A 6-year-old girl is brought to the office by her mother due to pubertal development over the past year.  The mother has noticed that her daughter has developed breasts and is also much taller than most of her classmates.  Weight is at the 50th percentile and height is at the 95th percentile.  Physical examination reveals Tanner stage 3 breast development and coarse pubic hair.  She is diagnosed with idiopathic precocious puberty.  Without treatment, this patient’s projected height will most likely be shorter than average due to which of the following hormonal effects?

A 37-year-old woman, gravida 2 para 1, at 30 weeks gestation comes to the office to discuss her recent laboratory work.  At her last visit at 28 weeks gestation, the patient drank a solution containing 50 g of glucose, and her serum glucose was abnormally elevated an hour later.  Today, she is scheduled to undergo a confirmatory 3-hour glucose test.  Her pregnancy has been uncomplicated, and the patient has no chronic medical conditions.  She is taking a daily prenatal vitamin.  Vital signs are normal.  Physical examination shows a uterine size consistent with gestational age.  Fetal heart rate is 140/min.  Which of the following hormones is most likely contributing to this patient’s abnormal laboratory findings?

A patient is treated with a gonadotropin-releasing hormone (GnRH) infusion.  An intravenous line is placed and connected to a reservoir through a computerized pump.  The pump is programmed to deliver a predetermined dose of GnRH every 90 minutes, which results in a sharp rise in serum GnRH levels with each dose, followed by a rapid return to baseline.  LH and FSH levels are monitored in the initial phase of treatment.  Which of the following is the most likely indication for using this GnRH infusion?

A 23-year-old woman, gravida 1, para 0, comes to the office for a routine prenatal care visit.  She is at 35 weeks gestation and feels well.  She reports regular fetal movement and no contractions, loss of fluid, or vaginal bleeding.  Pregnancy to date has been uncomplicated and the patient has no underlying medical conditions.  She signed up for a clinical trial investigating prolactin.  At 34 weeks gestation, she had a serum prolactin level several times higher than what was recorded prior to pregnancy.  Which of the following hormones prevents lactation in this patient?

A 25-year-old man comes to the physician because he and his wife have been unable to conceive for the last 2 years.  They have no children.  Infertility evaluation is begun, and laboratory studies show a low sperm count.  A more thorough evaluation elucidates a rare genetic abnormality that leads to permanently inactive FSH receptors.  Which of the following substances is most likely decreased in this patient?

A 23-year-old female is being evaluated for infertility.  Hormone studies reveal a normal rise in the blood estradiol level during the first phase of the menstrual cycle.  Androgens synthesized in this patient’s ovaries are converted to estradiol in which of the following cell types?

A 27-year-old woman comes to the office for evaluation of irregular menses.  Menarche was at age 12, and the patient started taking combined oral contraceptives at age 18.  She had no menstrual periods while using oral contraceptives and was advised that this was normal.  The patient stopped her contraception 6 months ago to conceive with her husband, but she still has not menstruated.  BMI is 24 kg/m².  Urine pregnancy testing is negative.  TSH, FSH, and prolactin levels are normal.  Oral medroxyprogesterone for 10 days is prescribed; a few days after completing the progesterone course, the patient has moderately heavy bleeding with some cramping.  Which of the following endometrial processes is most likely responsible for this patient’s bleeding?

A 42-year-old man comes to the office seeking advice on male contraception.  He and his wife have 6 children and do not want any more, and his wife wants to stop taking oral contraceptive pills.  The patient’s medical history is notable for an appendectomy, during which he had no complications from the procedure or the associated anesthesia.  He does not smoke.  On examination, the patient has a normal circumcised penis with no visible genital lesions and no palpable abnormalities in the scrotum.  After appropriate discussion regarding contraceptive options, the patient elects to undergo a vasectomy.  The patient should be advised to expect which of the following side effects during the first few months following the procedure?

