Endocrinology of Pregnancy Practice Questions

Q: Which of the following statements about cholestasis of pregnancy is false?

Most common cause of jaundice in pregnancy. ***Most common cause of jaundice in pregnancy*** - This statement is **FALSE** - while **intrahepatic cholestasis of pregnancy (ICP)** is the most common **pregnancy-specific** cause of jaundice, it is NOT the most common cause of jaundice overall in pregnancy. - **Viral hepatitis** (especially hepatitis A, B, and E) remains the **most common cause of jaundice in pregnancy** worldwide, accounting for approximately 40-50% of cases. - ICP accounts for about 20-25% of jaundice cases in pregnancy, making it the leading obstetric-specific cause but not the overall leading cause. *Bilirubin level >2mg%* - In ICP, **bilirubin levels** are typically **normal or only mildly elevated** (usually 10 μmol/L), not bilirubin. *Oestrogen is involved* - **TRUE** - Elevated **estrogen and progesterone levels** during pregnancy play a key role in ICP pathophysiology. - These hormones affect **hepatic bile salt transporters** (particularly BSEP and MDR3), leading to impaired bile secretion in genetically susceptible individuals. *Manifestations usually appear in last trimester* - **TRUE** - ICP typically presents in the **third trimester** (usually after 28 weeks), with **pruritus** as the predominant symptom. - Symptoms resolve within days to weeks after delivery, correlating with declining hormone levels.

Q: The "cutoff" value of plasma glucose in a 50-g glucose challenge test is

140 mg/dL. ***140 mg/dL*** - A plasma glucose level of **140 mg/dL** (7.8 mmol/L) or higher one hour after a **50-g glucose challenge** is considered abnormal and warrants further investigation with a 3-hour oral glucose tolerance test (OGTT). - This cutoff helps identify individuals at risk for **gestational diabetes mellitus (GDM)**. *120 mg/dL* - This value is below the established cutoff for an abnormal 50-g glucose challenge test. - A plasma glucose level of 120 mg/dL one hour after glucose intake is generally considered within the **normal range** for this screening test. *160 mg/dL* - While 160 mg/dL is an elevated value, the standard cutoff used to indicate a positive screen is 140 mg/dL. - Using a higher cutoff like 160 mg/dL would **decrease the sensitivity** of the screening test, potentially missing cases of gestational diabetes. *180 mg/dL* - A plasma glucose level of 180 mg/dL is significantly elevated and would certainly lead to further testing. - However, the American College of Obstetricians and Gynecologists (ACOG) and other major organizations recommend the **140 mg/dL cutoff** for initial screening to maximize sensitivity.

Q: Estrogen is secreted during pregnancy, mostly by which organ?

Placenta. ***Placenta*** - During pregnancy, the **placenta** takes over the primary role of **estrogen production** from the ovaries, especially after the first trimester. - It synthesizes significant amounts of **estriol**, the main estrogen produced during pregnancy, using precursors from the fetal adrenal glands. *Fetal ovary* - The **fetal ovary** is not the primary source of estrogen synthesis during pregnancy. - While it has some hormonal activity, it does not produce the large quantities of estrogen needed to support the pregnancy. *Pituitary* - The **pituitary gland** produces hormones like **FSH and LH**, which regulate ovarian function, but it does not directly secrete estrogen itself. - Its role is supervisory, not secretory of sex steroids. *Hypothalamus* - The **hypothalamus** secretes **gonadotropin-releasing hormone (GnRH)**, which stimulates the pituitary, but it does not produce estrogen. - It is part of the central control system for reproductive hormones, not a direct estrogen secretor.

Q: Which of the following statements about placental hormones is true?

hCS plays a role in maternal glucose metabolism.. **Correct: *hCS plays a role in maternal glucose metabolism.*** - **Human chorionic somatomammotropin (hCS)**, also known as placental lactogen, has **anti-insulin effects** that reduce maternal glucose utilization. - This action diverts glucose to the fetus, helping to meet the growing **fetal energy demands**. *Incorrect: hCG levels remain consistently high throughout pregnancy.* - **hCG (human chorionic gonadotropin)** levels peak in the first trimester (around 8-10 weeks) and then **decline and plateau** at much lower levels for the remainder of the pregnancy. - Its primary role is to maintain the **corpus luteum** during early pregnancy. *Incorrect: The luteal-placental shift occurs around 10-12 weeks of gestation.* - The **luteal-placental shift**, where the placenta takes over progesterone production from the corpus luteum, occurs around **7-9 weeks of gestation**. - By 10-12 weeks, the placenta is already the primary producer of progesterone. *Incorrect: Progesterone production requires fetal adrenal precursors.* - **Progesterone** is synthesized by the placenta from **maternal cholesterol** without requiring fetal steroid precursors. - **Estrogen**, particularly **estriol**, on the other hand, relies on **fetal adrenal androgens** as precursors.

