USMLE Step 1 - Problem Drill 22: The Reproductive System

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1 USMLE Step 1 - Problem Drill 22: The Reproductive System Question No. 1 of A 60 year old man who recently had a urinary tract infection that was treated and resolved has returned complaining of increased frequency of urination that is even interrupting his sleep. Upon questioning he describes some difficulty starting and stopping his flow of urine and some discomfort when urinating. Upon his physical examine you note his vitals are stable and he has some slight bladder distention despite having just provided a urine sample upon arrival at the office. His urine sample is unremarkable. You suspect he may be suffering from. Question #01 (A) Peyronies disease (B) Prostatitis (C) Prostatic Adenocarcinoma (D) Benign Prostatic Hyperplasia (E) Hydrocele Peyronies disease is characterized by abnormal curvature of the penis. Prostatitis presents with dysuria, frequency, urgency, and pain in the lower back. Prostatic carcinoma is characterized by a slowly progressing prostate tumor. D. Correct! Benign prostatic hyperplasia, most commonly found in men over 50, is when the urethra is compressed by an enlarged prostate gland. Hydrocele is fluid accumulation around the testicle. Benign prostatic hyperplasia, most commonly found in men over 50, is when the urethra is compressed by an enlarged prostate gland. It may cause bladder distention and hypertrophy, hydronephrosis, and UTI s. Symptoms of this condition include: Increased frequency of urination Nocturia Difficulty starting and stopping the flow of urine Dysuria Image source: National Cancer Institute. (D)Benign Prostatic Hyperplasia

2 Question No. 2 of Androstenedione is secreted from the. Question #02 (A) Adrenal cortex (B) Testis (C) Hypothalamus (D) Placenta (E) Granulosa cells A. Correct! Androstenedione is secreted from the adrenal cortex. Dihydrotestosterone (DHT) and Testosterone are secreted from the testis. The hypothalamus stimulates the anterior pituitary to release LH (luteinizing hormone) and FSH (follicle-stimulating hormone). Progesterone is a hormone that elevates during ovulation and acts to prepare the body for pregnancy. It is produced in several places in the body including the placenta. Androstenedione can be converted to estrogen in the presence of FSH within the Granulosa cells. Androstenedione is secreted from the adrenal cortex. However, the body is adaptable in that it can also convert cholesterol to androstenedione in the presence of LH within the Theca cells. (A)Adrenal cortex Androstenedione

3 Question No. 3 of A 52 year old woman is brought to the emergency room for a bone fracture after falling down in the shower. While reviewing her medical history, you notice she is taking anastrozole, which may have contributed to her bone weakness. Anastrozole is a therapeutic of the reproductive system that is used. Question #03 (A) As an oral contraceptive. (B) To treat breast cancer. (C) To treat BPH. (D) To diminish menopausal symptoms. (E) To treat prostate cancer. Synthetic progestin and estrogen are therapeutics commonly used by women as oral contraceptives to prevent pregnancy. B. Correct! Women who receive this treatment typically are diagnosed with breast cancer. Finasteride (Propecia) is used to treat BPH. Hormone replacement therapy (HRT) is used to diminish menopausal symptoms. Flutamide is used to treat prostate cancer. Anastrozole is an Aromatase inhibitor. Women who receive this treatment typically meet both of the following criteria. They are diagnosed with breast cancer and they are of postmenopausal age. Tamoxifen is an estrogen partial agonist. It is another therapeutic that is used to treat breast cancer (ER positive). (B)To treat breast cancer. Anastrozole

4 Question No. 4 of Ovulation marks the end of the phase of the menstrual cycle. Question #04 (A) Menstrual (B) Progestational (C) Leuteal (D) Proliferative (E) Secretory The first day of menstruation is the start of a new cycle and is the onset of the menstrual or follicular phase. Progestational is another name for the secretory or leuteal phase, and it occur after ovulation. Leuteal is another name for the secretory or progestational phase, and it occurs after ovulation. D. Correct! The proliferative phase begins when menstruation ends and continues until ovulation. Secretory is another name for progestational or leuteal phase, and it occurs after ovulation. The menstrual cycle typically takes 28 days and consists of three phases. The proliferative phase begins when menstruation ends and continues until ovulation. During this time the endometrium thickens and follicle grows. LH surges which triggers ovulation. Ovulation typically occurs on day 14 of the cycle. (D)Proliferative

5 Question No. 5 of A 15 year old female requests to be placed on oral contraceptives. You advise her that oral contraceptives work by preventing. Question #05 (A) Ovulation (B) Ejaculation (C) Menopause (D) Spermatagonia (E) Obesity A. Correct! Oral contraceptives work by preventing ovulation. Oral contraceptives are taken by women. Ejaculation is the second phase of the male sexual response. While puberty marks the beginning of a woman s childbearing years, menopause marks its end. Sperm development begins with spermatogonia at puberty and continues throughout a man s life. Oral contraceptives are taken by women. An adverse side effect of oral contraceptives is weight gain. Oral contraceptives work by preventing estrogen and LH surges thus preventing ovulation. Synthetic progestin and estrogen are therapeutics commonly used by women as oral contraceptives to prevent pregnancy, and to regulate menstrual flow. When used as a method of contraception effectiveness is excellent with a less than 1% rate of failure. (A) Ovulation

