Name: Test (1): Gynecology endocrinology 1 ( 100 Marks)

I. Choose the most correct single answer: (1 Mark each)

1.The last step in estradiol synthesis requires the following enzyme:
a. 5α reductase
b. 21 hydroxylase
c. aromatase
d. 11 β hydroxylase
e. 17 (OH) dehydrogenase

2.The following androgen is produced by the ovary:

a. testosterone
b. androstendione
c. dihydrotestosterone
d. dehydroepiandrosterone sulfate
e. tetrahydrotestosterone

3.All the following are anterior pituitary hormones EXCEPT:

a. prolactin
b. growth hormone
c. thyrotropin releasing hormone
d. follicle-stimulating hormone
e. luteinizing hormone

4. A 27 years old female presents by bilateral nipple discharge, no breast masses, she has
history of Schizophrenia and mildly elevated prolactin level. The most likely cause of
prolactinemia is:
a. renal disease
b. medication side effect
c. prolactin producing pituitary adenoma
d. breast tumor
e. hypothalamic disease

5. Steroidogenesis in the corpus luteum is mainly under the control of:

a. LH
b. FSH
c. Activin
d. Inhibin
e. PAPP-A

6. A 32years old woman presented with 2ry amenorrhea for 3months. Her pregnancy test
was negative. She noticed vaginal dryness and episodes of sweating by night, her FSH: 45
IU/L, her LH: 30 IU/L, her PRL: 25ng/ml. Most probable cause of amenorrhea is:
a. hyperprolactenemia
b. microadenoma
c. POI (premature ovarian insufficiency)
d. PCO (polycystic ovarian disease)
e. pregnancy

7. Which of the following meets the definition of amenorrhea:

a. 12years old girl with no breast development
b. 14years old girl with well developed breast
c. 16years old girl with well developed breast
d. 18years old with well developed breast and cessation of menses for 2 cycles
e. Any of the above

8. Inhibin inhibits the synthesis and secretion of the following hormone:

a. LH
b. FSH
c. CRH
d. GnRH
e. TRH

9.An 18years old female presented with 1ry amenorrhea. She had well developed breast,
sparse pubic and axillary hairs, and blind ending vagina. Most likely diagnosis:
a. Mullerian agenesis
b. POI
c. AIS
d. Congenital adrenal hyperplasia (CAH)
e. PCO

10. A 14years old girl with 1ry amenorrhea, had non developed pubic and axillary hair, and
no breast development. Her FSH: 34 IU/L, LH: 30 IU/L. She is most likely:
a. Kallman syndrome
b. AIS
c. MRKH Syndrome
d. Turner syndrome
e. Kleinfelter syndrome

11. During the reproductive life, GnRH is released in a pulsatile manner from:
a. corpus luteum
b. ovarian follicle
c. pituitary gonadotropes
d. arcuate nucleus of the hypothalamus
e. basal ganglia

12. In a postmenopausal woman, the cut-off value for the normal endometrial thickness by
TVS is:
a. 1mm
b. 4 mm
c. 5mm
d. 7mm
e. 10mm

13. Most common medical complaint of women during menopausal transition is:
a. depression
b. painful intercourse
c. urinary incontinence
d. vasomotor flashes
e. vaginal dryness

14. HRT is contraindicated in all the following EXCEPT:

a. vasomotor flashes
b. active liver disease
c. known or suspected breast cancer
d. abnormal genital bleeding of unknown origin
e. history of DVT

15. An 18years old presents with 1ry amenorrhea. She reports vaginal bleeding following a
hormone withdrawal test. The following conditions is most likely EXCLUDED:
a. Mullerian agenesis
b. hypothalamic amenorrhea
c. POI
d. PCO
e. Turner syndrome

16. The luteal phase of the menstrual cycle is associated with:

a. High luteinizing hormone level
b. High progesterone levels
c. High prolactin level
d. Excessive watery cervical secretion
e. Proliferative changes in the endometrium.

17. Ovulation occurs:

a. Immediately after LH surge.
b. 6-8 hours after LH surge.
c. After Prolactin surge.
d. After follicles ripened in the ovary.
e. 36 hours after LH surge.

