Reproductive Endocrinology Practice Questions

Q: Which of the following is NOT a typical symptom or sign of Polycystic Ovarian Disease (PCOD)?

Weight loss. **Explanation:** **Polycystic Ovarian Disease (PCOD/PCOS)** is a complex endocrine disorder characterized by insulin resistance, hyperandrogenism, and chronic anovulation. **Why Weight Loss is the Correct Answer:** Weight loss is **not** a feature of PCOD; instead, **obesity** (specifically central/android obesity) is a hallmark sign, seen in approximately 50-60% of patients. Obesity exacerbates the condition because adipose tissue decreases Sex Hormone Binding Globulin (SHBG) and increases peripheral conversion of androgens to estrogens, further disrupting the hypothalamic-pituitary-ovarian axis. **Analysis of Incorrect Options:** * **Alopecia:** High levels of circulating free androgens (testosterone) lead to "male-pattern" hair loss (androgenetic alopecia) and hirsutism. * **Theca Cell Hyperplasia:** In PCOD, elevated Luteinizing Hormone (LH) levels cause hyperplasia of the ovarian theca cells. These cells are responsible for the overproduction of androgens (androstenedione and testosterone). * **Hyperandrogenism:** This is a core diagnostic criterion (Rotterdam Criteria). It manifests clinically as acne, hirsutism, and biochemically as elevated serum testosterone levels. **High-Yield Clinical Pearls for NEET-PG:** * **Rotterdam Criteria (2 out of 3):** 1. Oligo/Anovulation, 2. Clinical/Biochemical Hyperandrogenism, 3. Polycystic ovaries on Ultrasound ("String of pearls" appearance). * **LH:FSH Ratio:** Classically elevated to **>2:1 or 3:1**. * **Insulin Resistance:** Leads to **Acanthosis Nigricans** (velvety hyperpigmentation in skin folds). * **First-line Management:** Weight loss and lifestyle modification. For infertility, **Letrozole** is now the drug of choice (DOC), surpassing Clomiphene Citrate.

Q: All of the following statements about Androgen Insensitivity Syndrome are true except?

Pubic hair are abundant. **Explanation:** **Androgen Insensitivity Syndrome (AIS)**, formerly known as Testicular Feminization Syndrome, is an X-linked recessive condition where there is a functional defect in the androgen receptors. **Why Option B is the correct answer (The False Statement):** In AIS, although the body produces high levels of testosterone, the peripheral tissues cannot respond to it due to receptor resistance. Since the development of **pubic and axillary hair** is dependent on androgen action, these patients typically have **absent or very sparse** pubic and axillary hair. Therefore, the statement that pubic hair is "abundant" is incorrect. **Analysis of Incorrect Options:** * **Option A (XY Genotype):** True. These individuals are genetically male (46, XY). * **Option C (Blind Vagina):** True. Due to the presence of the Y chromosome, the SRY gene leads to the development of testes which secrete **Müllerian Inhibiting Substance (MIS)**. MIS causes regression of the Müllerian ducts (uterus, fallopian tubes, and upper 1/3rd of the vagina). The lower 2/3rd of the vagina (derived from the urogenital sinus) develops but ends blindly. * **Option D (Ovaries are absent):** True. These patients have undescended testes (often located in the labia majora or inguinal canal) rather than ovaries. **High-Yield Clinical Pearls for NEET-PG:** * **Phenotype:** Phenotypically female with well-developed breasts (due to peripheral conversion of testosterone to estrogen). * **Primary Amenorrhea:** AIS is a leading cause of primary amenorrhea with breast development. * **Management:** Gonadectomy is performed **after puberty** (to allow natural breast development) to prevent the risk of gonadoblastoma/dysgerminoma. * **Differential Diagnosis:** Differentiate from **Müllerian Agenesis (MRKH Syndrome)** where the genotype is 46, XX, ovaries are present, and pubic hair is normal.

Q: A patient presents with a history of amenorrhea and hirsutism. Ultrasound of the ovary is provided. What is the most likely diagnosis?

Polycystic Ovary Syndrome (PCOS). ***Polycystic Ovary Syndrome (PCOS)*** - **Amenorrhea** and **hirsutism** are classic presenting symptoms of PCOS, part of the **Rotterdam criteria** for diagnosis. - Ultrasound typically shows **multiple peripheral follicles** arranged in a "**string-of-pearls**" pattern around the ovarian cortex. *Endometriosis* - Primarily presents with **cyclical pelvic pain** and **dysmenorrhea**, not amenorrhea or hirsutism. - Ultrasound would show **endometriomas** (chocolate cysts) rather than multiple peripheral follicles. *Adenomyomatosis* - This is a **benign gallbladder condition** characterized by **hyperplasia of the gallbladder wall**, not an ovarian pathology. - Would not cause **amenorrhea** or **hirsutism** as it doesn't affect reproductive hormones. *Choriocarcinoma* - A **malignant gestational trophoblastic neoplasm** that presents with **irregular bleeding** and elevated **β-hCG levels**. - Would not typically cause **hirsutism** or the characteristic ovarian ultrasound findings described.

