A Quiz On Reproductive Physiology
As we age, our body changes in different ways, and with this comes to some diseases and puts some more difficulty in reproduction. We must understand everything about reproductive physiology and how to make corrective measures to some of the reproduction problems one may face. This quiz will test your knowledge of the same.
Questions and Answers
- 1.
A 24 yo man visits his dermatologist. The man is extremely upset because he is suffering from male pattern baldness. None of his older brothers exhibit male pattern baldness. Further, this man was under the assumption that hair growth and baldness were traits inherited through his mother's genes, and he notes his maternal grandfather is 76 yo sporting a full head of thick hair. What hormone is usually elevated in young men experiencing male pattern baldness?
- A.
Testosterone
- B.
Dehydroepiandrosterone (DHEA)
- C.
Androstenedione
- D.
Androstenediol
- E.
Dihydrotestosterone
Correct Answer
E. DihydrotestosteroneExplanation
Testosterone is converted intracellarly by the 5 alpha‐reductase enzyme to
dihydrotestosterone (DHT) in the prostate gland, sebaceous glands, hair follicles and testis. Changes in the localized
levels of DHT are associated with adverse prostate function, and elevated levels of DHT in hair follicles are associated
with male pattern baldness.
DHT and testosterone both bind to the androgen receptor. However, DHT exhibits a greater affinity for the androgen
receptor, and therefore able to exert heightened effects at lower concentrations.Rate this question:
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- 2.
A 26 yo male visits his primary care physician (PCP). The man complains of lethargy and muscle weakness. He then explains to his PCP that he and his wife have been trying to get pregnant for the past 8 months with no success. The man further explains that sometimes he is unable to maintain an erection, and because he can't match his wife's libido he is feeling depressed. His PCP suspects this man may have decreased levels of testosterone. Which of the following hormone assays should the PCP order to determine if this man has low testosterone as a result of an impaired hypothalamic‐pituitary‐testicular axis?
- A.
Testesterone and dehydrotestosterone
- B.
Dehydrotestosterone and prolactin
- C.
Testosterone and follicle stimulating hormone
- D.
Luteinizing hormone and follicle stimulating hormone
- E.
Testosterone and luteinizing hormone
Correct Answer
E. Testosterone and luteinizing hormoneExplanation
Luteinizing hormone (LH) works directly on the interstitial cells of Leydig (i.e.
Leydig cells) to stimulate the production of testosterone. Low levels of LH can result in decreased levels of testosterone,
which can subsequently lead to decreased sperm production. Remember that LH acts directly on the Leydig cells, and
then the testosterone generated within the Leydig cells acts on the Sertoli cells to regulate spermatogenesis Prolonged
exposure to low levels of testosterone can also lead to systemic effects, such as decreased muscle mass and/or lethargy.
Evaluating the levels of DHT and FSH would also be beneficial, since levels of DHT are directly correlated with levels of
testosterone and FSH is also required by the Sertoli cells during the process of spermatogenesis. Additionally, checking
the levels of prolactin could be informative, since prolactin helps stimulate the expression of the LH receptors.
However, in this particular case the PCP suspects a problem with testosterone production and/or secretion, and
therefore the first step is to directly measure serum levels of testosterone and LH.Rate this question:
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- 3.
A mature spermatazoan typically survives for how many weeks?
- A.
1‐2 weeks
- B.
3‐4 weeks
- C.
4‐6 weeks
- D.
6‐10 weeks
- E.
10‐15 weeks
Correct Answer
C. 4‐6 weeksExplanation
Mature sperm survive in the epididymis for approximately 4 to 6 weeks before
being ejaculated or being catabolized and resorbed. A man is informed that he can father a child for up to 6 weeks
following a vasectomy. Most urologists and or vasectomy clinics will test a man's sperm count after 20 ejaculations or 6
weeks following a vasectomy.
Sperm are able to survive for this extended duration due to the lower temperatures within the scrotum. In the female
reproductive tract, most sperm die within 24‐48 after ejaculation, although viable sperm can be recovered up to 5 days
after a single ejaculation during intercourse.Rate this question:
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- 4.
