Advanced Reproductive Dynamics Q & A w/ Rationales, Exams of Nursing

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NURSING 7281

Advanced Reproductive

Dynamics

Q & A w/ Rationales

1. A 35-year-old woman with a history of endometriosis and infertility is undergoing in vitro fertilization (IVF) treatment. She receives daily injections of gonadotropins to stimulate ovarian follicle development. On day 10 of her cycle, she undergoes transvaginal ultrasound to assess the number and size of the follicles. The ultrasound reveals that she has 12 follicles, ranging from 15 to 20 mm in diameter. What is the most appropriate next step in her treatment? A) Continue gonadotropin injections until the follicles reach 25 mm in diameter. B) Administer human chorionic gonadotropin (hCG) injection to trigger ovulation and schedule oocyte retrieval. C) Reduce the dose of gonadotropins to prevent ovarian hyperstimulation syndrome (OHSS). D) Cancel the cycle and start a new one with a lower dose of gonadotropins. Answer: B) Administer human chorionic gonadotropin (hCG) injection to trigger ovulation and schedule oocyte retrieval. Rationale: The optimal size of the follicles for IVF is between 18 and 22 mm in diameter. When the majority of the follicles reach this size, hCG injection is given to induce final maturation and ovulation of the oocytes. Oocyte retrieval is performed 34 to 36 hours after hCG injection. Continuing gonadotropin injections or reducing the dose may compromise the quality and quantity of the oocytes. Cancelling the cycle is not necessary unless there are signs of OHSS or other complications.

3. A 32-year-old woman with a history of polycystic ovary syndrome (PCOS) and obesity is undergoing ovulation induction with clomiphene citrate. She has been taking 100 mg of clomiphene citrate daily from day 3 to day 7 of her cycle. On day 14, she undergoes serial serum progesterone measurements to confirm ovulation. Her progesterone level is 0.5 ng/mL. What does this result indicate? A) She has ovulated and has a good luteal phase function. B) She has ovulated but has a poor luteal phase function. C) She has not ovulated and needs a higher dose of clomiphene citrate. D) She has not ovulated and needs a different ovulation induction agent. Answer: C) She has not ovulated and needs a higher dose of clomiphene citrate. Rationale: Clomiphene citrate is an anti-estrogen that acts on the hypothalamus to increase the secretion of gonadotropins, which stimulate ovarian follicle growth and ovulation. The success rate of clomiphene citrate depends on the dose, the duration of treatment, and the presence of other factors affecting fertility. A serum progesterone level above 3 ng/mL indicates ovulation, while a level below 1 ng/mL indicates anovulation. If anovulation persists after taking 100 mg of clomiphene citrate, the dose can be increased to 150 mg or 200 mg, up to a maximum of 250 mg. If ovulation still does not occur, a different ovulation induction agent, such as gonadotropins or letrozole, may be used.

B:

1. Case Study: A 30-year-old female presents with secondary amenorrhea. On examination, her breasts are non-tender, and she does not have any facial hair. Her pelvic ultrasound reveals multiple small follicles in the ovaries. What is the most likely diagnosis? A. Polycystic Ovary Syndrome (PCOS) B. Premature Ovarian Failure (POF) C. Endometriosis D. Asherman syndrome Answer: A. Polycystic Ovary Syndrome (PCOS) Rationale: The clinical findings of secondary amenorrhea, multiple small follicles on pelvic ultrasound, and absence of hirsutism or galactorrhea are suggestive of PCOS.
2. Case Study: A 32-year-old female presents with heavy and prolonged menstrual bleeding over the past six months. She denies any pain or dyspareunia. On pelvic examination, her uterus is enlarged and mobile. Which of the following is the most likely diagnosis? A. Uterine fibroids B. Adenomyosis C. Endometrial hyperplasia D. Endometrial polyp Answer: A. Uterine fibroids

Answer: A. Endometriosis Rationale: The cyclic pelvic pain, tenderness on cul-de-sac palpation, and limited uterine mobility are indicative of endometriosis.

