IM 3B ENDO 2016 MEDICINE 2017

MIDTERMS

Questions and Answers Ratio

A 30 year old female consulted because of Thyrotoxicosis may cause unexplained weight loss, despite anenhanced
palpitations, anxiety and weight loss. Physical appetite, due to the increased metabolic rate. Weight gain occurs in 5% of
examination confirms a diffusely enlarged thyroid patients, however, because of increased food intake. Other prominent
and hand tremors. Which of the following is the features include hyperactivity, nervousness, and irritability, ultimately
most common cardiovascular manifestation in this leading to a sense of easy fatigability in some patients. Insomnia and
patient? impaired concentration are common; apathetic thyrotoxicosis may be
A. Sinus tachycardia mistaken for depression in the elderly. Fine tremor is a frequent finding, best
B. Atrial fibrillation elicited by having patients stretch out their fingers while feeling the
C. Cardiomegaly fingertips with the palm.
D. None of the above Common neurologic manifestations include hyperreflexia, muscle wasting,
and proximal myopathy without fasciculation. Chorea is rare.
Answer: A Thyrotoxicosis is sometimes associated with a form of hypokalemic periodic
paralysis; this disorder is particularly common in Asian males
with thyrotoxicosis, but it occurs in other ethnic groups as well. The most
common cardiovascular manifestation is sinus tachycardia, often
associated with palpitations, occasionally caused by supraventricular
tachycardia. The high cardiac output produces a bounding pulse, widened
pulse pressure, and an aortic systolic murmur and can
lead to worsening of angina or heart failure in the elderly or those
withpreexisting heart disease. Atrial fibrillation is more common in patients
>50 years of age. Treatment of the thyrotoxic state alone converts atrial
fibrillation to normal sinus rhythm in about half of patients, suggesting the
existence of an underlying cardiac problem in the remainder.
The above patient is expected to have a (W. In Graves disease, the TSH level is suppressed, and total and unbound
Suppressed, X. Elevated) TSH and (Y. Decreased, Z, thyroid hormone levels are increased.
Increased) Free T4.
A. W, Y
B. W, Z
C. X, Y
D. X, Z

Answer: B
If the above patient wants to have radioidine Pregnancy and breast-feeding are absolute contraindications to radioiodine
therapy, which of the following is/are absolute treatment, but patients can conceive safely 6 months after treatment.
contraindication/s?
A. Pregnancy
B. Breast-feeding
C. Both
D. Neither

Answer: C
Which of the following is/are causes of primary Causes of Thyrotoxicosis
hyperthyroidism? Primary Hyperthyroidism
A. Struma ovarii Graves disease
B. Silent thyroiditis Toxic multinodular goiter
C. Gestational thyrotoxicosis Toxic adenoma
D. All of the above Functioning thyroid carcinoma metastases
Activating mutation of the TSH receptor
Answer: A Activating mutation of G (McCune-Albright syndrome)
Struma ovarii
Drugs: iodine excess (Jod-Basedow phenomenon)
Thyrotoxicosis Without Hyperthyroidism
Subacute thyroiditis
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A 50 year old female consulted because of weight
gain despite of poor appetite, weakness and
dyspnea. On examination, she has bradycardia and
dry skin. Which of the following is/are expected
finding/s in this patient?
A. Systolic hypertension- hyperthyroidism
B. Proximal myopathy- hyperthyroidism
C. Pretibial edema
D. None of the above
Answer: C
The above patient is expected to have a (M.
MEDICINE 2017
Silent thyroiditis
Other causes of thyroid destruction: amiodarone, radiation,
infarction of
adenoma
Ingestion of excess thyroid hormone (thyrotoxicosis factitia) or
thyroid tissue
Secondary Hyperthyroidism
TSH-secreting pituitary adenoma
Thyroid hormone resistance syndrome: occasional patients may
have
features of thyrotoxicosis
Chorionic gonadotropin-secreting tumors
Gestational thyrotoxicosis
Signs and Symptoms of Hypothyroidism (Descending Order of Frequency)
Symptoms
Tiredness, weakness
Dry skin
Feeling cold
Hair loss
Difficulty concentrating and poor
memory
Constipation
Weight gain with poor appetite
Dyspnea
Hoarse voice
Menorrhagia (later oligomenorrhea
or amenorrhea)
Paresthesia
Impaired hearing
Signs
Dry coarse skin; cool peripheral
extremities
Puffy face, hands, and feet
(myxedema)
Diffuse alopecia
Bradycardia
Peripheral edema
Delayed tendon reflex relaxation
Carpal tunnel syndrome
Serous cavity effusions
The skin is dry, and there is decreased sweating, thinning of the epidermis,
and hyperkeratosis of the stratum corneum. Increased dermal
glycosaminoglycan content traps water, giving rise to skin thickening without
pitting (myxedema). Typical features include a puffy face with edematous
eyelids and nonpittingpretibial edema. There is pallor, often with a yellow
tinge to the skin due to carotene accumulation. Nail growth is retarded, and
hair is dry, brittle, difficult to manage, and falls out easily. In addition to
diffuse alopecia, there is thinning of the outer third of the eyebrows,
although this is not a specific sign of hypothyroidism. Other common
features include constipation and weight gain
(despite a poor appetite). In contrast to popular perception, the weight gain
is usually modest and due mainly to fluid retention in the myxedematous
tissues. Libido is decreased in both sexes, and there may be oligomenorrhea
or amenorrhea in long-standing disease, but menorrhagia is also common.
Normal TSH level excludes primary (but not secondary) hypothyroidism. If
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suppressed, N. elevated) TSH and (O. increased, P. the TSH is elevated, an unbound T4 level is neededto confirm the presence
decreased) free T4 of clinical hypothyroidism, but T4 is inferior toTSH when used as a screening
A. M, O test, because it will not detect subclinicalhypothyroidism.
B. M, P
C. N, O
D. N, P

