Estrogen

ESTROGEN

Q. 1

Failure of bleeding after withdrawal of oestrogen indicates :

 A

Uterine factor

 B

Ovarian factors

 C

Pituitary factor

 D

Hypothalamic factor

Q. 1

Failure of bleeding after withdrawal of oestrogen indicates :

 A

Uterine factor

 B

Ovarian factors

 C

Pituitary factor

 D

Hypothalamic factor

Ans. A

Explanation:

Uterine factor


Q. 2

Estrogen replacement for post — menopausal symptoms causes an increase in :

 A

LDL

 B

Cholesterol

 C

VLDL

 D

Triglycerides

Q. 2

Estrogen replacement for post — menopausal symptoms causes an increase in :

 A

LDL

 B

Cholesterol

 C

VLDL

 D

Triglycerides

Ans. D

Explanation:

Ans. is d i.e Triglycerides                  

Estrogen causes : — plasma LDL

— T plasma HDL

—  T Triglycerides

  • It also increases blood coagulability by inducing formation of clotting factors
  • Estrogen increases lithogenesity of bile.

Q. 3

Estrogen administration in a menopausal woman increases the

 A

Gonadotrophin secretion

 B

LDL — cholesterol

 C

Bone mass

 D

Muscle mass

Q. 3

Estrogen administration in a menopausal woman increases the

 A

Gonadotrophin secretion

 B

LDL — cholesterol

 C

Bone mass

 D

Muscle mass

Ans. C

Explanation:

Ans. is c i.e Bone mass   

Before seeing any Reference for the Question let’s rule out some options.

  • Estrogen administration will exert a negative feedback on gonadotropin secretion and decreases Gonadotropin secretion rather than increasing it (Option ‘a’ ruled out).

As I have already discussed in previous Question -Estrogen decreases LDL and not increases it (ruling out Option `b).

Now we are left with 2 options, Option ‘c’ i.e. Bone mass and Option ‘rile. Muscle mass.

  • Estrogen given as hormone replacement therapy is most beneficial in preventing osteoporosis i.e it must be increasing bone mass.

So, Option ‘c’seems to be correct.

Now have a look what texts have to say :

Estrogen helps to maintain bone mass and skeletal integrity thereby protecting against osteoporosis.

Effect of estrogen on bones :          

  • Estrogen causes increased osteoblastic activity in the bones.
  • It is important in maintaining bone mass primarily by retarding bone resorption. The major action of estrogen is directed at reducing the maturation and activity of osteoclasts, by modifying regulatory cytokine signals from osteoblasts.
  • The action of estrogen and progesterone result in increased expression of bone matrix proteins such as osteonectin, osteocalcin, collagen and alkaline phosphatase.

Extra Edge :

An overveiw of osteoporosis

Risk factors for osteoporosis

Non modifiable

Modifiable

Associated  

Medical Conditions

 

•     Age

•     Race (caucasian, asian)

•     Small body frame

•     Early menopause

•     Prior fracture

•     Family history of osteoporosis

 

Inadequate intake of calcium

and vitamin D

Smoking

Low body weight

Excess alcohol use

Sedentary lifestyle

 

Hyperthyroidism

Hyperparathyroidism

Chronic renal disease

Conditions requiring

systemic corticosteroid use

 

Diagnosis : Bone Mineral Density Measurement (BMD)

  • Dual X-ray Absorptiometry (DXA) of hip and spine is the primary technique for BMD assessment.
  • BMD is expressed as a T score, which is the number of standard deviations from the mean for a young healthy woman.
  • A T score above —1 is considered normal, a value between —1 and —2.5 denotes osteopenia and a score below —2.5 indicates osteoporosis.
  • Evaluation of BMD by DXA is recommended for all women aged 65 and older, regardless of risk factors and for younger postmenopausal women with 1 or more risk factors.
Prevention : Women should receive 1000 to 1500 mg of calcium and 400 to 800 IU of vitamin D daily

Options for osteoporosis prevention and treatment

BisphosphonatesO

Alendronate : 35 – 70 mg/week

Risedronate : 35 mg/week

lbandronate : 150 mg/month

  • Additional potential benefits : none
  • Potential risks : esophageal ulcers
  • Side effects : gastrointestinal distress, arthralgia / myalgia

Hormone therapy

Estrogen° or estrogen / progestin therapy°

  • Additional potential benefits : treatment of vasomotor symptoms and urogenital atrophy
  • Potential risk : breast cancer, gallbladder disease, venous thromboembolic events, cardiovascular disease, stroke.
  • Side effects : vaginal bleeding, breast tenderness

