Premenstrual Syndrome and PMDD Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Premenstrual Syndrome and PMDD. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Premenstrual Syndrome and PMDD Indian Medical PG Question 1: 35 yr old with 4 months amenorrhea with increased FSH, decreased estrogen. What is the diagnosis?
- A. Premature ovarian failure (Correct Answer)
- B. Pituitary dysfunction
- C. Hypothalamic dysfunction
- D. Polycystic Ovary Syndrome
Premenstrual Syndrome and PMDD Explanation: ***Premature ovarian failure***
- The combination of **amenorrhea** for 4 months in a 35-year-old, with **increased FSH** and **decreased estrogen**, is characteristic of premature ovarian failure, indicating the ovaries are no longer responding to FSH stimulation.
- This condition signifies the cessation of ovarian function before the age of 40, leading to menopausal symptoms and infertility.
*Pituitary dysfunction*
- Pituitary dysfunction might lead to **decreased FSH** (hypogonadotropic hypogonadism) due to insufficient stimulation of the ovaries, not increased FSH.
- In cases of pituitary adenomas, increased prolactin can cause amenorrhea, but FSH would not be elevated in the manner described.
*Hypothalamic dysfunction*
- Hypothalamic dysfunction, such as **functional hypothalamic amenorrhea**, typically presents with **low or normal FSH and LH levels** (hypogonadotropic hypogonadism) due to reduced GnRH pulsatility.
- This condition is often associated with stress, excessive exercise, or low body weight, and would not cause elevated FSH as seen here.
*Polycystic Ovary Syndrome*
- **Polycystic Ovary Syndrome (PCOS)** is characterized by **anovulation**, resulting in amenorrhea or oligomenorrhea, but typically involves **elevated androgens** and a **high LH-to-FSH ratio**, with FSH levels generally normal or low, and estrogen levels often normal or slightly elevated.
- It would not present with simultaneously high FSH and low estrogen, which points to ovarian failure rather than anovulation with intact ovarian reserve.
Premenstrual Syndrome and PMDD Indian Medical PG Question 2: Which of the following statements regarding prolactin levels is true?
- A. Hyperthyroidism - Increased prolactin
- B. Sleep - Increased prolactin (Correct Answer)
- C. Organic seizure - normal prolactin
- D. Psychogenic seizure - Normal prolactin
Premenstrual Syndrome and PMDD Explanation: ***Sleep - Increased prolactin***
- Prolactin secretion is **pulsatile** and highest during **nocturnal sleep**, peaking around 4-5 AM.
- This physiological increase occurs regardless of sleep onset and is a normal diurnal rhythm.
*Hyperthyroidism - Increased prolactin*
- **Hyperthyroidism** typically causes **decreased prolactin levels** due to altered dopaminergic tone and thyroid hormone effects on pituitary lactotrophs.
- Conversely, **hypothyroidism**, particularly primary hypothyroidism, can lead to **increased prolactin** due to elevated TRH stimulating prolactin secretion.
*Organic seizure - normal prolactin*
- An **organic seizure** (e.g., tonic-clonic seizure) usually causes an **acute, significant elevation in prolactin** levels postictally.
- This transient rise in prolactin can be a valuable diagnostic marker to differentiate epileptic seizures from non-epileptic events.
*Psychogenic seizure - Decreased prolactin*
- **Psychogenic non-epileptic seizures (PNES)** typically result in **normal or slightly decreased prolactin** levels after the event.
- This is a key diagnostic differentiator from true epileptic seizures, which show postictal prolactin elevation.
Premenstrual Syndrome and PMDD Indian Medical PG Question 3: 22-year-old female comes to your outpatient department complaining of frequent periods, which occur every 18 days. What is this condition called?
- A. Polymenorrhea (Correct Answer)
- B. Metrorrhagia
- C. Hypermenorrhea
- D. Menorrhagia
Premenstrual Syndrome and PMDD Explanation: ***Polymenorrhea***
- This term describes **menstrual bleeding** that occurs **more frequently than normal**—specifically, an interval of **less than 21 days** between periods.
