Puberty and Its Disorders — MCQs
A child with decreased levels of LH, FSH and Testosterone presents with delayed puberty. Which of the following is the most likely Diagnosis
Young male presents with delayed puberty with decreased FSH, LH, and testosterone. Which of the following is NOT possible?
After injecting testosterone in a hypoandrogenic male, which of the following occurs ?
Puberty happens due to pulsatile release of -
What is the most common cause of delayed puberty in males?
The following instrument is used for:
The image shows a child with virilisation and clitoromegaly. What laboratory finding is typical for this condition, assuming the most common enzyme defect?
A 16-year-old girl is in your office for a preparticipation sports examination. She plans to play soccer in the fall, and needs her form filled out. Which of the following history or physical examination findings is usually considered a contraindication to playing contact sports?
A child with Down syndrome is typically mentally retarded. Which of the following cytogenetic abnormalities is NOT a cause of Down syndrome?
What is the age range for early adolescence?
Puberty and Its Disorders Indian Medical PG Practice Questions and MCQs
Question 1: A child with decreased levels of LH, FSH and Testosterone presents with delayed puberty. Which of the following is the most likely Diagnosis
- A. Klinefelter's syndrome
- B. Kallman's syndrome (Correct Answer)
- C. Testicular infection
- D. Androgen Insensitivity Syndrome
Explanation: ***Kallman's syndrome*** - **Kallmann's syndrome** is characterized by **isolated hypogonadotropic hypogonadism**, meaning the hypothalamus fails to produce **GnRH**, leading to low LH and FSH, and consequently low testosterone, causing delayed puberty. - A key distinguishing feature is the association with **anosmia or hyposmia** (impaired sense of smell) due to abnormal migration of olfactory neurons and GnRH-producing neurons. *Klinefelter's syndrome* - This condition is characterized by **primary hypogonadism** (testicular failure) due to an extra X chromosome (47,XXY), leading to **high LH and FSH** in an attempt to stimulate the failing testes. - Although testosterone is low and puberty is delayed, the **elevated gonadotropins** differentiate it from Kallmann's syndrome. *Testicular infection* - An infection like **orchitis** can lead to testicular damage and *primary hypogonadism*, resulting in low testosterone. - However, similar to Klinefelter's, this would typically cause **elevated LH and FSH** due to the lack of negative feedback from the testes. *Androgen Insensitive syndrome* - In **Androgen Insensitivity Syndrome (AIS)**, testosterone levels are typically **normal or even elevated**, but the body's cells are unable to respond to androgens due to defective receptors. - This condition presents with a female phenotype despite a 46,XY karyotype, and **gonadotropin levels (LH and FSH) are usually normal to high**, not decreased.
Question 2: Young male presents with delayed puberty with decreased FSH, LH, and testosterone. Which of the following is NOT possible?
- A. Kallmann syndrome
- B. Klinefelter's syndrome (Correct Answer)
- C. Constitutional delay
- D. DAX-1 gene mutation
Explanation: ***Klinefelter's syndrome*** - Klinefelter's syndrome is characterized by **primary hypogonadism**, meaning the testes themselves fail to produce testosterone [3]. This leads to **high FSH and LH** levels due to the lack of negative feedback from testosterone [2],[3]. - The presenting clinical picture of **low FSH, LH, and testosterone** indicates **central hypogonadism**, where the pituitary or hypothalamus is at fault, not the testes directly [2]. *Kallmann syndrome* - Kallmann syndrome is a form of **congenital hypogonadotropic hypogonadism** characterized by a failure of GnRH-producing neurons to migrate to the hypothalamus, leading to **low FSH, LH, and testosterone**. - It is often associated with **anosmia (loss of smell)**, which is a key diagnostic feature. *Constitutional delay* - **Constitutional delay of growth and puberty** is a common cause of delayed puberty, characterized by a temporary suppression of the GnRH pulse generator [1]. - This results in **low FSH, LH, and testosterone** that eventually normalize, and often has a family history of delayed puberty [1]. *DAX-1 gene mutation* - Mutations in the **DAX-1 gene (NR0B1)** are associated with **X-linked adrenal hypoplasia congenita (AHC)**, which often presents with central or **hypogonadotropic hypogonadism**. - This condition leads to **low FSH, LH, and testosterone** due to hypothalamic-pituitary dysfunction in addition to adrenal insufficiency.
Question 3: After injecting testosterone in a hypoandrogenic male, which of the following occurs ?