Answer: D

If the above patient has no evidence of heart Adult patients under 60 years old without evidence of heart disease maybe
disease and weighs 50 kg, she should be started on started on 50100 g levothyroxine(T4) daily. The dose is adjusted on the
the following daily dose/s of levothyroxine (in basis of TSH levels, with the goal
micrograms) of treatment being a normal TSH, ideally
A. 12.5 in the lower half of the reference range.
B. 50
C. 150
D. All of the above

Answer: B
If primary hypothyroidism is suspected and TPOAb
is positive, which of the following is the most likely
cause?
A. Autoimmune
B. Pituitary disease
C. Sick euthyroid disease
D. None of the above

Answer: A

A 25 year old female was noted to lose weight 4 SILENT THYROIDITIS

months after giving birth to her first baby. She was
noted to be tachycardic but thyroid was not
enlarged. Which of the following is/are true
regarding this patients condition?
A. Occurs in up to 5% after pregnancy
B. Associated with (+) TPO Ab
C. Methimazole is the drug of choice
D. A and B only
Answer: D
Treatment of the above patient during hypothyroid
phase include the following:
A. Prednisone
B. Levothyroxine
C. Both
D. Neither
Painless thyroiditis, or silent thyroiditis, occurs in patients withunderlying
autoimmune thyroid disease and has a clinical course similarto that of
subacute thyroiditis. The condition occurs in up to 5% ofwomen 36
months after pregnancy and is then termed postpartumthyroiditis. Typically,
patients have a brief phase of thyrotoxicosis lasting 24 weeks, followed by
hypothyroidism for 412 weeks, and thenresolution; often, however, only
one phase is apparent. The conditionis associated with the presence of TPO
antibodies antepartum, and it isthree times more common in women with
type 1 diabetes mellitus.
Glucocorticoid treatment is not indicated for silent thyroiditis. Severe
thyrotoxic symptoms can be
managed with a brief course of propranolol, 2040 mg three or four times
daily. Thyroxine replacement may be needed for the hypothyroid
phase but should be withdrawn after 69 months, as recovery is the rule.

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Answer: B
Which of the following thyroiditis can occur in Causes of Thyroiditis
patients taking Amiodarone? Acute
A. Acute Bacterial infection: especially Staphylococcus, Streptococcus, and
B. Subacute Enterobacter
C. Chronic Fungal infection: Aspergillus, Candida, Coccidioides, Histoplasma,
D. All of the above and
Pneumocystis
Answer: D Radiation thyroiditis after 131I treatment
Amiodarone (may also be subacute or chronic)
Subacute
Viral (or granulomatous) thyroiditis
Silent thyroiditis (including postpartum thyroiditis)
Mycobacterial infection
Drug induced (interferon, amiodarone)
Chronic
Autoimmunity: focal thyroiditis, Hashimotos thyroiditis, atrophic
thyroiditis
Riedels thyroiditis
Parasitic thyroiditis: echinococcosis, strongyloidiasis, cysticercosis
Traumatic: after palpation
A 21 year old male came for medical evaluation
prior to employment. He was noted to have a 2cm
thyroid nodule on palpation. Which of the
following should be done next?
A. Fine needle aspiration cytology
B. Radionuclide scanning
C. TSH
D. None of the above

