week 11

Causes of delayed or incomplete puberty can be divided into categories based on

gonadotropic secretion: hypergonadotropism (increased levels of FSH and LH) and hypogonadotropism (decreased LH and FSH levels).

Ovarian events of the menstrual cycle are controlled by

gonadotropins.

FSH and LH that stimulate the

gonads (ovaries or testes) [ the gonads to secrete female or male sex hormones.

Ophthalmic antibiotic prophylaxis alone is not sufficient to prevent vertical transmission in

gonrrhea

. In some men there are

gradual changes with testosterone deficiency, hypogonadism, proliferative disorders of the prostate, and erectile dysfunction.

The bacteria are

gram negative and survive within macrophages

Breast cancer is a

heterogeneous disease with diverse molecular, biologic, phenotypic, and pathologic changes

Fibrocystic changes or physiologic nodularity and cysts are not clinically definitive because they include a

heterogeneous group of disorders and refer to nonproliferative lesions

DCIS refers to a

heterogeneous group of proliferative lesions limited to ducts and lobules without invasion to the basement membrane

Breast cancer is

heterogeneous within the same tumor

The risk of perinatal transmission of HBV is

high for infants of HBV-infected mothers unless they receive immunoglobulin and are vaccinated

The uterus is the

hollow, muscular organ in which a fertilized ovum develops.

Gynecomastia is the overdevelopment (hyperplasia) of breast tissue in a male resulting from

hormonal alterations, which may be idiopathic or caused by systemic disorders, drugs, or neoplasms. gynocomastia usually involves an [imbalance of the estrogen/testosterone ratio

The female reproductive system can be altered by

hormonal imbalances, infectious microorganisms, inflammation, structural abnormalities, and benign or malignant proliferative conditions.

Complications of orchitis include

hydrocele and atrophy

Its most common cause is nonpuerperal

hyperprolactinemia, a rise in serum prolactin levels that is not associated with pregnancy and childbirth

The structure and function of male and female reproductive systems are controlled by the

hypothalamic-pituitary-gonadal (HPG) axis, a set of complex neurologic and hormonal interactions that accelerate at puberty and lead to sexual maturation and reproductive capability.

Alterations of sexual maturation can be

idiopathic or caused by a disease or congenital anomaly

Alterations of sexual maturation can be

idiopathic or caused by a disease or congenital anomaly.

Hydroceles can be

idiopathic or caused by trauma or infection of the testes

Sperm motility can be

impaired by unfavorable constituents or characteristics of semen

Urine and sperm are never

in the urethra at the same time.

Risk factors for vaginal cancer are

in utero diethylstilbestrol (DES) exposure and prior or concurrent cervical cancer

C. trachomatis is susceptible to

inexpensive, readily accessible antibiotics

Single-dose azithromycin is the drug of choice for

infected individuals and all sexual contacts

ovulation disorders and tubal blockages are the most common pathologies of

infertility

Uncorrected cryptorchidism is associated with

infertility and a significantly increased risk of testicular cancer

. Prolonged anovulation often leads to

infertility, menstrual bleeding disorders, hirsutism, acne, endometrial hyperplasia, cardiovascular disease, and diabetes mellitus in women with hyperinsulinemia.

Secondary lesions in LV involve

inflammation and swelling of the lymph nodes with formation of large buboes that rupture and drain

Vulvovestibulitis is an

inflammation of the skin of the vulva

Biologic attributes of a tumor are

influenced by the surrounding neighborhood or microenvironment.

Single-dose therapy for syphillis with

injectable ceftriaxone or oral azithromycin for both partners is recommended

However, still unknown are the precise events occurring at the

invasive edge

Preinvasive lesions do not invariably progress to

invasive malignancy

IN LV Treatment of sexual partners

is recommended

Treatment urithral stricture

is usually surgical.

Men maintain reproductive capacity into their

later years

PCOS

least two of the following are present: irregular ovulation or anovulation; elevated levels of androgens, or clinical signs of hyperandrogenism; and polycystic ovaries

Herpes simplex virus (HSV) infection is

lifelong and can result in an initial outbreak and subsequent outbreaks

The basic functional unit of the female breast is the

lobe, a system of ducts that branches from the nipple to milk-producing units called lobules.

chlamydia

localizes to epithelial tissue and can spread throughout the urogenital tract or pass from the infected mother to the eyes and respiratory tract of newborn infants during birth.

Paracrine hormones (inhibin, activin, and follistatin) influence the positive and negative feedback

loops that occur along the HPG axis.

Pelvic organ prolapse—uterine prolapse, cystocele, rectocele, and urethrocele—is caused by

loss of support provided by the pelvic muscles and fascia.

Urethral stricture often manifests itself as

lower urinary tract symptoms or urinary tract infections with significant impairment in the quality of life

Most disorders of the breast are disorders of the

mammary gland, that is, the female breast

EMT-associated reprogramming is involved in

many cancer cell characteristics, including suppression of cell death and senescence, and is reactivated during wound healing

The function of the female reproductive system is to produce

mature ova and, when fertilized, to protect and nourish them through embryonic and fetal life, and expel them at birth.

Benign ovarian cysts develop from

mature ovarian follicles that do not release their ova (follicular cysts) or from a corpus luteum that persists abnormally instead of degenerating (corpus luteum cyst)

Hyperprolactinemia can be caused by

medications, pituitary tumors, hypothyroidism, chronic stress, or persistent and repeated suckling

. Menstruation ceases, and women move into

menopause.

Vaginitis, or vaginal infection, can be caused by a variety of

microorganisms or irritants, or disruptions in the vaginal pH

. Symptoms crabs

mild and severe pruritus

Sperm

millions are produced daily, usually for life. Females release mature ova at the time of puberty.

Precocious puberty also can be caused by

mistiming of the stimulatory surge in a child whose HPG system is otherwise normal

The external female genitalia are the

mons pubis, labia majora, labia minora, clitoris, vestibule (urinary and vaginal openings), Bartholin glands, and Skene glands.

Ovarian cancer causes

more deaths than any other genital cancer in women

Chlamydia is the

most common bacterial STI in the United States and a leading preventable cause of infertility and ectopic pregnancy

. Immunization against hepatitis B is the

most effective means of preventing transmission.

Recurrent infections are

most often attributable to HSV-2 and are generally milder and of shorter duration

Herpes simplex virus can pass from

mother to fetus; thus women with active lesions should give birth by cesarean section to avoid vertical transmission

Cowper glands (bulbourethral glands) secrete

mucus in the urethra and add fluid to the ejaculate.

The etiology of cryptorchidism is considered to be

multifactorial (genetic, maternal, and environmental factors) and occurs most often as an isolated disorder with no obvious cause

The cervix is the

narrow, lower portion of the uterus that opens into the vagina.

Sperm production is also impaired by

neoplastic disease, cryptorchidism, or any factor that causes testicular temperature to rise

Granulomatous orchitis, an autoimmune disease, is a

nonspecific, noninfectious, inflammatory process that occurs in middle-aged men

Incidence is greatest among

northwestern European and North American men (particularly blacks) older than 65 years of age

Epididymitis, inflammation of the epididymis, is usually caused by a

sexually transmitted pathogen that ascends through the vasa deferentia from an already infected urethra or bladder

Although noninfectious urethritis can occur, most cases of urethritis result from

sexually transmitted pathogens

Externally the penis consists of a

shaft and a tip, which is called the glans.

invasive carcinoma of the penis involves the

shaft as well

As the corpus luteum degenerates, production of both hormones drops

sharply, and the "starved" endometrium degenerates and sloughs off, causing menstruation, the ischemic/menstrual phase.

