Polycystic Ovary Syndrome — MCQs
Which of the following statements is true regarding Stein-Leventhal syndrome?
Hirsutism is seen in all except:
Which drug is most appropriate for reducing risk of ovarian cancer in a BRCA1 positive woman not planning for children?
Which type of cancer is most commonly associated with polycystic ovarian syndrome (PCOS)?
Which hormone is known to be elevated in Polycystic Ovary Syndrome (PCOS)?
Oligomenorrhoea means ?
A woman, who is in the reproductively active age group, presents with a history of greenish and frothy vaginal discharge. On examination, she has multiple punctuate strawberry-like spots. What is the likely diagnosis?
A 16-year-old girl with primary amenorrhoea presents to the gynaecology OPD for evaluation. She has normal secondary sexual characters. Her karyotype is 46,XX and ultrasound reveals normal ovaries and tubes but absent uterus. What is her clinical diagnosis?
Which condition is associated with HAIR-AN syndrome?
What conditions is Metformin primarily used to treat?
Polycystic Ovary Syndrome Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following statements is true regarding Stein-Leventhal syndrome?
- A. It is only characterized by oligomenorrhea and amenorrhea.
- B. It is only characterized by amenorrhea.
- C. It does not involve ovarian cysts.
- D. It is associated with enlarged ovaries and multiple follicular cysts. (Correct Answer)
Explanation: ***It is associated with enlarged ovaries and multiple follicular cysts.*** - Stein-Leventhal syndrome, now known as **polycystic ovary syndrome (PCOS)**, is characterized by the presence of **multiple small follicular cysts** on enlarged ovaries. - These cysts are immature follicles that fail to ovulate and instead accumulate in the ovarian stroma, leading to the characteristic **"string of pearls" appearance** on ultrasound. - This ovarian morphology, combined with biochemical hyperandrogenism and ovulatory dysfunction, forms the diagnostic triad of PCOS. *It is only characterized by oligomenorrhea and amenorrhea.* - This statement is **incorrect** because it limits PCOS to only menstrual irregularities, ignoring other cardinal features. - While **oligomenorrhea** and **amenorrhea** are common manifestations of anovulation in PCOS, the syndrome also includes **hyperandrogenism** (hirsutism, acne), **metabolic features** (insulin resistance), and **polycystic ovarian morphology**. - The Rotterdam criteria require at least 2 of 3 features: oligo/anovulation, hyperandrogenism, and polycystic ovaries on ultrasound. *It is only characterized by amenorrhea.* - This statement is incorrect because **amenorrhea** is just one possible menstrual irregularity seen in PCOS; many patients have **oligomenorrhea** or irregular cycles rather than complete absence of periods. - The word "only" makes this doubly incorrect by excluding all other features of the syndrome. *It does not involve ovarian cysts.* - This statement is completely incorrect as the presence of **multiple ovarian cysts** (polycystic ovaries) is a hallmark feature of Stein-Leventhal syndrome (PCOS). - The characteristic ultrasound finding shows **12 or more follicles (2-9 mm diameter)** in each ovary and/or increased ovarian volume (>10 mL).
Question 2: Hirsutism is seen in all except:
- A. Acromegaly
- B. Arrhenoblastoma
- C. PCOD
- D. Hypothyroidism (Correct Answer)
Explanation: Hypothyroidism - Hypothyroidism is a state of insufficient thyroid hormone production, which typically leads to dry skin, brittle hair, and hair loss (alopecia), not hirsutism [1]. - Hirsutism is characterized by excessive male-pattern hair growth in women, which is primarily driven by elevated androgens, a hormonal imbalance not directly caused by hypothyroidism. Acromegaly - Acromegaly is a hormonal disorder resulting from excessive growth hormone (GH) and insulin-like growth factor 1 (IGF-1) production, primarily from a pituitary tumor. - Patients with acromegaly may experience hirsutism due to increased IGF-1 stimulating androgen production and increased sensitivity of hair follicles to androgens. Arrhenoblastoma - An arrhenoblastoma is a rare ovarian tumor that produces androgens (male hormones). - The elevated androgen levels lead to virilization, a common feature of which is hirsutism, along with clitoromegaly and voice deepening [2]. PCOD - Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by hormonal imbalances, including elevated androgen levels [2]. - Hirsutism is one of the primary diagnostic criteria and a frequent complaint in women with PCOS, driven by the increased androgen production from the ovaries and adrenal glands [2].
