Chapter 24: Alterations of the Female Reproductive System MULT!L" C#$C"
1. In 95% of children of delayed puberty, the problem is caused by: a. Disruption in the hypothalamus c. Deficit in estrogen or testosterone b. Disruption of the pituitary d. Physiologic hormonal delays A!: D
In 95% of children "ith delayed puberty, the delay is physiologic# that is, hormonal le$els are normal and the hypothalamicpituitarygonadal &'P() a*is is intact, but maturation is slo"ly happening. +his option is the only ans"er that accurately describes the most common cause of delayed puberty. P+!: 1
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. 2hat is the first sign of puberty in girls3 a. 4reast enlargement b. (ro"th of pubic hair
c. enstruation d. 6aginal discharge
A!: A
7f the options a$ailable, the first sign of puberty in girls is usually thelarche or breast de$elopment. P+!: 1
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8. 2hich type of precocious puberty causes the child to de$elop some secondary se*
characteristics of the opposite se*3 a. i*ed b. Incomplete
c. Isose*ual d. 'omose*ual
A!: A
i*ed precocious puberty, "hich is $iriliation of a girl or feminiation of a boy, causes the child to de$elop some secondary se* characteristics of the opposite se*. +his option is the only ans"er that accurately identifies the type of precocious puberty described. P+!: 1
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. +he release of "hich chemical mediator causes primary dysmenorrhea3 a. ;eu
Primary dysmenorrhea is painful menstruation associated "ith the release of prostaglandins in o$ulatory cycles. +his option is the only ans"er that ac curately identifies the chemical mediator associated "ith dysmenorrhea. P+!: 1
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5. =onsidering the pathophysiologic characteristics of primary amenorrhea, "hat anatomic
structure is in$ol$ed in compartment II3
a. 7$ary b. Anterior pituitary
c. 'ypothalamus d. 6agina
A!: A
=ompartment II disorders in$ol$e only the o$ary. P+!: 1
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>. =onsidering the pathophysiologic characteristics of primary amenorrhea, "hat anatomic
structure is in$ol$ed in compartment I63 a. 6agina c. 7$ary b. 'ypothalamus d. Anterior pituitary A!: 4
7f the options a$ailable, only compartment I6 disorders include central ner$ous system &=!) conditions, in particular hypothalamic disorders. P+!: 1
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?. 2hich condition is considered a clinical cause of amenorrhea3 a. Disorder in the endometrium c. ;ac< of physical e*ercise b. 7bstruction of the fallopian tubes d. ailure to o$ulate A!: D
Depressed o$arian hormone le$els, "hich are a ssociated "ith a $ariety of clinical disorders, also cause amenorrhea by pre$enting o$ulation. +his option is the only ans"er that accurately identifies a clinical cause of cycle irregularities. P+!: 1
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/. =linical manifestations that include irregular or hea$y bleeding, the p assage of large clots, and
the depletion of iron stores support "hich diagnosis3 a. Premenstrual syndrome c. Polycystic o$ary syndrome b. Dysfunctional uterine bleeding d. Primary dysmenorrhea A!: 4
@npredictable and $ariable bleeding, in terms of amount and duration, characterie dysfunctional uterine bleeding. -specially during perimenopause, dysfunctional bleeding also may in$ol$e flooding and the passage of large clots, "hich often indicate e*cessi$e blood loss. -*cessi$e bleeding can lead to irondeficiency anemia. +his option is the only ans"er that demonstrates the clinical manifestations described. de scribed. P+!: 1
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9. 2hat statement concerning the pathogenetic mechan isms of polycystic o$arian syndrome
&P7!) is true3 true3 a. P7! causes a decrease in leptin le$els# this decrease reduces the hypothalamic pulsatility of gonadotropinreleasing hormone, "hich reduces the number of follicles that mature. b. P7! is a result of a disorder in the anterior pituitary that increases the follicle stimulating hormone, "hich reduces the luteiniing hormone released. c. P7! is a result of a combination of conditions that include oligoo$ulation or
ano$ulation, ele$ated le$els of androgens, or clinical signs of hyperandrogenism and polycystic o$aries. d. P7! inhibits testosterone, "hich stimulates androgen secretion by the o$arian stroma and indirectly reduces se* hormonebinding globulin. A!: =
