Hormonal problems

1. Weight reduction of 5–10% can induce an improvement in hirsutism by

A. 5-20% within 6 months of weight loss
B. 20-40% within 6 months of weight loss
C. 40–55% within 6 months of weight loss
D. 60-75% within 6 months of weight loss

2. All are true about cyproterone acetate, except

A. Cyproterone acetate is a strong progestogen, a progestational antiandrogen.
B. Cyproterone acetate can be expected to lower the Ferriman–Gallwey score by 15–40% within 6 months; again, maximum effects occur between 6–12 months
C. Reported adverse effects of cyproterone acetate are weight gain, depression, fatigue and sexual dysfunction.
D. It can also, rarely, alter liver function; liver function tests should be performed prior to commencing treatment and after 6 months.
E. It is thought to have a thromboembolic risk similar or greater than second generation COCPs.
F. Dianette is licensed for use in the treatment of acne, hirsutism, and a contraceptive

3. Precocious puberty – all are true except

A. Is defined as onset of puberty after 10 years
B. Is associated with encephalitis C
C. Is associated with McCune–Albright syndrome
D. Has been associated with exogenous administration of oestrogens
E. Is associated with Cushing disease

4. A 30-year-old woman presents to GP with increase in growth of hair on the chin, chest and back which she noticed for the last 3 months. She also gives history of deepening of voice, thinning of the scalp hair and frontal hair loss. Vulval examination reveals clitoromegaly. Which one of the following tests differentiates androgen-producing adrenal tumour from ovarian tumour?

A. Increased free serum testosterone levels
B. Increased serum dehydroepiandrosterone (DHEA) levels
C. Decreased serum sex hormone binding globulin (SHBG) levels
D. Increased serum 17-hydroxyprogesterone levels
E. Increased serum dehydroepiandrosterone sulphate (DHEAS) levels

5. What is the most common cause of central precocious puberty (CPP) in girls?

A. Idiopathic
B. Craniopharyngioma
C. Encephalitis
D. Hypothalamic hamartoma
E. McCune–Albright syndrome

6. A ﬁve-year-old girl presents with a history of accelerated growth, thelarche, pubarche and menarche. Examination revealed light to dark brown spots, predominantly noticeable on one side of the body without crossing the midline. What is your differential diagnosis?

A. Central precocious puberty
B. Cushing syndrome
C. Exogenous oestrogen exposure
D. Iatrogenic excessive use of cortisol treatment
E. McCune–Albright syndrome

7. A 7 year old girl was brought to the GP with complaints of pubic and axillary hair growth. She is otherwise asymptomatic with no history of vaginal bleeding. On examination, pubic hair was sparse. Her breasts had not developed beyond a small bud. Physical examination did not reveal any abnormality with a normal linear growth pattern. What is the probable diagnosis

A. Cushing syndrome
B. Central precocious puberty
C. Pseudopuberty
D. Physiological premature adrenarche
E. Congenital adrenal hyperplasia

8. A 6+ years old child has been brought to the GP with advanced growth spurt with thelarche and adrenarche of Tanner classiﬁcation stage 4 and with regular uterine bleeding for the last ﬁve months. Her bone age report showed she is two years more advanced than her chronological age. A pelvic ultrasound showed a pear-shaped uterus and with a 5 mm endometrial thickening and normal ovaries. She was otherwise asymptomatic with no signs of any significant medical illnesses. What is the probable diagnosis?

A. McCune–Albright syndrome
B. Central precocious puberty (CPP)
C. Estrogen-secreting ovarian tumours
D. Chronic Hypothyroidism
E. Pseudopuberty

9. A 7 old girl is brought to the GP clinic because she has been having regular monthly bleeds for the last four months. You suspect gonadotropin-dependent precocious puberty. What is the gold standard to conﬁrm your diagnosis?

A. Accelerated growth velocity of more than 6 cm/year
B. Advanced bone age
C. A pear-shaped uterine length >35 mm with an endometrial line
D. FSH response after GnRH stimulation test
E. Luteinizing hormone (LH) peak after gonadotropin-releasing hormone (GnRH) stimulation

10. A mother brings her ﬁve-year-old girl to the clinic. She noticed early excess pubic and body hair with clitoromegaly. She also noticed that her girl is taller than her peers. You suspect a mild non- classical form of CAH. What is the most sensitive investigation to diagnose mild forms of CAH?

A. Adrenocorticotrophic hormone (ACTH)-stimulation test
B. 17-hydroxy progesterone (17-OHPG)
C. Free Testosterone
D. Androstenedione
E. DHEAS

11. Prolactin is increased in all the following situations, except

A. Exercise
B. Physiological Stress
C. Repeated nipple stimulation
D. Acute renal failure
E. Pregnancy

12. Regarding Bromocriptine, which of the statements is false:

A. It is a dopamine antagonist
B. It has a short-half life
C. It restores ovulation in 80–90% of women and to reduce the size of prolactinomas in 70% of cases
D. It has a high prevalence of adverse gastrointestinal effects (nausea 30%, vomiting 20%) and postural hypotension (25%)
E. It has an established safety profile in pregnancy