Menstrual Cycle — MCQs
LH surge is associated with?
Which structure provides level 1 support for the uterus and vagina?
Positive feedback action of estrogen for inducing luteinizing hormone surge is associated with which of the following steroid hormone ratios in peripheral circulation?
In the transition from a Graafian follicle to a functional corpus luteum, which of the following cellular events occurs?
By which mechanism do LH and FSH primarily return to baseline levels after ovulation?
At the time point indicated by the arrow, the hormone levels are:
What physiological event occurs during ovulation?
In this normal menstrual cycle graph, the mark 'X' represents levels of which hormone?
Which of the following statements regarding functional epimenorrhoea is not correct ?
Hormone predominantly secreted after 14 days that acts on the endometrium is?
Menstrual Cycle Indian Medical PG Practice Questions and MCQs
Question 1: LH surge is associated with?
- A. Increased estrogen & decreased progesterone (Correct Answer)
- B. Increased estrogen & increased progesterone
- C. Decreased estrogen & increased progesterone
- D. Decreased estrogen & decreased progesterone
Explanation: ***Increased estrogen & decreased progesterone*** - The **LH surge** is triggered by a significant rise in **estrogen** levels from the dominant follicle, indicating ovarian readiness. - At the time of the LH surge, **progesterone** levels remain low; they only begin to rise significantly after ovulation, when the corpus luteum forms. *Increased estrogen & increased progesterone* - While **estrogen** levels are high, **progesterone** only significantly increases *after* ovulation, as the corpus luteum develops. - High estrogen *and* high progesterone together are typically seen in the **luteal phase**, not at the peak of the LH surge. *Decreased estrogen & increased progesterone* - A decrease in **estrogen** would suppress LH, not trigger a surge. - Increased **progesterone** would also inhibit LH release via negative feedback in the follicular phase if it were to occur pre-ovulation. *Decreased estrogen & decreased progesterone* - Both **decreased estrogen** and **decreased progesterone** would lead to low FSH/LH levels and would not promote an LH surge or ovulation. - This hormonal profile is more characteristic of the very early follicular phase or menopause.
Question 2: Which structure provides level 1 support for the uterus and vagina?
- A. Perineal body
- B. levator ani
- C. Uterosacral ligaments (Correct Answer)
- D. All of the options
Explanation: ***Uterosacral ligaments*** - The **uterosacral ligaments** provide **level 1 support**, forming the apex of the vagina and supporting the cervix, preventing uterine prolapse [1]. - They extend from the lower uterus/cervix to the sacrum, maintaining the **anteverted-anteflexed position** of the uterus [1]. *levator ani* - The **levator ani muscles** provide **level 2 support**, forming the pelvic floor and supporting the mid-vagina and pelvic organs [2]. - These muscles are crucial for maintaining the **hiatal closure** and **preventing prolapse** [2]. *Perineal body* - The **perineal body** offers **level 3 support**, anchoring the distal vagina and perineum by connecting the perineal muscles [3]. - It maintains the **vaginal introitus** and provides a stable base for the pelvic floor, preventing distal vaginal prolapse [3]. *All of the options* - While all these structures contribute to pelvic organ support, their roles are categorized into different "levels" of support. - The question specifically asks for **level 1 support**, which is primarily provided by the uterosacral and cardinal ligaments, not all mentioned structures collectively [1].
Question 3: Positive feedback action of estrogen for inducing luteinizing hormone surge is associated with which of the following steroid hormone ratios in peripheral circulation?
