Endocrinology of Pregnancy Practice Questions

Q: Which is the least likely physiological change in pregnancy?

Increase in peripheral vascular resistance. **Explanation:** In pregnancy, the cardiovascular system undergoes significant adaptation to meet the metabolic demands of the fetus. The correct answer is **D (Increase in peripheral vascular resistance)** because systemic vascular resistance (SVR) actually **decreases** significantly during pregnancy. **Why D is correct:** The decrease in SVR is one of the earliest physiological changes, driven by high levels of **progesterone** (a smooth muscle relaxant) and increased production of local vasodilators like **nitric oxide and prostaglandins**. This drop in resistance is necessary to accommodate the massive increase in blood volume and ensures adequate perfusion to the uteroplacental unit. **Why other options are incorrect:** * **A. Increase in intravascular volume:** Plasma volume increases by 40–50%, starting as early as 6 weeks. This is a hallmark of normal pregnancy. * **B. Increase in cardiac output:** Cardiac output increases by 30–50%. It is the product of Heart Rate × Stroke Volume, both of which increase during pregnancy. * **C. Increase in stroke volume:** Stroke volume increases early in pregnancy (peaking at 20–24 weeks) due to increased blood volume and decreased afterload (SVR). **NEET-PG High-Yield Pearls:** * **Blood Pressure:** Despite increased cardiac output, BP typically **decreases** in the first and second trimesters (due to decreased SVR), reaching its nadir at 24 weeks before returning to pre-pregnancy levels at term. * **Heart Sounds:** A physiological S3 and a systolic ejection murmur (grade 1 or 2) are considered normal in pregnancy. A diastolic murmur is **always** pathological. * **Positioning:** Cardiac output is highest in the **left lateral position** because it relieves the compression of the inferior vena cava by the gravid uterus (preventing Supine Hypotension Syndrome).

Q: Corpus luteum in the first 6 weeks of pregnancy is maintained by?

Beta-hCG. **Explanation:** The **Corpus Luteum (CL)** is essential for the maintenance of early pregnancy as it produces the progesterone required to support the decidua. In a non-pregnant cycle, the CL regresses after 14 days due to a lack of LH. However, if fertilization occurs, the developing syncytiotrophoblast secretes **Human Chorionic Gonadotropin (hCG)**. **Why Beta-hCG is correct:** hCG is structurally similar to Luteinizing Hormone (LH) and binds to the LH/hCG receptors on the corpus luteum. This "rescues" the CL from luteolysis, maintaining its functional integrity for the first **6–8 weeks** of gestation. After this period, the placenta takes over progesterone production (the **luteo-placental shift**). **Why the other options are incorrect:** * **Estrogen:** While produced by the CL, it does not maintain it. Estrogen levels rise during pregnancy to support uterine growth and breast development. * **Progesterone:** This is the *product* of the CL, not the stimulator. It is vital for maintaining pregnancy, but its secretion depends on the stimulation of the CL by hCG. * **Human Placental Lactogen (hPL):** Also known as Human Chorionic Somatomammotropin (hCS), it is involved in fetal growth and maternal insulin resistance (diabetogenic effect) but has no role in maintaining the CL. **High-Yield Clinical Pearls for NEET-PG:** * **Luteo-placental shift:** Occurs between **7–10 weeks**. If the corpus luteum is removed before 7 weeks without progesterone supplementation, abortion will occur. * **hCG Levels:** hCG is detectable in maternal serum **8–9 days after fertilization** (or 21–22 days of LMP). * **Doubling Time:** In a healthy pregnancy, serum beta-hCG levels double every **48–72 hours**. * **Peak Levels:** hCG reaches its peak at **8–10 weeks** (approx. 100,000 mIU/mL) and then declines to a plateau.