- A. Decreased LH secretion
- B. Decreased FSH secretion (Correct Answer)
- C. Increased spermatogenesis
- D. None of the options
Explanation: ***Decreased FSH secretion*** - Exogenous testosterone administration leads to **negative feedback** on the hypothalamic-pituitary-gonadal axis, suppressing **GnRH** release, which in turn decreases both **LH** and **FSH** secretion. - FSH suppression is particularly clinically significant because it results in **inhibition of spermatogenesis**, which is a key consideration when using testosterone replacement therapy. - The decrease in FSH, combined with reduced **intratesticular testosterone** (due to LH suppression), impairs Sertoli cell function and sperm production. *Decreased LH secretion* - **This also occurs** with exogenous testosterone administration due to negative feedback on the hypothalamus and pituitary. - Testosterone primarily suppresses **LH** through direct negative feedback at the hypothalamic-pituitary level. - However, in the context of this question focusing on the consequences in a hypoandrogenic male receiving testosterone, the **FSH suppression** and its impact on spermatogenesis is the more clinically emphasized outcome. - **Note:** Both LH and FSH decrease; this question likely emphasizes FSH due to its role in fertility concerns with testosterone therapy. *Increased spermatogenesis* - This is **incorrect**. Exogenous testosterone actually **suppresses spermatogenesis** through multiple mechanisms: - Decreased **FSH** (essential for Sertoli cell function) - Decreased **intratesticular testosterone** concentration (despite high systemic levels) - The high local testosterone concentration within the seminiferous tubules (30-100x serum levels) cannot be achieved by systemic testosterone alone. *None of the options* - This is incorrect because exogenous testosterone administration clearly causes **suppression of gonadotropins** (both LH and FSH) through well-established negative feedback mechanisms.
Question 4: Puberty happens due to pulsatile release of -
- A. Testosterone
- B. LH/ICSH
- C. GnRH (Correct Answer)
- D. Estrogen
Explanation: ***GnRH*** - Puberty is initiated by the pulsatile release of **Gonadotropin-Releasing Hormone (GnRH)** from the hypothalamus. - This pulsatile release primes the anterior pituitary to secrete gonadotropins, **Luteinizing Hormone (LH)** and **Follicle-Stimulating Hormone (FSH)**. *Testosterone* - **Testosterone** is a sex hormone whose release is stimulated by LH, but it is not the primary initiator of puberty. - Its levels rise later in puberty, driven by the pituitary-gonadal axis, causing the development of **secondary sexual characteristics** in males. *LH/ICSH* - **Luteinizing Hormone (LH)** and **Interstitial Cell-Stimulating Hormone (ICSH)** (the male equivalent of LH) are pituitary hormones whose release is stimulated by GnRH. - They act on the gonads to stimulate sex hormone production, but their release is a consequence, not the initial trigger, of the pulsatile activity related to puberty. *Estrogen* - **Estrogen** is a sex hormone primarily produced in females in response to FSH and LH. - Similar to testosterone, its elevated levels are a downstream effect of the hypothalamic-pituitary-gonadal axis activation during puberty, leading to the development of female secondary sexual characteristics.
Question 5: What is the most common cause of delayed puberty in males?
- A. Constitutional delay (Correct Answer)
- B. Kallmann syndrome
- C. Klinefelter syndrome
- D. Prader-Willi syndrome
Explanation: ***Constitutional delay of growth and puberty*** - This is the most common cause of delayed puberty, representing a **normal variant** of development where puberty onset is simply later than average. - Individuals typically have a family history of delayed puberty and eventually achieve normal pubertal development and adult height. *Kallmann syndrome* - This is a form of **hypogonadotropic hypogonadism** characterized by a deficiency in **GnRH production** and an associated **anosmia (loss of smell)**. - While a significant cause of delayed puberty, it is far less common than constitutional delay. *Klinefelter syndrome* - This is a **sex chromosome aneuploidy (47, XXY)**, leading to **hypergonadotropic hypogonadism** (high FSH/LH, low testosterone). - It usually presents with small, firm testes, gynecomastia, and often intellectual and learning difficulties, and is not the most common cause overall. *Prader-Willi syndrome* - This is a genetic disorder on **chromosome 15**, characterized by features like **hypotonia** in infancy, obesity, intellectual disability, and **hypogonadism**. - While it includes delayed puberty, it is a rare syndrome with many other prominent features, making it much less common than constitutional delay.