- A. High estrogen : high progesterone
- B. High estrogen : low progesterone (Correct Answer)
- C. Low estrogen : high progesterone
- D. Low estrogen : low progesterone
Explanation: ***High estrogen : low progesterone*** - A sustained period of **high estrogen** levels, produced by the developing follicle, is crucial for triggering the **LH surge** through positive feedback. - At this pre-ovulatory stage, **progesterone levels remain relatively low**, as significant progesterone production only begins after ovulation from the corpus luteum. *High estrogen : high progesterone* - While high estrogen is required for the LH surge, **high progesterone levels** would typically occur *after* ovulation, suppressing LH rather than inducing its surge. - High progesterone usually exerts negative feedback on the hypothalamus and pituitary, preventing an LH surge. *Low estrogen : high progesterone* - **Low estrogen** levels are insufficient to exert the positive feedback necessary for an LH surge. - **High progesterone** during this phase would also inhibit GnRH and LH secretion. *Low estrogen : low progesterone* - Neither low estrogen nor low progesterone levels are conducive to the LH surge; this combination often characterizes the **early follicular phase** or the **late luteal phase/menstruation**, where ovarian activity is minimal. - The LH surge requires a specific hormonal milieu involving elevated estrogen.
Question 4: In the transition from a Graafian follicle to a functional corpus luteum, which of the following cellular events occurs?
- A. Granulosa cells begin to express estrogen receptors
- B. Granulosa cells begin to express LH receptors (Correct Answer)
- C. Theca cells begin to express androgen receptors
- D. Granulosa cells begin to express progesterone receptors
Explanation: ***Granulosa cells begin to express LH receptors*** - During the late follicular phase, under **FSH** stimulation, **granulosa cells** in the developing Graafian follicle acquire **LH receptors**. - This acquisition of LH receptors is essential for the transition to a corpus luteum, as it enables the **LH surge** to trigger ovulation and subsequently stimulate **luteinization** and **progesterone production** by the corpus luteum. - While the initial expression occurs before ovulation, the functional significance becomes apparent during the transformation to the corpus luteum, making this the most critical receptor-related event in this transition among the given options. *Granulosa cells begin to express estrogen receptors* - Granulosa cells already express **estrogen receptors** in early follicular stages, which are essential for their proliferation and **aromatase synthesis**. - Estrogen receptor expression is characteristic of developing follicles throughout folliculogenesis, not specifically associated with corpus luteum formation. *Theca cells begin to express androgen receptors* - **Theca cells** produce **androgen precursors** (androstenedione, testosterone) under LH stimulation during the follicular phase, which granulosa cells convert to estrogen. - While theca cells contribute to the corpus luteum (theca-lutein cells), androgen receptor expression is not the primary defining cellular event of this transition. *Granulosa cells begin to express progesterone receptors* - The corpus luteum is the major source of **progesterone** in the luteal phase, but granulosa cells do not significantly upregulate progesterone receptors as part of their luteinization. - The key functional change is the cells' ability to *produce* large amounts of progesterone in response to LH, not increased progesterone receptor expression.
Question 5: By which mechanism do LH and FSH primarily return to baseline levels after ovulation?
- A. Negative feedback on GnRH from testosterone
- B. LH surge
- C. Negative feedback on GnRH by estradiol
- D. Negative feedback on gonadotropin-releasing hormone (GnRH) by progesterone (Correct Answer)
