week 2 patho

The mucosal secretions of the cervix secrete which immunoglobulin? a. IgA c. IgG b. IgE d. IgM

ANS: A Mucosal secretions from the cervix contain enzymes and antibodies—predominantly IgA. PTS: 1 REF: Page 775

Which form of diabetes insipidus (DI) is treatable with exogenous antidiuretic hormone (ADH)? a. Neurogenic c. Nephrogenic b. Psychogenic d. Ischemic

ANS: A Neurogenic DI is treated with ADH replacement therapy. The other options are incorrect. PTS: 1 REF: Page 720

A Sims-Huhner test is of particular interest to a patient experiencing which condition? a. Infertility c. Venereal disease b. Possible HIV infection d. Perimenopause

ANS: A A Sims-Huhner test evaluates the ability of sperm to penetrate and maintain motility in cervical mucus 2 to 4 hours after coitus approximately 1 day before ovulation. The enzyme-linked immunosorbent assay (ELISA) detects the presence of antibodies to human immunodeficiency virus (HIV). Venereal Disease Research Laboratory (VDRL) is a test for nonspecific venereal diseases. Estradiol levels are associated with erratic or intermittent menstruation. PTS: 1 REF: Page 792 | Table 23-3

The common cause of elevated levels of antidiuretic hormone (ADH) secretion is: a. Ectopically produced ADH c. Posterior pituitary tumor b. Inflammation of the hypothalamus d. Inflammation of the nephrons

ANS: A A common cause of elevated levels of ADH secretion is ectopically produced ADH, which makes the other options incorrect. PTS: 1 REF: Page 718

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 do penile erections begin? a. Before birth c. Shortly before puberty b. Shortly after birth d. After puberty

ANS: A Erections begin in utero and continue throughout life, but ejaculation does not occur until sperm production begins at puberty. PTS: 1 REF: Page 787

Hypoglycemia, followed by rebound hyperglycemia, is observed in those with: a. The Somogyi effect b. The dawn phenomenon c. Diabetic ketoacidosis d. Hyperosmolar hyperglycemic nonketotic syndrome

ANS: A Hypoglycemia, followed by rebound hyperglycemia, is observed only in the Somogyi effect. PTS: 1 REF: Page 746

Which condition may result from pressure exerted by a pituitary tumor? a. Hypothyroidism c. Diabetes insipidus b. Hypercortisolism d. Insulin hyposecretion

ANS: A If the tumor exerts sufficient pressure, then thyroid and adrenal hypofunction may occur because of lack of thyroid-stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH). These result in the symptoms of hypothyroidism and hypocortisolism. The remaining options are not associated with the pressure exerted by a pituitary tumor. PTS: 1 REF: Page 722

What is the function of the mucus secreted by the Bartholin glands? a. Enhancement of the motility of sperm b. Lubrication of the urinary meatus and vestibule c. Maintenance of an acid-base balance to discourage proliferation of pathogenic bacteria d. Enhancement of the size of the penis during intercourse

ANS: A In response to sexual stimulation, the Bartholin glands secrete mucus that serves only to lubricate the inner labial surfaces, as well as to enhance the viability and motility of sperm. PTS: 1 REF: Page 772

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, 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 immunoglobulin is contained in breast milk? a. IgA c. IgG b. IgE d. IgM

ANS: A Not only does breast milk composition change over time to meet the changing digestive capabilities and nutritional requirements of the infant, but it also contains immune cells, specific immunoglobulins, especially IgA, and nonspecific antimicrobial factors, such as lysozymes and lactoferrin, that protect the infant against infection, allergies, and asthma. PTS: 1 REF: Page 784

Diabetes insipidus is a result of: a. Antidiuretic hormone hyposecretion c. Insulin hyposecretion b. Antidiuretic hormone hypersecretion d. Insulin hypersecretion

ANS: A Of the available options, diabetes insipidus is a result of insufficient antidiuretic hormone. PTS: 1 REF: Page 719

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

Type 2 diabetes mellitus is best described as a(an): a. Resistance to insulin by insulin-sensitive tissues b. Need for lispro instead of regular insulin c. Increase of glucagon secretion from cells of the pancreas d. Presence of insulin autoantibodies that destroy cells in the pancreas

ANS: A One of the basic pathophysiologic characteristics of type 2 diabetes is the development of insulin-resistant tissue cells. None of the remaining options appropriately describes type 2 diabetes. PTS: 1 REF: Page 739

Which classification of oral hypoglycemic drugs decreases hepatic glucose production and increases insulin sensitivity and peripheral glucose uptake? a. Biguanide (metformin) c. Meglitinides (glinides) b. Sulfonylureas (glyburide) d. -Glycosidase inhibitor (miglitol)

ANS: A Only biguanides decrease hepatic glucose production and increase insulin sensitivity and peripheral glucose uptake. PTS: 1 REF: Page 743 | Table 22-9

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.

