Metabolic Dysfunction in PCOS — MCQs
What conditions is Metformin primarily used to treat?
Which of the following is not the criteria for diagnosis of Metabolic syndrome?
Which condition is associated with HAIR-AN syndrome?
Mr. Murali has 126 mg/dl of fasting plasma glucose. His venous plasma glucose 2h after ingestion of 75g oral glucose load is 149 mg/dl. This patient comes under which stage of WHO diagnostic criteria of diabetes & intermediate hyperglycemia?
Which hormone is primarily responsible for insulin resistance during pregnancy?
Which of the following is not used to treat PCOD?
Which of the following is least effective in the management of polycystic ovary syndrome?
In Stein-Leventhal syndrome, which hormone is raised?
Type of wave in Metabolic Encephalopathy?
Which hormone is known to be elevated in Polycystic Ovary Syndrome (PCOS)?
Metabolic Dysfunction in PCOS Indian Medical PG Practice Questions and MCQs
Question 1: 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.
Question 2: Which of the following is not the criteria for diagnosis of Metabolic syndrome?
- A. High LDL (Correct Answer)
- B. Hyperiglyceridemia
- C. Hypertension
- D. Central obesity
Explanation: ***High LDL*** - While **high LDL (low-density lipoprotein)** is a risk factor for cardiovascular disease [1], it is **not** one of the specific diagnostic criteria for metabolic syndrome. - The criteria for metabolic syndrome focus on a cluster of metabolic abnormalities associated with insulin resistance. *Hypertriglyceridemia* - **Elevated triglycerides** (typically ≥ 150 mg/dL or on drug treatment for elevated triglycerides) is one of the key diagnostic criteria for metabolic syndrome. - It reflects impaired lipid metabolism often associated with insulin resistance [2]. *Hypertension* - **Elevated blood pressure** (systolic ≥ 130 mmHg or diastolic ≥ 85 mmHg, or on antihypertensive drug treatment) is a core component of metabolic syndrome. - Hypertension in this context is often linked to underlying insulin resistance. *Central obesity* - **Increased waist circumference** (varying by ethnicity and sex, e.g., >102 cm in men and >88 cm in women for adults of European descent) is a primary criterion for metabolic syndrome. - It is a strong indicator of visceral fat accumulation, which is closely linked to insulin resistance [3].
Question 3: 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 4: Mr. Murali has 126 mg/dl of fasting plasma glucose. His venous plasma glucose 2h after ingestion of 75g oral glucose load is 149 mg/dl. This patient comes under which stage of WHO diagnostic criteria of diabetes & intermediate hyperglycemia?
- A. Decreased glucose resistance
- B. IFG - Impaired fasting glucose
- C. Diagnosis of diabetes (Correct Answer)
- D. Impaired glucose tolerance
Explanation: **Diagnosis of diabetes** - The **fasting plasma glucose (FPG)** of 126 mg/dL meets the WHO criterion for **diabetes**, which is FPG ≥ 126 mg/dL [1]. - Although the 2-hour post-glucose load (149 mg/dL) falls within the **impaired glucose tolerance (IGT)** range (140-199 mg/dL), the elevated fasting glucose alone is sufficient for a diabetes diagnosis according to WHO guidelines. *Decreased glucose resistance* - This term is not a standard diagnostic category recognized by the WHO for glucose metabolism disorders. - Glucose resistance is more commonly associated with conditions like **insulin resistance** rather than a specific diagnostic stage [1]. *IFG - Impaired fasting glucose* - **Impaired fasting glucose (IFG)** is defined by a fasting plasma glucose level between 100 mg/dL and 125 mg/dL. - Mr. Murali's fasting glucose of 126 mg/dL is higher than the upper limit for IFG [1]. *Impaired glucose tolerance* - **Impaired glucose tolerance (IGT)** is defined by a 2-hour post-glucose load plasma glucose level between 140 mg/dL and 199 mg/dL. - While Mr. Murali's 2-hour reading of 149 mg/dL falls within this range, the elevated fasting glucose level takes precedence for the overall diagnosis [1].
Question 5: Which hormone is primarily responsible for insulin resistance during pregnancy?
- A. Estrogen
- B. HPL (Correct Answer)
- C. Progesterone
- D. GH
Explanation: ***HPL*** - **Human placental lactogen (HPL)**, also known as **chorionic somatomammotropin**, directly induces maternal insulin resistance to ensure a continuous supply of glucose to the fetus. - HPL levels rise throughout pregnancy, peaking in the third trimester, correlating with increasing insulin resistance. *Estrogen* - While **estrogen** levels are high in pregnancy, its primary role is in supporting uterine growth and maintaining the pregnancy, not directly causing significant insulin resistance. - High estrogen levels can enhance insulin sensitivity in some contexts, contrasting with the overall insulin resistance of pregnancy. *Progesterone* - **Progesterone** is crucial for maintaining pregnancy and relaxing smooth muscle but does not directly cause the marked insulin resistance seen in gestation. - It works synergistically with other hormones but is not the primary driver of glucose intolerance in pregnancy. *GH* - **Growth hormone (GH)** does contribute to insulin resistance in non-pregnant individuals and at high levels can cause insulin resistance, but it is not the primary hormone responsible for the unique physiological insulin resistance of pregnancy. - While GH is present, **HPL** is the dominant somatotropic hormone of pregnancy directly impacting glucose metabolism.
Question 6: Which of the following is not used to treat PCOD?
