Menstrual Disorders — MCQs

Menstrual Disorders Indian Medical PG Practice Questions and MCQs

Question 221: In a patient with secondary amenorrhea, failure to experience withdrawal bleeding after administration of estrogen and progesterone indicates dysfunction of which structure?

A. Pituitary
B. Hypothalamus
C. Ovary
D. Endometrium (Correct Answer)

Explanation: ***Endometrium*** - If the **endometrium** fails to respond to **estrogen and progesterone therapy**, it suggests a problem with the uterine lining itself, such as **Asherman's syndrome** or severe endometrial atrophy. - In such cases, despite adequate hormonal stimulation, there is **no withdrawal bleeding** because the target tissue (endometrium) cannot proliferate or shed. *Pituitary* - A **dysfunctional pituitary gland** would typically cause secondary amenorrhea by failing to produce adequate **gonadotropins (LH and FSH)**, which in turn leads to ovarian dysfunction. - However, in this scenario, if the pituitary were the primary issue, providing exogenous **estrogen and progesterone** would likely still induce withdrawal bleeding if the uterus is responsive. *Hypothalamus* - The **hypothalamus** controls pituitary function by releasing **GnRH**. Hypothalamic dysfunction (e.g., due to stress, extreme exercise, or weight loss) causes **hypogonadotropic hypogonadism**. - While it's a common cause of secondary amenorrhea, exogenous **estrogen and progesterone** should still induce withdrawal bleeding if the uterus is healthy and responsive. *Ovary* - **Ovarian failure** (e.g., premature ovarian insufficiency) leads to low **estrogen** and **high FSH/LH** levels. - If the ovaries are the cause, administering **estrogen and progesterone** would typically induce withdrawal bleeding because the uterus is usually functional and responsive to these hormones.

Question 222: In a young female of reproductive age with a regular menstrual cycle of 28 days, ovulation occurs around the 14th day of the period. When is the first polar body extruded?

A. 24 hours prior to ovulation
B. 48 hours after the ovulation
C. Accompanied by ovulation (Correct Answer)
D. At the time of fertilization

Explanation: ***Accompanied by ovulation*** - The **first meiotic division** is completed just prior to or with ovulation, extruding the **first polar body**. - This process transitions the oocyte from a primary to a **secondary oocyte**, making it ready for fertilization. *24 hours prior to ovulation* - The first polar body extrusion typically occurs very close to the moment of ovulation, not a full 24 hours before. - The **LH surge** triggers the completion of meiosis I, leading to polar body extrusion and ovulation. *48 hours after the ovulation* - By 48 hours post-ovulation, if fertilization has not occurred, the **oocyte begins to degenerate**. - Extrusion of the first polar body occurs much earlier, at the time of ovulation itself. *At the time of fertilization* - At the time of fertilization, the **second meiotic division** is completed, leading to the extrusion of the **second polar body**. - The first polar body is extruded much earlier, when the oocyte is released from the ovary.

Practice by Chapter

Normal Menstrual Physiology

Practice Questions

Primary Dysmenorrhea

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Secondary Dysmenorrhea

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Premenstrual Syndrome and PMDD

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Primary Amenorrhea

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Secondary Amenorrhea

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Polycystic Ovary Syndrome

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Abnormal Uterine Bleeding: Classification

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Evaluation of Menstrual Disorders

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Management Approaches to Menstrual Disorders

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