COMSAE Endocrine and Reproductive Systems

Question 1

A 45-year-old woman presents with weight gain, cold intolerance, constipation, and a TSH of 12 mIU/L with low free T4. Which is the most appropriate initial treatment?

Accepted Answer

Levothyroxine

Answer

Liothyronine

Answer

Methimazole

Answer

Radioactive iodine

Question 2

On COMSAE, a patient with Cushing's syndrome undergoes an overnight dexamethasone suppression test. Which finding is most consistent with a pituitary ACTH-secreting adenoma (Cushing's disease)?

Accepted Answer

Suppression with high-dose dexamethasone

Answer

No suppression with either dose

Answer

Suppression with low-dose dexamethasone

Answer

Undetectable ACTH levels

Question 3

A 28-year-old woman has oligomenorrhea, hirsutism, and an LH:FSH ratio of 3:1. Pelvic ultrasound shows bilateral ovarian cysts. Which is the most likely diagnosis?

Accepted Answer

Polycystic ovary syndrome (PCOS)

Answer

Premature ovarian insufficiency

Answer

Hypothyroidism

Answer

Hyperprolactinemia

Question 4

A patient with type 2 diabetes has an HbA1c of 9.2% despite lifestyle modification. Which medication class improves insulin sensitivity primarily in peripheral tissues?

Accepted Answer

Thiazolidinediones

Answer

Sulfonylureas

Answer

DPP-4 inhibitors

Answer

Alpha-glucosidase inhibitors

Question 5

Which hormone is primarily responsible for stimulating milk ejection (let-down reflex) during breastfeeding?

Accepted Answer

Oxytocin

Answer

Prolactin

Answer

Estrogen

Answer

Progesterone

Question 6

A 32-year-old man presents with bilateral gynecomastia, small firm testes, and infertility. Karyotype shows 47,XXY. Which of the following best describes this condition?

Accepted Answer

Klinefelter syndrome

Answer

Turner syndrome

Answer

Kallmann syndrome

Answer

Androgen insensitivity syndrome