Question 6: The following instrument is used for:
- A. Hypothyroidism
- B. Hypogonadism (Correct Answer)
- C. Hypoadrenalism
- D. Soto syndrome
Explanation: ***Hypogonadism*** - The image displays an **orchidometer**, specifically a Prader orchidometer, which is a medical instrument used to measure the **volume of the testes**. - Testicular volume measurement is crucial for diagnosing and monitoring conditions like **hypogonadism**, where testicular size can be reduced. - It is primarily used to assess **pubertal development** and detect **delayed or precocious puberty**. *Hypothyroidism* - Hypothyroidism is a condition caused by **underactive thyroid gland**, leading to low thyroid hormone production. - While it can cause various systemic symptoms, it is not primarily diagnosed or monitored using an orchidometer. *Hypoadrenalism* - Hypoadrenalism, or Addison's disease, is a condition where the **adrenal glands produce insufficient steroid hormones**. - Diagnosis involves **blood tests measuring hormone levels** (e.g., cortisol, aldosterone) and is unrelated to testicular volume measurement. *Soto syndrome* - **Soto syndrome** is a genetic overgrowth disorder characterized by **excessive physical growth** during childhood, along with intellectual disability and distinctive facial features. - Its diagnosis is based on **clinical features and genetic testing**, not testicular volume measurement. - While some overgrowth syndromes can have testicular findings, the orchidometer is not a primary diagnostic tool for Soto syndrome.
Question 7: The image shows a child with virilisation and clitoromegaly. What laboratory finding is typical for this condition, assuming the most common enzyme defect?
- A. Low urinary sodium
- B. Increased plasma cortisol
- C. Increased urinary sodium (Correct Answer)
- D. Increased aldosterone
Explanation: ***Increased urinary sodium*** - **Congenital adrenal hyperplasia (CAH)** due to **21-hydroxylase deficiency** is the most common cause of virilization and clitoromegaly in female infants, accounting for >90% of CAH cases. - This enzyme defect blocks the conversion of 17-hydroxyprogesterone to 11-deoxycortisol, impairing both **cortisol and aldosterone synthesis**. - The lack of **aldosterone** (mineralocorticoid) results in a **salt-wasting crisis** with renal sodium loss, leading to **hyponatremia, hyperkalemia, and inappropriately elevated urinary sodium excretion** despite low serum sodium. - Among the given options, increased urinary sodium is the characteristic laboratory finding of the salt-wasting form (seen in ~75% of 21-hydroxylase deficiency cases). *Low urinary sodium* - Low urinary sodium would suggest effective renal sodium retention with intact aldosterone function. - This is contrary to the aldosterone deficiency seen in salt-wasting CAH, where the kidneys cannot retain sodium appropriately. *Increased plasma cortisol* - In 21-hydroxylase deficiency, the enzyme block **prevents cortisol synthesis**, leading to **decreased plasma cortisol** levels. - The low cortisol triggers increased ACTH secretion, which drives adrenal androgen overproduction (causing virilization) and accumulation of precursors like 17-hydroxyprogesterone. *Increased aldosterone* - **Aldosterone synthesis is severely impaired** in 21-hydroxylase deficiency, leading to **decreased or absent aldosterone** levels. - Increased aldosterone would cause sodium retention and potassium excretion—the opposite of the salt-wasting crisis observed in this condition.
Question 8: A 16-year-old girl is in your office for a preparticipation sports examination. She plans to play soccer in the fall, and needs her form filled out. Which of the following history or physical examination findings is usually considered a contraindication to playing contact sports?
- A. Congenital heart disease, repaired
- B. Obesity
- C. Absence of a single ovary
- D. Absence of a single eye (Correct Answer)
Explanation: **Explanation:** The primary goal of a preparticipation physical evaluation (PPE) is to identify conditions that predispose an athlete to injury or sudden death. In the context of contact or collision sports (like soccer), the **absence of a single paired organ** is a critical consideration. **Why Option D is Correct:** The **absence of a single eye** (or a functional loss of vision in one eye) is considered a contraindication to contact sports because the risk of injury to the remaining eye is high. If the "good" eye is injured, the patient faces permanent, total blindness. While some guidelines allow participation if the athlete wears high-quality protective eyewear (polycarbonate lenses), traditional teaching for exams like NEET-PG classifies a single eye as a contraindication for high-impact contact sports. **Analysis of Incorrect Options:** * **A. Congenital heart disease (repaired):** Most children with successfully repaired CHD (e.g., ASD or VSD) without residual pulmonary hypertension or arrhythmias can participate in sports. * **B. Obesity:** Obesity is not a contraindication; in fact, sports participation is actively encouraged as part of weight management, provided there are no underlying cardiovascular risks. * **C. Absence of a single ovary:** Unlike the eyes or kidneys, the loss of a single ovary does not pose a significant risk to life or essential function, as the remaining ovary is well-protected within the pelvic cavity and maintains hormonal/reproductive function. **High-Yield Clinical Pearls for NEET-PG:** * **Single Kidney:** Previously a contraindication, but current AAP guidelines allow participation in contact sports if the athlete is informed of the risks and uses protective padding. * **Atlantoaxial Instability:** A classic contraindication for contact sports in patients with **Down Syndrome**. * **Hypertrophic Cardiomyopathy (HCM):** The most common cause of sudden cardiac death in young athletes; it is an absolute contraindication to competitive sports. * **Acute Splenomegaly (e.g., Infectious Mononucleosis):** Contraindication due to the risk of splenic rupture; athletes must wait at least 3–4 weeks before returning to play.
