Block 7 Male Female Repro Physio W/Exp
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A 26-year-old man visits his primary care physician (PCP) complaining of lethargy and muscle weakness. Upon history, the patient also reveals decreased libido, and that he is unable to maintain an erection during intercourse. The 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 an impaired hypothalamic-pituitarytesticular axis?
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Testesterone and dihydrotestosterone
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Dihydrotestosterone and prolactin
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Testosterone and follicle stimulating hormone
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Luteinizing hormone and follicle stimulating hormone
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Testosterone and luteinizing hormone
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About This Quiz
From the Awesome Dr Keator
S2_Male Reproductive Physiology Quiz_Questions_Fall 2012
S2_Female Reproductive Physiology Quiz_Questions_Fall 2012
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- 2.
A 24-year-old man visits his dermatologist. The man is extremely upset because he is suffering from male pattern baldness. The patient explains that none of his older brothers exhibit male pattern baldness. The patient further complains that he 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-years-old and sporting a full head of thick hair. Which of the following hormones is most likely elevated in this patient?
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Testosterone
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Dehydroepiandrosterone (DHEA)
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Androstenedione
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Androstenediol
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Dihydrotestosterone
Correct Answer
A. DihydrotestosteroneExplanation
Testosterone is converted intracellularly by the 5 alpha-reductase (5ARD)
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 DHT is able to exert
heightened effects at lower concentrations.
Distracter explanations:
1) Androstenedione, Androstenediol, and DHEA are weaker androgens, and are not
associated with male pattern baldness.
2) Levels of testosterone may affect circulating levels of DHT - but localized/intracellular
concentrations of DHT are more dependent on the level and activity of 5ARD.Rate this question:
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- 3.
A 29-year-old man visits his urologist for a vasectomy. The patient explains that he is sexually active with multiple partners and does not want to father a child. Following the procedure, how long should the man abstain from intercourse to ensure he does not become a father?
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1-2 weeks
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3-4 weeks
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4-6 weeks
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6-10 weeks
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10-15 weeks
Correct Answer
A. 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 - however, some studies have shown that viable sperm can be recovered 5
days after a single ejaculation during intercourse.Rate this question:
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- 4.
A 57-year-old man visits his urologist complaining of the sudden onset of a sexuallyrelated concern. The patient explains that he and his wife enjoy intercourse 3 to 4 times each week, but within the past 2 weeks he has been unable to ejaculate, yet mentally feels like he has achieved an orgasm. The patient further explains that he has had no difficulty in becoming aroused, he has always achieved a full erection, and has experienced no difficulties maintaining an erection during intercourse. The patient denies taking any erectile dysfunction drugs (e.g. Viagara). Physical exam is unremarkable; lab results reveal normal levels of testosterone and luteinizing hormone. Which of the following is the most likely cause of this patient's symptoms and signs?
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Impaired release of nitric oxide
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Lack of emission
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Impaired penile nervous system resulting in lack of ejaculatory stimuli
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The patient is depressed and failure to ejaculate is a psychological problem
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Reduced blood flow to the corpus cavernosa
Correct Answer
A. Lack of emissionExplanation
This man is suffering from a condition termed anejaculation. This man is
experiencing a problem with the ejaculatory process and you recognized that emission
is the transport of semen from the testis into the urethra.
Distracter explanations:
1) History reveals this patient is exhibiting no difficulties in achieving an erection, and
therefore this suggests that he has a sufficient release of nitric oxide and adequate
blood flow to the penis.
2) He has no problems with arousal or erection, therefore there is most likely no
problems with his penile nervous system.
3) This man may be depressed, but men experiencing psychological sexual problems
typically experience erectile dysfunction or do not experience an emotional "orgasm".Rate this question:
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- 5.