KC is a 54 yo man who visits his urologist for sudden onset of a sexually‐related concern. KC explains that he and his wife enjoy intercourse 3‐4 times each week, but within the past 2 weeks he has been unable to ejaculate yet emotionally feels like he has achieved an orgasm. KC further explains that he has had no difficulty in becoming aroused and achieving a full erection, and has had no difficulties with the actual act of intercourse with his wife. His wife is concerned that these prolonged bouts of intercourse will eventually lead to a cardiac event. The doctor asks if KC is taking any erectile dysfunction drugs (e.g. Viagara), and KC insists that he is not taking any medication. What event in the male sexual response is most likely causing this man's failure to ejaculate during intercourse?
- A.
Impaired release of nitric oxide
- B.
Lack of emission
- C.
Reduced blood flow to the corpus cavernosa
- D.
Reduced nerve stimulation on the glans penis
- E.
KC is depressed and failure to ejaculate is a psychological problem
Correct Answer
B. Lack of emissionExplanation
This man is experiencing a problem with the ejaculatory process and you must recognize that emission is the transport of semen from the testis into the urethra. The history reveals that this 54 yo man is exhibiting no difficulty in achieving an erection, and therefore this suggests that he has a sufficient release of nitric oxide and adequate blood flow to the penis.
He has no problems with arousal or erection, therefore there is most likely no problems with his penile nervous system.
This man may be depressed, but men experiencing psychological sexual problems typically experience erectile dysfunction or do not experience an emotional "orgasm".
This man is suffering from a condition termed anejaculation. Pathophysiological and anatomical disorders of the male reproductive tract will be covered in detail during Semester 4.Rate this question:
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- 5.
Theca interna cells and granulosa cells work synergistically to produce the ovarian hormones within the follicle. Which of the following adverse physiological responses is the most likely outcome if a woman is treated with an LH receptor antagonist during the early proliferative phase of the menstrual cycle?
- A.
Estradiol levels will decline
- B.
Progesterone levels will increase
- C.
Androstenedione levels will increase
- D.
LH levels will decline
- E.
The follicle will undergo atresia and die
Correct Answer
A. Estradiol levels will declineExplanation
This question pertains directly to the 2‐cell theory of steroidogenesis. Theca
interna cells express LH receptors and, in response to LH, primarily produce androgens. These androgens then cross the
basement membrane and enter the granulosa cells, where these androgens are then converted (by the aromatase
enzyme) into estrogen (predominantly estradiol). By blocking the LH receptor, this pathway will be inhibited and
estradiol levels will decline. It is possible that the follicle will undergo atresia and die, but many follicles persist on low
levels of FSH and LH, which is why the proliferative phase can exhibit such extended variations in length.Rate this question:
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- 6.
The Tanner scale (i.e. Tanner Stage) is used by pediatricians to correlate changes in anatomy with the onset of physiological hormone production during puberty. A 13‐yo girl was taken to her pediatrician for a physical exam. This girl was classified as Tanner Stage 2. What are the common physical and physiological characteristics of a girl in Tanner Stage 2?
- A.
Villus hair, basal growth
- B.
Breast buds, accelerated growth
- C.
Coarse pubic hair, acne
- D.
Adrenarche, axillary hair
- E.
Projection of aerola, menses
Correct Answer
B. Breast buds, accelerated growthExplanation
Tanner Stage 2 is typically defined by thelarche, which is the development of
breast buds. Adrenarche is a primary characteristic associated with Stage 1, peak growth occurs during Stage 3,
Menarche occurs during Stage 4, and adult features and menstrual cyclicity define Tanner Stage 5.Rate this question:
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- 7.
The majority of a woman's follicles are lost due to atresia. At what age does the greatest rate of atresia usually occur?
- A.
During fetal development
- B.
During the toddler years
- C.
During peri‐menopause while experiencing irregular cyclicity
- D.
During puberty before regular cyclicity
- E.
