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Question 1
Correct
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Which of the following is the primary source of oestrogen ?
Your Answer: Granulosa cells
Explanation:Ovarian granulosa cells (GC) are the major source of oestradiol synthesis. Induced by the preovulatory luteinizing hormone (LH) surge, cells of the theca and, in particular, of the granulosa cell layer profoundly change their morphological, physiological, and molecular characteristics and form the progesterone-producing corpus luteum that is responsible for maintaining pregnancy.
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This question is part of the following fields:
- Endocrinology
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Question 2
Incorrect
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Maternal blood flow through the uterine artery at term is approximately
Your Answer: 175ml/min
Correct Answer: 750ml/min
Explanation:Uterine blood flow increases 40-fold to approximately 700 mL/min at term, with 80 per cent of the blood distributed to the intervillous spaces of the placentae, and 20 per cent to the uterine myometrium.
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This question is part of the following fields:
- Endocrinology
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Question 3
Correct
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Hirsutism can be found in all of the following conditions, EXCEPT:
Your Answer: Patient on oral contraceptive pills
Explanation:Classically, hirsutism has been considered a marker of increased androgen levels in females from increased production of androgens (i.e. testosterone) either by the adrenals or due to an ovarian disease. The ovarian causes for hyperandrogenism are polycystic ovarian syndrome (PCOS) and ovarian tumours. Adrenal causes include Cushing’s syndrome, androgen-producing tumours, and congenital adrenal hyperplasia (CAH), most commonly due to 21-hydroxylase deficiency. Less common causes include the hyperandrogenic-insulin resistant-acanthosis nigricans syndrome (HAIRAN). Hyperprolactinemia by increasing adrenal dehydroepiandrosterone sulphate (DHEA-S) production may cause hirsutism. Androgenic drugs are also an important cause of hirsutism. About 20% of the patients may present with idiopathic hirsutism (IH) with normal androgen levels and ovarian function. The cause of increased hair in these women is thought to be related to disorders in peripheral androgen activity. Onset of IH occurs shortly after puberty with slow progression. PCOS and IH account for 90% of the hirsutism in women. Hirsutism can also occur in some premenopausal women and continue for a few years after menopause. This is due to decrease in ovarian oestrogen secretion with continuous androgen production.
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This question is part of the following fields:
- Endocrinology
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Question 4
Incorrect
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Gonadotropin-releasing hormone (GnRH) stimulates the release of:
Your Answer: Growth hormone
Correct Answer: Luteinizing hormone
Explanation:Gonadotropin-releasing hormone (GnRH) is the hormone responsible for the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary gland.
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This question is part of the following fields:
- Endocrinology
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Question 5
Correct
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Where are ADH (vasopressin) and Oxytocin synthesised?
Your Answer: Hypothalamus
Explanation:ADH and vasopressin are synthesized in the supraoptic and periventricular nuclei of the hypothalamus, they are eventually transported to the posterior pituitary where they are stored to be released later.
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This question is part of the following fields:
- Endocrinology
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Question 6
Incorrect
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Placental production of hPL, hCG, Oestrogen and Progesterone are examples of which type of mechanism
Your Answer: Autocrine
Correct Answer: Endocrine
Explanation:Endocrine hormones are released from their site of origin and travel through the blood to act on other distant target organs. Autocrine hormones act within the same cell and exocrine glands secrete their products into ducts.
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This question is part of the following fields:
- Endocrinology
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Question 7
Incorrect
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Delayed puberty in girls is defined as?
Your Answer: Absence of pubic hair development in girls beyond 15
Correct Answer: Absence of breast development in girls beyond 13 years old
Explanation:Breast development occurs from the age of 9-13 at the onset of puberty. Delayed puberty is defined as the absence of breast development after the age of 13.
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This question is part of the following fields:
- Endocrinology
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Question 8
Incorrect
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All of the following are autosomal recessive conditions EXCEPT which one?
Your Answer: Cystic Fibrosis
Correct Answer: Osteogenesis Imperfecta
Explanation:Osteogenesis imperfect is an autosomal dominant condition. All the rest of the options are autosomal recessive conditions.