A 33-year-old man presents to a clinic complaining of infertility. He previously fathered a child with another woman, but explains that he and his wife have been having unprotected intercourse for the past 14 months and have been unable to get pregnant. Multiple semen analyses taken two weeks apart reveal oligospermia (sperm count 100,000 sperm/mL) with normal motility. Testosterone levels are in the normal range. Which hormone is most likely reduced in this man?
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Luteinizing Hormone
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Prolactin
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Follicle Stimulating Hormone
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Estradiol
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Gonadotropin releasing hormone
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Dihydrotestosterone
Correct Answer
A. Follicle Stimulating HormoneExplanation
You remembered the two major hormones regulating spermatogenesis are
testosterone and FSH. Testosterone is manufactured in the Leydig cells, crosses the
blood-testis barrier and then binds to the nuclear androgen receptor in Sertoli cells.
FSH binds directly with the FSH receptor on Sertoli cells. Collectively, FSH and
testosterone regulate Sertoli cells and the process of spermatogenesis.
Distracter explanations:
1) LH is not correct because testosterone levels are normal. Remember that LH
stimulates Leydig cells to produce testosterone.
2) Prolactin stimulates the upregulation of LH receptors on the Leydig cells, and
therefore because testosterone is normal, reduced prolactin is also not correct.
3) Testosterone levels are normal, which indicates LH levels are normal, and therefore
levels of GnRH are also likely in the normal range. Also remember that even though
GnRH stimulates the secretion of FSH and LH, that different mechanisms regulate the
secretion of the gonadotropins.
4) Reduced levels of DHT are associated with impaired motility - this patient is
presenting with low sperm count with normal motility - and therefore reduced levels of
DHT are also not correct.Rate this question:
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- 6.
A 56-year-old man complains of urinary incontinence. Digital rectal exam (DRE) reveals an abnormally-shaped and enlarged prostate gland pushing on the man's bladder. Which of the following biomarkers is most likely elevated in this patient?
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Testosterone
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Dihydrotestosterone
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Luteinizing hormone
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Aromatase
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Prostate specific antigen
Correct Answer
A. Prostate specific antigenExplanation
You recognized that the enlarged and abnormally-shaped prostate gland
suggests that this man may have prostate cancer, and that elevated levels of prostate
specific antigen (PSA) are used as a biomarker for prostate cancer. Elevated levels of
PSA are detected in ~30%-50% of men with prostate cancer (rates depend on study).
PSA levels may also be elevated in patients with benign prostate hyperplasia (BPH) -
but the DRE exam does not typically reveal an "abnormally-shaped" prostate exam if
the patient has BPH or inflammation of the prostate gland (i.e. prostatitis).
Distracter information:
1) Testosterone and LH levels would most likely be normal in this patient, are not
associated with an enlarged prostate, and are not used as biomarkers for abnormal
prostate health.
2) DHT levels are likely elevated, but remember that DHT is produced within the cells
and therefore would not be used as a biomarker (i.e. DHT is typically not measured in
serum samples,. and previous studies have not been able to show a correlation
between serum DHT levels and abnormal prostate health). Also recall that slight
elevations in DHT or increased DHT function in the prostate gland is not abnormal,
since approximately 90% of men will develop BPH by age 85.
3) Aromatase converts androgens into estrogens within target tissues - predominantly
the brain and bone in men - and therefore would not be used as a biomarker for
prostate problems. Recall that aromatase may be elevated in patients with
gynecomastia.Rate this question:
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- 7.
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-yearold 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 this young girl?
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Adrenarche, axillary hair
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Breast buds, accelerated growth
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Projection of aerola, menses
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Villus hair, basal growth
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Coarse pubic hair, acne
Correct Answer
A. Breast buds, accelerated growthExplanation
Tanner Stage 2 is typically defined by thelarche, which is the development
of breast buds.
Distracter explanations:
1) Adrenarche is a primary characteristic associated with Stage 1.
2) Peak growth occurs during Stage 3.
3) Menarche occurs during Stage 4.
4) Adult features and menstrual cyclicity define Tanner Stage 5.Rate this question:
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- 8.