Q: At any given point during pregnancy, AFP levels are highest in:

Fetal serum. ***Fetal serum*** - **Alpha-fetoprotein (AFP)** is primarily produced by the **fetal yolk sac** and then the **fetal liver**, leading to the highest concentrations directly in the fetal circulation. - AFP serves as the fetal equivalent of **albumin** and is crucial for regulating osmotic pressure and transporting various substances in the fetus. *Placenta* - The placenta acts as a **barrier** and site of exchange between the mother and fetus, but it does not produce significant amounts of AFP itself. - While AFP passes through the placenta, its concentration within the placental tissue itself is not the highest. *Amniotic fluid* - AFP enters the **amniotic fluid** through fetal urination and transudation from fetal serum across fetal membranes and skin. - Although detectable in amniotic fluid, its levels are significantly lower than in the fetal bloodstream from which it originates. *Maternal serum* - **Maternal serum AFP (MSAFP)** levels are much lower than fetal serum or even amniotic fluid levels because only a small fraction of fetal AFP crosses the placenta into the maternal circulation. - MSAFP is used as a screening tool, but its concentration reflects the *diluted* presence of fetal AFP.

Q: Hypothyroidism in pregnancy is most likely associated with which of the following?

Preeclampsia. ***Preeclampsia*** - **Hypothyroidism** in pregnancy is strongly linked to an increased risk of **preeclampsia**, a serious condition characterized by **hypertension and proteinuria** after 20 weeks of gestation. - The exact mechanism is not fully understood, but thyroid hormones play a crucial role in maintaining **vascular tone and endothelial function**, which are disrupted in preeclampsia. - Studies show that both **overt and subclinical hypothyroidism** increase the risk of preeclampsia, making this the **most likely association** among the given options. *Recurrent abortions* - While uncontrolled **hypothyroidism** can increase the risk of **first-trimester miscarriage**, it is not typically cited as the most likely association for **recurrent abortions** compared to preeclampsia. - Other causes like **chromosomal abnormalities, uterine anomalies, or antiphospholipid syndrome** are more common for recurrent pregnancy loss. - Early detection and treatment with **levothyroxine** can reduce miscarriage risk. *Polyhydramnios* - **Polyhydramnios** (excess amniotic fluid) is more often associated with conditions like **gestational diabetes**, fetal anomalies (e.g., GI obstruction, neural tube defects), or multiple gestation. - **Hypothyroidism** is not a primary risk factor for **polyhydramnios**; fetal thyroid dysfunction (e.g., fetal hyperthyroidism due to maternal Graves' disease) is more relevant to amniotic fluid disorders. - Maternal hypothyroidism does not typically affect amniotic fluid volume. *Preterm labour* - Poorly controlled **hypothyroidism** can increase the risk of **preterm birth**, but **preeclampsia** is generally considered a more distinct and stronger association. - Other common causes of **preterm labor** include infections, uterine abnormalities, cervical insufficiency, and multiple gestations. - Adequate thyroid hormone replacement reduces obstetric complications including preterm delivery.

Q: Which of the following endocrinological conditions may be associated with hydatidiform mole: 46,XX?

Hyperthyroidism. ***Hyperthyroidism*** - A **complete hydatidiform mole** produces very high levels of **human chorionic gonadotropin (hCG)**, which has a structural similarity to **thyroid-stimulating hormone (TSH)**. - This **hCG** can bind to **TSH receptors** on the thyroid gland, stimulating **thyroid hormone production** and leading to **hyperthyroidism**. *Hypothyroidism* - **Hypothyroidism** is characterized by **low thyroid hormone levels** and is not directly induced by the hormonal changes associated with a hydatidiform mole. - While pregnancy can sometimes unmask or worsen hypothyroidism, it is not a direct endocrinological consequence of a molar pregnancy. *Diabetes* - **Diabetes mellitus** is a metabolic disorder characterized by **high blood glucose**, commonly associated with insulin resistance or deficiency. - There is no direct endocrinological link between **hydatidiform mole** and the development of diabetes. *Hyperprolactinemia* - **Hyperprolactinemia** is characterized by **elevated prolactin levels**, often leading to menstrual irregularities and galactorrhea. - While pregnancy itself causes an increase in prolactin, a hydatidiform mole does not specifically induce pathological **hyperprolactinemia**.