Explanation: ***Negative feedback on GnRH by progesterone*** - After ovulation, the **corpus luteum** secretes **progesterone** (and estradiol), which exerts powerful **negative feedback** on the hypothalamus and pituitary - **Progesterone** is the **dominant hormone** in the **luteal phase** that suppresses **GnRH** pulsatility, leading to decreased secretion of both **LH** and **FSH** to baseline levels - This negative feedback maintains low gonadotropin levels throughout the luteal phase until corpus luteum regression *Negative feedback on GnRH by estradiol* - **Estradiol** does provide negative feedback, particularly in the **early-mid follicular phase**, where it primarily suppresses **FSH** secretion - In the luteal phase, estradiol works **synergistically with progesterone**, but **progesterone is the dominant feedback signal** for returning both LH and FSH to baseline after ovulation - Estradiol alone (without progesterone) triggers the **LH surge** via positive feedback at high concentrations *Negative feedback on GnRH from testosterone* - This mechanism is specific to **males**, where **testosterone** from Leydig cells provides negative feedback to regulate **GnRH**, **LH**, and **FSH** secretion - In females, testosterone plays only a minor role in feedback regulation of the hypothalamic-pituitary-gonadal axis *LH surge* - The **LH surge** is a **positive feedback** phenomenon triggered by high **estradiol** levels in the late follicular phase - This represents the **peak** of LH secretion that triggers ovulation, not a mechanism for returning LH and FSH to **baseline** levels - After the surge, LH falls due to negative feedback from progesterone and estradiol during the luteal phase
Question 6: At the time point indicated by the arrow, the hormone levels are:
- A. Decreased estrogen, increased progesterone
- B. Increased estrogen, increased progesterone
- C. Decreased estrogen, decreased progesterone
- D. Increased estrogen, decreased progesterone (Correct Answer)
Explanation: ***Increased estrogen, decreased progesterone*** - The arrow (red circle) points to Day 14, marking the approximate time of **ovulation**. At this point, the graph shows that **estrogen levels peak** just before ovulation and begin to decrease during ovulation. - Progesterone levels are relatively **low** during the follicular phase and only start to significantly increase **after ovulation** as the corpus luteum forms. *Decreased estrogen, increased progesterone* - This hormonal profile is characteristic of the **mid to late luteal phase**, not ovulation. - During the luteal phase, post-ovulation, the **corpus luteum** predominantly produces **progesterone**, leading to its increase, while estrogen levels decline from their pre-ovulatory peak. *Increased estrogen, increased progesterone* - While estrogen is high just before ovulation, **progesterone remains low** until after ovulation. - An increase in both significant progesterone and estrogen would be more indicative of the middle of the **luteal phase** when the corpus luteum is fully functional and producing both hormones in higher amounts. *Decreased estrogen, decreased progesterone* - This hormone profile typically occurs at the **very end of the luteal phase** if pregnancy does not occur, leading to the breakdown of the corpus luteum and subsequent menstruation. - It also characterizes the early follicular phase, not the time around ovulation.
Question 7: What physiological event occurs during ovulation?
- A. Inhibin A levels increase.
- B. FSH increases steroid synthesis in granulosa cells. (Correct Answer)
- C. Activin enhances FSH action on granulosa cells.
- D. Completion of the first meiotic division of the oocyte occurs just before ovulation.
Explanation: ***FSH increases steroid synthesis in granulosa cells.*** - During the **periovulatory period**, FSH continues to support **estrogen synthesis** in granulosa cells of the dominant follicle. - While FSH levels peak in the **mid-follicular phase**, FSH (along with the LH surge) maintains steroidogenic activity through ovulation. - Among the given options, this represents the most relevant ongoing physiological process during ovulation, though the primary event is follicular rupture and oocyte release. *Completion of the first meiotic division of the oocyte occurs just before ovulation.* - The **LH surge** triggers completion of **meiosis I** approximately **36-38 hours before ovulation**, forming a secondary oocyte and first polar body. - This event occurs **prior to** ovulation, not during it. At ovulation, the **secondary oocyte** (arrested in **metaphase II**) is released. - Meiosis II is only completed if **fertilization** occurs. *Inhibin A levels increase.* - **Inhibin A** levels rise significantly **after ovulation** during the **luteal phase**, produced by the corpus luteum. - Around ovulation, **inhibin B** is more prominent, while inhibin A remains relatively low. *Activin enhances FSH action on granulosa cells.* - **Activin** enhances FSH action throughout the **follicular phase**, promoting follicular growth and estrogen production. - This is a continuous regulatory mechanism, not a specific event occurring during ovulation itself.
Question 8: In this normal menstrual cycle graph, the mark 'X' represents levels of which hormone?
