mock questions for neet pg , usmle , plab and fmge (mci screening exam) on puberty

Q:1 Bilateral cryptorchidism usually results in oligospermia and infertility. Orchiopexy for cryptorchidism is done at the age of:

A: 1 to 2 yearsB: 5 to 6 yearsC: PubertyD: Neonatal period

Correct Ans:A

Explanation

Cryptorchidism is defined as testes that have not fully descended into the scrotum and,unlike retractile testes cannot be manipulated into the scrotum with gentle pressure.

Surgical repair (orchiopexy) is done at 612 months of age and has a success rate(99%). Ref: Blueprints Pediatrics By Bradley S. Marino, Katie Katie Snead Fine, 2009, Page221.

Want To Solve More Such Question on Mobile without connecting to internetDownload Our FREE Subjectwise Mobile Apps at www.medicoapps.org

Q:2What is the ratio of length of cervix and body of the uterus before puberty?

A: 2:1B: 1:2C: 1:3D: 1:4

Correct Ans:A

Explanation

Before puberty the ratio of length of cervix to corpus is 2:1At puberty the ratio of length of cervix to corpus is 1:2During reproductive years the ratio may be 1:3 or 1:4

Ref: Shaw’s Textbook of Gynecology, Edition 21, Page 7


Q:3In some children, precocious puberty can be part of a syndrome that is alsocharacterized by polyostotic fibrous dysplasia and caféaulait skin pigmentation.Which of the following is the MOST likely diagnosis in these individuals?

A: McCuneAlbright syndromeB: CREST syndromeC: CriglerNajjar syndromeD: Cushing's syndrome

Correct Ans:A

Explanation

McCuneAlbright syndrome is a rare syndrome characterized by fibrous dysplasia (atype of bony defect), caféaulait skin pigmentation (also seen in neurofibromatosis),and autonomous endocrine hyperfunction. The endocrine abnormalities mostcommonly take the form of gonadotropinindependent precocious puberty, but may alsoinclude hyperthyroidism, hypercortisolism, and pituitary gigantism. These patients arealso vulnerable to chronic liver disease and sudden death (possibly related to cardiacarrhythmias).

CREST syndrome is a variant of scleroderma with calcinosis, esophageal motilityproblems, telangiectasias, Raynaud's phenomenon, and sclerodactyly.CriglerNajjar syndrome is a hereditary defect in bilirubin metabolism.Cushing's syndrome refers to the physical problems seen as a result ofhypercortisolism.

Note:The caféaulait spots in children with MAS are large melanotic macules with irregularoutline, described as "coast of Maine".

Ref: Muram D. (2007). Chapter 34. Pediatric & Adolescent Gynecology. In A.H.DeCherney, L. Nathan (Eds), CURRENT Diagnosis & Treatment Obstetrics & Gynecology,10e.


Q:4An 8 year old girl is brought to the outpatient department for having early periods.Assertion: Precocious puberty can be heterosexual. Reason: It is due to excessproduction of progesterone.

A: Both Assertion and Reason are true, and Reason is the correct explanation forAssertion

B: Both Assertion and Reason are true, and Reason is not the correct explanationfor AssertionC: Assertion is true, but Reason is falseD: Assertion is false, but Reason is true

Correct Ans:C

ExplanationPrecocious puberty is heterosexual due to excess production of androgen, whereasisosexual due to excess production of estrogen. Ref: Textbook of Gynecology byD.C.Dutta, 4th Edition, Page 48.


Q:5 According to Tanner stages of development, which is the first sign of puberty infemales?

A: PubarcheB: ThelarcheC: MenarcheD: Increase in height

Correct Ans:B

Explanation

GnRH stimulates secretion of LH and FSH which causes the ovary to produce estrogens.Subsequently changes of puberty occur including breast development (thelarche),development of pubic and axillary hair (pubarche), the growth spurt (peak heightvelocity), and onset of menstruation (menarche).

Thelarche (breast development) is the first sign of puberty (Tanner stage B2). Itusually begins between 8 and 10 years of age and is associated with increasedestrogen production.

Pubarche (development of pubic and axillary hair) is the second stage in maturationand typically occurs between 11 and 12 years of age. Axillary hair usually appears afterthe growth of pubic hair is complete.

Menarche (onset of menstruation) usually occurs 23 years after thelarche at anaverage age of 1113 years. Initial cycles are often anovulatory and irregular.

Ref: Blueprints Obstetrics & Gynecology By Tamara L. Callahan, Aaron B Caughey,Aaron B Caughey, M.D., 2008, Page 212 ; Obstetrics and Gynaecology at a Glance ByErrol R. Norwitz, John O. Schorge, 2010, Page 49 ; Nelson Textbook of Paediatrics 17thedition page 1882


Q:6Which of the following is not seen in congenital hypothyroidism?

A: Delayed bone ageB: Delayed pubertyC: Short metacarpalsD: Large anterior fontanelle

Correct Ans:C

Explanation

Short metacarpals are seen in Turner’s syndrome. Infants withcongenital hypothyroidism are usually born at term or after term.

