Chapter 25

Question 1

What is usually the first clinical manifestation of breast cancer?
a. Nipple dimpling
c. Enlargement of one breast
b. Nipple discharge
d. Painless lump

Answer 1

d. Painless lump

Question 2

In 95% of children of delayed puberty, the problem is caused by:
a. Disruption in the hypothalamus
b. Disruption of the pituitary
c. Deficit in estrogen or testosterone
d. Physiologic hormonal delays

Answer 2

d. Physiologic hormonal delays

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.

Question 3

What is the first sign of puberty in girls?
a. Breast enlargement
b. Growth of pubic hair
c. Menstruation
d. Vaginal discharge

Answer 3

a. Breast enlargement

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

Question 4

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

Answer 4

a. Mixed

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.

Question 5

The release of which chemical mediator causes primary dysmenorrhea?
a. Leukotrienes
b. Prostaglandins
c. Bradykinin
d. C-reactive protein

Answer 5

b. Prostaglandins

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.

Question 6

Considering the pathophysiologic characteristics of primary amenorrhea, what anatomic structure is involved in compartment II?
a. Ovary
b. Anterior pituitary
c. Hypothalamus
d. Vagina

Answer 6

a. Ovary

Compartment II disorders involve only the ovary.

Question 7

Considering the pathophysiologic characteristics of primary amenorrhea, what anatomic structure is involved in compartment IV?
a. Vagina
b. Hypothalamus
c. Ovary
d. Anterior pituitary

Answer 7

b. Hypothalamus

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

Question 8

Which condition is considered a clinical cause of amenorrhea?
a. Disorder in the endometrium
b. Obstruction of the fallopian tubes
c. Lack of physical exercise
d. Failure to ovulate

Answer 8

d. Failure to ovulate

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.

Question 9

Clinical manifestations that include irregular or heavy bleeding, the passage of large clots, and the depletion of iron stores support which diagnosis?
a. Premenstrual syndrome
b. Dysfunctional uterine bleeding
c. Polycystic ovary syndrome
d. Primary dysmenorrhea

Answer 9

b. Dysfunctional uterine bleeding

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.

Question 10

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 follicle-stimulating 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 hormone-binding globulin.

Answer 10

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.

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.

Question 11

What is the leading cause of infertility in women?
a. Pelvic inflammatory disease
b. Endometriosis
c. Salpingitis
d. Polycystic ovary syndrome

Answer 11

d. Polycystic ovary syndrome

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.

Question 12

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
b. Estrogen
c. SSRIs
d. Progesterone

Answer 12

c. SSRIs

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.

Question 13

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

Answer 13

d. Contracting this infection increases the risk of uterine cancer

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.

Question 14

When a woman’s uterus is assessed as protruding through the entrance of the vagina to the hymen, which grade of prolapse does this indicate?
a. 0
b. 1
c. 2
d. 3

Answer 14

c. 2

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

Question 15

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

Answer 15

c. Cystocele

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.

Question 16

What type of cyst develops when an ovarian follicle is stimulated but no dominant follicle develops and completes the maturity process?
a. Follicular
b. Corpus luteal
c. Corpus albicans
d. Benign ovarian

Answer 16

d. Benign ovarian

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.

Question 17

Which term is used to identify benign uterine tumors that develop from smooth muscle cells in the myometrium and are commonly called uterine fibroids?
a. Endometrial polyps
b. Myometrial polyps
c. Leiomyomas
d. Myometriomas

Answer 17

c. Leiomyomas

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.

Question 18

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.

Answer 18

b. Endometrial tissue passes through the fallopian tubes and into the peritoneal cavity and remains responsive to hormones.

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.

Question 19

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)

Answer 19

a. Human papillomavirus (HPV)

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.

Question 20

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

Answer 20

c. Cervical carcinoma in situ

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.

Question 21

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

Answer 21

a. Use of fertility drugs

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.

Question 22

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

Answer 22

b. 12

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

Question 23

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

Answer 23

a. Proliferation of the lactiferous ducts of the breast

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.

Question 24

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

Answer 24

a. Proliferation of the lactiferous ducts of the breast

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.

Question 25

Fluid-filled squishy sacs characterize which breast disorder?
a. Paget disease
b. Cysts
c. Nonproliferative breast lesions
d. Lobular carcinoma in situ

Answer 25

c. Nonproliferative breast lesions

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.

Question 26

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

Answer 26

c. Smooth, solid, mobile, and well-circumscribed mass

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

Question 27

Which benign breast tumor affects postmenopausal women and is characterized by the principal lactiferous ducts becoming dilated and filled with cellular debris?
a. Mammary duct ectasia
b. Intraductal papilloma
c. Phyllodes tumor
d. Fibroadenoma

Answer 27

a. Mammary duct ectasia

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

Question 28

The majority of the small percentage of ovarian cancers that are associated with a known pattern of inheritance are associated with:
a. Susceptibility of the BRCA1 gene
b. Mutations of the BRCA2 gene
c. Hereditary nonpolyposis colorectal cancer (HNPCC) syndrome
d. Low progesterone levels

Answer 28

a. Susceptibility of the BRCA1 gene

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

Question 29

What is usually the first clinical manifestation of breast cancer?
a. Nipple dimpling
b. Nipple discharge
c. Enlargement of one breast
d. Painless lump

Answer 29

d. Painless lump

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.