Menstrual cycles

shorten and then become irregular as anovulation occurs

Syphilis is an STI that becomes systemic

shortly after infection

Hepatitis B infection poses

significant health risks including chronic liver disease and hepatocellular cancer

Prior to puberty, male breast development is

similar to female development.

Until puberty the female and male breasts are

similar, consisting of a small underdeveloped nipple, some fatty and fibrous tissue, and a few ductlike structures under the areola.

The nonproliferative lesions include

simple breast cysts, papillary apocrine change, and mild hyperplasia of the usual type

Endometriosis causes an inflammatory reaction at the

site of implantation and is a cause of pain and infertility

. The lice bite into the

skin for nutrition

lymphogranuloma vernerum lesion begins as a

skin infection and spreads to the lymph tissue, causing inflammation, necrosis, buboes, and abscesses of the inguinal lymph nodes

It is transmitted by

skin-to-skin contact in children and adults

most myomas remain

small and asymptomatic.

The first clinical manifestation of breast cancer is usually a

small, painless lump in the breast

Benign breast disease is a

spectrum of noncancerous changes in the breast

The spermatids develop into

sperm with the help of nutrients and hormonal signals from Sertoli cells.

The testes have two functions:

spermatogenesis (sperm production) and production of male sex hormones (androgens, chiefly testosterone).

Spermatogenesis is a continuous process because

spermatogonia, the primitive male gametes, undergo continuous mitosis within the seminiferous tubules of the testes.

Priapism is associated with

spinal cord trauma, sickle cell disease, leukemia, and pelvic tumors. It can also be idiopathic and can occur with cocaine use.

Cysts usually regress

spontaneously

The male hormones are produced

steadily, with diurnal variations.

Precocious puberty, more common in girls, also can be caused by mistiming of the

stimulatory surge in a child whose HPG system is otherwise normal.

Cancer cells behave as communities and the cooperative behaviors of

subclones can influence cancer progression

In most cases of delayed puberty, the hypothalamic-pituitary-gonadal (HPG) axis is intact but the

surge of activity that stimulates puberty is delayed.

Treatment is based on the extent or stage of cancer and includes

surgery, radiation, chemotherapy, hormone therapy, and biologic therapy.

PMS . Treatment is

symptomatic and includes self-help techniques, lifestyle changes, counseling, and selective serotonin reuptake inhibitors (SSRIs).

alterations in gynocomastia can result from

systemic disorders, drugs, neoplasms, or idiopathic causes

LCIS originates from the

terminal duct-lobular unit

Orchitis is an acute infection of the

testes

The epididymis receives sperm from the

testis and stores them while they develop further

Testicular torsion is the rotation of a

testis, which twists blood vessels in the spermatic cord

The uterine walls have three layers:

the endometrium (lining), myometrium (muscular layer), and perimetrium (outer covering, which is continuous with the pelvic peritoneum).

Lack of high levels of estrogen and progesterone prevents

the further development of the male breast.

Except for skin cancer, breast cancer is

the most common form of cancer in American women

The external male genitalia are

the testes, epididymides, scrotum, and penis.

most commonly infection reach the testes by ascending through

the vas deferens and epididymis

Cyclic changes in hormone levels also cause

thinning and thickening of the vaginal epithelium, thinning and thickening of cervical secretions, and changes in basal body temperature.

The penis is a cylindrical organ consisting of

three longitudinal compartments (two corpora cavernosa and one corpus spongiosum) and the urethra.

Emerging evidence supports

three main prerequisites that must be met for metastatic colonization to succeed: the capacity to seed and maintain a population of tumor-initiating stem cells; the ability to create adaptive, organ-specific colonization programs; and the development of a supportive microenvironmental niche

Risk factors for ovarian cancer include an increased number of

total lifetime ovulations including early menarche, late menopause, nulliparity, use of fertility drugs

Pediculosis pubis (crabs) is commonly

transmitted sexually and is caused by the crab louse, P. pubis

gential warts can be

transmitted to the infant at birth

Although its cause is unknown, high androgen levels, genetic predisposition, and a history of cryptorchidism, trauma, or infection may contribute to

tumorigenesis

Breast cancer is relatively

uncommon in males, but it has a poor prognosis because men tend to delay seeking treatment until the disease is advanced

Peyronie disease is an

underdiagnosed condition with a prevalence as high as 9% in the male population

Risk factors for endometrial cancer include

unopposed estrogen exposure, obesity, infertility, failure to ovulate, early menarche or late menopause, and tamoxifen

Disorders of the

urethra include urethritis (inflammation of the urethra) and urethral strictures (narrowing or obstruction of the urethral lumen caused by scarring)

Acquired or congenital scarring that causes

urethral stricture can be caused by trauma or by severe or untreated urethral infection

Priapism, a prolonged painful erection not stimulated by sexual arousal, is a

urologic emergency

Men with trich

usually are asymptomatic

Women with trich

usually have a copious, malodorous, gray-green discharge with prurituss

Ovarian hormones control the

uterine (endometrial) events of the menstrual cycle.

Common abnormalities include

uterine agenesis or structural malformations of the vagina, uterus, and fallopian tubes.

Leiomyomas, also called

uterine fibroids, are tumors arising from the muscle layer of the uterus, the myometrium.

Most cancers of the female genitalia involve the

uterus (particularly the cervix) and the ovaries

The two fallopian tubes extend from the

uterus to the ovaries.

The internal female genitalia are the

vagina, uterus, fallopian tubes, and ovaries.

, Vaginitis involves

vaginal irritation, itching, burning, odor, or abnormal discharge. The primary forms are vulvovaginal candidiasis, bacterial vaginosis, or trichomoniasis.

Trichomoniasis (T. vaginalis) causes

vaginitis in women and urethritis in men

The internal genitalia are the

vas deferens, ejaculatory duct, prostatic and membranous sections of the urethra, seminal vesicles, prostate gland, and Cowper glands.

Sperm travel the length of the epididymis and then are ejaculated into the

vas deferens.

Lesions initially appear as groups of

vesicles that progress to ulceration with pain, lymphadenopathy, and fever

Molluscum contagiosum is a benign

viral infection of the skin

The prostate gland is about the size of a

walnut and surrounds the urethra.

Differentiation of female and male genitalia begins around

weeks 7 to 8 of embryonic development, when the gonads of genetically male embryos begin secretion of male sex hormones, primarily testosterone; expression of testes-determining factor (TDF); and expression of the SRY gene. Until that time the primitive reproductive organs of males and females are homologous (the same).