The term used to describe a person who experiences a lack of all hormones associated with the anterior pituitary is: a. Panhypopituitarism c. Hypopituitarism b. Adrenocorticotropic hormone deficiency d. Anterior pituitary failure

ANS: A Panhypopituitarism is the only available term that is correctly associated with the lack of all anterior pituitary hormones. PTS: 1 REF: Page 721

Which serum glucose level would indicate hypoglycemia in a newborn? a. 28 mg/dl c. 60 mg/dl b. 40 mg/dl d. 80 mg/dl

ANS: A Serum glucose <30 mg/dl in newborn (first 2 to 3 days) and <55 to 60 mg/dl in adults is associated with hypoglycemia. PTS: 1 REF: Page 744 | Table 22-10

Which laboratory value is consistently low in a patient with diabetes insipidus (DI)? a. Urine-specific gravity c. Urine protein b. Serum sodium d. Serum total protein

ANS: A The basic criteria for diagnosing DI include a low urine-specific gravity while sodium levels are high. Protein levels are not considered. PTS: 1 REF: Page 720

Pathologic changes associated with Graves disease include: a. High levels of circulating thyroid-stimulating immunoglobulins b. Diminished levels of thyrotropin-releasing hormone c. High levels of thyroid-stimulating hormone d. Diminished levels of thyroid-binding globulin

ANS: A The only option that correctly describes the changes associated with Graves disease identifies high levels of circulating thyroid-stimulating immunoglobulins that are found in more than 95% of individuals diagnosed with the disease. PTS: 1 REF: Page 726

What structure in the male lies posterior to the urinary bladder? a. Seminal vesicles c. Cowper glands b. Prostate glands d. Parabladder glands

ANS: A The seminal vesicles are a pair of glands, each measuring approximately 4 to 6 cm long, which lie behind the urinary bladder and in front of the rectum. None of the other structures lie in this location. PTS: 1 REF: Page 788

A patient who is diagnosed with a closed head injury has a urine output of 6 to 8 L/day. Electrolytes are within normal limits, but his antidiuretic hormone (ADH) level is low. Although he has had no intake for 4 hours, no change in his polyuria level has occurred. These symptoms support a diagnosis of: a. Neurogenic diabetes insipidus b. Syndrome of inappropriate antidiuretic hormone c. Psychogenic polydipsia d. Osmotically induced diuresis

ANS: A The stated symptoms are reflective of neurogenic diabetes insipidus and not of the remaining options. PTS: 1 REF: Pages 719-720

Which statements are true regarding the female menstrual cycle? (Select all that apply.) a. Initial cycles may dramatically vary in length. b. By adulthood, the commonly accepted cycle average is 28 (27 to 30) days. c. The length of a cycle varies among women. d. Up to 8 years before menopause, the intervals of the menstrual cycle begin to lengthen. e. Menopause is achieved when a woman is without a period for 2 years.

ANS: A, B, C, D At first, cycles are anovulatory and may vary in length from 10 to 60 days or longer. As adolescence proceeds into adulthood, regular patterns of menstruation and ovulation are established at intervals ranging from 25 to 35 days. The length of the menstrual cycle varies considerably among women. The commonly accepted cycle average is 28 (27 to 30) days, with rhythmic intervals of 21 to 35 days considered normal. Approximately 2 to 8 years before menopause, cycles begin to lengthen again. Menopause is defined as the cessation of menstrual flow for 1 year. PTS: 1 REF: Page 778

Testosterone is believed to have a role in: (Select all that apply.) a. Male-patterned baldness b. Libido levels c. Acne development d. Altered cholesterol metabolism e. Thinning of the larynx

ANS: A, B, C, D Testosterone is associated with all the options except thinning of the larynx; it actually stimulates the growth of the larynx's cartilage. PTS: 1 REF: Page 789

The human zygote has a total of how many chromosomes? a. 23 c. 46 b. 25 d. 50

ANS: C A 23-chromosome female gamete, the ovum, and a 23-chromosome male gamete, the spermatozoon (sperm cell), unite to form a 46-chromosome zygote that is capable of developing into a new individual. PTS: 1 REF: Page 768

