Gynaecological endocrinology: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Gynaecological endocrinology

Sample item

A phenotypic woman has primary amenorrhoea, well-developed breasts, scanty axillary and pubic hair, a blind vagina and inguinal masses. Karyotype is 46,XY with normal-to-high testosterone. Which management is appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Gonadectomy after puberty, then oestrogen replacement

Complete androgen insensitivity is caused by an X-linked androgen receptor mutation, so testosterone cannot act, and peripheral aromatisation to oestrogen gives breast development. Testes are retained until after puberty to allow spontaneous feminisation, then removed because of malignancy risk, followed by oestrogen replacement.

Option by option

  • A. Gonadectomy after puberty, then oestrogen replacement (correct)

    Correct. Delayed gonadectomy allows natural puberty and then removes the malignancy risk.

  • B. Cyclical progesterone to induce withdrawal bleeds

    There is no uterus, so withdrawal bleeding cannot occur.

  • C. Testosterone supplementation to induce male puberty

    Testosterone is ineffective because the receptor is non-functional.

  • D. Immediate gonadectomy before puberty in all cases

    Early removal is not required and would cause loss of spontaneous puberty.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Gonadectomy after puberty, then oestrogen replacement. Complete androgen insensitivity is caused by an X-linked androgen receptor mutation, so testosterone cannot act, and peripheral aromatisation to oestrogen gives breast development.

Why is "Cyclical progesterone to induce withdrawal bleeds" not the answer?

There is no uterus, so withdrawal bleeding cannot occur.

Why is "Testosterone supplementation to induce male puberty" not the answer?

Testosterone is ineffective because the receptor is non-functional.

Why is "Immediate gonadectomy before puberty in all cases" not the answer?

Early removal is not required and would cause loss of spontaneous puberty.

What concept does this question test?

It tests Gynaecological endocrinology in OBG. Testes are retained until after puberty to allow spontaneous feminisation, then removed because of malignancy risk, followed by oestrogen replacement.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gynaecological endocrinology?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.