The majority of a woman's follicles are lost due to atresia. At what age does the greatest rate of atresia usually occur?
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During puberty before regular cyclicity
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During the toddler years
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During a woman's cyclical years
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During peri-menopause while experiencing irregular cyclicity
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During fetal development
Correct Answer
A. During fetal developmentExplanation
Follicular atresia is an ongoing process from fetal development until follicle
depletion, which most often occurs after 40 years of age. Oocyte number peaks at ~7-
10 million follicles during the second trimester (~28 weeks of fetal development), and
these numbers then decline rapidly.
Distracter explanations:
1) Rates of atresia are high during toddler years and before puberty - at puberty most
women have ~300,000 follicles. However, women have ~7-10 million follicles at ~28
weeks of development, and therefore `6 million follicles undergo atresia before birth -
which is a much greater loss.
2) Approximately 300,000 follicles are lost between puberty and menopause.
3) The majority of follicles are lost before the peri-menopause - and the loss of follicles
is the cause of premature ovarian failure or menopause.Rate this question:
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- 9.
Theca interna cells and granulosa cells work synergistically to generate ovarian hormones. If a woman is treated with a luteinizing hormone (LH) receptor antagonist during the early proliferative phase of the menstrual cycle, which of the following adverse physiological responses is the most likely outcome?
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LH levels will decline
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The follicle will undergo atresia and die
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Progesterone levels will increase
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Androstenedione levels will increase
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Estradiol levels will decline
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
( estradiol and estrone). By blocking the LH receptor, this pathway will be inhibited and
estradiol levels will decline.
Distracter explanations:
1) Progesterone levels will decline - recall that progesterone is an immediate precursor
required for androgen production.
2) Androstenedione is an androgen and will decrease, not increase.
3) LH levels will increase (think about the HPO axis) - but will be unable to act on cells,
due on the receptor antagonist blocking the LH receptor pathway.
4) 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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- 10.
The gonadotropins, follicle stimulating hormone (FSH) and luteinizing hormone (LH), in large part regulate ovarian function. Elevations in which of the following proteins predominantly inhibits the secretion of FSH?
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Chorionic Gonadotropin
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Progesterone
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Testosterone
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Inhibin
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Activin
Correct Answer
A. InhibinExplanation
Inhibin B produced by the follicles, and Inhibin A produced by the corpus
luteum, acts primarily on the pituitary to suppress the production and secretion of FSH.
The placenta manufacturers and secretes both Inhibin A & B, which suppresses follicle
recruitment/growth during pregnancy.
Remember that Inhibin B produced in granulosa cells inhibits FSH during the
proliferative phase of the cycle. Levels of Inhibin B fall, and levels of Activin increase,
during the ovulatory window - collectively, these changes in Inhibin B and Activin
modulate the FSH surge.
Distracter explanations:
1) Evidence(s) suggest hCG acts directly on the hypothalamus to block the production
of GnRH, thereby reducing production of both LH and FSH - but evidence is lacking to
suggest hCG acts directly on the pituitary.
2) Activin stimulates the production and/or release of the gonadotropins.
3) Testosterone and progesterone are not proteins (they are steroids). Both exert
negative feedback on the pituitary and regulate LH secretion - Inhibins/Activin exert
greater regulatory control on FSH secretion.Rate this question:
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- 11.
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?
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Epidermal growth factor (EGF)
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Vascular endothelial growth factor (VEGF)
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Placental growth factor (pGF)
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Insulin growth factor I (IGF1)
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Insulin growth factor II (IGF2)
Correct Answer
A. 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.
Distracter explanations:
1) 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.
2) The IGFs have no known role in the angiogenic process associated with CL
development.
3) EGF acts in concert with VEGF to regulate vascular growth - but is not the best
answer.Rate this question:
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- 12.
A 32-year-old woman complains of irregular menstrual cycles. Physical exam reveals galactorrhea; hyperprolactinemia is suspected. Decreased levels in which of the following hormones would confirm this diagnosis?