Question 3: Which drug is most appropriate for reducing risk of ovarian cancer in a BRCA1 positive woman not planning for children?
- A. Gonadotropin-releasing hormone
- B. Oral contraceptive pills (Correct Answer)
- C. Tamoxifen
- D. Progesterone IUD
Explanation: ***Oral contraceptive pills*** **Oral contraceptive pills (OCPs)** are the most appropriate pharmacological intervention for **reducing ovarian cancer risk in BRCA1/2 carriers** who do not plan to have children. - OCPs **suppress ovulation**, and this reduction in ovulatory cycles is associated with a **~50% decrease in epithelial ovarian cancer risk** in BRCA mutation carriers - The protective effect increases with **longer duration of use** (5+ years provides maximum benefit) - This is a **well-established, evidence-based strategy** supported by multiple large cohort studies and meta-analyses - OCPs are recommended by major guidelines (NCCN, ACOG) for ovarian cancer risk reduction in this population prior to risk-reducing salpingo-oophorectomy *Gonadotropin-releasing hormone* **GnRH agonists or antagonists** are not recommended for long-term ovarian cancer prevention in BRCA carriers. - Primarily used for **infertility treatments, endometriosis management**, and uterine fibroid treatment through temporary ovarian suppression - **Not established as effective** for ovarian cancer risk reduction - **Not suitable for long-term use** due to significant side effects (bone loss, menopausal symptoms) - Lack of evidence supporting their role in cancer prevention *Tamoxifen* **Tamoxifen** is a **selective estrogen receptor modulator (SERM)** used for breast cancer prevention and treatment, not ovarian cancer prevention. - Effective for **reducing breast cancer risk** in high-risk women (including BRCA carriers) - **Does not reduce ovarian cancer risk** and has no protective effect against epithelial ovarian cancer - May **slightly increase endometrial cancer risk** (relative risk ~2-3) - Not indicated for ovarian cancer risk reduction *Progesterone IUD* A **levonorgestrel-releasing intrauterine device (IUD)** provides excellent contraception and manages heavy menstrual bleeding, but does not reduce ovarian cancer risk. - Acts **locally on the endometrium** with minimal systemic hormonal effects - **Does not reliably suppress ovulation** (only 5-15% of cycles are anovulatory) - **No established protective effect** against ovarian cancer - While useful for contraception and menstrual management, it lacks the ovulation suppression needed for cancer risk reduction
Question 4: Which type of cancer is most commonly associated with polycystic ovarian syndrome (PCOS)?
- A. Ovarian carcinoma
- B. Endometrial carcinoma (Correct Answer)
- C. Cervical carcinoma
- D. Adrenal carcinoma
Explanation: ***Endometrial carcinoma*** - PCOS is associated with **chronic anovulation**, leading to unopposed **estrogen exposure** which causes continuous endometrial proliferation and increased risk of **endometrial hyperplasia** and **carcinoma**. - The elevated **androgen levels** in PCOS can be aromatized to estrogens, further contributing to endometrial stimulation. *Ovarian carcinoma* - While PCOS involves the ovaries, it is not consistently linked to an increased risk of **ovarian cancer**. - Most ovarian cancers arise from **epithelial cells**, and the specific mechanisms related to PCOS do not directly promote their development. *Cervical carcinoma* - **Cervical cancer** is primarily caused by persistent infection with **high-risk human papillomavirus (HPV)**. - There is no strong direct association between PCOS and an increased risk of cervical carcinoma. *Adrenal carcinoma* - **Adrenal carcinoma** is a rare and aggressive cancer of the adrenal glands. - Although PCOS can involve some adrenal androgen excess, it is not considered a risk factor for adrenal cancer.