Question 9: A child with Down syndrome is typically mentally retarded. Which of the following cytogenetic abnormalities is NOT a cause of Down syndrome?
- A. Deleted chromosome 21 (Correct Answer)
- B. Trisomy 21
- C. Robertsonian translocation
- D. Mosaicism
Explanation: **Explanation:** Down syndrome (Trisomy 21) is caused by an **excess of genetic material** from chromosome 21. Therefore, a **deleted chromosome 21 (Option A)** would result in monosomy or partial monosomy, which does not cause Down syndrome; in fact, complete autosomal monosomies are generally incompatible with life. **Analysis of Options:** * **Trisomy 21 (Nondisjunction):** The most common cause (approx. 95%). It usually occurs due to meiotic error, most frequently during maternal Meiosis I. Risk increases significantly with advanced maternal age. * **Robertsonian Translocation:** Occurs in about 3–4% of cases. The extra long arm of chromosome 21 is attached to another acrocentric chromosome (usually 14 or 22). This is the only form that can be inherited from a carrier parent, necessitating parental karyotyping. * **Mosaicism:** Occurs in 1–2% of cases. It results from mitotic nondisjunction after fertilization, leading to two cell lines (one normal, one trisomic). These patients often have a milder phenotype. **NEET-PG High-Yield Pearls:** * **Most common cause:** Meiotic nondisjunction (95%). * **Recurrence risk:** ~1% for Trisomy 21; however, if a parent is a **14;21 translocation carrier**, the risk is ~10-15% (maternal) or ~2-3% (paternal). If a parent has a **21;21 translocation**, the recurrence risk is **100%**. * **Screening:** First-trimester screening includes Dual Marker (PAPP-A and β-hCG) and Ultrasound (Nuchal Translucency). * **Quadruple Test:** Low AFP, Low Estriol, **High hCG, High Inhibin A** (Mnemonic: **HI**gh for **H**CG and **I**nhibin).
Question 10: What is the age range for early adolescence?
- A. 8-11 years
- B. 10-13 years (Correct Answer)
- C. 14-15 years
- D. 16-19 years
Explanation: ### Explanation **Correct Answer: B (10-13 years)** Adolescence is the developmental period marking the transition from childhood to adulthood. According to standard pediatric guidelines (including the WHO and the American Academy of Pediatrics), adolescence is divided into three distinct stages based on physical, cognitive, and psychosocial changes: 1. **Early Adolescence (10–13 years):** This stage is characterized by the onset of puberty, the development of secondary sexual characteristics (Tanner Stages 1-3), and a shift toward concrete operational thinking. 2. **Middle Adolescence (14–16 years):** This stage involves the completion of physical growth, increased peer group influence, and the emergence of abstract thinking. 3. **Late Adolescence (17–19/21 years):** This stage focuses on identity formation, future orientation, and emotional independence. **Analysis of Incorrect Options:** * **Option A (8-11 years):** While puberty may begin as early as age 8 in girls (thelarche), the formal definition of adolescence begins at age 10. * **Option C (14-15 years):** This range falls within **Middle Adolescence**, where the focus shifts from physical changes to peer conformity and independence. * **Option D (16-19 years):** This range encompasses **Late Adolescence**, characterized by the transition into adult roles and cognitive maturity. **High-Yield Clinical Pearls for NEET-PG:** * **WHO Definition:** The WHO defines "Adolescents" as individuals aged **10–19 years**, "Youth" as **15–24 years**, and "Young People" as **10–24 years**. * **Growth Spurt:** The peak height velocity (PHV) usually occurs during early-to-middle adolescence (Tanner Stage 2-3 in girls, Stage 3-4 in boys). * **Psychosocial Milestone:** The hallmark of early adolescence is a preoccupation with body image due to rapid pubertal changes.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free