Selective estrogen° receptor modulators (SERMSP

Raloxifene° : 60 mg/day

  • Additional potential benefits : reduced risk of breast cancer
  • Potential risks : venous thromboembolic events
  • Side effects : Vasomotor symptoms, leg cramp
  • Calcitonin° : 200 IU/day intranasally or 100 IU/day subcutaneously or intramuscularly
  • Additional potential benefits : non
  • Potential risks : none
  • Side effects : rhinitis, back pain Tariparatide° : 20 mg/day subcutaneously
  • Additional potential benefits : none
  • Potential risks : osteosarcoma after long – term use in rodents, hypercalcemia
  • Side effects : leg cramps

Q. 4

Oestrogen causes all except :

 A

Weight gain

 B

Fluid and water

 C

Disappearance of comedones

 D

None

Q. 4

Oestrogen causes all except :

 A

Weight gain

 B

Fluid and water

 C

Disappearance of comedones

 D

None

Ans. D

Explanation:

None


Q. 5

Post menopausal estrogen production is due to :

 A

Peripheral aromatization of androstenedione

 B

Adrenal – Direct production

 C

Ovarian tumour

 D

Ovary testosterone secretion

Q. 5

Post menopausal estrogen production is due to :

 A

Peripheral aromatization of androstenedione

 B

Adrenal – Direct production

 C

Ovarian tumour

 D

Ovary testosterone secretion

Ans. A

Explanation:

Ans. is a i.e. Peripheral aromatization of androstenedione

  • In menopause estrogen levels decrease by 66%.
  • Main source of estrogen production postmenopausaly is by peripheral aromatization of androstenedione.
  • Main estrogen after menopause – oestrone.

Also know : • Main estrogen during reproductive year is oestradiol.°

  • Main estrogen in pregnancy is oestriol.°

Q. 6 Functions of estrogen are all EXCEPT
 A

Secretory function on endometrium

 B

Synthetic function on endometrium

 C

 Causes secondary sexual characters in female

 D

 Breast enlargement during puberty

Q. 6 Functions of estrogen are all EXCEPT
 A

Secretory function on endometrium

 B

Synthetic function on endometrium

 C

 Causes secondary sexual characters in female

 D

 Breast enlargement during puberty

Ans. A

Explanation:

Secretory function on endometrium

REF: Ganong’s 22ed chapter 23

Organ

Estrogen

Progesterone

Vagina

Epithelium becomes cornified

A thick mucus is secreted, and the epithelium

proliferates and becomes infiltrated with leukocytes

Fallopian

tubes

Increase the motility of the uterine

tubes

 

Ovary

Follicular or preovulatory

Luteal

Endometrium

Proliferative

Secretory, It also decreases the number of estrogen

receptors in the endometrium and increases the rate of

conversion of 17 -estradiol to less active estrogens.

Body of uterus

Increase the amount of uterine

muscle and its content of

contractile proteins

Anti-estrogenic effect on the myometrial cells,

decreasing their excitability, their sensitivity to

oxytocin, and their spontaneous electrical activity while

increasing their membrane potential.

Cervix                  Mucus thinner and more alkaline        Mucus thick, tenacious, and cellular                                      
Breast Proliferation of mammary ducts Growth of lobules and alveoli

Q. 7 Secretion of estrogen is maximum at? 
 A

Just before menopause

 B

At puberty

 C

At menstruation

 D

Before ovulation

Q. 7 Secretion of estrogen is maximum at? 
 A

Just before menopause

 B

At puberty

 C

At menstruation

 D

Before ovulation

Ans. D

Explanation:

Before ovulation REF: Ganong’s 22nd ed p. 24

Post menopausal estradiol levels: 35 pg / L

Reference ranges for serum estradiol

 

Patient type

Lower limit

Upper limit

Unit

 

Adult male

50

200

pmol/L

 

 

14

55

pg/mL

 

Adult female (follicular

70

500

pmol/L

 

phase, day 5)

 

 

110

220

 

 

19

140

pg/mL

 

 

3

60

 

 

Adult female (preovulatory

peak)

400

1500

pmol/L

 

110

410

pg/mL

 

Adult female

70

600

pmol/L

 

(luteal phase)

 

19

160

pg/mL

 

Adult female – free

0.5

9

pg/mL

 

(not protein bound)

 

1.7

33

pmol/L

 

Post-menopausal female

N/A

< 130

pmol/L

 

 

N/A

< 35

pg/mL

 

Q. 8 The enzyme associated with the conversion of androgen to oestrogen in the growing ovarian follicle is:
 A Desmolase
 B Isomerase
 C Aromatase
 D Hydroxylase
Q. 8 The enzyme associated with the conversion of androgen to oestrogen in the growing ovarian follicle is:
 A Desmolase
 B Isomerase
 C Aromatase
 D Hydroxylase
Ans. C

Explanation:

Aromatase


Q. 9

Effects of estrogen are all of the following, except:

 A

Reduces HDL

 B

Reduces LDL

 C

Increases Triglycerides

 D

Increases HDL

Q. 9

Effects of estrogen are all of the following, except:

 A

Reduces HDL

 B

Reduces LDL

 C

Increases Triglycerides

 D

Increases HDL

Ans. A

Explanation:

Estrogens increase HDL cholesterol.

