Postpartum haemorrhage and emergencies: Sheehan syndrome: 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 · Postpartum haemorrhage and emergencies: Sheehan syndrome

Sample item

A woman who had a severe postpartum haemorrhage two years ago has failure of lactation, amenorrhoea and fatigue. Which hormone replacement must be started before thyroxine?

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

The answer and the reasoning

B. Hydrocortisone

Pituitary necrosis after haemorrhage causes panhypopituitarism, and a cortisol deficit must be replaced first because thyroxine can precipitate adrenal crisis. Sex steroids are added later.

Option by option

  • A. Growth hormone

    Growth hormone has no role in the acute treatment.

  • B. Hydrocortisone (correct)

    Correct. Glucocorticoid replacement comes before thyroxine.

  • C. Oestrogen

    Oestrogen is replaced later to restore menses and protect bone.

  • D. Oxytocin

    Oxytocin is posterior pituitary and not required for this deficiency.

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.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Hydrocortisone. Pituitary necrosis after haemorrhage causes panhypopituitarism, and a cortisol deficit must be replaced first because thyroxine can precipitate adrenal crisis.

Why is "Growth hormone" not the answer?

Growth hormone has no role in the acute treatment.

Why is "Oestrogen" not the answer?

Oestrogen is replaced later to restore menses and protect bone.

Why is "Oxytocin" not the answer?

Oxytocin is posterior pituitary and not required for this deficiency.

What concept does this question test?

It tests Postpartum haemorrhage and emergencies: Sheehan syndrome in OBG. Sex steroids are added later.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Postpartum haemorrhage and emergencies: Sheehan syndrome?

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.