Symptoms and signs include the following:

Decreased activityCoarse facial featuresMacroglossiaUmbilical herniaMottled, cool, and dry skinDevelopmental delayLarge anterior fontanellePoor feeding and weight gainSmall stature or poor growthJaundicePallorMyxedemaDecreased stooling or constipationHypotoniaHoarse cryGoiter

Often, they are described as "good babies" because they rarelycry and sleep most of the time. A small but significant number(37%) of infants with congenital hypothyroidism have otherbirth defects, mainly atrial and ventricular septal defects. Anemiamay occur, due to decreased oxygen carrying requirement.


Q:7

Which of the following statement regarding precocious puberty is true?

A: Mental retardation is presentB: Absent reproductive dysfunctionC: Sexual maturity attained earlyD: Enlarged body proportions

Correct Ans:C

Explanation

Precocious puberty refers to the onset of secondary sexual characteristics below the age limit set for normal onset of puberty, i.e onset before the age of 8 years in girls and 9 years in boys.


Q:8A neurosurgeon saw a child with precocious puberty and uncontrollable laughing.He suggested the parent of child to get a MRI done to evaluate for the possibilityof?

A: CraniopharyngiomaB: Hypothalamic HamartomaC: PheochromocytomaD: Pituitary adenoma

Correct Ans:B

Explanation

Hypothalamic hamartomas and gangliocytoma may arise from astrocytes,oligodendrocytes, and neurons with varying degrees of differentiation. These tumorsmay overexpress hypothalamic neuropeptides, including GnRH, GHRH, and CRH. WithGnRHproducing tumors, children present with precocious puberty, psychomotor delay,and laughingassociated seizures. Medical treatment of GnRHproducing hamartomaswith longacting GnRH analogues effectively suppresses gonadotropin secretion andcontrols premature pubertal development.

Ref:Melmed S., Jameson J.L. (2012). Chapter 339. Disorders of the Anterior Pituitaryand Hypothalamus. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J.Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.


Q:9Which of the following condition is associated with precocious puberty?

A: HyperthyroidismB: Addison's diseaseC: McCune Albright syndromeD: Neuroblastoma

Correct Ans:C

ExplanationMc Cune Albright syndrome clinically manifests as a triad of irregular café au lait spots,fibrous dysplasia of long bones with cysts, and precocious puberty. Endocrineabnormalities associated with it are hyperthyroidism, adrenal nodules with Cushing’ssyndrome, acromegaly, hyperprolactinemia, hyperparathyroidism, hypophosphatemichyperphosphaturic rickets.

Central precocious puberty: In this precocious puberty is caused by prematureactivation of hypothalamic pituitary axis and is gonadotropic dependent. Incomplete precocious puberty: It is not gonadotropin dependent. Isosexual precocity: In this feminization occur in girls and virilization occur inboys.Contrasexual precocity: In this feminization occur in boys and virilization occur ingirls.

In all forms of sexual precocity, there is an increase in growth velocity, somaticdevelopment, and skeletal maturation.

Ref: Styne D. (2011). Chapter 15. Puberty. In D.G. Gardner, D. Shoback(Eds),Greenspan’s Basic & Clinical Endocrinology, 9e.


Q:10 The first sign of puberty in girls is:

A: Breast buddingB: Growth spurt (Peak height velocity)C: MenarcheD: Pubic and axillary hair growth

Correct Ans:A

Explanation

In girls, Thelarche (development of breast tissue) is the first sign of development ofpuberty. The embryological development of breasts starts in the sixth embryonic week.The thelarche usually starts at a mean age between 89 years.

Ref: Principles and Practice of Endocrinology and Metabolism By Kenneth L. Becker,Pages 88590; Fundamentals of Pediatric Surgery By Peter Mattei, Pages 829303;Recent Advances in Adolescent Health By Roza Olyai, Pages 1516


Q:11 All are true about familial male limited precocious puberty, EXCEPT:

A: It is also called TestotoxicosisB: Autosomal dominant conditionC: Testosterone and LH levels are elevatedD: Flutamide can be used for treatment

Correct Ans:C

Explanation

Familial male limited precocious puberty is also called testotoxicosis.

FACTS :

It is an autosomal dominant disorderIt presents as premature androgenization of boys Testosterone is elevated, LH is suppressed in the condition

Treatment options :

1. Ketoconazole Inhibits testosterone synthesis.

2. Flutamide Used as an androgen receptor antagonist.

3. Anastrazole Is a useful aromatase inhibitor.

Ref: Harrison, Edition 18, Page 3015


Q:12What is the approximate weight of thymus gland at puberty?

A: 15 gmsB: 35 gmsC: 25 gmsD: <15 gms

Correct Ans:B

Explanation

The thymus is largest and more active during the neonatal and preadolescent periods.By the early teens, the thymus begins to atrophy and thymic stroma is replaced byadipose tissue. Nevertheless, residual T lymphopoiesis continues throughout adult life.The thyroid reaches maximum weight ( 2037 grams) by the time of puberty.