P7! has at least t"o of the follo"ing conditions: oligoo$ulation or an o$ulation, ele$ated le$els of androgens, or clinical signs of hyperandrogenism h yperandrogenism and polycystic o$aries. 7f the options a$ailable, only this ans"er accurately defines the pathogenetic mechanisms of P7!. P+!: 1
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10. 2hat is the leading cause of infertility in "omen3 a. Pel$ic inflammatory disease c. !alpingitis b. -ndometriosis d. Polycystic o$ary syndrome A!: D
Polycystic o$ary syndrome remains one of the most common endocrine disturbances affecting "omen, especially young "omen, and is a leading cause of infertility in the @nited !tates. P+!: 1
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11. =onsidering the mediating factors of premenstrual syndrome &P!), "hich medication may
be used either continually or only during the menstrual period as a treatment for the condition3 a. !AIDs c. !!Is b. -strogen d. Progesterone A!: =
A selecti$e serotonin reupta0% to 90% of "omen and may be continually administered or only prescribed during the premenstrual period. 7ral contracepti$e pills that contain estrogen and progesterone also can be continuously used for up to 8 months to decrease the freBuency of menstrual periods, P!, and premenstrual dysphoric disorder &PDD). onsteriodal antiinflammatory drugs &!AIDs) "ould not be continually administered. P+!: 1
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1. 2hich statement regarding pel$ic inflammatory disease &PID) is true3 true3 a. An episode of mild PID can decrease the possibility of a successful pregnancy by
/0%. b. !uch an inflammation results in temporary changes to the ciliated epithelium of the fallopian tubes. c. PID has not been associated "ith an increased ris< of an ectopic pregnancy. pregnanc y. d. =ontracting this infection increases the ris< of uterine cancer. A!: D
PID infection results in permanent changes to the ciliated epithelium of the fallopian or uterine tubes. A recent study has found that one episode of mild, subclinical PID resulted in a 0% decrease in later pregnancy rates, and multiple episodes of PID further increase the ris< of infertility. infertility. !carring caused by PID greatly increases the ris< of a later ectopic pregnancy by by up to tenfold. !carring and adhesions ad hesions also can result in chronic pel$ic pain and, potentially, an increased ris< of later uterine cancer. P+!: 1
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18. 2hen a "omanCs uterus is assessed as protruding through the entrance of the $agina to the
hymen, "hich grade of prolapse p rolapse does this indicate3 a. 0 c. b. 1 d. 8 A!: =
A grade prolapse reaches the hymen &see igure 10). P+!: 1
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1. 2hich term is used to identify the descent of o f the posterior bladder and trigone into the $aginal
canal3 a. ectocele b. 6aginocele
c. =ystocele d. -nterocele
A!: =
=ystocele is the only term used to identify the descent of a portion of the posterior bladder "all and trigone into the $aginal canal# can al# the trauma of childbirth is usually the cause. P+!: 1
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15. 2hat type of cyst de$elops "hen an a n o$arian follicle is stimulated but no dominant follicle
de$elops and completes the maturity process3 a. ollicular c. =orpus albicans b. =orpus luteal d. 4enign o$arian A!: D
7nly benign cysts of the o$ary are produced "hen a follicle or a number of follicles are stimulated but no dominant follicle de$elops and co mpletes the maturity process. P+!: 1
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1>. 2hich term is used to identify benign uterine tumors that de$elop from smooth muscle cells
in the myometrium and are commonly called uterine fibroids3 fibroids3 c. ;eiomyomas d. yometriomas
a. -ndometrial polyps b. yometrial polyps A!: =
Leiomyomas% commonly called myomas or uterine fibroids% are benign smooth muscle tumors in the myometrium &see igure 1). +he other terms do not accurately identify the tumors described. P+!: 1