- The patient's 18-day cycle falls within this definition, indicating abnormally frequent menstruation.
*Menorrhagia*
- **Menorrhagia** refers to **heavy or prolonged menstrual bleeding**, where the duration is typically more than 7 days or blood loss exceeds 80 mL.
- It does not specifically describe the frequency of the periods.
*Metrorrhagia*
- **Metrorrhagia** is characterized by **irregular, acyclic bleeding** between menstrual periods, or bleeding that is not associated with the expected menstrual cycle.
- This patient's periods are regular in their frequency, although too frequent, rather than irregular or intermenstrual.
*Hypermenorrhea*
- This term is often used interchangeably with **menorrhagia**, referring to **excessively heavy menstrual bleeding**.
- It does not address the issue of the short interval between menstrual cycles.
Premenstrual Syndrome and PMDD Indian Medical PG Question 4: The most common cause of hyperthyroidism in a young female is?
- A. TSH-secreting pituitary adenoma
- B. Graves' disease (Correct Answer)
- C. Subacute thyroiditis
- D. Toxic multinodular goiter
Premenstrual Syndrome and PMDD Explanation: ***Graves' disease***
- This is an **autoimmune disorder** where antibodies stimulate the thyroid gland, leading to **overproduction of thyroid hormones** [1], [2].
- It is the **most common cause of hyperthyroidism** in young to middle-aged women, making it highly probable in a young female patient [1], [2].
*Toxic multinodular goiter*
- This condition is characterized by **multiple nodules** within the thyroid gland that autonomously produce thyroid hormones.
- While a cause of hyperthyroidism, it is **more common in older individuals**, typically those over 50 years of age.
*Subacute thyroiditis*
- This is a **self-limiting inflammatory condition** of the thyroid often following a viral infection, causing a transient hyperthyroid phase due to the release of preformed hormones.
- It presents with **painful thyroid enlargement** and is usually followed by a hypothyroid phase, which is different from sustained hyperthyroidism.
*TSH-secreting pituitary adenoma*
- This is a **very rare cause of hyperthyroidism** where a pituitary tumor produces excess **Thyroid-Stimulating Hormone (TSH)**, leading to thyroid overstimulation.
- It is often accompanied by other symptoms of a pituitary mass like **headaches or visual field defects**, which are not implied here.
Premenstrual Syndrome and PMDD Indian Medical PG Question 5: A newly married couple, the woman is having irregular menstruation. What is the contraceptive of choice?
- A. Barrier method
- B. Calendar method
- C. OCP (Correct Answer)
- D. Progesterone only pills
Premenstrual Syndrome and PMDD Explanation: ***OCP***
- **Oral Contraceptive Pills (OCPs)** are a highly effective method that also help regulate **menstrual cycles** due to their hormonal content.
- They provide effective contraception while simultaneously addressing the symptom of **irregular menstruation** in a newly married woman.
*Barrier method*
- **Barrier methods** like condoms are effective for contraception but do not address or regulate irregular menstrual cycles.
- Their effectiveness depends heavily on consistent and correct use with each act of intercourse.
*Calendar method*
- The **calendar method** relies on tracking the menstrual cycle to predict fertile windows and is unreliable with **irregular menstruation**.
- It would be ineffective as a contraceptive for a woman with unpredictable cycle lengths, leading to a high risk of unintended pregnancy.
*Progesterone only pills*
- **Progesterone-only pills** (POPs) can be used for contraception, but they may cause or exacerbate **menstrual irregularities**.
- While effective in preventing pregnancy, they do not offer the cycle-regulating benefits that combination OCPs do for women with irregular periods.
Premenstrual Syndrome and PMDD Indian Medical PG Question 6: Which of the following is MOST effective as a first-line management for premenstrual syndrome?