A person may experience which complications as a result of a reduction in parathyroid hormone (PTH)? (Select all that apply.) a. Muscle spasms b. Tonic-clonic seizures c. Laryngeal spasms d. Hyporeflexia e. Asphyxiation

ANS: A, B, C, E Symptoms associated with hypoparathyroidism are related to hypocalcemia. Hypocalcemia causes a lowering of the threshold for nerve and muscle excitation so that a slight stimulus anywhere along the length of a nerve or muscle fiber may initiate a nerve impulse. This creates tetany manifested as muscle spasms, hyperreflexia, tonic-clonic convulsions, laryngeal spasms, and, in severe cases, death from asphyxiation. PTS: 1 REF: Pages 733-734

Which statements about the human papillolmavirus (HPV) and vaccine are true? (Select all that apply.) a. Currently, two HPV vaccines have been approved for use in the United States. b. HPV is believed to be responsible for the majority of the diagnosed cases of cervical cancer. c. A form of the vaccine has been approved for use in males to prevent genital warts. d. The administration of the vaccine is a one-dose intramuscular injection. e. The recommended age for vaccination of girls is between 11 and 12 years of age.

ANS: A, B, C, E Two HPV vaccines are currently approved in the United States: (1) quadrivalent HPV recombinant vaccine and (2) bivalent HPV recombinant vaccine. HPV is responsible for 99.7% of cervical cancer cases, 40% of penile cancers, and an estimated 5% of all cancers worldwide. The vaccine is administered by intramuscular injection, and the recommended schedule is a three-dose series with the second and third doses administered 2 and 6 months after the first dose. The recommended age for vaccination of girls is 11 to 12 years. The vaccine can be administered to girls as young as 9 years of age. The quadrivalent vaccine has been approved for males 9 to 26 years of age to prevent genital warts. PTS: 1 REF: Page 775 | What's New box

Estrogen has many biological effects on the female body including: (Select all that apply.) a. Maturation of reproductive organs b. Differentiating female physical characteristics c. Postpuberty closure of short bones d. Regulation of the menstrual cycle e. Endometrial regeneration after menstruation

ANS: A, B, D, E Estrogen has numerous biologic effects, many of which involve interactions with other hormones. Estrogen is needed for the maturation of the reproductive organs, development of secondary sex characteristics (differentiating male and female physical characteristics that are not directly related to reproduction), closure of long bones after the pubertal growth spurt, regulation of the menstrual cycle, and endometrial regeneration after menstruation. PTS: 1 REF: Page 776

A chronic complication of diabetes mellitus is likely to result in microvascular complications in which areas? (Select all that apply.) a. Eyes b. Coronary arteries c. Renal system d. Peripheral vascular system e. Nerves

ANS: A, C, E Of the options provided, the areas most often affected are the retina, kidneys, and nerves. PTS: 1 REF: Page 747

Which disorder is caused by hypersecretion of the growth hormone (GH) in adults? a. Cushing syndrome c. Giantism b. Acromegaly d. Myxedema

ANS: B Acromegaly is a term for adults who have been exposed to continuously high levels of GH, whereas the term giantism is reserved for children and adolescents. The other options do not apply to hypersecretion of GH. PTS: 1 REF: Page 722

What happens to the vagina's lining at puberty? a. It becomes thinner. c. It assumes a neutral pH. b. It becomes thicker. d. It undergoes atrophy.

ANS: B Before puberty, vaginal pH is approximately 7 (neutral) and the vaginal epithelium is thin. At puberty, the pH becomes more acidic (4 to 5) and the squamous epithelial lining thickens. Cell atrophy is not associated with puberty. PTS: 1 REF: Page 773

The initial reproductive structures of the male and female embryos appear the same until which week of gestation? a. Third c. Twentieth b. Eighth d. Thirtieth

ANS: B Between 6 and 7 weeks' gestation, the male embryo differentiates under the influence of testes-determining factor (TDF). In the absence of testosterone, a loss of the wolffian system occurs and the two gonads develop into ovaries at 6 to 8 weeks' gestation. PTS: 1 REF: Page 769

Renal failure is the most common cause of which type of hyperparathyroidism? a. Primary c. Exogenous b. Secondary d. Inflammatory

ANS: B Chronic renal failure is the most common cause of secondary hyperparathyroidism because of the resulting hyperphosphatemia that stimulates parathyroid hormone secretion. Although the other options may occur, they are not the most common types of the disorder. PTS: 1 REF: Page 732

