Cigarette smoking
OCPs
Hypertension
Hypercholesterolemia
HTN
What does oophorectomy in a postmenopausal woman have the greatest effect on? (1999)
DHEAS
Testosterone
Estrone
Androstenedione
Estradiol
Testosterone
What does the post-menopausal ovary make most? (2023 NIH)
Androstenedione
What is an LDL receptor defect most likely to cause? (2003, 2005)
Atherogenesis
What is the primary function of HDL? (What is a consequence of processing HDL?) (1999, 2001, 2003, 2010, 2023 NIH)
- Atherogenesis
- Decreased hepatic lipase
- Reverse cholesterol transport
- Act as a scavenger transporting cholesterol back to the liver
Reverse cholesterol transport
Which hormone would not be expected to decrease in aging? (Which hormone is least likely to decrease with aging?) (2003, 2010, 2023 NIH)
Testosterone
Insulin
TSH
FSH
FSH
Which hormone does not change during menopause? (2005, 2023 NIH)
Insulin
Testosterone
DHEA
Androstenedione
Estrogen
Insulin
For a woman taking cyclic HRT, which progestin will be least likely to have androgenic side effects? (2003)
Norethindrone
Micronized progesterone
Medroxyprogesterone acetate (MPA) (Provera)
Micronized progesterone
HRT is most likely to decrease the risk of which of the following? (2003)
Colon cancer
Ovarian cancer
Endometrial cancer
Colon cancer
Which of the following daily regimens is least likely to preserve bone density (BMD)? (2003)
Ethinyl estradiol 20μg and norethindrone 1mg
Conjugated estrogens 0.625mg and methyltestosterone 1.25mg
Conjugated estrogens 0.3mg
Medroxyprogesterone acetate (MPA) (Provera) 10mg
Medroxyprogesterone acetate (MPA) (Provera) 10mg
What substance is least likely to be increased in a patient with low bone mass? (2005)
Vitamin D
IL-6
PTH
Calcitonin
Vit D
42yoF with a history of previously regular menses presents with recent increased frequency of menses. What is the next step? (2005, 2023 NIH)
Observation
*Perimenopause
In another recall list, OCP was listed – would choose OCPs** 2005
Which clinical presentation does not require further evaluation? (2005, 2023 NIH)
- 52yoF on cyclic OCP with endometrial thickness 8mm
- 60yoF with fluid in the endometrial cavity
52yoF on cyclic OCP with endometrial thickness 8mm
What is postmenopausal HRT therapy for? (2023 NIH)
Primary and secondary prevention
Primary prevention only
Prevention of heart disease
Others
Primary and secondary prevention
How would you titrate the dose of testosterone in a female using it for sexual dysfunction? (2023 NIH)
Titrate to testosterone levels
Titrate to clinical improvement despite high levels
Titrate to testosterone levels
A woman in her late 40s had regular menses followed but her next cycle started 17d later then her most recent cycle was 65d after that. What do you do? (2023 NIH)
FSH
AMH
Ultrasound (US)
Endometrial biopsy
Menstrual period calendar
Menstrual period calendar
What is the most common ocular complaint in menopause? (2023 NIH)
Macular degeneration
Glaucoma
Cataracts
Dry eyes
Dry eyes
A 50yo menopausal patient presents with hot flashes and vaginal dryness. What is the best treatment? (2023 NIH)
Vaginal estrogen
SSRI
Clonidine
Systemic estrogen
Systemic estrogen
What is estrogen in HRT is least associated with? (2023 NIH)
Decreased cholesterol
Increased HDL
Increased LDL
Plaque formation
Increased LDL
What is the best strategy for lasting weight loss in an obese woman with a BMI 56 kg/m2? (2018)
- Diet
- Exercise
- Medications
- Bariatric surgery
What is the best strategy for lasting weight loss in an obese woman with a BMI 56kg/m2? (2018, 2023 NIH)
Gastric bypass
Lap band
Others
Bariatric surgery
Gastric bypass
What leads to obesity? (2015)
Defect in leptin
Defect in leptin receptor
Defect in leptin receptor
What is most common with obesity? (2015, 2023 NIH)
Defect in leptin receptor
High adiponectin
Decreased adiponectin
Low leptin
High ghrelin
Decreased adiponectin
Which of the following does not increase in obese women? (2012)
Leptin
Insulin
Hyperandrogenism
SHBG
SHBG
A patient had gastric bypass surgery. What is the most likely change? (2014, 2023 NIH)
Decreased leptin
Neuropeptide Y (NPY)
Decreased ghrelin
Adiponectin
Decreased ghrelin
What happens if a patient is on the Atkins diet? (2011, 2023 NIH)
Fat intake suppresses appetite
Decrease in insulin
Decreased total calories
Decrease in insulin
What is the most likely effect of leptin in a normal weight person? (2023 NIH)
Change ghrelin
Decrease appetite
Decrease appetite
Ghrelin is an endogenous ligand for which receptor? (2015)
Insulin
Growth hormone
Growth hormone
What do TPO antibodies bind to? (2021, 2022)
Thyroid microsomes
TBG
T4
TSH
Thyroid microsomes
What is the best test to diagnose recurrence of [papillary] thyroid carcinoma? (2021)
- Thyroglobulin
- TPO antibody
- TSH
- Free T4
TG
When is the soonest thyroid levels should be checked after an increase in levothyroxine (Synthroid) dose? (2012)
1wk
2wk
4wk
8wk
8 weeks
What are the changes in thyroid function tests in early pregnancy (In a woman with known hypothyroidism)?: (2018, 2021)
Elevated TSH, decreased T4
Elevated TSH, decreased T3
Low TSH, increased T4
Low TSH, normal T3
Low TSH, increased T4
What is the best next step for a palpable 2cm painless thyroid nodule/mass in the right lobe with normal thyroid function tests? (2005, 2007, 2011, 2014, 2019)
Ultrasound (US) with doppler
Open core biopsy
Fine needle aspiration (FNA)
Thyroidectomy
Uptake scan
US with Doppler
How do you evaluate a malignant thyroid nodule? (2011)
Ultrasound (US) with doppler
Open core biopsy
Fine needle aspiration (FNA)
Thyroidectomy
Uptake scan
FNA
What is the best diagnostic test for a thyroid nodule? (2023 NIH)
Fine needle aspiration (FNA)
TFTs
Thyroid scan
Open biopsy
FNA
A patient presents with a painful diffusely enlarged thyroid, elevated TSH, decreased T4, and fatigue. What is the diagnosis? (2011, 2023 NIH)
Subacute thyroiditis (viral, deQuervain)
Hashimoto thyroiditis
Graves disease
A patient presents with symptoms of hyperthyroidism and a painful, enlarged thyroid gland. What is the most likely cause? (2011)
Graves disease
Subacute (DeQuervain) thyroiditis
Postpartum thyroiditis
Thyroid cancer
Subacute thyroiditis (viral, deQuervain)
Subacute (DeQuervain) thyroiditis
What is the most common cause of hyperthyroidism in the United States? (2010)
Graves disease
Graves disease
What kind of receptor does T3 use? (2013, 2014, 2018)
Cell surface receptor
Nuclear receptor
Combination of cell surface and nuclear receptor
Endoplasmic reticulum receptor
Nuclear receptor
What happens to fetal thyroid hormones in pregnancy? (2007, 2011, 2012, 2016, 2018)
Elevated TSH
Elevated T3
Elevated rT3
Low T4
Elevated rT3
What is the fetal thyroid function profile at 20wk? (2012, 2018)
Decreased TSH, increased T4, increased rT3
Increased TSH, increased T4, decreased rT3
Increased TSH, stable T4, increased rT3
Increased TSH, increased T4, increased rT3
Increased TSH, increased T4, increased rT3
Which is true about the fetal thyroid? (2014, 2015)
TSH maxes out at 10wk with peak in hCG
Resembles pattern seen in cachexia
Other thyroid options
What is the neonatal thyroid panel characterized by? (2023 NIH)
Resembles pattern seen in cachexia (high rT3, low T3)
Similar to patients with eating disorders (increased rT3, low T3)
A woman with hyperthyroidism presents with fever to 101F and tachycardia to 110s. What do you do first? (2014, 2015, 2017)
Glucocorticoids
Give T4
Beta blocker
Radioablation
Beta blocker
A patient presents in thyroid storm. What do you do first? (2005, 2015, 2023 NIH)
Propranolol (Beta blocker)
Radioactive iodine
Propylthiouracil (PTU)
Propranolol (Beta blocker)
A healthy 23yoF presents with new onset hyperthyroidism. TSH <0.1 mU/mL, high T3, and radioactive iodine was <3% (low). What is the most likely diagnosis? (2018)
Graves disease
Thyroiditis
Hot thyroid nodule
Thyroiditis
What is most likely to occur in a 60yoF with hypothyroidism? (2003, 2005, 2011, 2012, 2014, 2018)
Elevated total cholesterol
Elevated HDL
Elevated LDL
Decreased LDL
Decreased conversion/metabolism/clearance of T4 to T3
Elevated total cholesterol
What is least likely to be seen in a 69yoF with hypothyroidism? (2011)
Elevated cholesterol
Elevated HDL
Decreased conversion/metabolism/clearance of T4 to T3
Elevated HDL
What is the most common cause of hyperthyroidism in pregnancy? (2018)
Gestational trophoblastic disease
Graves disease
Subclinical hyperthyroidism
Idiopathic hyperthyroidism
Graves disease
What is the best next test when a patient with symptoms of hypothyroidism is found to have low/normal TSH and low free T4? (2007, 2009, 2011, 2012, 2018, 2023 NIH)
TSH stimulation test
Free T4
rT3
TRH stimulation test
Thyroglobulin
Radio-Iodine uptake
TRH stimulation test
What are the changes in TSH that occur within the fetus during gestation? (2021)
Increases progressively until term
Increases until midgestation and then decreases
Increases until midgestation and then plateaus
Increases in first trimester then progressively decreases until term
Increases until midgestation and then plateaus
*TSH starts to increase at 20 weeks, plateaus at 28 weeks, peaks shortly after birth
A patient with a history of hypothyroidism has a positive pregnancy test. How do you adjust dosing of their levothyroxine (Synthroid)? (2011, 2012, 2013, 2014, 2015, 2016, 2017, 2018, 2020, 2022)
Increase 2 doses per week
Increase by 30% and then check monthly
Measure TSH, treat based on value
Measure TSH, free T4; treat based on value
Measure hCG, TSH, free T4; treat based on value
No change
A patient with a history of hypothyroidism has a positive pregnancy test. What do you do next? (2017 and 2018 was on a second time with different answer options)
Increase 2 doses per week
Check T4 every 8-10 weeks
No change
Increase T4 dose
Check TSH
Counsel on increased risk SAB
A patient with hypothyroidism on levothyroxine (Synthroid) has positive pregnancy test. How do you manage her? (2023 NIH)
Increase dose empirically
Check thyroid antibodies
Check TSH
Check T4
A patient with a TSH of 4.5mU/mL has a positive pregnancy test. What do you do next? (2013, 2014)
Increase 2 doses per week
Increase by 30% and then check monthly
Measure TSH, treat based on value
Measure TSH, free T4; treat based on value
Measure hCG, TSH, free T4; treat based on value
Increase by 30% then check monthly
Increase dose empirically
Increase by 30% then check monthly
How do you monitor hypothyroidism in a pregnant patient? (2023 NIH)
Free T4
TSH
Thyroid antibodies
TSH
A pregnant patient presents with Graves in the first trimester, but no symptoms. What do you do next? (2021)
Expectant management
Start propylthiouracil (PTU)
Start methimazole
Biopsy
Start PTU
What is postpartum thyroiditis most commonly associated with? (2020, 2021)
Diffusely enlarged thyroid
Thyroid nodule
Anti-TPO antibodies
Antithyroglobulin antibodies
Anti-TPO abs
What is postpartum thyroiditis most likely associated with? (2017, 2018)
T1DM
What is the least important lab to get in postpartum thyroiditis? (2011, 2012, 2018)
TSH
Free T4
Free T3
Antithyroglobulin
Thyroglobulin
TG
Postpartum thyroiditis is least associated with which of the following? (2007, 2009, 2018, 2023 NIH)
Anti-TPO
Hyperthyroidism
Hypothyroidism
Decrease rT3
Hyperthyroidism
Which laboratory test is least helpful in patients with postpartum thyroiditis? (2023 NIH)
TSH, T4
TPO, T3
TBG
TBG
What do you give a pregnant female with hyperthyroidism in the first trimester? (2018)
Methimazole
Propylthiouracil (PTU)
PTU
What is impact on thyroid hormone levels and TSH if a fetus is exposed to propylthiouracil (PTU)? (1999, 2003, 2007, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2018, 2023 NIH)
Decreased T4, increased TSH, clinically euthyroid at birth and quickly recover
Congenital hypothyroidism
Clinical hypothyroidism
Goiter
Hyperthyroidism
A pregnant woman is taking 100-200mg PTU, what is the effect on the fetus? (1999, 2011, 2012, 2018)
Decrease fetal TSH
Increase fetal TSH
Increase fetal T4
Increase fetal T3
Decreased T4, increased TSH, clinically euthyroid at birth and quickly recover
Increase fetal TSH
What makes the most antithyroid antibodies? (2007, 2023 NIH)
Thyroid peroxidase (TPO)
Thyroglobulin
Apical iodine transporter
rT3
TPO
Thyroid antibody is least likely to develop against which of the following? (2007, 2023 NIH)
Peroxidase
Microsomal
rT3
ALT
rT3
A 30yoF G1P0 wants to conceive immediately. What abnormality would you treat immediately with levothyroxine (Synthroid)? (2012, 2018)
Hyperprolactinemia
Free T4 in normal range
TPO (antimicrosomal antibodies)
Antithyroglobulin
TPO
What is the most common cause of hypothyroidism arising in the United States? (2003)
Autoimmune thyroiditis
Hyperemesis gravidarum
Autoimmune thyroiditis
Iodination of thyroglobulin occurs at which residue? (2003)
Serine
Leucine
Valine
Tyrosine
Tyrosine
A patient presents with fatigue, constipation, and pretibial edema. You suspect pituitary etiology. What is the best test to order? (2003)
TSH
Free T4
TSH
A patient has low TSH with symptoms of hyperthyroidism. What is the best diagnostic test? (2023 NIH)
T3
Radio-iodine uptake
Ultrasound (US)
Antimicrosomal antibody
T3
What is the next most appropriate test to diagnose a patient with an abnormal low TSH and T4? (2023 NIH)
TRH stimulation test
Free T3
ACTH stimulation test
Free T3
What is the next step in a patient with clinical signs of hypothyroidism and hypocarotenemia who is found to have normal thyroid testing? (2023 NIH)
TRH stim test
What is true of TBG (2023 NIH?)
Carries 95% of T4 & T3
Carries 75% of T4 and T3
Carries 75% of T4 and T3
What is true of TBG (2023 NIH?)
Lower affinity for T4 than T3
Higher affinity for T4 than T3
Higher affinity for T4 than T3
What is true of TBG (2023 NIH?)