Question 5: Which hormone is known to be elevated in Polycystic Ovary Syndrome (PCOS)?
- A. FSH
- B. Estrogen
- C. TSH
- D. Luteinizing Hormone (LH) (Correct Answer)
Explanation: ***Luteinizing Hormone (LH)*** - In **Polycystic Ovary Syndrome (PCOS)**, there is often an elevated **Luteinizing Hormone (LH)** level, leading to an increased **LH:FSH ratio**. - This high LH level contributes to **increased androgen production** by the ovaries, a key feature of PCOS. *FSH* - **Follicle-stimulating hormone (FSH)** levels are typically normal or even low in PCOS, contributing to the **imbalance with LH**. - This relative deficiency of FSH impairs proper **follicle maturation**, leading to anovulation and cyst formation. *Estrogen* - While **estrogen** levels can be normal or slightly elevated due to peripheral conversion of androgens, they are not primarily responsible for the characteristic hormonal imbalance in PCOS. - The elevated **androgens** in PCOS are converted to estrogen in adipose tissue, but this is a secondary effect. *TSH* - **Thyroid-stimulating hormone (TSH)** is involved in thyroid function and is generally unrelated to the **pathophysiology of PCOS**, although thyroid disorders can co-exist with PCOS. - Elevated TSH suggests **hypothyroidism**, a distinct endocrine condition that would present with different symptoms.
Question 6: 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)
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**.
Question 7: A woman, who is in the reproductively active age group, presents with a history of greenish and frothy vaginal discharge. On examination, she has multiple punctuate strawberry-like spots. What is the likely diagnosis?
- A. Chlamydia infection
- B. Gonococcal vaginitis
- C. Candidiasis
- D. Trichomoniasis (Correct Answer)
Explanation: ***Trichomoniasis*** - The classic presentation of **greenish, frothy vaginal discharge** coupled with **strawberry cervix (multiple punctate spots)** is highly characteristic of trichomoniasis, caused by the parasite *Trichomonas vaginalis*. - This infection often causes **vaginal itching, irritation**, and dyspareunia. *Chlamydia infection* - Chlamydia often presents with **mucopurulent cervical discharge** and can be **asymptomatic**, but typically does not cause frothy, green discharge or strawberry cervix. - It is more commonly associated with symptoms like **dysuria** or **post-coital bleeding** when symptomatic. *Gonococcal vaginitis* - Gonorrhea typically causes **purulent discharge** that may be yellowish or greenish, but it is not typically frothy. - It is also associated with **dysuria** and pelvic pain, but the strawberry cervix is not a common finding. *Candidiasis* - Candidiasis (yeast infection) typically presents with a **thick, white, curd-like vaginal discharge**, often described as cottage cheese-like. - It is associated with **intense vulvovaginal itching and burning**, but not a frothy discharge or strawberry cervix.
Question 8: A 16-year-old girl with primary amenorrhoea presents to the gynaecology OPD for evaluation. She has normal secondary sexual characters. Her karyotype is 46,XX and ultrasound reveals normal ovaries and tubes but absent uterus. What is her clinical diagnosis?