18. A 16-year-old girl presents with primary amenorrhea. The girl is short with non-
developed 2ry sexual characters. Investigation needed for her diagnosis is:
a. Prolactin level
b. US pelvis
c. MRI pelvis
d. Karyotyping
e. FSH/LH level

19. All the following are likely diagnoses in a 16-year-old woman with primary
amenorrhoea but normal 2ry sexual characters EXCEPT:
a. Androgen insensitivity syndrome
b. Uterine agenesis
c. Kallman’s syndrome
d. Vaginal atresia
e. Imperforate hymen

20. The following are characteristics of Turner’s syndrome EXCEPT:

a. Secondary amenorrhea
b. Hypergonadotrophic hypogonadism
c. Short stature
d. Streak ovaries
e. Wide carrying angle
21. A 35-year-old woman with regular periods until 3 months previously suddenly develops
amenorrhea. FSH levels of 26, with reduced estradiol and normal prolactin levels. Her BMI
is 20 and she is athletic. There is similar history of amenorrhea in her sister who is 38 years
of age. What is the most likely diagnosis?
a. Hyperprolactinaemia
b. Normogonadotrophic hypogonadism
c. Hypogonadotrophic hypogonadism
d. Pregnancy
e. Premature ovarian failure

22. A 68yrs old woman presents with vaginal dryness and dyspareunia. she is not taking any
medications or HRT. TVS is normal. PV shows loss of rugae. most appropriate next step:
a. Outpatient hysteroscopy to assess the endometrium
b. Transdermal continuous combined HRT
c. Water based vaginal lubricants
d. Estrogen-containing vaginal pessaries
e. Flexible cystourethroscopy

23. The effect of which hormone causes arborization on Fern test:

a. Estrone
b. Estradiol
c. Estriol
d. Progesterone
e. Testosterone

24. A patient with high FSH and LH levels and low AMH probably suffers from:
a. PCOS
b. Endometriosis
c. Premature ovarian failure
d. Hypogonadotropic hypogonadism
e. Sheehan Syndrome

25. An 18y old with 1ry amenorrhea is complaining of a Rt inguinal mass. O/E: a normal
breast development, while axillary and pubic hair are sparse. The vulva appears normal but
the vagina ends in a blind pouch. The uterus is not palpable by PR. The Rt inguinal mass is
most probably:
a. Lymph node
b. Gonad
c. Endometrioma
d. A metastatic lesion
e. Inguinal hernia
26. In the previous pt, the following tumor is most likely to occur in the Rt inguinal mass:
a. Endodermal sinus tumour
b. Dysgerminoma
c. Gonadoblastoma
d. Choriocarcinoma
e. Sertoli-Leydig cell tumour

27. The hormone best used as a measurement of ovarian reserve is:

a. FSH
b. Estradiol
c. LH
d. inhibin
e. AMH

28. Several follicles begin to grow in a menstrual cycle. Their ultimate fate is:
a. Ovulation
b. Dominance
c. Cyst formation
d. Atresia
e. Regression

29. Which structure produces gonadotropins?

a. Hypothalamus
b. Anterior pituitary
c. Posterior pituitary
d. Ovaries
e. Endometrium

30. One of the major long-term implications of precocious puberty is:

a. Epiphyseal closure.
b. Hair growth.
c. Genital development.
d. Breast tissue development.
e. Start of menstruation.

31. Regarding osteoporosis in postmenopausal females:

a. Obesity is a predisposing factor.
b. Smoking has no role.
c. Calcium therapy is curative.
d. Long term treatment by heparin therapy increases the risk.
e. Axial bone fractures are very unlikely.

32. A 49-year-old P4+4 presents with severe hot flushes for 8 months following cessation of
menstruation. Appropriate management for symptoms relief include:
a. Reassurance and multivitamins.
b. Tranquilizers.
c. Ovarian biopsy should be done first.
d. Administration of bromocryptine.
e. Estrogen containing replacement therapy.

33. A 29-year-old patient presented with 2ry amenorrhea following severe postpartum
hemorrhage and failure of lactation. The most probable diagnosis/ investigation:
a. Asherman’s syndrome, for hysteroscopy.
b. Sheehan’s syndrome, for hormonal assay.
c. Sheehan’s syndrome, for pituitary imaging.
d. Asherman’s syndrome, hysterosalpingography.
e. Physiological amenorrhea, no investigations are required.

34. 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

35. All the following are causes of primary amenorrhea EXCEPT:

a. Turner syndrome.
b. Imperforate hymen
c. Asherman’s syndrome.
d. Mayer Rokitansky Kuster Hauser syndrome.
e. Androgen insensitivity syndrome.

