Chapter 24: Alterations of the Female Reproductive System

MULTIPLE CHOICE
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
ANS: D

In 95% of children with delayed puberty, the delay is physiologic; that is, hormonal levels are
normal and the hypothalamic-pituitary-gonadal (HPG) axis is intact, but maturation is slowly
happening. This option is the only answer that accurately describes the most common cause of
delayed puberty.
PTS: 1

REF: Page 802

2. What is the first sign of puberty in girls?

a. Breast enlargement
b. Growth of pubic hair

c. Menstruation
d. Vaginal discharge

ANS: A

Of the options available, the first sign of puberty in girls is usually thelarche or breast
development.
PTS: 1

REF: Page 802

3. Which type of precocious puberty causes the child to develop some secondary sex

characteristics of the opposite sex?

a. Mixed
b. Incomplete

c. Isosexual
d. Homosexual

ANS: A

Mixed precocious puberty, which is virilization of a girl or feminization of a boy, causes the
child to develop some secondary sex characteristics of the opposite sex. This option is the
only answer that accurately identifies the type of precocious puberty described.
PTS: 1

REF: Page 804

4. The release of which chemical mediator causes primary dysmenorrhea?

a. Leukotrienes
c. Bradykinin
b. Prostaglandins
d. C-reactive protein
ANS: B

Primary dysmenorrhea is painful menstruation associated with the release of prostaglandins in

ovulatory cycles. This option is the only answer that accurately identifies the chemical
mediator associated with dysmenorrhea.
PTS: 1

REF: Page 804

5. Considering the pathophysiologic characteristics of primary amenorrhea, what anatomic

structure is involved in compartment II?

a. Ovary
b. Anterior pituitary

c. Hypothalamus
d. Vagina

ANS: A

Compartment II disorders involve only the ovary.

PTS: 1

REF: Page 805

6. Considering the pathophysiologic characteristics of primary amenorrhea, what anatomic

structure is involved in compartment IV?

a. Vagina
b. Hypothalamus

c. Ovary
d. Anterior pituitary

ANS: B

Of the options available, only compartment IV disorders include central nervous system
(CNS) conditions, in particular hypothalamic disorders.
PTS: 1

REF: Page 805

7. Which condition is considered a clinical cause of amenorrhea?

a. Disorder in the endometrium
c. Lack of physical exercise
b. Obstruction of the fallopian tubes
d. Failure to ovulate
ANS: D

Depressed ovarian hormone levels, which are associated with a variety of clinical disorders,
also cause amenorrhea by preventing ovulation. This option is the only answer that accurately
identifies a clinical cause of cycle irregularities.
PTS: 1

REF: Page 807

8. Clinical manifestations that include irregular or heavy bleeding, the passage of large clots, and

the depletion of iron stores support which diagnosis?

c. Polycystic ovary syndrome
d. Primary dysmenorrhea

a. Premenstrual syndrome
b. Dysfunctional uterine bleeding
ANS: B

Unpredictable and variable bleeding, in terms of amount and duration, characterize

dysfunctional uterine bleeding. Especially during perimenopause, dysfunctional bleeding also
may involve flooding and the passage of large clots, which often indicate excessive blood
loss. Excessive bleeding can lead to iron-deficiency anemia. This option is the only answer
that demonstrates the clinical manifestations described.
PTS: 1

REF: Page 809

9. What statement concerning the pathogenetic mechanisms of polycystic ovarian syndrome

(POS) is true?
a. POS causes a decrease in leptin levels; this decrease reduces the hypothalamic
pulsatility of gonadotropin-releasing hormone, which reduces the number of
follicles that mature.
b. POS is a result of a disorder in the anterior pituitary that increases the folliclestimulating hormone, which reduces the luteinizing hormone released.
c. POS is a result of a combination of conditions that include oligo-ovulation or

anovulation, elevated levels of androgens, or clinical signs of hyperandrogenism

and polycystic ovaries.
d. POS inhibits testosterone, which stimulates androgen secretion by the ovarian
stroma and indirectly reduces sex hormonebinding globulin.
ANS: C