"Clue cells" are found on the

wet mount

. Although normally transmitted through mosquito bites,

zika virus can be transmitted through sexual contact with infected body fluids or through vertical transmission

Epithelial-to-mesenchymal transition (EMT) is involved in the

generation of tissues and organs during embryogenesis, is essential for driving tissue plasticity during development, and is hijacked during cancer progression

The mean age at diagnosis in male breast cancer is

between 60 and 70 years of age

Pathogenic organisms may reach the testes through the

blood or the lymphatics

testicular torsion interrupts

blood supply to the testis, resulting in edema and, if not corrected within 4 to 6 hours, necrosis and atrophy of testicular tissues

The corpora cavernosa (but not the corpus spongiosum) fills with

blood that does not drain, probably because of venous obstruction

This situation is common in

boys

The influence of pregnancy on the risk of

breast cancer also depends on family history, lactation postpartum, and overall parity

The scabies mite

burrows through the skin, depositing eggs, causing intense pruritus, especially at night

The presence of macrophages in the involuting mammary gland contributes to

carcinogenesis

Causes of delayed or incomplete puberty can be divided into

categories based on gonadotropic secretion: hypergonadotropism (increased levels of FSH and LH) and hypogonadotropism (decreased LH and FSH levels).

infertility Treatment depends on the

cause of the infertility

Sexually transmitted diseases may be more common in

certain populations related to increased physiologic risk for acquisition (such as with younger women or with men who have sex with men) or insufficient access to quality health care (such as with lower socioeconomic groups, racial/ethnic minorities, and marginalized groups)

vaccine is now available for the HPV types with highest risk for

cervical cancer

Human papillomavirus (HPV) is associated with the development of

cervical dysplasia and cancer as well as condylomata acuminata

Cervical cancer arises from the

cervical epithelium

The vagina leads from the introitus (its external opening) to the

cervical portion of the uterus.

vulvovesibulitis can be caused by

chemical and mechanical irritants, allergens, skin disorders, nerve problems, or vaginal infections, such as candidiasis.

Because of the asymptomatic nature of

chlamydia and the potential sequelae of infection, widespread screening is recommended by the CDC

Sperm quality is impaired by

chromosomal abnormalities resulting from genetic factors, irradiation, or toxins

Lymphogranuloma venereum is a

chronic STI uncommon in the United States

Symptoms include

chronic vulvar irritation, pruritus, bloody discharge, and a hard, ulcerated area of the vulva or large cauliflower-like lesions

Possible causes include

genetic predisposition, environmental and dietary factors, inflammation, and alterations in levels of hormones (testosterone, dihydrotestosterone, and estradiol) and growth factors

Abnormalities of the female reproductive tract have multifactorial causes, including

genetics and environmental factors.

During this transition period the ovaries produce

erratic and high levels of estrogen that contribute to such symptoms as hot flashes, breast tenderness and nodularity, and migraine headaches.

Developing ovarian follicles (structures that enclose the ovum) produce

estrogen (primarily estradiol).

The velvety cauliflower-like lesions occur in the

genital and anal areas, vagina, and cervix and are painless

. During the luteal/secretory phase,

estrogen maintains the thickened endometrium, and progesterone causes it to develop blood vessels and secretory glands (secretory phase).

Most breast cancers in men are

estrogen positive

Gynecomastia is caused by hormonal or breast tissue alterations that cause

estrogen to dominate

Diagnostic tests are performed to

evaluate fertility

Genital herpes is the most common

genital ulceration in the United States and is caused by either HSV-1 or HSV-2

primary dysmenorrhea often results from

excessive synthesis of prostaglandins (or sensitivity to prostaglandins), which cause the myometrium to contract and constrict blood vessels, resulting in ischemic pain.

Primary lesions in lv appear on the

penis and scrotum in men and on the cervix, vaginal wall, and labia in women

The high-risk strains of HPV (HR-HPV) that are precursors to the development of cervical cancer do not cause

genital warts

Most testicular neoplasms are

germ cell tumors

Inflammation blocks the

glands, preventing the outflow of glandular secretions, and is caused by trauma or infection.

Infection and inflammation of the female genitalia may result from

exogenous pathogens, most often sexually transmitted, or from overproliferation of microorganisms that normally populate the genital tract.

Penile carcinoma in situ tends to involve the

glans

Fertility can be impaired by

factors in the male, female, or both partners

Cryptorchidism is a condition in which one or both testes

fail to descend into the scrotum

Balanitis is an inflammation of the

glans penis and usually occurs in conjunction with posthitis

. From puberty to menopause, one female gamete matures

per menstrual cycle.

Benign growths and proliferative conditions of the

female reproductive tract tend to affect the ovaries (benign ovarian cysts) or uterine tissues (endometrial polyps, leiomyomas, and endometriosis).

Production of primitive female gametes (ova) occurs solely during

fetal life

Prostate syndromes have been classified by the National Institutes of Health as

(a) acute bacterial prostatitis (ABP), (b) chronic bacterial prostatitis (CBP), (c) chronic pelvic pain syndrome (CPPS), and (d) asymptomatic inflammatory prostatitis.

From puberty to menopause, the ovaries are the site of

(a) ovum maturation and release and (b) production of female sex (estrogen and progesterone) and male (androgens) hormones.

Gonorrhea can be passed to the

fetus from the mother and typically manifests as an eye infection 1 to 12 days after birth

Hepatitis C is generally transmitted

percutaneously but sexual transmission appears possible

The progressively serious neoplastic alterations are:

(1) cervical intraepithelial neoplasia (cervical dysplasia), (2) cervical carcinoma in situ, and (3) invasive cervical carcinoma.

Benign lesions are broadly classified as

(1) nonproliferating breast lesions, (2) proliferative breast disease, and (3) atypical (atypia) hyperplasia.

Criteria for the diagnosis of intraductal proliferative lesions have been the subject of much research and controversy and include the following structurally diverse lesions:

(1) usual ductal hyperplasia, (2) intraductal papillomas, (3) sclerosing adenosis, (4) radial scar, and (5) simple fibroadenoma

The four stages of the disease are

(a) primary syphilis with a chancre at the site of infection; (b) secondary syphilis with systemic spread to all body systems; (c) latent syphilis with minimal symptoms or the development of skin lesions; and (d) tertiary syphilis, the most severe stage, with destruction of bone, skin, and soft and neurologic tissues.

At puberty breast change due to these hormones

(estrogen, progesterone, prolactin, growth hormone, insulin, cortisol) cause the female breast to develop into a system of glands and ducts that is capable of producing and ejecting milk.

The incubation period of syphillis is

1 to 14 days.

Infertility, or the inability to conceive after

1 year of unprotected intercourse, affects approximately 15% of all couples

The vagina is a

fibromuscular canal that receives the penis during sexual intercourse and is the exit route for menstrual fluids and products of conception.

Primary amenorrhea is the continued absence of menarche and menstrual function by

13 years of age without the development of secondary sex characteristics, or by age 15 years if these changes have occurred.

Each breast contains

15 to 20 lobes, which are separated and supported by Cooper ligaments.

Testicular cancer is the most common malignancy in males

15 to 35 years of age

In women the transition from fertility to menopause (perimenopause) starts about

2 to 8 years before the last menstrual period and ends the following year.