Answer: C

Which of the following is/are risk factor/s for Risk Factors for Thyroid Carcinoma in Patients with Thyroid Nodule
thyroid carcinoma in the above patient? History of head and neck irradiation, including total-body irradiation
A. Age for bone marrow transplant and brain radiation for childhood
B. Gender leukemia
C. Nodule size Exposure to ionizing radiation from fallout in childhood or
D. All of the above adolescence
Age <20 or >65 years
Answer: B Increased nodule size (>4 cm)
New or enlarging neck mass
Male gender
Family history of thyroid cancer, MEN 2, or other genetic
syndromes associated with thyroid malignancy (e.g., Cowdens
syndrome, familial polyposis, Carney complex)
Vocal cord paralysis, hoarse voice
Nodule fixed to adjacent structures
Extrathyroidal extension
Lateral cervical lymphadenopathy
Which of the following would be an indication for Surgical excision of the abnormal parathyroid tissue is the definitive therapy
surgical excision of a parathyroid adenoma in a for this disease. As noted above, medical surveillance without operation for
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patient with asymptomatic primary patients with mild, asymptomatic disease is, however, still preferred by
hyperparathyroidism? some physicians and patients, particularly when the patients are more
A. Lumbar spine osteoporosis elderly. Evidence favoring surgery, if medically feasible, is growing because
B. Creatinine 80ml/min of concerns about skeletal, cardiovascular, and neuropsychiatric disease,
C. Both even in mild hyperparathyroidism.
D. Neither

Answer: A
Which of the following is/are parathyroid related Classification of Causes of Hypercalcemia
cause/s of hypercalcemia? I. Parathyroid-Related
A. Alumni excess A. Primary hyperparathyroidism
B. Thiazides 1. Adenoma(s)
C. Lithium 2. Multiple endocrine neoplasia
D. All of the above 3. Carcinoma
B. Lithium therapy
Answer: C C. Familial hypocalciurichypercalcemia
II. Malignancy-Related
A. Solid tumor with metastases (breast)
B. Solid tumor with humoral mediation of hypercalcemia (lung, kidney)
C. Hematologic malignancies (multiple myeloma, lymphoma, leukemia)
III. Vitamin DRelated
A. Vitamin D intoxication
B. 1,25(OH)2D; sarcoidosis and other granulomatous diseases
C. 1,25(OH)2D; impaired 1,25(OH)2D metabolism due to 24-hydroxylase
deficiency
IV. Associated with High Bone Turnover
A. Hyperthyroidism
B. Immobilization
C. Thiazides
D. Vitamin A intoxication
E. Fat necrosis
V. Associated with Renal Failure
A. Severe secondary hyperparathyroidism
B. Aluminum intoxication
C. Milk-alkali syndrome
Which of the following is expected to be LOW in The diagnosis is typically made by detecting an elevated immunoreactive
patients with primary hyperparathyroidism PTH level in a patient with asymptomatic hypercalcemia.
secondary to a parathyroid adenoma? Serum phosphate is usually low but may be normal, especially if renal
A. 1,25 (OH)2 D failure has developed.
B. Urinary calcium excretion
C. Serum magnesium
D. Serum phosphate

Answer: D
A patient was noted to have low ionized calcium The cause of hypocalcemia remains unclear. PTH values arereported to be
after she was brought to the emergency room low, normal, or elevated, and both resistance to PTH and impaired PTH
because of seizures. Which of the following is/are secretion have been postulated.
expected finding/s in this patient? Neuromuscular and neurologic manifestations of
A. Prolonged QT interval chronichypocalcemia include muscle spasms, carpopedal spasm, facial
B. Papilledema grimacing, and, in extreme cases, laryngeal spasm and convulsions.
C. Low PTH Respiratory arrest may occur. Increased intracranial pressure occurs in some
D. All of the above patients with long-standing hypocalcemia, often in association
withpapilledema. Mental changes include irritability, depression, and
Answer: D psychosis. The QT interval on the electrocardiogram is prolonged, in
contrast to its shortening with hypercalcemia. Arrhythmias occur, and
digitalis effectiveness may be reduced. Intestinal cramps and chronic
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malabsorption may occur. Chvosteks or Trousseaus sign can be used to
confirm latent tetany.
In a patient with hypocalcemia due to
rhabdomyolysis, PTH is classified as:
A. Absent
B. Ineffective
C. Overwhelmed
D. None of the above