A patient diagnosed with diabetic ketoacidosis (DKA) has the following laboratory values: arterial pH 7.20; serum glucose 500 mg/dl; positive urine glucose and ketones; serum potassium (K+) 2 mEq/L; serum sodium (Na+) 130 mEq/L. The patient reports that he has been sick with the "flu" for 1 week. What relationship do these values have to his insulin deficiency? a. Increased glucose use causes the shift of fluid from the intravascular to the intracellular space. b. Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis. c. Increased glucose and fatty acids stimulate renal diuresis, electrolyte loss, and metabolic alkalosis. d. Decreased glucose use results in protein catabolism, tissue wasting, respiratory acidosis, and electrolyte loss.

ANS: B Decreased glucose causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis, which have resulted in the symptoms listed in the question. The relationship between the stated assessment values and insulin deficiency is not effectively described by any of the other options. PTS: 1 REF: Pages 744-745

Giantism occurs only in children and adolescents because their: a. Growth hormones are still diminished. b. Epiphyseal plates have not yet closed. c. Skeletal muscles are not yet fully developed. d. Metabolic rates are higher than in adulthood.

ANS: B Giantism is related to the effects of growth hormones on the growth of long bones at their epiphyseal plates. This information makes the other options incorrect. PTS: 1 REF: Page 722

Which statement is true regarding the major difference between male and female sex hormone production? a. Luteinizing hormone has no apparent action in a man. b. In a man, sex hormone production is relatively constant. c. Estradiol is not produced in a man. d. In a man, gonadotropin-releasing hormone does not cause the release of follicle stimulating hormone.

ANS: B In men, sex hormone production is relatively constant with some diurnal variation. The other options are not true statements. PTS: 1 REF: Page 789

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

A surge of which hormone causes the corpus luteum to produce progesterone? a. Follicle stimulating hormone c. Gonadotropin-releasing hormone b. Luteinizing hormone d. Estrogen

ANS: B Luteinizing hormone from the anterior pituitary stimulates the corpus luteum to secrete progesterone, the second major female sex hormone. PTS: 1 REF: Page 778

What directly causes ovulation during the menstrual cycle? a. Gradual decrease in estrogen levels c. Sharp rise in progesterone levels b. Sudden increase of LH d. Gradual increase in estrogen levels

ANS: B Menstrual cyclicity and regular ovulation are dependent on (1) the activity of the gonadostat (GnRH pulse generator); (2) the pituitary secretion of gonadotropins; and (3) estrogen (estradiol)-positive feedback for the preovulatory LH and FSH surges, oocyte maturation, and corpus luteum formation. PTS: 1 REF: Pages 778-780

Which structure is lined with columnar epithelial cells? a. Perimetrium c. Myometrium b. Endocervical canal d. Vagina

ANS: B Of the available options, only the endocervical canal does not have an endometrial layer; rather, the layer is lined with columnar epithelial cells. PTS: 1 REF: Page 775

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

Which form of diabetic insipidus (DI) will result if the target cells for antidiuretic hormone (ADH) in the renal collecting tubules demonstrate insensitivity? a. Neurogenic c. Psychogenic b. Nephrogenic d. Ischemic

ANS: B Only nephrogenic DI is associated with an insensitivity of the renal collecting tubules to ADH. PTS: 1 REF: Page 720

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

Which hormone promotes the development of testosterone in both males and females? a. Progesterone c. Oxytocin b. Prolactin d. Estrogen

ANS: B Prolactin, a polypeptide synthesized and secreted from the pituitary, helps maintain biosynthesis of testosterone. PTS: 1 REF: Page 791

Which hormone is linked to an increase in appetite during puberty? a. Inhibin c. Activin b. Leptin d. Follistatin

ANS: B Sensitivity to leptin, which regulates appetite and energy metabolism, increases during puberty; in theory, the adolescent consumes more calories to meet the caloric needs of the pubertal growth spurt. The percent of body fat and leptin levels in girls continue to increase, whereas muscle mass increases in boys. No apparent link exists between increased appetite during puberty and any of the other options. PTS: 1 REF: Page 778

Which disorder is considered a co-morbid condition of acromegaly? a. Hypotension c. Brain cancer b. Diabetes d. Thyroid cancer

ANS: B Symptoms of type 2 diabetes mellitus, such as polyuria and polydipsia, may occur. Acromegaly-associated hypertension is usually asymptomatic until symptoms of heart failure develop. Neither thyroid nor brain cancer has been associated with acromegaly. PTS: 1 REF: Page 724