Ref: KDT 5th Edition, Pages 274-9; KDT 6th Edition, Page 229; Harrison’s Principles of Internal Medicine, 16th Edition, Chapter 30; Novak’s Textbook of Gynecology, 14th Edition, Pages 272-73


Q. 10

All the following are the effects of oestrogen, EXCEPT:

 A

Beneficial effect on cognition

 B

Reduced osteoclastic activity

 C

Increased osteoblastic activity

 D

Increased protein C and S levels

Q. 10

All the following are the effects of oestrogen, EXCEPT:

 A

Beneficial effect on cognition

 B

Reduced osteoclastic activity

 C

Increased osteoblastic activity

 D

Increased protein C and S levels

Ans. D

Explanation:

The effects of oestrogen on the skeletal system includes:

1) Increased osteoblastic activity
2) Reduced osteoclastic activity
3) Prevents osteoporosis
4) Promotes fusion of epiphyses
 
Also know
Oestrogen increases factor II, III, IX, X, XII and decreases protein C , S and antithrombin III.

Ref: Essentials of Gynaecology by Lakshmi Seshadri, Edition 1, page – 44


Q. 11

All are true about estrogen, EXCEPT:

 A

Causes cholestasis

 B

Used in treatment of gynacomastia

 C

Used in HRT

 D

Increased risk of breast cancer

Q. 11

All are true about estrogen, EXCEPT:

 A

Causes cholestasis

 B

Used in treatment of gynacomastia

 C

Used in HRT

 D

Increased risk of breast cancer

Ans. B

Explanation:

They promote the development of female secondary sexual characteristics, such as breast development.

So it is not used in treatment of gynaecomastia.

Estrogen and other hormones are given to postmenopausal women as a part of hormone replacement therapy (HRT) in order to prevent osteoporosis as well as treat the symptoms of menopause.

About 80% of breast cancers rely on supplies of the hormone estrogen to grow: they are known as hormone-sensitive or hormone-receptor-positive cancers.

Suppression of production of estrogen in the body is a treatment for these cancers.

Estrogens cause intrahepatic cholestasis by altering the composition of the lipid membrane and inhibiting the rate of secretion of bile into the canaliculi.


Q. 12

 
 

By estrogen administration in a menopausal woman, which of the following is increased?

 A

Gonadotrophin secretion

 B

LDL-cholesterol

 C

Bone mass

 D

Muscle mass

Q. 12

 
 

By estrogen administration in a menopausal woman, which of the following is increased?

 A

Gonadotrophin secretion

 B

LDL-cholesterol

 C

Bone mass

 D

Muscle mass

Ans. C

Explanation:

Hormone therapy reduces the rate of bone resorption and results in an increase in bone mass density (BMD). Estrogen therapy acts via the inhibition of bone resorption. Both BMD and fracture rate are improved with estrogen therapy. However, with cessation of estrogen therapy, there is a rapid and progressive loss of bone mineral content. Estrogen is approved for prevention of osteoporosis.
 
Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 22. The Mature Woman. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.

Q. 13

The success of estrogen and estrogen-like drugs in combating osteoporosis in postmenopausal women may indicate that estrogen:

 A

Stimulates osteoclastic activity

 B

Inhibits osteoclastic activity

 C

Inhibits osteoblastic activity

 D

Inhibits recalcification during bone turnover

Q. 13

The success of estrogen and estrogen-like drugs in combating osteoporosis in postmenopausal women may indicate that estrogen:

 A

Stimulates osteoclastic activity

 B

Inhibits osteoclastic activity

 C

Inhibits osteoblastic activity

 D

Inhibits recalcification during bone turnover

Ans. B

Explanation:

Estrogens directly regulate osteoblasts and increase the synthesis of type I collagen, osteocalcin, osteopontin, osteonectin, alkaline phosphatase, and other markers of differentiated osteoblasts.

Estrogens also increase osteocyte survival by inhibiting apoptosis.

However, the major effect of estrogens is to decrease the number and activity of osteoclasts.

Much of the action of estrogens on osteoclasts appears to be mediated by altering cytokine (both paracrine and autocrine) signals from osteoblasts.