Q: In a 40-day menstrual cycle, at which day does ovulation typically occur?

26th day. **Explanation:** The key to solving this question lies in understanding the phases of the menstrual cycle. A menstrual cycle consists of two main phases: the **Follicular Phase** (pre-ovulatory) and the **Luteal Phase** (post-ovulatory). 1. **The Concept of the Fixed Luteal Phase:** While the follicular phase varies in length among women, the **luteal phase is constant and lasts 14 days** (ranging from 12–16 days). This is because the lifespan of the *corpus luteum* is biologically predetermined. 2. **Calculation:** To determine the day of ovulation, subtract the fixed luteal phase from the total cycle length. * **Formula:** Day of Ovulation = Total Cycle Length – 14 days * **Calculation:** 40 – 14 = **26th Day**. **Analysis of Incorrect Options:** * **Option A (14th day):** This is only correct for a "textbook" 28-day cycle (28 – 14 = 14). It is a common misconception that ovulation always occurs on day 14. * **Option B (20th day):** This would be the ovulation day for a 34-day cycle. * **Option D (30th day):** This would imply a luteal phase of only 10 days, which is generally considered a "Luteal Phase Defect" and is not the physiological norm. **NEET-PG High-Yield Pearls:** * **Variable Phase:** The Follicular phase is the variable part of the cycle; its length determines the overall cycle length. * **Ovulation Marker:** The most reliable indicator that ovulation has occurred is a rise in **Basal Body Temperature (BBT)** due to the thermogenic effect of Progesterone. * **LH Surge:** Ovulation occurs **24–36 hours** after the onset of the LH surge and **10–12 hours** after the LH peak. * **Best Timing for Biopsy:** If performing an endometrial biopsy to check for ovulation, it is traditionally done on Day 21–23 of a 28-day cycle (Mid-luteal phase).

Q: A 20-year-old girl presents with a history of rapidly developing hirsutism and amenorrhea. Which of the following blood tests would be most appropriate to establish the diagnosis?

Testosterone. **Explanation:** The clinical presentation of **rapidly developing hirsutism** (virilization) and amenorrhea in a young woman is a "red flag" that strongly suggests an **androgen-secreting tumor** (ovarian or adrenal), rather than a functional disorder like PCOS. 1. **Why Testosterone is correct:** Serum **Total Testosterone** is the most appropriate initial test to screen for ovarian tumors (like Sertoli-Leydig cell tumors). A testosterone level **>200 ng/dL** is highly suggestive of a malignancy. In cases of rapid onset virilization, testosterone is the most potent androgen responsible for the clinical symptoms and is the primary marker for ovarian sources of androgen excess. 2. **Why other options are incorrect:** * **17-hydroxyprogesterone:** This is the screening test for **Congenital Adrenal Hyperplasia (CAH)**, specifically the 21-hydroxylase deficiency. While CAH causes hirsutism, it is usually present from childhood/puberty and is rarely "rapidly progressive." * **DHEA/DHEAS:** DHEAS is a marker for **adrenal tumors**. While it should be measured alongside testosterone, testosterone is generally considered the first-line marker for overall androgen excess in this clinical context. (Note: DHEAS >7000 µg/dL suggests an adrenal tumor). * **LH:FSH ratio:** An elevated ratio (>2:1 or 3:1) is characteristic of **PCOS**. However, PCOS typically presents with a slow, chronic progression of symptoms since puberty, not a rapid onset of virilization. **High-Yield Clinical Pearls for NEET-PG:** * **Slow onset hirsutism:** Think PCOS or Idiopathic. * **Rapid onset + Virilization:** Think Androgen-secreting tumors. * **Source Localization:** If Testosterone is markedly elevated but DHEAS is normal, the source is likely **Ovarian**. If DHEAS is markedly elevated, the source is **Adrenal**. * **Ferriman-Gallwey Score:** Used to clinically quantify hirsutism (Score ≥8 is significant).

Q: All are true about hormonal levels in Polycystic Ovarian Disease except?

