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Quiz 03 Soln - 1 of 16 1 During a normal menstrual cycle...

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1 of 16 1. During a normal menstrual cycle, the window of implantation occurs at the same time as which of the following? A. Highest inhibin A level during the cycle. B. Highest estrogen level during the cycle. C. Increasing FSH levels. D. Recruitment of a cohort of follicles. E. Rapid endometrial proliferation. 1 out of 1 Answer A is correct. The corpus luteum cells secrete inhibin A, progesterone and estrogen most strongly between about days 20 and 24 of the menstrual cycle. The progesterone causes secretory changes in the endometrium, creating the window of implanation during which the endometrium could support a successful implanation by an embryo. The inhibin A and estrogen suppress FSH secretion (answer C is incorrect), and FSH rises as the corpus luteum dies from about day 25 to 28. This rise in FSH recruits the cohort of early 3˚ follicles (answer D is incorrect). The presence of progesterone prevents the estrogen from causing endometrial proliferation (answer B is incorrect). The highest estrogen level occurs about a day before the LH peak, and causes the LH peak (answer B is incorrect). Question 2 of 16 2. A 23-year old woman never began normal menstrual cycles or entered normal puberty. She has taken cyclic estrogen and progesterone supplements since age 16, which led to normal breast development and cyclic menstrual bleeding. She now is interested in pregnancy. Her evaluation reveals an anatomically normal uterus, fallopian tubes and ovaries, but no significant LH and FSH pulsatile activity (i.e., Kallmann’s Syndrome). Which of the following is the MOST appropriate way to induce ovulation in this patient to maximize her chance of a successful pregnancy? 1 out of 1 Answer D is correct . GnRH must be administered in pulses to avoid down-regulating GnRH receptors to the point of losing GnRH effect. This is why long-acting GnRH agonists are used to eliminate GnRH effects in the treatment of prostate cancer and certain other conditions. A continuous infusion of GnRH would have the same effect (answer C is incorrect). A single injection will not provide the ongoing pulses needed to establish and maintain LH and FSH secretion (answer A is incorrect). Clomiphine citrate is a SERM that blocks central estrogen effects, and so will increase FSH secretion by reducing negative feedback if GnRH pulses are present. But reduced negative feedback cannot replace the GnRH pulses required to stimulate FSH secretion (answer B is incorrect). Question 3 of 16 3. Women attempting to get pregnant are told to avoid using non- steroidal anti-inflammatory drugs (NSAIDs), e.g., ibuprofen, during their mid-cycle because the drugs may inhibit: A. Stigma formation and release of the oocyte.
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