6 Question No. 6 of A 27 year old woman presents with dull, aching discomfort in the lower abdomen; pain during menstrual period; irregular periods; and an unusual increase in facial and body hair. Ultrasound reveals this type of blood-filled cyst associated with ovarian endometriosis: Question #06 (A) Follicular (B) Chocolate (C) Dermoid (D) Pilar (E) Theca-lutien A follicular ovarian cyst is one in which there is distension of unruptured graafian follicle associated with hyperestrinism and endometrial hyperplasia. B. Correct! A chocolate ovarian cyst is one in which ovarian endometriosis causes blood filled cysts. Dermoid cysts come from embryonal tissue and are lined with epithelium. The cavity inside this type of cyst may contain fatty material, hair, teeth, bones, and cartilage. A pilar cyst is found on the scalp. A theca-lutien ovarian cyst is one in which often multiple and bilateral cysts are caused by gonadotropin stimulation. These cysts are associated with choriocarcinoma and moles. Ovarian Cysts are fluid or semisolid sacs that develop in or on the ovary. They may be transient and physiologic or pathologic. A chocolate ovarian cyst is one in which ovarian endometriosis causes blood filled cysts. (B)Chocolate

7 Question No. 7 of The develops into the glans penis in the male and the glans clitoris in the female. (A) Genital tubercle (B) Labioscrotal swelling (C) Paramesenteric duct (D) Urogenital sinus (E) Urogenital folds Question #07 A. Correct! The Genital tubercle develops into the glans penis in the male, and the glans clitoris in the female. The Labioscrotal swelling develops into the scrotal sac in males, and the labia majora in females. The paramesenteric or Mullerian duct progresses to form the fallopian tubes, uterus and a portion of the vagina. The urogenital sinus develops into the corpus spongiosum, bulbourethral glands of Cowper, prostate gland in males, and the vestibular bulbs, greater vestibular glands of Bartholin, urethral and paraurethral glands of Skene in females. The urogenital folds develop into the ventral shaft of the penis and penile urethra in males, and the labia minora in females. The fetal genital structures develop into either male genital components under stimulatory effects from dihydrotestosterone or female genital components under stimulatory effects from estrogen. The Genital tubercle develops into the glans penis in the male, and the glans clitoris in the female. (A)Genital tubercle

8 Question No. 8 of In males, sperm development occurs within the. Question #08 (A) Vas Deferens (B) Penis (C) Seminiferous tubule (D) Epididymis (E) Urethra The vas deferens carries sperm from the epididymis to the ejaculatory ducts. The penis is the external reproductive organ that becomes erect during the first stage of a male s sexual response. C. Correct! Sperm development occurs within the seminiferous tubule of the testis. The epididymis is a pair of ducts that connects the seminiferous tubules to the vas deferens. The urethra is a passageway for both urine and sperm to exit a male s penis. Sperm development begins with spermatogonia (type A+B) at puberty and continues throughout a man s life. This process takes about 2 months and occurs within the seminiferous tubule of the testis. To prevent an autoimmune response the tissues responsible for spermotogenesis are separated from the bloodstream by the blood-testis barrier. The phrase SEVEN UP can be used to help remember the path that sperm travels: Seminiferous tubules, Epididymis, Vas Deferens, and Ejaculatory ducts, (Nothing), Urethra, Penis. (C)Seminiferous tubule

9 Question No. 9 of A 61 year old man would like to start a medication to treat his erectile dysfunction. Before you prescribe Sildenafil or Vardenafil you must confirm that he is not already taking which type of medication? Question #09 (A) Antibiotics (B) Nitrates (C) Nonsteroidal antiinflammatories (D) Parasympatholytics (E) Beta Blockers Think of a class of drugs that affect blood pressure. B. Correct! A potential life-threatening side effect of severe hypotension can occur if they are taken in conjunction with nitrates. Think of a class of drugs that affect blood pressure. Think of a different class of drugs that affect blood pressure. Think of a different class of drugs that affect blood pressure. Sildenafil and Vardenafil are both used to treat erectile dysfunction. A potential lifethreatening side effect of severe hypotension can occur if they are taken in conjunction with nitrates. (B)Nitrates

10 Question No. 10 of A 25 year old woman who is 7 months pregnant presents with elevated blood pressure. The diagnosis of preeclampsia is advanced to eclampsia if symptoms worsen and develops. Question #10 (A) Seizure activity (B) Cerebral hemorrhage (C) ARDS (D) HELLP syndrome (E) Proteinuria A. Correct! The diagnosis of preeclampsia is advanced to eclampsia if seizures develop. Cerebral hemorrhage is a potentially fatal complication of eclampsia. Acute respiratory distress syndrome (ARDS) is a potentially fatal complication of eclampsia. HELLP syndrome is a symptom associated with PIH, preeclampsia, and eclampsia. Proteinuria is a symptom associated with PIH, preeclampsia, and eclampsia. Pregnancy induced hypertension (PIH) is a complication of 7% of pregnancies occurring between 20 wks gestation and 6 weeks postpartum (when it occurs before 20 wks gestation it can be indicative of a molar pregnancy). When severe it can lead to preeclampsia with hypertension, proteinuria, and edema. Preeclampsia, in turn, can worsen into eclampsia if seizures develop. PIH is also associated with HELLP (Hemolysis, Elevated LFT s and Low Platelets) syndrome. Mortality can occur due to cerebral hemorrhage and ARDS. Risk factors for PIH include: a history of hypertension pre-pregnancy, chronic renal disease, diabetes, and/or autoimmune disorders. (A)Seizure activity

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