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WorksheetsPuberty and Puberty Disorders
Total questions: 64
Worksheet time: 32mins
List two effects of oestrogen during puberty.
Development and maintenance of female reproductive tract; Pubertal growth spurt
Increased production of testosterone; Deepening of voice
Growth of facial hair; Broadening of shoulders
Decrease in body fat; Growth of Adam's apple
What is the average age range for male puberty?
9-14 years (average 11-12)
6-9 years (average 8)
15-20 years (average 17)
12-18 years (average 15)
Precocious puberty occurs before the age of ____ in girls and ____ in boys.
8 in girls and 9 in boys
7 in girls and 10 in boys
9 in girls and 8 in boys
10 in girls and 7 in boys
What is the treatment for central precocious puberty?
GnRH agonist (leuprolide) as it decreases release of gonadotropins via negative feedback loop
Growth hormone therapy to accelerate bone age
Testosterone replacement therapy to delay puberty
Surgical removal of the pituitary gland
Delayed puberty in girls is defined as no sign of sexual maturation (breasts) by age ____ and no period by age ____.
13 and 15
12 and 14
14 and 16
11 and 13
Delayed puberty in boys is defined as no signs of sexual maturation (testicles) by age ____.
14
12
16
10
What are some factors influencing early puberty?
Ethnicity, if mum has early period, low birth weight, excessive weight gain
High calcium intake, frequent exercise, late sleep schedule, high protein diet
Living at high altitude, frequent travel, high fiber diet, low salt intake
Daily meditation, high vitamin C intake, regular swimming, low sugar diet
What is the definition of Gynecomastia?
Breast development in boys
Loss of hair in boys
Increase in height in boys
Deepening of voice in boys
What is the definition of Premature thelarche?
Breast development occurs without any other signs of puberty
Early onset of menstruation before age 8
Development of pubic hair without breast development
Rapid growth of height and weight before age 5
What is the definition of Premature adrenarche?
Pubic hair appears without signs of puberty
Early onset of breast development
Delayed appearance of secondary sexual characteristics
Rapid growth spurt with early menarche
Name two genetic disorders that can cause puberty disorders.
Turner syndrome and Klinefelter syndrome
Down syndrome and Marfan syndrome
Sickle cell anemia and Hemophilia
Cystic fibrosis and Thalassemia
What is the main difference between hypogonadotropic hypogonadism and hypergonadotropic hypogonadism?
Hypogonadotropic hypogonadism is due to deficiency of GnRH or LH/FSH, while hypergonadotropic hypogonadism is due to impaired response to sex organs to gonadotropins and is characterized by elevated FSH/LH.
Hypogonadotropic hypogonadism is due to excess production of sex hormones, while hypergonadotropic hypogonadism is due to deficiency of sex hormones.
Hypogonadotropic hypogonadism is characterized by elevated FSH/LH, while hypergonadotropic hypogonadism is characterized by low FSH/LH.
Hypogonadotropic hypogonadism is caused by primary gonadal failure, while hypergonadotropic hypogonadism is caused by hypothalamic or pituitary dysfunction.
In hypogonadotropic hypogonadism, what is the treatment for boys?
Androgen replacement (testosterone IM or oral and may be lifelong)
Estrogen therapy
Growth hormone only
Thyroid hormone replacement
In hypergonadotropic hypogonadism, what is the treatment for girls?
Ultra-low doses of estrogen
High doses of testosterone
Thyroid hormone replacement
Insulin therapy
What are the main features of Klinefelter syndrome?
Small testicles, infertility (some can have babies with ART)
Large testicles, increased fertility
Short stature, webbed neck
Early onset puberty, excessive hair growth
What is the cause of Turner syndrome (45 X or missing part of X)?
Female is missing all or part of one X chromosome
Male is missing all or part of one Y chromosome
Female has an extra X chromosome
Male has an extra Y chromosome
Define oogenesis.
The process where egg cells (oocytes) develop and mature inside ovarian follicles. Germ cells in the ovary differentiate into oogonia, they then divide and mature into primary oocytes.
The process where sperm cells are produced in the testes from spermatogonia.
The process of fertilization where sperm and egg fuse to form a zygote.
The process of embryo implantation in the uterine wall.
What hormone is secreted by the hypothalamus and stimulates the release of FSH & LH from the anterior pituitary?
Gonadotropin releasing hormone (GnRH)
Prolactin
Thyroid stimulating hormone (TSH)
Adrenocorticotropic hormone (ACTH)
Which hormone stimulates further development of ovarian follicles and their secretion of oestrogen, brings out ovulation, and promotes formation of corpus luteum?