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cau se of endometriosis3 1?. 2hat theory is used to describe the cause a. 7bstruction "ithin the fallopian tubes pre$ents the endometrial tissue from adhering to the lining of the uterus. b. -ndometrial tissue passes through the fallopian tubes and into the p eritoneal ca$ity and remains responsi$e to hormones. c. Inflammation of the endometrial tissue de$elops after recurrent se*ually transmitted diseases. d. -ndometrial tissue lies dormant in the uterus until the o$aries produce sufficient hormone to stimulate its gro"th. A!: 4
It has been proposed that endometriosis is caused by the implantation of endometrial cells during retrograde menstruation, during "hich menstrual fluids mo$e through the fallopian tubes and empty into the pel$ic ca$ity &see igure 1>). !imilar to normal endometrial tissue, the ectopic &out of place) endometrium endo metrium responds to the hormonal fluctuations of the menstrual cycle. 7f the a$ailable options, this ans"er is the only accepted theory for the cause ca use of endometriosis. P+!: 1
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1/. 2hich $irus is a precursor for de$eloping cer$ical intraepithelial neoplasia &=I) and cer$ical
cancer3 a. 'uman papilloma$irus &'P6) b. -pstein4arr $irus &-46)
c. 'erpes simple* II $irus &'!6) d. =ytomegalo$irus &=6)
A!: A
Infection "ith highris< &oncogenic) types of 'P6 &predominantly 1> and 1/) is a necessary precursor to the de$elopment of precancerous dysplasia of the cer$i* that leads to in$asi$e cancer. +he other options are not precursors to =I and cer$ical cancer. P+!: 1
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19. 2hich description is used "hen a progressi$e neoplastic chan ge in$ol$es the full epithelial
thic
c. =er$ical carcinoma in situ d. In$asi$e carcinoma of the cer$i*
A!: =
+he progressi$e neoplastic changes of cer$ical cells are classified on a continuum from cer$ical intraepithelial neoplasia &dysplasia) to cer$ical carcinoma in situ &full epithelial thic
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0. 2hich factor increases the ris< for o$arian cancer after the age of 0 years3 a. @se of fertility drugs c. ultiple pregnancies b. 7ral contracepti$e use d. Prolonged lactation A!: A
7$arian cancer in "omen older than 0 years of age is associated a ssociated "ith early menarche, late menopause, nulliparity, and the use of fertility drugs. +he other options are not necessarily related to "omen older than the age of 0 years. P+!: 1
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1. Infertility is defined as the inability to concei$e after ho" man y months of unprotected
intercourse "ith the same partner3 a. > b. 1
c. 1/ d.
A!: 4
Infertility is defined as the inability to concei$e after 1 year of unprotected intercourse "ith the same partner. P+!: 1
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considered a cause of galactorrhea3 . 2hich of the follo"ing is not considered a. Proliferation of the lactiferous ducts of the breast b. 'ypothyroidism, resulting from a decrease in thyroidreleasing hormone c. -*cess prolactin secretion from the pituitary d. Drugs such as highdose oral contracepti$es and p henothiaines A!: A
+he most common cause of galactorrhea ga lactorrhea is nonpuerperal hyperprolactinemia, or e*cessi$e amounts of prolactin. A $ariety of e*ogenous agents &such as drugs) and disorders can trigger one of these three mechanisms, thereby causing hyperprolactinemia. 'ypothyroidism causes increased secretion of hypothalamic thyroidreleasing hormone, "hich stimulates the release of prolactin from the pituitary. +he proliferation of lactiferous breast ducts du cts is not associated "ith galactorrhea. P+!: 1
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8. luidfilled squishy luidfilled squishy sacs sacs characterie "hich breast disorder3 a. Paget disease c. onproliferati$e breast lesions b. =ysts d. ;obular carcinoma in situ A!: =
Cysts &fluidfilled Cysts &fluidfilled sacs) are a specific type of lump that commonly occurs in "omen in their 80s, 0s, and early 50s. =ysts feel sBuishy "hen they occur close to the surface of the breast# ho"e$er, "hen deeply embedded, cysts can feel hard. +he other options do not accurately a ccurately identify the disorder associated "ith these symptoms. P+!: 1
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. 2hat are typical findings on breast palpation of a "oman diagnosed "ith simple
fibroadenoma3 Painful, round, mo$able, and fluidfilled mass Painless, mo$able, hard, and irregular mass !mooth, solid, mobile, and "ellcircumscribed mass !mooth, nonmo$able, irregular, and soft mass
a. b. c. d.
