Gynaecological endocrinology: secondary amenorrhoea work-up: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Gynaecological endocrinology: secondary amenorrhoea work-up

Sample item

A 26-year-old has had 8 months of amenorrhoea. Pregnancy test, TSH and prolactin are normal. She does not bleed after a 10-day progestogen course, but she does bleed after oestrogen followed by progestogen. What is the most appropriate next investigation?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Serum FSH and LH

Bleeding after oestrogen and progestogen shows that the endometrium and outflow tract are intact, so the problem is low oestrogen. FSH and LH then separate ovarian failure (high levels) from a hypothalamic-pituitary cause (low or normal levels).

Option by option

  • A. Hysteroscopic inspection of the cavity

    Intrauterine adhesions would have prevented withdrawal bleeding after oestrogen and progestogen.

  • B. MRI of the pituitary fossa

    Pituitary imaging is considered only after gonadotropins are found low or other features suggest a lesion.

  • C. Serum FSH and LH (correct)

    Correct. Gonadotropin levels decide between ovarian and hypothalamic-pituitary failure.

  • D. Peripheral blood karyotype

    Karyotyping is reserved for high FSH in a young woman, so it follows the gonadotropin result.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is C, Serum FSH and LH. Bleeding after oestrogen and progestogen shows that the endometrium and outflow tract are intact, so the problem is low oestrogen.

Why is "Hysteroscopic inspection of the cavity" not the answer?

Intrauterine adhesions would have prevented withdrawal bleeding after oestrogen and progestogen.

Why is "MRI of the pituitary fossa" not the answer?

Pituitary imaging is considered only after gonadotropins are found low or other features suggest a lesion.

Why is "Peripheral blood karyotype" not the answer?

Karyotyping is reserved for high FSH in a young woman, so it follows the gonadotropin result.

What concept does this question test?

It tests Gynaecological endocrinology: secondary amenorrhoea work-up in OBG. FSH and LH then separate ovarian failure (high levels) from a hypothalamic-pituitary cause (low or normal levels).

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gynaecological endocrinology: secondary amenorrhoea work-up?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.