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WorksheetsMens. Disorders and Contraceptive Drugs
Total questions: 60
Worksheet time: 30mins
Which event is directly triggered by the mid-cycle LH surge?
Thickening of cervical mucus
Endometrial shedding
Rupture of the dominant follicle and ovulation
Regression of the corpus luteum
Which hormone is primarily responsible for converting the endometrium from proliferative to secretory phase?
FSH
LH
Estrogen
Progesterone
Which of the following is a synthetic estrogen commonly used in oral contraceptives?
Norethindrone
Ethinyl estradiol
Medroxyprogesterone
Norgestrel
Which progestin is derived from spironolactone and may increase potassium levels?
Norgestimate
Norethindrone
Drospirenone
Etonogestrel
What is the primary mechanism by which combination oral contraceptives prevent ovulation?
Thinning endometrium
Suppression of GnRH and inhibition of LH surge
Increasing FSH levels
Blocking progesterone receptors
Which effect is unique to progestin-only contraceptives?
Suppression of FSH
Inhibition of mid-cycle LH surge
Thickening of cervical mucus
Increased estrogen levels
Combination oral contraceptives are associated with a decreased risk of which condition?
DVT
Breast cancer
Ovarian cancer
Hypertension
Which patient group has increased risk of DVT when using combined oral contraceptives?
Adolescents
Smokers
Patients using only progestin therapy
Vegetarians
Which of the following significantly reduces the effectiveness of oral contraceptives by inducing hepatic enzymes and inhibiting enterohepatic recycling?
Ciprofloxacin
Rifampin
Duloxetine
Metoprolol
The primary mechanism by which certain antibiotics (e.g., penicillin, tetracycline) reduce oral contraceptive efficacy is through:
CYP inhibition
CYP induction
Eradication of gut flora reducing enterohepatic recycling
Increased renal elimination
Which structural feature allows norethindrone to be orally active?
Removal of C-3 hydroxyl group
Addition of ethinyl group
Presence of lactone ring
Addition of methyl group at C-19
Which statement about Medroxyprogesterone Acetate (MPA) is TRUE?
Has strong androgenic activity
Administered intramuscularly and can reduce bone mineral density
Increases GnRH release
Used exclusively as an oral contraceptive
Which agent is a progesterone antagonist effective for post-coital contraception and early pregnancy termination when paired with misoprostol?
Drospirenone
Mifepristone
Norethindrone
Medroxyprogesterone
Ulipristal acetate acts primarily by:
Inhibiting progesterone synthesis
Blocking progesterone receptors
Thickening cervical mucus
Suppressing estrogen production
Which statement accurately describes male hormonal contraception?
Effective and widely used
Androgens produce complete azoospermia in all men
Testosterone enanthate causes azoospermia in ~50% of men and can cause gynecomastia
Cyproterone acetate increases sperm production
Which change caused by progestins plays the largest role in preventing sperm from reaching the ovum?
Suppression of LH
Thickening of cervical mucus
Increased FSH pulses
Increased endometrial proliferation
Why do estrogen components of combined oral contraceptives suppress follicular development?
They directly block ovulation at the ovary
They stimulate GnRH secretion
They suppress FSH release
They prevent cervical mucus thickening
A patient taking a drospirenone-containing contraceptive should be monitored for which abnormality?
Elevated sodium
Elevated potassium
Low estrogen levels
Low FSH levels
Which progestin is intentionally designed to reduce androgenic effects?
Norgestrel
Norethindrone
Norgestimate
Dimethisterone
Why does medroxyprogesterone acetate (MPA) have a boxed warning for bone mineral density loss?
It contains estrogen
It causes high androgen levels
It dramatically reduces GnRH
It prevents progesterone breakdown
Which characteristic of mifepristone makes it effective for post-coital contraception?
It inhibits androgen receptors
It stimulates FSH release
It blocks progesterone receptors
It inhibits estrogen synthesis
Why has testosterone enanthate not become a widely used male contraceptive?
It is too expensive
It is ineffective in suppressing sperm production in most men
It produces azoospermia in only ~50%
It increases estrogen to toxic levels
Which structural feature is essential for a molecule to exhibit progestin activity?
An aromatic A-ring
A lactone ring at the C-17 position
A steroid nucleus structure
A hydroxyl group at C-3
The ethinyl group found in norethindrone and norgestrel is primarily responsible for which property?
Increasing androgenic side effects
Reducing mineralocorticoid activity
Making the drug orally active
Increasing estrogenic activity
Structural derivatives of testosterone used as progestins (e.g., estrane derivatives) are associated with which side effect?
Hyperkalemia
Increased risk of osteoporosis
Acne and hirsutism
Increased blood glucose
Medroxyprogesterone acetate (MPA) contains which functional modification that enhances its stability and activity?
Removal of C-19 methyl
Esterification at the 17-alpha hydroxyl
Aromatization of ring A
Addition of lactone ring
Which structural change distinguishes estrane derivatives (e.g., norethindrone) from other steroid hormones?
Addition of a methyl at C-6
Removal of the methyl group at C-19
Conversion of ring D into a lactone
Aromatization of ring A
Which structural component of mifepristone is primarily responsible for its antagonism at progesterone receptors?