5. Case Study: A 38-year-old female presents with primary amenorrhea and absent secondary sexual characteristics. On examination, she has a short stature, webbed neck, and widely spaced nipples. What is the most likely diagnosis? A. Turner syndrome B. Klinefelter syndrome C. Androgen insensitivity syndrome D. Congenital adrenal hyperplasia Answer: A. Turner syndrome Rationale: The combination of primary amenorrhea, absent secondary sexual characteristics, short stature, webbed neck, and widely spaced nipples is consistent with Turner syndrome.
6. Case Study: A couple has been trying to conceive for the past year with no success. The male partner's semen analysis reveals reduced sperm motility and fragmented DNA. What is the most likely diagnosis? A. Oligospermia B. Asthenospermia C. Teratospermia D. Azoospermia

Answer: B. Asthenospermia Rationale: Reduced sperm motility indicates asthenospermia, which can contribute to infertility.

7. Case Study: A 35-year-old female presents with irregular menstrual cycles and hirsutism. Her laboratory results reveal an increased testosterone level and elevated luteinizing hormone (LH) to follicle-stimulating hormone (FSH) ratio. What is the most likely diagnosis? A. Polycystic Ovary Syndrome (PCOS) B. Premature Ovarian Failure (POF) C. Adrenal hyperplasia D. Androgen insensitivity syndrome Answer: A. Polycystic Ovary Syndrome (PCOS) Rationale: The combination of irregular menstrual cycles, hirsutism, increased testosterone level, and elevated LH to FSH ratio is suggestive of PCOS.
8. Case Study: A 26-year-old female presents with cyclic abdominal pain, dysmenorrhea, and dyspareunia. On pelvic examination, areas of palpable nodularity are found within the posterior vaginal fornix. What is the most likely diagnosis? A. Endometriosis B. Pelvic inflammatory disease (PID) C. Ovarian cysts D. Uterine fibroids

D. Ovarian cysts Answer: A. Premature Ovarian Failure (POF) Rationale: The combination of a thin endometrial lining, failed oocyte retrieval, and advanced age suggests POF.

11. Case Study: A 25-year-old female presents with abnormal uterine bleeding. On endometrial biopsy, the histopathology reveals complex atypical hyperplasia. What is the most appropriate management for this patient? A. Hysteroscopic resection B. Medroxyprogesterone therapy C. Hysterectomy D. Observation Answer: C. Hysterectomy Rationale: Complex atypical hyperplasia is a premalignant condition that requires definitive treatment, typically by hysterectomy.
12. Case Study: A 30-year-old female presents with primary infertility. The hysterosalpingogram reveals a unicornuate uterus. What would be the most appropriate next step? A. In vitro fertilization (IVF) B. Hysteroscopic metroplasty C. Laparoscopic removal of fibroids D. Observation

Answer: A. In vitro fertilization (IVF) Rationale: A unicornuate uterus often has a small cavity, which may reduce the chances of successful pregnancy. IVF is the most appropriate next step for assisted reproduction.

13. Case Study: A 40-year-old female presents with hot flashes, night sweats, and irregular menstrual cycles. Her FSH level is elevated. What is the most likely diagnosis? A. Perimenopause B. Premature Ovarian Failure (POF) C. Hypogonadotropic hypogonadism D. Polycystic Ovary Syndrome (PCOS) Answer: A. Perimenopause Rationale: The symptoms, elevated FSH level, and age of the patient are consistent with the perimenopausal period.
14. Case Study: A 24-year-old nulliparous female presents with cyclic pelvic pain and dysmenorrhea. On pelvic examination, there is a palpable adnexal mass. What is the most likely diagnosis? A. Ovarian cysts B. Polycystic Ovary Syndrome (PCOS) C. Endometriosis D. Uterine fibroids Answer: C. Endometriosis