- A. Hysterectomy with oophorectomy
- B. Diuretics
- C. Niacin (vitamin B3)
- D. Combined oral contraceptive pills (Correct Answer)
Premenstrual Syndrome and PMDD Explanation: ***Combined oral contraceptive pills***
- **Combined oral contraceptive pills** are the **most comprehensive first-line pharmacological treatment** for **premenstrual syndrome (PMS)** by suppressing ovulation and stabilizing hormonal fluctuations throughout the menstrual cycle.
- They address both physical and mood-related symptoms of PMS effectively.
- Continuous or extended-cycle regimens can be particularly beneficial by reducing the number of menstrual periods and related symptom flares.
*Niacin (vitamin B3)*
- There is **no robust scientific evidence** to support the efficacy of **niacin (vitamin B3)** in the management of PMS symptoms.
- While **vitamin B6** has some evidence for mild PMS symptoms, **niacin (B3)** is not recommended.
- High doses of niacin can cause side effects such as flushing, itching, and gastrointestinal upset.
*Diuretics*
- **Spironolactone**, a potassium-sparing diuretic, can be effective for managing **specific fluid retention symptoms** associated with PMS, such as bloating and breast tenderness.
- However, diuretics are typically used as **adjunctive therapy** for specific symptoms rather than comprehensive first-line management.
- They do not address the broader spectrum of emotional and psychological symptoms of PMS.
*Hysterectomy with oophorectomy*
- **Hysterectomy with oophorectomy** (removal of the uterus and ovaries) is a **last-resort treatment** for severe, refractory Premenstrual Dysphoric Disorder (PMDD) after all medical therapies have failed.
- This is an **irreversible surgical procedure** that induces immediate surgical menopause with significant risks and long-term implications.
- It is **never a first-line treatment** for PMS management.
Premenstrual Syndrome and PMDD Indian Medical PG Question 7: Oligomenorrhoea means ?
- A. Cycle < 20 days
- B. Cycle more than 45 days
- C. Cycle more than 28 days
- D. Cycle longer than 35 days (Correct Answer)
Premenstrual Syndrome and PMDD Explanation: ***Cycle longer than 35 days***
- **Oligomenorrhea** is defined by menstrual cycles that are **infrequently occurring**, specifically lasting longer than 35 days.
- This condition is distinct from **amenorrhea**, which is the complete absence of menstruation.
*Cycle < 20 days*
- A menstrual cycle lasting less than 20 days is considered **polymenorrhea**, indicating abnormally frequent menstruation.
- This is the opposite of oligomenorrhea, which refers to infrequent menstruation.
*Cycle more than 45 days*
- While a cycle longer than 45 days would technically fall under **oligomenorrhea**, the general definition begins at an interval longer than **35 days**.
- Cycles significantly longer than 45 days might also point to **amenorrhea**, depending on the exact duration and pattern.
*Cycle more than 28 days*
- A cycle lasting more than 28 days is within the **normal range** for many individuals, as the average cycle length is 21-35 days.
- Therefore, this duration alone does **not define oligomenorrhea**.
Premenstrual Syndrome and PMDD Indian Medical PG Question 8: A 28 year old woman develops amenorrhoea after having dilatation and curettage. The most likely diagnosis is :
- A. Kallman syndrome
- B. Turner syndrome
- C. Asherman syndrome (Correct Answer)
- D. Anorexia nervosa
Premenstrual Syndrome and PMDD Explanation: ***Asherman syndrome***
- It is characterized by the formation of **intrauterine adhesions** or **synechiae** that occur due to trauma to the endometrial lining, most commonly following a **D&C procedure**.
- These adhesions can lead to **amenorrhea**, hypomenorrhea, infertility, and recurrent pregnancy loss due to the obstruction of the uterine cavity.
*Kallman syndrome*
- This is a **congenital hypogonadotropic hypogonadism** characterized by a deficiency in GnRH production and an associated **anosmia** (loss of smell), neither of which are suggested by the clinical presentation.
- Patients typically present with **primary amenorrhea** and delayed puberty, not secondary amenorrhea following a D&C.
