Reproductive Physiology — MCQs

A 27-year-old woman with Kallmann syndrome (congenital GnRH deficiency) desires pregnancy. She has been on estrogen-progesterone replacement for bone health. Her physician plans to switch her to pulsatile GnRH therapy. After 6 weeks of treatment, labs show: LH 4 mIU/mL, FSH 5 mIU/mL, estradiol 120 pg/mL. Ultrasound shows a 16mm dominant follicle. Evaluate and synthesize the physiologic response to determine the appropriate next intervention for ovulation induction.

A 30-year-old woman at 28 weeks gestation with gestational diabetes managed with insulin presents with decreased fetal movement. Fetal monitoring shows category II tracing. Umbilical artery Doppler shows absent end-diastolic flow. Her glucose control has been suboptimal (HbA1c 7.8%). Maternal blood pressure is normal. Synthesize the pathophysiologic relationship between her metabolic condition and the Doppler findings to determine the primary mechanism.

A 42-year-old woman with previously regular 28-day cycles now reports cycles varying from 24-35 days over the past year. Day 3 labs show: FSH 18 mIU/mL (normal: 3-10), LH 10 mIU/mL, estradiol 35 pg/mL, AMH 0.4 ng/mL (normal age 40-44: 0.5-2.5). She has three children and desires no future pregnancies but wants to understand her physiology. Evaluate these findings and synthesize the underlying pathophysiologic process.

A 38-year-old G3P2 woman at 39 weeks gestation presents in active labor. She has a history of postpartum hemorrhage with her second delivery requiring transfusion. After delivery of the infant, the placenta is delivered intact 8 minutes later. Her obstetrician administers oxytocin. Ten minutes postpartum, she has moderate vaginal bleeding. Analyze the physiologic mechanisms and determine the most likely cause of bleeding.

A 26-year-old woman with regular menses undergoes hormonal evaluation on day 3 of her cycle: FSH 8 mIU/mL, LH 6 mIU/mL, estradiol 45 pg/mL. On day 14, repeat testing shows: FSH 10 mIU/mL, LH 42 mIU/mL, estradiol 250 pg/mL. On day 21: progesterone 16 ng/mL, estradiol 150 pg/mL. Analyze this hormonal pattern to identify the physiologic mechanism driving the day 14 LH surge.