Over the years, the AMA has run dozens of example questions from Kaplan Medical. If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 1 exam, you might want to know which questions are most often missed by test-prep takers. We’ve compiled six cases from Kaplan Medical involving women’s health. Each question comes with an expert explanation of the answer. You can check out all posts in this series.  

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Think you can answer these questions involving women’s health? Find out now.   

  1. Never had a menstrual period

    1. A 23-year-old woman comes to the physician because she has never had a menstrual period. Physical examination shows absent pubic and axillary hair, small breasts and no palpable uterus. Karyotypic results show 46,XY. Surgical resection of gonadal structures is performed. Examination of tissue obtained shows seminiferous tubules with normal Leydig cells. A loss-of-function mutation of the androgen receptor (AR) gene is found. Which laboratory findings in serum were most likely in this patient prior to surgery?
  2. Postpartum amenorrhea

    1. A 32-year-old woman comes to the physician because of amenorrhea for the past 15 months after delivering a baby. She says that she has also had fatigue, facial swelling, cold intolerance and has gained an additional 4.5 kg (10 pounds) since her baby was born. A review of her records shows that the delivery was complicated by severe hemorrhage. Injection of 500 µg of thyrotropin-releasing hormone fails to produce an increase in either serum TSH or prolactin. Tests will most likely show normal levels of what hormones?
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  3. Woman with vaginal itching, discharge

    1. A 32-year-old woman comes to the physician because of vaginal itching and a malodorous discharge that is worse following her menses. She is sexually active with two partners and recently had unprotected sex. Pelvic examination shows erythema of the cervix and malodorous frothy yellow-green discharge present in the cervical os and vaginal vault. What will a microscopic examination of vaginal secretions show?
  4. Shortness of breath and weight gain

    1. A 68-year-old woman is brought to the emergency department because of shortness of breath and a 4.5 kg (10 lbs.) weight gain over the past two weeks. Her pulse is 105 per minute and blood pressure is 160/84 mm Hg. Physical examination of the neck reveals bilateral jugular venous distension. The abdomen is soft and nontender but a positive fluid wave is present. The extremities show 2+ bilateral pitting edema. She is admitted to the medicine service for treatment. Intravenous furosemide is administered and diuresis of 5 L of fluid occurs in a relatively short time. What is the explanation for the acid-base abnormality in this patient?
  5. Excessive thirst and urination

    1. A 38-year-old woman comes to the physician because of excessive thirst and urination for the past four weeks. Her appetite is increased, but she has lost 6.8 kg (15 lbs.) in one month. Her temperature is 37.5°C (99.5°F), pulse is 87 per minute, respirations are 15 per minute, and blood pressure is 142/88 mm Hg. Physical examination shows erythematous necrotizing skin eruptions on her legs. Her fasting blood glucose is 170 mg/dL and a gastric acid test reveals normal gastric acid volume and a pH of 2.0. A CT scan shows a tumor in the tail of the pancreas. What is the cell from which the pancreatic tumor is derived?
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  6. Which drug to blame for symptoms?

    1. A 33-year-old woman is brought to the physician because of profound nausea, vomiting, headache, sweating, tachycardia, blurred vision and dizziness. Her temperature is 37.8 °C (100 °F), pulse is 120 beats per minute, blood pressure is 104/66 mm Hg, and respirations are 19 per minute. She says that she was out with a couple of friends having a few glasses of wine when she suddenly became ill. A review of her records shows that she was diagnosed with a duodenal ulcer, and triple-therapy treatment was started three days ago. Which drug is responsible for this patient's symptoms?  

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