A 50-year-old woman has had a relapse of her multiple sclerosis (MS) after several years of being symptom-free. Which of the following factors is most likely to have contributed to her relapse?

Correct Answer: C

Rationale: Physical overexertion can contribute to an MS relapse, triggering symptoms to reappear.

Correct Answer: B

Rationale: Erectile function is primarily controlled by the parasympathetic nervous system, which facilitates the dilation of blood vessels in the penis. The parasympathetic nerves are responsible for vasodilation in the penis, allowing blood to enter and creating an erection. Sympathetic nerves, on the other hand, are responsible for ejaculation by causing contraction of the muscles around the vas deferens. Somatic nerves are involved in sensation and movement, not specifically in controlling blood supply to the penis. Spinal reflexes can play a role in the erectile process, but they are not directly responsible for controlling the venous blood supply.

Correct Answer: A

Rationale: Androgen therapy can cause liver dysfunction, so liver function tests should be monitored during treatment.

Correct Answer: A

Rationale: High blood pressure is a significant contraindication for the use of combined oral contraceptives due to the increased risk of stroke and myocardial infarction.

Correct Answer: A

Rationale: The correct action specific to hormonal contraceptives that should be taught to the woman is that they alter cervical mucus to prevent sperm penetration. This mechanism helps in preventing pregnancy by reducing the chances of sperm reaching the egg. Choices B, C, and D are incorrect. Choice B is inaccurate as hormonal contraceptives work by inhibiting ovulation rather than increasing follicle-stimulating hormone release. Choice C is incorrect as hormonal contraceptives do not activate the maturation of the endometrial lining; instead, they modify it to prevent implantation. Choice D is also incorrect as hormonal contraceptives do not stimulate the pituitary gland to increase luteinizing hormone synthesis and release.

Correct Answer: A

Rationale: The correct answer is A because the main reason HRT is not recommended for all women is due to the increased risks of stroke and breast cancer associated with its use. Choices B, C, and D are incorrect as they do not address the primary concerns regarding HRT use. HRT can indeed cause mood disturbances and may have effects on bone health, but the main concerns regarding its use revolve around the risks of stroke and breast cancer.

Correct Answer: C

Rationale: Combined oral contraceptives are associated with a higher risk of blood clots, especially in patients with additional risk factors.

Correct Answer: C

Rationale: Physical overexertion can contribute to an MS relapse, triggering symptoms to reappear.

Correct Answer: B

Rationale: Androgen therapy can increase the risk of cardiovascular events, including heart attack and stroke, particularly in older patients.