Mcqs On Neuroendocrine syndromes in Gynaecology

MCQs On Neuroendocrine syndromes in Gynaecology

1. A 21-year-old athletic woman with diabetes on a low-dose oral contraceptive comes to your clinic with irregular menses and bilateral breast discharge. On examination, the discharge is expressed and galactorrhea is confirmed with fat globules seen microscopically. She currently takes metoclopramide (Reglan) for delayed gastric emptying. A random serum prolactin level is 65 ng/mL. Which of the following is most likely responsible for her hyperprolactinemia?

(A) metoclopramide

(B) pregnancy

(C) oral contraceptive

(D) pituitary adenoma

(E) exercise

2. During pregnancy, the placenta and fetus actively contribute to the maternal hormone levels and impact the maternal-fetal unit physiology. Which of the following hormones decreases after the first trimester of pregnancy?

(A) progesterone

(B) prolactin

(C) human chorionic gonadotropin (hCG)

(D) human placental lactogen (hPL)

(E) estriol

3. A 25-year-old woman who underwent menar-che at 11 years of age presents with a history of irregular menstrual cycles over the last 12 months, increased weight gain, and bilateral pelvic pain. Transvaginal ultrasound shows large cystic ad-nexa, with cysts measuring 7 to 9 cm in size. A urine pregnancy test is negative. Her thyroid-stimulating hormone (TSH) level is 17 mlU/mL, and prolactin level is 10 ng/mL. Which of the following is the treatment of choice for this patient to regain normal menstrual cycles?

(A) monophasic birth control pills

(B) triphasic birth control pills

(C) levothyroxine treatment

(D) bromocriptine treatment

(E) gonadotropin-releasing hormone (GnRH) agonist treatment

4. A 22-year-old woman with amenorrhea of 6 weeks’ duration undergoes surgery for acute appendicitis. At the time of surgery, a 3-cm semisolid left ovarian cyst is discovered. It is vascular and appears to contain a blood-filled central cavity. A serum pregnancy test is positive. Which of the following is the most appropriate next step in this patient’s management?

(A) ovarian cystectomy

(B) ovarian wedge resection

(C) oophorectomy

(D) salpingo-oophorectomy

(E) no additional therapy indicated

5. A 25-year-old woman is having a severe intrapartum hemorrhage with hypovolumic shock. Which of the following symptoms is evidence of pituitary infarction?

(A) infrequent urination

(B) diarrhea

(C) easy bruisability

(D) lactation failure

(E) perspiration

6. A 16-year-old girl has not experienced menarche. Examination shows absence of breast development and small but otherwise normal female pelvic organs. Which of the following diagnostic tests is most useful in determining the etiology of the amenorrhea?

(A) serum follicle-stimulating hormone (FSH)

(B) serum estradiol

(C) serum testosterone

(D) magnetic resonance imaging (MRI) of the head

(E) ovarian biopsy

Questions 7 and 8 apply to the following patient:

An 18-year-old patient has not experienced menar-che. Examination shows normal breast development and absence of a uterus.

7. Which of the following diagnostic tests is most useful in determining the etiology of the amenorrhea?

(A) serum FSH

(B) serum estradiol

(C) serum testosterone

(D) MRI of the head

(E) ovarian biopsy

8. If congenital androgen insensitivity syndrome (testicular feminization) is diagnosed, it is caused by a defect in what aspect of androgen function?

(A) synthesis

(B) metabolism

(C) receptor action

(D) excretion

(E) aromatization

9. An adult genetic male with 17-alpha-hydro-xylase deficiency would have which of the following findings?

(A) no breast development, uterus present, hypertension

(B) no breast development, uterus present, hypotension

(C) breast development, uterus absent, hypotension

(D) no breast development, uterus absent, hypertension

(E) breast development, uterus present, hypertension

10. A 28-year-old patient complains of amenorrhea after dilation and curettage (D&C) for postpartum bleeding. She denies any other complaints and did not require a blood transfusion at the time of her postpartum bleed. Which of the following is the most likely diagnosis?

