Errors in First Aid for the USMLE (2007): Reproductive

As always, comments are welcome


  1. P. 414, Reproductive Pathology
    1. There is no section for vaginal pathology. I think the following should be added:
      1. Vaginal Carcinomas
        1. Squamous Cell CA – typically an extension from the cervix
        2. Clear Cell CA – seen in women exposed to DES
        3. Sarcoma Botryoides – rhabdomyosarcoma variant. “bunch of grapes”
  2. P.417, Polycystic ovarian syndrome
    1. One of the ways to treat PCOD is with clomiphene, which is neither an OCP or a gonadotropin analog. In women with PCOD that want to conceive, clomiphene is used. In women that do not want to conceive, oral contraceptive pills are used. I think that clomiphene should be included in the treatments.
  3. P.417, Ovarian non-germ cell tumors
    1. Serous cystadenocarcinoma is responsible for 50% of ovarian carcinomas, not 50% of ovarian tumors.
  4. P.418, Breast tumors
    1. I think “commonly found in the upper outer quadrant” should be included in the general description of malignant tumors.
    2. Invasive lobular – often multiple, bilateral. Cells in Indian file.
    3. Paget’s disease of the breast – ….suggest underlying ductal carcinoma.
  5. P.418, Common breast conditions
    1. Cystic – fluid filled. “Blue dome
    2. Fat Necrosis, …..Pendulous breasts
  6. P.419, Cryptorchidism
    1. I think the following should be included:
      1. Leydig cells spared – [up arrow] FSH, [up arrow] LH
      2. Increased risk for seminoma, embryonal germ cell tumors.
  7. P.419, Testicular germ cell tumors
    1. Seminoma – radiosensitive
    2. Yolk sac (endodermal sinus) tumor – infancy and early childhood
  8. P.420, Clomiphene
    1. Under clinical use, I think it should include “induce ovulation in PCOD”

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11 Responses to Errors in First Aid for the USMLE (2007): Reproductive

  1. Sanjay Linganna says:

    Reproductive Pharm, page 420, Antiandrogens:

    Perhaps not very high-yield, but Spironolactone can also be listed with Flutamide as a competitive inhibitor of androgens at the testosterone receptor. Spironolactone is used for the treatment of Hirsutism in this capacity.

    Ref Baby Katzung 7th edition, page 342

    Incidentally, it looks like Baby Katzung has an error on this page as well. In the “Key Drugs” table, they list Flutamide and Bicalutamide under “Receptor agonist” instead of “antagonists”

  2. Akiko Chiba says:

    Reproductive Pharm, page 420, Clomiphene:

    First Aid incorrectly states that Clomiphene is a partial AGONIST at pituitary estrogen receptors. Clomiphene actually works as an ANTAGONIST at pituitary estrogen receptors.

    Through this antagonist effect, clomiphene blocks estrogen’s negative feedback on GnRH/gonadotropin production. The resultant increase in LH/FSH levels can then stimulate the ovaries.

    Clomiphene does, however, work as a partial agonist in some tissues, such as at the ovaries. This agonist effect, when combined with the increased levels of LH/FSH can lead to an increased ovarian size.

    Since Clomiphene has agonist effect in some tissue and antagonist effect in other tissue, it is included as a SERM along with Tamoxifen and Raloxifene.

    Ref Golan, pg 451

  3. Brian says:

    Ch. 57 of G&G 11th Ed. lists clomiphene as an Anti-estrogen. “These compounds are distinguished from the SERMs in that they are pure antagonists in all tissues studied.” The chapter goes on to state, “Clomiphene is approved for the treatment of infertility in anovulatory women…”, which would include women with PCOS.

  4. Sameer Shah says:

    On page 413, it says that ovulation stimulates LH and inhibits FSH. In BRS phys, it says that the estrogen surge for ovulation stimulates LH and FSH. Also, the chart shows both LH and FSH levels increasing. Any thoughts?

  5. Matthew Krzemienski says:

    On page 410 on Sperm development, it lists the Spermatogonium undergoing mitosis to form a primary spermatocyte with diploid and 4N nuclear material. This is not true. The spermatogonium regenerates itself (Type A) with mitosis and forms a primary spermatocyte (Type B) with meiosis. Therefore the first step, where it is labeled mitosis, should actually be the first part of meiosis 1.

  6. amy says:

    Akiko> your explanation is right but I think first aid is not incorrect as it states clomiphene is a partial agonist because duality (acting either as agonist or antagonist depending on a situation/ location, etc) is a characteristic of a partial agonist unlike full agonist (acting only as agonist)

  7. Garet says:

    Kinda trivial, but on pg. 410 Epididimis should read Epididymis.

  8. ZedX says:

    Response to Sameer Shah> In the Merck Manual it states that
    ” Ovulation (ovum release) occurs. Estradiol levels usually peak as the ovulatory phase begins. Progesterone levels also begin to increase. Stored LH is released in massive amounts (LH surge), usually over 36 to 48 h, with a smaller increase in FSH. The LH surge occurs because at this time, high levels of estradiol trigger LH secretion by gonadotropes (positive feedback” (

    -however leading up to this point, FSH is more directly inhibited due to the production of inhibin by the follicles, which I believe directly inhibits FSH secretion but not LH secretion.

  9. Jeff says:

    It seems that the on page 419 in the 2007 edition, there is an error when describing teratomas and testicular germ cell tumors.

  10. Angel says:

    Amy….You are so correct…..A partial agonist like clomiophene acts as a competitive antagonist when combined to a full agonist like estrogen, this occurs mainly in the anterior pituitary gland estrogen receptors…Clomiphene would act as an agonist in the ovaries as an analog of estriol when its levels peaks as the ovulatory phase begins (as ZedX said) and this high estradiol levels trigger the LH surge secretion by the gonadotropes, causing ovulation. However, this could lead to multiple ovulation, increases the chances of having twins and can lead to ovarian cancer.

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