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

Levothyroxine (synthetic T4) is the first-line treatment for hypothyroidism due to its stable half-life and reliable conversion to active T3.

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

Pituitary Cushing's disease retains partial feedback sensitivity and suppresses cortisol with high-dose (but not low-dose) dexamethasone.

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

PCOS is characterized by hyperandrogenism, oligoovulation, and polycystic ovaries, often with an elevated LH:FSH ratio.

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

Thiazolidinediones (e.g., pioglitazone) activate PPAR-gamma receptors, enhancing insulin sensitivity in muscle and adipose tissue.

Question 5

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

Accepted Answer

Oxytocin

Answer

Oxytocin, released from the posterior pituitary in response to suckling, causes myoepithelial cell contraction and milk ejection.

COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Practice Test

COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Practice Test

COMSAE Endocrine and Reproductive Systems