Chapter 25: Alterations of the Female Reproductive System

Question 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

Answer 1

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

Question 2

What is the first sign of puberty in girls?

a. Breast enlargement
c. Menstruation
b. Growth of pubic hair
d. Vaginal discharge

Answer 2

ANS: A
Of the options available, the first sign of puberty in girls is usually thelarche or breast
development.
PTS: 1 REF: Page 802

Question 3

Which type of precocious puberty causes the child to develop some secondary sex
characteristics of the opposite sex?
a. Mixed 
c. Isosexual
b. Incomplete 
d. Homosexual

Answer 3

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

Question 4

The release of which chemical mediator causes primary dysmenorrhea?

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

Answer 4

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

Question 5

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

Answer 5

ANS: A
Compartment II disorders involve only the ovary.
PTS: 1 REF: Page 805

Question 6

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

Answer 6

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

Question 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

Answer 7

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

Question 8

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
c. Polycystic ovary syndrome
b. Dysfunctional uterine bleeding
d. Primary dysmenorrhea

Answer 8

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

Question 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
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 9

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

Question 10

What is the leading cause of infertility in women?

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

Answer 10

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

Question 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

Answer 11

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

Question 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.

Answer 12

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

Question 13

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
c. 2
b. 1
d. 3

Answer 13

ANS: C
A grade 2 prolapse reaches the hymen (see Figure 24-10).
PTS: 1 REF: Page 818 | Box 24-10

Question 14

Which term is used to identify the descent of the posterior bladder and trigone into the
vaginal canal?
a. Rectocele 
c. Cystocele
b. Vaginocele 
d. Enterocele

Answer 14

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

Question 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

Answer 15

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

Question 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?
a. Endometrial polyps
c. Leiomyomas
b. Myometrial polyps
d. Myometriomas

Answer 16

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

Question 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

Answer 17

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

Question 18

Which virus is a precursor for developing cervical intraepithelial neoplasia (CIN) and
cervical cancer?
a. Human papillomavirus (HPV) 
c. Herpes simplex II virus (HSV)
b. Epstein-Barr virus (EBV) 
d. Cytomegalovirus (CMV)

Answer 18

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

Question 19

Which description is used when a progressive neoplastic change involves the full epithelial
thickness of the cervix?
a. Cervical intraepithelial neoplasia 
c. Cervical carcinoma in situ
b. Cervical dysplasia 
d. Invasive carcinoma of the cervix

Answer 19

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

Question 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

Answer 20

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

Question 21

Infertility is defined as the inability to conceive after how many months of unprotected
intercourse with the same partner?
a. 6 
c. 18
b. 12 
d. 24

Answer 21

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

Question 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

Answer 22

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

Question 23

Fluid-filled squishy sacs characterize which breast disorder?

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

Answer 23

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

Question 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

Answer 24

ANS: C
Only this option accurately identifies the typical palpation results of a simple
fibroadenoma.
PTS: 1 REF: Pages 840-841

Question 25

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
c. Phyllodes tumor
b. Intraductal papilloma
d. Fibroadenoma

Answer 25

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

Question 26

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 26

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

Question 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

Answer 27

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

Question 28

What is a recognized treatment for the symptoms often associated with pelvic organ
prolapse? (Select all that apply.)
a. Pessary
b. Kegel exercises
c. Estrogen therapy
d. Surgical repair
e. Bearing down exercises

Answer 28

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

Question 29

Dysfunctional uterine bleeding (DUB), secondary to ovarian dysfunction, is abnormal
uterine bleeding resulting from: (Select all that apply.)
a. Endometriosis
b. Progesterone deficiency
c. Sexually transmitted infections
d. Congenital abnormalities in the uterine structure
e. Estrogen excess

Answer 29

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

Question 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.)
a. Progesterone
b. Estrogen
c. Luteinizing hormone
d. Gonadotropin-stimulating hormone
e. Growth factors

Answer 30

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

Question 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

Answer 31

ANS: B, E
Common clinical manifestations primarily include infertility, dysmenorrhea, dyschezia
(pain on defecation), and dyspareunia (pain on intercourse).