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

Peyronie disease consists of

fibrosis that affects the corpora cavernosa, which causes penile curvature during erection

The average menstrual cycle lasts

27 to 30 days

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

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

What is the most common infectious cause of orchitis and one that usually affects postpubertal boys? a. Herpes c. Mumps b. Escherichia coli d. Cytomegalovirus

ANS: C Of the options available, mumps is the most common infectious cause of orchitis and usually affects postpubertal boys. PTS: 1 REF: Pages 894-895

Priapism has been associated with the abuse of what substance? a. Marijuana c. Cocaine b. Alcohol d. Heroin

ANS: C Of the options available, priapism has been associated with cocaine use. PTS: 1 REF: Page 890

Prevalence of leiomyomas increases in women between ages

30 and 50

Symptoms affect women ages

30 to 50 and include cyclic bilateral breast tenderness and transient breast lumps

Gynecomastia affects

32% to 40% of the male population

A hydrocele is a collection of

fluid between the testicular and scrotal layers of the tunica vaginalis

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

Which sexually transmitted disease occasionally causes clinical manifestations of scant intermittent penile discharge, slight pruritus, and mild dysuria? a. Campylobacter enteritis c. Cytomegalovirus enteritis b. Shigellosis d. Trichomoniasis

ANS: D Most men with trichomoniasis are asymptomatic but may have scant intermittent discharge, slight pruritus, and mild dysuria. The other options do not demonstration these symptoms. PTS: 1 REF: Page 937

treatment of LV

A 21-day or longer course of oral doxycycline or erythromycin

Most breast cancer occurs in women older than

50 years

Peak incidence occurs at

58 to 60 years of age

Sexual maturation, or puberty, should begin in girls between ages

8 and 13 years

Sexual maturation, or puberty, should begin in boys between

9 and 14 years of age.

Proliferative breast lesions with atypia include

ADH and ALH.

Systemic diseases known to be sexually transmitted include

AIDS (see Chapter 10), cytomegalovirus infection, and Epstein-Barr virus

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

Which age group should be targeted for testicular cancer education and screening? a. 15 to 35 year olds c. 30 to 55 year olds b. 20 to 45 year olds d. 45 to 70 year olds

ANS: A Overall, testicular cancers are rare, yet they are the most common form of cancer in young men between the ages of 15 and 35 years. PTS: 1 REF: Page 895

What is the major concern regarding the treatment of gonococci infections? a. Development of antibiotic resistance c. Changes in pathogenicity b. Changes in virulence d. Mutations into different strains

ANS: A Several types of drug-resistant strains have been identified; they are penicillinase-producing Neisseria gonorrhoeae (PPNG), which is resistant to penicillin; tetracycline-resistant N. gonorrhoeae (TRNG), which is resistant to tetracycline; chromosomal control of mechanisms of resistance of N. gonorrhoeae (CMRNG), which is resistant to penicillin and tetracycline; and increasingly a fluoroquinolone-resistant N. gonorrhoeae (QRNG). The other options are not major concerns. PTS: 1 REF: Page 922

What local complication of a gonococcal infection is diagnosed in approximately 10% of affected women? a. Acute salpingitis c. Vaginitis b. Cystitis d. Cervicitis

ANS: A Acute salpingitis, or pelvic inflammatory disease (PID), is the most common local complication in women. Approximately 10% of women with untreated cervical gonorrhea develop PID. PTS: 1 REF: Page 921

Which drug may be prescribed orally for outbreak management of herpes simplex viral (HSV) infections? a. Acyclovir (Zovirax) c. Zidovudine (AZT) (Retrovir) b. 5-Fluorouracil (5-FU) d. Bichloroacetic acid (BCA)

ANS: A Although no curative treatment for HSV infection is known, only oral acyclovir, valacyclovir, penciclovir, and famciclovir are used for primary and periodic outbreaks and to prevent recurrences. PTS: 1 REF: Page 934

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

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

When a patient has small, vesicular lesions that last between 10 and 20 days, which sexually transmitted infection is suspected? a. Genital herpes c. Syphilis b. Chancroid d. Chlamydia

ANS: A If symptoms occur, the individual may have small (1 to 2 mm), multiple, vesicular lesions that are generally located on the labia minora, fourchette, or penis. They may also appear on the cervix, buttocks, and thighs and are often painful and pruritic. These lesions usually last approximately 10 to 20 days. The other options do not demonstrate these symptoms. PTS: 1 REF: Page 933

In women, what is the usual site of original gonococcal infection? a. Endocervical canal c. Fallopian tube b. Vagina d. Labia majora

ANS: A In women, the endocervical canal (inner portion of the cervix) is the usual site of original gonococcal infection, although urethral colonization and infection of Skene or Bartholin glands also are common. The other options are not usually associated with gonococcal infections. PTS: 1 REF: Page 921

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)

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

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

ANS: A Mixed precocious puberty (i.e., virilization of a girl or feminization of a boy) causes the child to develop some secondary sex characteristics of the opposite sex. This selection is the only option that accurately identifies the type of precocious puberty described. PTS: 1 REF: Page 887

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

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

Which statement is false regarding the risk of transmission of the herpes simplex virus (HSV) from mother to fetus? a. Neonatal infection of HSV rarely occurs in the intrapartum or postpartum period. b. The risk is higher in women who have a primary HSV infection. c. The risk is higher in women who experience ruptured membranes more than 6 hours before delivery. d. The risk is higher when internal fetal monitoring devices are used.

ANS: A Neonatal infections can occur in utero or, more commonly, during the intrapartum or postpartum period. The other options are accurate statements. PTS: 1 REF: Page 933

What are the clinical manifestations of testicular cancer? a. Firm, nontender testicular mass c. Painful fluid-filled testicular mass b. Painful, mobile, firm testicular mass d. Soft, nontender testicular mass

ANS: A Of the options available, a firm, painless testicular enlargement is commonly identified as the first sign of testicular cancer. PTS: 1 REF: Pages 895-896

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

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

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

Which microorganism is sexually transmitted, primarily by homosexual men, through infected feces? a. Shigellosis c. Giardia lamblia b. Cytomegalovirus (CMV) d. Entamoeba histolytica

ANS: A Only the Shigella infection, termed shigellosis, is transmitted by contact with infected feces particularly among homosexual men. PTS: 1 REF: Page 940 | Table 26-3

Match the description with the disorder. Spermatocele

Painless diverticulum of the epididymis located between the head of the epididymis and the testis

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

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

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

Which is a characteristic lesion of secondary syphilis? a. Condylomata lata c. Chancroid b. Gummas d. Donovan bodies

ANS: A The only secondary syphilis lesion is the condylomata lata. PTS: 1 REF: Pages 924-925

How does the epididymis become infected? a. The pathogenic microorganisms ascend the vasa deferentia from an already infected urethra or bladder. b. The pathogenic microorganisms are attached to sperm that travel through the genital tract. c. The pathogenic microorganisms from the tunica vaginalis are transported to the epididymis. d. The pathogenic microorganisms from the prostate fluid ascend to the epididymis.

ANS: A The pathogenic microorganisms usually reach the epididymis by ascending the vasa deferentia from an already infected urethra or bladder. Of the selections available, this is the only option that accurately describes how the epididymis becomes infected. PTS: 1 REF: Page 897

Which treatment is used for trichomoniasis? a. Topical application of 5-Fluorouracil (5-FU) b. Topical application of acyclovir c. Systemic metronidazole d. Systemic tetracycline

ANS: A The treatment of choice for trichomoniasis is a single 2-gram dose of metronidazole (Flagyl) or tinidazole. The other options are not applicable. PTS: 1 REF: Page 938

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

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

Which statements are true regarding the hepatitis B infection? (Select all that apply.) a. Hepatitis B poses a significant risk for chronic liver disease. b. Hepatocellular cancer is a common comorbid condition. c. Universal vaccination of infants and children is recommended. d. The preventive method of choice is immunization. e. Universal vaccination of sexually active adults is recommended.