- A. Primary ovarian failure
- B. Androgen insensitivity syndrome
- C. Turner syndrome
- D. Mayer-Rokitansky-Küster-Hauser syndrome (Correct Answer)
Explanation: ***Mayer-Rokitansky-Küster-Hauser syndrome (MRKH)*** - This syndrome is characterized by **agenesis of the uterus and upper vagina** in a genotypically and phenotypically normal female (46,XX karyotype, normal ovaries, and normal secondary sexual characteristics). - The presence of **normal secondary sexual characteristics** indicates normal ovarian function and estrogen production, ruling out ovarian failure as the primary cause of amenorrhea. *Primary ovarian failure* - This condition would typically lead to **absent or delayed development of secondary sexual characteristics** due to insufficient estrogen production by the ovaries. - The patient's **normal secondary sexual characteristics** contradict primary ovarian failure. *Androgen insensitivity syndrome* - Individuals with CAIS are **genetically male (46,XY)** but phenotypically female, with **absent or rudimentary uterus** and internal female reproductive organs. - While they have absent menses and normal secondary sexual characteristics (due to peripheral conversion of androgens to estrogens), their **karyotype is 46,XY**, not 46,XX as in this patient. *Turner syndrome* - This syndrome is characterized by a **45,X karyotype**, leading to **gonadal dysgenesis** (streak gonads) and thus absent or delayed secondary sexual characteristics. - The patient's **normal secondary sexual characteristics** and **46,XX karyotype** rule out Turner syndrome.
Question 9: Which condition is associated with HAIR-AN syndrome?
- A. CA ovary
- B. Adrenal tumours
- C. Endometriosis
- D. Polycystic Ovary Syndrome (PCOS) (Correct Answer)
Explanation: ***Polycystic Ovary Syndrome (PCOS)*** - **HAIR-AN syndrome** is a specific, severe form of **PCOS**, characterized by **HyperAndrogenism**, **Insulin Resistance**, and severe **Acanthosis Nigricans**. - It represents the most pronounced metabolic and endocrine abnormalities associated with PCOS, often with significant hyperinsulinemia. *Endometriosis* - Endometriosis involves the growth of **endometrial-like tissue outside the uterus**, causing pain and infertility. - It is not directly linked to the metabolic and hormonal disturbances seen in HAIR-AN syndrome. *CA ovary* - **Ovarian cancer** is a malignant proliferation of ovarian cells, which is not associated with the unique features of **hyperandrogenism**, **insulin resistance**, or **acanthosis nigricans** that define HAIR-AN syndrome. - Ovarian tumors can be hormone-producing, but this is distinct from the syndrome's chronic metabolic dysregulation. *Adrenal tumours* - **Adrenal tumors** can cause **hyperandrogenism** in some cases, leading to symptoms like hirsutism, but they typically do not present with the constellation of **insulin resistance** and severe **acanthosis nigricans** that define HAIR-AN syndrome. - The primary defect in HAIR-AN is ovarian and metabolic, rather than adrenal.
Question 10: What conditions is Metformin primarily used to treat?
- A. Only Type 2 Diabetes
- B. Only Polycystic Ovary Syndrome (PCOS)
- C. Both Type 2 Diabetes and Polycystic Ovary Syndrome (PCOS) (Correct Answer)
- D. Pregnancy Induced Hypertension
Explanation: ***Both Type 2 Diabetes and Polycystic Ovary Syndrome (PCOS)*** - **Metformin** is a first-line treatment for **Type 2 Diabetes** due to its ability to decrease hepatic glucose production and improve insulin sensitivity [1], [2]. - It is also commonly used off-label for **PCOS** to improve insulin resistance, ovulation, and reduce androgen levels. *Only Type 2 Diabetes* - While Metformin is a cornerstone for **Type 2 Diabetes** treatment, stating "only" is incorrect as it has other significant therapeutic uses [2]. - Its benefits extend beyond diabetes management, particularly in conditions involving **insulin resistance**. *Only Polycystic Ovary Syndrome (PCOS)* - Metformin is used in **PCOS**, but it is not the sole condition it treats, and its primary indication remains **Type 2 Diabetes** [2]. - This option incorrectly limits its application to just one condition, overlooking its major role in diabetes. *Pregnancy Induced Hypertension* - **Metformin** is not indicated for the treatment of **pregnancy-induced hypertension** (gestational hypertension). - Treatment for pregnancy-induced hypertension typically involves medications like **labetalol**, **methyldopa**, or **nifedipine**, with delivery being the definitive management for severe cases.
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