The Skene glands are located on either side of which structure? a. Introitus c. Clitoris b. Urinary meatus d. Vestibule

ANS: B The ducts of the Skene glands (also called the lesser vestibular or paraurethral glands) are related only to the urinary meatus. PTS: 1 REF: Page 772

The level of thyroid-stimulating hormone (TSH) in individuals with Graves disease is usually: a. High c. Normal b. Low d. In constant flux

ANS: B The hyperfunction of the thyroid gland leads to suppression of TSH because of the normal negative feedback mechanism, thus eliminating the other options as being correct. PTS: 1 REF: Page 726

A deficiency of which chemical may result in hypothyroidism? a. Iron c. Zinc b. Iodine d. Magnesium

ANS: B The only cause of hypothyroidism from among the provided options is a deficiency of endemic iodine. PTS: 1 REF: Page 728

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

What are normal characteristics of aging of the male reproductive system? (Select all that apply.) a. Reduced sperm count b. Slower, less forceful ejaculations c. Testicular atrophy and softening d. Longer time to achieve full erection e. Decreased levels of testosterone

ANS: B, C, D, E The described effects on ejaculation, testes, erection, and testosterone are normal characteristics of male aging. Sperm count remains normal with age, although the semen tends to contain more defective and nonmotile sperm. PTS: 1 REF: Pages 795-796

Which laboratory value would the nurse expect to find if a person is experiencing syndrome of inappropriate antidiuretic hormone (SIADH)? a. Hypernatremia and urine hypoosmolality b. Serum potassium (K+) level of 5 mEq/L and urine hyperosmolality c. Serum sodium (Na+) level of 120 mEq/L and serum hypoosmolality d. Hypokalemia and serum hyperosmolality

ANS: C A diagnosis of SIADH requires a serum sodium level of less than 135 mEq/L, serum hypoosmolality less than 280 mOsm/kg, and urine hyperosmolarity. Potassium levels are not considered a factor. PTS: 1 REF: Page 719

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 change is a result of puberty and defends the vagina from infection? a. The pH stabilizes between 7 and 8. b. A thin squamous epithelial lining develops. c. Vaginal pH becomes more acidic. d. Estrogen levels are low.

ANS: C At puberty, the pH becomes more acidic (4 to 5) and the squamous epithelial lining thickens. These changes are maintained until menopause (cessation of menstruation), at which time the pH rises again to more alkaline levels and the epithelium thins out. Therefore protection from infection is greatest during the years when a woman is most likely to be sexually active. Estrogen does not play a role in infection protection. PTS: 1 REF: Page 773

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

During the time that ovulation occurs, which statement concerning basal body temperature (BBT) is true? a. BBT increases. b. BBT decreases. c. BBT fluctuates around 37° C (98° F). d. BBT rises consistently above 37.8° C (100° F).

ANS: C During the follicular phase of ovulation, the BBT fluctuates around 37° C (98° F). PTS: 1 REF: Page 782

When does the male body begin to produce sperm? a. Before birth c. At puberty b. Shortly after birth d. When erection is possible

ANS: C Erections begin in utero and continue throughout life, but ejaculation does not occur until sperm production begins at puberty. PTS: 1 REF: Page 787

Which hormone stimulates gonads to produce both male and female hormones? a. Gonadotropin-releasing hormone (GnRH) b. Follicle-stimulating hormone (FSH) c. Luteinizing hormone (LH) d. Estrogen

ANS: C Extrahypothalamic factors cause the hypothalamus to secrete GnRH, which stimulates the anterior pituitary to secrete gonadotropins—FSH and LH. These hormones, in turn, stimulate the gonads (ovaries or testes) to secrete female or male sex hormones. PTS: 1 REF: Pages 769-771

Polyuria occurs with diabetes mellitus because of the: a. Formation of ketones c. Elevation in serum glucose b. Chronic insulin resistance d. Increase in antidiuretic hormone

ANS: C Glucose accumulates in the blood and appears in the urine as the renal threshold for glucose is exceeded, producing an osmotic diuresis and the symptoms of polyuria and thirst. None of the other options appropriately describes the pathologic features of diabetes mellitus-induced polyuria. PTS: 1 REF: Page 738

Having ejected a mature ovum, the ovarian follicle develops into a(n): a. Atretic follicle c. Corpus luteum b. Thecal follicle d. Functional scar

ANS: C Having ejected a mature ovum, the only resulting structure is the corpus luteum. PTS: 1 REF: Page 776

Which gland produces the associated hormones that are found in high levels in a female fetus? a. Posterior pituitary excretes gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH). b. Hypothalamus excretes luteinizing hormone (LH) and gonadotropin-releasing hormone (GnRH). c. Anterior pituitaryfollicle-stimulating hormone (FSH) and luteinizing hormone (LH). d. Hypothalamus excretes gonadotropin-releasing hormone (GnRH) and follicle-stimulating hormone (FSH).

