NU 661 MIDTERM EXAM 2026/2027 | Primary Care of
Childbearing Woman | Study Guide | Regis College | Pass
Guaranteed - A+ Graded
Section 1: Anatomy & Physiology of Female Reproductive System (15
Questions)
Q1: A 24-year-old patient asks about the hormonal events that trigger ovulation. Which
hormone, produced by the anterior pituitary, is responsible for the final maturation and
rupture of the dominant ovarian follicle?
A. Follicle-stimulating hormone (FSH)
B. Luteinizing hormone (LH) [CORRECT]
C. Estrogen
D. Progesterone
Correct Answer: B
Rationale: The LH surge, triggered by rising estrogen levels from the dominant follicle, is
the direct hormonal stimulus for ovulation. FSH (A) promotes early follicular
development but does not trigger ovulation. Estrogen (C) creates positive feedback on
the hypothalamus/pituitary to induce the LH surge but does not directly cause follicular
rupture. Progesterone (D) dominates the luteal phase, not the ovulatory event. ACOG
Committee Opinion on menstrual cycle physiology.
Q2: During the luteal phase of the menstrual cycle, which structure produces the
majority of circulating progesterone?
A. Granulosa cells of the developing follicle
,B. Corpus luteum [CORRECT]
C. Endometrial stromal cells
D. Anterior pituitary gonadotrophs
Correct Answer: B
Rationale: The corpus luteum, formed from the remnants of the ruptured follicle after
ovulation, secretes progesterone to prepare the endometrium for potential implantation.
Granulosa cells (A) produce estrogen during the follicular phase. Endometrial cells (C)
respond to progesterone but do not produce it. The anterior pituitary (D) produces LH
and FSH, not ovarian steroids. ACOG Practice Bulletin on menstrual disorders.
Q3: A 28-year-old patient with primary amenorrhea has normal breast development but
absent pubic and axillary hair. Pelvic examination reveals a blind-ending vaginal pouch
and no palpable uterus. What is the most likely diagnosis?
A. Turner syndrome (45,X)
B. Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome) [CORRECT]
C. Polycystic ovary syndrome (PCOS)
D. Androgen insensitivity syndrome
Correct Answer: B
Rationale: Müllerian agenesis presents with primary amenorrhea, normal breast
development (indicating functional ovaries and estrogen production), and absent uterus
due to failed müllerian duct development. Turner syndrome (A) would show absent
breast development (streak ovaries). PCOS (C) presents with secondary amenorrhea
and hyperandrogenism. Androgen insensitivity (D) would show absent pubic/axillary
hair (androgen receptor defect) but typically has a short blind vagina; however, the
absence of a uterus points specifically to müllerian agenesis. ACOG Committee Opinion
on primary amenorrhea evaluation.
Q4: A 32-year-old patient reports heavy menstrual bleeding with cycles occurring every
21-35 days. Laboratory studies show normal TSH, prolactin, and androgen levels.
Transvaginal ultrasound reveals a normal uterus with no fibroids or polyps. Endometrial
,biopsy shows no hyperplasia. According to the PALM-COEIN classification system, how
is this abnormal uterine bleeding classified?
A. PALM - Structural etiology
B. COEIN - Non-structural etiology [CORRECT]
C. Ovulatory dysfunction (AUB-O)
D. Not classifiable within PALM-COEIN
Correct Answer: B
Rationale: The PALM-COEIN system classifies AUB: PALM (structural: Polyps,
Adenomyosis, Leiomyoma, Malignancy) and COEIN (non-structural: Coagulopathy,
Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified). With normal imaging
and biopsy, this is a non-structural etiology. AUB-O (C) is a subtype within COEIN but
requires confirmation of ovulatory dysfunction. ACOG Practice Bulletin on abnormal
uterine bleeding.
Q5: Which of the following best describes the function of inhibin during the menstrual
cycle?