(A) gonadal dysgenesis

(B) Sheehan syndrome

(C) Kallmann syndrome

(D) Mayer-Rokitansky-Kiister-Hauser syndrome

(E) Asherman syndrome

11. A 25-year-old woman experiences galactorrhea and amenorrhea of 8 weeks’ duration with irregular vaginal bleeding. Which of the following serum assays should initially be performed?

(A) hCG

(B) progesterone

(C) prolactin

(D) FSH

(E) luteinizing hormone (LH)

12. A 14-year-old girl complains of irregular vaginal bleeding. Her general examination and pelvic organs are normal. Which of the following is the most likely cause of anovulatory bleeding (dysfunctional uterine bleeding [DUB]) in this patient?

(A) hypothyroidism

(B) pituitary adenoma

(C) polycystic ovary syndrome (PCOS)

(D) congenital adrenal hyperplasia (CAH)

(E) hypothalamic immaturity

13. A 15-year-old girl is seen in the emergency department. She has a sudden onset of heavy vaginal bleeding. She has noted irregular, painless vaginal bleeding of 6 months’ duration. Her medical history is unremarkable, and she is not sexually active. Physical and pelvic examinations are normal, but blood is coming through the cervical os. A serum pregnancy test is negative, and complete blood cell count has hematocrit of 37% (normal 35% to 45%) and normal white blood cell and platelet counts. Which of the following is the best course of immediate action?

(A) observation

(B) estrogen therapy

(C) progesterone therapy

(D) nonsteroidal anti-inflammatory therapy

(E) D&C

14. An 18-year-old woman comes to your clinic with irregular cycles since menarche and mild hirsutism. She is not interested in pregnancy or contraception. Her serum TSH, prolactin, and dehydroepiandrosterone sulfate (DHEAS) levels are normal, with a slightly elevated serum testosterone level of 80 ng/dL. Which of the following is the most appropriate next step for this patient?

(A) oral contraceptive treatment

(B) endometrial biopsy

(C) GnRH stimulation test

(D) clomiphene citrate

(E) bromocriptine

15. A 24-year-old nulligravid patient presents with complaints of increasing dark coarse hair growth over upper lip and chin, on the abdomen, and on her chest. She denies any change in her voice, balding, or clitoral enlargement. Which of the following is she most likely experiencing?

(A) masculinization

(B) defeminization

(C) virilization

(D) hirsutism

(E) androgenization

16. A 4-year-old girl is brought in by her mother for evaluation of clitoral enlargement. She is tall for her age, with no breast or axillary hair development. There is slight pubic hair growth on examination and an enlarged clitoris with a single perineal opening. Karyotype is 46,XX. The 17-OHP level is 108 ng/mL. What is the most likely diagnosis?

(A) androgen insensitivity syndrome

(B) PCOS

(C) CAH with 21-hydroxylase deficiency

(D) ovarian thecoma

(E) germ cell ovarian tumor

17. Female pseudohermaphroditism refers to individuals who have which of the following?

(A) ovaries, an XX karyotype, and varying degrees of masculinization

(B) testes, an XY karyotype, and varying degrees of masculinization failure

(C) ovaries, an XY karyotype, and varying degrees of masculinization failure

(D) testes, an XX karyotype, and severe masculinization

(E) both ovarian and testicular tissue

18. An infant with ambiguous genitalia is found to have testes and an XY karyotype. Seminal vesicles, ejaculatory ducts, epididymis, and vas deferens (Wolffian duct derivatives) are present. There is no uterus, fallopian tubes, or upper vagina. The ratio of circulating testosterone to dihydrotestosterone (DHT) is elevated compared to normal male infants. What is the most likely diagnosis?

(A) 20,22 desmolase deficiency

(B) 21-hydroxylase deficiency

(C) testicular feminization

(D) 5-alpha-reductase deficiency

(E) embryonic testicular regression

19. A 17-year-old boy presents for delayed sexual development. He is 6 ft 5 in. tall with a weight of 152 lb. There is a reduced amount of pubic hair with a small phallus and small testicles. Endocrine testing reveals increased FSH and LH levels and a low testosterone level. What is the most likely diagnosis?

