Endocrinology of Pregnancy Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Endocrinology of Pregnancy. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Endocrinology of Pregnancy Indian Medical PG Question 1: Test done at sub-centre during pregnancy:
- A. Haemoglobin (Correct Answer)
- B. Triple test
- C. USG
- D. OGTT
Endocrinology of Pregnancy Explanation: ***Haemoglobin***
- **Haemoglobin testing** is a routine and essential screening measure performed at the subcenter level during pregnancy, primarily to detect and monitor **anaemia**.
- Its simplicity, cost-effectiveness, and direct impact on maternal and fetal health make it suitable for primary healthcare settings.
*Triple test*
- The **triple test** (or multiple marker screen) is a prenatal diagnostic test for chromosomal abnormalities and neural tube defects, typically performed between weeks 15 and 20 of pregnancy.
- This test requires specialized laboratory facilities and interpretation, which are usually not available or routinely performed at the subcenter level.
*USG*
- **Ultrasonography (USG)** is a vital imaging technique used to monitor fetal growth, development, and maternal health during pregnancy.
- While crucial, USG requires specialized equipment and trained personnel (sonographers or radiologists) and is generally conducted in higher-level healthcare facilities, not routinely at a subcenter.
*OGTT*
- An **Oral Glucose Tolerance Test (OGTT)** is used to screen for **gestational diabetes mellitus**.
- While it is a routine test in pregnancy, performing a full OGTT (which involves multiple blood draws over several hours after glucose ingestion) is often logistically challenging for routine performance at a subcenter; usually, only initial screening (like random blood sugar or fasting glucose) or a single-step glucose challenge test might be done at a primary level before referral.
Endocrinology of Pregnancy Indian Medical PG Question 2: Thyroxine binding globulin (TBG) is increased in:
- A. Pregnancy (Correct Answer)
- B. Cancer chemotherapy
- C. Nephrotic syndrome
- D. Glucocorticoid therapy
Endocrinology of Pregnancy Explanation: ***Pregnancy***
- Estrogen levels are elevated during **pregnancy**, which leads to an increase in the synthesis of **TBG** by the liver.
- Increased TBG binds more thyroid hormone, reducing free thyroid hormone levels, which then stimulates the thyroid gland to produce more.
*Cancer chemotherapy*
- Many **chemotherapeutic agents** can damage the liver or interfere with protein synthesis, potentially leading to a *decrease* in TBG and other plasma proteins.
- Chemotherapy can also induce **hypothyroidism** directly or indirectly, which may alter thyroid hormone binding.
*Nephrotic syndrome*
- **Nephrotic syndrome** is characterized by significant proteinuria, where plasma proteins, including **TBG**, are lost through the kidneys in the urine.
- This leads to a *decrease* in serum TBG levels, which can affect total thyroid hormone measurements but typically does not cause overt thyroid dysfunction due to compensatory mechanisms.
*Glucocorticoid therapy*
- **Glucocorticoids** (e.g., prednisone, dexamethasone) are known to *decrease* the hepatic synthesis of **TBG**.
- This reduction in TBG can lead to lower total thyroid hormone levels without necessarily indicating thyroid gland dysfunction, as free thyroid hormone levels often remain normal.
Endocrinology of Pregnancy Indian Medical PG Question 3: A 20 year old Primigravida, comes at 35 weeks of gestation with complaints of swelling of feet. On examination her blood pressure is 170/110 mm Hg on 2 occasions; urine examination shows proteinuria. Which one of the following statements regarding her management is NOT true?
- A. Injection Dexamethasone is to be given for fetal lung maturity (Correct Answer)
- B. Can be labelled as Preeclampsia
- C. Both maternal and fetal monitoring are required
- D. Requires urgent admission
Endocrinology of Pregnancy Explanation: ***Injection Dexamethasone is to be given for fetal lung maturity***
- At **35 weeks of gestation**, corticosteroids for fetal lung maturity are **traditionally NOT routinely indicated** according to classical obstetric teaching.
- The primary indication for antenatal corticosteroids is between **24 and 34 weeks of gestation**, when the risk of respiratory distress syndrome is highest.
- At 35 weeks, fetal lungs are generally considered sufficiently mature, and the risk-benefit ratio of routine steroid administration changes.
- **Note**: Evolving evidence (post-2016) suggests potential benefits of late preterm steroids (34-36+6 weeks) in certain scenarios, but this was not standard practice at the time of this examination.
- In the context of this question and examination year, this statement is **NOT true** as routine practice.
