BC Contraception Flashcards
Which of the following method has an expected failure rate of less than 2% during the first year of use?
A- IUD B- Male condom C- DMPA(Depot medroxyprogesterone acetate) D- spermicide E- Oral contraceptive pill
IUD
Which of the following carries the highest risk of death in fertile women aged 35 to 44
A- tubal ligation B- IUD-levonorgestrel releasing C- OCP D- copper IUD E- pregnancy
Pregnancy
36 year old with a history of migraines with aura wishes to use combined OCP. What is the safety profile for use in this patient?
A- caution but safe to use B- advantages of method outweigh risks C- risks of use outweigh advantages D- unacceptable high health risk E- use is not currently restricted
unacceptable high health risk
Which of the following contraceptive method has an expected failure rate of 3 to 9 pregnancies per 100 users in the first year?
A- tubal ligation B- IUD-levonorgestrel releasing C- OCP D- DMPA(Depot medroxyprogesterone acetate) E- Male condom
OCP
Regarding post partum contraception, Which of the following is there strong evidence that use decreases the volume and composition of breast milk?
A- Depot medroxyprogesterone acetate B- progestin –only pills C- combined OCP D- etonogestrel implant E- None of the above
None of the above
15 year old nulligravida who plans to become sexually active with her boyfriend soon, is requesting hormonal contraception.
Which of the following is legally required prior to prescribing the BCP?
A- pap smear B- pelvic exam and cervical swabs C- breast exam D- parental consent E- none of the above
None of the above
Which of the following statements is NOT a progestin- mediated mechanism of levonorgestrel-IUD in pregnancy prevention?
A- thickening of cervical mucous B- endometrial atrophy C- decrease tubal motility D- decrease sperm penetration E- lysosomal activation and inflammation
Lysosomal Activation and Inflammation
For which of the following is IUD contraindicated due to an increased in complication rate?
A- Insertion immediately after spontaneous/induce abortion B- Insertion immediately post partum C- Adolescence D- HIV E- none of the above
None of the above
What is the spontaneous expulsion rate for the IUD during the first year after placement?
A- 5% B- 15% C- 1% D-0.5% E- 0.05%
5%
What is the approximate risk of IUD perforation per insertion?
A- 1 in 1000 B- 1 in 10,000 C- 1 in 100,000 D- 1 in 100 E- 1 in 500
1 in 1000
36 year old multigravida with a copper IUD in place presents for removal because she plans to become pregnant. Her LNMP was 6 weeks ago and a urine preg. test is positive. She is afebrile and denies cervical discharge. TV ultrasound confirms a 6 weeks IUP.
Which of the following strategies would you recommend to optimize the outcome for your patient?
A- remove IUD and plan expectant pregnancy Mx
B- remove IUD and abort pregnancy
C- leave IUD in place and plan expectant pregnancy
D- leave IUD in place and administer 2 weeks of oral antibiotics
E- leave IUD in place and administer 2 weeks of IV antibiotics
A- remove IUD and plan expectant pregnancy Mx
Which of the following is true regarding tubal sterilization?
A- Approximately 10%of pregnancies occurring post procedure are ectopic
B- increase incidence of dysmenorrhea and menorrhagia
C- ovarian cancer risk is increased
D- 50 percent of women aged 30 years or younger express regret by 5 years after the procedure
E- endometrial cancer risk is increased
A- Approximately 10%of pregnancies occurring post procedure are ectopic
Which of the following statements regarding vasectomy is true?
A- Failure rate is 30 times less than tubal sterilization
B- post op complication rate is 20 times less than that of tubal sterilization
C- semen analysis is performed 3 months after vasectomy to confirm azoospermia.
D- all of the above
E- none of the above statements are true
All of the above
Which of the following is not an absolute contraindication to use of combined OCP?
A- Cholestatic jaundice B- Migraine with focal neuro deficits C- Thrombotic disorders D- uncomplicated SLE with negative antiphospholipid antibodies E- uncontrolled HTN
D- uncomplicated SLE with negative antiphospholipid antibodies
What is the approximate rate of thromboembolic events per 10,000 woman years with combined OCP?
A- 40 events B- 100 events C- 4 events D- 400 events E- 24 events
4 events
Combined OCP significantly decrease serum levels of which of the following anticonvulsant?
A- Phenobarbital B- Phenytoin C- Carbamazepine D- Lamotrigine E- Oxcarbazepine/topiramate
Lamotrigine
Which of the following drug most clearly decreases combined OCP efficacy?
A- Cefixime B- Azithromycin C- Ciprofloxacin D- Doxycycline E- Rifampin
Rifampin
Which of the following disadvantages of progestin-only pills compared to
Combination OCP?
