First Aid for the USMLE Step 1 2011 EXPRESS workbook

page 175

Reproductive
Questions
ANATOMY
1.

Describe the venous drainage flow from the left ovary/testicle. Describe the venous drainage flow
from the right ovary/testicle. (p. 478) _________________________________________________
______________________________________________________________________________

2.

On which side are varicoceles more common? (p. 478) __________________________________

3.

Match the female reproductive system ligament to the structures it connects. (p. 478)
_____ A. Connects cervix to side wall of pelvis
_____ B. Connects ovaries to lateral pelvic wall
_____ C. Connects ovaries to lateral uterus
_____ D. Connects uterine fundus to labia majora
_____ D. Connects uterus, fallopian tubes, and
ovaries to side wall of pelvis

4.

1.
2.
3.
4.
5.

Broad ligament
Cardinal ligament
Ligament of the ovary
Round ligament
Suspensory ligament of the ovary

What is the pathway of sperm during ejaculation? (p. 479) ________________________________

______________________________________________________________________________

5.

Why arent gametes attacked by a mans immune system? (p. 480) _________________________
______________________________________________________________________________

PHYSIOLOGY
6.

What are the three major forms of androgens? How do they compare in potency? (p. 482) _______
______________________________________________________________________________

7.

List the five functions of testosterone. (p. 482) __________________________________________

______________________________________________________________________________

8.

What are the three major forms of estrogen? How do they compare in potency? (p. 482) ________
______________________________________________________________________________

9.

What are the three major sources of estrogens? (p. 482) _________________________________
______________________________________________________________________________

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10.

First Aid for the USMLE Step 1 2011 EXPRESS workbook

List the four functions of estrogen. (p. 482) ____________________________________________

______________________________________________________________________________
______________________________________________________________________________

11.

Identify which hormone levels are shown on the image below. (p. 483)

12.

Define the following terms. (p. 483)

13.

A.

Menometrorrhagia __________________________________________________________

B.

Metrorrhagia _______________________________________________________________

C.

Oligomenorrhea _____________________________________________________________

D.

Polymenorrhea _____________________________________________________________

In a nonpregnant woman, where is hCG synthesized? Where is hCG synthesized after pregnancy?
After pregnancy, when is hCG first detectable in the blood? In the urine? (pp. 484-485)
______________________________________________________________________________

14.

In what pathologic states can hCG levels be elevated? (p. 485) _______________________
______________________________________________________________________________

15.

What hormonal changes occur during menopause? (p. 485) ______________________________

______________________________________________________________________________

16.

What are the sequelae of menopause? (p. 485) ________________________________________

______________________________________________________________________________

PATHOLOGY
17.

Klinefelters syndrome is associated with which genotype? What are the clinical findings? (p. 485)
______________________________________________________________________________

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

18.

page 177

Turners syndrome is associated with which genotype? What are the clinical findings? (p. 485) ___
______________________________________________________________________________

19.

In the chart below, indicate whether the lab findings are elevated, decreased, or normal. (p. 486)
Diagnosis

LH

Testosterone

Defective androgen receptor

Hypogonadotropic hypogonadism
Primary hypogonadism
Testosterone-secreting tumor or
exogenous steroids
20.

21.

What is the most common cause of recurrent miscarriage during the periods below? (p. 487)
A.

First weeks ________________________________________________________________

B.

First trimester ______________________________________________________________

C.

Second trimester ____________________________________________________________

What are the risk factors for preeclampsia/eclampsia? (p. 487) ____________________________
______________________________________________________________________________

22.

What is HELLP syndrome? (p. 487) __________________________________________________

23.

Define the following terms and list the risk factors. (p. 488)
A.

Abruptio placentae __________________________________________________________

__________________________________________________________________________

B.

Placenta accreta ____________________________________________________________

__________________________________________________________________________

C.

Placenta previa _____________________________________________________________

__________________________________________________________________________

24.

What are the most common risk factors for ectopic pregnancy? (p. 488) _____________________
______________________________________________________________________________

25.

Rank the incidence of gynecologic tumors in the United States from most common to least
common: Cervical, endometrial, and ovarian. Then rank the prognosis of these tumors from worst
to best. (p. 489) _________________________________________________________________

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26.