During a woman's cyclical years
Correct Answer
A. During fetal developmentExplanation
Follicular atresia is an ongoing process from fetal development until full‐blown
menopause. Oocyte number peaks during the second trimester of fetal development, and then these numbers decline rapidly. Rates of atresia are also high during early life, and the rate of atresia then gradually declines throughout a woman's reproductive years until menopause.Rate this question:
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- 8.
A woman goes to her doctor for dysfunctional uterine bleeding. This woman has a high BMI, irregular menstrual cycles ranging from 21 to 65 days in length, and experiences heavy menstrual bleeding for 2 to 3 days during each menstrual period. This woman is afflicted with abnormally large amounts of acne, and has an unusually high degree of facial hair. This woman suffers from unusually high levels of which hormone?
- A.
Progesterone
- B.
Adolsterone
- C.
Testosterone
- D.
Cortisol
- E.
Estrone
Correct Answer
C. TestosteroneExplanation
This woman is exhibiting a classic presentation of polycystic ovary syndrome
(PCOS), and this question tests your knowledge of the 2 cell theory of ovarian steroidogenesis. Women with PCOS typically exhibit elevated androgen levels, produced by the theca interna cells of the follicles. This excess androgen then exerts phenotypic changes associated with androgen action, such as increased facial hair. For reasons unknown, this overabundance of androgen is not aromatized into estradiol. A sufficient amount of androgen is aromatized, which leads to unopposed estradiol acting directly on the endometrium. The dysfunctional uterine bleeding is a direct effect of unopposed estradiol causing excessive endometrial proliferation. PCOS will be covered in detail in semester 4.Rate this question:
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- 9.
Ovarian follicles respond to the gonadotropic hormones, follicle stimulating hormone (FSH) and luteinizing hormone (LH). Which of the following proteins inhibit the secretion of FSH and LH?
- A.
Activin
- B.
Testosterone
- C.
Progesterone
- D.
Human Chorionic Gonadotropin
- E.
Inhibin
Correct Answer
E. InhibinExplanation
Inhibin acts primarily on the pituitary to suppress the production and secretion
of FSH, and can also suppress the secretion of LH. Levels of inhibin fall during the ovulatory window, leading to the LH and FSH surges, respectively. Evidences suggest hCG acts directly on the hypothalamus to block the production of GnRH, thereby reducing production of both LH and FSH. Activin stimulates the production and/or release of the gonadotropins. Testosterone and progesterone can both block the production and release of FSH and LH, but these are steroids, not proteins.Rate this question:
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- 10.
The dominant follicle is a highly vascularized structure that, following ovulation, evolves into a highly vascularized corpus luteum . Which of the following growth factors is most likely involved with the process of luteal angiogenesis?
- A.
Placental growth factor (PGF)
- B.
Insulin growth factor I (IGF1)
- C.
Insulin growth factor II (IGF2)
- D.
Epidermal growth factor (EGF)
- E.
Vascular endothelial growth factor (VEGF)
Correct Answer
E. Vascular endothelial growth factor (VEGF)Explanation
VEGF is an angiogenic growth factor secreted by the follicle just prior to
ovulation. VEGF is required to form the dense capillary bed in the corpus luteum. The dense capillary bed provides the
corpus luteum with a high rate of blood flow, and this high rate of blood flow is second only to the brain (on a per gram
tissue basis). This dense capillary bed also permits for the rapid secretion of progesterone into the maternal circulation.
PGF is also an angiogenic growth factor, but is secreted after formation of the corpus luteum is complete. PGF acts in
concert with VEGF to assist in the vascular remodeling of the uterine vessels and formation of the placental blood
vessels during early pregnancy.Rate this question:
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- 11.
Prolactin secretion from the anterior pituitary is under the primary control of which primary hormone?
- A.
Neuropeptide Y
- B.
Nitric Oxide
- C.
Dopamine
- D.
Prolactin releasing hormone
- E.