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This question is part of the following fields:
- Endocrinology
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Question 9
Incorrect
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In normal pregnancy, levels of all of the following hormones increases, EXCEPT:
Your Answer: Total thyroxine (T4)
Correct Answer: FSH
Explanation:Hormones that increase during pregnancy and their roles:
- Human Chorionic Gonadotropin (hCG): Peaks between the eighth to tenth weeks of gestation and supports the corpus luteum to maintain progesterone production.
- Progesterone: Initially produced by the corpus luteum and later by the placenta, it rises steadily throughout pregnancy, suppressing the maternal immune response to fetal antigens and preparing the endometrium for implantation.
- Estrogen: Produced by the placenta from fetal and maternal precursors, estrogen levels increase to promote uterine growth and blood flow.
- Human Placental Lactogen (hPL): Rises significantly during pregnancy, influencing maternal metabolism by increasing insulin resistance and promoting lipolysis.
- Relaxin: Increases early in pregnancy to relax the uterine muscles, inhibit contractions, and prepare the cervix and pelvis for childbirth.
- Prolactin: Levels increase to prepare the breasts for lactation.
- Corticotropin-Releasing Hormone (CRH): Increases towards the end of pregnancy and is involved in the timing of labor.
- Adrenocorticotropic Hormone (ACTH): Levels increase, contributing to elevated cortisol levels during pregnancy.
- Total Thyroxine (T4): Levels increase due to elevated thyroid-binding globulin (TBG) production stimulated by increased estrogen levels, meeting the increased metabolic demands of pregnancy.
- Parathyroid Hormone (PTH): Levels increase to regulate calcium metabolism, ensuring adequate calcium for fetal bone development.
- Cortisol: Levels increase due to higher production by the adrenal glands and increased binding to cortisol-binding globulin (CBG), supporting glucose metabolism, managing stress, and aiding fetal development, particularly lung maturation.
During pregnancy, some hormones either remain stable or do not increase significantly. These include:
- Follicle-Stimulating Hormone (FSH): Levels decrease due to the negative feedback from high levels of estrogen and progesterone.
- Luteinizing Hormone (LH): Levels also decrease due to negative feedback from elevated estrogen and progesterone.
- Growth Hormone (GH): Although a variant of growth hormone (hGH-V) is produced by the placenta and increases, the maternal pituitary GH levels may not significantly increase.
- Melatonin: Generally remains stable during pregnancy, though some studies suggest there may be slight fluctuations.
- Insulin: While insulin resistance increases due to hPL and other factors, the actual levels of insulin may not increase proportionally; instead, pancreatic beta-cell function adapts to meet the increased demand.
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This question is part of the following fields:
- Endocrinology
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Question 10
Incorrect
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Which of the following is the primary stimulator of uterine involution following child birth?
Your Answer: Prolactin
Correct Answer: Oxytocin
Explanation:Oxytocin stimulates the myoepithelial cells in the breast causing the milk production. It also helps augment contractions in labour and cause uterine involution after childbirth.
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This question is part of the following fields:
- Endocrinology
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Question 11
Incorrect
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Which major hormone of pregnancy is produced by the placenta from 16-hydroxydehydroepiandrosterone sulphate (16-OH DHEAS)?
Your Answer: Estrone
Correct Answer: Estriol
Explanation:The placenta produces Estriol from 16-OH DHEAS. Estriol is the major oestrogen (oestrogen) of pregnancy and the placenta is the primary site of production. Pregnenolone is synthesised by the placenta from cholesterol and this is converted to dehydroepiandrosterone (DHEA) in the fetal adrenal gland
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This question is part of the following fields:
- Endocrinology
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Question 12
Incorrect
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Which of the following drugs is associated with reduced milk production whilst breastfeeding?
Your Answer: Atenolol
Correct Answer: Cabergoline
Explanation:Domperidone and metoclopramide are D2 dopamine receptor antagonists. They are primarily used to promote gastric motility. They are also known as galactagogues and they promote the production of milk. Cabergoline and bromocriptine are prolactin inhibitors and they reduce milk production.