First Aid for the USMLE Step 1 2011 EXPRESS workbook

Match these gynecologic conditions with their associated diagnostic findings. (pp. 488-492)
_____ A. Cervical carcinoma in situ
_____ B. Choriocarcinoma
_____ C. Dysgerminoma
_____ D. Endometriosis
_____ E. Granulosa cell tumor
_____ F. Invasive cervical carcinoma
_____ G. Krukenberg tumor
_____ H. Oligohydramnios
_____ I. Ovarian cancer
_____ J. Polyhydramnios
_____ K. Teratoma
_____ L. Yolk sac tumor

27.

<0.5 L of amniotic fluid

>1.5-2 L of amniotic fluid
Call-Exner bodies
Chocolate cysts
Dermoid cyst
HPV types 16 and 18
Increased AFP level
Increased CA-125 level
Increased hCG level
Increased hCG and LDH levels
Koilocytes
Signet cells

Match these breast tumors with their associated diagnostic findings. (pp. 492-493)
_____ A. Ductal carcinoma in situ
_____ B. Fibroadenoma
_____ C. Inflammatory carcinoma
_____ D. Intraductal papilloma
_____ E. Invasive ductal carcinoma
_____ F. Invasive lobular carcinoma
_____ G. Pagets disease of breast

28.

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

1.
2.
3.
4.
5.
6.
7.

Bilateral
Ductal hyperplasia
Eczematous patches on nipple
Hard mass with sharp margins
Increased tenderness with menstruation
Peau dorange
Serous nipple discharge; benign

Why is benign prostatic hyperplasia more likely to cause urinary retention than prostatic
adenocarcinoma? (p. 495) _________________________________________________________
______________________________________________________________________________

29.

How are most prostate cancers diagnosed? (p. 495) _____________________________________

30.

Match these testicular conditions with their associated diagnostic findings. (p. 496)
_____ A. Bowenoid papulosis
_____ B. Bowens disease
_____ C. Choriocarcinoma
_____ D. Embryonal carcinoma
_____ E. Erythroplasia of Queyrat
_____ F. Hydrocele
_____ G. Leydig cell tumor
_____ H. Peyronies disease
_____ I. Seminoma
_____ J. Sertoli cell tumor
_____ K. Spermatocele
_____ L. Squamous cell carcinoma
_____ M. Testicular lymphoma
_____ N. Varicocele
_____ O. Yolk sac tumor

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Androblastoma
Associated with lack of circumcision
Crusty plaques on penis
Dilated epididymal duct
Dilated vein in pampiniform plexus
Fibrous tissue formation bends penis
Increased AFP and hCG levels
Increased fluid around testicle
Increased hCG level
Most common testicular tumor
Most common testicular tumor in older men
Multiple papular lesions
Red, velvety plaques on penis
Reinke crystals
Schiller-Duval bodies

PHARMACOLOGY
31.

Continuous leuprolide has __________ (agonist/antagonist) properties, while pulsatile leuprolide

has __________ (agonist/antagonist) properties. (p. 497)

32.

What drug is commonly used to treat BPH? (p. 498) _____________________________________

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page 179

33.

When would estrogen be prescribed to a man? (p. 498) __________________________________

34.

How does clomiphene stimulate ovulation? (p. 498) _____________________________________

______________________________________________________________________________

35.

What is the main clinical use of tamoxifen? (p. 498) _____________________________________

36.

How do oral contraceptive pills prevent pregnancy? (p. 499) ______________________________

______________________________________________________________________________

37.

In which patients are oral contraceptive pills contraindicated? (p. 499) _______________________
______________________________________________________________________________

38.

What toxicities are associated with sildenafil and vardenafil? (p. 499) ________________________
______________________________________________________________________________

Answers
ANATOMY AND PHYSIOLOGY
1.

Left ovary/testicle left gonadal vein left renal vein inferior vena cava. Right ovary/testicle
right gonadal vein inferior vena cava.

2.

Left side.

3.

A-2, B-3, C-5, D-4, E-1.

4.

Remember SEVEN-UP: Seminiferous tubules Epididymus Vas deferens Ejaculatory ducts

(Nothing) Urethra Penis.

5.