Q: In normal pregnancy, β-HCG doubles in

48 hours. **48 hours** - In a **normal, singleton intrauterine pregnancy**, the serum β-HCG levels approximately **double every 48 hours** (or every 2 days) during early gestation. - This doubling time is a key indicator used to assess the viability and progression of a pregnancy in its initial stages. *24 hours* - A doubling time of 24 hours (or less) is **faster than typically observed** in normal pregnancies. - Such a rapid rise might sometimes be seen but is not the characteristic average doubling time for a healthy early pregnancy. *72 hours* - While a doubling time of up to 72 hours can still be considered within normal limits for some pregnancies, the **average and most common normal doubling time is 48 hours**. - A doubling time consistently longer than 48-72 hours can raise concern for an **ectopic pregnancy** or **miscarriage**. *90 hours* - A doubling time of 90 hours is **significantly prolonged** and is generally considered abnormal. - This slower rise in β-HCG is often indicative of a **non-viable pregnancy**, such as an evolving miscarriage or an ectopic pregnancy.

Q: Heat-stable alkaline phosphatase in pregnancy is primarily derived from which source?

The placenta. ***The placenta*** - The **placenta** is the primary source of heat-stable alkaline phosphatase (HSAP) during pregnancy. This specific isoform is distinct from other alkaline phosphatase isoforms. - Increased levels of HSAP are observed in maternal serum throughout pregnancy, reflecting **placental metabolic activity** and growth. - HSAP levels typically **rise progressively** from the first trimester and peak near term, serving as a marker of **placental function**. *Maternal liver* - The maternal liver produces **liver-specific alkaline phosphatase**, which is **not heat-stable**. - While liver ALP levels may fluctuate slightly in pregnancy, they are not the primary source of the heat-stable form. - Liver ALP is inactivated by heating at 56°C, unlike the placental isoform. *Fetal liver* - The fetal liver produces **alkaline phosphatase**, but this is not released into the maternal circulation in significant amounts as **heat-stable ALP**. - Fetal contribution to maternal serum **heat-stable ALP** is negligible compared to the placenta. - The placental barrier prevents significant transfer of fetal enzymes to maternal blood. *Maternal bone* - Maternal bone produces **bone-specific alkaline phosphatase**, which is also **not heat-stable**. - Bone ALP may increase during pregnancy due to skeletal remodeling, but it represents a different isoform. - Bone ALP can be distinguished from placental ALP by heat stability testing and electrophoresis.

Question 1

Which of the following statements about cholestasis of pregnancy is false?

Accepted Answer

Most common cause of jaundice in pregnancy

Answer

Bilirubin level >2mg%

Answer

Oestrogen is involved

Answer

Manifestations usually appear in last trimester

Question 2

The "cutoff" value of plasma glucose in a 50-g glucose challenge test is

Accepted Answer

140 mg/dL

Answer

120 mg/dL

Answer

160 mg/dL

Answer

180 mg/dL

Question 3

Estrogen is secreted during pregnancy, mostly by which organ?

Accepted Answer

Placenta

Answer

Fetal ovary

Answer

Pituitary

Answer

Hypothalamus

Question 4

Which of the following statements about placental hormones is true?

Accepted Answer

hCS plays a role in maternal glucose metabolism.

Answer

hCG levels remain consistently high throughout pregnancy.

Answer

The luteal-placental shift occurs around 10-12 weeks of gestation.

Answer

Progesterone production requires fetal adrenal precursors.

Question 5

At any given point during pregnancy, AFP levels are highest in:

Accepted Answer

Fetal serum

Answer

Placenta

Answer

Amniotic fluid

Answer

Maternal serum

Question 6

Hypothyroidism in pregnancy is most likely associated with which of the following?

Accepted Answer

Preeclampsia

Answer

Recurrent abortions

Answer

Preterm labour

Answer

Polyhydramnios

Question 7

Which of the following endocrinological conditions may be associated with hydatidiform mole: 46,XX?

Accepted Answer

Hyperthyroidism

Answer

Hypothyroidism

Answer

Diabetes

Answer

Hyperprolactinemia

Question 8

In normal pregnancy, β-HCG doubles in

Accepted Answer

48 hours

Answer

24 hours

Answer

72 hours

Answer

90 hours

Question 9

Heat-stable alkaline phosphatase in pregnancy is primarily derived from which source?

Accepted Answer

The placenta

Answer

Maternal liver

Answer

Fetal liver

Answer

Maternal bone

Endocrinology of Pregnancy — MCQs

Endocrinology of Pregnancy — MCQs

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