36. Cryptomenorrhea is caused by one of the following pathologies:

a. Complete Mullerian agenesis.
b. Androgen insensitivity syndrome.
c. Longitudinal uterine and vaginal septum.
d. Imperforate hymen.
e. Turner syndrome.

37. Galactorrhea may be caused by which of the following:

a. Malignant breast mass.
b. Hormone producing ovarian tumors.
c. Adrenal insufficiency.
d. Hyperthyroidism.
e. Drugs as tricyclic antidepressants.

38. A 30 years old nullipara presented by 2ry amenorrhea for 6 month. Pelvic ultrasound
was normal, -ve pregnancy test and F.S.H was 50 mIU/ml. and L.H was 30 mIU/ml. Which
of the following is the most probable cause?
a. Polycystic ovarian disease.
b. Hypothalamic amenorrhea.
c. Thyroid disorders should be excluded 1st.
d. Premature ovarian failure.
e. Sheehan syndrome.

39. All of the following statements are true for physiological menopause EXCEPT:
a. Some of the symptoms experienced include hot flashes, headaches, and insomnia.
b. Onset of menopause is usually between the early forties and mid-fifties.
c. Depression is a significant problem in all menopausal females.
d. Vasomotor symptoms are caused by estrogen deprivation.
e. Osteoporosis can be a potentially fatal health hazard.

40. A 58-year-old G2P2 patient presents with complaints of severe vulvar pruritus. She is 10
years postmenopausal. Her examination is consistent with atrophic vulvitis. Most effective
treatment for her condition:
a. Antihistamines.
b. Hydrocortisone.
c. Alcohol injections.
d. Tranquilizers.
e. Topical estrogen therapy.
41. Effects of progesterone production in menstrual cycle include:
a. Increases amount of cervical secretions.
b. Facilitates upward transfer of sperms at day of ovulation.
c. Renders the endometrium suitable for implantation.
d. Responsible for colicky pains at onset of menstrual flow.
e. Exerts +ve feedback on FSH and LH in mid-luteal period.

42. Hormonal changes in menopause is characterized by one of the following:

a. High FSH and LH levels.
b. High FSH and low LH levels.
c. Low FSH and high LH levels.
d. Low FSH and LH levels.
e. High FSH and E2 (estradiol) levels.

43. Congenital absence of the vagina is most commonly associated with:

a. Absent secondary sexual characteristics.
b. Absent uterus.
c. Streak gonads.
d. Clitoromegaly.
e. Imperforate hymen.

44. Which of the following is not controlled by hypothalamic releasing hormones?

a. Prolactin.
b. FSH and LH.
c. TSH.
d. ACTH.
e. Growth hormone.

45. Regarding the luteal phase of the menstrual cycle:

a. It starts after end of the menstrual flow till ovulation.
b. It is of variable length.
c. Dominant pituitary hormone is FSH.
d. Proliferative endometrium is characteristic.
e. Progesterone level reaches a peak at mid luteal phase.

46. Under the effect of estrogen, cervical mucus shows one of the following characteristics:
a. Increased amount with increased viscosity.
b. Increased amount with decreased viscosity.
c. Decreased amount with increased viscosity.
d. Decreased amount with decreased viscosity.
e. Increased leucocytes and low protein content.

47. A 29-year-old patient presents with 2ry amenorrhea following severe postpartum
hemorrhage and failure of lactation. What is the expected hormone profile?
a. High FSH and LH levels.
b. High FSH and low LH levels.
c. Low FSH and high LH levels.
d. Low FSH and LH levels.
e. High T3 and T4 with low TSH.
48. A 35-year-old woman complains of amenorrhea for 10 months following surgical
evacuation for a 10 weeks missed abortion. She received oral contraceptive pills for 3 cycles
but no withdrawal bleeding occurred. What is the most probable diagnosis?
a. Retained products of conception.
b. Psychological.
c. Polycystic ovarian disease.
d. Hyperprolactinemia.
e. Intrauterine synechia.
49. What is the recommended investigation that confirms diagnosis in the previous case?
a. Ultrasound.
b. Dilatation and curettage.
c. Hormone profile.
d. Hysteroscopy.
e. Laparoscopy.