Estrogens decrease osteoblast and stromal cell production of the osteoclast-stimulating cytokines interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF)- and increase the production of IGF-1, bone morphogenic protein (BMP)-6, and transforming growth factor (TGF) Beta which are antiresorptive.

Ref: Levin E.R., Hammes S.R. (2011). Chapter 40. Estrogens and Progestins. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12e.


Q. 14

Which of the following is the main form of oestrogen secreted from the ovary?

 A

Estradiol

 B

Estrone

 C

Estriol

 D

All of the above

Q. 14

Which of the following is the main form of oestrogen secreted from the ovary?

 A

Estradiol

 B

Estrone

 C

Estriol

 D

All of the above

Ans. A

Explanation:

The major estrogens produced by women are estradiol (estradiol-17, E2), estrone (E1), and estriol (E3).

Estradiol is the major secretory product of the ovary.

Although some estrone is produced in the ovary, most estrone and estriol are formed in the liver from estradiol or in peripheral tissues from androstenedione and other androgens. 

 
During the first part of the menstrual cycle estrogens are produced in the ovarian follicle by the theca and granulosa cells.

After ovulation, the estrogens as well as progesterone are synthesized by the luteinized granulosa and theca cells of the corpus luteum, and the pathways of biosynthesis are slightly different.
 
Ref: Chrousos G.P. (2012). Chapter 40. The Gonadal Hormones & Inhibitors. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds), Basic & Clinical Pharmacology, 12e.

Q. 15

The amount of estrogen in low dose oral contraceptive pills is:

 A

30 micrograms

 B

40 micrograms

 C

50 micrograms

 D

20 micrograms

Q. 15

The amount of estrogen in low dose oral contraceptive pills is:

 A

30 micrograms

 B

40 micrograms

 C

50 micrograms

 D

20 micrograms

Ans. D

Explanation:

Over time, the estrogen and progestin contents of COCs have been reduced remarkably to minimize hormone-related adverse effects.

Currently, the lowest acceptable dose is limited by their ability to prevent pregnancy and unacceptable breakthrough bleeding. Although daily estrogen content varies from 20 to 50 g of ethinyl estradiol, most contain 35 µg or less.

Low-dose COCs usually contains 20 µg ethinyl estradiol.

 
Ref: Leveno K.J., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 32. Contraception. In K.J. Leveno, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

Q. 16

Which of the following enzyme is associated with the conversion of androgen to oestrogen in a growing ovarian follicle is:

 A

Aromatase

 B

5 alpha reductase

 C

Desmolase

 D

Isomerase

Q. 16

Which of the following enzyme is associated with the conversion of androgen to oestrogen in a growing ovarian follicle is:

 A

Aromatase

 B

5 alpha reductase

 C

Desmolase

 D

Isomerase

Ans. A

Explanation:

Aromatase enzyme: In a normal ovary, LH acts on the theca interstitial stromal cells, whereas FSH acts on granulosa cells. In response to LH the thecal cells secretes androgen, and the produced androsendione is converted in the granulosa cells to estrogen by the action of aromatase enzyme.

Ref: Physiology By James N. Pasley 2nd Edition, Page 145 ; Androgens in health and disease By William J. Bremne Page 84 ; Padé approximation and its applications: Diagnosis and management of PCOS, Issue 765, By Luc Wuytack, Page 107


Q. 17

All of the following are functions of estrogen, EXCEPT:

 A

Secretory function on endometrium

 B

Synthetic function on endometrium

 C

Causes secondary sexual characters in female

 D

Breast enlargement during puberty

Q. 17

All of the following are functions of estrogen, EXCEPT:

 A

Secretory function on endometrium

 B

Synthetic function on endometrium

 C

Causes secondary sexual characters in female

 D

Breast enlargement during puberty

Ans. A

Explanation:

Estrogen is found to induce proliferation of endometrial glands and stroma including vascular endothelium. Progestin is responsible for the secretory differentiation in endometrial glands and decidual type changes in the stroma.

Other effects of estrogen are: 

  • Estrogen facilitate the growth of ovarian follicles and increase the motility of uterine tubes. 
  • Estrogen increases the growth of ducts in breasts and is responsible for breast enlargement at puberty in girls.
  • It is also associated with the development of secondary sexual characters in females.
  • It increases libido in humans, by exerting a direct effect on certain neurons in hypothalamus.