A. Stimulates FSH release from the anterior pituitary
B. Provides negative feedback to suppress FSH secretion [CORRECT]
C. Promotes endometrial proliferation
D. Triggers the LH surge
Correct Answer: B
Rationale: Inhibin, produced by ovarian granulosa cells, selectively suppresses FSH
secretion from the anterior pituitary through negative feedback. This prevents multiple
follicle development. Inhibin does not stimulate FSH (A), promote endometrial
proliferation (C—that's estrogen), or trigger the LH surge (D—that's estrogen positive
feedback). ACOG Committee Opinion on reproductive endocrinology.
Q6: During pregnancy, which anatomical change occurs in the uterus due to the
influence of estrogen and progesterone?
A. Decreased uterine blood flow
B. Hypertrophy and hyperplasia of myometrial cells [CORRECT]
, C. Cervical shortening and firming
D. Decreased uterine weight
Correct Answer: B
Rationale: Estrogen and progesterone cause both hypertrophy (increased cell size) and
hyperplasia (increased cell number) of myometrial cells, increasing uterine weight from
approximately 70g to 1100g at term. Uterine blood flow increases dramatically (A is
incorrect). The cervix softens and elongates (C is incorrect). Uterine weight increases
significantly (D is incorrect). ACOG Educational Bulletin on maternal physiology in
pregnancy.
Q7: A 19-year-old patient presents with primary amenorrhea. She has short stature,
webbed neck, and widely spaced nipples. What karyotype would confirm the most likely
diagnosis?
A. 46,XX
B. 46,XY
C. 45,X [CORRECT]
D. 47,XXX
Correct Answer: C
Rationale: The clinical presentation (short stature, webbed neck, widely spaced nipples,
primary amenorrhea) is classic for Turner syndrome, confirmed by karyotype 45,X.
46,XX (A) is normal female. 46,XY (B) would suggest complete androgen insensitivity.
47,XXX (D) typically presents with normal stature and normal menses. ACOG
Committee Opinion on primary amenorrhea.
Q8: In the hypothalamic-pituitary-ovarian axis, which hormone is primarily responsible
for the proliferative phase changes in the endometrium?
A. Progesterone
B. Estrogen [CORRECT]
C. Human chorionic gonadotropin (hCG)
D. Prolactin
Correct Answer: B
Childbearing Woman | Study Guide | Regis College | Pass
Guaranteed - A+ Graded
Section 1: Anatomy & Physiology of Female Reproductive System (15
Questions)
Q1: A 24-year-old patient asks about the hormonal events that trigger ovulation. Which
hormone, produced by the anterior pituitary, is responsible for the final maturation and
rupture of the dominant ovarian follicle?
A. Follicle-stimulating hormone (FSH)
B. Luteinizing hormone (LH) [CORRECT]
C. Estrogen
D. Progesterone
Correct Answer: B
Rationale: The LH surge, triggered by rising estrogen levels from the dominant follicle, is
the direct hormonal stimulus for ovulation. FSH (A) promotes early follicular
development but does not trigger ovulation. Estrogen (C) creates positive feedback on
the hypothalamus/pituitary to induce the LH surge but does not directly cause follicular
rupture. Progesterone (D) dominates the luteal phase, not the ovulatory event. ACOG
Committee Opinion on menstrual cycle physiology.
Q2: During the luteal phase of the menstrual cycle, which structure produces the
majority of circulating progesterone?
A. Granulosa cells of the developing follicle
,B. Corpus luteum [CORRECT]
C. Endometrial stromal cells
D. Anterior pituitary gonadotrophs
Correct Answer: B
Rationale: The corpus luteum, formed from the remnants of the ruptured follicle after
ovulation, secretes progesterone to prepare the endometrium for potential implantation.
Granulosa cells (A) produce estrogen during the follicular phase. Endometrial cells (C)
respond to progesterone but do not produce it. The anterior pituitary (D) produces LH
and FSH, not ovarian steroids. ACOG Practice Bulletin on menstrual disorders.
Q3: A 28-year-old patient with primary amenorrhea has normal breast development but
absent pubic and axillary hair. Pelvic examination reveals a blind-ending vaginal pouch
and no palpable uterus. What is the most likely diagnosis?
