Hormonal Evaluation and Testing — MCQs
A middle-aged female presents with increasing visual loss, breast enlargement, and irregular menses. What is the most appropriate investigation to diagnose the underlying condition?
Which of the following is the most reliable test for ovulation?
On which day LH & FSH should be measured?
Which of the following hormones does not mediate its action through cAMP?
35 yr old with 4 months amenorrhea with increased FSH, decreased estrogen. What is the diagnosis?
Ovarian reserve is best indicated by
While investigating a case of gynecomastia, all of the following hormone levels are estimated, except:
Substrate-controlled hormone is
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?
Delayed puberty in a female is characterized by which of the following?
Hormonal Evaluation and Testing Indian Medical PG Practice Questions and MCQs
Question 1: A middle-aged female presents with increasing visual loss, breast enlargement, and irregular menses. What is the most appropriate investigation to diagnose the underlying condition?
- A. S. calcitonin
- B. S. prolactin (Correct Answer)
- C. S. hemoglobin concentration
- D. S. calcium
Explanation: ***S. prolactin*** - **Hyperprolactinemia** is the most likely cause of the presented symptoms: **galactorrhea** (**breast enlargement** with milk production), **amenorrhea** (**irregular menses**), and **visual field defects** due to a pituitary tumor compressing the optic chiasm [1]. - Measuring serum prolactin levels directly confirms or rules out **hyperprolactinemia**, guiding further management, including imaging of the pituitary gland if elevated [1]. *S. calcitonin* - **Calcitonin** is a hormone primarily involved in **calcium regulation** and is typically elevated in medullary thyroid carcinoma. - The presented symptoms (visual loss, breast enlargement, irregular menses) are not characteristic of elevated calcitonin levels or a **medullary thyroid carcinoma**. *S. hemoglobin concentration* - **Hemoglobin concentration** measures the amount of oxygen-carrying protein in red blood cells and is used to diagnose **anemia** or polycythemia. - While general labs might include this, it is not directly relevant to the specific constellation of symptoms pointing towards an **endocrine or pituitary issue**. *S. calcium* - **Serum calcium** levels are checked for disorders of calcium metabolism, such as **hyperparathyroidism** or hypocalcemia. - Though calcium is regulated by hormones, the symptoms of **visual loss**, **breast enlargement**, and **menstrual irregularities** are not typically associated with primary disturbances in calcium levels.
Question 2: Which of the following is the most reliable test for ovulation?
- A. Basal body temperature
- B. Vaginal cytology
- C. Serum Progesterone level (Correct Answer)
- D. Endometrial biopsy
Explanation: ***Serum Progesterone level*** - A **serum progesterone level** measured approximately 7 days after the presumed ovulation (mid-luteal phase) is the most reliable biochemical indicator of ovulation. A level of **≥3 ng/mL** confirms ovulation. - The rise in progesterone is due to its production by the **corpus luteum** formed after the rupture of the mature follicle during ovulation. *Basal body temperature* - **Basal body temperature (BBT)** charting shows a slight increase (0.5-1.0°C) after ovulation due to the thermogenic effect of progesterone. However, this rise is **retrospective** and only indicates that ovulation has already occurred. - BBT can be influenced by various factors, such as illness, stress, and sleep patterns, making it **less precise** than direct hormonal measurement. *Vaginal cytology* - **Vaginal cytology** can show changes in epithelial cell morphology (e.g., increased cornified cells) during the periovulatory period due to estrogen influence. - These changes are **indicative of estrogen activity** and cervical mucus quality, but they do not directly confirm the rupture of the follicle or the release of an egg. *Endometrial biopsy* - An **endometrial biopsy** can reveal secretory changes in the endometrium characteristic of the luteal phase, which are a result of progesterone production after ovulation. - However, this is an **invasive procedure** and not a practical or primary test used solely for confirming ovulation.
Question 3: On which day LH & FSH should be measured?
