Q.1 Which of the following is the most common cause of secondary amenorrhea in reproductive-aged women?
Polycystic ovary syndrome (PCOS)
Pregnancy
Thyroid dysfunction
Hyperprolactinemia
Explanation - Secondary amenorrhea is most commonly caused by pregnancy. Other endocrine causes like PCOS, thyroid dysfunction, and hyperprolactinemia are less common.
Correct answer is: Pregnancy
Q.2 Menorrhagia is best defined as:
Painful menstruation
Menstrual bleeding lasting more than 7 days or >80 mL per cycle
Absence of menstruation for more than 6 months
Irregular bleeding between cycles
Explanation - Menorrhagia refers to abnormally heavy or prolonged menstrual bleeding, typically >80 mL or lasting more than 7 days.
Correct answer is: Menstrual bleeding lasting more than 7 days or >80 mL per cycle
Q.3 Which hormone primarily regulates the proliferative phase of the menstrual cycle?
Progesterone
Estrogen
LH
FSH
Explanation - The proliferative phase is dominated by estrogen, which stimulates endometrial growth after menstruation.
Correct answer is: Estrogen
Q.4 Which of the following is a typical feature of primary dysmenorrhea?
Occurs in women over 35
Associated with pelvic pathology
Begins within 6–12 months of menarche
Occurs irregularly after menopause
Explanation - Primary dysmenorrhea usually begins shortly after menarche and is not associated with pelvic pathology.
Correct answer is: Begins within 6–12 months of menarche
Q.5 Polycystic ovary syndrome (PCOS) is most commonly associated with which menstrual abnormality?
Hypomenorrhea
Amenorrhea or oligomenorrhea
Menorrhagia
Postmenopausal bleeding
Explanation - PCOS commonly presents with irregular or absent menstrual cycles due to anovulation.
Correct answer is: Amenorrhea or oligomenorrhea
Q.6 Which of the following is the first-line treatment for primary dysmenorrhea?
Oral contraceptive pills
NSAIDs
GnRH agonists
Endometrial ablation
Explanation - NSAIDs are first-line because they inhibit prostaglandin synthesis, reducing menstrual pain.
Correct answer is: NSAIDs
Q.7 A 28-year-old woman presents with heavy, irregular periods for 6 months. Her physical exam is normal. Which is the most likely cause?
Pregnancy
Anovulation
Endometrial cancer
Pelvic infection
Explanation - In reproductive-aged women with normal physical exams, anovulatory cycles are the most common cause of abnormal uterine bleeding.
Correct answer is: Anovulation
Q.8 Which lab test is most appropriate to initially evaluate amenorrhea?
Serum prolactin
FSH, LH, and pregnancy test
Endometrial biopsy
Pelvic MRI
Explanation - Initial evaluation should rule out pregnancy and assess ovarian function with FSH and LH.
Correct answer is: FSH, LH, and pregnancy test
Q.9 Premenstrual syndrome (PMS) typically occurs in which phase of the menstrual cycle?
Follicular phase
Ovulatory phase
Luteal phase
Menstrual phase
Explanation - PMS symptoms occur in the luteal phase and resolve with the onset of menstruation.
Correct answer is: Luteal phase
Q.10 Which of the following is a risk factor for developing endometriosis?
Late menarche
Short menstrual cycles
Multiparity
Obesity
Explanation - Short cycles increase retrograde menstruation exposure, a key factor in endometriosis development.
Correct answer is: Short menstrual cycles
Q.11 Which structural abnormality is a common cause of secondary dysmenorrhea?
Endometriosis
Primary ovarian insufficiency
PCOS
Hyperprolactinemia
Explanation - Secondary dysmenorrhea is due to underlying pathology, most commonly endometriosis.
Correct answer is: Endometriosis
Q.12 Oligomenorrhea is defined as menstrual cycles occurring at intervals of:
<21 days
21–35 days
>35 days
>90 days
Explanation - Oligomenorrhea refers to infrequent menstruation, with cycles longer than 35 days.
Correct answer is: >35 days
Q.13 Which of the following medications can commonly cause abnormal uterine bleeding?