Decreases in pregnancy
Increases in pregnancy
Increases in pregnancy
What are the 4th generation OCPs? (2018)
Drospirenone, dienogest, nomegestrol acetate
What is the mechanism of Factor V Leiden deficiency? (How does Factor V Leiden deficiency lead to increased clot formation?) (2019, 2020, 2022, 2023 NIH)
Activated protein C resistance
Activated protein C interaction with estrogen
Elevated prothrombin activity
Activated protein C resistance
What is the most potent progestin? (2001, 2003, 2005, 2010, 2011, 2012, 2013, 2014, 2018, 2021)
Levonorgestrel
Norethindrone
Norethindrone acetate
Medroxyprogesterone acetate (MPA)
Levonorgestrel
What is the most potent progesterone? (2001, 2003, 2005, 2007, 2023 NIH)
Gestodene
Levonorgestrel
Norethindrone
Norethindrone acetate
Medroxyprogesterone acetate (MPA)
Gestodene
What progesterone has the greatest progestational effect on endometrium? (Which of the following would have the most potent effect on endometrial progesterone receptors (PR)?) (2003, 2005, 2014, 2015, 2016, 2018)
Levonorgestrel
Norethindrone
Gestodene
Levonorgestrel
Which OCP theoretically leads to the lowest levels of circulating free androgens? (2021)
20ug ethinyl estradiol and norethindrone
30ug ethinyl estradiol and norethindrone acetate
50ug ethinyl estradiol and levonorgestrel
35ug ethinyl estradiol and some progestin
50ug ethinyl estradiol and levonorgestrel
What is the serum level of estradiol most likely associated with ethinyl estradiol use in OCPs? (2007, 2009, 2011, 2012, 2014, 2018, 2023 NIH)
20-40pg/ml
<30pg/ml
>40pg/ml
<30pg/ml
What is the most potent androgen (in a female)? (2009, 2011, 2014, 2017, 2018, 2021, 2023 NIH)
Testosterone
DHT
DHEA
19-nor testosterone
Androstenedione
DHEAS
DHT
What is the most potent androgen from the ovary? (2015)
Androstenedione
DHEA
DHEAS
Testosterone
Testosterone
*Potency (greatest > least): DHT>T>Androstendione>DHEAS
What is the most potent androgen CIRCULATING in females? (2013, 2018, 2023 NIH)
Testosterone
DHT
DHEA
19-nor testosterone
Androstenedione
DHEAS
Testosterone
What is the most androgenic progesterone (on primed endometrium)? (2012, 2013, 2014, 2015, 2017, 2018, 2019, 2023 NIH)
Levonorgestrel
Norethindrone
Desogestrel
Medroxyprogesterone acetate (MPA)
Etonogestrel
Levonorgestrel
What determines the efficacy of OCPs? (2005, 2007, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2018, 2023 NIH)
Estrogen dose
Progestin dose
Type of estrogen
Type of progestin
Estrogen:progesterone ratio
Progestin dose
*The progestational agent in the pill suppresses LH (prevents ovulation), while estrogenic agent suppresses FSH (prevents emergence of a dominant follicle). Even if follicular growth and development were not sufficiently inhibited, the progestational component would prevent the surge-like release of LH necessary for ovulation.
What progestin is like an estrane? (2009. 2014, 2015, 2018, 2023 NIH)
Levonorgestrel
Norgestimate
Ethynodiol diacetate
Norethindrone
Desogestrel
Ethynodiol diacetate
Norethindrone
Estranes: 1st generation progestins, C18 derivate of norethindrone
* Norethindrone (Ovcon, Ortho Novum, Micronor)
* Norethindrone acetate (Loestrin)
* Ethynodiol diacetate (Kelnor)
Gonanes: 2nd generation progestins, C17 derivatives, biologically more potent
* Levonorgestrel (Tri Levlen, Seasonale, Plan B, Mirena)
* Norgestrel (Ovral)
- 3rd generation progestins (lower androgenicity than LNG and estranes)
- Gestodene
- Desogestrel (Kariva)
- Norgestimate (Ortho Cyclen)
- Etenogestrel (metabolite of desogestrel, Implanon, NuvaRing)
The latest progestin to be developed is drosperinone. Drosperinone: progestin analogue of spironolactone with high affinity for the mineralocorticoid receptor and anti-androgenic activity.
Pregnane family: C21 derivatives of 17α-acetoxyprogesterone
* MPA: structurally most closely related to progesterone instead of testosterone, LESS androgenic activity, rapidly metabolized to progesterone
All Synthetic Estrogens & Progestins have an ethinyl group at position C17→ enhances the oral activity
What 19-nortestosterone is known as estrane? (2023 NIH)
Ethynodiol diacetate
Levonorgestrel
Destrogen
Desogestrel
Norgestimate
Ethynodiol diacetate
Which progesterone is a gonane? (2007, 2009, 2015)
Levonorgestrel
Norethindrone
Ethynodiol diacetate
Norethisterone
Levonorgestrel
Desogestrel and norgestimate are related to which progesterone? (2007, 2009, 2011, 2012, 2018, 2023 NIH)
Medroxyprogesterone acetate (MPA)
Levonorgestrel
Drospirenone
Dienogest
Nomegestrol acetate
Levonorgestrel
Which of the following is levonorgestrel most closely related to? (2011)
Norethindrone
Norgestimate
Norgestrel
Gestodene
Norgestrel
Which of the following could act at the same receptor as desogestrel? (2007)
Levonorgestrel
Others
Levonorgestrel
What is the main mechanism of decreased androgenicity in gestodene and desogestrel? (2018)
Increased SHBG leading to decreased free testosterone
Which of the following is gestodene most similar to? (2003, 2023 NIH)
Norethisterone
Levonorgestrel
Levonorgestrel
What is an absolute contraindication to OCP use? (2018)
Unexplained vaginal bleeding
1 ppd smoker
Obesity
1 ppd smoker if > 35 years old
Other absolute contraindications:
- Liver disease
- VTE, stroke, ischemic heart disease
- pregnancy
- complicated valvular heart disease
- migraines with aura
What is the best choice for contraception in a woman with lupus? (2018)
Systemic progesterone
OCPs
Levonorgestrel IUD (Mirena)
Mirena IUD
What drug is most likely to interfere with OCPs and decrease efficacy? (2001, 2009, 2011, 2012, 2014, 2015, 2018)
Rifampin
Tetracycline
Ampicillin
Captopril
Rifampin
What is the best test for ovarian reserve testing in a woman on OCPs? (2023 NIH)
Day 3 FSH/LH
AMH
AFC
What is the best marker of ovarian reserve to measure on someone on OCPs? (2017)
AFC
FSH
AMH
Inhibin
AMH
What is the effect of decreasing the pill-free interval from 7d to 4d? (2015, 2016, 2017)
Increased GnRH suppression
Decrease breakthrough bleeding
Increased efficacy
Decrease breakthrough bleeding
What is the expected serum estradiol level in a patient using estrogen vaginal ring contraception? (2009)
<30pg/mL
30-60pg/mL
60-120pg/mL
>120pg/mL
<30pg/mL
What is the vaginal ring most likely to decrease? (2007, 2023 NIH)
SHBG
Triglycerides
Total cholesterol
HDL
HDL
What is most likely to be elevated with vaginal combined contraception use? (2009)
SHBG
17-beta-estradiol
LDL
HDL
Other
SHBG
What are “new” progestins (third generation)? (2018)
Desogestrel
Gestodene
Norgestimate
All are 3rd gen
Drospirenone is most like what medication? (2015, 2023 NIH)
Spironolactone
Why does transvaginal contraception not need a conductance layer? (2011, 2012)
Less adipose
More areolar tissue
No keratinocytes
No keratinocytes
Which of the following has the most potent antiproliferative effect on an estrogen primed endometrium? (1999)
Norethindrone
Norgestrel
Levonorgestrel
Medroxyprogesterone acetate (MPA)
Desogestrel
Levonorgestrel
What hormone is present in the greatest quantity in conjugated equine estrogens (CEE) (Premarin)? (1999)
Estrone sulfate
Equilin
Estriol
Estrone sulfate
A woman has been taking OCPs for 5yrs and she now wishes to conceive. She asks if it’s okay to try to conceive immediately upon discontinuing the pills. You advise her which of the following? (2003, 2010)
Immediate conception will lead to a greater chance of congenital anomalies
It is harder to calculate gestational age if conception occurs before the second menses off the pills
It is harder to calculate gestational age if conception occurs before the second menses off the pills
A healthy 25yoF develops a pulmonary embolism while on OCPs. She will be most likely found to have what on evaluation? (2003, 2010)
Lupus anticoagulant
Antithrombin III deficiency
Protein C deficiency
Protein S deficiency
Factor V Leiden mutation
Factor V Leiden mutation
When administered in the follicular phase, mifepristone (RU-486) is most likely to do which of the following? (2003)
Induce menstrual changes in the endometrium
What induces LH receptors on granulosa cells just before ovulation? (2014, 2016, 2022, 2023 NIH)
Progesterone
Estrogen
LH
Activin
Inhibin A
Estrogen
What is the strongest contraindication to OCP use in a 40yoF? (2007)
Diabetes
Migraines
Controlled hypertension
Mother with breast cancer
Lupus
Controlled HTN
Which form of estrone is found in the highest circulating levels? (2023 NIH)
Estrone
Estrone sulfate
16-alpha-hydroxyestrone
Estrone sulfate
What is a pregnancy with copper IUD (ParaGard) most likely to result in? (2021, 2022)
Previa
Preeclampsia
GDM
Previa
What is least likely to happen with a levonorgestrel IUD (Mirena)? (2007, 2013, 2014)
Amenorrhea 3mo after removal
Ovulation
Amenorrhea 3 mo after removal
What is most likely to happen with a levonorgestrel IUD (Mirena)? (2007, 2011, 2014, 2015, 2023 NIH)
Amenorrhea 3mo after removal
Ovulation
Abnormal bleeding
Ovulation
What is the best emergency contraception 5 days after unprotected intercourse? (2003, 2007, 2011, 2012, 2013, 2014, 2015, 2016, 2018, 2023 NIH)
Yuzpe method
High dose levonorgestrel
Mifepristone
IUD
IUD
What is true about IUDs? (2014, 2015)
Do not cause PID
Contraindicated in HIV
Increases absolute rate of ectopic pregnancy
Do not cause PID
What is least true about the levonorgestrel IUD (Mirena)? (2012, 2015)
Effect limited to the uterus
Decrease ovarian cysts
Improved dysmenorrhea
Decrease ovarian cysts
What is the levonorgestrel IUD (Mirena) least useful for? (2014)
Dysmenorrhea
Menorrhagia
Reducing endometrial cancer risk
Dysmenorrhea
What form of contraception has the lowest failure rate with typical use? (2011, 2023 NIH)
Subdermal implant
IUD
OCPs
Condoms
Subdermal implant
What is the least likely time in the menstrual cycle for a single act of intercourse to result in pregnancy? (2014, 2015)
2 days before ovulation
4 days before ovulation
1 day after ovulation
1 day after ovulation
What is the most likely time in the menstrual cycle for a single act of intercourse to result in pregnancy? (2007, 2015, 2023 NIH)
At ovulation
2 days before ovulation
2 days after ovulation
4 days after ovulation
1 day before ovulation
1 day after ovulation
1 day before ovulation
What is the most common abnormality found in a normal fertile couple? (2005, 2007, 2011, 2012, 2018, 2023 NIH)
Abnormal semen analysis
Out of phase endometrial biopsy Antisperm antibodies
FSH
Ultrasound (US)
Glucose tolerance
Abnormal SA
What is the most likely reason for bilateral hydronephrosis in a woman from India? (2019)
Chlamydia
Gonorrhea
Tuberculosis
TB
What percentage of women with chlamydia are asymptomatic? (2015)
10%
50-60%
70-80%
>90%
70-80%
What doesn’t change AMH? (2023 NIH)
PCOS
3rd trimester of pregnancy
Ovulation
Hypothalamic amenorrhea
Hypothalamic amenorrhea
What is the best initial screening test for intracavitary abnormality in infertility evaluation? (2023 NIH)
HSG
SIS
Ultrasound (US)
SIS
A patient is undergoing vasectomy reversal and there is no sperm present in the vas remnant aspiration. What is the next best step? (2021, 2022)
Vaso-vasotomy
Vasoepididymostomy
MESA
microTESE
Vasoepididymostomy
What is the most important factor of vasectomy and reversal when predicting successful pregnancy? (2007, 2009, 2011, 2018, 2023 NIH)
Type of reversal
Time since vasectomy
Antisperm antibodies
Age of patient
Previous fertility
Length of vas
Time since vasectomy
A male is found to have CBAVD with a normal cystic fibrosis screen. What do you do next? (2012, 2013, 2014, 2015, 2017, 2018, 2019, 2020, 2022, 2023 NIH)
(Expanded carrier) screen the partner for cystic fibrosis
YCMD testing
Karyotype analysis
Biopsy
Expanded testing of the patient
No further testing is needed
(Expanded carrier) screen the partner for cystic fibrosis
Male patient presents with CBAVD, what is the best next step of workup on him? (2021)
CFTR gene sequencing
Expanded CF carrier sequencing panel
mTESE
CFTR gene sequencing
When do primary spermatocytes appear (begin differentiation)? (2018, 2019, 2021, 2023 NIH)
8wk gestation
20wk gestation
At birth
Adrenarche
Puberty
Puberty
What is the most common/likely cause of azoospermia? (2005, 2007, 2009)
Cystic fibrosis carrier
47,XXY
47,XYY
47,XXY
What male genetic diseases with azoospermia has the highest incidence? (2023 NIH)
Kallman syndrome
AZYa and AZYb
AZYc
Klinefelter syndrome
Klinefelter
Male presents with non-obstructive azoospermia (NOA), what is the best surgical procedure? (2021)
MESA
PESA
mTESE
mTESE
What is more likely to be associated with abnormal male karyotype? (2011, 2013, 2014, 2017, 2018)
Oligospermia
0% morphology
Teratospermia
CBAVD
Low motility
Y chromosome micro-deletion (YCM)
Oligospermia
What is more likely to be associated with abnormal male karyotype? (2011, 2012, 2023 NIH)
1% normal morphology
4 million sperm/mL
CBAVD
Low motility
4 million sperm/mL
Which is most likely to be associated with chromosomal abnormality in a male? (2014, 2015)
0% normal forms (strict)
Morphology 4% or less
10% motile
What is the most likely semen analysis defect associated with abnormal karyotype in man? (2014, 2018)
Oligospermia
What is the most likely genetic defect in a male with azoospermia, low testosterone, high LH, and high FSH? (2014, 2015)
XX+XY
Yp11
Yq11
Yp15
SRY
Yq11 - AZF microdeletion
What is the most common karyotype in a man with azoospermia and elevated FSH? (2009, 2012, 2018, 2023 NIH)
AZFa or AZFb
47,XXY
AZFc
46,XY DSD
47,XXY
What karyotype is most likely in azoospermia? (2012)
46,XY
46,XY, del(Yq11)
46,XY, del(Yq11)
*AZF microdeletion
Which finding is associated with azoospermia? (2012, 2013, 2014, 2017, 2018)
AZFa and AZFb
AZFc
AZFa and AZFb
A man presents with azoospermia. What gene deletion is he most likely to have? (2013, 2018)
AZFa or AZFb
DAX
FOXL2
AZFc
AZFa or AZFb
What is an inactivating FSH receptor mutation most likely associated with? (2023 NIH)
Male hypogonadism
Normal sperm parameters
Normal female fertility
Male hypogonadism
What is the effect of antisperm antibodies? (2013, 2018)
Sperm agglutination and infertility
Sperm agglutination and infertility
What is the most likely diagnosis for a male with azoospermia, normal size testes, palpable vas, and FSH 5mIU/mL? (2019, 2021)
CBAVD
47,XXY
AZFa
Ejaculatory duct obstruction
Exogenous steroids
Gonadal failure
Testicular cancer
Ejaculatory duct obstruction
What is least likely in a 47,XXY male? (2005, 2007, 2018, 2023 NIH)
Cryptorchid testis
Hypergonadotrophic hypogonadism
Infertility
Oligospermia
Small testes
Delayed puberty*** per 2007, 2009, 2018, 2023 NIH
Delayed puberty
An infertile couple presents. The male has isolated teratospermia and female with normal workup. What is the best recommendation for treatment? (2021)
Expectant management
Ovulation induction with IUI
Ovarian stimulation with conventional insemination
Ovarian stimulation with ICSI
Ovulation induction with IUI
What is the most likely semen analysis defect with an abnormal male karyotype? (2023 NIH)
Abnormal morphology
Abnormal motility
Abnormal number
Abnormal number
Which chromosome is the regulator of all androgen activity? (2023 NIH)
X
Y
11
13
18
X
What most increases free testosterone? (2023 NIH)
SHBG
Total testosterone
SHBG
What hormone change do you see in conjunction with decreased total testosterone in an aging man? (2018, 2023 NIH)
Increased free testosterone
Increased DHEAS
Decreased LH
