Reproductive Endocrinology Practice Questions

Q: All of the following are used in the management of hirsutism except?

Danazol. **Explanation:** The management of hirsutism focuses on reducing circulating androgens or blocking their action at the hair follicle. **Why Danazol is the correct answer (The "Except"):** Danazol is a synthetic steroid and an **isoxazole derivative of ethisterone**. It is primarily used in the treatment of endometriosis and hereditary angioedema. Crucially, Danazol has **strong androgenic properties** and can cause side effects such as weight gain, acne, and **hirsutism** itself. Therefore, it is contraindicated in the management of hirsutism as it would exacerbate the condition. **Analysis of other options:** * **Spironolactone:** This is a potassium-sparing diuretic that acts as a potent **androgen receptor antagonist** and inhibits 5-alpha reductase. It is a first-line agent for idiopathic hirsutism. * **OCPs (Oral Contraceptive Pills):** These are the first-line treatment for PCOS-related hirsutism. They work by suppressing LH (decreasing ovarian androgen production) and increasing **Sex Hormone Binding Globulin (SHBG)**, which lowers free testosterone levels. * **GnRH Agonists:** These are used in severe cases or hyperthecosis. By causing pituitary desensitization, they lead to a profound decrease in ovarian steroidogenesis. **NEET-PG High-Yield Pearls:** * **First-line drug for PCOS-related hirsutism:** OCPs. * **Most common cause of hirsutism:** PCOS (Polycystic Ovary Syndrome). * **Ferriman-Gallwey Score:** Used to clinically quantify hirsutism (Score ≥8 is significant). * **Finasteride:** A 5-alpha reductase inhibitor also used in treatment. * **Eflornithine:** A topical cream used to inhibit hair growth by blocking ornithine decarboxylase.

Q: A 23-year-old female presents with a history of recurrent abortions. Which of the following tests is NOT indicated in the investigation of recurrent abortions?

TORCH infection screening. **Explanation:** Recurrent pregnancy loss (RPL) is defined as the loss of two or more consecutive pregnancies. The investigation of RPL focuses on identifying chronic or structural causes rather than sporadic events. **Why TORCH screening is NOT indicated:** TORCH infections (Toxoplasmosis, Other, Rubella, CMV, Herpes) are known to cause **sporadic** pregnancy loss or congenital malformations. However, they do not cause **recurrent** abortions because the mother typically develops lasting immunity after the primary infection, preventing subsequent pregnancy losses from the same pathogen. Therefore, routine TORCH screening is no longer recommended in the workup of RPL. **Why the other options are indicated:** * **Parental Cytogenetics:** Indicated to rule out balanced reciprocal or Robertsonian translocations in either parent, which can lead to unbalanced gametes and recurrent miscarriages. * **Thyroid Profile:** Endocrine disorders, specifically uncontrolled hypothyroidism or the presence of anti-thyroid antibodies, are established risk factors for RPL. * **Antiphospholipid Antibodies (APLA):** Antiphospholipid Syndrome is the most important treatable causes of RPL. Testing for Lupus anticoagulant, Anticardiolipin, and Anti-β2 glycoprotein I antibodies is mandatory. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of sporadic abortion:** Fetal chromosomal anomalies (Autosomal trisomy). * **Most common cause of RPL:** Often remains "unexplained" (approx. 50%), but among identifiable causes, APLA and uterine anomalies are frequent. * **Uterine factor:** Hysterosalpingography (HSG) or Hysteroscopy is indicated to rule out a septate uterus (the uterine anomaly most associated with RPL). * **Progesterone:** Luteal phase deficiency is a controversial but often tested endocrine cause of RPL.

Q: Which of the following is NOT a major source of androgens in females?