A newborn boy is found to have micropenis at birth.  Genetic analysis identifies a specific mutation in the NR5A1/SF-1 gene that results in selective impairment in Sertoli cell function.  The remainder of the hypothalamic-pituitary-gonadal axis is unaffected.  The patient undergoes regular follow-up with a pediatric endocrinologist during childhood and has otherwise normal childhood and pubertal development.  When he is 16 years old, serum hormone levels are obtained.  Which of the following patterns of blood hormone levels are most likely to be seen as a result of this patient’s condition?

A 50-year-old woman comes to the office concerned that her menstrual periods have stopped.  She took oral contraceptive pills for the past 17 years, which she discontinued 3 months ago, and her menses have not returned.  The patient had one spontaneous abortion at age 27 and otherwise has never been pregnant.  She is monogamous with her husband, and they have sexual intercourse regularly.  The patient has some vaginal dryness but no pain or discomfort with intercourse.  BMI is 21 kg/m² and vital signs are normal.  Speculum examination shows a normal vaginal mucosa and cervix.  Bimanual examination shows a normal uterus and ovaries.  Urine pregnancy test is negative.  Which of the following hormones is most likely elevated in this patient?

A healthy, nulliparous 29-year-old woman with regular 28-day cycles comes to the office for a fertility evaluation.  Over the past year, she and her 30-year-old husband have been trying to conceive.  Her only medications are prenatal vitamins.  She tracks her periods, cervical mucus, basal temperature, and intercourse with a smartphone app.  The couple has intercourse every other day from cycle day 8 through the LH surge.  The patient’s urine pregnancy test is positive.  The oocyte was most likely arrested in which of the following stages of meiosis immediately prior to fertilization?

A 21-year-old man undergoes a routine pre-employment physical examination.  During testicular examination, he is found to have only 1 testis in his scrotum.  Further evaluation reveals an elevated serum FSH level and a normal serum LH level.  Production of which of the following substances is likely to be impaired in this patient?

A 25-year-old woman comes to the office due to amenorrhea.  The patient’s last menstrual period was 8 weeks ago, and she normally has regular, monthly menses.  The patient has no chronic medical conditions and has had no surgeries.  She takes no daily medications.  Blood pressure is 100/60 mm Hg and pulse is 92/min.  BMI is 24 kg/m².  Abdominal examination shows a soft, nontender abdomen with no palpable masses.  Pelvic examination shows an 8-week-sized, nontender uterus.  Serum β-hCG level is elevated.  Which of the following is the most important direct role of hCG in this patient?

A 32-year-old woman, gravida 2 para 1, at 30 weeks gestation comes to the office for a routine prenatal visit.  The patient’s pregnancy has been uncomplicated, and she has had no vaginal bleeding or contractions.  She has continued to jog daily throughout the pregnancy but is becoming more fatigued by the end of her workouts.  The patient has no chronic medical conditions, and her only medication is a daily prenatal vitamin.  She does not use tobacco, alcohol, or illicit drugs.  Blood pressure is 110/70 mm Hg, pulse is 76/min, and respirations are 20/min.  Fetal heart tones are normal.  Physical examination is unremarkable.  Compared to a nonpregnant state, this patient most likely has which of the following hematologic changes?

A 16-year-old boy is brought to the office for evaluation of irritability, slow growth, and acne.  The patient plays soccer and has been following an aggressive strength-training program.  When asked, he admits to using a performance-enhancing substance for the past 6 months.  What additional findings would most likely be present in this patient now compared to 6 months ago?

A 28-year-old woman, gravida 1 para 0, at 12 weeks gestation comes to the office for follow-up.  During the first trimester, the patient had mild nausea, which has now resolved, and the patient feels well.  She has a history of epilepsy for which she is taking lamotrigine; her only other medication is a prenatal vitamin with folic acid.  Vital signs and physical examination show no abnormalities.  Fetal heart tones are normal.  In addition to routine prenatal care, the patient’s serum lamotrigine level is being closely monitored because the drug is eliminated primarily by the kidneys.  Which of the following renal changes are expected in this patient during her pregnancy?