Increased SHBG
Increased SHBG
What is the most important determinant of testosterone production as men age? (2014)
Age
SHBG
Albumin
CBG
Age
How do you obtain sperm from a man with a spinal cord injury? (2013, 2017, 2023 NIH)
MESA
TESA
Electroejaculation
Electroejaculation
What is the most likely finding in a male with atrophic testes and hypergonadism? (2014, 2018)
Klinefelter syndrome
Klinefelter syndrome
What is least likely in Klinefelter syndrome? (2007)
Cryptorchidism
Small testes
Low testosterone
Pubertal delay
Pubertal delay
A man with Klinefelter syndrome undergoes testicular biopsy to obtain sperm for ICSI with his partner. What is the most likely karyotype of a resulting fetus? (2007)
Normal
47,XXY
47,XYY
46,XY
XY mosaic
Normal
A patient is found to have a testicular volume of 5mL. What is the most likely deletion? (2023 NIH)
Y
X
X
What is the most likely karyotype of a man with 5cc testicles, elevated LH, elevated FSH, and testosterone 150ng/dL? (2011, 2018, 2022)
A. 46,XX
B. 46,XY; del Yp
C. 46,XY; del Yq
D. 46,XY; del 15
C. 46,XY; del Yq
A male is found to have a testosterone 117ng/dL, LH 3mIU/mL, FSH 4mIU/mL, azoospermia, and atrophied testes. What is the most likely etiology? (2014)
Microdeletion of Y chromosome
CBAVD
Fragile X
Kallmann Syndrome
Kallmann Syndrome
What causes CGG repeat (alpha subunit) deficiency? (2014, 2018)
Fragile X
What disorder is most associated with adult onset disease in males? (2012, 2014, 2015, 2018)
Sulfatase deficiency
Aromatase deficiency
Klinefelter syndrome
Fragile X
Fragile X
A woman has a son who is affected by Fragile X. What will her father most likely experience as late onset disease? (2012, 2018)
Ataxia
What is the most common mutation in men with CBAVD? (2017)
Point mutation
What is the mechanism of action of sildenafil (Viagra)? (2015, 2016)
NO synthase inhibitor
Phosphodiesterase inhibitor
Phosphodiesterase inhibitor
What side effect is sildenafil (Viagra) least likely to have? (2023 NIH)
Ptosis
Priapism
Colored vision (blue vision, cyanopsia)
Dyspepsia
Ptosis
What other medication should men not take if they are using a phosphodiesterase inhibitor? (2017)
Nitroglycerin
SSRI
ASA
Nitroglycerin
What is the chance of CBAVD in offspring of a delta F508 carrier father and 5T allele carrier mother? (2007, 2009, 2010, 2011, 2018)
100%
50%
25%
Depends on other factors
25%
How do you counsel a couple about risks to offspring when the father is a delta F508 carrier and the mother is a 5T allele carrier? (2007, 2023 NIH)
They are not at increased risk for having a child with CF, but if they have a male, he is at increased risk of CBAVD
A male patient with Kallman syndrome wants children. How do you induce spermatogenesis? (2012, 2015)
hCG followed by HMG
A couple presents with a delta F508 heterozygous/carrier father and 5T allele heterozygous/carrier mother. How do you counsel them regarding male offspring? (2007)
100% chance of CBAVD
25% chance of CBAVD
100% chance of classic cystic fibrosis and CBAVD
If the male child has cystic fibrosis, 10% chance of CBAVD
If the male child has cystic fibrosis, 100% chance of CBAVD
If the male inherits 5T and delta F508 on same chromosome, then will have classic cystic fibrosis (pancreatic involvement/respiratory involvement)
25% chance of classic cystic fibrosis
25% chance of CBAVD
What initiates spermatogenesis in a male with hypogonadotropic hypogonadism (hypo-hypo)? (2023 NIH)
FSH
hCG
Clomiphene citrate (Clomid)
LH
hCG
What mutation is found in a late onset hereditary condition in males with this disorder? (2014, 2015, 2023 NIH)
FMR1
KAL1
KCNQ1
FMR1
What is least likely to decrease in a man as he ages? (2011, 2012)
Insulin
Growth hormone
DHEAS
Androstenedione
Insulin
Which mutation has a risk to male relatives later in life? (2011)
Angelman
Beckwith-Wiedemann
Kallman
Fragile X
Fragile X
Semen volume is least affected by which of the following? (2011)
Hypogonadotropic hypogonadism (hypo-hypo)
Obstruction
CBAVD
Vasectomy
Vasectomy
What is the most likely cause of erectile dysfunction if a man still achieves morning erections? (2007)
Depression
Diabetes
Spinal cord injury
Vascular disease
Psychogenic
Psychogenic
An initial screening of the male partner of an infertile couple is indicated for which of the following? (2022)
If the man questions his reproductive potential
After 1yr of contemplating having children
After 1yr if his partner is >35yo
After 1yr if the couple is using birth control
If the man questions his reproductive potential
What is true regarding the evaluation for retrograde ejaculation? (2022)
Is necessary if the man has CBAVD
Should be performed in men with azoospermia due to hypogonadism
Is indicated for all men with ejaculate volume <1mL
Consists of microscopic evaluation of centrifuged pellet of a post-ejaculate urine sample
Consists of microscopic evaluation of centrifuged pellet of a post-ejaculate urine sample***
What is true regarding ultrasonography (US) of the male genital tract? (2022)
Can detect prostate cancer
Is performed as a part of the initial male evaluation for infertility
Can show if spermatogenesis is occurring within the testicle
Is indicated for men with azoospermia, normal vasa, and low volume ejaculate
Is never indicated in the evaluation of male infertility
Is indicated for men with azoospermia, normal vasa, and low volume ejaculate
What is included in a thorough male infertility evaluation? (2022)
A physical exam by a specialist in male reproduction
Three semen analyses
Mandatory genetic testing
Scrotal ultrasound (US)
A physical exam by a specialist in male reproduction
Men with azoospermia or severe oligospermia should have which of the following? (2022)
CFTR gene testing
Genetic counseling
A karyotype and Y chromosome microdeletion testing before IVF
Intact AZFc region
A karyotype and Y chromosome microdeletion testing before IVF
When is sperm viability testing indicated? (2022)
Count <10million/mL
Most sperm are immotile
There are an increased number of round cells
Most sperm have abnormal morphology
There is excess sperm DNA fragmentation
Most sperm are immotile
What semen analysis value is most likely to be associated with a chromosomal abnormality in male?
(2023 NIH)
Total motile sperm 1 million sperm/mL
Morphology 0% normal
Total motile sperm 1 million sperm/mL
What is true regarding antisperm antibody testing? (2022)
Should be performed in men with azoospermia
Is best performed on serum
May be indicated in a man with a history of orchitis
Involves mixing the patient’s serum with his sperm
May be indicated in a man with a history of orchitis
Patient instructions for semen analysis should include which of the following? (2022)
Cooling to room temperature after collection
Collection in a standard latex condom
Abstinence for no more than 24hr
Analysis within 1hr after collection
Analysis within 1hr after collection
A 35yoM presents with azoospermia, a history of delayed puberty, sparse facial hair, erectile dysfunction, and small testes. Which test is most likely to reveal the cause of his infertility? (2022)
Antisperm antibody testing
Hormonal evaluation
CFTR genetic testing
Scrotal ultrasound (US)
Quantification of leukocytes in the semen
Hormonal evaluation
Which is true of sperm DNA fragmentation testing? (2022)
Can measure the number of breaks in sperm DNA that can’t be repaired
Is indicated in the routine evaluation of all men with infertility
Tests for sperm damage due to improper lab storage
Is indicated in men with azoospermia
Can measure the number of breaks in sperm DNA that can’t be repaired
Which is the most common sex chromosome disorder in men? (2022)
Kallmann syndrome
Myotonic dystrophy
Kartagener syndrome
Klinefelter syndrome
Noonan syndrome
Klinefelter syndrome
Most men with CBAVD have which of the following? (2022)
Hypogonadism
CFTR gene mutations
Low testosterone levels
Decreased sperm production
Small testes
CFTR gene mutations
Which of the following is a manifestation of Kallmann syndrome in men? (2022)
Increased FSH production
Azoospermia
Testicular dysgenesis
Normal spermatogenesis
Absent epididymis
Azoospermia
Sertoli cell-only syndrome is manifested by which of the following? (2022)
Germ cell hyperplasia
Only occurs as a congenital disorder
Absence of germ cells
Presence of Sertoli cells outside of the seminiferous tubules
Lack of ability to smell
Absence of germ cells
What is the best next treatment for a couple trying to conceive when the male partner is 15yr post vasectomy? (2005, 2009, 2010, 2011, 2014, 2018, 2023 NIH)
Vasectomy reversal
TESE
Vaso-vasotomy
MESA with ICSI
Percutaneous epididymal sperm extraction (PESA) and ICSI
Donor sperm
MESA with ICSI
Which of the following is true regarding antisperm antibodies? (2022)
Are due to varicoceles
Result in hormone deficiencies
May result from testicular surgery
Cause FSH deficiency
Cause disruption of the blood-testis barrier
May result from testicular surgery
Patients with Y chromosome microdeletions have which of the following? (2022)
An abnormality in the long arm of the Y chromosome
Are always azoospermic
Experience delayed puberty
Mental retardation
An abnormality in the long arm of the Y chromosome
What is most true of patients with cryptorchidism? (2022)
Always have abnormal semen parameters
Are more likely infertile if both testicles are undescended
If full term, always have an identifiable cause of the condition
Usually have elevated LH levels
Have absent vas deferens
Are more likely infertile if both testicles are undescended
Which of the following is usually a congenital cause of male infertility? (2022)
Anejaculation
Pituitary tumors
Erectile dysfunction
AIS
AIS
A 32yoM with infertility is found to have azoospermia with a normal FSH. What is the most likely cause? (2022)
CBAVD
Kallmann syndrome
Klinefelter syndrome
Myotonic muscular dystrophy
Hypospermatogenesis
CBAVD
Which of the following is true of varicoceles? (2022)
Always bilateral
Most common correctable cause of male infertility
Due to dilated veins in the pelvic plexus
Present in 25% of all men
Usually right sided
Most common correctable cause of male infertility
What does the male reproductive tract develop from embryologically? (2022)
Mullerian ducts
Seminiferous tubules
Wolffian ducts
Corpus cavernosum
Wolffian ducts
Which testicular cells produce testosterone? (2022)
Seminiferous tubules
Epididymis
Seminal vesicles
Rete testis
Seminiferous tubules
What is the part of the sperm maturation process in which the round spermatids are engulfed by Sertoli cells and transformed into elongated spermatozoa with tails? (2022)
Spermatogenesis
Spermiogenesis
Spermiation
Mitosis
Spermiogenesis
Which hormone regulates testosterone synthesis? (2022)
FSH
LH
GnRH
Inhibin
LH
Sertoli cells perform which function? (2022)
Regulate testicular blood flow
Provide blood-testis barrier
Synthesize testosterone
Fluid absorption
Provide blood-testis barrier
What is the predominant regulator of penile erection? (2022)
Blood flow
Testosterone
Vas deferens
cAMP
Hypogastric nerve
Blood flow
What accessory sex gland aids in semen liquefaction? (2022)
Seminal vesicle
Prostate gland
Bulbourethral gland
Epididymis
Prostate gland
What is the site of sperm maturation, concentration, and storage? (2022)
Epididymis
Vas deferens
Seminiferous tubules
Seminal vesicle
Epididymis
Which sperm structure provides enzymes for penetrating the oocyte? (2022)
Midpiece mitochondria
Acrosome
Cytoplasmic droplet
Centrioles
Acrosome
What percent of couples with infertility have a male factor component? (2022)
10%
25%
33%
50%
75%
50%
What is the proposed mechanism for varicoceles being associated with male infertility? (2022)
Reflex of toxic metabolites to the testes from the renal vein
Disruption of the countercurrent heat exchange of the testes preventing cooling
Stagnation of the blood in the testes, leading to the build up of toxic waste
Hypoxia of the testes due to decreased blood flow
Disruption of the countercurrent heat exchange of the testes preventing cooling
What is the average length of time to improvement following varicocele repair and why? (2022)
2wk due to post-operative swelling
2mo due to transient decrease in testis function
3mo due to the length of the spermatogenic cycle
4mo due to the time required for full healing
6mo due to the length of the spermatogenic cycle
3mo due to the length of the spermatogenic cycle
Which of the following is the best predictor of success for vasectomy reversal? (2022)
More than 10yr since vasectomy
Female partner age <35yr
Method of vasectomy
Shorter testicular vasal remnant
Female partner age <35yr
A couple presents to discuss fertility options after a vasectomy. The vasectomy was performed 8yr ago. Prior to this, the patient had conceived two children with his previous wife. He is now remarried to a 32yoF who has never been pregnant. Which of the following would preclude the performance of a vasectomy reversal? (2022)
Female partner with irregular cycles, felt to have PCOS
Patient had a post-operative infection
The couple only wants one child
Female partner had a previous tubal ligation
None of the above are contraindications for vasectomy reversal
Female partner had a previous tubal ligation
Which of the following statements regarding men with non-obstructive azoospermia (NOA) is true? (2022)
Sperm may be obtained from the testes, even if a previous biopsy does not show mature sperm
A markedly elevated FSH means that no sperm will be retrieved
Percutaneous epididymal sperm aspiration (PESA) is a highly successful procedure in this patient population
If sperm are obtained, they typically will not fertilize an egg, even with ICSI
Sperm may be obtained from the testes, even if a previous biopsy does not show mature sperm
A 28yoM comes in for evaluation for male factor infertility. His history and physical exam are normal. His semen analysis demonstrates oligospermia and his hormonal parameters are all normal except for a mildly decreased testosterone level. Which one of the following treatment options is the most reasonable? (2022)
Testosterone replacement therapy with either injectable or topical testosterone preparation
Scrotal ultrasound (US) to identify subclinical varicoceles with subsequent varicocele repair
Injection of hMG or other FSH-like medication
Scrotal exploration to identify subclinical obstruction
Clomiphene citrate (Clomid) administration to increase endogenous testosterone production
Clomiphene citrate (Clomid) administration to increase endogenous testosterone production
Which one of the following patients is most likely to respond to hCG/hMG injection? (2022)
25yoM with Kallmann syndrome
28yoM with large grade 3 varicocele and normal hormones
35yoM currently with substance abuse including marijuana and cocaine use on a daily basis
30yoM who is morbidly obese with metabolic syndrome
25 yo M with Kallmann syndrome
Which one of the following describes a significant mechanism of injury to a male’s fertility secondary to testicular cancer? (2022)
Cancer decreases sexual desire which leads to decreased fertility
Loss of 10% of testicular tissue due to orchiectomy
Damage due to adjuvant treatments (chemotherapy or radiation)
Damage to the autonomic nerve trunk during lymph node dissection
Changes in sperm DNA
Damage due to adjuvant treatments (chemotherapy or radiation)