Answer: C

Treatment of hypocalcemia from Treatment involves replacement with vitamin D or 1,25(OH)2D (calcitriol)
hypoparathyroidism include/s the following combined with a high oral calcium intake. In mostpatients, blood calcium
A. Daily 2-3g of elemental calcium and phosphate levels are satisfactorily regulated,
B. Calcitriol 0.25-1 mcg daily but some patients show resistance and a brittleness, with atendency to
C. Vitamin D at least 1000 daily alternate between hypocalcemia and hypercalcemia.For many patients,
D. All of the above vitamin D in doses of 40,000120,000 U/d(13 mg/d) combined with 1 g
elemental calcium is satisfactory.
Answer: D The wide dosage range reflects the variation encountered frompatient to
patient; precise regulation of each patient is required.
Which of the following cause/s impaired Treatment of sarcoidosis-associated hypercalcemia with
hydroxylation of Vitamin D? glucocorticoids,ketoconazole, or chloroquine reduces 1,25(OH)2D
A. Phenytoin productionand effectively lowers serum calcium. In contrast, chloroquine
B. Barbiturates has notbeen shown to lower the elevated serum 1,25(OH)2D levels in
C. Ketoconazole patientswith lymphoma.
D. All of the above

Answer: C
Which of the following is the most specific The most specific screening test for vitamin D deficiency in otherwise
screening test for vitamin D deficiency? healthyindividuals is a serum 25(OH)D level. Although the normal
A. 25 (OH) D rangesvary, levels of 25(OH)D<37 nmol/L (<15 ng/mL) are associatedwith
B. 1,25 (OH)2 D increasing PTH levels and lower bone density.
C. 7-Dehydrocholesterol
D. None of the above

Answer: A
The following is/are indication/s for bone density Clinical guidelines have been developed for the use of bone densitometryin
testing: clinical practice. The original National Osteoporosis Foundation
A. Postmenopausal women guidelines recommend bone mass measurements in
B. Fracture before the age of 50 postmenopausalwomen, assuming they have one or more risk factors for
C. Men over the age of 60 osteoporosisin addition to age, sex, and estrogen deficiency. The guidelines
D. All of the above furtherrecommend that bone mass measurement be considered in all
womenby age 65.
Answer: A

Which of the following can reduce fractures in Several bisphosphonates (alendronate, risedronate, and zoledronicacid)
glucocorticoid induced osteoporosis? have been demonstrated in large clinical trials to reduce the
A. Tamoxifen risk of vertebral fractures in patients being treated with glucocorticoids, as
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B. Alendronate well as improve bone mass in spine and hip. Teriparatidealso improves bone
C. Calcitonin mass and reduces fracture risk in glucocorticoid-
D. All of the above treated osteoporosis compared to an active comparator (alendronate).

Answer: B

FINALS

Question Ratio
1. Diagnostic criteria of Diabetes Mellitus? Criteria for DM
a. RBS > 11mmol/L with signs and symptoms of FBG 126 mg/dL (7 mmol/L)
diabetes HbA1C 6.5%
b. FPG >5.6 mmol/L with signs and symptoms of 2hr plasma glucose 11.1 mmol/L (200 mg/dL) during a 75g OGTT
diabetes Symptoms of DM + RBG concentration of 11.1 mmol/L (200
c. 2hr post 75g OGTT >7.6mmol/L mg/dL)
d. A1c > 5.7%

ANSWER: A
2. A 30 year old male was referred to you for the Type 1 DM is the result of interactions of genetic, environmental, and
treatment of diabetes mellitus. He is overweight, immunologic factors that ultimately lead to the destruction of the pancreatic
non-hypertensive, alcoholic and smoker. He is beta cells
maintained on basal-bolus insulin since the time of
diagnosis, his latest laboratory result showed Type 1 DM results from autoimmune beta cell destruction, and most
uncontrolled diabetes, hyperlipidemia, individuals have evidence of islet-directed autoimmunity
hyperuricemia, and (+) ICA. Which of the following
supports the diagnosis of type 1 diabetes mellitus?
a. age
b. weight
c. immune markers
d. use of insulin

