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

CHAPTER 15
Reproductive Endocrinology

15–1. Which of the following terms most accurately describes autocrine hormone communication?

a. The hormone produced and secreted acts on its own cell

b. The hormone produced and secreted acts on distant organs

c. The hormone produced and secreted acts on neighboring cells

d. The hormone produced acts intracellularly prior to secretion

15–2. The image below portrays which type of hormone action?

Image

Reproduced, with permission, from Halvorson LM: Reproductive endocrinology. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 15-2B.

a. Autocrine

b. Endocrine

c. Paracrine

d. Intracrine

15–3. Luteinizing hormone (LH) and human chorionic gonadotropin (hCG) have similar biologic activity for which of the following reasons?

a. Their β-subunits have 80% homology.

b. They have nearly homologous α-subunits.

c. They are produced by the same pituitary cell type.

d. They are converted to the same amino acid sequence peripherally.

15–4. The last step in estrogen synthesis requires which of the following enzymes?

a. Aromatase

b. 5α-Reductase

c. 21-Hydroxylase

d. 11β-Hydroxylase

15–5. Based on the diagram below, Enzyme A is which of the following?

Image

Reproduced, with permission, from Halvorson LM: Reproductive endocrinology. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 15-13.

a. 21-Hydroxylase

b. 11β-Hydroxylase

c. 17α-Hydroxylase

d. 3β-Hydroxysteroid dehydrogenase

15–6. Based on the diagram in Question 15–5, Enzyme B is which of the following?

a. 21-Hydroxylase

b. 11β-Hydroxylase

c. 17α-Hydroxylase

d. 3β-Hydroxysteroid dehydrogenase

15–7. Which of the following hormones is the primary androgen and/or androgen precursor produced by the ovary?

a. Testosterone

b. Androstenedione

c. Dihydrotestosterone

d. Dehydroepiandrosterone sulfate

15–8. Peripheral conversion of androstenedione contributes what percentage to the circulating testosterone concentration in women?

a. 10

b. 25

c. 50

d. 75

15–9. Which of the following will most likely increase circulating sex hormone-binding globulin (SHBG) levels?

a. Insulin

b. Estrogen

c. Androgens

d. Progestins

15–10. Patients with congenital adrenal hyperplasia (CAH) secondary to 21-hydroxylase deficiency will have a deficiency in which of the following hormones?

a. Cortisol

b. Testosterone

c. Androstenedione

d. 17-Hydroxyprogesterone

15–11. Steroid receptors can be found in which of the following locations?

a. In the cell nucleus

b. In the cell cytoplasm

c. In both the cell nucleus and cytoplasm

d. None of the above

15–12. Gonadotropin-releasing hormone (GnRH) agonists, such as leuprolide acetate, reduce gonadotropin secretion via which of the following mechanisms?

a. Receptor antagonism

b. Receptor destruction

c. Receptor downregulation

d. None of the above

Image

Reproduced, with permission, from Halvorson LM: Reproductive endocrinology. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 15-4.

15–13. As shown here, β-melanocyte stimulating hormone (MSH) is a direct product of which of the following?

a. β-Endorphin

b. β-Lipoprotein

c. Pro-opiomelanocortin

d. Adrenocorticotropic hormone (ACTH) intermediate

15–14. Which of the following conditions causes the release of neuropeptide Y?

a. Obesity

b. Anorexia

c. Diabetes mellitus

d. Hyperprolactinemia

15–15. All EXCEPT which of the following are anterior pituitary hormones?

a. Prolactin

b. Growth hormone

c. Thyrotropin-releasing hormone

d. Follicle-stimulating hormone (FSH)

15–16. Sustained gonadotropin secretion requires which of the following patterns of gonadotropin-releasing hormone (GnRH) secretion?

a. Pulsatile release of GnRH

b. Nocturnal release of GnRH

c. Low doses of GnRH secretion

d. High doses of GnRH secretion

15–17. Endorphin levels in the brain peak during which of the following menstrual cycle events?

a. Menses

b. Ovulation

c. Luteal phase

d. Follicular phase

15–18. Which of the following potentiates the release of prolactin from the anterior pituitary gland?

a. Dopamine

b. Thyrotropin-releasing hormone

c. Gonadotropin-releasing hormone

d. Corticotropin-releasing hormone

15–19. Cells of the anterior pituitary primarily express which of the following dopamine receptors?

a. D1

b. D2

c. D3

d. None of the above

15–20. Growth hormone effects are mediated through which of the following?

a. Insulin-like growth factor I

b. Insulin-like growth factor II

c. Both, insulin-like growth factors I and II

d. None of the above

15–21. If affecting the pituitary gland, which of the following can lead to hypogonadotropic hypogonadism?