A 22yo single male presents with 3wk of painless left testicular swelling. An ultrasound (US) demonstrates a solid mass suspicious for testicular neoplasm. What is the most appropriate next step? (2022)
Sperm banking
Testosterone injection
Antibiotics for 2-3wk
Percutaneous scrotal biopsy of mass
Reassurance
Sperm banking
Cystic fibrosis is commonly associated with which of the following? (1999)
CBAVD
Testicular atrophy
Oligospermia
CBAVD
Which of the following is an indication for testicular biopsy? (1999)
Azoospermia with absence of fructose in semen
Oligospermia with FSH 2mIU/mL
Oligospermia with prolactin 110ng/mL
Azoospermia with FSH 7.5mIU/mL
Azoospermia with FSH 7.5mIU/mL
An alcoholic man presents with gynecomastia. What is the cause of his gynecomastia? (2007, 2023 NIH)
Decrease free estradiol/free testosterone production
Decrease SHBG production
Increase binding of estradiol to SHBG
Increase liver conjugation of estradiol to estrone glucuronide
Decrease in renal clearance of estradiol
An alcoholic man presents with gynecomastia? What is the cause of his gynecomastia? (2007, 2023 NIH)
Low testosterone
High testosterone
Low SHBG
High SHBG
Low estrogen
Decrease SHBG production
ICSI is most likely to be successful with what mutation? (2017, 2020, 2022, 2023 NIH)
AZFa
AZFb
AZFc
CFTR
47,XXY
SRY
AZFc or CFTR
What mutation can’t be treated by ICSI? (2012, 2018)
AZFa/AZFb
AZFc
CFTR
47,XXY
SRY
AZFa/AZFb
Which is least likely to cause decreased libido in older men? (2003)
Decreased testosterone
Increased incidence of chronic diseases
Others
Others
Which of the following is the least useful test for oligospermia? (2003)
LH
Testosterone
Testicular biopsy
Prolactin
Seminal fructose
seminal fructose
Which of the following is the best way to differentiate CBAVD from spermatogenic arrest? (2003)
LH
Karyotype
Inhibin
Seminal fructose
Post-ejaculatory examination of the urine
How do you differentiate between germ cell arrest and cystic fibrosis? (2005, 2010, 2023 NIH)
Seminal fructose
What is Klinefelter syndrome least characterized by? (2003)
Small testes
Low testosterone
Low estrogen
Others
Low estrogen
What is an activating LH receptor mutation most likely associated with? (2023 NIH)
Precocious puberty
Decreased FSH
Azoospermia
Precocious puberty
What initiates spermatogenesis? (2005, 2023 NIH)
Testosterone and FSH
Testosterone and LH
Testosterone
Testosterone and LH
What is the risk of a karyotype abnormality in a fetus conceived by ICSI whose father has severe oligospermia? (2003, 2005, 2014, 2023 NIH)
10-11%
6-7%
2-4%
6-7%
Vasodilatory treatment helps erectile dysfunction except in which of the following? (2005, 2023 NIH)
Spinal cord injury
Peripheral neuropathy
Peripheral vasculopathy
Psychologic
Peripheral vasculopathy
A man presents with normal testicular volume, normal FSH, palpable vas deferens, and azoospermia. What is the most likely cause? (2023 NIH)
Idiopathic, normal karyotype
How do you treat persistent teratospermia? (2023 NIH)
DNA fragmentation analysis
Controlled ovarian hyperstimulation with IUI
Repeat semen analysis
Clomiphene citrate (Clomid)
ICSI
DNA fragmentation analysis
What is the primary feedback on the hypothalamus with regards to testicular androgens? (2023 NIH)
Testosterone
Estradiol
DHT
Inhibin A
Testosterone
25yo w/ azoospermia T1200ng, FSH and LH undetectable, PRL and TSH normal. Most common cause? (2019)
Testosterone-secreting tumor
Cannabis use
Steroid abuse
Smoking
Steroid abuse
What is an absolute contraindication to initiation of testosterone therapy in a hypogonadal male? (2021, 2023 NIH)
PSA 2.5ng/mL
Hct 45%
Breast cancer
Obesity
CHF Class 1
Breast cancer
What is absolutely contraindicated for men with breast cancer? (2018)
Testosterone therapy
What is the next step for a patient with unexplained infertility after three unsuccessful clomiphene citrate (Clomid)/IUI cycles? (2021)
Continue clomiphene citrate (Clomid)/IUI
Letrozole/IUI
Gonadotropins/IUI
IVF
IVF
How does tamoxifen work as an ovulation induction agent? (2021)
At the adipocyte level
Interrupting HPO axis feedback
Interrupting HPO axis feedback
What is the mechanism of action of clomiphene citrate (Clomid) in anovulatory women? (2021)
Increasing GnRH pulse amplitude
Increasing GnRH pulse frequency
Decreasing GnRH pulse amplitude
Decreasing GnRH pulse frequency
Increasing GnRH pulse amplitude
*increases pulse frequency in already ovulatory women
What is the mechanism of action of clomiphene citrate (Clomid)? (2015)
Increased estrogen synthesis in the ovary
Decreased GnRH pulse amplitude
Increased GnRH pulse frequency
Increased LH pulse amplitude
Increased GnRH pulse frequency
*increases amplitude in anovulatory women
Aromatase inhibitors lead to ovulation by what mechanism? (2021)
Inhibition of negative feedback on the HPO axis
Decreased aromatization at the level of the adipocytes (this is true but I find it hard to believe it leads to ovulation mostly from action at fat cells)
Inhibition of the estrogen receptor (ER) at the level of the hypothalamus
Inhibition of the estrogen receptor (ER) at the level of the pituitary
Inhibition of negative feedback on the HPO axis
What is the first step for ovulation induction in a patient with PCOS, BMI 40kg/m2, and oligomenorrhea? (2020)
Weight loss
Gonadotropins
Ovarian drilling
Weight loss
What is the difference between follitropin alpha and beta? (2019)
Follitropin beta is more potent
An infertile male is found to have a moderate varicocele. What is true? (2023 NIH)
Improved fertility with correction
Venous reflux leads to testicular dysfunction
Uncommon finding
Unilateral varicocele is super common
Oligospermia then that is enough of an indication to correct surgically
Oligospermia then that is enough of an indication to correct surgically
A 32yoF with 1yr of infertility, normal semen analysis, and mild endometriosis. What is the next step? (2014, 2018)
SOH/IUI
Clomiphene citrate (Clomid)/IUI
Repeat l/s
Clomiphene citrate (Clomid)/IUI
What is the best treatment to induce ovulation in PCOS with a normal BMI? (2009, 2010, 2018, 2023 NIH)
Metformin
Clomiphene citrate (Clomid) and metformin
Clomiphene citrate (Clomid)
Letrozole
Letrozole
A 24yoF with anovulation (or oligo-ovulation) and a BMI 25kg/m2 presents for infertility. Her workup is negative. What medication would you use for ovulation induction? (2016)
Clomiphene citrate (Clomid)
Letrozole
Gonadotropins
No medications
Clomiphene citrate (Clomid)
What is the most cost effective for ovulation induction and IUI in unexplained infertility? (2007)
IUI x2
IUI x1
ICI with IUI
ICI x2
IUI x 1
Which of the following accounts for clomiphene citrate’s (Clomid) less than expected rate of pregnancy per ovulation? (1999)
Decreased endometrial receptivity
Others
Decreased endometrial receptivity
What is the conception rate of a patient with idiopathic anovulation treated with clomiphene citrate (Clomid)? (2005, 2023 NIH)
15%
45-50%
Others
15%
A 30yoF with a religious objection to IVF is found to have phimosis on laparoscopy. What treatment will provide the best chance of pregnancy? (2012, 2018)
GIFT
Salpingectomy
Tubal cannulation
Fimbrioplasty
GIFT
How many oocytes do you implant in GIFT? (2022)
One in each tube
Two in each tube
One in one tube, one in the other tube
One in one tube, one in the other tube
What is the highest risk factor for OHSS? (2018, 2020, 2022)
PCOS
AMH >3ng/mL
AFC 18
BMI 40kg/m2
PCOS
What is most predictive of OHSS? (2009)
Day 3 FSH
AFC
Day 3 E2
Day 3 Inhibin
Other
AFC
What medications may be necessary in OHSS? (2018)
IV hydration (normal saline, possibly albumin)
Anticoagulation
Both may be necessary
What is the most likely cause of OHSS? (2023 NIH)
hCG excess
High peak E2
VEGF
VEGF
What procedures may be necessary in OHSS? (2018)
Paracentesis
Thoracocentesis
Paracentesis
What electrolyte abnormality is most commonly seen in OHSS? (1999, 2003, 2011, 2012, 2013, 2014, 2018, 2022, 2023 NIH)
Hyponatremia
Hypernatremia
Hyperkalemia
Hypokalemia
Hypocalcemia
Hyponatremia
What is ICSI most indicated for? (2010, 2011, 2018, 2019, 2021, 2023 NIH)
Unexplained infertility with prior failed IVF
PGT-A
PGT-M
Elevated sperm DNA fragmentation
AMA (Maternal age of 40yo)
Strict morphology <4%
Low oocyte number
PGT-M
Which of the following is not an indication for ICSI? (2018, 2023 NIH)
Morphology <4%
Prior failed IVF
Maternal age >40yo
<4 oocytes
Maternal age >40yo
What is the most important reason to do ICSI? (2011, 2023 NIH)
PGT-A
PGT-M
Low morphology
Unexplained infertility
PGT-M
What is an indication for ICSI? (2015, 2016, 2018, 2023 NIH)
Low oocyte yield
Unexplained infertility with failed IVF previously
PGT-A
PGT-M for cystic fibrosis
PGT-M for cystic fibrosis
What is least likely to matter to do ICSI? (2007, 2023 NIH)
Morphology <4%
PGT-M
Oligospermia
Oligospermia
Which of the following is the best indication for ICSI? (2003, 2010)
Klinefelter syndrome
Radiation and chemotherapy for Hodgkin lymphoma
Klinefelter
What is the best/most likely reason to do ICSI? (2023 NIH)
Thawed oocytes
Unexplained infertility with history of IVF
AMA (Maternal age of 40yo)
Low oocyte yield
Thawed oocytes
What is associated most with low sperm morphology? (2012, 2018, 2023 NIH)
Low fertilization with ICSI
Low fertilization with IVF
Low fertilization with IVF
What is the most important determinant of fertilization with ICSI? (2007, 2011, 2018, 2023 NIH)
Culture media
Injection technique
Sperm media
Number of oocytes
Age
Method of specimen collection
Injection technique
What would make you do ICSI? (2023 NIH)
Prolactinoma
Hypothyroidism
High FSH
Low FSH
Testosterone
High FSH
Who is the best candidate for freeze all with subsequent FET? (2021)
E2 >3000pg/mL
AMH 2.0ng/dL
15 oocytes retrieved
AFC 25
E2 >3000pg/mL
What is the most common imprinting syndrome associated with IVF? (2013, 2014, 2017, 2019, 2021)
Beckwith- Wiedemann
Prader Willi
Retinoblastoma
Maternal hypermethylation
Angelman
Beckwith- Wiedemann
What is the least common imprinting syndrome associated with IVF/ICSI? (2011, 2023 NIH)
Beckwith-Wiedemann
Prader Willi
Retinoblastoma
Maternal hypermethylation
Angelman
Prader Willi
FET cycle is more likely to be associated with increased risk of following compared to fresh transfer? (2021)
Preterm labor
Small for gestational age
Preeclampsia
Birth defects
Preeclampsia
What is the most effective way to reduce risk of OHSS? (2019, 2021)
Leuprolide acetate (Lupron) trigger
Reduced dosing
Cabergoline
A patient undergoing IVF with a GnRH antagonist protocol is a high responder. What is the most effective way to reduce the risk of OHSS? (2013)
Single embryo transfer
Dopamine agonist
GnRH agonist trigger
Leuprolide acetate (Lupron) trigger
GnRH agonist trigger
Which of the following would be the best reason to cancel a patient for a fresh embryo transfer after ovarian stimulation? (2021)
Progesterone 1.5ng/mL
Known endometrial polyp
E2 5000pg/mL
E2 5000pg/mL
What has led to the most improvement in pregnancy rates (implantation) following embryo transfer? (2009, 2011, 2012, 2014, 2015, 2018, 2021, 2023 NIH)
Use of soft-tipped catheter
PGT-A
Assisted hatching
Embryo glue
Progesterone supplementation during luteal phase and early pregnancy
What has led to the most improvement in pregnancy rates (implantation) following embryo transfer? (2009)
Use of soft-tipped catheter
Ultrasound (US) guidance
Volume of fluid in the catheter
Distance from the fundus
Use of soft-tipped catheter
US guidance
What is least important for pregnancy rates (implantation) following an embryo transfer? (2009, 2023 NIH)
Use of a soft-tipped catheter
Ultrasound (US) guidance
Distance from the fundus
Uterine contractions
Blood in catheter
Embryo culture media
Blood in catheter
What is the least likely to impact pregnancy rates (implantation) following an embryo transfer? (2007)
Ultrasound (US) guidance
Retained embryo
Uterine size
Blood in catheter
Retained embryo
When is the least appropriate time to initiate progesterone supplementation? (2014)
Intramuscular injection on day of trigger
Vaginal suppository on day prior to retrieval
Intramuscular injection day after trigger
Vaginal suppository on day of retrieval
Intramuscular injection on day of trigger
What is the best predictor of ovarian response to gonadotropins in a woman with PCOS? (2021)
AMH
Day 3 FSH
AFC
Inhibin B
AFC
What is the least predictive of implantation? (2007, 2009, 2023 NIH)
Early cleavage
Cell number
Fragmentation
Number of embryos
Symmetry
Vacuolization
Vacuolization
What is the biggest advantage to an antagonist stimulation cycle compared to a GnRH agonist downregulation cycle? (2021)
Decreased OHSS risk
Where does a GnRH agonist work? (2012, 2018)
Binding to the pituitary receptors
Binding to the hypothalamic receptors
Binding to the ovarian receptors
Binding to the adrenal receptors
Binding to the pituitary receptors
What is the GnRH agonist protocol most associated with? (2015)
Decreased OHSS
Decreased dose of FSH during stim
Increased pregnancy rates
Decreased need for luteal support
Decreased need for luteal support
How do GnRH antagonists work? (2015)
Competitive inhibition
Prevent dimerization of receptor
Others
Competitive inhibition
What is the mechanism of GnRH agonists? (2005, 2009, 2011, 2018, 2023 NIH)
Downregulation of hypothalamic receptors
Downregulation of ovarian receptors
Depletion of pituitary receptors
Competitive inhibition of pituitary receptors
Immediate internalization of receptor
Depletion of pituitary receptors
What is the mechanism of GnRH antagonists? (2014, 2015)
Downregulation of hypothalamic receptors
Downregulation of ovarian receptors
Depletion of pituitary receptors
Competitive inhibition of pituitary receptors
Immediate internalization of receptor
Competitive inhibition of pituitary receptors
The most common reason for monozygotic twinning related to IVF is a splitting event that occurs from which of the following? (2021)
2PN
8 cell blastomere
Inner cell mass (ICM)
Trophectoderm
ICM
When is best time for biopsy if the father has cystic fibrosis? (2023 NIH)
8 cell embryo
Blastocyst
Morula
1st polar body, then 2nd polar body
Blastocyst
What O2 tension in embryology is best? (2021)
5%
10%
15%
20%
5%
PGT is most likely to do which of the following? (2020)
Increase cumulative live birth rate
Increase SIR per embryo transfer
Others
Increase sustained implantation rate per embryo transfer
What is the best choice of trigger for a patient on GnRH antagonist protocol and whose E2 6000pg/mL? (2016, 2017, 2018, 2019, 2023 NIH)
Leuprolide acetate (Lupron) 1mg
hCG
Dual/Co-trigger with leuprolide acetate (Lupron) and 1500 hCG
hCG and cabergoline
Coast for a few days
Lupron only trigger (if correct dosing listed)
A couple goes through IVF and 2PNs develop but none progress to the cleavage stage. Why would a 2PN not progress? (2013, 2015, 2016, 2017, 2023 NIH)
Failure to release 2nd polar body
Failure to have cortical granule reaction
Thickened zona pellucida
Failure of paternal genome to activate
Abnormal sperm
Failure of paternal genome to activate
A couple goes through IVF and 2PNs develop but none progress to the cleavage stage. Why would a 2PN not progress? (2013)
Decreased oocyte quality
What is the least likely cause of this (image of poly-fertilization with three nuclei) in IVF? (2013, 2015, 2016)
Digeny
Polyspermy
ICSI
Poor oocyte quality
Post-mature oocyte MII
ICSI
What is the most likely cause of 3PN? (2023 NIH)
Perivitelline space debris
