Postpartum haemorrhage and emergencies: replacement order in 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: replacement order in Sheehan syndrome

Sample item

A woman with Sheehan syndrome has low cortisol and low free T4. In what order should replacement begin?

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

The answer and the reasoning

C. Hydrocortisone first, then levothyroxine

Glucocorticoid is replaced before thyroid hormone, because thyroxine increases cortisol clearance and metabolic demand and can precipitate an adrenal crisis in a woman with cortisol deficiency. Sex steroids and other hormones follow according to need.

Option by option

  • A. Growth hormone first, then the other hormones

    Growth hormone is not the priority and does not treat the dangerous deficiency.

  • B. Levothyroxine first, then hydrocortisone

    Starting thyroxine first can unmask adrenal insufficiency.

  • C. Hydrocortisone first, then levothyroxine (correct)

    Correct. Cortisol must be restored first to avoid precipitating adrenal crisis.

  • D. Oestrogen-progestogen first, then the other hormones

    Sex steroid replacement is not the priority in a woman with life-threatening cortisol 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.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is C, Hydrocortisone first, then levothyroxine. Glucocorticoid is replaced before thyroid hormone, because thyroxine increases cortisol clearance and metabolic demand and can precipitate an adrenal crisis in a woman with cortisol deficiency.

Why is "Growth hormone first, then the other hormones" not the answer?

Growth hormone is not the priority and does not treat the dangerous deficiency.

Why is "Levothyroxine first, then hydrocortisone" not the answer?

Starting thyroxine first can unmask adrenal insufficiency.

Why is "Oestrogen-progestogen first, then the other hormones" not the answer?

Sex steroid replacement is not the priority in a woman with life-threatening cortisol deficiency.

What concept does this question test?

It tests Postpartum haemorrhage and emergencies: replacement order in Sheehan syndrome in OBG. Sex steroids and other hormones follow according to need.

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 Postpartum haemorrhage and emergencies: replacement order in 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.