- A. Tamoxifen (Correct Answer)
- B. OCP
- C. Metformin
- D. Clomiphene citrate
Explanation: ***Tamoxifen*** - **Tamoxifen** is a selective estrogen receptor modulator (SERM) primarily used in the treatment of **estrogen receptor-positive breast cancer**. - While other SERMs like clomiphene citrate are used in PCOD for ovulation induction, tamoxifen is not a standard treatment for **PCOD** itself. *OCP* - **Oral contraceptive pills (OCPs)** are a common first-line treatment for managing various symptoms of PCOD, such as **menstrual irregularities** and **hirsutism**. - They work by suppressing ovarian androgen production and providing regular withdrawal bleeds. *Metformin* - **Metformin** is an insulin-sensitizing agent often used in PCOD, especially in women with **insulin resistance** or impaired glucose tolerance. - It helps improve **menstrual regularity** and can facilitate ovulation in some patients by reducing insulin levels. *Clomiphene citrate* - **Clomiphene citrate** is a selective estrogen receptor modulator (SERM) commonly used as an **ovulation induction agent** in women with PCOD who are trying to conceive. - It works by blocking estrogen receptors in the hypothalamus, leading to increased release of **gonadotropins** (FSH and LH).
Question 7: Which of the following is least effective in the management of polycystic ovary syndrome?
- A. OC pills
- B. Cyclical progesterones
- C. Myoinositol
- D. Danazol (Correct Answer)
Explanation: ***Danazol (Least Effective - Correct Answer)*** - **Danazol** is an attenuated androgen that suppresses ovarian function and is primarily used for the treatment of **endometriosis** and **fibrocystic breast disease**, not for PCOS. - Its **androgenic side effects**, such as hirsutism and acne, would **exacerbate symptoms already present in PCOS**, making it unsuitable and often contraindicated. - It does not address the underlying metabolic or hormonal derangements in PCOS and may worsen the clinical picture. *OC Pills (Effective Treatment)* - **Oral contraceptive pills** (OCPs) are a cornerstone in PCOS management, primarily by suppressing **androgen production** from the ovaries. - They help regulate menstrual cycles, reduce **hirsutism** and **acne**, and protect the endometrium from hyperplasia. - First-line therapy for women with PCOS not seeking pregnancy. *Cyclical Progesterones (Effective Treatment)* - **Cyclical progesterones** are used in PCOS to induce regular shedding of the **endometrial lining** in anovulatory women. - This prevents **endometrial hyperplasia** and reduces the risk of endometrial cancer, making them effective for endometrial protection. - Although they do not address hyperandrogenism, they serve an important role in preventing long-term complications. *Myoinositol (Effective Treatment)* - **Myoinositol** is a natural insulin sensitizer that can improve ovarian function, reduce **hyperandrogenism**, and improve **insulin resistance** in women with PCOS. - It plays a role in the **insulin signaling pathway**, improving follicular development and ovulation rates. - Increasingly recognized as an evidence-based supplement in PCOS management.
Question 8: In Stein-Leventhal syndrome, which hormone is raised?
- A. LH (Correct Answer)
- B. FSH
- C. GnRH
- D. Progesterone
Explanation: ***LH*** - In **Stein-Leventhal syndrome** (Polycystic Ovary Syndrome, PCOS), there is an elevated **LH (Luteinizing Hormone)** level. - This high LH-to-FSH ratio contributes to increased **androgen production** by the ovarian theca cells, leading to symptoms like hirsutism and anovulation. *FSH* - **FSH (Follicle-Stimulating Hormone)** levels are typically normal or even low in PCOS, contributing to the elevated LH:FSH ratio. - Low FSH levels impair proper follicle maturation, leading to **anovulation** and the characteristic polycystic appearance of the ovaries. *GnRH* - **GnRH (Gonadotropin-Releasing Hormone)** secretion can be altered in PCOS, often showing increased pulse frequency, which preferentially stimulates LH release over FSH. - However, **GnRH levels themselves are not directly measured** as "raised" in the clinical diagnostic criteria for PCOS. *Progesterone* - **Progesterone** levels are often low or absent in PCOS, particularly in the luteal phase, due to **anovulation**. - The lack of regular ovulation means no corpus luteum forms, which is responsible for progesterone production after ovulation.
Question 9: Type of wave in Metabolic Encephalopathy?
- A. Delta (Correct Answer)
- B. Beta
- C. Gamma
- D. Alpha
Explanation: ***Delta*** - **Delta waves** [1] are typically the predominant slow-wave activity seen in an **EEG** during states of **metabolic encephalopathy**, indicating significant brain dysfunction. - These are **high-amplitude, low-frequency waves** (0.5-4 Hz) [1] that are normally present only during **deep sleep**. *Beta* - **Beta waves** (13-30 Hz) are typically associated with an **alert, active, or anxious state** of the brain. - Their presence as a predominant rhythm would suggest normal wakefulness or active mental engagement, not metabolic encephalopathy, where brain activity is generally suppressed. *Gamma* - **Gamma waves** (30-100 Hz) are associated with **high-level cognitive functions** such as learning, memory and problem-solving, and are not typically seen as a characteristic abnormality in metabolic encephalopathy. - While they are important for brain function, their prominence is not indicative of widespread metabolic disturbance. *Alpha* - **Alpha waves** (8-13 Hz) are normally observed when an individual is **awake but relaxed with closed eyes** [1]. - While the alpha rhythm can slow down in some mild encephalopathies, the more severe metabolic disturbances typically progress to slower delta activity.
Question 10: 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.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free