Teratospermia
Post-mature oocyte
Thickened zona pellucida
Post-mature oocyte
What is the least likely to cause 3PN during IVF? (2013, 2014, 2015, 2023 NIH)
Polyspermy
ICSI
Post-mature oocyte
Oocyte quality
Digeny
Regular IVF
ICSI
What is the least likely predictor of poor response to ovarian stimulation? (2011, 2013)
Clomiphene citrate (Clomid) challenge test (CCCT)
FSH
AMH
AFC
Inhibin
Inhibin
What is the most likely predictor of a good response to ovarian stimulation? (2012, 2013, 2014, 2016, 2017, 2018, 2023 NIH)
Day 3 FSH
Prior response to stimulation/Prior cycle response
Inhibin A
Inhibin B
Prior response to stimulation/Prior cycle response
Measurement of which of the following on cycle day 3 is most predictive of the number of oocytes that will be retrieved? (2007, 2023 NIH)
FSH
LH
AMH
AFC
AFC
What is the worst test for IVF predictive response? (2023 NIH)
Inhibin B
Inhibin B
What is the best predictor of IVF response? (2023 NIH)
Clomiphene citrate (Clomid) challenge test (CCCT)
FSH
AMH
Prior IVF response
Prior IVF response
What is most predictive of IVF outcomes in a specific IVF cycle? (2007)
Day 3 FSH*
AFC*
Day 3 estradiol
Day 3 inhibin
What is most predictive of IVF outcomes in a specific IVF cycle? (2007)
Day 3 FSH
AFC
Day 3 estradiol
Day 3 inhibin
AFC
What are cleavage stage (day 3) embryos less likely to have compared to blastocysts? (2012, 2013, 2018, 2020, 2023 NIH)
Monozygotic twinning
Live birth
Ectopic pregnancy
Monozygotic twinning
What was the most common malignancy associated with IVF? (2012, 2013, 2014, 2015, 2017, 2023 NIH)
Borderline
Breast cancer
In situ breast cancer
Ovarian cancer
What is increased in patients who have had IVF compared to patients who didn’t have IVF? (2012, 2018)
Borderline ovarian tumors
Invasive ovarian carcinoma
Invasive breast cancer
DCIS
Low malignant potential (LMP) tumor
Borderline
A patient who previously had RPL is diagnosed with a DVT in pregnancy. What is the most likely etiology for all of these issues? (2010)
APLS
What is the best predictor of ovarian response to gonadotropins in a woman with PCOS? (2021)
AMH
Day 3 FSH
AFC
Inhibin B
AMH
How do you prevent OHSS in a patient who is obese with PCOS and has a midcycle E2 6000pg/mL? (2018, 2023 NIH)
Metformin
GnRH antagonist
Letrozole
Albumin
Metformin vs letrozole
What is the best time for the fertilization check? (2015)
4hr after
12hr after
18hr after
24hr after
18 hours after
In what way is rFSH is most like FSH? (What is most likely to be similar between recombinant versus endogenous gonadotropins?) (2003, 2007, 2009, 2011, 2012, 2013, 2018, 2023 NIH)
Amino acid sequence/structure/bioactivity
Post-translational modifications
Glycosylation
Carboxy content
Similar presence of urinary contaminants
Amino acid sequence/structure/bioactivity
What is the difference between follitropin-alpha (Follistim) and follitropin-beta (Puregon)? (2023 NIH)
Structurally different
Difference in glycosylation
Difference at the 6th amino acid
CHO vs. HELA cells
Difference in glycosylation
What is the treatment for a patient with low/normal FSH and low LH? (2023 NIH)
Menotropins (Repronex)
FSH (Follistim)
Menotropins
PGT is most indicated for which of the following? (2014, 2018)
Age
Balanced translocation
RPL
Implantation failure
Balanced translocation
What is the primary energy source for blastocysts? (2005, 2011, 2012, 2018)
Pyruvate
Non-essential amino acids
Glucose
Cholesterol
Glucose
What is the least responsible for OHSS? (2007, 2011, 2012, 2018, 2023 NIH)
rFSH
uFSH
u-hCG
r-hCG
rLH
Use of which of the following would decrease the risk of OHSS? (2007, 009)
rFSH
uFSH
u-hCG
r-hCG
rLH
rLH
What is the biggest impact on reduction of multiple rates in the United States? (2009, 2018, 2023 ASRM)
Single day 3 embryo transfer
Single blastocyst transfer
Mandated insurance
SART/CDC registry
What is the biggest impact on reduction of multiple rates in the United states? (2011, 2023 ASRM)
Single day 3 embryo transfer
ASRM guidelines
Mandated insurance
SART/CDC registry/reporting
Single blastocyst transfer
ASRM guidelines
What is the least important factor in deciding on the number of embryos to transfer? (2007, 2009, 2018, 2023 NIH)
Maternal age
Number of prior cycles
Number of surplus embryos left to freeze
Day 3 FSH
Embryo morphology
Embryo grading
Day 3 FSH
What is a benefit of using GnRH antagonists in IVF? (2015)
Decreased OHSS risk
Less total gonadotropin used
Others
Both
What is the best reason to use a GnRH antagonist in IVF? (2014)
Reduced risk of OHSS
Reduced need for luteal support
Improved implantation rates
Improved pregnancy rates
Reduced risk of OHSS
What is the best prognosticator of risk for OHSS? (2015)
AFC
Age
AMH
FSH
AMH
A 38yoF with an AMH 0.4ng/mL and AFC of 5 presents. What is the best treatment? (2014, 2023 NIH)
IVF with donor oocytes
Clomiphene citrate (Clomid)
IVF with autologous oocytes
IVF with donor oocytes
A 46,XY woman presents. What IVF treatment will benefit her the most? (2012)
Gestational carrier
Sperm donor
Oocyte donor
Oocyte donor
What is most advantageous about using a GnRH antagonist cycle? (2012)
Better IR
Better PR
No need for luteal support
Can use a leuprolide acetate (Lupron) trigger
Can use a leuprolide acetate (Lupron) trigger
What has the highest increased risk of imprinting disorders? (2011, 2012)
Culture to day 3
Blastocyst culture
Embryo culture
Oocyte maturation
Gonadotropins
Sperm something
Blastocyst and embryo culture
What are imprinting disorders most related to in IVF? (2011)
Time of in vitro embryo culture
Blastocyst culture
Ovarian stimulation
Infertility
Blastocyst culture
What has IVF increased the risk of the most? (2007, 2012, 2023 NIH)
Chromosomal abnormality
Low birth weight in singletons
Male to female sex ratio
Congenital abnormality
Imprinting disorder
Low birth weight in singletons
What is the most common bad outcome in an IVF singleton pregnancy? (2023 NIH)
Chromosomal abnormality
Preterm birth
Low birth weight in singletons
Male to sex ratio
Congenital abnormality
Imprinting disorder
Preterm birth
Low birth weight in singletons
What is the most important factor in the success of a fresh transfer donor cycle? (1999, 2007, 2010, 2011)
Estrogen duration
Estrogen timing
Progesterone duration
Progesterone timing
Age of the recipient
Progesterone timing
What is true when counseling about the potential effects of ICSI with respect to offspring? (2011, 2023 NIH)
Increased risk of anomalies of X and Y
Increased risk of congenital abnormalities of autosomes
Can be attributed to ovarian stimulation, not ICSI itself
Congenital abnormalities can be attributable to epigenetic modifications
Congenital abnormalities can be attributable to epigenetic modifications
What is ICSI associated with increased risk of? (2011)
C-section
Post-term pregnancy
Sex chromosome abnormalities
Other types of chromosomal disorders also listed
Sex chromosome abnormalities
What is the least reliable test for ovarian reserve? (2007, 2011)
Day 3 FSH
AFC
Inhibin
Clomiphene citrate (Clomid) challenge test (CCCT)
Inhibin
What is the most likely chromosomal make-up of offspring after ICSI is used for a 47,XXY male and 46,XX female? (2009, 2010, 2023 NIH)
45,X
46,XY
46,XX
47,XXY
47,XYY
46,XY
46,XX
(Normal)
Which substrate is most important in extended culture media? (2007, 2023 NIH)
Addition of glucose and essential amino acids
Some amino acid
Addition of glucose and essential amino acids
What criteria is least important when deciding to perform assisted hatching? (2007, 2010, 2023 NIH)
> 37yo
Thickened zona
Repeated IVF failures
Unexplained infertility
Unexplained infertility
What is the least likely to improve results in IVF? (2003)
Antibiotics in the culture media
Preculture of sperm in yolk-rich media
Percoll gradient
Swim-up
Antibiotics in the culture media
What is most likely semen analysis abnormality associated with failed fertilization in IVF? (2023 NIH)
Abnormal morphology
Abnormal motility
Abnormal number
Abnormal morphology
A couple undergoes IVF twice with failed fertilization. What is the next most appropriate step? (1999, 2003)
hMG with IUI
ICSI
Others
ICSI
Measurement of which of the following on day 3 of the menstrual cycle is most predictive of response to gonadotropin stimulation? (1999)
Estradiol
FSH
Inhibin B
LH
Activin
FSH
What is the most important factor to embryo viability with cryopreservation? (1999)
Time taken to thaw
Time taken to freeze
Maternal age
Paternal age
Maternal age
The most success with cryopreservation has come from the use of which of the following? (1999)
Oocytes
Ovarian slices
Cleavage stage embryos
Blastocyst
Morula
Blastocyst
What are the preferred energy sources for blastocysts? (2005, 2007)
Lactate
Pyruvate and nonessential amino acids
Glucose and essential amino acids
Glucose and essential amino acids
What are the preferred energy sources for pre-compaction embryos? (2005, 2007)
Lactate
Pyruvate and nonessential amino acids
Glucose and essential amino acids
Pyruvate and nonessential amino acids
What is least likely to be true in a blastocyst? (2003)
Inner cell mass (ICM) is rapidly dividing
Cells in the inner cell mass (ICM) undergo apoptosis
Inner cell mass (ICM) secretes hCG
Inner cell mass (ICM) secretes hCG
What is the purpose of cryoprotectants? (1999, 2003, 2010)
Preventing formation of cytoplasmic ice crystals
Preventing disruption of the cell membrane
Others
Preventing formation of cytoplasmic ice crystals
Which of the following findings is most predictive of ART failure in a 31yoF? (2003)
Day 3 FSH 8.7mIU/mL, day 3 estradiol 75pg/ml
Day 3 estradiol 45pg/mL
Day 3 inhibin 180pg/mL
Day 9 FSH 9mIU/mL after five days of clomiphene citrate (Clomid) 100mg/day
Day 3 FSH 8.7mIU/mL, day 3 estradiol 75pg/ml
What is the best predictor of successful pregnancy in a 39yoF undergoing IVF? (2005)
Clomiphene citrate (Clomid) challenge test (CCCT)
Day 3 FSH
FSH:E2 ratio
Day 3 FSH
A woman undergoing IVF is incidentally found to have a positive anticardiolipin antibody. What is indicated? (2023 NIH)
Heparin
Luteal phase progesterone
Nothing
Nothing
What infectious disease screening do you need to do for anonymous oocyte donors? (2013, 2014, 2015, 2016)
Hepatitis B core antibody
Hepatitis B surface antigen
HIV antibody
Hepatitis C nucleic acid antibody
HSV
T. cruzi
All except HSV, T cruzi
What screening do you need to do for anonymous oocyte donors (2015, 2017, 2018)
T. palladium
CMV
HTLV1
West Nile virus
T. palladium
West Nile Virus
What do you not need to do for anonymous oocyte donor screening? (2022)
HTLV
What virology is not needed for an intimate partner? (2023 NIH)
HSV1 and HSV2
Patient with new diagnosis of breast cancer and wants to pursue fertility preservation with oocyte cryopreservation. What is the most important factor in considering which stimulation protocol to use? (2021)
Tumor receptor status
Current status within the menstrual cycle
Specific histologic/pathologic breast cancer diagnosis
BRCA1 status
Specific histologic/pathologic breast cancer diagnosis
Who is eligible for leuprolide acetate (Lupron) protection of ovaries? (2021)
7yo with cancer
15yo with cancer
28yo with cancer
33yo with cancer
28yo with cancer
A patient with breast cancer needs fertility preservation right away, how do you stimulate? (2021)
Letrozole and random start
What is least affected in oocyte cryopreservation? (2012, 2013, 2014, 2018)
Zona pellucida
Cortical reaction
Cortical granules
Mitotic spindle
Cytoskeleton
Mitochondria
What cellular structure is most resistant to damage with cryopreservation? (2023 NIH)
Zona pellucida
Cortical granule
Spindle
Mitochondria
Mitochondria
What cryopreservatives are used for 2PN embryos? (2005, 2009, 2018, 2023 NIH)
Glycerol
Glycine
Pyruvate-free
DMSO
Propanediol
DMSO
Propanediol
Which chemotherapy has the most toxic effect on the ovaries/oocytes? (2012, 2023 NIH)
Anthracyclines
Antimetabolites
Vinca alkaloids
Alkylating agents
Alkylating agents
What tumor is most likely to produce ectopic hCG as a tumor marker? (2007, 2011, 2023 NIH)
Ovary
Liver
Brain
Breast
Lung
Ovary
Malignancy/Cancer in which organ is most likely to cause ectopic erythropoietin production? (2009)
Lung
Ovary
Liver
Kidney
Kidney
What is the best method to conserve a 35yoF’s fertility before cyclophosphamide? (2007, 2019, 2023 NIH)
GnRH agonist
OCPs
Embryo cryopreservation
Ovarian tissue cryopreservation
Embryo cryopreservation
What is the most common finding in RPL evaluations? (2022)
Cytogenetics
Uterine anomaly
APLS
Uterine anomaly
What is the most common finding in a spontaneous abortion? (2022)
Aneuploidy of POCs
Aneuploidy of POCs
What uterine anomaly is most related to spontaneous abortions? (2023 NIH)
Septate
Bicornuate
Didelphys
Arcuate
Septate
What is the estimated incidence of mullerian anomaly in a woman with recurrent first trimester pregnancy losses (RPL)? (2022)
2-3%
5-10%
25-30%
50-60%
5-10%
What is the most likely reason for two consecutive clinical losses? (2020, 2021)
Aneuploidy
Translocation
Uterine anomaly
Acquired thrombophilia
APLS
Aneuploidy
What is the chance that a first trimester loss is due to a chromosomal abnormality? (2003)
25%
40-60%
80%
40-60%
Which of the following is the least useful test for RPL? (2003)
HSG
Karyotype
Mycoplasma
Mycoplasma
What is the most likely diagnosis (cause) for a couple with RPL? (2013, 2014, 2016, 2017, 2019, 2021, 2023 NIH)
Endocrine abnormality
Uterine anomaly (Anatomic)
Translocation
Immunologic
Acquired thrombophilia
Uterine anomaly (Anatomic)
A 35yoF with three consecutive biochemical losses. What is the best next step? (2020, 2021)
APS/Karyotype
Prolactin/TSH
PGT-A
Continue to attempt spontaneous conception
APS/Karyotype
Prolactin/TSH
A patient with RPL after three spontaneous abortions and has a negative work-up. What is the next step? (2007, 2009, 2010, 2012, 2013, 2018, 2023 NIH)
IVF with PGT-A
Attempt spontaneous conception
Natural killer (NK) cell test
Aspirin and heparin
A patient has had three spontaneous abortions after one full term pregnancy. What is the best treatment? (2011)
IVF with PGT-A
Attempt spontaneous conception
Sperm fragmentation
Aspirin and heparin
Attempt spontaneous conception
What is the worst prognosis uterine structural defect associated with RPL (three prior first trimester spontaneous abortions)? (2005, 2007, 2012, 2013, 2018)
Arcuate
Septum
Submucosal fibroids
Adenomyosis
Septum
What medication has been shown to be helpful for RPL associated with APLS (with no history of DVT)? (2012, 2013, 2014, 2016, 2015, 2017, 2018, 2023 NIH)
ASA and twice daily unfractionated heparin
ASA
Therapeutic heparin
LMWH heparin
Immunoglobulin
ASA and twice daily unfractionated heparin
Which is most specific for APLS? (2023 NIH)
Increased APTT
Decreased clotting time
Anticardiolipin IgA
Anti-beta-2-glycoprotein IgM
Anti-beta-2-glycoprotein IgM
What is the best treatment for somebody with APLS? (2013, 2014)
ASA
Heparin
Heparin
What test is least likely to help with diagnosing APLS? (2011, 2012, 2013, 2014, 2015, 2016, 2023 NIH)
Anti-beta-2-glycoprotein
Anticardiolipin antibodies
Russell’s venom
aPTT
Antiphosphatidyl serine
Antiphosphatidyl serine
What test is most likely to diagnose APLS? (2012, 2013, 2015, 2017, 2018)
Anti-beta-2-glycoprotein IgM
Anticardiolipin IgA
PT corrected for phospholipid
Anti-beta-2-glycoprotein IgM
A patient who previously had RPL is diagnosed with a DVT in pregnancy.