- A. 1-3rd day (Correct Answer)
- B. 7th day
- C. 14th day
- D. 10th day
Explanation: ***1-3rd day*** - Measuring **LH** (Luteinizing Hormone) and **FSH** (Follicle-Stimulating Hormone) on cycle days 1-3 provides a baseline assessment of **ovarian reserve** and pituitary function. - At this early follicular phase, hormone levels are relatively stable and reflect the intrinsic **gonadal feedback** mechanisms before significant follicular development begins. *7th day* - By day 7, **follicular development** is usually well underway, and FSH levels might be decreasing as a dominant follicle is selected. - Measuring hormones on this day would not provide an accurate baseline assessment, as the levels are already influenced by **follicular growth**. *14th day* - Day 14 is often associated with the **LH surge** that triggers ovulation, making it unsuitable for a baseline assessment of ovarian reserve. - FSH levels would also be significantly different from the early follicular phase due to the ongoing **ovarian cycle events**. *10th day* - On day 10, **estrogen levels** are typically rising, which would already be providing negative feedback to the pituitary, affecting FSH and LH levels. - This timing would not be ideal for assessing baseline hormone levels for **fertility evaluations**.
Question 4: Which of the following hormones does not mediate its action through cAMP?
- A. Glucagon
- B. Follicle stimulating hormone
- C. Estrogen (Correct Answer)
- D. Luteinizing hormone
Explanation: ***Estrogen*** - **Estrogen** is a **steroid hormone** that mediates its action by binding to intracellular receptors, forming a complex that directly influences gene transcription. - Steroid hormones, due to their **lipophilicity**, can cross the cell membrane and do not typically rely on cell surface receptors or second messengers like cAMP. *Glucagon* - **Glucagon** acts on a **G protein-coupled receptor (GPCR)**, specifically a Gs-coupled receptor, leading to the activation of adenylyl cyclase. - This activation increases the intracellular concentration of **cAMP**, which then activates protein kinase A to mediate its effects, primarily on glucose metabolism. *Follicle stimulating hormone* - **FSH** binds to a **GPCR** on target cells, activating the Gs protein pathway. - This activation stimulates **adenylyl cyclase** and increases intracellular **cAMP** levels, which are critical for its role in gamete development. *Luteinizing hormone* - **LH**, like FSH, binds to a cell surface **GPCR** that activates the Gs protein. - This leads to the stimulation of **adenylyl cyclase** and an increase in **cAMP**, mediating its effects on steroidogenesis and ovulation.
Question 5: 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
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.
Question 6: Ovarian reserve is best indicated by
- A. Follicle-stimulating hormone (FSH)
- B. Anti-Müllerian Hormone (AMH) (Correct Answer)
- C. Luteinizing hormone (LH)
- D. LH/FSH ratio
Explanation: ***Anti-Müllerian Hormone (AMH)*** - **AMH is currently considered the best single biochemical marker** for assessing ovarian reserve - Produced by **granulosa cells of preantral and small antral follicles**, directly reflecting the size of the primordial follicle pool - **Cycle-independent** - can be measured at any time during the menstrual cycle - **More sensitive and specific** than FSH for detecting diminished ovarian reserve - **Minimal inter-cycle and intra-cycle variability**, providing consistent and reliable results - Widely used in **fertility assessment, IVF protocols**, and predicting ovarian response to stimulation *Follicle-stimulating hormone (FSH)* - Elevated **early follicular phase FSH** (measured on day 3) indicates diminished ovarian reserve - Historically the most commonly used marker, but **less sensitive than AMH** - **Cycle-dependent** - must be measured on specific days (day 2-4 of cycle) - A **late marker** - rises only when ovarian reserve is already significantly diminished - Still clinically useful and widely available, but not the "best" indicator *Luteinizing hormone (LH)* - **LH** primarily triggers ovulation and does not directly reflect ovarian reserve - Elevated in conditions like **PCOS** but does not assess the quantity or quality of remaining follicles - Not a reliable indicator of overall ovarian reserve *LH/FSH ratio* - An elevated **LH/FSH ratio** (>2:1 or >3:1) is associated with **Polycystic Ovary Syndrome (PCOS)** - Reflects anovulation and hormonal imbalance, not the number or viability of ovarian follicles - Does not assess ovarian reserve capacity