Ethinyl group
Dimethyl-aminophenyl group
Lactone ring
21-carbon backbone
Norgestrel is described as a racemic mixture, but only one isomer is biologically active. Which is the active isomer?
D-isomer
(+)-isomer
S-enantiomer
L-isomer
Which statement best describes monophasic oral contraceptive formulations?
The estrogen dose changes weekly
The progestin dose changes twice during the cycle
The estrogen and progestin doses remain constant throughout the cycle
Only progestin is supplied
Which of the following best describes dysmenorrhea?
Bleeding at irregular intervals
Painful menstrual cramps caused by uterine contractions
Absence of menstruation
Heavy menstrual bleeding
Menorrhagia is characterized by:
Bleeding between menstrual periods
Light menstrual periods
Prolonged or excessive menstrual bleeding
Painful ovulation
Which of the following is NOT listed as a cause of menstrual disorders?
Uterine fibroids
Hormonal imbalances
Autoimmune thyroiditis
Polycystic ovary syndrome
Which treatment is considered first-line for heavy menstrual bleeding?
Tranexamic acid
Depo-Provera
Mirena
NSAIDs alone
Tranexamic acid works by:
Blocking estrogen receptors
Increasing progesterone levels
Preventing fibrinolysis
Stimulating FSH and LH release
Which medication is associated with masculinizing side effects and therefore not suitable for long-term use?
Leuprolide
Danazol
Clomiphene
Bromocriptine
Endometriosis is best defined as:
Growth of uterine fibroids
Presence of estrogen-sensitive endometrial tissue outside the uterus
Excessive menstrual bleeding due to clotting disorder
Ovarian cyst formation
Which of the following is a key risk factor for endometriosis?
High BMI
Late menarche
Short menstrual cycles
Low estrogen levels
A major complication of endometriosis includes:
VTE
Infertility
Polycystic ovarian syndrome
Heavy menstrual bleeding only
Which therapy is limited to 6 months due to its risk of bone mineral density loss?
Danazol
Aromatase inhibitors
GnRH agonists
Bromocriptine
Which symptom is commonly associated with endometriosis?
Frequent urination
Pain with bowel movements or urination
Polyphagia
Weight loss
Infertility is defined as the inability to conceive after:
3 months of unprotected intercourse
6 months of unprotected intercourse
1 year of unprotected intercourse
2 years of unprotected intercourse
The MOST common causes of female infertility include all of the following EXCEPT:
Ovulation disorders
Tubal abnormalities
Endometriosis
Hypothyroidism
Clomiphene induces ovulation primarily by:
Blocking dopamine receptors
Inhibiting estrogen’s negative feedback on GnRH
Increasing prolactin levels
Directly stimulating ovarian follicles
Which adverse effect is associated with clomiphene use?
Bone loss
Visual disturbances and hot flashes
Masculinizing effects
Postural hypotension
Bromocriptine is used to treat infertility by:
Stimulating FSH and LH directly
Increasing estrogen production
Decreasing prolactin secretion via D2 receptor activation
Enhancing ovulation through aromatase inhibition
Which ovulation-inducing drug has a 20–40% chance of causing multiple births?
Clomiphene
hMG/FSH
Bromocriptine
GnRH pump
Aromatase inhibitors such as letrozole promote ovulation by:
Blocking androgen production
Inhibiting conversion of androgens to estrogens
Increasing prolactin release
Mimicking FSH
PCOS is characterized by all of the following EXCEPT:
Many small cysts containing immature follicles
Regular ovulation
Infertility
Irregular menstrual periods
Which therapy is appropriate for PCOS when pregnancy is NOT desired?
hMG
GnRH pump
Low-dose oral contraceptives
High-dose estrogen
Metformin helps in PCOS management by:
Increasing estrogen levels
Increasing insulin sensitivity via AMPK activation
Stimulating LH release
Blocking progesterone receptors
Which drug used for menstrual disorders carries a contraindication in women with venous thromboembolism?
Danazol
Tranexamic acid
Mirena
GnRH agonists
hich drug class is used for both menstrual disorders and endometriosis due to its ability to suppress LH and FSH?
Aromatase inhibitors
GnRH agonists
Dopamine agonists
Insulin sensitizers
What is the primary rationale for avoiding long-term Danazol therapy?
Bone mineral density loss
Severe hepatotoxicity
Masculinizing side effects
Increased risk of thrombosis
Which symptom best differentiates PMDD from PMS?
Bloating
Mood swings and severe irritability
Breast tenderness
Fatigue
Which infertility therapy requires the patient to wear an infusion pump delivering medication every 90 minutes?
GnRH therapy
hMG/FSH injections
Bromocriptine
Aromatase inhibitors
Which drug should be avoided in patients with pituitary tumors >1 cm?
Clomiphene
Bromocriptine
hMG
GnRH agonists
Which menstrual disorder is defined as infrequent menstrual periods?
Amenorrhea
Oligomenorrhea
Hypomenorrhea
Metrorrhagia
GnRH agonists manage menstrual disorders by
Enhancing estrogen production
Blocking LH and FSH release
Increasing progesterone secretion
Inhibiting aromatase
Which of the following theories describes menstrual blood flowing backward into the pelvic cavity?
Immune system defect
Transformed peritoneal cells
Retrograde menstruation
Endometrial cell transport