ANS: C In the female fetus, the anterior pituitary excretes high levels of two gonadotropins—FSH and LH. The other sequences are not correct. PTS: 1 REF: Pages 769-770

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

The first laboratory test that indicates type 1 diabetes is causing the development of diabetic nephropathy is: a. Dipstick test for urine ketones b. Increase in serum creatinine and blood urea nitrogen c. Protein on urinalysis d. Cloudy urine on the urinalysis

ANS: C Microalbuminuria is the first manifestation of this form of renal failure. Although the other options may develop, they occur after protein is found in the urine. PTS: 1 REF: Pages 748-749

What causes the microvascular complications in patients with diabetes mellitus? a. The capillaries contain plaques of lipids that obstruct blood flow. b. Pressure in capillaries increase as a result of the elevated glucose attracting water. c. The capillary basement membranes thicken, and cell hyperplasia develops. d. Fibrous plaques form from the proliferation of subendothelial smooth muscle of arteries.

ANS: C Microvascular complications are a result of capillary basement membranes thickening and endothelial cell hyperplasia. None of the remaining options appropriately describes the cause of microvascular complications in patients with diabetes mellitus. PTS: 1 REF: Page 747

The cause of neurogenic diabetes insipidus (DI) is related to an organic lesion of the: a. Anterior pituitary c. Posterior pituitary b. Thalamus d. Renal tubules

ANS: C Neurogenic DI is a result of dysfunctional antidiuretic hormone synthesis, caused by a lesion of the posterior pituitary, hypothalamus, or pituitary stalk. PTS: 1 REF: Page 719

Visual disturbances are a result of a pituitary adenoma because of the: a. Liberation of anterior pituitary hormones into the optic chiasm b. Pituitary hormones clouding the lens of the eyes c. Pressure of the tumor on the optic chiasm d. Pressure of the tumor on the optic and oculomotor cranial nerves

ANS: C Of the available options, pressure on the optic chiasm is the only cause for visual disturbances resulting from a pituitary adenoma. PTS: 1 REF: Page 722

Amenorrhea, galactorrhea, hirsutism, and osteoporosis are each caused by a: a. Posterior pituitary adenoma c. Prolactinoma b. Thymoma d. Growth hormone adenoma

ANS: C Of the options available, the hallmark of a prolactinoma is the sustained elevation of serum prolactin that is responsible for the symptoms listed in the question. PTS: 1 REF: Page 724

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 hormone relaxes the myometrium and prevents lactation until the fetus is born? a. Gonadotropin-releasing hormone (GnRH) b. Follicle-stimulating hormone (FSH) c. Progesterone d. Estrogen

ANS: C Progesterone is sometimes called the hormone of pregnancy. Its effects in pregnancy include (1) maintenance of the thickened endometrium; (2) relaxation of smooth muscle in the myometrium, which prevents premature contractions and helps the uterus expand; (3) thickening of the myometrium, which prepares it for the muscular work of labor; (4) prevention of lactation until the fetus is born; and (5) prevention of additional maturation of ova by way of suppressing FSH and LH, thereby stopping the menstrual cycle. PTS: 1 REF: Page 778

Where in the male body does spermatogenesis occur? a. Epididymis c. Seminiferous tubules b. Rete testes d. Vas deferens

ANS: C Spermatogenesis takes place only in the seminiferous tubules of the testes (see Figure 23-14). PTS: 1 REF: Pages 784-785

Where is the usual site of fertilization of an ovum? a. Trumpet end of the fallopian tubes c. Ampulla of the fallopian tubes b. Fimbriae of the fallopian tubes d. Os of the fallopian tubes

ANS: C The ampulla, or distal third, of the fallopian tube is the usual site of fertilization (see Figure 23-7). PTS: 1 REF: Page 775

Which anatomic structure secretes follicle stimulating hormone (FSH) and luteinizing hormone (LH)? a. Hypothalamus c. Anterior pituitary b. Ovaries d. Adrenal cortex

ANS: C The anterior pituitary is the gland that secretes FSH and LH. PTS: 1 REF: Pages 780-781

