Topics › System and discipline
Reproductive & Endocrine Pathology — Step 1 practice questions
70 questions in this area, with an explanation for every answer choice.
Three samples below, free and without an account.
How this shows up on Step 1
Pathology questions in this section combine two things the exam tests separately elsewhere. Pathology is the largest discipline on Step 1. Endocrine questions are built on feedback loops.
Sample questions
Sample question 1
A 55-year-old postmenopausal woman presents with vaginal bleeding and a unilateral adnexal mass. Endometrial biopsy shows hyperplasia. Histology of the resected ovarian tumor shows cells arranged around small follicle-like spaces filled with eosinophilic material. Which of the following is most likely elevated in her serum?
Explanations
A. Testosterone
Testosterone rises with Sertoli-Leydig cell tumors, which virilize.
B. Alpha-fetoprotein
AFP marks yolk sac tumors (Schiller-Duval bodies) in young patients.
C. Beta-hCG
hCG marks choriocarcinoma and some dysgerminomas.
D. CA 19-9
CA 19-9 is a pancreatic/GI marker.
E. Estrogen and inhibin · correct
Call-Exner bodies (rosettes of granulosa cells around eosinophilic secretions) identify a granulosa cell tumor, a sex cord–stromal tumor that produces estrogen — causing postmenopausal bleeding, endometrial hyperplasia or carcinoma in adults, and precocious puberty in children. Inhibin is the serum marker for follow-up.
Sample question 2
A 38-year-old woman presents with heavy menstrual bleeding, pelvic pressure, and iron-deficiency anemia. Pelvic examination reveals an enlarged, irregularly contoured, nontender uterus. She notes the masses grew during a recent pregnancy and her symptoms were absent before her 30s. Which of the following is correct about her most likely diagnosis?
Explanations
A. It arises from endometrial glands within the myometrium
Endometrial glands in the myometrium define adenomyosis — a uniformly enlarged, boggy, tender uterus.
B. It is a premalignant lesion that frequently progresses to leiomyosarcoma
Malignant transformation of a leiomyoma is exceedingly rare; leiomyosarcomas arise independently, usually in older women.
C. It is associated with elevated CA-125 and ovarian involvement
CA-125 elevation suggests ovarian or endometrial pathology, not fibroids.
D. It is a benign, estrogen-sensitive smooth muscle tumor that typically regresses after menopause and rarely undergoes malignant transformation · correct
Leiomyomas (fibroids) are the most common benign tumor in women, more frequent in Black women, estrogen- and progesterone-responsive (growing in pregnancy, shrinking after menopause). They are well-circumscribed whorled bundles of smooth muscle; leiomyosarcoma arises de novo, not from fibroids. Treatment ranges from NSAIDs/hormonal therapy and GnRH agonists (to shrink before surgery) to myomectomy or hysterectomy.
E. It is most common in postmenopausal women
Fibroids are a disease of reproductive-age women and regress after menopause.
Sample question 3
A patient has episodic severe headaches, palpitations, diaphoresis, and hypertension. Laboratory testing shows elevated plasma free metanephrines. Which of the following is the most likely diagnosis?
Explanations
A. Carcinoid syndrome
Carcinoid syndrome causes flushing and diarrhea, a different presentation without this metanephrine elevation.
B. Pheochromocytoma · correct
Episodic headache, palpitations, diaphoresis, and hypertension ("the classic triad" plus hypertension) with elevated plasma free metanephrines is classic for pheochromocytoma, a catecholamine-secreting tumor of the adrenal medulla (or extra-adrenal paraganglia).
C. Primary hyperaldosteronism
Primary hyperaldosteronism causes hypertension with hypokalemia, not this classic episodic catecholamine-excess symptom pattern with elevated metanephrines.
D. Hypothyroidism
Hypothyroidism causes fatigue and cold intolerance, the opposite metabolic picture.
E. Cushing syndrome
Cushing syndrome causes a different symptom complex (central obesity, striae, hyperglycemia), not primarily this episodic catecholamine pattern.
Practice the rest
Build a quiz from this topic, or sit a full length exam under real conditions.
Start free