Luteinizing hormone (LH)
Follicle-stimulating hormone (FSH)
Prolactin
Thyroid-stimulating hormone (TSH)
Which hormone promotes the development and maintenance of female reproductive structures and increases protein anabolism?
Oestrogen
Testosterone
Insulin
Adrenaline
Which hormone is secreted by the corpus luteum and prepares the endometrium for implantation of a fertilised ovum?
Progesterone
Estrogen
Testosterone
Oxytocin
During which phase of the menstrual cycle does FSH stimulate the development of several follicles?
Menstruation (Days 1-5)
Ovulation (Day 14)
Luteal phase (Days 15-28)
Secretory phase
Which hormone's high levels inhibit the secretion of GnRH and LH?
Progesterone
Testosterone
Insulin
Cortisol
During the preovulatory phase (days 6-13), what hormone is secreted by secondary follicles that leads to a decrease in FSH?
Estrogen and inhibin
Progesterone and relaxin
Testosterone and LH
Cortisol and prolactin
What hormone is responsible for rescuing the corpus luteum if fertilisation occurs during the postovulatory phase?
hCG (human chorionic gonadotropin)
FSH (follicle-stimulating hormone)
LH (luteinizing hormone)
Progesterone
Which hormone thickens the endometrium and peaks 1 week after ovulation?
Progesterone
Estrogen
Testosterone
Cortisol
Pregnancy is most likely between how many days after period starts to how many days after period starts?
9-10 days to 15-16 days after period starts
1-2 days to 5-6 days after period starts
20-21 days to 25-26 days after period starts
17-18 days to 23-24 days after period starts
Which period is critical for the formation of major body organs in the embryo?
Embryonic period (weeks 1-8)
Fetal period (weeks 9-40)
Neonatal period (birth to 4 weeks)
Adolescent period (12-18 years)
Which of the following is NOT an effect of synthetic estrogen on the uterine lining?
A. Stabilises endometrial lining
B. Reduces breakthrough bleeding
C. Increases endometrial proliferation
D. Allows predictable withdrawal bleed
Which hormone thickens cervical mucus to hinder sperm penetration?
Estrogen
Progestin
Which of the following is a contraindication for contraceptive use?
Controlled hypertension
Migraine
Age under 35
Mild liver disease
Fill in the blank: Ethinylestradiol is a very potent estrogen with ______ hepatic effects.
increased
decreased
neutral
minimal
Which type of estrogen is bioidentical and used in HRT?
Ethinylestradiol
Estradiol & valerate
Estetrol
Conjugated estrogens
Which androgenic type may cause acne and fluid retention?
Norethisterone
Drospirenone
Dienogest
Estradiol
According to UKMEC guidance, what is the category for COC + enzyme inducers?
UKMEC 1
UKMEC 2
UKMEC 3-4
UKMEC 4
Which contraceptive method is classified as long-acting reversible contraception (LARCS)?
Male condom
Intrauterine contraceptive device (IUD)
Contraception ring
Vasectomy
Fill in the blank: Emergency contraception options include oral emergency and ________.
copper IUD
hormonal patch
male condom
surgical abortion
Which of the following is a side effect of Implanon (etonogestrel)?
Skin changes
Improved mood
Weight loss
No change in bleeding
Which contraceptive method can delay fertility for up to 1 year in most users with fertility?
Depot medroxy-progesterone
Copper IUD
Condoms
Combined oral contraceptive pills
Which contraceptive method is suitable for breastfeeding and requires stricter timing?
Progesterone only pill
Combined oral contraceptive pill
Copper intrauterine device
Condoms
Which contraceptive method is the only one that provides STI protection?
Barrier methods
Hormonal methods
Intrauterine devices (IUDs)
Withdrawal method
Which contraceptive method is least likely to be reversible?
Surgical intervention (Tubal ligation or vasectomy)
Oral contraceptive pills
Condoms
Intrauterine device (IUD)
Which of the following is a side effect of the Combined oral contraceptive pill?
VTE, nausea, breast tenderness, breakthrough bleeding
Acne, breast tenderness
Altered bleeding patterns, mood changes
Post-surgical healing process
Which contraceptive method can be inserted any time postpartum, including immediately before leaving the hospital?
Etonogestrel implant
Combined oral contraceptive pills
Copper IUD (delayed insertion)
Vaginal ring
Which contraceptive method does not increase the risk of VTE but must be taken within the same time each day?