Age Mass Birth about 15 gms Puberty About 35 gms Twenty five years 25 gms Sixty years < 15 gms Seventy years as low as 5 gms

Ref: Guyton and Hall 11/e, age 441 ; Gray’s anatomy 39/e, Page 962


Q:13 Males and females show difference in the age of onset of puberty. The differencein the age of onset of puberty amongst males may be explained by:

A: Increased Activin A levelsB: Decreased Follistatin levelsC: Increased Inhibin levelsD: Easily releasable FSH pool

Correct Ans:C

Explanation

The onset of puberty is delayed in males when compared to females. As Inhibin levels suppresses FSH secretions thereby an increase in its production delays the onset of puberty.

Ref: Journal of Human Reproduction Vol. 19, Page 1107; Pediatric Endocrinology: Mechanisms,Manifestations, and Management By Ora Hirsch Pescovitz, Erica A. Eugster, Chapter 22


Q:14Which of the following hormones is mainly responsible for skeletal maturation oflong bones during puberty?

A: TestosteroneB: EstrogenC: Growth hormoneD: Testosterone/estrogen ratio

Correct Ans:B

ExplanationEstrogen promotes bone maturation and closure of epiphyseal plates in long bones. Itconserves bone mass by suppressing bone turnover and maintaining balanced rates ofbone formation and bone resorption. Estrogen affects the generation, lifespan, andfunctional activity of both osteoclasts and osteoblasts. It promotes synthesis ofosteoprotegerin, decreases osteoclast formation and activity, and increases osteoclastapoptosis.

Ref: Molina P.E. (2013). Chapter 9. Female Reproductive System. In P.E. Molina (Ed),Endocrine Physiology, 4e.


Q:15 All are true about in puberty menorrhagia Except:

A: Associated with anovulatory bleedingB: Endometrial biopsy confirms diagnosisC: Routine screening for bleeding disorder is doneD: Hematinics & Hormone therapy is the treatment of choice

Correct Ans:B

Explanation

Endometrial biopsy confirms diagnosis REF: Novak's gynecology 13' edition page152

Causes of mennorhagia in adoloscese

Anovulatory bleedingPregnancyrelated BleedingExogenous HormonesHematologic AbnormalitiesInfectionsAnatomic Causes Obstructive or partially obstructive genital anomalies typicallypresent during adolescence. mUllerian abnormalities, such as obstructinglongitudinal vaginal septa or uterus didelphisolycystic ovarian syndrome

Diagnosis

Any adolescent with abnormal bleeding should undergo sensitive pregnancytesting, regardless of whether she states that she has had intercourse.Laboratory Testing In addition to a pregnancy test, laboratory testing shouldinclude a complete blood count with platelets, coagulation studies, and bleedingtime.Thyroid studies also may be appropriate. A complete pelvic examination isappropriate if the patient has been sexually active, is having severe pain, or ananomaly is suspected.Cultures for gonorrhea and testing for chlamydia infection are appropriate ifthe patient has been sexually active. Some young teens who have a history that isclassic for anovulation, who deny sexual activity, and who agree to return forfollowup evaluation may be managed with a limited gynecologic examinationand pelvic ultrasonographyImaging Studies If the pregnancy test is positive, pelvic imaging usingultrasonography may be necessary to confirm a viable intrauterine pregnancyand rule out a spontaneous abortion or ectopic pregnancy. If a pelvic mass issuspected on examination, or if the examination is inadequate (more likely to bethe case in an adolescent than an older woman) and additional information isrequired, pelvic ultrasonography may be helpful

Management

Management of bleeding abnormalities related to pregnancy, thyroiddysfunction, hepatic abnormalities, hematologic abnormalities, or androgenexcess syndromes should be directed to treating the underlying condition. Oralcontraceptives can be extremely helpful in managing androgen excesssyndromes. After specific diagnoses have been ruled out by appropriatelaboratory testing, anovulation or dysfunctional bleeding becomes the diagnosisof exclusion.


Q:16 Before the onset of puberty, the GnRH neurons are under the inhibitory control of :

A: GlycineB: GlutamateC: Gamma amino butyric acid (GABA)D: Betaendorphin

Correct Ans:C

Explanation

C i.e. Gamma amino butyric acid

Gn RH neurosecretion has been shown to be under the control of manyneurotransmitter & neuropeptides:

GABA exerts an inhibitory action on GnRH secretion before onset of pubertyQ.

Glutamate has an excitatory effectQ & whose levels increase at the onset ofpubertyQ.

Gama amino butyric acid (GABA)Q appears to be an inhibitory neurotransmitterresponsible for restricting LHRH release before onset of puberty in female rhesusmonkey.

Recent studies suggest that during prepubertal period an inhibitory neuronal systemsuppresses LHRH release & that during the subsequent maturation of hypothalamusthis prepubertal inhibition is removed allowing the adult pattern of pulsatile LHRHrelease. (Endocrine review by E. tersawa & D. Fernandez)


Q:17 Thalassaemia major manifests in

A: ChildhoodB: PubertyC: Adolescence

D: Middle age

Correct Ans:A

Explanation

Ans. is 'a' i.e., Childhood

o Severe anemia manifests 69 months after birth, as hemoglobin synthesis switchesfrom HbF to HbA.


mock questions for neet pg , usmle , plab and fmge (mci screening exam) on puberty

Health & Medicine