*Turner syndrome*
- A **chromosomal disorder (45, XO)** leading to **gonadal dysgenesis** and ovarian failure.
- It typically presents with **primary amenorrhea**, short stature, webbed neck, and other distinct physical features, which are not mentioned here.
*Anorexia nervosa*
- This is an **eating disorder** associated with severe caloric restriction and low body weight.
- It can cause **hypothalamic amenorrhea** due to impaired GnRH pulsatility but is usually accompanied by significant weight loss and psychological symptoms, not typically heralded by a D&C.
Premenstrual Syndrome and PMDD Indian Medical PG Question 9: Day 20 of menstrual cycle falls under which phase?
- A. Menstrual phase
- B. Follicular phase
- C. Ovulation phase
- D. Luteal phase (Correct Answer)
Premenstrual Syndrome and PMDD Explanation: ***Luteal phase***
- The **luteal phase** typically starts after ovulation, around day 14, and lasts until menstruation begins, usually day 28 of a 28-day cycle. Therefore, **day 20 falls squarely within this phase**.
- During this phase, the **corpus luteum** forms and produces **progesterone**, preparing the uterus for potential pregnancy.
*Menstrual phase*
- The **menstrual phase** is the period of shedding of the uterine lining, typically occurring from **day 1 to day 5** of the menstrual cycle.
- Day 20 is well past this phase, during which bleeding and low hormone levels are characteristic.
*Follicular phase*
- The **follicular phase** starts on day 1 of menstruation and lasts until ovulation, usually around **day 13-14** in a 28-day cycle.
- During this phase, follicles mature under the influence of **FSH** and **estrogen** levels rise. Day 20 is beyond this period.
*Ovulation phase*
- The **ovulation phase** is a short period, typically around **day 14** of a 28-day cycle, when the mature egg is released from the ovary.
- This phase is brief and marks the transition from the follicular to the luteal phase, so day 20 is considerably after ovulation.
Premenstrual Syndrome and PMDD Indian Medical PG Question 10: What is the commonest cause of primary amenorrhea?
- A. Genital tuberculosis
- B. Ovarian dysgenesis (Correct Answer)
- C. Mullerian duct anomalies
- D. Hypothyroidism
Premenstrual Syndrome and PMDD Explanation: **Explanation:**
Primary amenorrhea is defined as the failure of menarche to occur by age 15 in the presence of secondary sexual characteristics, or by age 13 in their absence.
**Why Ovarian Dysgenesis is Correct:**
**Ovarian dysgenesis (specifically Turner Syndrome, 45,XO)** is the most common cause of primary amenorrhea, accounting for approximately 40-50% of cases. In these patients, accelerated atresia of germ cells leads to "streak ovaries," resulting in hypergonadotropic hypogonadism (high FSH/LH, low Estrogen). This lack of estrogen prevents both the development of secondary sexual characteristics and the stimulation of the endometrium.
**Analysis of Incorrect Options:**
* **Genital Tuberculosis:** While a significant cause of infertility and secondary amenorrhea in developing countries, it rarely presents as primary amenorrhea unless it causes severe prepubertal endometrial destruction.
* **Mullerian Duct Anomalies:** Conditions like MRKH syndrome (Mullerian Agenesis) are the *second* most common cause. These patients have normal ovaries and secondary sexual characteristics but lack a functional uterus/vagina.
* **Hypothyroidism:** This is a systemic endocrine cause that more typically results in secondary amenorrhea or oligomenorrhea; it is rarely the primary etiology for a complete failure of menarche.
**High-Yield Clinical Pearls for NEET-PG:**
* **Most common cause overall:** Ovarian Dysgenesis (Turner Syndrome).
* **Most common cause with normal secondary sexual characteristics:** Mullerian Agenesis (MRKH Syndrome).
* **Initial investigation of choice:** Karyotyping (if FSH is high) or Ultrasound (to check for the presence of a uterus).
* **Turner Syndrome Hallmark:** Short stature, webbed neck, and high FSH levels.
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