Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

Psychosocial Issues and Female Sexuality

13–1. Which of the following common psychiatric problem frequently accompanies reproductive disorders?

a. Mood disorder

b. Anxiety disorder

c. Alcohol or substance abuse

d. All of the above

13–2. The diagnostic criteria defining a major depressive episode include nearly daily feelings of depressed mood and/or decreased interest or pleasure in most activities. Diagnostic criteria may also include all EXCEPT which of the following?

a. Insomnia

b. Poor concentration

c. Compulsive, repetitive behaviors

d. Inappropriate guilt or feelings of worthlessness

13–3. Anxiety disorders are more common in women and of the mood disorders, have the highest prevalence rates in the United States. What is the approximate lifetime prevalence rate (percent)?

a. 10

b. 20

c. 30

d. 40

13–4. Which of the following is more commonly diagnosed in men than in women at the present time?

a. Anxiety

b. Depression

c. Eating disorders

d. Substance misuse

13–5. The etiology of anorexia nervosa may be multifactorial with both biologic and psychosocial factors at play. What is the approximate concordance rate (percent) of the restricting type of anorexia among monozygotic twins?

a. 11

b. 33

c. 66

d. 99

13–6. A characteristic clinical feature of bulimia nervosa includes Russell sign. This finding refers to which of the following?

a. Patchy alopecia

b. Knuckle calluses

c. Electrolyte imbalance

d. Gastric and proximal small bowel dilation

13–7. Nearly 300 symptoms have been reported by women during the luteal phase of the menstrual cycle (premenstrual syndrome). In most women, these symptoms are self-limited and cause no excessive distress or functional impairment. In approximately what percentage of women are such symptoms severe enough to cause functional impairment or require special attention?

a. 5

b. 15

c. 25

d. 35

13–8. The etiology of premenstrual disorders remains obscure and likely involves a variety of biological factors. Activity of which of the following is NOT currently suspected of playing a significant role in these disorders?

a. Prolactin

b. Serotonin

c. Sex steroids

d. Renin-angiotensin-aldosterone system

13–9. At present, which of the following is considered primary therapy for psychological symptoms of premenstrual syndrome?

a. Prostaglandin inhibitors

b. Combination oral contraceptives

c. Selective serotonin-reuptake inhibitors

d. None of the above

13–10. Which of the following is the unique progestin in Yaz, an oral contraceptive that has received Food and Drug Administration (FDA) approval for the treatment of premenstrual dysphoric disorder?

a. Gestodene

b. Desogestrel

c. Drospirenone

d. Etonogestrel

13–11. Which of the following statements regarding pregnancy and depression is FALSE?

a. Suicide is a leading cause of maternal death in developed countries.

b. Depression in pregnancy has diagnostic criteria and prognosis different from those in nonpregnant women.

c. During pregnancy, there is an increased risk of relapse of a preexisting psychiatric disorder.

d. The prevalence of depression is highest in the first trimester with a slight decrease in the second and third trimesters.

13–12. Selective serotonin-reuptake inhibitor use during pregnancy has been associated with a small increased risk of which of the following in the exposed neonate?

a. Congenital malformations

b. Irritability and feeding problems

c. Persistent pulmonary hypertension

d. All of the above

13–13. Which of the following is a FALSE statement regarding postpartum depression?

a. There is no standardized screening tool available.

b. DSM-IV diagnostic criteria include diagnosis within 4 weeks of delivery.

c. Postpartum “blues” place a woman at increased risk of developing frank depression.

d. Postpartum depression affects approximately 15 percent of women after pregnancy.

13–14. Which of the following statements is true regarding clinician involvement in the grieving process following a perinatal loss?

a. Couples and family therapy may be helpful.

b. Clinicians should limit information regarding the loss.

c. Support efforts should be concentrated on the grieving mother.

d. There are no clinician interventions that aid the grieving process.

13–15. Which of the following is FALSE regarding mood disorders that develop during the menopausal transition?

a. Thyroid function should be assessed along with other possible new-onset medical conditions.

b. Depression or anxiety symptoms are a normal and expected feature of menopausal transition.

c. A short-term trial of estrogen is a reasonable therapeutic option in the absence of contraindications.

d. Rates of new-onset depression during the menopausal transition are nearly double those before menopause.

13–16. As in the general population, what is the most common psychiatric disorder diagnosed in the elderly?

a. Anxiety

b. Depression

c. Alcohol and substance misuse

d. Obsessive-compulsive behaviors

13–17. Approximately what percentage of sexual assault cases are reported by victims to authorities?

a. 10

b. 30

c. 50

d. 70

13–18. What percentage of rape victims show no gross findings during physical examination of having been assaulted?

a. 10

b. 30

c. 50

d. 70

13–19. Emergency contraception is routinely offered to rape victims who are not pregnant. What is the per rape risk (percent) of pregnancy in women of reproductive age?

a. 1

b. 5

c. 10

d. 20

13–20. A 24-year-old rape victim understands that she is at increased risk of contracting any sexually transmitted infection, but is especially fearful of human immunodeficiency virus (HIV) infection. Her assailant was not known to her. She is trying to decide whether or not to accept postexposure HIV prophylaxis. What is her approximate risk (percent) of HIV infection with receptive penile–vaginal rape?

a. 0.1

b. 1

c. 3

d. 5

13–21. Rape may result in long-term psychological symptoms that include which of the following?

a. Anxiety

b. Depression

c. Somatic complaints

d. All of the above

13–22. A 1-year-old female toddler is brought for evaluation of suspected sexual abuse. The presence of which of the following infections is the strongest indicator that such abuse has indeed occurred?

a. Gonorrhea

b. Hepatitis B

c. Genital warts

d. Trichomoniasis

13–23. Which of the following demographic characteristics does NOT increase a woman’s risk of falling victim to intimate partner violence?

a. Pregnancy

b. Younger age

c. Hispanic race

d. Witness to violence as a child

13–24. What is reported as the leading cause of death during pregnancy?

a. Suicide

b. Homicide

c. Thromboembolic event

d. Motor vehicle accident

13–25. In women, which of the following is thought to be most involved in feelings of empathy, love, and emotional intimacy?

a. Dopamine

b. Oxytocin

c. Androgens

d. Estrogens

13–26. Which of the following is NOT a component of the normal female sexual response?

a. Vaginal narrowing

b. Clitoral engorgement

c. Elevated heart and respiratory rates

d. Increased production of vaginal transudate

13–27. Which of the following therapies has been shown to positively affect postmenopausal sexual difficulties related to urogenital atrophy?

a. Estrogen

b. Progesterone

c. Testosterone

d. Selective serotonin-reuptake inhibitors

Chapter 13 ANSWER KEY