POS has at least two of the following conditions: oligo-ovulation or anovulation, elevated
levels of androgens, or clinical signs of hyperandrogenism and polycystic ovaries. Of the
options available, only this answer accurately defines the pathogenetic mechanisms of POS.
PTS: 1

REF: Page 810

10. What is the leading cause of infertility in women?

a. Pelvic inflammatory disease
c. Salpingitis
b. Endometriosis
d. Polycystic ovary syndrome
ANS: D

Polycystic ovary syndrome remains one of the most common endocrine disturbances affecting
women, especially young women, and is a leading cause of infertility in the United States.
PTS: 1

REF: Page 810

11. Considering the mediating factors of premenstrual syndrome (PMS), which medication may

be used either continually or only during the menstrual period as a treatment for the
condition?
a. NSAIDs
c. SSRIs
b. Estrogen
d. Progesterone
ANS: C

A selective serotonin reuptake inhibitors (SSRI) (an antidepressant) relieves symptoms in

approximately 60% to 90% of women and may be continually administered or only prescribed
during the premenstrual period. Oral contraceptive pills that contain estrogen and
progesterone also can be continuously used for up to 3 months to decrease the frequency of
menstrual periods, PMS, and premenstrual dysphoric disorder (PMDD). Nonsteriodal
antiinflammatory drugs (NSAIDs) would not be continually administered.
PTS: 1

REF: Page 813

12. Which statement regarding pelvic inflammatory disease (PID) is true?

a. An episode of mild PID can decrease the possibility of a successful pregnancy by

80%.
b. Such an inflammation results in temporary changes to the ciliated epithelium of the

fallopian tubes.
c. PID has not been associated with an increased risk of an ectopic pregnancy.
d. Contracting this infection increases the risk of uterine cancer.
ANS: 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
40% decrease in later pregnancy rates, and multiple episodes of PID further increase the risk
of infertility. Scarring caused by PID greatly increases the risk of a later ectopic pregnancy by
up to tenfold. Scarring and adhesions also can result in chronic pelvic pain and, potentially, an
increased risk of later uterine cancer.
PTS: 1

REF: Pages 813-814

13. When a womans uterus is assessed as protruding through the entrance of the vagina to the

hymen, which grade of prolapse does this indicate?

c. 2
d. 3

a. 0
b. 1

ANS: C

A grade 2 prolapse reaches the hymen (see Figure 24-10).

PTS: 1

REF: Page 818 | Box 24-10

14. Which term is used to identify the descent of the posterior bladder and trigone into the vaginal

canal?
a. Rectocele
b. Vaginocele

c. Cystocele
d. Enterocele

ANS: C

Cystocele is the only term used to identify the descent of a portion of the posterior bladder
wall and trigone into the vaginal canal; the trauma of childbirth is usually the cause.
PTS: 1

REF: Page 819

15. What type of cyst develops when an ovarian follicle is stimulated but no dominant follicle

develops and completes the maturity process?

a. Follicular
c. Corpus albicans
b. Corpus luteal
d. Benign ovarian
ANS: D

Only benign cysts of the ovary are produced when a follicle or a number of follicles are
stimulated but no dominant follicle develops and completes the maturity process.
PTS: 1

REF: Page 820

16. Which term is used to identify benign uterine tumors that develop from smooth muscle cells

in the myometrium and are commonly called uterine fibroids?

c. Leiomyomas
d. Myometriomas

a. Endometrial polyps
b. Myometrial polyps
ANS: C

Leiomyomas, commonly called myomas or uterine fibroids, are benign smooth muscle
tumors in the myometrium (see Figure 24-14). The other terms do not accurately identify the
tumors described.
PTS: 1

REF: Page 821

17. What theory is used to describe the cause of endometriosis?

a. Obstruction within the fallopian tubes prevents the endometrial tissue from

adhering to the lining of the uterus.

b. Endometrial tissue passes through the fallopian tubes and into the peritoneal cavity
and remains responsive to hormones.
c. Inflammation of the endometrial tissue develops after recurrent sexually
transmitted diseases.
d. Endometrial tissue lies dormant in the uterus until the ovaries produce sufficient
hormone to stimulate its growth.
ANS: B