Q. 18

The enzyme associated with the conversion of androgen to oestrogen in the growing ovarian follicle is

 A

Desmolase

 B

Isomerase

 C

Aromatase

 D

Hydroxylase

Q. 18

The enzyme associated with the conversion of androgen to oestrogen in the growing ovarian follicle is

 A

Desmolase

 B

Isomerase

 C

Aromatase

 D

Hydroxylase

Ans. C

Explanation:

C i.e. Aromatase


Q. 19

Estrogen action on carbohydrate metabolism:

 A

Increases uptake of glucose through increase in insulin sensitivity

 B

Glycolysis increases

 C

Increasing central adipose deposition

 D

Worsening of NIDDM

Q. 19

Estrogen action on carbohydrate metabolism:

 A

Increases uptake of glucose through increase in insulin sensitivity

 B

Glycolysis increases

 C

Increasing central adipose deposition

 D

Worsening of NIDDM

Ans. B

Explanation:

B i.e. Glycolysis increases


Q. 20

Which of the following hormones is mainly responsible for skeletal maturation:

 A

Testosterone

 B

Estrogen

 C

Growth hormone

 D

Testosterone/ estrogen ratio

Q. 20

Which of the following hormones is mainly responsible for skeletal maturation:

 A

Testosterone

 B

Estrogen

 C

Growth hormone

 D

Testosterone/ estrogen ratio

Ans. B

Explanation:

B i.e. Estrogen

Growth spurt at puberty occurs because of androgen & estrogens, but estrogen ultimately terminate growth by causing the epiphyses to fuse to the long bones (epiphysial closure). Once the epiphyses have closed, linear growth ceases.

Patient with sexual precocity are apt to be dwarfed. On the other hand men who were castrated before puberty tend to be tall because their estrogen production is decreased & their epiphysis remain open.

These observation suggest that estrogen, rather than androgen, are responsible for bone maturation that ultimately leads to epiphyseal fusion and cessation of growthQ.


Q. 21

Major estrogen in normal adult women is –

 A

Estradiol

 B

Estrone

 C

Estriol

 D

None of the above

Q. 21

Major estrogen in normal adult women is –

 A

Estradiol

 B

Estrone

 C

Estriol

 D

None of the above

Ans. A

Explanation:

Ans. is ‘a’ i.e., Estradiol

o Estradiol is the major estrogen secreted by the ovary.


Q. 22

All of the following are natural estrogens except ‑

 A

Estradial

 B

Ethinylestradiol

 C

Estriol

 D

Estrone

Q. 22

All of the following are natural estrogens except ‑

 A

Estradial

 B

Ethinylestradiol

 C

Estriol

 D

Estrone

Ans. B

Explanation:

Ans. is ‘b’ i.e., Ethinylestradiol

o Estradial, estrone and estrial, all three are found in blood, but estradiol is the most potent estrogen.


Q. 23

Effects of estrogen are all of the following except ‑

 A

Reduces HDL

 B

Reduces LDL

 C

Increases triglyceride

 D

Reduces bone resorption

Q. 23

Effects of estrogen are all of the following except ‑

 A

Reduces HDL

 B

Reduces LDL

 C

Increases triglyceride

 D

Reduces bone resorption

Ans. A

Explanation:

Ans. is ‘a’ i.e., Reduces HDL

o Estrogens decrease LDL while increase HDL and triglyceride -4 atherosclerosis is rare before menopause.


Q. 24

All are true about estrogen EXCEPT-

 A

Causes cholestasis

 B

Used in treatment of gynaecomastia

 C

Used in HRT

 D

Increased risk of breast cancer

Q. 24

All are true about estrogen EXCEPT-

 A

Causes cholestasis

 B

Used in treatment of gynaecomastia

 C

Used in HRT

 D

Increased risk of breast cancer

Ans. B

Explanation:

Ans. is ‘b’ i.e., Used in treatment of gynacomastia

o Estrogen can cause gynaecomastia (not used in gynaecomastia), cholestasis and breast cancer.

o One of the most important use of estrogen is HRT in postmenopausal females.


Q. 25

Which of the following is a synthetic estrogen ?

 A

Estrone

 B

Estriol

 C

Estradiol

 D

Diethylstibestrol

Q. 25

Which of the following is a synthetic estrogen ?

 A

Estrone

 B

Estriol

 C

Estradiol

 D

Diethylstibestrol

Ans. D

Explanation:

Ans. is ‘d’ i.e., Diethylstibestrol

Synthetic progesterones

1. Progesterone derivatives —> Medroxyprogesterone, Megestrol, Dydrogesterone, Hydroxyprogesterone, Nomegestrol.

2. 1 9-Nortestosterone derivatives —> Norethindrone, Lynesternol, Allylesterone, Levonorgestrel, Desogestrel, Norgestimate, Gestodene.