The most probable cause of low serum calcium after a thyroidectomy is: a. Hyperparathyroidism, secondary to Graves disease b. Myxedema, secondary to surgery c. Hypoparathyroidism caused by surgical injury d. Hypothyroidism caused by the lack of thyroid replacement

ANS: C The most common cause of hypoparathyroidism is damage caused during thyroid surgery, resulting in a lack of circulating PTH and causing a depressed level of serum calcium. This information supports the elimination of the other options. PTS: 1 REF: Page 733

The most common cause of hypoparathyroidism is: a. Pituitary hyposecretion c. Parathyroid gland damage b. Parathyroid adenoma d. Autoimmune parathyroid disease

ANS: C The most common cause of hypoparathyroidism is damage caused during thyroid surgery, thus eliminating the other options as being correct. PTS: 1 REF: Page 733

A person diagnosed with type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion. The most probable cause of these symptoms is: a. Hyperglycemia caused by incorrect insulin administration b. Dawn phenomenon from eating a snack before bedtime c. Hypoglycemia caused by increased exercise d. Somogyi effect from insulin sensitivity

ANS: C The most likely cause of these symptoms is hypoglycemia, which is often caused by a lack of systemic glucose as a result of muscular activity. None of the remaining options appropriately describes why a person diagnosed with type 1 diabetes experiences the described symptoms. PTS: 1 REF: Page 744 | Table 22-10

Graves disease develops from a(n): a. Viral infection of the thyroid gland that causes overproduction of thyroid hormone b. Autoimmune process during which lymphocytes and fibrous tissue replace thyroid tissue c. Thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones d. Ingestion of goitrogens that inhibits the synthesis of the thyroid hormones, causing a goiter

ANS: C The pathologic features of Graves disease indicates that normal regulatory mechanisms are overridden by abnormal immunologic mechanisms that result in the stimulation of excessive TH. The remaining options are incorrect statements. PTS: 1 REF: Page 726

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

The effects of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion include solute: a. Retention and water retention c. Dilution and water retention b. Retention and water loss d. Dilution and water loss

ANS: C The symptoms of SIADH secretion are a result of dilutional hyponatremia and water retention. This information supports the elimination of the other options. PTS: 1 REF: Page 719

The signs of thyrotoxic crisis include: a. Constipation with gastric distention c. Hyperthermia and tachycardia b. Bradycardia and bradypnea d. Constipation and lethargy

ANS: C The systemic symptoms of thyrotoxic crisis include hyperthermia and tachycardia. The remaining options are not associated with this disorder. PTS: 1 REF: Page 728

What causes the vasomotor flushes (hot flashes) that are associated with declining ovarian function with age? a. Decreased estrogen levels c. Increased estrogen levels b. Absence of estrogen d. Rapid changes in estrogen levels

ANS: D A rapid change in estrogen levels (withdrawal or increase), rather than low estrogen levels, induces hot flashes. PTS: 1 REF: Pages 794-795

The equivalent to the female gonad is the male: a. Epididymis c. Vas deferens b. Spermatic cord d. Testes

ANS: D Between 6 to 7 weeks' gestation, the male embryo will differentiate under the influence of TDF. TDF stimulates the male gonads to develop into the two testes. The ovaries, the female gonads, are the primary female reproductive organs. PTS: 1 REF: Page 769

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

Diagnosing a thyroid carcinoma is best performed with: a. Measurement of serum thyroid levels c. Ultrasonography b. Radioisotope scanning d. Fine-needle aspiration biopsy

ANS: D Fine-needle aspiration of a thyroid nodule is generally performed to diagnose this condition; this method is best for early detection, thus eliminating the other options. PTS: 1 REF: Page 731

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

The absence of which major hormone is a determinant of sexual differentiation (wolffian system) in utero? a. Estrogen c. Growth hormone b. Progesterone d. Testosterone

ANS: D In the absence of testosterone, a loss of the wolffian system occurs and the two gonads develop into ovaries at 6 to 8 weeks' gestation. Between 6 and 7 weeks' gestation, the male embryo differentiates under the influence of TDF. The presence of estrogen is a determinating factor. None of the other options function as a major determinant to sexual differentiation in utero. PTS: 1 REF: Page 769

When comparing the clinical manifestations of both diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNKS), which condition is associated with only DKA? a. Fluid loss c. Increased serum glucose b. Weight loss d. Kussmaul respirations

ANS: D Kussmaul respirations are only observed in those with DKA. PTS: 1 REF: Pages 745-746