NSAIDs
Warfarin
Metformin
Levothyroxine
Explanation - Anticoagulants like warfarin can increase menstrual bleeding.
Correct answer is: Warfarin
Q.14 Which of the following is a hallmark of anovulatory cycles?
Regular menstrual flow with ovulation
Irregular menstrual cycles without ovulation
Painful menstruation
Excessive progesterone secretion
Explanation - Anovulatory cycles are characterized by irregular bleeding due to lack of ovulation and progesterone production.
Correct answer is: Irregular menstrual cycles without ovulation
Q.15 Postmenopausal bleeding warrants which of the following investigations first?
Endometrial biopsy
Pelvic ultrasound
Hormone assay
MRI pelvis
Explanation - Postmenopausal bleeding may indicate endometrial cancer, so biopsy is the first-line investigation.
Correct answer is: Endometrial biopsy
Q.16 Which of the following is characteristic of primary amenorrhea due to Turner syndrome?
Normal stature
Delayed puberty and streak ovaries
Early menarche
Excess androgen production
Explanation - Turner syndrome patients have gonadal dysgenesis with streak ovaries leading to primary amenorrhea and delayed puberty.
Correct answer is: Delayed puberty and streak ovaries
Q.17 Which diagnostic tool is most useful for evaluating structural causes of abnormal uterine bleeding?
Hysteroscopy
Serum LH assay
Pelvic X-ray
Thyroid function test
Explanation - Hysteroscopy allows direct visualization and diagnosis of uterine structural abnormalities like polyps or fibroids.
Correct answer is: Hysteroscopy
Q.18 Which of the following is a common cause of hypomenorrhea in adolescents?
Anovulatory cycles
PCOS
Pregnancy
Hypothalamic immaturity
Explanation - In early adolescence, hypomenorrhea may occur due to immature hypothalamic-pituitary-ovarian axis.
Correct answer is: Hypothalamic immaturity
Q.19 Premature ovarian insufficiency is diagnosed when menopause occurs before which age?
35
40
45
50
Explanation - Premature ovarian insufficiency (POI) is defined by loss of ovarian function before age 40.
Correct answer is: 40
Q.20 Which of the following is a common non-structural cause of heavy menstrual bleeding?
Adenomyosis
Fibroids
Coagulopathy
Polyps
Explanation - Systemic causes like coagulation disorders (e.g., von Willebrand disease) can lead to heavy menstrual bleeding.
Correct answer is: Coagulopathy
Q.21 Which of the following best describes dysfunctional uterine bleeding (DUB)?
Bleeding due to pelvic pathology
Abnormal bleeding with no identifiable cause
Bleeding after menopause
Bleeding due to trauma
Explanation - DUB refers to abnormal uterine bleeding without structural or systemic causes, often hormonal in origin.
Correct answer is: Abnormal bleeding with no identifiable cause
Q.22 Which imaging modality is preferred for evaluating suspected endometrial hyperplasia?
Transvaginal ultrasound
CT scan
MRI pelvis
Hysterosalpingography
Explanation - Transvaginal ultrasound can measure endometrial thickness and guide further evaluation for hyperplasia.
Correct answer is: Transvaginal ultrasound
Q.23 Which of the following is a hallmark symptom of premenstrual dysphoric disorder (PMDD)?
Severe mood swings during luteal phase
Amenorrhea
Heavy menstrual bleeding
Painful menstruation
Explanation - PMDD is characterized by severe emotional and mood disturbances in the luteal phase of the cycle.
Correct answer is: Severe mood swings during luteal phase
Q.24 Which condition is associated with absent menstruation, short stature, and webbed neck?
Turner syndrome
Klinefelter syndrome
Androgen insensitivity syndrome
PCOS
Explanation - Turner syndrome presents with primary amenorrhea, short stature, and classic physical features like webbed neck.
Correct answer is: Turner syndrome
Q.25 Which of the following is a characteristic finding in secondary amenorrhea due to hyperprolactinemia?
Galactorrhea
Hirsutism
Obesity
Menorrhagia
Explanation - Hyperprolactinemia can inhibit GnRH, leading to amenorrhea and often galactorrhea.
Correct answer is: Galactorrhea