ANS: A, B, C, D Hepatitis B infection poses significant health risks including chronic liver disease and hepatocellular cancer. Immunization against hepatitis B is the most effective means of preventing transmission. Universal vaccination of infants and children is recommended, as well as vaccination of high-risk adults. PTS: 1 REF: Page 941

What are the common modes of transmission for the hepatitis B virus (HBV)? (Select all that apply.) a. Needle punctures b. Blood transfusions c. Contact with infected body fluids d. Skin cuts e. Ingestion of infected substances

ANS: A, B, C, D Transmission of HBV can occur through needle puncture, blood transfusion, cuts in the skin, and contact with infected body fluids. Ingestion is not a recognized transmission mode. PTS: 1 REF: Page 941

Which statements are true regarding urethritis? (Select all that apply.) a. A purulent drainage may be present. b. A clear mucus-like discharge may be present. c. Symptoms include urethral tingling and itching or burning on urination. d. A 24-hour urine test is required to diagnose the disorder. e. Treatment includes appropriate antibiotic therapy.

ANS: A, B, C, E Symptoms of urethritis include urethral tingling and itching or a burning sensation on urination (dysuria), frequency, and urgency. The individual may note a purulent or clear mucus-like discharge from the urethra. Nucleic acid detection amplification tests allow easy detection of Neisseria gonorrhoeae and Chlamydia trachomatis in first-void urine. Treatment consists of appropriate antibiotic therapy for infectious urethritis and an avoidance of future chemical or mechanical irritation. PTS: 1 REF: Page 888

Which are clinical manifestations of male breast cancer? (Select all that apply.) a. Ulceration present on the breast b. Retraction of breast tissue c. Nipple discharge d. Palpable mass midline of the nipple e. Unilateral solid mass

ANS: A, B, C, E The malignant male breast lesion is usually a unilateral solid mass located near the nipple. Because the nipple is commonly involved, crusting and nipple discharge are typical clinical manifestations. Other findings include skin retraction, ulceration of the skin over the tumor, and axillary node involvement. PTS: 1 REF: Page 914

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

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

During the latent period of a herpes virus infection, where in the host cell is the genome of the virus maintained? a. Mitochondria c. Nucleus b. Lysosomes d. Cytoplasm

ANS: C During the latent period, the genome for the virus is maintained in the host cell nucleus without causing the death of the cell. PTS: 1 REF: Page 933

Which statements are true regarding the parasitic infection referred to as scabies? (Select all that apply.) a. Scabies is spread through skin-to-skin contact. b. The crab lice, Phthirus pubis, cause scabies. c. Severe pruritus is its major clinical manifestation. d. Symptoms worsen at night. e. Treatment is provided through oral medication therapy.

ANS: A, C, D Scabies is a common parasitic infection that can be spread by skin-to-skin contact and sexual contact. The scabies mite burrows through the skin, depositing two or three large eggs per day. Intense pruritus, especially at night, is the most pronounced clinical manifestation. Treatment consists of topical application of a pediculicide. Pediculosis pubis (crabs) is commonly transmitted sexually and is caused by the crab louse, P. pubis. PTS: 1 REF: Pages 938-939

What term is used to identify an inflammation of the glans penis? a. Glanitis c. Priapism b. Balanitis d. Hydrocelitis

ANS: B Balanitis is the only term used to identify an inflammation of the glans penis (see Figure 25-4). PTS: 1 REF: Page 890

During which stage of syphilis do bloodborne bacteria spread to all the major organ systems? a. Primary c. Latent b. Secondary d. Tertiary

ANS: B Bloodborne bacteria spread to all major organ systems during only stage II, secondary syphilis (see Box 26-2). PTS: 1 REF: Page 923

What is the reason breast cancer in men has such a poor prognosis? a. Breast cancer is extremely aggressive in men. b. Treatment is usually delayed as a result of late detection. c. Chemotherapies are not as effective in men. d. Breast tumors tend to be small and hard to isolate.

ANS: B Breast cancer is relatively uncommon in men, but it has a poor prognosis because men tend to delay seeking treatment until the disease is advanced. This selection is the only option that accurately identifies the reason breast cancer in men has a poor prognosis. PTS: 1 REF: Page 914

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

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

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

Which laboratory test is considered adequate for an accurate and reliable diagnosis of gonococcal urethritis in a symptomatic man? a. Ligase chain reaction (LCR) c. Polymerase chain reaction (PCR) b. Gram-stain technique d. DNA testing

ANS: B Microscopic evaluation of Gram-stained slides of clinical specimens is deemed positive for Neisseria gonorrhoeae if gram-negative diplococci with the typical "kidney bean" morphologic appearance are found inside polymorphonuclear leukocytes. Such a finding is considered adequate for the diagnosis of gonococcal urethritis in a symptomatic man. The other options are not relevant to the diagnosis of this condition. PTS: 1 REF: Page 922

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

During reactivation (release from latency), herpes virus genomes are transported through which nerves to the dermal surface? a. Somatic c. Autonomic b. Peripheral sensory d. Peripheral motor

ANS: B Only during reactivation are the viral genomes transported through the peripheral sensory nerves back to the dermal surface. PTS: 1 REF: Page 933

Which hepatitis virus is known to be sexually transmitted? a. A c. C b. B d. D

ANS: B Only hepatitis B virus (HBV) is known to be sexually transmitted. PTS: 1 REF: Page 940

What unique factor causes adolescent girls to have a high risk for sexually transmitted infections (STIs)? a. They are in an experimental phase with sexual intercourse and believe they are resistant to developing STIs. b. The adolescent cervix is immature and lacks immunity. c. The length of the vaginal canal is short in adolescents, allowing a greater concentration of microorganisms within the internal genitalia. d. In adolescent girls, the anus to the vaginal introitus are in close proximity.

ANS: B Partly, perhaps, because of risk-taking behavior (unprotected intercourse or selection of high-risk partners), many adolescents have an increased risk for STI exposure and infection. The unique factor for adolescent women is that they have a physiologically increased susceptibility to infection because of increased cervical immaturity and lack of immunity. The remaining options are not considered legitimate risk factors for STIs. PTS: 1 REF: Pages 918-919

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

How does an established gonococcal infection usually express itself in newborns? a. Generalized skin rash 4 to 6 days after birth b. Systemic infection with fever c. Bilateral corneal ulceration d. Yellow vaginal or penile discharge approximately 10 days after birth

ANS: C Established infection causes bilateral corneal ulceration. The other options are not usual sites for such an infection. PTS: 1 REF: Page 922

Which of the following causes condylomata acuminata or genital warts? a. Chlamydia c. Human papillomavirus (HPV) b. Adenovirus d. Herpes simplex virus 1 (HSV-1)

ANS: C Genital warts are quite contagious and are a result of only HPV. PTS: 1 REF: Pages 934-935

Which statement is false about the factors that facilitate the ascent of gonococci into the uterus and fallopian tubes? a. Ascent of gonococci is facilitated because the cervical plug disintegrates during menstruation. b. Ascent of gonococci is facilitated because the vaginal pH decreases to 2 or 3. c. Ascent of gonococci is facilitated because the uterine contractions may cause retrograde menstruation into the fallopian tubes. d. Ascent of gonococci is facilitated because the bacteria may adhere to sperm and be transported to the fallopian tubes.