c) Pelvic ultrasound d) Thyroid function tests Answer: a) FSH and LH levels Rationale: FSH and LH levels are crucial for evaluating ovarian function and can help differentiate between primary and secondary amenorrhea. A 28-year-old female patient is diagnosed with polycystic ovary syndrome (PCOS). What is the first-line pharmacological treatment for managing her condition? a) Metformin b) Clomiphene citrate c) Combined oral contraceptive pills d) Spironolactone Answer: c) Combined oral contraceptive pills Rationale: Combined oral contraceptive pills are the first- line treatment for regulating menstrual cycles and reducing androgen levels in women with PCOS. A couple has been trying to conceive for over a year without success. The male partner's semen analysis reveals low sperm count and poor motility. What is the most appropriate next step in management? a) Referral to a reproductive endocrinologist b) In vitro fertilization (IVF) c) Empiric treatment with clomiphene citrate d) Intracytoplasmic sperm injection (ICSI) Answer: a) Referral to a reproductive endocrinologist Rationale: Referral to a reproductive endocrinologist is essential for further evaluation and management of male

factor infertility. A 42-year-old female patient desires fertility preservation before undergoing chemotherapy for breast cancer. Which of the following options would be most suitable for her? a) Ovarian transposition b) Oocyte cryopreservation c) Intrauterine insemination (IUI) d) Gonadotropin-releasing hormone (GnRH) agonist therapy Answer: b) Oocyte cryopreservation Rationale: Oocyte cryopreservation is the most effective method for fertility preservation in women undergoing cancer treatment. A 38-year-old woman with a history of recurrent pregnancy loss is found to have antiphospholipid syndrome (APS). What is the recommended treatment to improve her chances of successful pregnancy? a) Low-dose aspirin b) Intravenous immunoglobulin (IVIg) c) Heparin therapy d) Corticosteroids Answer: c) Heparin therapy Rationale: Heparin therapy is the mainstay treatment for preventing recurrent pregnancy loss in women with APS. A 32-year-old female patient presents with primary infertility and is diagnosed with tubal factor infertility. What is the most appropriate assisted reproductive

indication for PGT to screen embryos for aneuploidy. A 30-year-old woman with endometriosis is planning to undergo assisted reproductive treatment. Which of the following interventions has been shown to improve fertility outcomes in women with endometriosis? a) Ovarian drilling b) Gonadotropin-releasing hormone (GnRH) agonist therapy c) Laparoscopic excision of endometriosis d) Intrauterine insemination (IUI) Answer: c) Laparoscopic excision of endometriosis Rationale: Laparoscopic excision of endometriosis has been associated with improved fertility outcomes in women with endometriosis. A 38 - year-old woman is diagnosed with diminished ovarian reserve. What is the most suitable ovarian stimulation protocol for her in the context of in vitro fertilization (IVF)? a) Agonist trigger protocol b) Antagonist trigger protocol c) Natural cycle IVF d) Mild ovarian stimulation Answer: b) Antagonist trigger protocol Rationale: The antagonist trigger protocol is the most appropriate ovarian stimulation protocol for women with diminished ovarian reserve undergoing IVF. A couple is interested in using donor gametes for assisted

reproduction. What counseling should be provided regarding the legal and ethical considerations of donor gametes? a) Anonymity of the donor b) Financial compensation for the donor c) Possibility of contact with the donor in the future d) Donor's medical history Answer: c) Possibility of contact with the donor in the future Rationale: Counseling should include information about the possibility of contact with the donor in the future, as well as legal and ethical implications related to donor gametes. A 34-year-old woman is undergoing controlled ovarian hyperstimulation for IVF. Which medication is commonly used for triggering final oocyte maturation? a) Human chorionic gonadotropin (hCG) b) Gonadotropin-releasing hormone (GnRH) agonist c) Clomiphene citrate d) Letrozole Answer: a) Human chorionic gonadotropin (hCG) Rationale: Human chorionic gonadotropin (hCG) is commonly used to trigger final oocyte maturation in the context of IVF. A 40-year-old woman with a history of recurrent implantation failure is considering endometrial receptivity testing (ERA) to optimize embryo transfer timing. What is the main goal of ERA?

Answer: b) Oocyte cryopreservation Rationale: Oocyte cryopreservation is the most suitable method for elective fertility preservation in women desiring to preserve their reproductive potential.