What is the most likely etiology for all of these issues? (2010)
APLS
What are recurrent late first trimester losses most likely due to abnormalities in? (2011)
Factor V Leiden
Prothrombin gene mutation
Antithrombin II
Protein C
MTHFR
Factor V Leiden
A patient presents with a history of full term delivery complicated by VTE/clot in the 3rd trimester. Since then, she has been diagnosed with RPL. Which of the following is most likely etiology? (2007, 2023 NIH)
Factor V Leiden
APLS
Protein S
APLS
What is the prevalence of APLS in women with RPL? (2018)
3-5%
What is the mechanism of late loss (>10wk) in women with APLS? (2018)
Thrombosis
What is the mechanism of early loss (<10wk) in women with APLS? (2018)
Trophoblast invasion
Which HLA in the endometrium allows for implantation? (2014, 2015)
A
B
D
G
G
A patient had three early spontaneous abortions following a full term delivery. What is the least likely reason for her recurrent losses? (2005, 2010, 2011, 2018, 2023 NIH)
Embryotoxic factor
Uterine septum
Lupus anticoagulant antibodies
Male balanced translocation
Embryotoxic factor
A patient had three early spontaneous abortions following a full term delivery. What is the least likely reason for her recurrent losses? (2003, 2011, 2009)
APLS
Rh sensitization
Uterine septum
Abnormal male karyotype
Didelphys
Unicornuate
Rh sensitization
A patient has three prior first trimester losses. What is the most likely mechanism? (2005, 2014, 2015)
Anatomical abnormality
APLS
Balanced translocation
Anatomical abnormality
What is the least common cause of spontaneous abortions? (2010)
Fetal aneuploidy
Parental chromosome abnormality
Endometritis
Endometritis
A couple with normal karyotypes experiences three consecutive losses. What is the most likely cause? (1999, 2011)
Autosomal trisomy
Triploidy
Diploidy
Monosomy 45,X
Autosomal trisomy
What is the most common karyotype of a spontaneous abortion in a woman with recurrent loss? (2003, 2018)
Autosomal trisomy
Monosomy X
Polyploidy
46,XX or 46,XY
Autosomal trisomy
A patient with RPL presents following a recent spontaneous abortion whose karyotype was 47,XX,+22. What is the most likely reason for this finding? (2018)
Oocyte nondisjunction
Reciprocal translocation
Robertsonian translocation
Embryotoxic factor
Uterine septum
Oocyte nondisjunction
What is the most common cause of familial clotting? (2018)
Prothrombin gene mutation
MTHFR homozygous with elevated homocysteine
Antithrombin III
Protein C deficiency
Protein S deficiency
Prothrombin gene mutation
What is the single most common genetic finding in an abortus? (1999)
45,X
46,XXY
46,XYY
Trisomy 18
Trisomy 21
45,X (if T16 unavailable as most common)
A couple have a history of a full term vaginal delivery followed by three consecutive first trimester losses. How do you counsel them? (1999)
Their chances are increased since they had one successful pregnancy
Others
Their chances are increased since they had one successful pregnancy
A 30yo couple has just had two consecutive spontaneous abortions, the last of which had a trisomy 15 karyotype. How do you counsel them? (1999)
Their risk of subsequent miscarriage is 50%
Their risk of subsequent miscarriage is 20-30%
They will not be able to have a successful pregnancy without donor gametes
They should undergo genetic testing
Their risk of subsequent miscarriage is 20-30%
What is the least likely finding APLS? (2003)
Thrombocytopenia
Elevated PTT
None of the above
Elevated PTT
What is the least useful test when evaluating RPL? (2005)
EMB
What is the most sensitive imaging study for RPL? (2007)
HSG
Saline sonogram (SIS)
Ultrasound (US)
Saline sonogram (SIS)
Which of the following is the most common abnormality with history of DVT and three first trimester spontaneous abortions? (2007, 2023 NIH)
Factor V Leiden
APLS
APLS
A 28yoF G3P1021 has a history of two losses at 8wk after fetal heart rate as well as a history of a term delivery complicated by a VTE in the third trimester. What test would be diagnostic? (2007)
Factor V Leiden
Lupus anticoagulant/Anticardiolipin antibody
Lupus anticoagulant/Anticardiolipin antibody
What is the most likely cause of RPL at <10wk? (2023 NIH)
Anatomic
Immune
Thrombotic
Environmental
Anatomic
Which uterine abnormality has the worst prognosis for someone with three prior 1st trimester losses? (2023 NIH)
Uterine septum
Arcuate
Subserosal leiomyoma
Uterine septum
Which of the following is most likely to be associated with three 1st trimester losses? (2023 NIH)
Prothrombin mutation
MTHFR
Activated Protein C
Prothrombin mutation
How do you determine the number of Fragile X repeats in a patient? (2016)
PCR
What mechanism is responsible for environmental impact on genetics? (2021)
Methylation
Post-transcriptional histone modification
Methylation
What is the correct order of events in PCR? (2011, 2013, 2021, 2022, 2023 NIH)
Denaturation, annealing, synthesis, extension
What is the correct order of events in RT-PCR? (2013, 2017, 2018)
Make cDNA, denature, anneal, extension
Denature, anneal, extension, make cDNA
Extension, anneal, denature, make cDNA
Make cDNA, denature, anneal, extension
What is PCR most likely to miss? (2011, 2021, 2023 NIH)
Nonsense
Missense
Large deletion
Small three nucleotide repeat
Large deletion
What is the best use of aCGH? (2021)
Comparing mitochondrial DNA between two individuals
Comparing genomic DNA between two populations
Comparing mRNA transcripts
Comparing tRNA transcripts
Comparing genomic DNA between two populations
What is CGH best for? (2012)
Gain or loss of DNA
SNP
Uniparental disomy
Gain or loss of DNA
Karyotype is able to detect which of the following that aCGH cannot? (2021)
Aneuploidy
Deletion
Unbalanced translocations
Inversion
Inversion
What PGT-A platform has the most mosaicism rates? (2021)
qPCR
NGS
aCGH
NGS
How do you locate a gene on a chromosome? (2012, 2018)
Southern blot
FISH
PCR
Southwestern blot
FISH
What is the most labor intensive application of FISH? (2007, 2023 NIH)
Polyploidy
Sex typing
DNA inversions/translocations
DNA point mutations
Polyploidy
FISH is most labor intensive with which kind of evaluation? (2007, 2023 NIH)
Chromosome number
Translocations
Single gene mutation
Sex chromosome abnormalities
Chromosome number
What is the most labor intensive test to attempt to perform using FISH? (2007)
Identification of single gene mutations
Identification of sex-linked disorders
Identification of trisomies
Other
Identification of trisomies
Which of the following can FISH best detect? (2005, 2023 NIH)
Sex aneuploidy
Single gene defect
Y chromosome microdeletion
Reciprocal translocation
Sex aneuploidy
- PCR is used for single gene defects and FISH for sex selection, structural anomalies and aneuploidy screening.
What heterozygote is least likely to be detected on PCR gene sequencing? (2023 NIH)
Large deletion
Missense mutation
Nonsense mutation
Silent mutation
Large deletion
There is a gene mutation that generates a protein. What is the best way to identify the “gene product” (protein)? (2005, 2009, 2013, 2015, 2016, 2018, 2021)
Western blot
Northern blot
Southern blot
Southwestern blot
PCR
What is the best test to evaluate for a genetic mutation that creates a protein? (2023 NIH)
Western immunoblot analysis
Northern immunoblot analysis
Southern immunoblot analysis
Western blot
How do you detect mutant protein that is significantly shorter in length? (2011, 2015, 2018)
PCR
Western blot
Northern blot
Southern blot
Western blot
A mutant gene with a shorter amino acid sequence produces a mutant protein in Sertoli cells. What is the best test to identify the gene product? (2023 NIH)
Southern blot
Western blot
PCR
Western blot
There are Sertoli cells that have a mutation in the gene for protein G and produce a shorter product (shorter protein G). How do you detect the mutated product of Sertoli cells? (2007, 2011)
Northern blot
Western blot
Southern blot
RT-PCR
Western blot
How do you verify the integrity of isolated RNA? (2003, 2005)
Western blot
Northern blot
Southern blot
Southwestern blot
Northern blot
What is involved in a Northern blot? (2003, 2010)
Complementary DNA binding to radiolabeled RNA
Genomic DNA binding to radiolabeled RNA
Radiolabeled DNA binding to RNA
Hybridize radiolabeled DNA to RNA
What is involved in a Northern blot? (2007)
Radiolabeled cDNA combining with RNA
Radiolabeled RNA combining with DNA
Radiolabeled RNA combining with protein
Other
Radiolabeled DNA binding to RNA
Hybridize radiolabeled DNA to RNA
Radiolabeled cDNA combining with RNA
Which of the following uses antibodies for hybridization identification of proteins? (2001)
Northern blot
Southern blot
Southwestern blot
Western blot
Western blot
What is the recommended parental genetic screening for all couples attempting conception? (2021)
CF, spinal muscular atrophy
CF, spinal muscular atrophy, Fragile X
CF, spinal muscular atrophy, Fragile X, familial autosomal something
Another option with something added to the familial autosomal something
CF, SMA
A 30yoF with POI wants to use her 22yo sister’s oocytes for IVF. What screening is most likely to reveal the cause of the patient’s POI? (2009, 2023 NIH)
Karyotype
Fragile X
Cystic fibrosis
A 30yoF with POI wants to use her 22yo sister’s oocytes for IVF. What test would most likely exclude her? (2009)
Karyotype
Fragile X
Cystic fibrosis
Karyotype
What is the best way to determine copy number? (2018)
Amount of DNA
What is the best test to detect copy number variants? (2012, 2013, 2014, 2015, 2020, 2023 NIH)
Karyotype
FISH
aCGH
Southern blot
aCGH
*Takes up to 72h to perform due to long hybridization step. Can only detect copy number changes (only changes that result in loss or gain of chromosome material). Less sensitive than PCR.
What is CGH useful for? (2015, 2017)
Copy number variants
Uniparental disomy
Ploidy
CNVs
*This technology is also particularly useful as a complementary diagnostic test to detect large deletions in genes related to mitochondrial disorders.
CGH cannot detect which of the following? (2019)
Aneuploidy
Deletions
Unbalanced translocations
Inversions
Inversions
What can aCGH cannot distinguish between? (2012, 2018)
Euploid and aneuploid karyotype
Small deletions in the genome
Uniparental disomy
Mitochondrial differences
Uniparental disomy
What is the quickest way to determine sex of blastomeres in someone with an X-linked recessive gene mutation?
FISH
Sequence the pseudoautosomal region of Y chromosome
Cytogenetic banding
FISH
What most characterizes whole exome sequencing (WES)? (2016)
Only looks at part of the genome
Good to look for copy number variation
CNV
WES is a form of next-generation sequencing that focuses only on the exons (the protein-coding regions) to detect CNVs, SNPs, and somatic mutations. WES data is useful for the clinical interpretation of genetic variation discovered in exomes
Who is the best candidate for PGT-A? (2017)
Recent implantation failure
Advanced maternal age
Balanced translocation
Recurrent pregnancy loss
Balanced translocation
What can you use to determine a single parent polymorphism? (2015)
SNP array
What happens when two acrocentric chromosomes interact? (2007, 2010, 2011, 2012, 2014, 2018, 2023 NIH)
Balanced reciprocal translocation
Robertsonian translocation
Pericentric inversion
Meiotic nondisjunction
Premature sister chromatid separation
Robertsonian translocation
What do acrocentric chromosomes joined at the centromere cause? (2003)
Robertsonian translocation
Ring chromosome
Inversion
Reciprocal translocation
Robertsonian translocation
If a male partner is elderly, what is the most likely karyotypic abnormality in the offspring? (2015)
47,XXY
Sex chromosome
Autosomal
Monosomy X
Autosomal
What is the most likely reason for failure of oligonucleotide binding in PCR based sequencing? (2014)
Large deletion
Missense mutation
Nonsense mutation
Silent mutation
Large deletion
What test is the best for finding the chromosomal location of a gene? (2005, 2012)
Southern blot
PCR
Methylation analysis
FISH
FISH
CGH would be least likely to determine which of the following chromosomal abnormalities? (2012)
Polyploidy
Turner syndrome
Trisomy
Polyploidy
What is the best test to use in an oocyte donor to rule out a genetic carrier disease? (What is the best microarray for screening of oocyte donors for carrier disease status?) (2009, 2011, 2023 NIH)
Genomic DNA
Chromatin DNA
Proteomics
Metabolomic
RNA
PCR
Genomic DNA
What is cDNA microarray best for? (2011, 2023 NIH)
Genomic DNA between two populations
Transfer RNA between to individuals
mRNA between two different experiments
mRNA between two different experiments
Which of the following clinical scenarios is the best application of PGT-M that will lead to the best outcome? (2005)
Translocation
Cystic fibrosis carrier
Others
CF carrier
What is the best method to assess chromosomal abnormalities? (2023 NIH)
PGT-M
CGH
G banding
CGH
Which test gives the most information about the genome? (2007)
FISH
PCR
Comparative hybridization
G-banding
Comparative hybridization
Why does Taq polymerase work? (2015)
Stable at high temperatures
What do you test with a cDNA array? (2014, 2015, 2018, 2023 NIH)
mRNA
tRNA
Genomic DNA
mRNA
What is detected when cDNA is analyzed? (2012, 2018)
Complementary strand to known DNA sequence
Complementary strand to known RNA sequence
Full DNA sequence, including exons and introns
Total molecular weight of DNA strand
Complementary strand to known RNA sequence
What is the best test for maternal contamination of POCs? (2014, 2015, 2017, 2018, 2019, 2020, 2021, 2023 NIH)
Array CGH (CGH or microarray)
SNP array
FISH
Karyotype
cDNA microarray
SNP array
What is the best test for abnormality in POC? (2023 NIH)
High density SNP
Geimsa staining of metaphase chromosomes
microRNA
Cell free DNA
High density SNP
How does inflammatory process of endometriosis work? (2021)
Increase in suppressive modulators in pelvic fluid
Increase in suppressive modulators in abdominal fluid
Decrease in suppressive modulators in pelvic fluid
Decrease in suppressive modulators in pelvic fluid
Decrease in suppressive modulators in pelvic fluid
A patient is going to begin IVF with an endometrioma. What is the best thing to do? (2011, 2023 NIH)
Drain endometrioma at retrieval
Avoid endometrioma at retrieval
Laparoscopic drainage of endometrioma before IVF
Laparoscopic resection of endometrioma before IVF
GnRH agonist 3mo before IVF
Long term suppression with OCPs
Avoid endometrioma at retrieval
A woman presents with a 4cm endometrioma. What would you do before IVF? (2013, 2014, 2023 NIH)
Expectant management
Drain endometrioma
Robotic cystectomy
Expectant management
A woman presents with a 2cm endometrioma. What would you do before IVF? (2015, 2023 NIH)
Proceed with IVF
Remove endometrioma
Treat with GnRH agonist first then IVF
Treat with danazol first then IVF
A 38yoF presents with a 2cm endometrioma and no pain. She is planning to do IVF. What is the best management? (2015, 2023 NIH)
Surgery
Avoid surgery, proceed with IVF
GnRH agonist with add back pre-treatment
GnRH agonist with no add back
A 38yoF presents with a 4cm endometrioma and no pain. She is planning to do IVF. What is the best management? (2012, 2014, 2023 NIH)
Surgery
Avoid surgery, proceed with IVF
Puncture and drain
Proceed with IVF
Avoid surgery, proceed with IVF
Avoid surgery, proceed with IVF
In GnRH agonist suppression what is the effect of adding norethindrone? (2023 NIH)
Decreased flushing, decreased bone mass
Decreased flushing, no change in bone
Increased flushing, decreased bone
Increased flushing, no change in bone
Decreased flushing, no change in bone
What decreases ovarian reserve most in an endometrioma resection? (2012, 2015)
Electrocautery of wall
Laser ablation of wall
Resect endometrioma
Electrocautery of wall
Which therapy is the least likely to provide pain relief from endometriosis? (What is the worst treatment for endometriosis?) (2011, 2018, 2023 NIH)