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This question is part of the following fields:
- Endocrinology
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Question 13
Incorrect
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Which of the following Oestrogens (Oestrogens) becomes the predominant circulating oestrogen during pregnancy?
Your Answer: Mestranol
Correct Answer: Estriol
Explanation:Oestradiol is the predominant form of oestrogen during the reproductive life of a female. The estrogenic potency of oestradiol is 12 times more than estrone and 80 times that of estriol.
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This question is part of the following fields:
- Endocrinology
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Question 14
Incorrect
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Which of the following causes an increase in Sex Hormone Binding Globulin (SHBG)?
Your Answer: Cushing's syndrome
Correct Answer: Liver cirrhosis
Explanation:Liver cirrhosis is known to lead to decreased levels of SHBG. Other causes of high SHBG are:
Oestrogens e.g. oral contraceptives
Pregnancy
Hyperthyroidism
Liver cirrhosis
Anorexia nervosa
Drugs e.g. anticonvulsants -
This question is part of the following fields:
- Endocrinology
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Question 15
Incorrect
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You review a 58 year old patient in clinic. She asks what the results of her recent DEXA scan are. You note her hip BMD hip T-score is -1.4. You note she has a history of olecranon fracture 4 years ago. What is her classification according to WHO criteria?
Your Answer: Severe Osteopenia
Correct Answer: Osteopenia
Explanation:Her T-score puts her in the osteopenic range. The presence of fragility fractures is more important in the osteoporotic patient. Olecranon fracture is not a typical fragility fracture.
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This question is part of the following fields:
- Endocrinology
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Question 16
Correct
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Raised FSH levels are found in all of the following conditions, EXCEPT:
Your Answer: Women on combined oral contraceptive pills
Explanation:Oestrogen- and progesterone-containing oral contraceptives inhibit LH, which suppresses the FSH and LH levels, preventing follicular development and ovulation. Combined pills suppress FSH and LH throughout the cycle, inhibit endometrial proliferation, and produce a scanty cervical mucus.
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This question is part of the following fields:
- Endocrinology
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Question 17
Incorrect
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All of the following organs are involved in oestrogen production except:
Your Answer: Testes
Correct Answer: Anterior pituitary
Explanation:Oestrogen can be produced by variety of organs including the corpus leuteum, placenta, adrenal glands and testes. However it is not produced by the anterior pituitary. The anterior pituitary produces LH and FSH which in turn causes oestrogen secretion.
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This question is part of the following fields:
- Endocrinology
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Question 18
Incorrect
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Oxytocin causes increased myometrial contraction via which of the following messenger pathways?
Your Answer:
Correct Answer: Activates phospholipase-C which produces IP3 which triggers intracellular Calcium ion release
Explanation:Oxytocin acts via the G protein receptors and the calcium-calmodulin complex. It activates phospholipase C which produces IP3 to further trigger the calcium-calmodulin complex increasing intracellular Ca ion release.
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This question is part of the following fields:
- Endocrinology
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Question 19
Incorrect
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Which of the following hormones are required for alveolar morphogenesis during pregnancy?
Your Answer:
Correct Answer: Progesterone, Prolactin and hPL
Explanation:The changes seen in breast tissue with the menstrual cycle are accentuated during pregnancy. Deposition of fat around glandular tissue occurs, and the number of glandular ducts is increased by oestrogen, while progesterone and human placental lactogen (hPL) increase the number of gland alveoli. Prolactin is essential for the stimulation of milk secretion and during pregnancy prepares the alveoli for milk production. Although prolactin concentration increases throughout pregnancy, it does not then result in lactation since it is antagonized at an alveolar receptor level by oestrogen.
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This question is part of the following fields:
- Endocrinology
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Question 20
Incorrect
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Prognathism and macroglossia are features of which of the following?
Your Answer:
Correct Answer: Acromegaly
Explanation:These are features of excess growth hormone i.e. Acromegaly. Down’s and Cri du chat typically cause Micrognathia (small jaw)
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This question is part of the following fields:
- Endocrinology
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