(A) Kallmann syndrome

(B) Klinefelter syndrome

(C) Savage syndrome

(D) Beckwith-Wiedemann syndrome

(E) Turner syndrome

20. During pregnancy, the most likely change in maternal levels of thyroxine-binding globulin (TBG), total thyroxine (T4), and total triiodothyronine (T3) are which of the following?

(A) TBG levels, total thyroxine (T4), and total triiodothyronine (T3) all rise.

(B) TBG levels rise, but total thyroxine (T4) and total triiodothyronine (T3) fall.

(C) TBG levels and total thyroxine (T4) rise while total triiodothyronine (T3) remains unchanged.

(D) TBG levels fall, while total thyroxine (T4) and total triiodothyronine (T3) both rise.

(E) TBG levels, total thyroxine (T4), and total triiodothyronine (T3) all remain unchanged

21. Successful lactation is initiated by which of the following?

(A) estrogen stimulation during pregnancy

(B) progesterone stimulation during pregnancy

(C) elevated levels of hCG

(D) elevated levels of prolactin near term

(E) the postpartum decline in circulating sex steroid levels

22. Amenorrhea, estrogen deficiency, and elevated circulating gonadotropin levels are noted in a normal-appearing 27-year-old woman. Which of the following conditions is most closely associated with these findings?

(A) X chromosome abnormalities

(B) polyglandular autoimmune syndrome

(C) Kallmann syndrome

(D) alkylating antineoplastic drugs

(E) pelvic irradiation

23. A 33-year-old woman who underwent normal puberty describes an 18-month history of secondary amenorrhea and hot flashes. A pregnancy test was negative. A progesterone withdrawal challenge test revealed no bleeding. Her FSH was 94 mlU/mL, and her LH level was 68 mlU/mL. She desires to be pregnant with her current partner. Which of the following is the most appropriate next step in the management of this individual?

(A) karyotype

(B) measurement of serum prolactin

(C) clomiphene citrate therapy

(D) gonadotropin stimulation therapy

(E) estrogen replacement therapy

24. What is the principal androgen used for placental estrogen synthesis?

(A) androstenedione

(B) testosterone

(C) DHEAS

(D) aldosterone

(E) cortisol

25. What is the principal hormone produced by the maternal zona glomerulosa?

(A) estriol

(B androstenedione

(C) testosterone

D) DHEAS

E) aldosterone

26. What is the principal hormone responsible for 1,25-dihydroxy vitamin D 3 synthesis?

(A) aldosterone

(B) cortisol

(C) thyroxine

(D) parathyroid hormone (PTH)

(E) insulin

27. A patient with hirsutism, ovarian androgen excess, and elevated serum LH levels is most likely to have which of the following?

(A) 11-beta-hydroxylase deficiency

(B) Cushing syndrome

(C) adrenal tumor

(D) polycystic ovarian syndrome (PCOS)

(E) arrhenoblastoma

28. Which of the following is the most common adrenal cause for hirsutism, adrenal androgen excess, and elevated 17-OHP?

(A) 20,22-desmolase deficiency

(B) 3-beta-hydroxysteroid dehydrogenase (3-n HSD) deficiency

(C) 21-hydroxylase deficiency

(D) 11-beta-hydroxylase deficiency

(E) Cushing syndrome

29. Sexual differentiation of the male internal and external genitalia is most dependent on the action of which of the following?

(A) anti-müllerian hormone (AMH)

(B) sex-determining region of the Y chromosome (SRY)

(C) testosterone

(D) DHEAS

(E) cortisol

30. For most girls, the onset of puberty is heralded by which of the following?

(A) growth acceleration

(B) thelarche

(C) pubarche

(D) menarche

(E) ovulation

31. The physical stigmata of Turner syndrome are due to loss of chromosomal material from which chromosome?

(A) chromosome 21

(B) chromosome 18

(C) chromosome 6

(D) the short arm of the X chromosome

(E) the Y chromosome

32. A 14-year-old girl is brought to you for evaluation of lower abdominal pain that has been progressive over the preceding 4 months. History indicates that she experienced a growth spurt at age 11 and has had normal breast and pubic hair growth that began approximately 2 years ago. She appears to be of appropriate height. She has no other medical conditions and takes no medications. She has not had a menstrual period and is not sexually active. What is the most appropriate next step in the evaluation of this patient?