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

Which hormone promotes the development of the lobular ducts in the breasts? a. Progesterone c. Oxytocin b. Prolactin d. Estrogen

ANS: D Only estrogen promotes the increase in the size of the breasts by the formation of a mass of tissue under the areola, which increases the size and pigmentation of the areola and contributes to the development of the lobular ducts. PTS: 1 REF: Page 783

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 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

What are clinical manifestations of hypothyroidism? a. Intolerance to heat, tachycardia, and weight loss b. Oligomenorrhea, fatigue, and warm skin c. Restlessness, increased appetite, and metrorrhagia d. Constipation, decreased heat rate, and lethargy

ANS: D The lower levels of thyroid hormone result in decreased energy metabolism, resulting in constipation, bradycardia, and lethargy, thus eliminating the remaining options. PTS: 1 REF: Pages 728-730 | Table 22-3

Palpation of the neck of a person diagnosed with Graves disease would detect a thyroid that is: a. Left of midline c. Normal in size b. Small with discrete nodules d. Diffusely enlarged

ANS: D The only option that characterizes Graves disease is a diffused enlargement of the thyroid gland. PTS: 1 REF: Page 760

Where is the usual site of cervical dysplasia or cancer in situ? a. Squamous epithelium of the cervix meets the cuboidal epithelium of the vagina. b. Columnar epithelium of the cervix meets the squamous epithelium of the uterus. c. Squamous epithelium of the cervix meets the columnar epithelium of the uterus. d. Columnar epithelium of the cervix meets the squamous epithelium of the vagina.

ANS: D The point at which the columnar epithelium of the cervix meets the squamous epithelium of the vagina is called the transformation zone or the squamous-columnar junction. The transformation zone is especially susceptible to the oncogenic human papillomavirus (HPV), which leads to cervical dysplasia and, ultimately, cervical cancer; these are the cells sampled during a Papanicolaou (Pap) test. PTS: 1 REF: Page 775

A person has acne, easy bruising, thin extremities, and truncal obesity. These clinical manifestations are indicative of which endocrine disorder? a. Hyperthyroidism c. Diabetes insipidus b. Hypoaldosteronism d. Cushing disease

ANS: D These symptoms are characteristic of Cushing disease and are caused by excessive ACTH secretion. The symptoms described are not characteristic of any of the other options. PTS: 1 REF: Pages 753-755

Diabetes insipidus, diabetes mellitus, and syndrome of inappropriate antidiuretic hormone all exhibit which symptom? a. Polyuria c. Vomiting b. Edema d. Thirst

ANS: D Thirst is the only symptom common to all these conditions. PTS: 1 REF: Pages 719-720 | Pages 737-738

______ A. Acromegaly ______ B. Cushing disease ______ C. Addison disease ______ D. Graves disease ______ E. Myxedema ______ F. Pheochromocytoma 43. Hypersecretion of thyroid hormone (TH) 44. Hypersecretion of adrenocorticotropic hormone (ACTH) 45. Hypersecretion of adrenal medulla hormones 46. Hyposecretion of thyroid hormone (TH) 47. Hyposecretion of adrenal cortex hormones 48. Hypersecretion of growth hormone (GH)

ANS: D PTS: 1 REF: Page 726 MSC: Graves disease is caused by the hypersecretion of TH. 44. ANS: B PTS: 1 REF: Page 753 MSC: Cushing disease is caused by the hypersecretion of ACTH. 45. ANS: F PTS: 1 REF: Page 758 MSC: Pheochromocytoma is a tumor that causes hypersecretion of adrenal medulla hormones. 46. ANS: E PTS: 1 REF: Page 729 MSC: Myxedema is the long-standing hyposecretion of TH. 47. ANS: C PTS: 1 REF: Page 757 MSC: Addison disease is a result of hyposecretion of adrenal cortex hormones. 48. ANS: A PTS: 1 REF: Pages 722-723 MSC: Acromegaly is the condition associated with the exposure of adults to high levels of GH.

Retinopathy develops in patients with diabetes mellitus because: a. Plaques of lipids develop in the retinal vessels. b. Pressure in the retinal vessels increase as a result of increased osmotic pressure. c. Ketones cause microaneurysms in the retinal vessels. d. Retinal ischemia and red blood cell aggregation occur. ANS: D

Retinopathy appears to be a response to retinal ischemia and red blood cell aggregation. None of the remaining options appropriately describes the relationship between retinopathy and diabetes mellitus. PTS: 1 REF: Page 747