ANS: B Several factors can facilitate the ascent of gonococci into the uterus and the fallopian tubes, where they cause pelvic inflammatory disease (PID). Among these factors are (1) disintegration of the cervical mucous plug and (2) a rise in vaginal pH greater than 4.5 during menstruation. The other options are accurate statements. PTS: 1 REF: Page 921

A woman diagnosed with trichomoniasis asks if her sexual partner should be treated as well. What is the appropriate response? a. Sexual partners should be treated only if symptoms are present. b. Sexual partners should be treated even if they are asymptomatic. c. Infections in men are self-limiting; therefore a male sexual partner does not require treatment. d. Sexual partners should be treated to prevent infection.

ANS: B Sexual partners, even if asymptomatic, are also treated and examined for coexisting sexually transmitted infections. PTS: 1 REF: Page 938

Which organism is responsible for the development of syphilis? a. Neisseria syphilis c. Haemophilus ducreyi b. Treponema pallidum d. Chlamydia trachomatis

ANS: B T. pallidum is the only cause of syphilis. PTS: 1 REF: Page 923

The risk of which cancer is greater if the man has a history of cryptorchidism? a. Penile c. Prostate b. Testicular d. Epididymal

ANS: B The risk of testicular cancer is 35 to 50 times greater in men with cryptorchidism or in those with a history of cryptorchidism than it is for the general male population. This is not true of the other options. PTS: 1 REF: Pages 893-894

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

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

Which statements are true concerning the sexually transmitted infection (STI) lymphogranuloma venereum? (Select all that apply.) a. Lymphogranuloma venereum is an STI commonly diagnosed in the United States. b. It begins as a skin infection. c. Lymphogranuloma venereum spreads to lymph tissues. d. Primary and secondary lesions are apparent with this STI. e. A 60-day course of oral erythromycin is the recommended treatment.

ANS: B, C, D Lymphogranuloma venereum is a chronic STI uncommon in the United States. The lesion begins as a skin infection and spreads to the lymph tissue, causing inflammation, necrosis, buboes, and abscesses of the inguinal lymph nodes. Primary lesions appear on the penis and scrotum in men and on the cervix, vaginal wall, and labia in women. Secondary lesions involve inflammation and swelling of the lymph nodes with the formation of large blue buboes that rupture and form draining ulcerative lesions. A 21-day or longer course of oral doxycycline or erythromycin is needed for treatment. Treatment of sexual partners is recommended. PTS: 1 REF: Pages 931-932

Which statements are true regarding prostate cancer? (Select all that apply.) a. It ranks second to lung cancer as being most common among American men. b. A familial history of prostate cancer is a risk factor. c. Dietary habits seem to play a role in its development. d. African-American men have an increased risk for its development. e. Being over 65 years of age increases the risk for developing prostate cancer.

ANS: B, C, D, E Prostate cancer is the most commonly diagnosed non-skin cancer in American men, and the incidence varies greatly worldwide. Possible causes include a genetic predisposition, environmental and dietary factors, inflammation, and alterations in levels of hormones (e.g., testosterone, dihydrotestosterone, estradiol) and growth factors. Incidence is greatest among northwestern European and North American men (particularly African Americans) older than 65 years of age. PTS: 1 REF: Pages 900-910

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

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

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

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

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

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

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

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

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.

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

Which sexually transmitted infection frequently coexists with gonorrhea? a. Syphilis c. Chlamydia b. Herpes simplex virus d. Chancroid

ANS: C The coexistence of chlamydial infection with gonorrhea frequently occurs. No coexistence exists with the other options. PTS: 1 REF: Page 922

What is the first sign of puberty in boys? a. Thickening of the scrotal skin c. Enlargement of the testes b. Growth of pubic hair d. Change in voice

ANS: C The first sign of puberty in boys is an enlargement of the testes and a thinning of the scrotal skin. PTS: 1 REF: Page 886

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

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

What is the primary site for uncomplicated local gonococci infections in men? a. Epididymis c. Urethra b. Lymph nodes d. Prostate

ANS: C Uncomplicated local infections are observed primarily as urethral infections in men. PTS: 1 REF: Page 921

How is gonorrhea transmitted from a pregnant woman to her fetus? a. Unbound in the blood via the placenta b. Attached to immunoglobulin G (IgG) via the placenta c. Across amniotic membranes by the direct inoculation with the fetal scalp electrodes during labor monitoring d. Predominately through infected cervical and secretions during the birth process

ANS: D A pregnant woman can transmit gonorrhea to her fetus during the birth process. The infection passes from mother to child predominately through infected cervical and vaginal secretions. The transmission is not associated with the other options. PTS: 1 REF: Page 920

Symptoms of benign prostatic hyperplasia (BPH) are a result of which pathophysiologic condition? a. Infection of the prostate c. Ischemia of the urethra b. Obstruction of the urethra d. Compression of the urethra

ANS: D BPH becomes problematic as prostatic tissue compresses the urethra, where it passes through the prostate. Of the selections available, only this option accurately describes the pathophysiologic condition behind the symptoms of BPH. PTS: 1 REF: Pages 897-899

Which infection has clinical manifestations that include the sudden onset of malaise, low back pain, and perineal pain with high fever and chills, dysuria, nocturia, and urinary retention? a. Orchitis c. Epididymitis b. Balanitis d. Bacterial prostatitis

ANS: D Bacterial prostatitis can exhibit common manifestations that include a sudden onset of malaise, low back and perineal pain, high fever (up to 40° C [104° F

By which method is the organism that causes syphilis best identified? a. Acid-fast stain c. In vitro culture b. Gram-stained slide d. Darkfield microscopy

ANS: D Because Treponema pallidum cannot be cultured in vitro, early definitive diagnosis of primary or secondary syphilis depends on darkfield microscopy of a specimen taken from a chancre, regional lymph node, or other lesion. The remaining options are not relevant. PTS: 1 REF: Page 925

Cryptorchidism can be defined as which of the following? a. Normal developmental state of the testes b. Abnormal state in which the testes are overdeveloped c. Lack of scrotum d. Testicular maldescent

ANS: D Cryptorchidism is a condition of testicular maldescent, the only option that accurately defines cryptorchidism. PTS: 1 REF: Page 892

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

In the 95% of those with delayed puberty, the problem is caused by which condition? 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 cases, delayed puberty is a physiologic delay; that is, hormonal levels are normal and the hypothalamic-pituitary-gonadal (HPG) axis is intact, but maturation is happening slowly. This selection is the only option that accurately describes 95% of those with delayed puberty. PTS: 1 REF: Page 886

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

Which statement provides the most accurate information regarding the transmission of herpes simplex virus (HSV)? a. HSV is transmitted only when vesicles are present. b. HSV is transmitted only while lesions are present. c. The use of condoms prevents the transmission of HSV. d. The risk of transmission is present even during latent periods.