*Can be labelled as Preeclampsia*
- The patient presents with **severe hypertension** (BP 170/110 mmHg on two occasions) and **proteinuria**, which are the hallmark diagnostic criteria for **severe preeclampsia**.
- BP ≥160/110 mmHg meets the criteria for severe features.
- Swelling of the feet (**edema**) is a common, though not diagnostic, associated symptom.
*Both maternal and fetal monitoring are required*
- In severe preeclampsia, **close maternal monitoring** for signs of worsening disease is crucial:
- Severe hypertension, headaches, visual disturbances, epigastric pain
- Laboratory monitoring: liver enzymes, platelets, creatinine, LDH
- **Fetal monitoring** is essential to assess fetal well-being:
- Non-stress tests, biophysical profiles
- Doppler velocimetry to assess placental insufficiency
- Monitoring for IUGR or fetal distress
*Requires urgent admission*
- With BP 170/110 mmHg and proteinuria at 35 weeks, this is **severe preeclampsia** - a medical emergency.
- **Urgent admission** is necessary for:
- Continuous maternal and fetal monitoring
- Blood pressure control with antihypertensives
- Magnesium sulfate for seizure prophylaxis
- Planning for timely delivery (delivery is the definitive treatment)
Endocrinology of Pregnancy Indian Medical PG Question 4: Intestinal absorption of calcium is mainly increased by?
- A. Calcitriol (Correct Answer)
- B. Parathormone
- C. Glucocorticoids
- D. ACTH
Endocrinology of Pregnancy Explanation: ***Calcitriol***
- **Calcitriol** (1,25-dihydroxyvitamin D3) is the hormonally active form of vitamin D, which is essential for increasing **calcium absorption** from the intestines.
- It stimulates the synthesis of **calcium-binding proteins** in intestinal epithelial cells, facilitating active transport of calcium.
*Parathormone*
- **Parathormone (PTH)** primarily regulates calcium by increasing its reabsorption in the **kidneys** and stimulating its release from **bones**.
- While it indirectly promotes calcitriol synthesis, its *direct* effect on intestinal calcium absorption is minimal compared to calcitriol.
*Glucocorticoids*
- **Glucocorticoids** generally have an *inhibitory* effect on calcium absorption in the intestine and can also increase renal excretion of calcium.
- Prolonged use can lead to **osteoporosis** due to their negative impact on bone formation and calcium balance.
*ACTH*
- **ACTH (adrenocorticotropic hormone)** primarily stimulates the adrenal cortex to produce **cortisol** and other glucocorticoids.
- It has **no direct role** in regulating calcium absorption from the intestines.
Endocrinology of Pregnancy Indian Medical PG Question 5: A 26-week pregnant female presents with hypertension for the first time. There is no proteinuria. What is the most likely diagnosis?
- A. Hypertension diagnosed before 20 weeks of gestation
- B. Hypertension diagnosed after 20 weeks of gestation without proteinuria (Correct Answer)
- C. Hypertension with proteinuria or end-organ damage
- D. Hypertension with seizures
Endocrinology of Pregnancy Explanation: ***Hypertension diagnosed after 20 weeks of gestation without proteinuria***
- This scenario describes **gestational hypertension**, defined as new-onset hypertension (≥140/90 mmHg) presenting *after* 20 weeks of gestation, without associated proteinuria or other signs of preeclampsia.
- The patient's presentation at **26 weeks** with **no proteinuria** directly aligns with the diagnostic criteria for gestational hypertension.
*Hypertension diagnosed before 20 weeks of gestation*
- This description corresponds to **chronic hypertension**, meaning the hypertension was present *before* pregnancy or diagnosed *before* 20 weeks of gestation.
- The question explicitly states the hypertension is presenting for the **first time** and the gestational age is **26 weeks**, ruling out chronic hypertension.
*Hypertension with proteinuria or end-organ damage*
- This definition describes **preeclampsia**, which involves new-onset hypertension *after* 20 weeks accompanied by significant **proteinuria** or signs of **end-organ damage** like renal insufficiency, liver dysfunction, or thrombocytopenia.
- The patient specifically has **no proteinuria**, making preeclampsia an unlikely diagnosis based on the provided information.
*Hypertension with seizures*
- This refers to **eclampsia**, a severe complication of preeclampsia characterized by the development of **generalized tonic-clonic seizures** in a pregnant patient with preeclampsia, unrelated to other brain conditions.
- The patient in this case is not experiencing seizures; therefore, eclampsia is not the correct diagnosis.
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