- A. LH
- B. FSH
- C. Progesterone (Correct Answer)
- D. Estrogen
Explanation: ***Progesterone*** - The mark 'X' (blue line) represents a hormone that significantly rises during the **luteal phase** after ovulation, reaching its peak around day 21-24 and then declining if pregnancy does not occur. - This pattern is characteristic of **progesterone**, which is primarily produced by the corpus luteum after ovulation to prepare the uterus for potential implantation. *LH* - **Luteinizing Hormone (LH)** is characterized by a sharp, transient peak just before ovulation (around day 14), which triggers the release of the egg. The blue line does not show this pre-ovulatory surge. - After ovulation, LH levels generally fall and remain relatively low throughout the luteal phase, unlike the sustained high levels shown by the blue line. *FSH* - **Follicle-Stimulating Hormone (FSH)** levels are typically higher during the early follicular phase, promoting follicle growth, and then decrease as estrogen rises. There is a smaller, transient peak around ovulation. - The blue line's profile, with its primary peak in the mid-luteal phase, does not match the typical FSH secretion pattern. *Estrogen* - **Estrogen** (specifically estradiol) typically shows a prominent peak during the late follicular phase, preceding the LH surge, and a secondary, smaller peak in the mid-luteal phase. - The blue line's peak is much higher and more sustained during the luteal phase than expected for estrogen, which is usually represented by the red curve in such graphs.
Question 9: Which of the following statements regarding functional epimenorrhoea is not correct ?
- A. It is seen more frequently at the ends of reproductive life
- B. The cycle is reduced to an arbitrary limit of 21 days or less
- C. It is a cyclic bleeding
- D. If epimenorrhoea is associated with heavy menstrual loss it is called menometrorrhagia (Correct Answer)
Explanation: ***If epimenorrhoea is associated with heavy menstrual loss it is called menometrorrhagia*** - This statement is **INCORRECT** - when epimenorrhoea (frequent regular cycles) is associated with heavy bleeding, it should be called **epimenorrhagia** or **polymenorrhagia**. - **Menometrorrhagia** specifically refers to **irregular AND heavy bleeding**, not just frequent and heavy bleeding. - The key difference: epimenorrhoea maintains **regular cyclicity** (just more frequent), whereas metrorrhagia implies **irregular, acyclic bleeding**. *It is seen more frequently at the ends of reproductive life* - This is **CORRECT** - functional epimenorrhoea commonly occurs during **adolescence** (as cycles are maturing) and **perimenopause** (due to hormonal fluctuations, particularly anovulatory cycles). - Both periods are characterized by unstable hypothalamic-pituitary-ovarian axis function. *The cycle is reduced to an arbitrary limit of 21 days or less* - This is **CORRECT** - epimenorrhoea (polymenorrhea) is defined as menstrual cycles occurring at intervals of **21 days or less**. - Normal menstrual cycle length is 21-35 days; anything less than 21 days is considered epimenorrhoea. *It is a cyclic bleeding* - This is **CORRECT** - functional epimenorrhoea indicates that bleeding is **still cyclical and regular**, occurring at predictable (though shortened) intervals. - This distinguishes it from **metrorrhagia** (irregular, acyclic bleeding) and confirms ovulatory or regular hormonal cycling.
Question 10: Hormone predominantly secreted after 14 days that acts on the endometrium is?
- A. Progesterone (Correct Answer)
- B. Estrogen
- C. LH
- D. FSH
Explanation: ***Progesterone*** - After **ovulation** (around day 14 of a typical 28-day cycle), the **corpus luteum** forms and begins secreting large amounts of progesterone. - Progesterone's primary role is to prepare the **endometrium** for potential implantation by making it secretory and vascularized. *Estrogen* - Estrogen levels are highest during the **proliferative phase** (days 1-14), promoting endometrial growth and thickening. - While present after day 14, its predominant role shifts to preparing the uterus, but not as the *main* hormone secreted to support the post-ovulatory endometrium. *LH (Luteinizing Hormone)* - LH is crucial for triggering **ovulation** itself, with a surge occurring just before day 14. - After ovulation, LH levels decrease and its primary role is not direct endometrial modification. *FSH (Follicle-Stimulating Hormone)* - FSH is primarily active in the **follicular phase** (days 1-14), stimulating ovarian follicle growth. - Its levels decrease after ovulation, and it does not directly regulate endometrial changes in the post-ovulatory period.
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