Gynaecological endocrinology: androgen insensitivity: 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: androgen insensitivity

Sample item

A phenotypic girl presents with primary amenorrhoea, well-developed breasts, scanty pubic and axillary hair, a short blind vagina and inguinal swellings. Which karyotype and plan are expected?

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

The answer and the reasoning

B. 46,XY; gonadectomy after puberty

Complete androgen insensitivity syndrome is an X-linked defect of the androgen receptor. Testes produce anti-Mullerian hormone, so there is no uterus. The testes are removed after puberty because of malignancy risk (gonadoblastoma), followed by oestrogen replacement.

Option by option

  • A. 45,X; oestrogen therapy

    45,X is Turner syndrome.

  • B. 46,XY; gonadectomy after puberty (correct)

    Correct. 46,XY with testes needs gonadectomy after pubertal development.

  • C. 47,XXX; observation

    47,XXX does not cause this phenotype.

  • D. 46,XX; hysterectomy

    A 46,XX karyotype would have a uterus.

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.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, 46,XY; gonadectomy after puberty. Complete androgen insensitivity syndrome is an X-linked defect of the androgen receptor.

Why is "45,X; oestrogen therapy" not the answer?

45,X is Turner syndrome.

Why is "47,XXX; observation" not the answer?

47,XXX does not cause this phenotype.

Why is "46,XX; hysterectomy" not the answer?

A 46,XX karyotype would have a uterus.

What concept does this question test?

It tests Gynaecological endocrinology: androgen insensitivity in OBG. Testes produce anti-Mullerian hormone, so there is no uterus. The testes are removed after puberty because of malignancy risk (gonadoblastoma), 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: androgen insensitivity?

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.