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Acetylcholine
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Dopamine
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Prolactin releasing hormone
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Nitric Oxide
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Neuropeptide Y
Correct Answer
A. 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.
Distracter explanations:
1) NPY - which is released from the arcuate nucleus - may stimulate the release of
prolactin, and therefore levels would not be decreased.
2) Nitric oxide (NO), in normal levels, has been shown in animal models to inhibit
prolactin release. However, there has been no clear consensus on the role (if any) of
changes in circulating NO and changes in prolactin secretion.
3) PRH would increase, not decrease.
4) Acetycholine (Ach) can stimulate oxytocin release - and therefore could stimulate
milk letdown. However, the role of Ach on prolactin is unclear, and therefore this is not
the best answer.Rate this question:
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- 13.
A clinical researcher wants 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?
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Estrogen receptor
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Progesterone receptor
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Luteinizing hormone receptor
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Follicle stimulating hormone receptor
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Gonadotropin releasing hormone 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.
Distracter explanations:
1) 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.
2) Blocking the ER or PR will have variable effects on different systems - and therefore
although also pausible, either of these are not the best answer.Rate this question:
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- 14.
Which of the following accurately describe the chronological set of descriptive changes that occur in the endometrium during the menstrual cycle?
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Secretion, menstruation, proliferation, decidualization
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Menstruation, decidualization, proliferation, secretion
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Menstruation, secretion, decidualization, proliferation
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Decidualization, menstruation, secretion, proliferation
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Proliferation, secretion, decidualization, menstruation
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, for 10 days or longer,
causes the endometrial stromal cells to undergo the decidual response (i.e.
"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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- 15.
A 29-year-old woman visits the gynecologist complaining of irregular cycles for the past 12 months. The patient further explains that her cycles range from 39 to 65 days, and that her menstrual period lasts for 2-3 days with very heavy menstrual blood flow. Physical and pelvic exams are unremarkable. Urinalysis is negative for chorionic gonadotropin (hCG). Which of the following is the best description and most likely cause of this patient's irregular menstrual cycles?
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Dysfunctional uterine bleeding caused by polycystic ovary syndrome
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Secondary amenorrhea caused by a luteal cyst
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Dysmenorrhea caused by a uterine fibroid
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Polymenorrhea caused by a follicular cyst
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Oligomenorrhea caused by hyperplasia of the endometrium
Correct Answer
A. Oligomenorrhea caused by hyperplasia of the endometriumExplanation
You recognized that the clinical definition of this women's irregular
menstrual cycles was "oligomenorrhea". Hormone values and a pelvic ultrasound
(examining the ovaries and uterus) are required to determine the exact cause of the
menstrual complaints.
Distracter explanations:
1) Polymenorrhea is defined as menstrual cycles less than 24 days apart.
2) This woman is experiencing irregular menstrual cycles, and therefore she is not
exhibiting amenorrhea.
3) The patient does not complain of pain, therefore dysmenorrhea is not correct.
4) The patient may be suffering from dysfunctional uterine bleeding, which is difficult to
clearly identify. However, most patients with PCOS typically exhibit secondary
symptoms - and this woman's physical and pelvic exams were unremarkable. Thus, the
most likely cause and best description of this patient's condition is "oligomenorrhea".Rate this question:
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- 16.
A 37-year-old woman visits the gynecologist complaining of heavy menstrual bleeding. The woman is referred to a Women's Health Research Center. Her menstrual blood loss for three consecutive 29 day menstrual cycles is measured as 122 mL, 118 mL, and 93 mL, respectively. The patient indicated menstrual blood flow for approximately 4 days each menstrual period, and she has no complaints of pain. Plasma levels of estradiol and progesterone are in the normal range for the luteal phase of the menstrual cycle. Urinalysis is negative for chorionic gonadotropin (hCG); pelvic exam is unremarkable.