It has been proposed that endometriosis is caused by the implantation of endometrial cells
during retrograde menstruation, during which menstrual fluids move through the fallopian
tubes and empty into the pelvic cavity (see Figure 24-16). Similar to normal endometrial
tissue, the ectopic (out of place) endometrium responds to the hormonal fluctuations of the
menstrual cycle. Of the available options, this answer is the only accepted theory for the cause
of endometriosis.
PTS: 1

REF: Page 823

18. Which virus is a precursor for developing cervical intraepithelial neoplasia (CIN) and cervical

cancer?
a. Human papillomavirus (HPV)
b. Epstein-Barr virus (EBV)

c. Herpes simplex II virus (HSV)

d. Cytomegalovirus (CMV)

ANS: A

Infection with high-risk (oncogenic) types of HPV (predominantly 16 and 18) is a necessary
precursor to the development of precancerous dysplasia of the cervix that leads to invasive
cancer. The other options are not precursors to CIN and cervical cancer.
PTS: 1

REF: Page 825

19. Which description is used when a progressive neoplastic change involves the full epithelial

thickness of the cervix?

a. Cervical intraepithelial neoplasia
b. Cervical dysplasia

c. Cervical carcinoma in situ

d. Invasive carcinoma of the cervix

ANS: C

The progressive neoplastic changes of cervical cells are classified on a continuum from
cervical intraepithelial neoplasia (dysplasia) to cervical carcinoma in situ (full epithelial
thickness of the cervix is involved), which is generally a precursor of invasive carcinoma of
the cervix to invasive carcinoma of the cervical tissue.
PTS: 1

REF: Page 827

20. Which factor increases the risk for ovarian cancer after the age of 40 years?
a. Use of fertility drugs
c. Multiple pregnancies
b. Oral contraceptive use
d. Prolonged lactation
ANS: A

Ovarian cancer in women older than 40 years of age is associated with early menarche, late
menopause, nulliparity, and the use of fertility drugs. The other options are not necessarily
related to women older than the age of 40 years.
PTS: 1

REF: Page 831

21. Infertility is defined as the inability to conceive after how many months of unprotected

intercourse with the same partner?

a. 6
b. 12

c. 18
d. 24

ANS: B

Infertility is defined as the inability to conceive after 1 year of unprotected intercourse with
the same partner.
PTS: 1

REF: Page 835

22. Which of the following is not considered a cause of galactorrhea?

a. Proliferation of the lactiferous ducts of the breast
b. Hypothyroidism, resulting from a decrease in thyroid-releasing hormone
c. Excess prolactin secretion from the pituitary
d. Drugs such as high-dose oral contraceptives and phenothiazines
ANS: A

The most common cause of galactorrhea is nonpuerperal hyperprolactinemia, or excessive

amounts of prolactin. A variety of exogenous agents (such as drugs) and disorders can trigger
one of these three mechanisms, thereby causing hyperprolactinemia. Hypothyroidism causes
increased secretion of hypothalamic thyroid-releasing hormone, which stimulates the release
of prolactin from the pituitary. The proliferation of lactiferous breast ducts is not associated
with galactorrhea.
PTS: 1

REF: Pages 836-837

23. Fluid-filled squishy sacs characterize which breast disorder?

a. Paget disease
c. Nonproliferative breast lesions
b. Cysts
d. Lobular carcinoma in situ
ANS: C

Cysts (fluid-filled sacs) are a specific type of lump that commonly occurs in women in their
30s, 40s, and early 50s. Cysts feel squishy when they occur close to the surface of the breast;
however, when deeply embedded, cysts can feel hard. The other options do not accurately
identify the disorder associated with these symptoms.
PTS: 1

REF: Pages 838-839

24. What are typical findings on breast palpation of a woman diagnosed with simple

fibroadenoma?
a. Painful, round, movable, and fluid-filled mass
b. Painless, movable, hard, and irregular mass
c. Smooth, solid, mobile, and well-circumscribed mass
d. Smooth, nonmovable, irregular, and soft mass