A 26-year-old man comes to the emergency department due to a 10-hour history of progressively worsening right-sided scrotal pain.  Clinical and radiological evaluations confirm testicular torsion with significant ischemic damage and the patient undergoes unilateral orchiectomy.  Three months later, he comes to the office for follow-up.  The patient is otherwise healthy and takes no medications but is worried about the risk of sexual dysfunction and infertility.  Further evaluation is most likely to show which of the following sets of findings in this patient?

A 28-year-old woman, gravida 1 para 0, at 16 weeks gestation comes to the office for a prenatal visit.  The patient feels well and has no concerns.  Medical history is significant for recurrent urinary tract infections.  Her only medication is a prenatal multivitamin.  Blood pressure is 116/68 mm Hg and pulse is 80/min.  Physical examination shows no abnormalities and fetal heart tones are normal.  Urine dipstick reveals no blood or leukocyte esterase but is positive for protein.  Laboratory testing shows the following:

A 24-hour urinary protein excretion is 200 mg.  Which of the following processes is most likely contributing to this patient’s urinary findings?

A 28-year-old woman, gravida 2 para 1, at 18 weeks gestation comes to the office for a routine prenatal appointment.  She is feeling well and has had no complications during this pregnancy.  The patient has no chronic medical conditions and has had no previous surgeries.  Her only medications are a daily prenatal vitamin and an iron supplement.  Blood pressure is 110/70 mm Hg and pulse is 62/min.  BMI is 24 kg/m2.  Cardiopulmonary examination is unremarkable.  The uterus is consistent with 18 weeks gestation and fetal heart tones are normal.  There is mild bilateral pedal edema to the shins.  Compared to a nonpregnant state, which of the following changes are most likely expected in this patient?

A 25-year-old man is found to have small testes on physical examination.  He has normal male pattern facial and pubic hair.  Further laboratory testing reveals a decreased sperm count and normal serum testosterone level.  Which of the following is the most likely cause of these findings?

A 38-year-old woman, gravida 1 para 0, at 34 weeks gestation comes to the office due to increasing swelling in her hands and legs.  The patient first noticed the swelling a few weeks ago but now cannot stand for more than an hour without needing to elevate her legs.  She has no orthopnea, dyspnea, or chest pain.  The patient has no chronic medical conditions and takes no daily medications.  Vital signs are normal.  Cardiac examination is within normal limits.  Lungs are clear to auscultation.  Bilateral lower extremities have 2+ pitting edema to the midshin.  Urine dipstick shows no protein.  Compared to a healthy nonpregnant woman, which of the following parameters is most likely to be decreased in this patient?

A 24-year-old woman, gravida 1 para 0, at 28 weeks gestation comes to the office for a routine prenatal visit.  She feels well and has had no vaginal bleeding, contractions, or leakage of fluid.  Fetal movement is normal.  The patient has no chronic medical conditions and her pregnancy has been uncomplicated.  She previously had heavy menstrual periods that were managed with oral contraceptives.  Blood pressure is 126/84 mm Hg and pulse is 78/min.  Fundal height and fetal heart tones are normal.  Today’s third-trimester complete blood count is as follows:

Coagulation studies and peripheral smear are within normal limits.  The patient’s first-trimester platelet count was 160,000/mm³.  Urine dipstick today is negative for protein.  Which of the following is the most likely cause of this patient’s thrombocytopenia?

A 27-year-old woman in her 2nd trimester of pregnancy comes to the office due to constipation.  Her stools have become increasingly hard and pellet-like over the past few weeks; bowel movements before then were always regular.  She also has mild crampy abdominal pain and bloating, both of which improve after defecation.  Medical history and family history are both unremarkable.  This is the patient’s first pregnancy and has so far been uncomplicated.  On physical examination, the abdomen appears gravid but nontender.  Which of the following best explains this patient’s symptoms?