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Polymenorrhea
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Menorrhagia
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Amenorrhea
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Oligomenorrhea
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Dysmenorrhea
Correct Answer
A. MenorrhagiaExplanation
You recognized that heavy menstrual blood flow is referred to clinically as
"menorrhagia".
Distracter explanations:
1) Dysmenorrhea is painful periods, and this patient states that she does not experience
pain.
2) Oligomenorrhea is irregular periods - but this woman exhibits 29 day menstrual
cycles.
3) Amenorrhea is the absence of menstrual bleeding - and this woman exhibits heavy
menstrual bleeding.
4) Polymenorrhea is menstrual bleeding every 21 days or less, and this woman has 29
day cycles.Rate this question:
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- 17.
A 25-year-old woman visits the gynecologist complaining of irregular menstrual cycles. Her cycles over the past year have been occurring every 7-10 weeks. Menstrual bleeding lasts for 3-5 days and there is no associated pain. Plasma levels of estradiol and progesterone are in the normal range for the luteal phase of the menstrual cycle. Urinalysis is negative for chorionic gonadotropin (hCG); pelvic exam is unremarkable. Which one of the following descriptions best defines this woman's menstrual periods?
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Menorrhagia
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Polymenorrhea
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Amenorrhea
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Oligomenorrhea
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Dysmenorrhea
Correct Answer
A. OligomenorrheaExplanation
You recognized that this woman was exhibiting the clinical signs associated
with oligomenorrhea.
Distracter explanations:
1) This patient is experiencing menstrual periods, therefore she is not presenting with
amenorrhea.
2) She is not experiencing extended bleeding or short menstrual cycles, therefore she is
not presenting with menorrhagia or polymenorrhea, respectively.
3) This patient indicates there is no associated pain, and therefore there is no
dysmenorrhea.Rate this question:
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- 18.
A 38-year-old primigravid woman complains of irregular menstrual cycles. Urinalysis is negative for chorionic gonadotropin. Physical exam reveals galactorrhea; otherwise unremarkable. Which of the following is the most likely cause of this patient's irregular menstrual cycles?
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Elevated thyroid stimulating hormone
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Elevated progesterone
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Elevated prolactin
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Elevated oxytocin
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Elevated growth hormone
Correct Answer
A. Elevated prolactinExplanation
This woman has hyperprolactinemia. The primary key provided in the stem
of this question was the finding of galactorrhea on physical exam. Additional keys were
primigravid status and absence of hCG. This woman may be prescribed a dopamine
agonist (such as bromocriptine or cabergoline) to reduce prolactin levels. Dopamine
agonists are effective in approximately 90% of people experiencing hyperprolactinemia.
[Additional information: Snyder PJ, 2011. Patient information: High prolactin levels and
prolactinomas (Beyond the Basics). www.uptodate.com].
Distracter explanations:
1) Growth hormone may also be stimulated in this patient, and may augment the actions
of prolactin and stimulate breast development - but GH does not directly simulate
lactogenesis.
2) Oxytocin is required for milk ejection during breastfeeding - but most women
experiencing abnormal galactorrhea (recall that galactorrhea during pregnancy is not
considered abnormal) are not experiencing milk let-down but rather exhibit "leaking"
(i.e.. the colostrum is not ejected, it is merely flowing/dribbling from the nipple).
3) Elevated progesterone may stimulate breast development, but recall that
progesterone acts to actively inhibit the prolactin receptor in mammary tissue - and
therefore, progesterone inhibits galactorrhea.
4) Elevated TSH is possible - this patient may have hypothyroidism (low T4/T3) which
can cause an increased release of TRH. High levels of TRH can overcome dopamine
inhibition and stimulate the release of prolactin - however, recognize the primary
problem causing this patient's irregular menstrual cycles and galactorrhea is still
elevated prolactin (even if she has hypothyroidism).Rate this question:
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Nov 25, 2012Quiz Created by
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