ANS: C

Only this option accurately identifies the typical palpation results of a simple fibroadenoma.
PTS: 1

REF: Pages 840-841

25. Which benign breast tumor affects postmenopausal women and is characterized by the

principal lactiferous ducts becoming dilated and filled with cellular debris?
c. Phyllodes tumor
d. Fibroadenoma

a. Mammary duct ectasia

b. Intraductal papilloma
ANS: A

Of the options available, only mammary duct ectasia is associated with the age and the
identified pathologic characteristics (see Table 24-9).
PTS: 1

REF: Page 838 | Table 24-9

26. The majority of the small percentage of ovarian cancers that are associated with a known

pattern of inheritance are associated with:

Susceptibility of the BRCA1 gene
Mutations of the BRCA2 gene
Hereditary nonpolyposis colorectal cancer (HNPCC) syndrome
Low progesterone levels

a.
b.
c.
d.

ANS: A

The majority (approximately 90%) of ovarian cancers are sporadic and not associated with a
known pattern of inheritance. Of the 5% to 10% that have a familial component, the majority
are associated with the breast cancer susceptibility gene 1 (BRCA1) and a smaller number
with mutations of the BRCA2 or mismatched repair genes (HNPCC syndrome). Low
progesterone levels are not associated with ovarian cancers.
PTS: 1

REF: Page 831

27. What is usually the first clinical manifestation of breast cancer?

a. Nipple dimpling
c. Enlargement of one breast
b. Nipple discharge
d. Painless lump
ANS: D

Invasive carcinoma of the breast generally exhibits a nontender palpable mass or thickened
area. This option is the only answer that accurately describes the first clinical manifestation of
breast cancer.
PTS: 1

REF: Page 873

MULTIPLE RESPONSE
28. What is a recognized treatment for the symptoms often associated with pelvic organ prolapse?

(Select all that apply.)

Pessary
Kegel exercises
Estrogen therapy
Surgical repair

a.
b.
c.
d.

e. Bearing down exercises

ANS: A, B, C, D

A common first-line treatment is a pessary, which is a removable mechanical device that

holds the uterus in position. The pelvic fascia may be strengthened through Kegel exercises
(repetitive isometric tightening and relaxing of the pubococcygeal muscles) or by estrogen
therapy in menopausal women. Maintaining a healthy body mass index, preventing
constipation, and treating chronic cough may help as well. Surgical repair with or without a
hysterectomy is the treatment of last resort. Bearing down would likely exacerbate the
problem.
PTS: 1

REF: Page 818

29. Dysfunctional uterine bleeding (DUB), secondary to ovarian dysfunction, is abnormal uterine

bleeding resulting from: (Select all that apply.)

Endometriosis
Progesterone deficiency
Sexually transmitted infections
Congenital abnormalities in the uterine structure
Estrogen excess

a.
b.
c.
d.
e.

ANS: B, E

Of the options available, DUB, secondary to ovarian dysfunction, is a result of either

progesterone deficiency or unopposed estrogen excess.
PTS: 1

REF: Pages 808-809

30. The size of benign uterine tumors, such as leiomyomas, is thought to be caused by the

influence of which hormone? (Select all that apply.)

Progesterone
Estrogen
Luteinizing hormone
Gonadotropin-stimulating hormone
Growth factors

a.
b.
c.
d.
e.

ANS: A, B, E

The cause of uterine leiomyomas is unknown, although their size appears to be related to only
estrogen, progesterone, growth factors, angiogenesis, and apoptosis.
PTS: 1

REF: Page 822

31. What are the common clinical manifestations of endometriosis? (Select all that apply.)
a. Back and flank pain
b. Infertility
c. Dysuria
d. Amenorrhea
e. Dysmenorrhea
ANS: B, E

Common clinical manifestations primarily include infertility, dysmenorrhea, dyschezia (pain

on defecation), and dyspareunia (pain on intercourse).

PTS: 1

REF: Page 824