Progesterone only pills
Combined oral contraceptive pills
Copper intrauterine device
Depot medroxyprogesterone acetate
What is the main recommendation for contraception in obese people?
Etonogestrel implant or IUD, or 2nd line is depot (due to risk of weight gain + BMD)
Combined oral contraceptive pills only
Barrier methods are preferred over all hormonal options
Emergency contraception as a regular method
What is the mechanism of action (MOA) of COC?
Suppress FSH & LH to prevent ovulation, thicken cervical mucous to block sperm, alter endometrial lining to reduce chance of implantation.
Increase FSH & LH to stimulate ovulation, thin cervical mucous to facilitate sperm entry, strengthen endometrial lining for implantation.
Directly destroy sperm in the uterus, promote ovulation, and enhance fertilization.
Block estrogen receptors in the brain, increase testosterone production, and stimulate follicle rupture.
When is COC immediately effective? Select all that apply.
Started on days 1-5 of cycle
<21 days postpartum
Within 5 days of post abortion
Switching from another form of contraception IUD
COC may be less effective if vomiting/diarrhea occurs within 2 hours of taking the pill.
True
False
What is the maximum time allowed for missed COC pill advice?
Max of 24 hours
Max of 12 hours
Max of 48 hours
Max of 72 hours
How should nausea as an adverse effect of contraceptive use be managed?
Decrease estrogen dose, take pill nocte, consider POP
Increase estrogen dose, take pill in the morning, avoid POP
Discontinue contraceptive use immediately, switch to IUD, increase caffeine intake
Take pill on an empty stomach, increase progesterone dose, avoid food with medication
How should breast tenderness as an adverse effect of contraceptive use be managed?
Decrease estrogen/progesterone dose, try drospirenone
Increase estrogen dose, continue same regimen
Discontinue contraceptive and avoid all hormonal methods
Switch to a higher dose of progesterone only
How should dysmenorrhoea as an adverse effect of contraceptive use be managed?
Decrease estrogen dose, increase progesterone dose
Increase estrogen dose, decrease progesterone dose
Discontinue contraceptive use immediately
Switch to non-hormonal contraceptive methods
How should chloasma (dark facial pigmentation) as an adverse effect of contraceptive use be managed?
Switch to POP (may resolve on its own)
Increase sun exposure to fade pigmentation
Continue the same contraceptive and ignore the pigmentation
Apply strong bleaching creams without medical advice
How should breakthrough bleeding as an adverse effect of contraceptive use be managed?
Increase estrogen dose, or change progestogen
Decrease estrogen dose, or continue same regimen
Discontinue contraceptive immediately
Switch to non-hormonal contraception
How should acne as an adverse effect of contraceptive use be managed?
Use less androgenic progesterone
Increase estrogen dose
Discontinue all contraceptives
Use more androgenic progesterone
What is the main mechanism of action of POP (Progestogen-only pill)?
Suppresses ovulation (especially drospirenone) and thickens cervical mucous
Increases estrogen production
Stimulates follicle development
Inhibits FSH release only
When is POP immediately effective? List one scenario.
Started on days 1-5 of cycle, <21 days postpartum, within 5 days of post abortion, or switching from another form of contraception IUD
Started after day 10 of cycle
Started 30 days postpartum
Started 2 weeks after abortion
How many active pills are there in a POP pack?
28 active pills (no placebo pills)
21 active pills and 7 placebo pills
24 active pills and 4 placebo pills
14 active pills and 14 placebo pills
If vomiting or diarrhea occurs within 2 hours of taking a POP, what should be done?
Take another pill
Wait until the next day to take another pill
Stop taking the pills completely
Double the dose the next day
What are some adverse effects of POP?
Irregular bleeding, breast tenderness, can cause acne sometimes
Improved vision and hearing
Rapid hair growth and muscle gain
Permanent weight loss
What is the advice for missed POP pills?
Missed pill advise: > 3 hours/unless drospirenone
Missed pill advise: > 12 hours for all POPs
Missed pill advise: > 24 hours/unless norethisterone
Missed pill advise: > 6 hours for all POPs
According to Queensland legislation, up to how many weeks can a woman have a medical abortion without emergency circumstances?
9 weeks
22 weeks
12 weeks
16 weeks
Fill in the blank: The only product in Australia for medical termination of pregnancy up until 9 weeks (63 days) is _________.
MS2 step (Mifepristone and Misoprostol)
Plan B (Levonorgestrel)
RU486 (Misoprostol only)
Methotrexate