Q: All of the following may be observed in a normal pregnancy EXCEPT:

Increase in blood viscosity. In normal pregnancy, the cardiovascular and hematological systems undergo significant physiological adaptations to support the growing fetus. **Explanation of the Correct Answer (C):** During pregnancy, **plasma volume increases by approximately 40–50%**, whereas **red cell mass increases by only 20–30%**. This disproportionate increase leads to **hemodilution** (physiological anemia of pregnancy). Because the plasma volume expands more than the cellular components, the **blood viscosity actually decreases**. This reduction in viscosity lowers peripheral vascular resistance, ensuring smoother microcirculatory flow to the placenta and vital organs. Therefore, an *increase* in blood viscosity is pathological, not physiological. **Analysis of Incorrect Options:** * **A. Fall in serum iron concentration:** Despite the increase in red cell mass, the demand for iron by the fetus and the expanding maternal blood volume often exceeds dietary intake, leading to a typical fall in serum iron levels. * **B. Increase in serum iron binding capacity:** As iron stores deplete and the liver increases the production of transferrin, the Total Iron Binding Capacity (TIBC) increases. This is a classic physiological response to the increased iron demand. * **D. Increase in blood oxygen carrying capacity:** Although there is hemodilution, the absolute total red cell mass and total hemoglobin increase. This enhances the total oxygen-carrying capacity of the blood to meet the metabolic demands of the mother and fetus. **High-Yield Clinical Pearls for NEET-PG:** * **Plasma Volume:** Starts increasing at 6 weeks, peaks at 32–34 weeks. * **Hematocrit:** Decreases due to hemodilution (lowest at 30–32 weeks). * **ESR:** Increases physiologically in pregnancy due to increased fibrinogen levels. * **Clotting Factors:** Pregnancy is a **hypercoagulable state**; all factors increase except Factors XI and XIII. Protein S levels decrease.

Q: Which of the following is FALSE regarding hyperemesis gravidarum?

Small heart is an incidental finding.. ### Explanation **Hyperemesis Gravidarum (HG)** is a severe form of nausea and vomiting in pregnancy characterized by dehydration, electrolyte imbalance, and weight loss. **1. Why Option C is the Correct (False) Statement:** The finding of a **"small heart"** on X-ray or autopsy in patients with severe HG is **not an incidental finding**. It is a pathological sign of **brown atrophy of the heart**, resulting from prolonged starvation, severe malnutrition, and chronic dehydration. The heart undergoes atrophy due to the body's catabolic state, where it breaks down its own tissues for energy. **2. Analysis of Other Options:** * **Option A (Allergic basis):** This is a recognized theory. HG is sometimes considered an immunological or allergic reaction to the "foreign" proteins of the chorionic villi or fetal antigens. * **Option B (Hormonal imbalance):** This is the most widely accepted etiology. High levels of **hCG** (especially in molar pregnancies or twins) and **Estrogen** are strongly associated with the severity of vomiting. * **Option D (Wernicke’s encephalopathy):** This is a dreaded complication of HG. Persistent vomiting leads to **Vitamin B1 (Thiamine) deficiency**. The classic triad includes ataxia, ophthalmoplegia, and confusion. **3. High-Yield Clinical Pearls for NEET-PG:** * **Metabolic Profile:** HG typically causes **Metabolic Alkalosis** (due to loss of HCl) with **Hypokalemia** and **Hyponatremia**. * **Ketonuria:** The presence of ketones in urine is a hallmark of HG, indicating starvation. * **Liver Function:** Mild elevation of serum bilirubin and transaminases may occur. * **Management:** The first-line drug is **Pyridoxine (Vit B6) + Doxylamine**. If Wernicke’s is suspected, always give Thiamine **before** IV Dextrose to prevent worsening of neurological symptoms.

Q: Clomiphene citrate is not known to produce which of the following effects in a 30-year-old female?