Corpus luteum. In the female body, androgens are produced through three primary pathways. Understanding the distribution of these sources is high-yield for NEET-PG. ### **Why "Corpus Luteum" is the Correct Answer** The **corpus luteum** is a temporary endocrine structure formed after ovulation. Its primary physiological role is the secretion of **progesterone** (to maintain the secretory endometrium) and some estrogen. While it produces small amounts of androstenedione as a precursor to estrogen, it is **not** considered a "major source" of systemic androgens. Its function is specialized for pregnancy maintenance rather than androgen contribution. ### **Analysis of Incorrect Options** * **A. Adrenals:** The adrenal glands (specifically the *zona reticularis*) contribute approximately **25%** of circulating testosterone and are the primary source of DHEA-S (95-100%). * **B. Ovaries:** The ovarian theca cells produce androgens under the influence of LH. The ovaries contribute roughly **25%** of circulating testosterone. * **C. Peripheral Conversion:** This is a significant source, accounting for the remaining **50%** of circulating testosterone. Precursors like androstenedione are converted into testosterone in the liver, skin, gastrointestinal tract, and adipose tissue. ### **Clinical Pearls for NEET-PG** * **The 25-25-50 Rule:** Remember that Testosterone in females comes 25% from Adrenals, 25% from Ovaries, and 50% from Peripheral conversion. * **DHEA-S Marker:** DHEA-S is almost exclusively produced by the adrenals. If a patient has virilization and elevated DHEA-S, the source is likely an adrenal tumor. * **Hyperandrogenism:** In PCOS (the most common cause of female hyperandrogenism), the excess androgens primarily originate from the ovarian theca cells due to elevated LH levels.

Q: Infertility is a common feature of Swyer cell syndrome because:

There are no germ cells in this condition.. **Explanation:** **Swyer Syndrome (Pure Gonadal Dysgenesis)** is a condition characterized by a **46,XY karyotype** in individuals who have a female phenotype. The underlying pathophysiology involves a failure of the primitive gonads to differentiate into testes, often due to mutations in the **SRY gene** or other sex-determining pathways (like SOX9). 1. **Why the correct answer is right:** In Swyer Syndrome, because the SRY gene fails to trigger testicular development, the bipotential gonads do not develop into testes or ovaries. Instead, they persist as non-functional, fibrous **"streak gonads."** These streak gonads lack follicles and **germ cells**. Without germ cells (oocytes), natural conception is impossible, leading to primary infertility. 2. **Why the incorrect options are wrong:** * **Options A, B, and D:** These options assume the presence of testicular tissue (Sertoli cells, blood-testis barrier, or spermatogenesis). In Swyer Syndrome, there is **no testicular development** despite the XY genotype. Therefore, these male-specific physiological processes never occur. **High-Yield Clinical Pearls for NEET-PG:** * **Phenotype:** Female external genitalia, well-developed Müllerian structures (uterus, fallopian tubes) because no Anti-Müllerian Hormone (AMH) is produced. * **Clinical Presentation:** Primary amenorrhea and delayed puberty (hypergonadotropic hypogonadism). * **Malignancy Risk:** There is a high risk (approx. 25-30%) of developing **Gonadoblastoma** or Dysgerminoma in the streak gonads; therefore, prophylactic **gonadectomy** is recommended upon diagnosis. * **Fertility Potential:** While naturally infertile, patients **can achieve pregnancy** through **Oocyte Donation** and IVF, as they have a functional uterus.

Q: Which hormone level is typically elevated in polycystic ovarian syndrome?

