Reproductive physiology (menstrual cycle, pregnancy) Practice Questions

Question 1

A 26-year-old woman comes to the emergency department because of a 3-day history of nausea and vomiting. Her last menstrual period was 9 weeks ago. A urine pregnancy test is positive. Ultrasonography shows an intrauterine pregnancy consistent in size with a 7-week gestation. The hormone that was measured in this patient's urine to detect the pregnancy is also directly responsible for which of the following processes?

Accepted Answer

Maintenance of the corpus luteum

Answer

Development of breast tissue

Answer

Preparation of the uterine endometrium for implantation

Answer

Inhibition of preterm uterine contractions

Answer

Inhibition of ovulation

Question 2

A scientist in Chicago is studying a new blood test to detect Ab to EBV with increased sensitivity and specificity. So far, her best attempt at creating such an exam reached 82% sensitivity and 88% specificity. She is hoping to increase these numbers by at least 2 percent for each value. After several years of work, she believes that she has actually managed to reach a sensitivity and specificity much greater than what she had originally hoped for. She travels to China to begin testing her newest blood test. She finds 2,000 patients who are willing to participate in her study. Of the 2,000 patients, 1,200 of them are known to be infected with EBV. The scientist tests these 1,200 patients' blood and finds that only 120 of them tested negative with her new exam. Of the patients who are known to be EBV-free, only 20 of them tested positive. Given these results, which of the following correlates with the exam's specificity?

Accepted Answer

98%

Answer

82%

Answer

90%

Answer

84%

Answer

86%

Question 3

A 15-year-old female presents to her family physician for an annual school physical exam and check-up. She is accompanied by her mother to the visit and is present in the exam room. The patient has no complaints, and she does not have any past medical problems. She takes no medications. The patient reports that she remains active, exercising 5 times a week, and eats a healthy and varied diet. Which of the following would be the best way for the physician to obtain a more in-depth social history, including sexual history and use of alcohol, tobacco, or recreational drugs?

Accepted Answer

Ask the mother to step outside into the hall for a portion of the visit

Answer

Disallow the mother to be present in the examination room throughout the entirety of the visit

Answer

Give the patient a social history questionnaire to fill out in the exam room

Answer

Ask the patient the questions directly, with her mother still in the exam room

Answer

Speak softly to the patient so that the mother does not hear and the patient is not embarrassed

Question 4

A 24-year-old woman comes to the physician for preconceptional advice. She has been married for 2 years and would like to conceive within the next year. Menses occur at regular 30-day intervals and last 4 days with normal flow. She does not smoke or drink alcohol and follows a balanced diet. She takes no medications. She is 160 cm (5 ft 3 in) tall and weighs 55 kg (121 lb); BMI is 21.5 kg/m2. Physical examination, including pelvic examination, shows no abnormalities. She has adequate knowledge of the fertile days of her menstrual cycle. Which of the following is most appropriate recommendation for this patient at this time?

Accepted Answer

Begin folate supplementation

Answer

Begin high-dose vitamin A supplementation

Answer

Begin vitamin B12 supplementation

Answer

Begin iron supplementation

Answer

Gain 2 kg prior to conception

Question 5

A newborn infant with karyotype 46, XY has male internal and external reproductive structures. The lack of a uterus in this infant can be attributed to the actions of which of the following cell types?

Accepted Answer

Sertoli

Answer

Granulosa

Answer

Theca

Answer

Leydig

Answer

Reticularis

Question 6

A 16-year-old female presents to her pediatrician’s office because she has not yet started menstruating. On review of systems, she states that she has been increasingly tired, constipated, and cold over the last 6 months. She also endorses a long history of migraines with aura that have increased in frequency over the last year. She complains that these symptoms have affected her performance on the track team. She states that she is not sexually active. Her mother and sister both underwent menarche at age 15. The patient is 5 feet, 4 inches tall and weighs 100 pounds (BMI 17.2 kg/m^2). Temperature is 98.4°F (36.9°C), blood pressure is 98/59 mmHg, pulse is 98/min, and respirations are 14/min. On exam, the patient appears pale and has thinning hair. She has Tanner stage IV breasts and Tanner stage III pubic hair. Which of the following would be most useful in determining this patient’s diagnosis?