50. Cryptomenorrhea may be caused by one of the following pathologies:

a. Streak gonads.
b. PCO.
c. Bicornuate uterus.
d. Cervical aplasia.
e. Longitudinal vaginal septum.

51. Galactorrhea may be caused by which of the following drugs:

a. Magnesium sulphate.
b. β blockers..
c. Metformin.
d. Thyroxin.
e. Tricyclic antidepressants.

52. A newly married 21-year-old woman complains of menstrual irregularities and

galactorrhea. Pelvic US is normal and serum prolactin level is 500 ng/ml. How can you
proceed?
a. Just follow up.
b. Thyroid function tests.
c. Soft tissue mammography.
d. Dilatation and curettage.
e. CT brain.

53. A 19-year-old woman has primary amenorrhea, Tanner stage IV breast development,
and a pelvic kidney. The most likely diagnosis is:
a. Müllerian agenesis.
b. Androgen insensitivity syndrome.
c. Gonadal dysgenesis.
d. Polycystic ovarian syndrome.
e. Kallmann syndrome

Questions 54- 55: A 32yrs old G1P1 woman presents with an 8 months amenorrhea. A
pregnancy test is negative. TSH, PRL are normal. FSH is above 40IU/L.
54. Most likely complication for this patient:
a. She is at significant risk for endometrial cancer.
b. She is at significant risk for ovarian cancer.
c. She is at significant risk for osteoporosis.
d. She is at significant risk of breast cancer.
e. She is at significant risk for multiple gestations.
55. In this patient diagnostic work up, the most likely to be noted is:
a. Obliterated uterine cavity on saline infusion sonography.
b. No bleeding with progestin challenge test.
c. Normal estradiol level.
d. Abnormal HSG.
e. Abnormal MRI brain.

Questions 56- 57: A 68 years old healthy woman presents for advice regarding the risk of
developing osteoporosis. Her height is 155 cm, her weight is 45 kg with regular treadmill
walks. She was menopausal at 42yrs old. She doesn’t take HRT or medications.
56. What is the best method to screen her for osteoporosis:
a. Peripheral measurement for her heel with photon absorptiometry.
b. Standard X-Ray for her spine.
c. Dual-Energy X-ray Absorptiometry (DEXA).
d. Measure biochemical markers of bone remodeling.
e. CT scan to measure the bone density.
57. If the investigation needed, demonstrated osteoporosis, next step is:
a. Begin a biphosphonate.
b. Encourage her to engage in weight bearing exercise and take calcium.
c. Repeat the study in 1 year.
d. Begin raloxifene therapy.
e. Recommend she begins combined HRT.

Questions 58-59: A 6-year-old girl is brought in to you by her mother as she has developed
breasts and few pubic hairs.
58. Her hormonal profile shows follicular levels of FSH, LH. These findings are with:
a. Theca cell tumor.
b. Iatrogenic sexual precocious puberty.
c. Premature thelarche.
d. Granulosa cell tumors.
e. Central precocious puberty.
59. What is the most suitable treatment?
a. Exogenous gonadotrophins.
b. Ethinyl estradiol.
c. GnRH agonists.
d. Clomiphene citrate.
e. No treatment; just reassurance.

Questions 60- 61: A 26 years old woman develops severe postpartum hemorrhage. 6 weeks
later, she presents with fatigue and inability to breast feed.
60. All the following hormones could be decreased EXCEPT:
a. Prolactin.
b. TSH.
c. LH.
d. Aldosterone.
e. FSH.
61. The following may occur as a result of Sheehan syndrome EXCEPT:
a. Pallor.
b. Galactorrhea.
c. Bradycardia.
d. Amenorrhea.
e. Asthenia.

Questions 62-63: An 18-year-old patient presents with primary amenorrhea. On

examination, patient has an average stature and body built with well-developed 2ry sex
characters. Investigations show normal serum FSH and E2.
62. Which of the following is the most likely diagnosis:
a. Androgen insensitivity syndrome.
b. Gonadal dysgenesis.
c. Physiological delay.
d. Mullerian agenesis.
e. Transverse vaginal septum.
63. Which of the following investigation is most valuable in this case?
a. Karyotyping.
b. Pelvic ultrasound.
c. Free testosterone essay.
d. CT brain.
e. Fundus examination.