Synthetic estrogens

  1. Steroidal —-> Ethinylestradiol, mestranol, tibolone.
  2. Nonsteroidal —-> Diethylstilbestrol, hexestrol, dienestrol

Q. 26

Uses of estrogen are all except –

 A

Senile vaginitis

 B

Carcinoma prostate

 C

Breast cancer

 D

Delayed puberty

Q. 26

Uses of estrogen are all except –

 A

Senile vaginitis

 B

Carcinoma prostate

 C

Breast cancer

 D

Delayed puberty

Ans. C

Explanation:

Ans. is ‘c’ i.e., Breast cancer

Antiestrogens (not estrogen) are used in breast cancer.


Q. 27

Thromboembolism is due to which component of OCP

 A

Progesterone

 B

Estrogen

 C

Iron

 D

FSH

Q. 27

Thromboembolism is due to which component of OCP

 A

Progesterone

 B

Estrogen

 C

Iron

 D

FSH

Ans. B

Explanation:

Ans. is ‘b’ i.e., Estrogen

o Estrogen is responsible for venous thromboembolism, i.e. leg vein and pulmonary thrombosis.

o Both estrogen and progesterone are responsible for arterial phenomena, i.e. coronary, and cerebral thrombosis —> MI and stroke


Q. 28

Ferning pattern of mucus under influence of:

March 2013

 A

Progesterone

 B

Testosterone

 C

Estrogen

 D

Prostaglandins

Q. 28

Ferning pattern of mucus under influence of:

March 2013

 A

Progesterone

 B

Testosterone

 C

Estrogen

 D

Prostaglandins

Ans. C

Explanation:

Ans. C i.e. Estrogen


Q. 29

Hormone responsible for ferning pattern of cervical mucus:  

March 2007

 A

Progesterone

 B

Estrogen

 C

LH

 D

Prolactin

Q. 29

Hormone responsible for ferning pattern of cervical mucus:  

March 2007

 A

Progesterone

 B

Estrogen

 C

LH

 D

Prolactin

Ans. B

Explanation:

Ans. B: Estrogen

An enzyme called plasmin contained in the endometrium tends to inhibit the blood from clotting.

Follicular Phase

Through the influence of a rise in (FSH), five to seven tertiary-stage ovarian follicles are recruited for entry into the next menstrual cycle.

One (or occasionally two) dominant follicles will continue to maturity and secrete increasing amounts of estradiol which initiate the formation of a new layer of endometrium in the uterus, histologically identified as the proliferative endometrium Ovulation

When the egg has matured, it secretes enough estradiol to trigger the acute release of (LH). In the average cycle this LH surge starts around cycle 12th day and may last 48 hours and leads to ovulation.

At the time of ovulation, the cervical mucus is thin and has the property of great elasticity and this is called spinnbarkeiti thread test under estrogenic activity. When viewed under the microscope, the mucus shows characteristic pattern of fern formation, which is due to presence of sodium chloride in the mucus secreted under estrogenic effect. Luteal phase

After ovulation, the residual follicle transforms into the corpus luteum. This corpus luteum will produce Progesterone in addition to estrogens for approximately the next 2 weeks.

Progesterone plays a vital role in converting the proliferative endometrium into a secretory lining receptive for implantation and supportive of the early pregnancy. It raises the body temperature.

Hormonal control

Gonadal

  • Estradiol peaks twice, during follicular growth and during the luteal phase.
  • Progesterone remains virtually absent prior to ovulation, but becomes critical in the luteal phase and during pregnancy. Many tests for ovulation check for the presence of progesterone.

After ovulation the corpus luteum which develops from the burst follicle and remains in the ovary secretes both estradiol and progesterone.

Hypothalamus and pituitary

These sex hormones come under the influence of the pituitary gland, and both FSH and LH play necessary roles:

  • FSH stimulates immature follicles in the ovaries to grow.
  • LH triggers ovulation.

The Gonadotropin releasing hormone of the hypothalamus controls the pituitary, yet both the pituitary and the hypothalamus receive feedback from the follicle.


Q. 30

Estrogen deficiency leads to:        

September 2005

 A

Postmenopausal bleeding

 B

Decreased risk of cardiovascular diseases

 C

Osteoporosis

 D

Dysmenorrhea

Q. 30

Estrogen deficiency leads to:        

September 2005

 A

Postmenopausal bleeding

 B

Decreased risk of cardiovascular diseases

 C

Osteoporosis

 D

Dysmenorrhea

Ans. C

Explanation:

Ans. C: Osteoporosis

Estrogen is cardioprotective in nature and hence deficiency of estrogen in postmenopausal phase increases the risk of cardiovascular diseases.