Acetylcholine
Correct Answer
C. DopamineExplanation
Dopamine is also referred to as "prolactin inhibiting factor". The vast majority
of hormones produced and secreted by the pituitary are stimulated by an associated releasing factor secreted by the hypothalamus. However, prolactin is under the tonic inhibition by dopamine. As levels of dopamine fall, the lactotrophs in the pituitary respond rapidly by actively secreting more prolactin. All of the currently prescribed galatagogues, such as Domperidone, are dopamine antagonists that act to increase prolactin secretion, resulting in increased breast milk production.
There is some evidence that TRH and a Prolactin Releasing Peptide (PrRP) may stimulate the secretion of prolactin. However, both of these compounds at physiological levels do not appear capable of overcoming the tonic inhibition of dopamine. Additionally, TRH stimulation of prolactin secretion is almost always accompanied by decreased levels of dopamine.Rate this question:
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- 12.
The dominant follicle is likely selected during the preceding menstrual cycle, and then grows prolifically during the proliferative phase of the next cycle. You want to administer a receptor antagonist designed to block growth of the dominant follicle. Inhibition of which receptor would most likely result in suppressed growth and development of the dominant follicle?
- A.
Gonadotropin releasing hormone receptor
- B.
Luteinizing hormone receptor
- C.
Follicle stimulating hormone receptor
- D.
Estrogen receptor
- E.
Progesterone receptor
Correct Answer
A. Gonadotropin releasing hormone receptorExplanation
Blocking the GnRH receptor will result in decreased production of LH and FSH,
which will subsequently inhibit growth of the dominant follicle.
Interestingly, you could also suppress follicle growth and development by administering receptor antagonists designed
to inhibit FSH receptor pathway or the LH receptor pathway, but the best answer is a GnRH antagonist that blocks both
LH and FSH activity. Recall the 2‐cell theory of steroidogenesis, and how LH and FSH action on the theca and granulosa
cells is a complementary system that results in estradiol production.Rate this question:
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- 13.
Which of the following accurately describe the chronological set of descriptive changes that occur in the endometrium during the menstrual cycle?
- A.
Proliferation, secretion, decidualization, menstruation
- B.
Decidualization, menstruation, secretion, proliferation
- C.
Menstruation, secretion, decidualization, proliferation
- D.
Menstruation, decidualization, proliferation, secretion
- E.
Secretion, menstruation, proliferation, decidualization
Correct Answer
A. Proliferation, secretion, decidualization, menstruationExplanation
The endometrium expresses estrogen and progesterone receptors, and therefore the ovarian hormones directly influence endometrial changes. The endometrium proliferates rapidly under the influence of estradiol, and therefore this is termed the "proliferative phase". Progesterone induces glandular
sacculation and stimulates the production of secretory compounds, and therefore this phase is termed the "secretory phase". Extended exposure to progesterone cause the endometrial stromal cells to differentiate, a process termed "decidualization". In a normal menstrual cycle, the corpus luteum stops secreting progesterone after 12‐16 days, and the subsequent progesterone withdrawal induces sloughing of the endometrial functionalis zone during "menstruation". Regardless of which phase you list first, the sequence of events is always constant (i.e. proliferation always precedes secretion, which always precedes decidualization, etc.).Rate this question:
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- 14.
A 39 yo woman is scared about starting a family this late in life, because she knows the quality of her oocytes is decreasing at a rapid rate. Which biological process explains the primary cause of oocyte depletion over time?
- A.
Folliculogenesis
- B.
Ovulation
- C.
Fertilization
- D.
Atresia
- E.
Oogenesis
Correct Answer
D. AtresiaExplanation
Atresia is the process by which follicles/oocytes are depleted from the ovarian
germ cell reserve. The highest rate of atresia occurs during fetal development, and continues throughout a woman's lifespan until menopause, which signals complete follicle depletion. One could argue that atresia is a part of folliculogenesis, but we typically think of the two processes separately. The processes are considered separately because the primary outcome of folliculogenesis is the selection and ovulation of a dominant follicle, whereas the outcome of atresia is follicle death, regardless of follicle stage (i.e. preantral and antral follicles undergo atresia).Rate this question:
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