Adjacent Sertoli cells form tight junctions that serve as a blood-testis barrier.

PATHOLOGY
6.

Dihydrotestosterone is more potent than testosterone, which is more potent than androstenedione.

7.

Differentiation of the internal genitalia (except prostate), growth spurts, deeping of the voice,
closing of the epipyseal plate, and libido.

8.

Estradiol is more potent than estrone, which is more potent than estriol.

9.

Ovary (estradiol), placenta (estriol), and blood (aromatization).

10.

Development of genitalia and breast/female fat distribution, growth of follicle/endometrial

proliferation, upregulation of estrogen/luteinizing hormone/progesterone receptors and feedback
inhibition of FSH/LH, and increased transport of proteins.

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

11.

12.

A.

Menometrorrhagia: heavy menstruation.

B.

Metrorrhagia: frequent/irregular menstruation.

C.

Oligomenorrhea: cycle of >35 days.

D.

Polymenorrhea: cycle of <21 days.

13.

Ovaries; in syncytiotrophoblasts of the placenta; 1 week (blood); 2 weeks (urine).

14.

hCG levels can be elevated in hydatidiform moles, choriocarcinoma, and gestational trophoblastic
tumors.

15.

Decreased estrogen and increased FSH, LH, and GnRH levels.

16.

Hirsutism, Hot flashes, Atrophy of Vagina, Osteoporosis, and Coronary artery disease.
(Remember: HHAVOC.)

PHYSIOLOGY
17.

XXY; testicular atrophy, eunuchoid body shape, tall stature, long extremities, and gynecomastia.

18.

XO; short stature, ovarian dysgenesis, webbing of neck, preductal coarctation of aorta, and primary
amenorrhea.

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page 181

19.

Diagnosis

LH

Defective androgen receptor

Hypogonadotropic
hypogonadism
Primary hypogonadism
Testosterone-secreting tumor
or exogenous steroids

Testosterone

20.

A = Low progesterone levels (no response to -hCG). B = Chromosomal abnormalities. C =

Bicornuate uterus or structural abnormalities.

21.

Preexisting hypertension, diabetes, chronic renal disease, and autoimmune disorders.

22.

Hemolysis, Elevated LFTs, Low Platelets.

23.

A.

Abruptio placenta: premature detachment of placenta from site of implantation. Risk factors
include smoking, hypertension, and cocaine use.

C.

Placenta accreta: defective decidual layer allows placenta to attach to the myometrium, which
prevents the placenta from separating after birth. Risk factors include prior C-section,
inflammation, and placenta previa.

D.

Placenta previa: placenta attaches to lower uterine segment. Risk factors include multiparity
and prior C-section.

24.

History of infertility, salpingitis (pelvic inflammatory disease), ruptured appendix, and prior tubal
surgery.

25.

For incidence: endometrial > ovarian > cervical. For prognosis: ovarian > cervical > endometrial.

26.

A-6, B-9, C-10, D-4, E-3, F-11, G-12, H-1, I-8, J-2, K-5, L-7.

27.

A-2, B-5, C-6, D-7, E-4, F-1, G-3.

28.

In BPH the periurethral lobes enlarge to compress the urethra. Prostatic adenocarcinoma occurs
most commonly in the posterior lobe of the prostate, and the tumor would need to grow quite large
before it impinged upon the urethra enough to cause urinary retention.

29.

By digital rectal examination and prostate biopsy.

30.

A-12, B-3, C-9, D-7, E-13, F-8, G-14, H-6, I-10, J-1, K-4, L-2, M-11, N-5, O-15.

PHARMACOLOGY
31.

Antagonist; agonist.

32.

Finasteride.

33.

If he has androgen-dependent prostate cancer.

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34.

By preventing normal feedback inhibition and increasing LH and FSH release from the pituitary.

35.

To treat estrogen receptorpositive breast cancer.

36.

OCPs prevent the estrogen surge, which in turn prevents the LH surge, and thus ovulation.

37.

Smokers >35 years old, patients with a history of thromboembolism and stroke, and those with a
history of estrogen-dependent tumor.

38.

Headache, flushing, dyspepsia, impaired blue-green color vision, and (in patients taking nitrates)
severe hypotension.

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