Osteoporosis: The most important risk factors for osteoporosis are :

Advanced age (in both men and women) and female sex;

Estrogen deficiency following menopause is correlated with a rapid reduction in bone mineral density, while in men a decrease in testosterone levels has a comparable (but less pronounced) effect


Q. 31

Aromatase produces estrogen from –

 A

Progesterone

 B

Cortisol

 C

Aldosterone

 D

Androgen

Q. 31

Aromatase produces estrogen from –

 A

Progesterone

 B

Cortisol

 C

Aldosterone

 D

Androgen

Ans. D

Explanation:

Ans. is ‘d’ i.e., Androgen


Q. 32

Estrogen Beta receptors are found on

 A

Uterus

 B

Blood vessels

 C

Ovary

 D

Vagina

Q. 32

Estrogen Beta receptors are found on

 A

Uterus

 B

Blood vessels

 C

Ovary

 D

Vagina

Ans. C

Explanation:

Ans. is ‘c’ i.e., Ovary


Q. 33

FSH and LH both are inhibited by ‑

 A

Cortisol

 B

Aldosterone

 C

Estrogen

 D

Progesterone

Q. 33

FSH and LH both are inhibited by ‑

 A

Cortisol

 B

Aldosterone

 C

Estrogen

 D

Progesterone

Ans. C

Explanation:

Ans. is ‘c’ i.e., Estrogen

Consistent with the phenomenon of negative feedback in which the secretion of the target hormone inhibits its trophic hormone, pregesterone inhibits LH and inhibin inhibits FSH.

  • Estrogen, whose secretion is stimulated by both LH and FSH, inhibits both LH and FSH.
  • Progesterone and estrogen act at both hypothalamic and pituitary levels while inhibin secreted by granulosa cells acts only on the pituitary.
  • Under certain conditions, estrogen causes stimulation (positive feedback) rather than inhibition of LH, e.g., at ovulation.

Q. 34

Reason for hepatic involvement in oral contraceptives is ‑

 A

Estrogen

 B

Progesterone

 C

Estrogen +Progesterone

 D

Mixed trace elements

Q. 34

Reason for hepatic involvement in oral contraceptives is ‑

 A

Estrogen

 B

Progesterone

 C

Estrogen +Progesterone

 D

Mixed trace elements

Ans. A

Explanation:

Ans. is ‘a’ i.e., Estrogen

Hepatotoxicity with oral contraceptive pills

  • While early formulations of OCPs were associated with frequent serum enzyme elevations, current formulations and hormonal replacement therapy have not been linked to ALT or alkaline phosphatase elevations at rates any higher than occur with placebo.
  • Estrogens in OCPs can cause mild inhibition of bilirubin excretion leading to jaundice in patients with inherited forms of bilirubin metabolism such as the Dubin Johnson syndrome.
  • It can induce a clinically apparent cholestatic liver injury which typically arises during the first few cycles of therapy, and rarely after the six months.
  • It has also been linked to hepatic tumors, both benign and malignant.

Q. 35

Following pubertal change is not due to estrogen ‑

 A

Vaginal cornification

 B

Pubic & axillary hair growth

 C

Cervical mucus production

 D

Menstruation

Q. 35

Following pubertal change is not due to estrogen ‑

 A

Vaginal cornification

 B

Pubic & axillary hair growth

 C

Cervical mucus production

 D

Menstruation

Ans. D

Explanation:

Ans. is ‘d’ i.e., Menstruation

It is the lack of progesterone support (progesterone withdrawl) that causes mucosal shedding and bleeding during menstration.

Actions of estrogen

1. Sex organs

  • Estrogen brings about pubertal changes in female .
  • Growth of uterus, fallopian tube and vagina. 
  • Vaginal epithelium gets thickened, stratified and cornified.
  • Estrogen induce watery cervical secretion.
  • Proliferation of endometrium in preovulatory phase.
  • Estrogen sensitizes the uterus to oxytocin.

2. Secondary sex character

  • Estrogen produced at puberty causes growth of breast-proliferation of duct and stroma, accumulation of fat.
  • Pubic and axillary hair appear.
  •  Feminine body contours and behaviour are influenced.
  • Acne is common in girls at puberty → due to small amount of androgens produced simultaneously.

3. Metabolic effects

  • Estrogens are anabolic
  • Estrogens promotes fusion of epiphysis
  • Maintain bone mass by reducing bone resorption.
  • Promote positive calcium balance by inducing renal I a-hydroxylase.
  • Cause salt and water retention.
  • Estrogens decrease LDL while increase HDL and triglyceride → atherosclerosis is rare before menopause.
  • Blood coagulability increases due to increased synthesis of factor II, VII, IX and X.
  • Estrogens increase lithogenicity of bile by increasing cholestrol secretion and decreasing bile secretion.