GnRH agonist with add back therapy
Cyclic OCPs
IM depot medroxyprogesterone acetate (MPA) (Depo-Provera)
Surgical destruction
Which is the least effective treatment for endometriosis? (2011)
GnRH agonist with add back therapy
Cyclic OCPs
IM depot medroxyprogesterone acetate (MPA) (Depo-Provera)
Surgical destruction
Cyclic OCPs
What is the best treatment for (chronic) pelvic pain in a patient with severe endometriosis and dysmenorrhea? (2014)
Laparoscopic uterosacral nerve ablation (LUNA)
Presacral neurectomy (PSN)
Alcohol injection
High frequency ultrasound (US)
What is the best treatment for (chronic) pelvic pain in a patient with severe endometriosis and dysmenorrhea who has failed surgical intervention? (2012, 2013, 2015)
Laparoscopic uterosacral nerve ablation (LUNA)
Presacral neurectomy (PSN)
Alcohol injection
High frequency ultrasound (US)
Presacral neurectomy (PSN)
What is most likely affected by epigenetic regulation of the endometrium? (2014, 2015, 2016, 2017, 2018)
Estrogen receptor beta (ER-beta)
Estrogen receptor beta (ER-beta)
Aromatase activity is highest in what type of endometriosis? (2014, 2015)
Red implant
Black implant
White implant
Yellow implant
Endometrioma cyst wall
Red implant
What is increased in endometrial implants? (2016)
Aromatase
Estrogen receptor beta (ER-beta)
Aromatase
Endometriosis is most associated with which of the following? (2012, 2018)
Increased 17-beta-hydroxysteroid dehydrogenase (17-beta-HSD)
Decreased COX-2
Increased estrogen receptor beta (ER-beta)
Increased estrogen receptor beta (ER-beta)
How does danazol induce androgenic effects? (2018, 2023 NIH)
Displacement of testosterone from SHBG
Binds to estrogen receptor (ER)
Induces SHBG
Induces ovarian steroidogenesis
Displacement of testosterone from SHBG
What is a side effect of danazol? (2018, 2023 NIH)
Completely reversible voice deepening
Anovulation
Osteoporosis
Hyperestrogenemia
Anovulation
Which binds the glucocorticoid receptor best? (2003, 2005, 2010, 2011, 2012, 2014, 2015)
Mifepristone (RU-486)
Progesterone
Estrogen
Testosterone (Androgens)
Spironolactone
Mifepristone (RU-486)
What is the treatment for catamenial pneumothorax? (2007, 2009, 2018)
Depot medroxyprogesterone acetate (DMPA) (Depo-Provera)
Aromatase inhibitor
Danazol
GnRH agonist with add back
GnRH agonist with add back
What is the worst treatment for catamenial pneumothorax? (2009, 2023 NIH)
Cyclic OCPs
GnRH agonist
Depot medroxyprogesterone acetate (DMPA) (Depo-Provera)
Cyclic OCPs
What is the least likely outcome with norethindrone add back for endometriosis? (2014, 2015)
Reduction in hot flashes
Increase in DVT risk
Reduction in bone loss
Increase in DVT risk
What epigenetic changes are seen in endometriosis implants? (2011, 2023 NIH)
Decreased aromatase
Increased 17-hydroxylase (17-OH)
Increased peritoneal macrophages
Increased estrogen receptor beta (ER-beta)
Increased estrogen receptor beta (ER-beta)
Endometriosis is associated with all of the following except? (2011)
Decreased prostaglandins
Increased HOX
Increased SF-1
Decreased prostaglandins
What are endometriosis lesions most highly associated with? (2011)
IL-beta
Abnormal estrogen receptor (ER) expression
Abnormal progesterone receptor (PR) expression
Abnormal estrogen receptor (ER) expression
What is the best long term medical treatment of endometriosis? (2009, 2023 NIH)
GnRH agonist
GnRH antagonist
Depot medroxyprogesterone acetate (DMPA) (Depo-Provera)
Depot medroxyprogesterone acetate (DMPA) (Depo-Provera)
A 50yoF had a TAH-BSO 24mo ago and now presents with flares of endometriosis. What is the best treatment? (2007)
Medroxyprogesterone acetate (MPA) (Provera)
Danazol
Mifepristone (RU-486)
GnRH agonist
GnRH antagonist
Anastrozole
Ketoconazole
Medroxyprogesterone acetate (MPA) (Provera)
What is the best pre-IVF endometriosis treatment? (2023 NIH)
3mo of OCPs
3mo of GnRH agonist
3mo of GnRH agonist
What is the best treatment for a 38yoF with recent BSO for stage IV endometriosis? (2023 NIH)
Nothing
Estrogen
Progestin
Combined estrogen and progestin
Combined estrogen and progestin
What immune cells are found in the peritoneal fluid of patients with endometriosis? (2023 NIH)
Neutrophils
Macrophages
Macrophages
What is the best chance of fertility with an endometrioma? (2023 NIH)
OCPs
GnRH agonist post-op
Ablate the wall of the endometrioma
Remove the endometrioma
Remove the endometrioma
What characterizes endometrium with ectopic pregnancy? (2013, 2014, 2020)
Arias-Stella reaction
Chorionic tissue
Endometrial hyperplasia
Secretory
Proliferative
Arias-Stella reaction
*Arias Stella Reactive and benign phenomenon of the endometrium induced by hormonal stimulation and characterized by cytomegaly and nuclear enlargement of endometrial glands; typically associated with intrauterine or extrauterine pregnancies or with gestational trophoblastic disease
The endometrium associated with ectopic pregnancy is most similar to which of the following? (2014, 2015, 2023 NIH)
Early proliferative
Late proliferative
Early secretory
Late secretory
Decidualized endometrium
Decidualized endometrium
What does robotic surgery offer best? (2015, 2016, 2018, 2020, 2022, 2023 NIH)
Decreased operative time
Easier learning curve
Improved visualization of pelvic organs
More cost effective
Less physician fatigue
Improved joint dexterity
What is an advantage of robotic surgery over laparoscopic surgery? (2012, 2019, 2021)
Reduced operative time
Better tactile feedback
Better visualization
Easier learning curve
Improved joint dexterity
Improved visualization of pelvic organs
Better visualization
What results in the highest patient satisfaction for patients undergoing surgery for AUB? (2007, 2009, 2011, 2012, 2014, 2015, 2018, 2023 NIH)
Rollerball ablation
Microwave ablation
Thermal ablation
Hysterectomy
Hysteroscopic loop resection
Hysterectomy
Which hysteroscopy fluid causes hyperammonemia? (2022)
Glycine
Which method to perform septoplasty is most likely to result in uterine rupture? (2021, 2022)
Morcellator
Cold scissors
Unipolar cautery/Electrocautery
Unipolar cautery/Electrocautery
What is more likely associated with laparoscopic myomectomy compared to open myomectomy? (2021)
Longer recovery
More likely for hysterectomy
More likely needs another myomectomy
More likely needs another myomectomy
What is the underlying mechanism causing post-op adhesions? (2018, 2019, 2021)
Fibrin deposition
Vascular constriction
Plasmin activation
Fibrin deposition
What is a disadvantage of laparoscopic myomectomy compared to open myomectomy? (2021)
Increased operative time
Increased risk of infection
Increased risk of adhesion formation
Higher chance for the patient to require future hysterectomy
Increased operative time
What is the best management for a patient with an asymptomatic 7cm type 6 fibroid and infertility? (2021)
Hysteroscopic myomectomy
Expectant management
Laparoscopic myomectomy
Open myomectomy
Expectant management
How does an electrocautery device cause tissue destruction? (2016)
Polarity
Energy density
Wave form
Tissue dessication
Tissue dessication
How do you minimize post-op adhesions? (2016, 2017)
Barrier
Minimize tissue destruction
Minimize tissue destruction
What do you do when you perforate the top of the uterus during a diagnostic hysteroscopy and there is no bleeding? (2018)
Re-evaluate and observe in PACU
Immediate laparoscopy
Transabdominal ultrasound (US) in OR
Re-evaluate and observe in PACU
What is the best treatment for a woman with a 3cm submucosal fibroid desiring future fertility? (2011, 2012, 2018)
Hysteroscopic myomectomy
Abdominal myomectomy
Uterine artery embolization (UAE)
Hysteroscopic myomectomy
A patient develops bleeding at venipuncture sites and gums after surgery. What was the most likely procedure? (What procedure can cause DIC?) (1999, 2003, 2005, 2007, 2009, 2010, 2011, 2018, 2023 NIH)
Hysteroscopic septum resection with glycine
Hysteroscopic polypectomy with dextran
Hysteroscopic myomectomy with loop electrode and CO2 medium
Endometrial ablation with YAG laser
Laparoscopy with argon beam
Hysteroscopic polypectomy with dextran
What is the least worrisome during hysteroscopy if there is a fluid deficit >1500mL? (2011, 2018)
Mannitol 5%
Sorbitol 3%
Glycine 1.5%
Saline 0.9%
Saline 0.9%
What is the least likely complication from hysteroscopic myomectomy using glycine? (1999, 2005, 2011, 2012, 2013, 2014, 2015, 2018, 2023 NIH)
CHF
Hypervolemia
Grand mal seizures
Elevated ammonia levels
DIC
Hyponatremia
Pulmonary edema
DIC
What is the first sign of glycine overload? (2005, 2018, 2023 NIH)
Hypoxia
Bradycardia
Seizures
Bradycardia
A 10cm multicystic mass with no excrescences is found in the adnexa 1yr after normal adnexal and tubal ligation with cautery. She had normal ovaries last year. What is the most likely diagnosis? (2003, 2007, 2011)
Fallopian tube cancer
Hydrosalpinx
Cystadenoma
Salpingitis isthmica nodosa (SIN)
Serous cancer
A 10cm complex mass is found in the adnexa 1yr after BTL. What is the most likely diagnosis? (2023 NIH)
Hydrosalpinx
Cystadenoma
Peritoneal inclusion cyst
A 17yoF presents with right lower quadrant pain is discovered to have a 10cm multiloculated cystic mass in her right adnexa. One year ago, she underwent laparoscopy where normal ovaries and a small right hydrosalpinx were noted. What is the most likely etiology? (1999)
Mature teratoma
Cystadenoma
Endometrioma
Hydrosalpinx
Hydrosalpinx
What is the least likely complication after a submucosal myomectomy? (2011)
CHF
Hypervolemia
DIC
Others
DIC
A 31yoF with 2yr of unexplained infertility has a 6cm posterior fibroid. What is the best treatment? (2007, 2023 NIH)
IVF
Clomiphene citrate (Clomid) IUI
Myomectomy
Myomectomy
The successful creation of a functional vagina in a 20yoF with a mullerian anomaly and a vaginal dimple on pelvic exam is best established by which of the following? (2022)
Abbe-McIndoe procedure
Vecchietti procedure
Csokmay bowel interposition
Vaginal dilation
Split-thickness skin graft
Vaginal dilation
What is the most effective way to improve pregnancy rates for IVF in patients with hydrosalpinges? (2007, 2023 NIH)
Proximal occlusion of tubes
Salpingectomy
Tubal aspiration at time of retrieval
Salpingectomy
Which of the following hysteroscopic distension medias is most commonly associated with anaphylaxis? (1999)
Sorbitol
Hyskon
Glycine
Mannitol
Saline
Hyskon
Which of the following is true regarding the reformation of adhesions after adhesiolysis? (1999)
Expected to be similar for laparoscopy or laparotomy
Greater with monofilament suture than with braided
Is decreased with lavage using lactated ringers
Is definitely decreased with instillation of dextran
Is decreased with lavage using lactated ringers
What is the most common site of injury during laparoscopy? (2007, 2023 NIH)
Bowel
Ureter
Vascular
Bladder
Bladder
You are negotiating the endocervical canal with a 30-degree hysteroscope. Where on the monitor screen should you keep the cervical os? (2003, 2010)
In the middle of the screen
In the lower half of the screen
In the upper half of the screen
If camera facing up, os should be on the lower half of the screen
What type of laser can be used to remove endometriosis from the bowel? (2005)
YAG
KTP
CO2
Cautery
CO2
What should be included in the pre-op evaluation of a patient who has POI and is undergoing elective surgery? (2005, 2007, 2023 NIH)
ACTH
ACTH stimulation test
Fasting glucose
Serum electrolytes
Serum cortisol
Antiadrenal antibodies
Serum cortisol
What is the most important test before performing laparoscopy on a patient with Turner Syndrome 45,X? (2023 NIH)
Dexamethasone suppression test
Electrolytes
TSH
Electrolytes
What is the best adhesion barrier? (2007)
Dextran
IV steroids
Cellulose paper
Gelfoam
Cellulose paper
What is the first sign of fluid overload in hysteroscopy? (2007)
Ventricular arrhythmia
Bradycardia
Hypoxia
Oliguria
Hypoxia
A patient is planning to undergo IVF but has a unilateral hydrosalpinx. What is the best treatment? (2023 NIH)
Proximal clips bilaterally
Unilateral salpingectomy
Bilateral tubal ligation
Bilateral salpingectomy
Expectant management
Unilateral salpingectomy
What are the two most prevalent immune cells in the uterus? (2012, 2021)
Uterine natural killer (uNK) cells and T-helper cells
Uterine natural killer (uNK) cells and B cells
Uterine natural killer (uNK) cells and something else (macrophages)
Uterine natural killer (uNK) cells and T-helper cells
What is the correct ratio in the uterus compared to peripheral serum? (2021)
Elevated uterine natural killer (uNK)
Elevated T-helper cells
Elevated uterine natural killer (uNK)
The immunosuppressive characteristics of progesterone include which of the following? (2021)
Mitogen-induced proliferation of CD8+
T cytokine secretion by these cells
Promotion of Th2-type responses with increased expression of LIF
Promotion of Th2-type responses with increased expression of LIF
Which is most true of endometrial immune cells? (2003, 2005, 2011)
Located only in the basalis
Located overlying superficial layer
Mostly monocytes, macrophages, and T cells
Plasma cells
Clusters of immune cells within the glandular epithelium
Scattered macrophages only in the basalis layer
Mostly monocytes, macrophages, and T cells
What immune cells are in the healthy endometrium? (2023 NIH)
B cells
Plasma cells
Monocytes
Macrophages
T cells
Macrophages
What cells are seen with chronic endometritis? (2012, 2018)
Plasma cells
Natural killer (NK) cells
Dendritic cells
Exhausted glandular cells
Plasma cells
Which of the following is seen during the luteal phase of normal endometrial tissue? (2021)
T-helper cells
CD8+
Decreased natural killer (NK) cells
B lymphocytes
T-helper cells
*Also NK cells
What immunologic cell change is characteristic of implantation? (2003, 2005, 2007, 2017, 2018, 2023 NIH)
Increased plasma cells
Increased B cells
Increased natural killer (NK) cells
No change
Increased natural killer (NK) cells
What cells are most likely to be found in endometrium at time of implantation? (2005, 2005, 2007, 2011, 2012, 2013, 2014, 2015, 2018)
Plasma cells
B cells
Natural killer (NK) cells
Monocytes
Natural killer (NK) cells
Where are endometrial lymphocytes? (2005)
Right near endometrial cavity
Perivascular
Perivascular
What is a proven treatment for immune related RPL? (2023 NIH)
IgG
Paternal sperm immunization
Paternal leukocyte immunization
Aspirin
Heparin
Nothing
Nothing
How do you make a clinical diagnosis of sexual dysfunction or anorgasmia? (2011, 2013, 2014, 2015, 2017, 2018, 2023 NIH)
When symptoms are bothersome to patient/Personal distress
Depression
Orgasm with masturbation
Fear of sexual intercourse
When symptoms are bothersome to patient/Personal distress
What percent of women in the United States have sexual dysfunction? (2015)
5%
11%
25%
35%
50%
11%
What is most common among sexual disorder in women? (2003, 2005, 2007, 2013, 2014, 2015, 2018, 2023 NIH)
Low desire
Anorgasmia
Arousal disorder
Sexual pain disorder
Low desire
What is associated with female sexual dysfunction? (2012, 2018)
Adrenal hyperplasia
Hypothyroidism
Diabetes
Hyperthyroidism
Diabetes
Female patients with a history of sexual abuse are most likely to have which of the following? (2011)
Decreased sexual desire, normal arousal
Decreased arousal, normal sexual desire
Decreased in arousal, decreased sexual desire
Normal arousal, normal sexual desire
Decreased in arousal, decreased sexual desire
Which of the following occurs after the completion of a meal? (2011, 2015, 2018, 2021, 2023 NIH)
Increased ghrelin
Increased leptin
Increased growth hormone
Increased glucagon
Increased CRH
__ somatostatin
Increased leptin
What decreases with food intake? (2011, 2018)
Leptin
Ghrelin
ACTH
Aromatase
Ghrelin
What type of receptor is the leptin receptor? (2011, 2013, 2014, 2021, 2022)
Tyrosine kinase