Decreased testosterone level. **Explanation:** Polycystic Ovarian Syndrome (PCOS) is characterized by a state of **hyperandrogenism** and chronic anovulation. The correct answer is **D (Decreased testosterone level)** because, in PCOS, testosterone levels are typically **elevated** or at the high end of the normal range, rather than decreased. **Why the other options are incorrect (True for PCOS):** * **A. Increased androstenedione:** The ovaries and adrenal glands produce excess androgens. Androstenedione is a key precursor that is elevated, contributing to hirsutism and acne. * **B. Reduced FSH/LH ratio:** In PCOS, there is an increased frequency of GnRH pulses, leading to **increased LH** and relatively **low/normal FSH**. This results in a classic **LH:FSH ratio of >2:1 or 3:1**. Since the denominator (FSH) is lower than the numerator (LH), the FSH/LH ratio is mathematically reduced. * **C. Increased oestrone (E1):** Due to peripheral aromatization of excess androstenedione in adipose tissue, levels of oestrone (E1) are elevated. This leads to a state of "unopposed estrogen," increasing the risk of endometrial hyperplasia. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for Diagnosis:** Rotterdam Criteria (requires 2 out of 3: Hyperandrogenism, Ovulatory dysfunction, Polycystic ovaries on USG). * **SHBG Levels:** Sex Hormone Binding Globulin is **decreased** in PCOS (often due to hyperinsulinemia), which further increases the "Free Testosterone Index." * **Insulin Resistance:** Hyperinsulinemia stimulates the ovarian theca cells to produce more androgens and inhibits hepatic SHBG production. * **USG Hallmark:** "String of pearls" appearance (12 or more follicles measuring 2–9 mm).

Question 1

Which of the following is NOT a typical symptom or sign of Polycystic Ovarian Disease (PCOD)?

Accepted Answer

Weight loss

Answer

Alopecia

Answer

Theca cell hyperplasia

Answer

Hyperandrogenism

Question 2

All of the following statements about Androgen Insensitivity Syndrome are true except?

Accepted Answer

Pubic hair are abundant

Answer

Patients have an XY genotype

Answer

A blind vagina may be present

Answer

Ovaries are absent

Question 3

Determination of serum progesterone level to document ovulation. For the evaluation, select the most appropriate day of a normal 28-day menstrual cycle for a woman with 5-day menstrual periods.

Accepted Answer

Day 21

Answer

Day 3

Answer

Day 8

Answer

Day 14

Question 4

A patient presents with a history of amenorrhea and hirsutism. Ultrasound of the ovary is provided. What is the most likely diagnosis?

Accepted Answer

Polycystic Ovary Syndrome (PCOS)

Answer

Endometriosis

Answer

Choriocarcinoma

Answer

Adenomyosis

Question 5

A 16-year-old female has not yet started having menstrual cycles. Her secondary sex characteristics appear normal, as does external examination of her genitalia. She is given an intramuscular injection of progesterone, and 5 days later she has her first period. What is the most likely mechanism responsible for the delay in menses?

Accepted Answer

A normal constitutional delay in menarche

Answer

Hypoestrogenism

Answer

Hypopituitarism

Answer

An end-organ abnormality

Question 6

In a 40-day menstrual cycle, at which day does ovulation typically occur?

Accepted Answer

26th day

Answer

14th day

Answer

20th day

Answer

30th day

Question 7

A 23-year-old woman presents for evaluation of a 7-month history of amenorrhea. Examination discloses bilateral galactorrhea and normal breast and pelvic examinations. Pregnancy test is negative. Which of the following classes of medication is a possible cause of her condition?

Accepted Answer

Phenothiazines

Answer

Antiestrogens

Answer

Gonadotropins

Answer

Prostaglandins

Question 8

In Swyer syndrome, what is typically found?

Accepted Answer

Testes are present

Answer

Ovaries are present

Answer

Short stature

Answer

Decreased FSH and LH

Question 9

A 20-year-old girl presents with a history of rapidly developing hirsutism and amenorrhea. Which of the following blood tests would be most appropriate to establish the diagnosis?

Accepted Answer

Testosterone

Answer

17-hydroxyprogesterone

Answer

Dehydroepiandrosterone (DHEA)

Answer

Luteinizing hormone (LH): Follicle-stimulating hormone (FSH) ratio

Question 10

All are true about hormonal levels in Polycystic Ovarian Disease except?

Accepted Answer

Decreased testosterone level

Answer

Increased androstenedione

Answer

Reduced FSH/LH ratio

Answer

Increased oestrone

Reproductive Endocrinology — MCQs

Reproductive Endocrinology — MCQs

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