Questions 64- 68: A 16-year-old girl attends the clinic complaining of 1ry amenorrhea. On
examination, she has average weight and height with absence of 2ry sexual characters. She
claims that she has anosmia.
64. What is your differential diagnosis?
a. Kallmann syndrome.
b. Sheehan syndrome.
c. Turner syndrome.
d. Covid 19 infection.
e. CNS tumor.
65. Confirmatory investigation needed to confirm your diagnosis include:
a. Pelvic ultrasound.
b. CT brain.
c. Karyotyping.
d. Hormone profile.
e. Nasopharyngeal swab.
66. Initial management for this case will be:
a. GnRH agonists.
b. HMG/HCG.
c. Clomiphene citrate.
d. Estrogen/progesterone replacement therapy.
e. Growth hormone.
67. Complications for this case include:
a. Associated cardiac anomalies.
b. Associated bone deformities.
c. Higher risk of subsequent osteoporosis.
d. Galactorrhea.
e. Masculinization with hirsutism and deepening of voice.
68. How can you counsel her about future fertility?
a. Uterus transplantation may be considered later.
b. She can never get pregnant as she has no ovaries.
c. Clomiphene citrate could be effective.
d. HMG/HCG will be the 1st line of treatment.
e. IVF-ICSI is a must to achieve pregnancy.

After studying the normal physiology of the menstrual cycle. To each of the hormones
mentioned in questions 69- 77, choose from the list below the best day to measure it to obtain
interpretive data. Each option can be used once, more than once or not at all.

a. Day 2.
b. Day 7.
c. Day 14.
d. Day 21.
e. Any day.
f. None of the above.

69. AMH.
70. Serum FSH.
71. Serum LH.
72. GnRH.
73. Progesterone.
74. Thyroid functions.
75. Prolactin.
76. ACTH.
77. TRH.

Questions 78- 83 are preceded by a list of lettered options. In an amenorrheic patient, choose
the most probable diagnosis. Each letter may be used once, more than once, or not at all:
a. Turner syndrome
b. Ashermann syndrome
c. Kallman syndrome
d. Sheehan syndrome
e. Rokitansky syndrome
f. Empty sella syndrome

78. A 17 years old girl with 1ry amenorrhea, she has well developed secondary sexual
characters, and normal BMI and stature. There is negative withdrawal on hormonal
injection.

79. A 14 years old girl with primary amenorrhea, has non-developed 2ry sexual characters,
her BMI is high, and she is of short stature. She is following up with pediatric cardiologist
due to some cardiac problems.

80. A 17years old girl with primary amenorrhea and absent secondary sexual characters.
Her karyotyping shows 45XO.

81. A 32 years old woman presents with secondary amenorrhea of 6 months duration
following her last abortion and curettage. Her medical history is irrelevant. She has no
other complaint.
82. A 24years old woman presents with failure of lactation after her last delivery, which was
complicated by severe postpartum hemorrhage that required blood transfusion, this was 2
months ago. She also still feels easy fatiguability and asthenia.

83. An 18 years old girl presents to ENT clinic with inability to differentiate between
different odors. She also reported that she still hasn’t got her menses. On examination,
there is absent secondary sexual characters.

For each of the statements below, mark True (T) or False (F):
84. FSH stimulates the granulose cells to produce estrogen.
85. Follicles over 20mm need to be drained with ultrasound guidance.
86. Estrogen has a positive feedback on the pituitary to release FSH.
87. The vaginal maturation index in the luteal phase is: 0/ 70/ 30.
88. The release of an oocyte from the follicle requires a sperm to lyse the follicle membrane
and results in ovulation.
89. Ovulation can be confirmed by measurement of progesterone on day 14.
90. The predominant hormone in the luteal phase is progesterone.
91. The luteal phase varies in duration depending on the time taken for the corpus luteum
to degenerate.
92. The first sign of puberty is growth spurt.
93. Low levels of estrogen and progesterone are the best indicators of the perimenopause.
94. Individuals with AIS, should receive HMG replacement to get their menses.
95. Inhibin levels decrease in the menopausal women.
96. Women with Sheehan syndrome can get pregnant by receiving induction with HMG.
97. The most common cause of precocious puberty is constitutional.
98. 1ry amenorrhea is defined as failure of menstruation by the age of 14 with absent 2ry
sex characters.
99. The most common cause of isosexual precocious puberty is constitutional.
100. 1ry amenorrhea is defined as absent menstruation by the age of 14 regardless of 2ry
sex characters.

Best of Luck☺