ANSWER: C
3. If a pregnant woman has the following 75g OGTT Criteria for Diagnosis of GDM
result: FBS 88mg/dl, 1 hr post glucose load of 197
mg/dl and 2 hr post glucose load of 154 mg/dl.
According to ADA, how would you classify the
patient?
a. overt diabetes
b. impaired glucose tolerance
c. GDM
d. normal glucose tolerance

ANSWER: C
4. What is microalbuminuria? Microalbuminemia- defined as 30-299 mg/d in a 24 h collection or 30-299
a. +1 protein on routine urinalysis g/mg creatinine in a spot collection
b. urine albumin less than 300 mg/dl
c. presence of bubbles in the urine
d. none of the above

ANSWER: B

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5. what laboratory result will differentiate DKA
from HHS?
a. elevated RBS
b. K 3.5 mmol/L
c. pH 7
d. Na 150 mmol/L

ANSWER: D

6. A 19 year old type 1 diabetic patient went to an Insulin secretagogues (ex. DPP-1) are agents that either act as a GLP-1
out of town trip, unfortunately he forgot to bring receptor agonist or enhance endogenous GLP-1 activity are approved for
his insulin and cant find nearby drugstore. Instead treatment of type 2 DM
of going back, he was given DPP-IV inhibitor by his
companion who has type 2 diabetes mellitus. What Do not cause hypoglycemia because of the glucose-dependent nature of
will happen to the patient? incretin-stimulated insulin secretion
a. he will have relative insulin deficiency but will be
able to survive for several days
b. if the fluid intake is adequate, the rise in glucose
will be neutralized
c. Insulin level, as well as insulin: glucagon ratio will
decrease
d. Counterregulatory hormone will also decrease
because of hyperglycemia

ANSWER: C
7. What is the cause of ketosis in DKA? Ketosis results from a marked increase in free fatty acid release from
a. lipolysis and increase FFA release adipocytes, with a resulting shift toward ketone body synthesis in the liver
b. gluconeogenesis
c. poor oral intake Reduced insulin levels, in combination with elevations in catecholamines and
d. glycogenolysis growth hormone, increase lipolysis and the release of FFA

ANSWER: A
8. When do we use biguanides in the treatment of
type 2 diabetes?
a. in a newly diagnosed patient
b. in a patient with renal failure
c. in a patient at risk of lactic acidosis
d. all of the above
Major toxicity of metformin, lactic acidosis, is very rare and can be
prevented by careful patient selection
Metformin should not be used in patients with renal insufficiency (GFR
<60mL/min), ant form of acidosis, unstable CHF, liver disease or severe
hypoxemia

ANSWER: A
9. What is the difference between proliferative The appearance of neovascularization in response to retinal hypoxemia is
retinopathy and non-proliferative retinopathy? the hallmark of proliferative diabetic retinopathy
a. hemorrhages
b. loss of vision
c. macular edema
d. neovascularization

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ANSWER: D
10. A type 2 diabetic elderly patient had sepsis Laboratory abnormalities of HHS
because of UTI, patient refuse to take anything by Marked hyperglycemia (>55.5 mmol/L or 1000 mg/dl)
mouth became dehydrated, hypotensive, lethargic. Hyperosmolality (>350 mosmol/L)
What laboratory examination is needed to Prerenal azotemia
diagnose HHS? Measured serum sodium may be normal or slightly low despite
a. ABG marked hyperglycemia
b. anion gap
c. serum osmolality
d. all of the above

ANSWER: C
11. What other treatment goals are needed to According to ADA, the target lipid values in diabetic individuals (age >40 y/o)
decrease cardiovascular risk of a patient with type without CVD should be as follows:
2 diabetes with good glycemic control? LDL <2.6 mmol/L (100 mg/dl)
a. bp<140/80 HDL >1 mmol/L (40 mg/dl) in men and >1.3 mmol/l (50 mg/dl) in
b. HDL >1mmol/L in males women
c. LDL <2 mmol/L TG <1.7 mmol/L (150mg/dl)
d. all of the above
Hypertension can accelerate ther complications of DM. Target BP should be
ANSWER: D <140/80 mmHg
12. What laboratory test are you going to use if you Measurement of glycated hemoglobin (HbA1c) is the standard method for
want to check the patients glycemic control? assessing long-term glycemic control.
a. RBS
b. OGTT It reflects the glycemic history over the previous 2-3 months
c. Glycosylated Hgb
d. FBS