Decreased FSH and LH secretion. **Explanation:** **Mechanism of Action and the Correct Answer:** Clomiphene Citrate (CC) is a Selective Estrogen Receptor Modulator (SERM). Its primary action is to act as a **competitive antagonist** at the estrogen receptors in the hypothalamus and pituitary gland. By blocking the negative feedback of endogenous estrogen, the body perceives a "hypoestrogenic" state. This triggers the pituitary gland to **increase** the secretion of **FSH and LH** (gonadotropins), which stimulates follicular development in the ovaries. Therefore, **Option C** is the correct answer because Clomiphene increases, rather than decreases, FSH and LH levels. **Analysis of Incorrect Options:** * **A. Hot flushes:** This is the most common side effect (approx. 10%). It occurs due to the anti-estrogenic effect of the drug on the thermoregulatory center in the hypothalamus. * **B. Ovulation:** This is the intended therapeutic effect. The rise in FSH leads to follicular growth, and the subsequent rise in estrogen eventually triggers an LH surge, leading to ovulation in 70-80% of patients. * **D. Polycystic ovaries:** Clomiphene causes ovarian stimulation. In some cases, this can lead to the formation of multiple follicular cysts or, in severe cases, Ovarian Hyperstimulation Syndrome (OHSS), making the ovaries appear polycystic or enlarged. **High-Yield NEET-PG Pearls:** * **First-line treatment:** Clomiphene is a traditional first-line drug for ovulation induction in PCOS (though Letrozole is now preferred in many guidelines due to higher live birth rates). * **Dose:** Usually started at 50 mg/day for 5 days, beginning on Day 2, 3, 4, or 5 of the menstrual cycle. * **Anti-estrogenic effects:** It can cause thinning of the endometrium and thickening of cervical mucus, which may lead to a "conception-ovulation gap" (high ovulation rate but lower pregnancy rate). * **Multiple Pregnancy:** There is an increased risk (approx. 5-10%), primarily twins.

Q: Which clotting factor is not increased in pregnancy?

Factor 11. **Explanation:** Pregnancy is a **hypercoagulable state** characterized by an increase in most procoagulant factors, a decrease in natural anticoagulants, and a reduction in fibrinolytic activity. This physiological adaptation serves to minimize blood loss during placental separation at delivery. **Why Factor 11 is the Correct Answer:** While most clotting factors rise during pregnancy, **Factor XI (11) and Factor XIII (13)** are notable exceptions. Factor XI levels actually **decrease** (by approximately 20-30%) or remain unchanged during pregnancy. Factor XIII also decreases significantly, reaching about 50% of non-pregnant levels by term. **Analysis of Incorrect Options:** * **Factor 2 (Prothrombin):** Levels of Factor II show a mild to moderate **increase** during pregnancy. * **Factor 7:** This factor shows the most dramatic rise among all clotting factors, often increasing by up to 100-200% of pre-pregnancy levels. * **Factor 10:** Along with Factors VII, VIII, IX, and XII, Factor X levels **increase** significantly to facilitate the clotting cascade. **High-Yield NEET-PG Pearls:** * **Factors that Increase:** I (Fibrinogen - increases by 50%), II, VII, VIII, IX, X, and XII. * **Factors that Decrease:** XI, XIII, and **Antithrombin III**. * **Protein S:** Levels of **Free Protein S decrease** significantly (a common exam trap), while Protein C remains relatively unchanged. * **Fibrinogen:** It is the most significantly increased factor by mass (reaching 400-600 mg/dL). * **ESR:** The Erythrocyte Sedimentation Rate (ESR) is physiologically **increased** in pregnancy due to the rise in fibrinogen.

Q: Serum testosterone levels exceeding 200 ng/dL is suggestive of which condition?