ANS: D Latent infections can become reactivated and cause a recurrent infection with similar manifestations. The other options are not accurate statements regarding the transmission of HSV. PTS: 1 REF: Pages 933-934

Galactorrhea, or inappropriate lactation, is the

persistent secretion of a milky substance by one or both breasts in nonpregnant, nonlactating women

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

What term is used to identify a fibrotic condition that causes lateral curvature of the penis during erection, which is associated with a local vasculitis-like inflammatory reaction and decreased tissue oxygenation? a. Phimosis c. Lateral paraphimosis b. Lateral phimosis d. Peyronie disease

ANS: D Peyronie disease (bent nail syndrome) is a fibrotic condition of the tunica albuginea of the penis, resulting in varying degrees of curvature and sexual dysfunction (see Figure 25-2). Although the exact cause is unknown, a local vasculitis-like inflammatory reaction occurs and decreased tissue oxygenation results in fibrosis and calcification. Peyronie disease is the only term used to identify the pathophysiologic condition described. PTS: 1 REF: Pages 889-890

What term is used to identify a condition in which the foreskin cannot be retracted over the glans penis? a. Paraphimosis c. Prephimosis b. Priapism d. Phimosis

ANS: D Phimosis is the only term used to identify the condition in which the foreskin cannot be retracted back over the glans. PTS: 1 REF: Page 888

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

In which stage of syphilis would the following clinical manifestations be found: destructive skin, bone and soft tissue lesions, aneurysms, heart failure, and neurosyphilis? a. Primary c. Latent b. Secondary d. Tertiary

ANS: D Stage IV, tertiary syphilis, is the only stage during which significant morbidity and mortality occur, including destructive skin, bone, and soft-tissue lesions (see Box 26-2). PTS: 1 REF: Page 924

Entamoeba histolytica

Amebiasis

High FSH levels stimulate

follicle and ovum maturation (follicular phase), and then a surge of LH causes ovulation, which is followed by development of the corpus luteum (luteal phase).

Prostate cancer is the most common cancer in

American men, and the incidence varies greatly worldwide

granuloma inguinale treatment

Antibiotics

Treatment of male sexual partners is not recommended in

BV

trich

Both partners usually are infected

The causative organism chlamydia is

C. trachomatis,

Infection with high-risk HPV, a sexually transmitted infection, is a necessary precursor to developing

CIN and cervical cancer. HPV vaccination can substantially [reduce the risk of cervical cancer

Haemophilus ducreyi

Chancroid

Hydrocele

Collection of fluid in the tunica vaginalis

balantis is associated with

phimosis, inadequate cleansing under the foreskin, skin disorders, and infections.

precocious puberty

Sexual maturation before age 6 in black girls and age 7 in white girls Sexual maturation before age 9 in boys

Extrahypothalamic factors cause the hypothalamus to secrete

GnRH

Calymmatobacterium granulomatis

Granuloma inguinale

Production of the male sex hormones is controlled by the

HPG axis and by complex feedback mechanisms.

Menstrual disorders usually involve some disruption of the

HPG axis and subsequent alteration of hormone production, reception by target organs, or feedback mechanisms.

The major risk for vulvar cancer is a history of

HPV infection or squamous dysplasia of the vagina or cervix

Testing is available to detect

HR-HPV

Secondary amenorrhea is the absence of regular menses

for 3 months, or 6 months of irregular menses in women who have previously menstruated.[ Secondary amenorrhea is usually associated with[ anovulation.

treatment BV

Metronidazole (Flagyl)

tx oftrich

Metronidazole is the treatment for both sexes

BV has been associated with

PID, chorioamnionitis, preterm labor, and postpartum endometritis

Complications of ghonorrhea include

PID, sterility, and disseminated infection

Approximately 300 emotional, physical, and behavioral symptoms have been attributed to

PMS.

Phimosis and paraphimosis are penile disorders involving the

foreskin (prepuce)

Testicular torsion

Rotation of a testis, which twists blood vessels of the spermatic cord Varicocele Abnormal dilation of the vein within the spermatic cord

Delayed puberty

Secondary sex characteristics have not appeared in girls by age 13 Breast development age decreasing Secondary sex characteristics have not appeared in boys by age 14

Treponema pallidum

Syphilis

ttx of crabs

Topical application of prescription or over-the-counter pediculicides

. Trichomonas vaginalis

Trichomoniasis

The scrotum is a skin-covered fibromuscular sac that encloses the

[testes and epididymides, which are suspended within the scrotum by the spermatic cord.

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

A varicocele is an

abnormal dilation of the veins within the spermatic cord caused by either congenital absence of valves in the internal spermatic vein or acquired valvular incompetence

ALH is

abnormal proliferating cells in the lumen of lobular units

Cervicitis, which is inflammation of the cervix, can be

acute (mucopurulent cervicitis) or chronic.

Most breast cancers are

adenocarcinomas and first arise from the ductal/lobular epithelium as carcinoma in situ

Most cancers of the prostate are

adenocarcinomas that develop at the periphery of the gland

gynocomastia incidence is greatest among

adolescents and men older than 50 years

Women's fertility decreases with

age, and older women may opt for intervention sooner than younger women

The lobules contain

alveolar cells, which are convoluted spaces lined with epithelial cells that secrete milk and subepithelial cells that contract, moving the milk into the system of ducts that leads to the nipple.

, secretion of GnRH stimulates the

anterior pituitary to secrete gonadotropins—FSH and LH

Treatment of urethritis consists of

appropriate antibiotic therapy and avoidance of future chemical or mechanical irritation.

phases mentrrual cycle

are named for ovarian and endometrial changes: the follicular/proliferative phase, the luteal/secretory phase, and the ischemic/menstrual phase.

With chancroid infection, women are generally

asymptomatic and men may develop inflamed, painful genital ulcers and inguinal buboes

Gonorrhea is rapidly becoming resistant to

available antibiotics

Localized nodules

coalesce to form granulomas and ulcers on the penis in men and on the labia in women

Invasion by primary tumor cells typically involves the

collective migration of large, cohesive groups into adjacent tissue rather than the scattering of individual carcinoma cells

The epididymis is a long coiled tube arranged in a

comma-shaped compartment that curves over the top and rear of the testis.

Amenorrhea is divided into compartments that reflect the underlying disorder:

compartment I, disorders of the outflow tract or uterine target organ; compartment II, disorders of the ovary; compartment III, disorders of the anterior pituitary; and compartment IV, disorders of the CNS or hypothalamic factors.

Precocious puberty can be

complete (sex appropriate), mixed (not sex appropriate), or partial (development of one secondary sex characteristic only).

fallopain tube function is to

conduct ova from the spaces around the ovaries to the uterus.

Treatment of scabies

consists of topical application of a pediculicide

The urethra runs through the

corpus spongiosum

Acyclovir reduces symptoms but does not

cure the disease

Fibrosis prevents engorgement on the affected side, causing a lateral

curvature that can prevent intercourse.

During the reproductive years breast tissue undergoes

cyclic changes in response to hormonal changes of the menstrual cycle.

A spermatocele is a

cyst located between the testis and epididymis that is filled with fluid and sperm

. Multidrug therapy is now recommended to

decrease drug resistance

In most cases of delayed puberty, the hypothalamic-pituitary-gonadal (HPG) axis is intact but the surge of activity that stimulates puberty is

delayed

Other important factors are

delayed involution of the mammary gland and increased breast density

The penis has two functions:

delivery of sperm to the female vagina and elimination of urine.

Emotional symptoms, particularly

depression, anger, irritability, and fatigue, are reported as the most distressing

Polycystic ovary syndrome (PCOS) is a

difficult syndrome to diagnose because several factors are involved

The primary symptom urithral stricture is

diminished force and caliber of the urinary stream; other symptoms include urinary frequency and hesitancy, mild dysuria, double urine stream or spraying, and postvoid dribbling

The term nonproliferative lesions is used to

discriminate such lesions from the "proliferative" changes associated with increased risk of breast cancer

Fertilization normally occurs in the

distal third of the fallopian tubes.

Numerous benign conditions occur in

ducts and lobules in the breast

Bartholinitis, also called Bartholin cyst, is an inflammation of the

ducts that lead from the Bartholin glands to the surface of the vulva.