Q. 36

True about estrogen production in menstural cycle‑

 A

Only by theca cells

 B

Only by granulosa cells

 C

Both theca and granulosa cells

 D

None of the above

Q. 36

True about estrogen production in menstural cycle‑

 A

Only by theca cells

 B

Only by granulosa cells

 C

Both theca and granulosa cells

 D

None of the above

Ans. C

Explanation:

Ans. is ‘c’ i.e., Both theca and granulosa cells

Ovarian follicle contains two types of cells in preovulatory phase :-

i) Granulosa cells :- Secrete mainly estrogen and very minimal amount of progesterone.

ii) Theca cells (interna & externa) Theca interna cells provide androgen and pregnenolone to granulosa cells to convert them into estrogen and progesterone respectively.

After ovulation, corpus luteum contain two types of cell :-

i) Granulosa luteal cells (formed by luteinization of granulosa cells) :- Produce mainly estrogen and minimal progesterone.

ii) Theca luteal cells (formed by luteinization of theca interna cells) :- Produce mainly progesterone.


Q. 37

False about estrogen action ‑

 A

Stimulates secondery sex characters in female

 B

Stimulates osteoclasts

 C

Decreases LDL

 D

Increases blood coagulability

Q. 37

False about estrogen action ‑

 A

Stimulates secondery sex characters in female

 B

Stimulates osteoclasts

 C

Decreases LDL

 D

Increases blood coagulability

Ans. B

Explanation:

Ans. is ‘b’ i.e., Stimulates osteoclasts

Major action of estrogen on bone is to inhibit osteoclastic bone resorption.

Estrogen blocks the action of IL-6, a potent stimulator of osteoclasts.

Estrogen also induces apoptosis of osteoclasts.

Other three options are correct.

Actions of estrogen have been explained in previous sessions.


Q. 38

Estrogen is secreted by ‑

 A

Granulosa cells

 B

Theca luteal cells

 C

Theca interna

 D

Theca externa

Q. 38

Estrogen is secreted by ‑

 A

Granulosa cells

 B

Theca luteal cells

 C

Theca interna

 D

Theca externa

Ans. A

Explanation:

Ans. is ‘a i.e., Granulosa cells


Q. 39

Vascular condition shown due to in Photograph occur

 A

Estrogens

 B

Steroids

 C

Androgens

 D

Progesterone

Q. 39

Vascular condition shown due to in Photograph occur

 A

Estrogens

 B

Steroids

 C

Androgens

 D

Progesterone

Ans. A

Explanation:

Ans is Estrogens

(Condition shown: Spider naevi) 

spider angioma (also known as a nevus araneusspider nevusvascular spider, and spider telangiectasia is a type of telangiectasis (swollen blood vessels) found slightly beneath the skin surface, often containing a central red spot and reddish extensions which radiate outwards like a spider’s web. They are common and may be benign, presenting in around 10–15% of healthy adults and young children


Q. 40

A patient with chronic liver disease developed this condition on chest. It may be due to excess of the following hormone:

 A

Estrogen

 B

Testosterone

 C

Aldosterone

 D

Hepatotoxin

Q. 40

A patient with chronic liver disease developed this condition on chest. It may be due to excess of the following hormone:

 A

Estrogen

 B

Testosterone

 C

Aldosterone

 D

Hepatotoxin

Ans. A

Explanation:

Ans is Estrogen

The spider nevus, or spider angioma, is the most representative and classic vascular lesion of chronic liver disease. Clinically, it has a central arteriole from which numerous small, twisted vessels radiate.
 
Vascular spider nevi and palmar erythema are generally attributed to estrogen excessparticularly because they also occur during pregnancy and because estrogens have an enlarging, dilating effect on the spiral arterioles of the endometrium. This would also explain spider nevi in men receiving estrogen therapy for prostatic cancer.

Q. 41

All are required for conversion of progesterone to estrogen except ‑

 A

Lyase

 B

11-hydroxylase

 C

Reductase

 D

Isomerase

Q. 41

All are required for conversion of progesterone to estrogen except ‑

 A

Lyase

 B

11-hydroxylase

 C

Reductase

 D

Isomerase

Ans. B

Explanation:

Ans. is ‘b’ i.e., 11-hydroxylase 

 


Q. 42

Which of the following acts on nuclear receptors‑

 A

Glucocorticoids

 B

Progesterone

 C

Estrogen

 D

Mineralocorticoids

Q. 42

Which of the following acts on nuclear receptors‑

 A

Glucocorticoids

 B

Progesterone

 C

Estrogen

 D

Mineralocorticoids

Ans. C

Explanation:

Ans. is ‘c’ i.e., Estrogen



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