LH (Luteinizing Hormone). **Explanation:** In Polycystic Ovarian Syndrome (PCOS), the primary endocrine hallmark is a disruption of the hypothalamic-pituitary-ovarian axis. The correct answer is **LH (Luteinizing Hormone)** because PCOS is characterized by an increased frequency and amplitude of GnRH pulses, which preferentially stimulates the anterior pituitary to secrete LH over FSH. This results in an **elevated LH:FSH ratio (typically >2:1 or 3:1)**. High LH levels act on the ovarian theca cells to increase androgen production, leading to hyperandrogenism and follicular arrest. **Analysis of Incorrect Options:** * **17-alpha-hydroxyprogesterone:** This is a marker for **Congenital Adrenal Hyperplasia (CAH)**. While it may be mildly elevated in some PCOS cases, a significant elevation is used to rule out CAH, which is a common differential diagnosis for PCOS. * **FSH (Follicle-Stimulating Hormone):** In PCOS, FSH levels are typically **low or low-normal**. The lack of sufficient FSH prevents the aromatization of androgens to estrogens and hinders the development of a dominant follicle. * **TSH (Thyroid-Stimulating Hormone):** TSH levels are usually normal in PCOS. Thyroid dysfunction is a separate endocrine disorder, though hypothyroidism can mimic some PCOS symptoms (like irregular cycles) and should be ruled out during workup. **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Rotterdam Criteria (requires 2 out of 3: Oligo/anovulation, Hyperandrogenism, and Polycystic ovaries on ultrasound). * **Insulin Resistance:** Hyperinsulinemia is a key driver in PCOS; it decreases Sex Hormone Binding Globulin (SHBG), further increasing free testosterone levels. * **Ultrasound Finding:** "String of pearls" appearance (12 or more follicles measuring 2–9 mm). * **First-line for Ovulation Induction:** Letrozole (now preferred over Clomiphene Citrate).

Question 1

Which of the following are true about Stein-Leventhal syndrome?

Accepted Answer

Seen in post-menopausal women

Answer

Oligomenorrhea and amenorrhea

Answer

Numerous cysts in ovary

Answer

Theca cell hypertrophy

Question 2

Ovarian senescence is described by all of the following except:

Accepted Answer

Follicular activation is dependent on pituitary stimulation.

Answer

Begins in utero within the embryonic ovary.

Answer

More rapid in the late 30s and early 40s.

Answer

Programmed oocyte atresia.

Question 3

All of the following are used in the management of hirsutism except?

Accepted Answer

Danazol

Answer

Spironolactone

Answer

GnRH

Answer

OCPs

Question 4

A 23-year-old female presents with a history of recurrent abortions. Which of the following tests is NOT indicated in the investigation of recurrent abortions?

Accepted Answer

TORCH infection screening

Answer

Parental cytogenetics

Answer

Thyroid profile

Answer

Antiphospholipid antibodies

Question 5

A 28-year-old obese woman presents with infertility and amenorrhea, accompanied by significant facial hair in a male distribution. Laboratory studies show increased serum LH, total serum testosterone, and dehydroepiandrosterone sulfate. What pelvic ultrasound finding would likely be observed?

Accepted Answer

Multiple small follicular cysts on the ovary

Answer

A mass resembling a bunch of grapes projecting into the vagina

Answer

Blood-filled cysts in the ovary

Answer

Fluid accumulation in the fallopian tubes

Question 6

Which of the following is NOT a major source of androgens in females?

Accepted Answer

Corpus luteum

Answer

Adrenals

Answer

Ovaries

Answer

Peripheral conversion from androgen precursors in the liver, gastrointestinal tract, and adipose tissue

Question 7

Infertility is a common feature of Swyer cell syndrome because:

Accepted Answer

There are no germ cells in this condition.

Answer

Too many Sertoli cells inhibit spermatogenesis.

Answer

Proper blood-testis barrier is not established.

Answer

Sufficient numbers of spermatozoa are not produced.

Question 8

In which of the following conditions do the ovaries function normally?

Accepted Answer

Rokitansky-Kuster-Hauser syndrome

Answer

Turner's syndrome

Answer

Androgen insensitivity syndrome

Answer

Swyer's syndrome

Question 9

Which hormone level is typically elevated in polycystic ovarian syndrome?

Accepted Answer

LH (Luteinizing Hormone)

Answer

17-alpha-hydroxyprogesterone

Answer

FSH (Follicle-Stimulating Hormone)

Answer

TSH (Thyroid-Stimulating Hormone)

Question 10

A woman treated for infertility presents with 6 weeks of amenorrhea and urinary retention. What is the most likely etiology?

Accepted Answer

Impacted cervical fibroid

Answer

Retroverted uterus

Answer

Pelvic hematocele

Answer

Carcinoma cervix

Reproductive Endocrinology — MCQs

Reproductive Endocrinology — MCQs

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