a. Brain surgery

b. Pituitary infarction

c. Head radiation therapy

d. All of the above

15–22. A 27-year-old female presents with bilateral nipple discharge. Microscopic evaluation of the discharge reveals galactorrhea. During examination, no breast masses are noted. Patient has a history of schizophrenia. Further laboratory evaluation reveals a mildly elevated prolactin level. Which of the following is most likely the cause of her hyperprolactinemia?

a. Renal disease

b. Medication side effect

c. Prolactin-producing pituitary adenoma

d. Breast examination performed prior to venipuncture

15–23. The arrow in the diagram shown below is pointing toward which of the following?

Image

Reproduced, with permission, from Halvorson LM: Reproductive endocrinology. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 15-8A.

a. The optic chiasm

b. A pituitary tumor

c. The third ventricle

d. A hypothalamic tumor

15–24. A 33-year-old female is being followed for a 5-mm prolactin-producing pituitary adenoma, which is well controlled on bromocriptine 0.5 mg orally daily. She presents with a positive pregnancy test result. How should you manage her treatment at this point?

a. Discontinue bromocriptine therapy

b. Increase bromocriptine to 1 mg daily

c. Check a prolactin level and if it is elevated, continue bromocriptine therapy

d. Obtain magnetic resonance (MR) imaging of the brain and base decisions on these findings

15–25. What is the first-line of treatment for a pituitary macroadenoma?

a. Radiation therapy

b. Dopamine-agonist therapy

c. Transsphenoidal resection

d. Somatostatin-agonist therapy

15–26. At what stage of the female life is the highest number of oocytes found in the ovary?

a. Age 35

b. At birth

c. At puberty

d. In utero at 5 months’ gestation

15–27. Meiosis I of the oocytes is completed at which of the following times?

a. Birth

b. Puberty

c. Ovulation

d. Fertilization

15–28. In the image below, which line corresponds to luteinizing hormone level changes during the menstrual cycle?

Image

Reproduced, with permission, from Halvorson LM: Reproductive endocrinology. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 15-18.

a. A

b. B

c. C

d. D

15–29. In the image found in Question 15–28, which line corresponds to estradiol level changes during the menstrual cycle?

a. A

b. B

c. C

d. D

15–30. Which of the following enzymes is absent in the granulosa cell?

a. Aromatase

b. 17-Hydroxylase

c. 3β-Hydroxysteroid dehydrogenase

d. Cholesterol side chain cleavage enzyme

15–31. Which hormone is the first to rise during female puberty?

a. Luteinizing hormone

b. Follicle-stimulating hormone

c. Estradiol

d. Progesterone

15–32. Which of the following zona pellucida proteins is responsible for zona hardening after sperm penetration?

a. ZP1

b. ZP2

c. ZP3

d. None of the above

15–33. An ovarian follicle that is visible on sonography has reached what stage of development?

a. Primary

b. Secondary

c. Preantral

d. Tertiary

15–34. Which of the following follicle developmental stages requires gonadotropin stimulation for further development?

a. Primary

b. Secondary

c. Preantral

d. Tertiary

15–35. What is the estradiol concentration and duration needed to initiate a luteinizing hormone surge?

a. 100 pg/mL for 24 hours

b. 100 pg/mL for 50 hours

c. 200 pg/mL for 24 hours

d. 200 pg/mL for 50 hours

15–36. Steroidogenesis in the corpus luteum is mainly under the control of which of the following hormones?

a. Luteinizing hormone

b. Follicle-stimulating hormone

c. Activin

d. Follistatin

15–37. Ovulation can be assumed at which of the following mid-luteal progesterone levels?

a. 0.5 ng/mL

b. 1.0 ng/mL

c. 2.0 ng/mL

d. 3.0 ng/mL

15–38. Images A and B, respectively, correspond to which of the following menstrual cycle phases?

Image

Reproduced, with permission, from Bradshaw KB: Menopausal transition. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 21-4.

a. Secretory, menstrual

b. Menstrual, proliferative

c. Proliferative, secretory

d. Late secretory, proliferative

15–39. Formation of endometrium pinopods, important for embryo implantation, is dependent on which of the following hormones?

a. Estriol

b. Cortisol

c. Estradiol

d. Progesterone

15–40. Which of the following growth factors is involved in embryo implantation?

a. Tumor necrosis factor-β (TNF-β)

b. Leukemia inhibitory factor (LIF)

c. Transforming growth factor-β (TGF-β)

d. Insulin-like growth factors (IGF-II)

Chapter 15 ANSWER KEY

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