Adrenal tumor. **Explanation:** In clinical practice, the degree of androgen elevation is a critical diagnostic marker for differentiating between functional and neoplastic causes of hyperandrogenism. **1. Why Adrenal Tumor is Correct:** Serum testosterone levels **exceeding 200 ng/dL** are highly suspicious for an **androgen-secreting tumor**, most commonly of ovarian or adrenal origin (e.g., Sertoli-Leydig cell tumor or Adrenal Cortical Carcinoma). While PCOS causes mild to moderate elevations, a rapid onset of virilization (clitoromegaly, deepening of voice) and testosterone levels >200 ng/dL necessitate imaging (CT/MRI or Ultrasound) to rule out a malignancy. **2. Why Other Options are Incorrect:** * **Polycystic Ovary Syndrome (PCOS):** This is the most common cause of hyperandrogenism, but testosterone levels are typically mildly elevated (usually ** 200 ng/dL are rare in PCOS. * **Metabolic Syndrome:** While often associated with PCOS and insulin resistance (which lowers SHBG and increases free testosterone), it does not independently cause extreme elevations of total testosterone. * **Ovarian Atresia:** This refers to the natural degeneration of follicles. It leads to a decrease in estrogen rather than a pathological increase in testosterone. **Clinical Pearls for NEET-PG:** * **Cut-off Values:** Testosterone **>200 ng/dL** suggests a tumor. DHEAS **>700 µg/dL** specifically suggests an **adrenal source/tumor**. * **Rapid Onset:** If symptoms of virilization appear rapidly (within 6 months), always suspect a tumor over PCOS. * **First-line Investigation:** For suspected androgen-secreting tumors, transvaginal ultrasound (TVS) is often the initial step to look for ovarian masses, followed by adrenal imaging.

Question 1

At what intrauterine gestational age are peak hCG levels typically observed?

Accepted Answer

8-10 weeks

Answer

11-13 weeks

Answer

20 weeks

Answer

25 weeks

Question 2

Which is the least likely physiological change in pregnancy?

Accepted Answer

Increase in peripheral vascular resistance

Answer

Increase in intravascular volume

Answer

Increase in cardiac output

Answer

Increase in stroke volume

Question 3

Corpus luteum in the first 6 weeks of pregnancy is maintained by?

Accepted Answer

Beta-hCG

Answer

Estrogen

Answer

Progesterone

Answer

Human placental lactogen

Question 4

All of the following may be observed in a normal pregnancy EXCEPT:

Accepted Answer

Increase in blood viscosity

Answer

Fall in serum iron concentration

Answer

Increase in serum iron binding capacity

Answer

Increase in blood oxygen carrying capacity

Question 5

Which of the following is FALSE regarding hyperemesis gravidarum?

Accepted Answer

Small heart is an incidental finding.

Answer

Allergic basis is suggested.

Answer

Hormonal imbalance may be a cause.

Answer

May show manifestations of Wernicke's encephalopathy.

Question 6

Clomiphene citrate is not known to produce which of the following effects in a 30-year-old female?

Accepted Answer

Decreased FSH and LH secretion

Answer

Hot flushes

Answer

Ovulation

Answer

Polycystic ovaries

Question 7

Which clotting factor is not increased in pregnancy?

Accepted Answer

Factor 11

Answer

Factor 2

Answer

Factor 7

Answer

Factor 10

Question 8

Serum testosterone levels exceeding 200 ng/dL is suggestive of which condition?

Accepted Answer

Adrenal tumor

Answer

Polycystic Ovary Syndrome (PCOS)

Answer

Metabolic syndrome

Answer

Ovarian atresia

Question 9

Which of the following changes that occur in the renal system during pregnancy is FALSE?

Accepted Answer

The kidneys become smaller compared to their pre-pregnant size.

Answer

The renal calyces and ureters show significant dilatation.

Answer

Pregnancy-induced changes are responsible for an increased risk of upper urinary tract infections.

Answer

There is an increased glomerular filtration rate.

Question 10

Which of the following statements regarding gestational diabetes is true?

Accepted Answer

As pre-conceptional glucose control worsens, the incidence of congenital malformations increases.

Answer

Gestational diabetes confers an increased risk of congenital malformations.

Answer

If HbA1c is less than 6%, there is no risk of congenital malformations.

Answer

The highest risk for congenital malformations is seen with an HbA1c level between 7 and 8.

Endocrinology of Pregnancy — MCQs

Endocrinology of Pregnancy — MCQs

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