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.

2. A 28-year-old man with a history of cryptorchidism and oligospermia is undergoing intracytoplasmic sperm injection (ICSI) treatment with his partner, who has normal fertility. He provides a semen sample on the day of his partner's oocyte retrieval. The semen analysis shows that he has a sperm concentration of 8 million/mL, a motility of 40%, and a morphology of 20%. What is the most likely outcome of his ICSI treatment? A) He will have a high fertilization rate and a good chance of achieving pregnancy. B) He will have a low fertilization rate and a poor chance of achieving pregnancy. C) He will have a normal fertilization rate but a low implantation rate and a poor chance of achieving pregnancy. D) He will have no fertilization and will need to use donor sperm or testicular sperm extraction (TESE). Answer: A) He will have a high fertilization rate and a good chance of achieving pregnancy. Rationale: ICSI is a technique that involves injecting a single sperm directly into an oocyte, bypassing the need for sperm to penetrate the zona pellucida. ICSI can overcome most causes of male factor infertility, such as low sperm count, poor motility, or abnormal morphology. The fertilization rate with ICSI is similar to that with conventional IVF, around 70%. The implantation rate and pregnancy rate depend on other factors, such as the quality of the oocytes and embryos, the age of the female partner, and the presence of uterine or tubal abnormalities.

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

Rationale: Heavy and prolonged menstrual bleeding with an enlarged and mobile uterus are suggestive of uterine fibroids.

3. Case Study: A 28-year-old female is experiencing infertility. She has regular menstrual cycles and her partner's semen analysis is normal. The hysterosalpingogram reveals bilateral tubal blockage. What is the most likely cause of infertility? A. Endometriosis B. Polycystic Ovary Syndrome (PCOS) C. Ovarian cysts D. Tubal factor Answer: D. Tubal factor Rationale: The hysterosalpingogram showing bilateral tubal blockage suggests that tubal factor is the most likely cause of infertility.
4. Case Study: A 20-year-old nulliparous female presents with cyclic pelvic pain during menstruation. On examination, there is tenderness on palpation of the cul-de-sac and limited uterine mobility. Which of the following is the most likely diagnosis? A. Endometriosis B. Polycystic Ovary Syndrome (PCOS) C. Uterine fibroids D. Pelvic inflammatory disease (PID)

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

Answer: A. Endometriosis Rationale: The cyclic abdominal pain, dysmenorrhea, dyspareunia, and palpable nodularity in the posterior vaginal fornix suggest endometriosis.

9. Case Study: A 34-year-old female with a history of Asherman syndrome undergoes an endometrial biopsy. The histopathology reveals absent glands and fibrotic tissue with lymphocytic infiltrates. What is the most likely finding? A. Endometrial hyperplasia B. Endometrial carcinoma C. Asherman syndrome D. Endometriosis Answer: C. Asherman syndrome Rationale: The absence of glands, presence of fibrotic tissue, and lymphocytic infiltrates are consistent with Asherman syndrome.
10. Case Study: A 38-year-old female undergoes an ultrasound for fertility evaluation. The ultrasound reveals a thin endometrial lining, and the oocyte retrieval procedure fails to obtain any eggs. What is the most likely cause? A. Premature Ovarian Failure (POF) B. Asherman syndrome C. Endometriosis

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

Rationale: The cyclic pelvic pain, dysmenorrhea, and palpable adnexal mass suggest endometriosis.

15. Case Study: A 28-year-old female presents with recurrent pregnancy loss. Her partner's semen analysis is normal, and there are no anatomical abnormalities detected. What additional testing should be considered? A. Thrombophilia screening B. Maternal serum alpha-fetoprotein (AFP) testing C. Cytogenetic analysis D. Carbohydrate antigen 125 (CA-125) levels Answer: A. Thrombophilia screening Rationale: Recurrent pregnancy loss with normal semen analysis and anatomical evaluation should prompt consideration of thrombophilia screening, as inherited or acquired thrombophilias can contribute to fetal loss. C: A 35-year-old female patient presents with secondary amenorrhea. She reports a history of regular menstrual cycles before, with no significant medical history. Which of the following tests should be ordered first to assess her reproductive status? a) FSH and LH levels b) Serum progesterone levels

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

technology (ART) for her condition? a) Gamete intrafallopian transfer (GIFT) b) Intrauterine insemination (IUI) c) In vitro fertilization (IVF) d) Zygote intrafallopian transfer (ZIFT) Answer: c) In vitro fertilization (IVF) Rationale: IVF is the preferred ART for tubal factor infertility, allowing for successful fertilization and embryo transfer. A 45-year-old male patient is diagnosed with non- obstructive azoospermia. What is the most suitable method for obtaining sperm for assisted reproductive techniques? a) Testicular sperm extraction (TESE) b) Microsurgical epididymal sperm aspiration (MESA) c) Percutaneous epididymal sperm aspiration (PESA) d) Electroejaculation Answer: a) Testicular sperm extraction (TESE) Rationale: TESE is the most effective method for retrieving sperm in cases of non-obstructive azoospermia. A couple is considering preimplantation genetic testing (PGT) to screen embryos for aneuploidy. What is the primary indication for PGT in this scenario? a) Advanced maternal age b) Previous pregnancy with chromosomal abnormality c) Recurrent pregnancy loss d) Family history of genetic disorders Answer: a) Advanced maternal age Rationale: Advanced maternal age is the primary

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?

a) Assessing endometrial thickness b) Evaluating endometrial receptivity window c) Monitoring hormonal levels d) Detecting uterine anomalies Answer: b) Evaluating endometrial receptivity window Rationale: The main goal of ERA is to evaluate the endometrial receptivity window for optimal embryo transfer timing. A couple is exploring gestational surrogacy as an option for building their family. What legal considerations should be addressed before proceeding with gestational surrogacy? a) Custody rights of the gestational carrier b) Financial compensation for the gestational carrier c) Informed consent of all parties involved d) Availability of surrogacy agencies Answer: c) Informed consent of all parties involved Rationale: Legal considerations in gestational surrogacy should include ensuring informed consent of all parties involved, including the intended parents and the gestational carrier. A 30-year-old woman is planning to undergo elective fertility preservation. What is the most suitable method for fertility preservation in this scenario? a) Ovarian transposition b) Oocyte cryopreservation c) Embryo cryopreservation d) Gonadotropin-releasing hormone (GnRH) agonist therapy

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