JAK/STAT (aka cytokine receptor)
Phospholipase C (PLC)
GPCR
JAK/STAT (aka cytokine receptor)
What change is most commonly seen in anorexia nervosa? (2016, 2020, 2021)
Increased T3
Loss of diurnal variation of leptin
Reduced cortisol
Increased prolactin
Loss of diurnal variation of leptin
What is changed in anorexia? (2012, 2017, 2018)
Low rT3
Low cortisol
Low leptin
Low leptin
What is the most likely thyroid profile in anorexia? (How are thyroid hormones affected by anorexia?) (2003, 2005, 2007, 2009, 2011, 2013, 2014, 2015, 2018, 2023 NIH)
High TSH, low free T4, high T3, normal rT3
Low TSH, low T4, normal T3, normal rT3
Low TSH, high T4, high T3, normal rT3
Normal TSH, normal T4, low T3, high rT3
Normal TSH, normal T4, low T3, high rT3
Anorexia is most associated with what thyroid abnormality? (2023 NIH)
Increased rT3
Decreased rT3
Increased rT3
What is the most likely hormone abnormality in anorexia? (2018, 2019)
Increased T3
Increased leptin
Increased CRH
Increased prolactin
Increased CRH
What is the second messenger for leptin? (2014, 2015, 2017, 2018)
cAMP
STAT
STAT
What is the central mechanism responsible for the decreased gonadotropin secretion in a woman with anorexia? (2005)
- Loss of GnRH function
- Opioid-mediated decrease in GnRH pulsatility
- Increased CRH
How does anorexia lead to amenorrhea/hypogonadism? (2009, 2011, 2018, 2022, 2023 NIH)
- Opioid inhibition of GnRH pulses
- Increased prolactin
- Catechol estrogens
- Low leptin
- CRH/High cortisol
How does anorexia lead to anovulation? (2023 NIH)
- Opioid on hypothalamus
- ACTH stimulates cortisol
What potentiates the action of CRH to suppress GnRH in anorexia? (2012)
- Neuropeptide Y (NPY)
- Ghrelin
- Opioids
Opioid-mediated decrease in GnRH pulsatility
What abnormality is seen with anorexia? (2012, 2023 NIH)
High cortisol
What is the least likely to be seen with anorexia? (2012, 2018, 2023 NIH)
Diarrhea
Lanugo
Carotenemia
Bradycardia
Hypotension
Diarrhea
What changes are seen in ghrelin in anorexia? (2023 NIH)
Increased ghrelin
Decreased ghrelin
Increased ghrelin
What is most likely in anorexia? (2015, 2023 NIH)
Leptin decreased
Ghrelin decreased
Others
Leptin decreased
What is least likely to be found in anorexia? (2011)
Hypercarotenemia
Bradycardia
Hypotension
High TSH
Low T3
High TSH
Leptin is most likely to increase which of the following? (2015)
Protein kinase A (PKA)
JAK
Phospholipase C (PLC)
JAK
Hypercarotenemia is associated with which abnormality? (2003, 2010)
Hypogonadotropic hypogonadism (hypo-hypo)
Hypergonadotropic hypogonadism (hyper-hypo)
Hypogonadotropic hypogonadism (hypo-hypo)
How do you reduce background noise in immunohistochemistry (IHC)? (2021)
Increase exposure time
Add a second antibody
Something about goat milk antigen
Something about goat milk antigen
How do you confirm specificity in immunohistochemistry (IHC)? (2023 NIH)
Positive and negative controls
How do you assure the sensitivity of an antibody when doing immunohistochemistry (IHC)? (2016)
Use known antigen
Use another antibody
Use known antigen
What does ELISA rely on? (2007, 2020)
Radiolabeled antigen
Radiolabeled antibody
Radiolabeled substrate
Chromagen/enzyme complex
Second antibody bound to solid matrix
Chromagen/enzyme complex
What is an important component of ELISA? (2001, 2007, 2011, 2012, 2014, 2015)
Radiolabeled antigen
Radiolabeled antibody
Competitive binding
Chromogenic
Chromogenic
What is a property of ELISA? (2011, 2014, 2015, 2016, 2017, 2018, 2023 NIH)
Chemical reaction (chemogen)
Radiolabeled antigen or antibody (ligand)
Antibody bound to (a solid) matrix
Requires secondary antibody
Requires secondary antibody
What type of assay is ELISA? (2015, 2018, 2023 NIH)
Competitive binding assay
Use of radioactive antigen
Use of radioactive antibody
Use of chromogen attached to immunoglobulin
Use of chromogen attached to immunoglobulin
What is the best technique to decrease background noise in the development of an immunoassay? (2021)
Longer antigen-antibody binding time
Culture in dry milk to prevent nonspecific binding
Others
What is the best technique to decrease nonspecific binding in the development of an immunoassay (2018)
Longer antigen-antibody binding time
Culture in dry milk
Culture in dry milk to prevent nonspecific binding
Which hormone assay is affected by the Hook effect? (208)
Radioimmunoassay (RIA)
Immunoradiometric assay (IRMA)
IRMA
What is the best next step when you suspect influence from the Hook effect? (2015, 2021, 2023 NIH)
Serum dilution
Develop an antibody complex to bind excess antigen
Repeat serum draw
Add polyethylene glycol
Something about radioimmunoassay (RIA) & something else I can’t remember
Serum dilution
Which assay has an inverse relationship between radiolabeled antigen and patient hormone/sample antigen? (2020)
Radioimmunoassay (RIA)
Immunoradiometric assay (IRMA)
ELISA
Which has an inverse relationship between concentration of unknown antigen and percent bound radioactive protein? (2001, 2018)
Radioimmunoassay (RIA)
Immunoradiometric assay (IRMA)
ELISA
Radioimmunoassay (RIA)
What is immunoradiometric assay (IRMA)? (2003, 2011, 2012, 2018)
Use of radioactive labeled antibodies to detect and quantify antigen concentration
Use of radioactive antigen to detect and quantify antibody concentration
Competition assay
Colorimetric assay
Use of radioactive labeled antibodies to detect and quantify antigen concentration
Which is correct concerning the immunoradiometric assay (IRMA)? (2009, 2018, 2023 NIH)
Radiolabeled antigen
Radiolabeled antibody
Requires matrix
Competition assay
Radiolabeled antibody
Spectrophotometric separation prior to radioimmunoassay (RIA) improves which of the following for the assay? (2003) purifying sample prior to radioimmunoassay
Precision
Accuracy
Reliability
Sensitivity
Specificity
Specificity
You wish to perform a single tube assay for two similar proteins, protein A and protein B, in the same sample. What must you do before you can begin the assay? (1999)
Prove that they have different ligand binding sites
Show that it cannot be done
Demonstrate that the second antibody has different affinity for the two proteins
Demonstrate that the second antibody has different affinity for the two proteins
The success of an immunosorbent radioimmunoassay (RIA) depends on which of the following? (1999, 2007)
The antibody is attached to a matrix, followed by addition of analyte and a second antibody
The antibody is linked to a solute reaction
The ligand is radiolabeled
The antibody is radiolabeled
The ligand is radiolabeled
What will shift the radioimmunoassay (RIA) curve to the left? (2007, 2010)
Increased sensitivity
Increased specificity
Increased accuracy
Increased sensitivity
Which one of the following antibodies is most likely to interfere with an immunoassay? (2007)
Heterophilic antibodies
What is the best way to assess for heterophilic antibodies in a patient who is clinically euthyroid with elevated TSH and works in a lab (is a vet tech)? (2014, 2015, 2019)
Serum dilution
Plasma dilution
Stop working with mice and rabbits
Serial collections
Serum dilution
Heterophilic antibodies are most likely to be found in someone with which of the following occupations? (2011, 2023 NIH)
Steel worker
Nurse
Vet tech
Vet tech
A patient is on levothyroxine (Synthroid) and clinically euthyroid, but her TSH is always increased. How do you prove heterophilic antibodies against TSH? (2023 NIH)
Serial dilutions
Precipitate with polyethylene glycol (PEG)
Serial dilutions
What is the best test to determine apoptosis? (2003, 2005, 2009, 2013, 2014, 2018, 2023 NIH)
Caspase gene
Frozen tissue section
H&E
TUNEL assay
TUNEL assay
*apoptosis in ovarian tissue: all of these are correct - DNA ladder testing, flow cytometry, TUNEL assay, Comet assay, IHC for caspase-3
How is apoptosis in ovarian tissue quantitated? (2003)
In situ hybridization
Histochemical testing on frozen section
DNA ladder testing
DNA ladder testing
What is least likely to cause an assay shift? (2014, 2015)
Too many samples
Minimal time putting in stopping reagent
Minimizing time between samples
Minimizing time between samples
What is the best strategy to minimize assay drift in a large sample? (2011, 2023 NIH)
Put on ice
Do small samples
Add antibody first
Use less antibody in early samples
Put on ice
What is the sandwich assay best for detecting? (2011)
Binding of receptors
Phosphorylated receptors
Density of receptors
Density of receptors
How can you quantify the number of LH receptors on Leydig cells? (2007, 2011)
RT-PCR
Radioimmunoassay (RIA)
Scatchard plot
Histochemistry
Immunofluorescence
Scatchard plot
How many moles of hormone are in the serum? (2009, 2023 NIH)
10-4 – 10-7
10-7 – 10-9
10-9 – 10-11
10-11 – 10-13
10-7 – 10-9
What is the most accurate way to measure steroid hormones? (2015)
Mass spectrometry
HPLC
Others
Mass spectrometry
What is the best way to identify the action of a newly identified progestin on the endometrium? (2021)
Something about mice endometrial tissue (no mention of estrogen priming)
Something about estrogen-primed rabbit endometrial tissue
ELISA
Sounds like the description of an radioimmunoassay (RIA)
Something about estrogen-primed rabbit endometrial tissue
How do you test progestin on an estrogen-primed endometrium? (2015, 2016)
Rabbit
Mice
Others
Rabbit
How to find out what is the most potent progestin? (2023 NIH)
Rabbit primed endometrium and see endometrial growth with progesterone
Mice decidualization
Renal clearance in a monkey
Decidua of a monkey
Rabbit primed endometrium and see endometrial growth with progesterone
What is the most specific assay for 17-beta-estradiol? (2011, 2012, 2018)
Direct immunoassay
Reco LC-MS or GC-MS
ELISA
Noncompetitive assay
Radioimmunoassay (RIA)
Gas chromatography
Reco LC-MS or GC-MS
Some type of chromatographic technique is used in a sample with low levels of estradiol to improve what aspect of the assay? (1999)
Specificity
Accuracy
Precision
Sensitivity
Sensitivity
Why are testosterone levels so difficult to measure in women? (Why are testosterone assays in women so unreliable?) (2011, 2012)
Lack of specificity
Lack of sensitivity
BMI
Why are testosterone levels so difficult to measure in women? (2011, 2018, 2023 NIH)
Low assay sensitivity
Low assay specificity
BMI
Fluctuating concentration in menopause
Menstrual variation
Lack of sensitivity
Low assay sensitivity
What is the most accurate way to detect estradiol? (2023 NIH)
HPLC
ELISA
HPLC (high performance liquid chromatography or MS)
What is the gold standard for measuring free testosterone? (2013, 2019)
Mass spectrometry
Equilibrium dialysis
Radioimmunoassay (RIA)
Immunoradiometric assay (IRMA)
Calculating with SHBG
Equilibrium dialysis
You are performing an assay on a new protein using radioiodine and the protein fails to bind to your label (failure of iodination). What is the protein most likely lacking? (1999, 2011, 2012)
Histidine or cysteine residues
Tyrosine (residues)
Correct hormone conformation
What causes failure to iodinate a new protein? (2001, 2007, 2018, 2023 NIH)
Excess tyrosine residues
Increased TSH
No tyrosine residues available
Abnormal receptor binding
Correct amino acid sequence for binding
Why would you be unable to label a protein? (2023 NIH)
Not enough amino acids
No phenylalanine or tyrosine
Tyrosine (residues)
No tyrosine residues available
No phenylalanine or tyrosine
What is meant by accuracy? (2023 NIH)
The extent to which a given measurement agrees with the actual value
What is the interassay coefficient of variation? (2020)
SD/mean for multiple values of one assay
SD/mean for multiple values of many assays
Other options that didn’t make sense
SD/mean for multiple values of many assays
What is increased if there is a leftward shift in a standard curve? (2007)
Sensitivity
Specificity
Validity
Accuracy
Sensitivity
Multiple samples are giving the same result. What is characteristic of this result? (2016, 2017)
Precision
Accuracy
Precision
What is the specificity of a given assay? (2018)
Smallest amount of a substance that can be measured
Capacity to measure only the substance in question
Ability to distinguish protein (large molecules) from steroid (small molecules)
Ability to reproduce test
Capacity to measure only the substance in question
What does an LH in vitro bioassay test for? (2005, 2014, 2023 NIH)
Immunologic specificity
What do you worry about if a test is binding at 5%? (2007)
Accuracy
Precision
Accuracy
A sample is purified before running an assay. What does this improve? (2010)
Accuracy
Precision
Accuracy
The best definition of the statistical accuracy of an assay? (2018, 2021)
The reproducibility of results over multiple tests from the same patient
The reproducibility of results over multiple tests from multiple patients
The reproducibility of results compared to a blank tube spiked with known antigen
The reproducibility of an assay over time
The reproducibility of results compared to a blank tube spiked with known antigen
What is the formula for plasma production rate? (What is the plasma production rate of a hormone equivalent to?) (2011, 2012, 2014, 2015, 2016, 2017, 2018, 2019, 2023 NIH)
(MCR+2C)/C
MCR/C
MCRxC
C/MCR
C+MCR
MCRxC
What are the units for MCR? (2012)
L/day
The discipline within clinical pharmacology that broadly describes the changes in the quantity of drug and/or drug metabolite in various body compartments over time. These changes can be described by four processes: absorption, distribution, metabolism, and excretion.
Pharmacokinetics
Study of how a drug affects an organism physiologically and biochemically, such as the relationships between the measured drug concentration and its efficacy and adverse effects
Pharmacodynamics
What is the effect of shifting the curve to the right? (2012, 2013, 2018)
Competitive agonist
Competitive antagonist
Noncompetitive antagonist
Irreversible antagonist
Competitive antagonist
The Arias-Stella reaction most commonly occurs in the presence of which of the following? (2021)
Chorionic tissue
Granulosa cell tumor
Theca-luteoma tumor
Can’t remember what else
Chorionic tissue
What is found on histology of granulosa cell tumors? (2018)?
Call-Exner bodies
Call-Exner bodies
What is seen on histology in endometritis? (2014, 2015, 2017, 2018)
Plasma cells
A 46yoF has an endometrial biopsy performed. She is perimenopausal. (Gave an image of what I thought was simple hyperplasia without atypia) What is the best treatment? (2012, 2023 NIH)
Hysterectomy
OCPs
Cyclic progesterone
Cyclic progesterone
Salpingitis isthmica nodosa (SIN) has which of the following findings? (2011)
Endometrial implants on histology
Inflammation and tubal scarring
Increased smooth muscle hypertrophy
Increased smooth muscle hypertrophy
(A histologic slide showing seminiferous tubule) History notes that the man has azoospermia. What is the diagnosis? (2023 NIH)
Sertoli only
FSH receptor defect
CBAVD
Sertoli only
Which histologic picture would be seen with prolonged progestin treatment? (2003)
(photomicrograph of endometrium with atrophic glands)
(photomicrograph of endometrium with atrophic glands)
What is closest to prevalence? (2007)
Morbidity rate
Mortality rate
Disease rate on autopsy
Attack rate
Morbidity rate
Referring to a 2x2 table, what does D/D+B represent? (2009, 2023 NIH)
Sensitivity
Specificity
NPV
Specificity
What best characterizes receiver operating characteristic (ROC) curve? (2023 NIH)
Shift to left indicates decrease in accuracy
The best way to demonstrate interrelationship of sensitivity and specificity
Demonstrates that at each point there is a tradeoff between false negatives and sensitivity
The best way to demonstrate interrelationship of sensitivity and specificity
What will shift the receiver operating characteristic (ROC) curve to the left? (2023 NIH)
Increased sensitivity
Increased specificity
Increased accuracy
Increased accuracy
