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Which of the following physiologic changes results in menopause?
Cessation of ovarian function and decreased estrogen levels.The physiology of menopause involves a gradual cessation of ovarian function and resultant diminished levels of estrogen. The process is not rooted in pituitary or hypothalamic function and it does not occur because of resistance by ovarian target cells.
Which of the following physiologic processes is caused by estrogens?
Promotion of ovarian follicle growth. Among the effects of estrogens is the promotion of ovarian follicle growth. Increased estrogen levels normally have an inhibitory effect on GnRH levels, whereas progesterone synthesis is not a result of estrogens. Lactation is stimulated by prolactin.
Cryptorchidism, or undescended testes, is a direct cause of:
infertility. The consequences of cryptorchidism include infertility, testicular (rather than prostate) malignancy, and the possible psychological effects of an empty scrotum. Males with cryptorchidism usually have decreased sperm counts, poorer-quality sperm, and lower fertility rates than do men whose testicles descend normally. Decreasing levels of testosterone affect sexual energy and muscle strength; the testes become smaller and lose their firmness. Paraphimosis is a condition in which the foreskin is so tight and constricted that it cannot cover the glans; the constriction can lead to ischemia and necrosis of the penis.
In a hydrocele, excess fluid is present in the:
tunica vaginalis. The testes and epididymis are completely surrounded by the tunica vaginalis, which consists of an outer parietal layer and a deeper visceral layer, the tunica albuginea. A space exists between these two layers that typically contains a few milliliters of clear fluid; a hydrocele forms when excess fluid collects between the layers of the tunica vaginalis. A varicocele is characterized by venous varicosities of the pampiniform plexus network that supplies blood in the testes. A spermatocele is a sperm-containing cyst that forms at the end of the epididymis. The vas deferens ampulla is a storage site for sperm (rather than fluid) after it travels from the epididymis and before it is released during ejaculation.
Carcinoma of the cervix is often considered to be a sexually transmitted disease associated with_____ viral infection.
human papilloma. Carcinoma of the cervix is often considered a sexually transmitted disease. A preponderance of evidence suggests a causal link between human papilloma virus (HPV) infection and cervical cancer. Herpes simplex II and Chlamydia trachomatis cause infections that are considered sexually transmitted diseases (STDs) and are unrelated to neoplastic changes of the cervix. Herpes varicella zoster is secondary chickenpox, also known as shingles, which forms along a dermatome path.
A 41-year-old patient has undergone a vasectomy. What is the physiologic basis for this contraception technique?
Sperm can no longer pass through the ductus deferens. When the male ejaculates, the smooth muscle in the wall of the epididymis contracts vigorously, moving sperm into the next segment of the ductal system, the ductus deferens, also called the vas deferens. A vasectomy severs this conduit, rendering the male effectively infertile within a few weeks of the procedure. The procedure has no hormonal effect and neither the epididymis nor the rete testis is altered.
Acute cervicitis is an inflammation of the cervix characterized by
mucopurulent drainage. With acute cervicitis, the cervix becomes reddened and edematous; irritation from the infection results in copious mucopurulent drainage and leukorrhea. Bartholin gland obstruction causes a cyst to form, becomes purulent, and results in abscess formation. Lichen simplex chronicus lesions are labial thick, gray-white plaques. Squamous cell vulvar carcinoma is characterized by a recurrent, persistent, pruritic vulvitis, sometimes as the only complaint.
In men, urethral pain and a creamy yellow, bloody discharge from the penis is characteristic of the sexually transmitted infection:
gonorrhea. In men, the initial symptoms of gonorrhea include urethral pain and a creamy, yellow, sometimes bloody discharge. Candidiasis, trichomoniasis, and bacterial vaginosis are vaginal infections that can be sexually transmitted, and the male partner usually is asymptomatic. Chancroid causes genital ulcers; the lesions begin as macules, progress to pustules, and then rupture.
Testicular torsion, a serious disorder affecting young male individuals, causes:
loss of testicular perfusion. With testicular torsion, the testis rotates about the distal spermatic cord, obstructs perfusion through the testicular arteries and spermatic veins, and obstructs nerve conduction. The dartos muscle separates the two testes and responds to changes in temperature by contracting when cold and relaxing when warm. Most squamous cell cancers of the scrotum occur after 60 years of age and are linked to poor hygiene, chronic inflammation, exposure to ultraviolet A radiation, or human papilloma virus (HPV). After descent of the testes, the inguinal canal normally closes almost completely; failure of this canal to close predisposes to the development of an inguinal hernia later in life.
A serious complication of chlamydial infections in women is:
fallopian tube damage. Chlamydia causes a wide variety of genitourinary infections; Chlamydia trachomatis is the most common reportable sexually transmitted infection (STI) in the United States. In women, untreated infection can lead to severe reproductive complications including infertility, fallopian tube damage, and chronic pelvic pain, and in men it can cause prostatitis and epididymitis with subsequent infertility. Chlamydial infections are not associated with any reproductive cancers or amenorrhea.
When the glomerular transport maximum for a substance such as blood glucose is exceeded and its renal threshold has been reached, the substance will:
spill into the urine. When the substance (such as blood glucose) exceeds the number of carrier proteins available for transport, the transport maximum has been exceeded, the renal threshold is reached, and the substance will spill (not reabsorb) into the urine. Sodium cotransport helps to move the substance back into the tubule.
An elderly female patient has been hospitalized for the treatment of acute pyelonephritis. Which of the following characteristics of the patient is most likely implicated in the etiology of her current health problem?
