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Reproductive & Endocrine Pharmacology — Step 1 practice questions
52 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
Pharmacology questions in this section combine two things the exam tests separately elsewhere. Pharmacology is examined as mechanism, effect and adverse effect, rarely as dosing. Endocrine questions are built on feedback loops.
Sample questions
Sample question 1
A woman presents 4 days after unprotected intercourse requesting emergency contraception. Her body mass index is 34 kg/m². Which of the following is the most appropriate option?
Explanations
A. Copper intrauterine device insertion, which is effective up to 5 days, is unaffected by body weight, and provides ongoing contraception · correct
The COPPER IUD is the most effective emergency contraception, reducing pregnancy risk by over 99% when placed within 5 days, and its efficacy is independent of body weight — an important advantage since levonorgestrel efficacy declines substantially above a BMI of about 26 and ulipristal above about 35. It also provides ongoing highly effective contraception. Hormonal emergency contraception works primarily by DELAYING OR INHIBITING OVULATION and does not disrupt an established pregnancy.
B. Combined oral contraceptives at standard dosing
The Yuzpe regimen is less effective with more nausea.
C. No option is effective beyond 24 hours
Several options remain effective for up to 5 days.
D. Mifepristone as the standard emergency contraceptive
Mifepristone at abortifacient doses is a different indication; ulipristal is the selective receptor modulator used for emergency contraception.
E. Levonorgestrel, which retains full efficacy at any weight and up to 5 days
Levonorgestrel efficacy declines with higher body weight and with delay.
Sample question 2
A postmenopausal woman has an estrogen receptor-positive, HER2-negative invasive breast cancer. Which of the following adjuvant endocrine therapies is most appropriate?
Explanations
A. Trastuzumab, indicated for this receptor profile
Trastuzumab targets HER2-positive disease.
B. Tamoxifen is the only option regardless of menopausal status
Tamoxifen is preferred premenopausally; aromatase inhibitors are superior after menopause.
C. No endocrine therapy is beneficial in receptor-positive disease
Endocrine therapy substantially reduces recurrence and mortality.
D. An aromatase inhibitor as the preferred agent in PREmenopausal women
Aromatase inhibitors do not suppress ovarian estrogen production.
E. An aromatase inhibitor such as anastrozole, which blocks peripheral conversion of androgens to estrogen — the main estrogen source after menopause · correct
Receptor status determines therapy. HORMONE receptor-positive disease is treated with endocrine therapy: AROMATASE INHIBITORS in POSTmenopausal women, since after menopause estrogen derives from peripheral aromatization of adrenal androgens — with adverse effects of arthralgia and bone loss. TAMOXIFEN, a selective estrogen receptor modulator, is used in premenopausal women (aromatase inhibitors are ineffective while ovaries produce estrogen) and carries risks of endometrial carcinoma and thromboembolism while protecting bone.
Sample question 3
A 22-year-old woman requests the most effective reversible contraception available. Which of the following is most appropriate?
Explanations
A. Combined oral contraceptive pills, which have the lowest typical-use failure rate
Typical-use failure with pills is substantially higher.
B. Depot medroxyprogesterone as the most effective reversible option
Injections require quarterly adherence and have higher typical-use failure than LARC.
C. A long-acting reversible contraceptive — intrauterine device or subdermal implant — since these have typical-use failure rates below 1% by eliminating adherence as a variable · correct
Long-acting reversible contraceptives — copper and levonorgestrel intrauterine devices and the etonogestrel implant — have typical-use failure rates under 1%, essentially matching perfect use because they remove user adherence from the equation. Oral contraceptives have perfect-use failure near 0.3% but TYPICAL-use failure around 7% because doses are missed. LARC methods are appropriate for nulliparous women and adolescents and are recommended as first-line by major guidelines; the copper IUD is also the most effective emergency contraception.
D. Fertility awareness methods
Fertility awareness has high typical-use failure.
E. Condoms, which are the most effective method with typical use
Condoms have typical-use failure around 13% but uniquely prevent sexually transmitted infection.
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