Accepted Answer

TSH level

Answer

GnRH level

Answer

FSH and estrogen levels

Answer

Prolactin level

Answer

Pelvic exam

Question 7

A 39-year-old woman seeks evaluation from her gynecologist due to recent changes in her menstrual cycle. Her last menstrual period was greater than 12 months ago. She has 2 children and had regular menstrual periods in the past. She also complains of difficulty in falling and staying asleep, occasional hot flashes, vaginal dryness, and decreased libido. The physical examination is unremarkable, and the height and weight are 1.68 m (5 ft 6 in) and 70 kg (154 lb), respectively. She has the following hormonal panel from 2 months ago when she first sought help for her symptoms.
Hormonal panel results  
Human Chorionic Gonadotropin 4 IU/L (0.8 - 7.3 IU/L)
Thyroid Stimulating Hormone 2.5 mIU/L (0.4 - 4.2 mIU/L)
Prolactin 5 ng/mL (2-29 ng/mL)
Follicle Stimulating Hormone 45 mIU/mL (Follicular phase: 3.1-7.9 mIU/mL; Ovulation peak: 2.3-18.5 mIU/mL; Luteal phase: 1.4-5.5 mIU/mL)
Estradiol 5 pg/mL (Mid-follicular phase: 27-123 pg/mL; Periovulatory: 96-436 pg/mL; Mid-luteal phase: 49-294 pg/mL)
Which of the following is the most likely diagnosis in this patient?

Accepted Answer

Primary ovarian insufficiency (POI)

Answer

Pituitary adenoma

Answer

Hyperthyroidism

Answer

Breast cancer

Answer

Polycystic ovary syndrome (PCOS)

Question 8

A 65-year-old man is admitted to the hospital because of a 1-month history of fatigue, intermittent fever, and weakness. Results from a peripheral blood smear taken during his evaluation are indicative of possible acute myeloid leukemia. Bone marrow aspiration and subsequent cytogenetic studies confirm the diagnosis. The physician sets aside an appointed time-slot and arranges a meeting in a quiet office to inform him about the diagnosis and discuss his options. He has been encouraged to bring someone along to the appointment if he wanted. He comes to your office at the appointed time with his daughter. He appears relaxed, with a full range of affect. Which of the following is the most appropriate opening statement in this situation?

Accepted Answer

What is your understanding of the reasons we did bone marrow aspiration and cytogenetic studies?

Answer

Your lab reports show that you have an acute myeloid leukemia

Answer

You must be curious and maybe even anxious about the results of your tests.

Answer

I may need to refer you to a blood cancer specialist because of your diagnosis. You may need chemotherapy or radiotherapy, which we are not equipped for.

Answer

Would you like to know all the details of your diagnosis, or would you prefer I just explain to you what our options are?

Question 9

A 26-year-old woman comes to the physician because she has not had a menstrual period for 5 weeks. Menarche was at the age of 14 years and menses occurred at regular 30-day intervals. She reports having unprotected sexual intercourse 3 weeks ago. A urine pregnancy test is positive. Which of the following best describes the stage of development of the embryo at this time?

Accepted Answer

Neural crest has formed, but limb buds have not yet formed

Answer

Fetal heart is beating, but cardiac activity is not yet visible on ultrasound

Answer

Limb buds have formed, but fetal movements have not begun

Answer

Sexual differentiation has begun, but fetal movement has not started

Answer

Implantation has occurred, but notochord has not yet formed

Question 10

A 34-year-old woman comes to a physician for a routine health maintenance examination. She moved to Denver 1 week ago after having lived in New York City all her life. She has no history of serious illness and takes no medications. Which of the following sets of changes is most likely on analysis of a blood sample obtained now compared to prior to her move?

Erythropoietin level | O2 saturation | Plasma volume

Accepted Answer

↑ ↓ ↓

Answer

↑ unchanged unchanged

Answer

Unchanged ↓ unchanged

Answer

↓ unchanged ↑

Answer

Unchanged unchanged ↓

Reproductive physiology (menstrual cycle, pregnancy)

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Hypothalamic-pituitary-gonadal axis

Spermatogenesis

Oogenesis and follicular development

Female reproductive cycle phases

Ovulation physiology

Corpus luteum function

Implantation physiology

Placental development and function

Maternal physiological adaptations to pregnancy

Parturition physiology

Lactation physiology

Male sexual physiology

Female sexual physiology

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