A!: =
7nly this option accurately identifies the typical palpation results of a simple fibroadenoma. P+!: 1
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5. 2hich benign breast tumor affects postmenopausal "omen and is characteried by the
principal lactiferous ducts becoming dilated and filled "ith cellular debris3 debris3 a. ammary duct ectasia c. Phyllodes tumor b. Intraductal papilloma d. ibroadenoma A!: A
7f the options a$ailable, only mammary duct du ct ectasia is associated "ith the age and the identified pathologic characteristics ch aracteristics &see +able +able 9). P+!: 1
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>. +he maEority of the small percentage of o$arian o $arian cancers that are associated "ith a
pattern of inheritance are associated "ith: a. Susceptibility of the BRCA1 gene b. utations of the BRCA2 the BRCA2 gene gene c. 'ereditary nonpolyposis colorectal cancer &'P==) syndrome d. ;o" progesterone le$els A!: A
+he maEority &appro*imately 90%) of o$arian cancers are sporadic and not associated "ith a
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?. 2hat is usually the first clinical manifestation of breast cancer3 a. ipple dimpling c. -nlargement of one breast b. ipple discharge d. Painless lump A!: D
In$asi$e carcinoma of the breast generally e*hibits a nontender palpable mass or thic
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MULT!L" R"S!$&S"
/. 2hat is a recognied treatment for the symptoms often associated "ith pel$ic organ prolapse3
(Select all that apply.) a. Pessary b. Fegel e*ercises c. -strogen therapy d. !urgical repair
e.
4earing do"n e*ercises
A!: A!: A, 4, 4, =, =, D
A common firstline treatment is a pessary a pessary,, "hich is a remo$able mechanical de$ice that holds the uterus in position. +he pel$ic fascia may b e strengthened through Fegel e*ercises &repetiti$e isometric tightening and rela*ing of the pubococcygeal muscles) or by estrogen therapy in menopausal "omen. aintaining a healthy body mass inde*, pre$enting constipation, and treating chronic cough may help as "ell. !urgical repair "ith or "ithout a hysterectomy is the treatment of last resort. 4earing do"n "ould li
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9. Dysfunctional uterine bleeding &D@4), secondary to o$arian d ysfunction, is abnormal uterine
bleeding resulting from: (Select all that apply.) a. -ndometriosis b. Progesterone deficiency c. !e*ually transmitted infections d. =ongenital abnormalities in the uterine structure e. -strogen e*cess A!: 4, -
7f the options a$ailable, D@4, secondary to o$arian dysfunction, is a result of either progesterone deficiency or unopposed estrogen e*cess. P+!: 1
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80. +he sie of benign uterine tumors, such as leiomyomas, is thought to be caused by the
influence of "hich hormone3 (Select all that apply.) Progesterone -strogen ;uteiniing hormone (onadotropinstimulating hormone (ro"th factors
a. b. c. d. e.
A!: A, 4, 4, -
+he cause of uterine leiomyomas is un
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81. 2hat are the common clinical manifestations of endometriosis3 (Select all that apply.) a. 4ac< and flan< pain b. Infertility c. Dysuria d. Amenorrhea e. Dysmenorrhea A!: 4, -
=ommon clinical manifestations primarily include infertility, dysmenorrhea, dyscheia &pain on defecation), and dyspareunia &pain on intercourse).
P+!: 1
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