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Reproductive endocrinology flashcards

10 high-yield MRCP Part 1 cards from the Intellect Medicos Endocrinology & Diabetes course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.

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1. Which syndrome combines hypogonadotrophic hypogonadism with anosmia?

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   Kallmann syndrome.

   Why? GnRH neurones fail to migrate with olfactory neurones in development, so GnRH, LH, FSH and sex steroids are low; MRI may show absent olfactory bulbs.

2. What is the karyotype in Klinefelter syndrome?

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   47,XXY.

   Why? Confirmed by karyotype (chromosomal analysis).

3. What are the LH, FSH and testosterone levels in Klinefelter syndrome?

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   High LH and FSH with low testosterone (primary hypogonadism).

   Why? The testes fail, so the pituitary drives harder.

4. What is the inheritance and karyotype of androgen insensitivity syndrome?

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   X-linked recessive androgen receptor mutation; karyotype 46,XY.

   Why? Testes form and make testosterone and AMH, but tissues cannot respond to androgen.

5. A 16-year-old girl has primary amenorrhoea, normal breast development and sparse pubic and axillary hair. Ultrasound shows no uterus. What is the most likely diagnosis?

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   Complete androgen insensitivity syndrome.

   Why? Testosterone is aromatised to oestradiol (breasts develop), AMH removes the uterus, and androgen resistance leaves hair sparse.

6. How are the gonads managed in complete androgen insensitivity syndrome?

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   Bilateral orchidectomy (often after puberty), followed by oestrogen replacement.

   Why? Undescended testes carry a malignancy risk; leaving them until after puberty allows natural breast development.

7. What are the Rotterdam criteria for PCOS (2 of 3 needed)?

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   Oligo-/anovulation; clinical or biochemical hyperandrogenism; polycystic ovaries on ultrasound.

   Why? Other causes (e.g. non-classical CAH, hyperprolactinaemia, thyroid disease) must be excluded.

8. What is the first-line management for an overweight woman with PCOS?

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   Weight reduction.

   Why? Even modest weight loss improves insulin resistance, ovulation and hyperandrogenism.

9. Which drug does current international PCOS guidance recommend first-line for ovulation induction in PCOS?

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   Letrozole (off-label in the UK).

   Why? It gives higher ovulation and live-birth rates than clomifene. Metformin can be added, especially with obesity or glucose intolerance; gonadotrophins are used if oral agents fail.

10. Which drugs are used for hirsutism and acne in PCOS?

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    A combined oral contraceptive (low-androgenic or co-cyprindiol); spironolactone under specialist care.

    Why? The COC raises SHBG and suppresses ovarian androgen production; it also regulates cycles.