Abnormal uterine bleeding (AUB) is bleeding that is abnormal in

duration, volume, frequency, regularity, or some combination of these factors.

Symptoms of urethritis include

dysuria, frequency, urgency, urethral tingling or itching, and clear or purulent discharge

Carcinoma in situ is an

early stage, noninvasive proliferation of epithelial cells confined to the ducts and lobules by the basement membrane

Prostatic secretions are alkaline and contribute to the

ejaculate.

Oral contraceptive use protects against

endometrial and ovarian cancers

Adenomyosis is the presence of

endometrial glands and stroma within the uterine myometrium.

During the follicular/proliferative phase of the ovarian cycle, estrogen produced by the follicle causes the

endometrium to proliferate (proliferative phase) and induces the LH surge and progesterone production in the granulosa layer

bph becomes symptomatic as the

enlarging prostate compresses the urethra, causing symptoms of bladder outlet syndrome and urine retention

Emission, which occurs at the peak of sexual arousal, is the movement of semen from the

epididymides to the penis

Like cervical cancers, vaginal cancers arise from the

epithelium and are identified as intraepithelial neoplasia (dysplasia), carcinoma in situ, or invasive carcinoma

Sexual intercourse is made possible by the

erectile reflex, in which tactile or psychogenic stimulation of the parasympathetic nerves causes arterioles in the corpora cavernosa and corpus spongiosum to dilate and fill with blood, causing the penis to enlarge and become firm.

. The corpora cavernosa and corpus spongiosum consist of

erectile tissue.

Studies demonstrate that the activation of a chronic, inflammatory prostatic response plays an important role in the

pathogenesis and progression of BPH and prostate cancer

Endometrial cancer is the most common cancer of the

pelvic region

Paraphimosis can constrict the

penile blood vessels, preventing circulation to the glans.

The scrotum keeps these organs at

optimal temperatures for sperm survival (about 1°C to 2°C [33.8°F to 35.6°F

Individuals are contagious during

outbreaks and episodes of asymptomatic viral shedding

Endometriosis is the presence of functional endometrial tissue (i.e., tissue that responds to hormonal stimulation) at sites

outside the uterus

BRCA1, BRCA2, and HNPCC gene abnormalities also are linked with

ovarian cancer

. Androgens in women are produced within the

ovarian follicle, adrenal glands, and adipose tissue.

Endometrial polyps are

overgrowths of endometrial tissue and often cause abnormal bleeding

Milk ejection is under the control of

oxytocin, which causes contraction of myoepithelial cells.

Primary dysmenorrhea is

painful menstruation not associated with pelvic disease.

Other manifestations include

palpable lymph nodes in the axilla, dimpling of the skin, nipple and skin retraction, nipple discharge, ulcerations, reddened skin, and bone pain associated with bony metastases

Scabies is a

parasitic infection that spreads by skin-to-skin and sexual contact

Overall, lifetime risk of breast cancer is reduced in

parous women compared to nulliparous women, but pregnancy must occur at a young age.

Metastases also may

occur early in the process of neoplastic transformation

In adults mollescum tends to occur

on the genitalia and be transmitted by sexual contact

Sexual dysfunction in males can be caused by any

physical or psychologic factor that impairs erection, emission, or ejaculation. 22. Spermatogenesis (sperm production by the testes) can be impaired by disruptions of the HPG axis that reduce testosterone secretion and by testicular trauma or atrophy from any cause

PMS is the cyclic recurrence of

physical, psychologic, or behavioral changes distressing enough to disrupt normal activities or interpersonal relationships.

95% of cases of delayed puberty are

physiologic (hormonal- or hypothalamic-pituitary-gonadal axis delay) 5% are caused by some type of disruption of the hypothalamic-pituitary-gonadal axis

Pelvic inflammatory disease (PID) is an acute ascending

polymicrobial infection of the upper genital tract and is often caused by sexually transmitted pathogens that are allowed to ascend because of disruptions in the normal vaginal flora.

Phimosis is caused by

poor hygiene and chronic infection and can lead to paraphimosis

Peak incidence vulvar cancer is in

postmenopausal women, but younger women can be affected

Female sex hormones

predominate and are involved in sexual differentiation and development, the menstrual cycle, pregnancy, and lactation

Congenital syphilis contributes to

prematurity of the newborn with bone marrow depression, CNS involvement, renal failure, and intrauterine growth retardation

. Androgens in women contribute to

prepubertal growth spurt, pubic and axillary hair growth, and activation of sebaceous glands.

Some of the spermatogonia develop into

primary spermatocytes, which divide meiotically into secondary spermatocytes and then spermatids.

; physical symptoms of PMS tend to be less

problematic

The function of the male reproductive system is to

produce male gametes (sperm) and deliver them to the female reproductive tract.

The corpus luteum, the structure that develops from the ruptured ovarian follicle after ovulation or ovum release, produces

progesterone

Milk production occurs in response to

prolactin, a hormone that is secreted by alveolar epithelial cells in larger amounts after childbirth.

The endometrium

proliferates (thickens) and sloughs off in response to cyclic hormonal changes.

ADH is abnormal

proliferating cells in breast ducts

Proliferative breast lesions without atypia are characterized by

proliferation of ductal epithelium and/or stroma

Prostatitis is inflammation of the

prostate

Benign prostatic hyperplasia (BPH) is enlargement of the

prostate gland

Production of the male gametes (sperm) begins at

puberty

. Ejaculation, which is a continuation of emission, is the

pulsatile ejection of semen from the penis.

Cancer of the vagina is

rare

Granuloma inguinale (donovanosis) is

rare in the United States

Cancer of the penis is

rare; major risk factors include HPV, smoking, and consequences of treatment for psoriasis.

Universal vaccination of infants and children is

recommended, as well as vaccination of high-risk adults

While the average age of pubertal onset appears to be decreasing for girls, the age of pubertal onset has

remained essentially unchanged for boys

Evaluation of fertility includes

reproductive hormone assays and assessment of structural alteration or infections and the determination of normal ovulation or adequate sperm motility and count

The major risk factors for breast cancer are classified as

reproductive, such as nulliparity and pregnancy-associated breast cancer; familial, such as inherited gene syndromes; and environmental and lifestyle, such as hormonal factors and radiation exposure

In phimosis the foreskin cannot be

retracted over the glans

In paraphimosis the foreskin is retracted and cannot be

returned to its normal anatomic position over the glans

Both emission and ejaculation involve

rhythmic contractions of smooth muscle within the internal glands and ducts.

Breast gland involution after pregnancy and lactation uses some of the

same tissue remodeling pathways activated during wound healing

Cellular subpopulations from different sections of the

same tumor vary in growth rate, immunogenicity, ability to metastasize, and drug response

The testes (male gonads) are paired glands suspended within the

scrotum

The glans contains

sebaceous glands and the opening of the urethra and is covered by a flap of skin (the foreskin).

Most are vaginal cancers are

secondary in nature

Syphilis is diagnosed with

serologic testing and is treated with injectable penicillin

. Bacterial vaginosis (BV) is a

sexually associated condition caused by an overgrowth of anaerobic bacteria that produce aromatic amines and raise the pH of the vagina, promoting further bacterial growth (without an inflammatory response) and a fishy odor

Condylomata acuminata (genital warts) are

sexually transmitted and highly contagious.

Gonorrhea is a

sexually transmitted communicable disease that can be local or systemic