A. Turner syndrome (45,X)
B. Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome) [CORRECT]
C. Polycystic ovary syndrome (PCOS)
D. Androgen insensitivity syndrome
Correct Answer: B
Rationale: Müllerian agenesis presents with primary amenorrhea, normal breast
development (indicating functional ovaries and estrogen production), and absent uterus
due to failed müllerian duct development. Turner syndrome (A) would show absent
breast development (streak ovaries). PCOS (C) presents with secondary amenorrhea
and hyperandrogenism. Androgen insensitivity (D) would show absent pubic/axillary
hair (androgen receptor defect) but typically has a short blind vagina; however, the
absence of a uterus points specifically to müllerian agenesis. ACOG Committee Opinion
on primary amenorrhea evaluation.
Q4: A 32-year-old patient reports heavy menstrual bleeding with cycles occurring every
21-35 days. Laboratory studies show normal TSH, prolactin, and androgen levels.
Transvaginal ultrasound reveals a normal uterus with no fibroids or polyps. Endometrial
,biopsy shows no hyperplasia. According to the PALM-COEIN classification system, how
is this abnormal uterine bleeding classified?
A. PALM - Structural etiology
B. COEIN - Non-structural etiology [CORRECT]
C. Ovulatory dysfunction (AUB-O)
D. Not classifiable within PALM-COEIN
Correct Answer: B
Rationale: The PALM-COEIN system classifies AUB: PALM (structural: Polyps,
Adenomyosis, Leiomyoma, Malignancy) and COEIN (non-structural: Coagulopathy,
Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified). With normal imaging
and biopsy, this is a non-structural etiology. AUB-O (C) is a subtype within COEIN but
requires confirmation of ovulatory dysfunction. ACOG Practice Bulletin on abnormal
uterine bleeding.
Q5: Which of the following best describes the function of inhibin during the menstrual
cycle?
A. Stimulates FSH release from the anterior pituitary
B. Provides negative feedback to suppress FSH secretion [CORRECT]
C. Promotes endometrial proliferation
D. Triggers the LH surge
Correct Answer: B
Rationale: Inhibin, produced by ovarian granulosa cells, selectively suppresses FSH
secretion from the anterior pituitary through negative feedback. This prevents multiple
follicle development. Inhibin does not stimulate FSH (A), promote endometrial
proliferation (C—that's estrogen), or trigger the LH surge (D—that's estrogen positive
feedback). ACOG Committee Opinion on reproductive endocrinology.
Q6: During pregnancy, which anatomical change occurs in the uterus due to the
influence of estrogen and progesterone?
A. Decreased uterine blood flow
B. Hypertrophy and hyperplasia of myometrial cells [CORRECT]
, C. Cervical shortening and firming
D. Decreased uterine weight
Correct Answer: B
Rationale: Estrogen and progesterone cause both hypertrophy (increased cell size) and
hyperplasia (increased cell number) of myometrial cells, increasing uterine weight from
approximately 70g to 1100g at term. Uterine blood flow increases dramatically (A is
incorrect). The cervix softens and elongates (C is incorrect). Uterine weight increases
significantly (D is incorrect). ACOG Educational Bulletin on maternal physiology in
pregnancy.
Q7: A 19-year-old patient presents with primary amenorrhea. She has short stature,
webbed neck, and widely spaced nipples. What karyotype would confirm the most likely
diagnosis?
A. 46,XX
B. 46,XY
C. 45,X [CORRECT]
D. 47,XXX
Correct Answer: C
Rationale: The clinical presentation (short stature, webbed neck, widely spaced nipples,
primary amenorrhea) is classic for Turner syndrome, confirmed by karyotype 45,X.
46,XX (A) is normal female. 46,XY (B) would suggest complete androgen insensitivity.
47,XXX (D) typically presents with normal stature and normal menses. ACOG
Committee Opinion on primary amenorrhea.
Q8: In the hypothalamic-pituitary-ovarian axis, which hormone is primarily responsible
for the proliferative phase changes in the endometrium?
A. Progesterone
B. Estrogen [CORRECT]
C. Human chorionic gonadotropin (hCG)
D. Prolactin
Correct Answer: B