ANSWER: C
13. A 15 year old female has a history of recurrent Hypoglycemia is suspected in patients with typical symptoms (confusion,
tremors, palpitation followed by behavioral altered level of consciousness, seizure)
changes and loss of consciousness early in the
morning. Few hours prior to ER consult, patient C-peptide- connecting peptide that is cleaved from proinsulin to insulin
was noted to have seizure episode. At the ER, vital insulin, C-peptide = endogenous insulin
signs were stable but RBS is low. What other insulin, C-peptide = exogenous insulin
laboratory test/s is/are needed to diagnose the
patient?
a. screening for oral antidiabetic agent
b. C-peptide
c. both
d. none

ANSWER: B
14. Given the history of the patient (ques. No. 96), Hypoglycemia due to endogenous hyperinsulinism can be caused by a
what is the most likely diagnosis if C-peptide is also primary beta-cell tumor (insulinoma)
elevated?
a. galactosemia insulin, C-peptide = endogenous insulin
b. overdose of oral antidiabetic agent
c. insulinoma
d. idiopathic cause

ANSWER: C
15. What is Whipples triad? Whipples Triad
a. low plasma glucose resolved by intake of glucose
b. low plasma glucose with symptoms of Hypoglycemia requires that the corresponding plasma glucose

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hypoglycemia resolved by intake of glucose concentration be low and that the symptoms resolve after glucose
c. low plasma glucose with symptoms of level is raised
hypoglycemia, symptoms are relieved when plasma
glucose is raised
d. low plasma glucose with symptoms of
hypoglycemia

ANSWER: C
16. What physical examination determines Intraabdominal circumference (visceral adipose tissue) is considered most
intraabdominal adiposity? strongly related to insulin resistance and risk of diabetes and CVD, and for
a. waist circumference any given waist circumference the distribution of adipose tissue between SC
b. waist-hip ratio and visceral depot varies substantially.
c. BMI
d. skinfold thickness

ANSWER: A
17. It is secreted by the adipocytes and provides Leptin
index of adipose energy stores secreted by adipose cells
a. insulin high level of leptin decreases food intake and increase energy
b. insulin growth factor 1 expenditures
c. leptin level of production provides an index of adipose energy stores
d. GLP-1

ANSWER: C
18. In what condition will you consider bariatric Bariatric Surgery
can be considered for severe obesity (BMI 40 kg/m ) or moderate
2
surgery in patients who are obese?
2
a. BMI > 32 with associated serious medical obesity (BMI 35 kg/m ) associated with serious medical condition
condition
b. BMI >27 for whom dietary and physical activity
has not been successful?
c. both
d. neither

ANSWER: D
19. If you are going to rate behavioral therapy in Combination of dietary modification and exercise is the most effective
terms of efficacy in the treatment of obesity, what behavioral approach for the treatment of obesity
will your number one?
a. diet and stimulus control
b. exercise and stress management
c. stress management
d. diet and exercise

ANSWER: D
20. In the treatment of obesity, it is a peripherally Choices A, C, D are all centrally acting
acting medication that block absorption of dietary
fats
a. sibutramine
b. Orlistat
c. Phentermine
d. Diethylpropion

ANSWER: B
21. In male, what test will differentiate primary and Because LH and FSH are trophic hormones for the testes, impaired secretion
secondary hypogonadism? of these pituitary gonadotropins results in secondary hypogonadism
a. sperm count
b. total/free testosterone Secondary hypogonadism
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c. FSH low testosterone, low LH, low FSH
d. Estrogen

ANSWER: C
22. Interpret the following laboratory results taken Klinefelter syndrome
in male with abnormally secondary sexual most common chromosomal disorder associated with testicular
characteristic, 47XXY, elevated FSH and estradiol dysfunction and male infertility
and low testosterone. The patient has Azoospermia is the rule in men with Klinefelters syndrome who
a. Klinefelter syndrome have 47 XXY karyotype
b. True hermaphroditism Low testosterone, estradiol is ncreased
c. mixed gonadal dysgenesis
d. Turners syndrome

ANSWER: A
23. The most common cause of infertility in female Female infertility
is
a. Hypothalamic-pituitary causes Hypothalamic-pituitary causes- 51%
b. PCOS PCOS- 30%
c. Primary ovarian failure Premature ovarian failure- 12%
d. Menopause Uterine or outflow tract disorders- 7%

ANSWER: A

THANK YOU!!!

EVITA DEL MUNDO

RUBELLE CABAL

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