Question 7: While investigating a case of gynecomastia, all of the following hormone levels are estimated, except:
- A. Lutenizing hormone
- B. Prolactin
- C. Follicle stimulating hormone (Correct Answer)
- D. None of the options
Explanation: ***Follicle stimulating hormone*** - While **FSH** levels can be assessed in cases of infertility or hypogonadism, they are generally **not a primary assessment** for gynecomastia. - The direct hormonal imbalance causing gynecomastia typically involves other hormones like testosterone, estrogen, LH, and prolactin. *Lutenizing hormone* - **LH** levels are crucial in assessing **gonadal function** and identifying the cause of altered testosterone production, which is directly linked to gynecomastia [1]. - Elevated or suppressed LH can indicate primary or secondary hypogonadism affecting the **testosterone-estrogen balance**. *Prolactin* - **Prolactin** levels are important to rule out **hyperprolactinemia**, which can lead to hypogonadism and subsequently gynecomastia [1]. - A **prolactinoma** (prolactin-secreting tumor) can suppress GnRH, leading to reduced testosterone and an increased estrogen-to-androgen ratio [1]. *None of the options* - This option is incorrect because there is a specific hormone (FSH) among the choices that is **less commonly estimated** in the initial workup for gynecomastia compared to LH and prolactin. - The workup for gynecomastia commonly involves assessment of other hormones like **testosterone** and **estrogen** along with LH and prolactin [1].
Question 8: Substrate-controlled hormone is
- A. LH
- B. TRH
- C. FSH
- D. Glucagon (Correct Answer)
Explanation: ***Glucagon*** - **Glucagon** secretion is primarily regulated by **blood glucose levels**. When blood glucose is low, glucagon is released to increase it. - This direct response to a metabolite concentration (glucose, a substrate) makes it a **substrate-controlled hormone**. *LH* - **Luteinizing hormone (LH)** is a gonadotropin secreted by the anterior pituitary, controlled by **GnRH** from the hypothalamus and feedback from gonadal steroids. - It is part of a complex **neuroendocrine axis**, not directly regulated by a metabolic substrate. *TRH* - **Thyrotropin-releasing hormone (TRH)** is a neurohormone produced in the hypothalamus that stimulates the pituitary to release TSH. - Its release is primarily controlled by **negative feedback** from thyroid hormones and environmental factors, not by a specific metabolic substrate. *FSH* - **Follicle-stimulating hormone (FSH)** is also a gonadotropin, like LH, regulated by **GnRH** and gonadal feedback. - Its regulation involves the **hypothalamic-pituitary-gonadal axis**, not direct substrate control.
Question 9: 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 10: Delayed puberty in a female is characterized by which of the following?
- A. Menarche > 16 year (Correct Answer)
- B. FSH < 20 in 16 year
- C. Menarche occurring more than 1 year after breast budding
- D. No breast budding by age 10
Explanation: ***Menarche > 16 year*** - Delayed puberty is defined as the **absence of menarche by 16 years of age**, or the absence of any secondary sexual characteristics by age 13. - This option correctly identifies one of the key diagnostic criteria for delayed puberty in females. *No breast budding by age 10* - This is incorrect; the absence of **breast budding by age 13** is the accepted cutoff for delayed puberty. - Breast development typically begins between ages 8 and 13. *Menarche occurring more than 1 year after breast budding* - This is incorrect; menarche typically occurs within **2 to 3 years** of breast development. A delay of merely one year following breast budding is usually within normal limits. *FSH < 20 in 16 year* - This statement itself does not definitively characterize delayed puberty and requires more context. A **low Follicle-Stimulating Hormone (FSH)** level in a 16-year-old with delayed puberty would suggest a **hypogonadotropic hypogonadism**, whereas high FSH levels would indicate **hypergonadotropic hypogonadism** (e.g., primary ovarian failure). - The threshold of FSH < 20 is not a universal or standalone diagnostic criterion for delayed puberty.
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