The patient recently had a urinary tract infection. Ascending infection from the lower urinary tract is the most important and common route by which bacteria reach the kidney, resulting in acute pyelonephritis
Impaired skin integrity and skin manifestations are common in persons with chronic kidney disease. Pale skin and subcutaneous bruising are often present as a result of:
impaired platelet function. Bruising and pale skin are present with chronic kidney disease because platelet function is impaired. Adequate platelets are available, but the function is abnormal. Renal patients do not routinely receive anticoagulant therapy, since they already have bleeding tendencies. Increased vascular volume is associated with renal disease
Which of the following patients is likely at the greatest risk of developing a urinary tract infection?
A 79-year-old patient with an indwelling catheter. Indwelling catheters are strongly associated with the development of UTIs, and this risk factor supersedes pregnancy and kidney disease. Frequency and incontinence may be signs and symptoms of UTIs, but they are not causative of the infections.
A 30-year-old man has been diagnosed with mumps orchitis, a disease that has the potential to result in:
sterility. The residual effects seen after the acute phase of mumps orchitis include hyalinization of the seminiferous tubules and atrophy of the testes, along with impaired spermatogenesis that has the potential to result in sterility. Penile atrophy, hematuria, and hematocele are not among the signs, symptoms, and sequelae of mumps orchitis.
Which of the following diagnoses is most likely to require surgical correction?
Hypospadias. Hypospadias is a congenital disorder of the penis resulting from embryologic defects in the development of the urethral groove and penile urethra; surgery is the treatment of choice for hypospadias. Orchitis, erectile dysfunction (ED), and spermatocele rarely require surgical intervention.
Both high-turnover and low-turnover renal osteodystrophy, the skeletal complications of chronic kidney disease, are manifested by abnormal _________ and defective bone __________.
absorption; remodeling. Both types of renal osteodystrophy are manifested by abnormal absorption and defective bone remodeling. Bone surface becomes hypocellular (low-turnover type only) and elevated parathyroid hormone (PTH) is associated with high turnover type only. Abnormal matrix density is present (high turnover type only), but bone marrow changes are not a feature of osteodystrophy. Bone shape is not affected by osteodystrophy. Although it can cause muscle weakness that affects movement, joint motion is unaffected.
Men older than age 50 are at high risk for prostatic hypertrophy with complications that include
urine retention. Benign prostatic hypertrophy (BPH) is a common disorder in men over 50; because the prostate encircles the urethra, BPH exerts its effect through obstruction of urinary outflow from the bladder. Hypospadias is a congenital condition in which the termination of the urethra is on the ventral surface of the penis. Scrotal edema is often the result of testicular disease or inflammation rather than prostate enlargement. Often the first sign of testicular cancer is a slight enlargement of the testicle that may be accompanied by some degree of discomfort.
Leiomyomas are smooth muscle fibroid tumors that usually develop in:
the corpus of the uterus. Leiomyomas, also known as myomas or fibroids, are benign uterine neoplasms of smooth muscle origin. The uterosacral and other ligaments maintain the uterus and other pelvic structures in proper position; ligaments weaken with age without forming fibrous tumors. Fibrocystic changes, formerly called fibrocystic breast disease, are benign irregular fibrous breast lesions. Most leiomyomas regress, rather than develop, with menopause due to a lack of estrogen supply.
Endometriosis is characterized by painful hemorrhagic lesions in the pelvis and complications that include:
pelvic adhesions. Endometriosis is the condition in which functional endometrial tissue is found in ectopic sites outside the uterus; the tissue may be small hemorrhagic lesions surrounded by scar tissue. Bleeding into the surrounding structures causes pain and the development of significant pelvic adhesions; the extensive fibrotic tissue can cause bowel obstruction.
Endometrial cancer often develops as a result of prolonged estrogenic stimulation and/or unopposed estrogen therapy with excessive growth (i.e., hyperplasia) of the endometrium inside the uterus. Candidiasis vaginitis is a common yeast infection unrelated to intrapelvic endometriosis. Bladder herniation, cystocele, happens when bladder muscle support weakens with age or multiple births.
Which of the following processes occurs in the pathophysiology of infection by herpes simplex virus (HSV)?
Periods of latency in the nervous system. The clinical course of HSV infection is a product of the virus's ability to remain latent in the dorsal root ganglia for long periods. When latent, the immune system is ineffective but the virus does not actively inhibit the cell-mediated immune system. HSV does not produce exotoxins, and replication of squamous epithelium accounts for the warts caused by HSV.
Glomerulonephritis is usually caused by:
antigen-antibody complexes. Two types of immune mechanisms have been implicated in the development of glomerular disease: injury resulting from antibodies reacting with fixed glomerular antigens, and injury resulting from circulating antigen-antibody complexes that become trapped in the glomerular membrane. Reflux, which is the most common cause of chronic pyelonephritis, results from superimposition of infection on congenital vesicoureteral reflux or intrarenal reflux. Urinary catheters provide a means for microorganisms to ascend into the urinary tract to cause bladder infections or pyelonephritis.
Which of the following disorders of renal function primarily affects the proximal and distal tubules?
Chronic pyelonephritis. Pyelonephritis is an infection of the renal tubular structures, whereas nephritic disease involves the glomeruli. Polycystic kidney disease does not primarily afflict the tubules, and renal calculi have an obstructive etiology.
Which of the following signs and symptoms is most clearly suggestive of primary genital herpes in a male patient?
Itching, pain, and the emergence of pustules on the penis. The initial symptoms of primary genital herpes infection include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. Firm, subcutaneous nodules are not associated with herpes simplex virus (HSV), and the production of penile discharge and cloudy urine are not suggestive of the disease.
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