(A) measurement of serum hCG

(B) measurement of serum FSH

(C) imaging of the pituitary and sella turcica

(D) pelvic ultrasonography

(E) pelvic examination

33. A 25-year-old G4P0040 presents for evaluation of recurrent documented pregnancy losses that have occurred between the 10th and 14th weeks of gestation. The patient has no ongoing medical conditions and takes no medications. Pubertal events and menstrual history are unremarkable. A pelvic examination is normal. What is the most appropriate next step in the evaluation of this patient?

(A) measurement of serum FSH on cycle day 3

(B) hysterosalpingography

(C) imaging of the pituitary and sella turcica

(D) pelvic ultrasonography

(E) measurement of mid-cycle LH

34. Which of the following ovarian tumors is most likely to result in virilization of a 35-year-old woman?

(A) Brenner (transitional cell) tumor

(B) dysgerminoma

(C) Sertoli-Leydic cell tumor

(D) mucinous cystademoma

(E) thecoma

35. A 30-year-old woman presents to your office with an ultrasound report stating she has “polycystic- appearing ovaries.” She has a friend who has PCOS and is currently having trouble conceiving and wants to know what this means for her. You tell her that she may have PCOS if she also

A. Occasionally skips a menstrual cycle

B. Is obese

C. Is hirsute

D. Has diabetes

E. Has elevated LH levels

36. A 25-year-old woman comes to your office complaining of irregular menses and hair on her chin, upper lip, and chest that requires frequent plucking. She reports that she is otherwise healthy. On physical examination, you notice increased hair on her lower abdomen and upper back, but the rest of the examination and her vitals are normal. Which laboratory tests would you NOT order for this patient?

A. Serum testosterone

B. Prolactin

C. 17-OHP

D. 24-hour urinary free cortisol

E. FSH and estradiol level

37. You diagnose the previous patient with PCOS and she would like to know what she can do to help with the excessive hair growth. She is currently on no medications. Which one of the following treatments for hirsutism would you NOT prescribe to her alone?

A Metformin

B Flutamide

C Laser epilation

D Oral contraceptive pills

E Eflornithine

38. A 36-year-old obese woman with known PCOS presents to your infertility practice. She was diagnosed with PCOS at the age of 24 years, at which time she reports having had a battery of tests done. She has been followed by her general gynecologist who has maintained her on oral contraceptive pills since that time. She reports she is otherwise healthy. She now desires to get pregnant and is coming to you for advice. What is one of the most important tests to perform at this time?

A. Ovarian ultrasound

B. Endometrial biopsy

C. Serum testosterone

D. Fasting glucose levels

E. 2-hour oral glucose tolerance test

39. A 28-year-old women with PCOS and her husband present to your infertility clinic for consultation. She stopped taking her oral contraceptive pills 6 months ago and has not had a period since. She is morbidly obese and her past medical history is significant for sleep apnea and diabetes. She and her husband want get pregnant and ask for your help. What would be your first recommendation to increase their chances of conception at this time?

A. In vitro fertilization

B. Clomiphene citrate

C. Weight loss program

D. Metformin

40. In polycystic ovary syndrome, estrogen levels are elevated, increasing the risk of which of the following?

A. Metabolic Syndrome

B. Endometrial Cancer

C. Hirsutism

D. Hypertension

Answers

1. (A)

2. (C)

3. (C)

4. (E)

5. (D)

6. (A)

7. (C)

8. (C)

9. (D)

10. (E)

11. (A)

12. (E)

13. (B)

14. (A)

15. (D)

16. (C)

17. (A)

18. (D)

19. (B)

20. (A)

21. (E)

22. (B)

23. (E)

24. (C)

25. (E)

26. (D)

27. (D)

28. (C)

29. (B

30. (A)

31. (D)

32. (E)

33. (B)

34. (C)

35. (C)

36. (D)

37. (B)

38. (E)

39. (D)

40. (B)