Endo Exam 3: SHARMA MENSTRAL

Case: What is the main endogenous estrogen?
A) Estrone
B) Estradiol
C) Estriol
D) Estetrol

B

Case: Which weaker estrogen is partly made by the liver metabolizing estradiol?
A) Estetrol
B) Mestranol
C) Estrone
D) Ethinyl estradiol

C

Case: Which plasma protein do estrogens bind mainly?
A) Albumin
B) SHBG
C) Transferrin
D) Ceruloplasmin

B

Case: Why must estrogen be paired with a progestin or SERM in women with a uterus?
A) To prevent bone loss
B) To raise HDL
C) To block ovulation
D) To prevent endometrial hyperplasia and carcinoma from unopposed estrogen

D

Case: What drives ovulation suppression in combined hormonal contraceptives?
A) Estrogen, mainly
B) Progestin only
C) Cervical mucus changes only
D) Tubal motility changes

A

Case: Which is a mechanism of progestin-only contraceptives?
A) Increased HDL
B) Estrogen-driven ovulation suppression only
C) Thickened cervical mucus and endometrial atrophy
D) Stimulated tubal motility

C

Case: Which progestin-only method reliably suppresses ovulation?
A) Norethindrone pill
B) Levonorgestrel EC
C) Copper IUD
D) DMPA injection

D

Case: Why is spotting common with PROGESTIN-only pills?
A) The endometrium is not stabilized as it is with CHCs
B) Estrogen excess
C) Ovarian cysts
D) Iron deficiency

A

Case: What does the 17α-ETHINYL group in ETHYNYL ESTRADIOL do?
A) Increases hepatic metabolism
B) Makes it an androgen
C) Makes it a SERM
D) Blocks hepatic metabolism, increasing oral bioavailability

D

Case: Which statement about estetrol is correct?
A) Pure estrogen agonist everywhere
B) Androgen receptor blocker
C) SERM: antagonist in breast, agonist elsewhere
D) Progestin

C

Case: Mestranol is a prodrug of which estrogen?
A) Estradiol
B) Ethinyl estradiol
C) Estrone
D) Estriol

B

Case: What ethinyl estradiol dose is found in most modern pills?
A) 50 to 100 mcg
B) 100 to 150 mcg
C) Under 35 mcg
D) 1 mg

C

Case: Why are estranes androgenic?
A) They lack a 17-methyl group
B) They contain a 17α-spirolactone
C) They share testosterone’s 3-keto and 17-methyl structure
D) They are estradiol prodrugs

C

Case: Which progestin is the prodrug of etonogestrel?
A) Desogestrel
B) Norgestimate
C) Levonorgestrel
D) Drospirenone

A

Case: Which fourth-generation progestin is antiandrogenic?
A) Norethindrone
B) Levonorgestrel
C) Desogestrel
D) Drospirenone

D

Case: A biphasic COC changes dose how often?
A) Never, the dose is constant
B) Once
C) Twice
D) Weekly

B

Case: The contraceptive patch delivers about 60% more estrogen than a COC. What is the main concern?
A) Hyperkalemia
B) Gallstones
C) Hyperglycemia
D) VTE

D

Case: Above what body weight is the contraceptive patch not recommended?
A) 70 kg
B) 80 kg
C) 90 kg
D) 100 kg

C

Case: What hormones are in the vaginal ring?
A) Ethinyl estradiol and etonogestrel
B) Ethinyl estradiol and norelgestromin
C) Levonorgestrel only
D) Estradiol valerate

A

Case: Which is a key feature of progestin-only pills?
A) Contains estrogen
B) Given as a monthly injection
C) Taken only on cycle days
D) No estrogen, taken daily at the same time with no placebo week

D

Case: How long does the etonogestrel implant last?
A) 1 year
B) 5 years
C) 10 years
D) 3 years

D

Case: How often is DMPA-SC given?
A) Every 12 weeks
B) Every 4 weeks
C) Every 6 months
D) Yearly

A

Case: What is the DMPA BBW about duration?
A) Avoid use for more than 6 months
B) Avoid use for more than 2 years
C) Avoid use for more than 1 year
D) Avoid use for more than 5 years

B

Case: What is the approximate VTE rate for low-dose COCs per 100,000 woman-years?
A) 12 to 20
B) 4 to 5
C) 24 to 50
D) 48 to 60

A

Case: How do the VTE risks of DROSPirenone, DESOgestrel, and NORGEstimate compare with LEVONorgestrel?
A) Lower
B) Higher
C) The same
D) Not studied

B

Case: The WHI and Million Women Study breast cancer findings came from which population?
A) Low-dose COC users
B) Implant users
C) Emergency contraception users
D) Postmenopausal HRT users

D

Case: Cervical cancer risk is about 2-fold with more than 5 years of hormonal contraception in women with what?
A) Persistent HPV
B) Diabetes
C) Smoking only
D) Hypertension only

A

Case: Within what window is levonorgestrel EC most effective?
A) 72 hours
B) 24 hours
C) 14 days
D) 30 days

A

Case: What is the levonorgestrel EC dose?
A) 0.75 mg as a single tablet
B) 30 mg as a single tablet
C) 1.5 mg as a single tablet, OTC
D) 50 mg as a single tablet

C

Case: What are the ulipristal EC dose and window?
A) 1.5 mg within 72 hours
B) 30 mg within 120 hours, prescription only
C) Copper IUD within 5 days
D) 0.75 mg twice

B

Case: Which EC option is the most effective and can serve as long-term contraception?
A) Copper IUD
B) Levonorgestrel EC
C) Hormonal IUD like Mirena
D) Oral ulipristal

A

Case: What is the primary mechanism of levonorgestrel EC?
A) Permanent tubal occlusion
B) Inhibiting or delaying ovulation
C) Spermicidal action
D) Preventing implantation

B

Case: Which best describes ulipristal EC?
A) Pure estrogen agonist
B) Androgen receptor antagonist
C) Selective progesterone receptor modulator
D) Prostaglandin synthase inhibitor

C