A- High rate of irregular bleeding B- Higher relative ectopic pregnancy rate , if pregnancy occurs C- higher failure rate D- all of the above E- none of the above
D- all of the above
Which of the following is an advantage of progestin only emergency contraception regimens compared with estrogen-progestin combinations for this purpose?
A- effective if taken beyond 5 days after exposure
B- better protection against STI
C- more effective in pregnancy prevention
D- Disruption of an implanted zygote
E- no advantages noted in the literature
C- more effective in pregnancy prevention
Which of the following is an advantage of lambskin condoms compared with latex rubber condoms
A- Better protection against STI B- lower breakage rates C- fewer allergic reactions D- lower slippage rates E- All of the above
C- fewer allergic reactions
37 year old woman requesting combined OCP’s
Her mother had breast cancer at age 45.
She has used them in the past without problems
Before prescribing the pill, which of the following is inappropriate?
A- fasting lipid profile B- Order a mammogram C- urine pregnancy test D- review previous abnormal pap smears E- assess smoking status
A- fasting lipid profile
Combination low dose OCP’S are most strongly implicated as a risk factor for the development of
which of the following neoplasm?
A- Cervical cancer B- endometrial cancer C- ovarian cancer D-Benign hepatic adenomas E- Lymphoma, if HIV infection coexists
A- Cervical cancer
How effective is plan B within 72h and when is it most effective?
75-85% in 72h. Most effectie in 24h
How effective is post coital IUD within 5d?
99%
When is the transdermal Contraceptive patch not effective?
on breast and weight >90kg
What physical exam do we do for OCP?
Blood pressure, BMI
breast exam after 1st rx, STI screen, pap after 21
When can you start contraceptive?
anytime during menstrual cycle.
When can hormonal contraception be continued until? In what kind of women?
Menopause (age 51-55), healthy non smoking
What preventative care do you need to think about when prescribing contraception?
HPV Vaccine
What is an absolute contraindication of OCP?
age >35 in smokers, aura with migraine
Thickening of cervical mucous, endometrial atrophy, decreased tubal motility and decreased sperm penetration are related to?
progestin mediated mechanisms.
T/F Failure rate of vasectomy is 30x less than tubal sterilization
True
T/F post op complication rate is 20x less than that of tubal sterilization
True
T/F Semen analysis is performed 3 months after vasectomy to confirm azoospermia
True
Is cholestatic jaundice an absolute contraindication to combined OCP?
True
Is migraine with focal neuro deficits an absolute contraindication to combined OCP?
True
Is thrombotic disorders an absolute contraindication to combined OCP?
True
Is uncontrolled HTN an absolute contraindication to combined OCP?
True
What is the rate of thromboembolic events per 10,000 women years with combined OCP?
4 in 10,000
What are the disadvantages of progestin only pills?
Higher rate of irregular bleeding, higher relative ectopic pregnancy rate (if occurs), higher failure rate
What is the advantage of progestin only pills in emergency contraception (compared to estrogen/progesterone)
Progestin is more effective in pregnancy prevention
What tests do you do for a 37yo woman requesting combined OCP (mother breast ca at 45)
Mammogram, urine preg test, review pap smears, assess smoking status, BP and BMI
What cancer does OCP protect for?
ovarian cancer
Actinomyces culture in the vagina or cervix in an asymptomatic patient do you treat?
NO (if asymptomatic)
do you remove an IUD for a LEEP?
NO
do you remove an IUD in pregnancy?
yes
do you remove an IUD with gonorrhoea?
YES
what do you do when someone misses two birth control pills?
back up contraception can be used for seven days after two missed pills
Are 20mcg estradiol pills (lolo) (normal is 30 - 35mcg estradiol) as effective as the regular?
Yes if adherence is good
T/F Metabolism of OCP is accelerated by any drug that increases liver microsomal enzyme activity
True
What drugs increase liver microsomal enzyme activity?
Phenytoin, phenobarb
do abx affect metabolism of OCPs?
NO except for rifampin
What abx does affect metabolism of OCPS
Rifampin
What is the Ddx of a woman with longstanding iUD with severe cramping or abdo tenderness?
PID, ectopic, miscarraige, IUD expulsion or perf.
What is the Ddx of AUB in women with prolonged use of IUDs?
Displacement of device, pregnancy, infection, dx of cervix or uterus (leiomyomas, polyps, endometrial ca)
- Watch out for Age
42 yo divorced, new sexual partner, met online dating site prep for first date? 3 counselling items to discuss?
Pregnancy, contraception, STI, safety
Barrier methods of contraception? (Two reusable)
diaphragm, cervical cap, sponge, female condoms, male condoms.
What are absolute contraindications for OCP?
Age >35 & smoking >15 cig/d, CV risk, HTN (160/100), VTE, thrombogenic dx, ischemic heart disease, stroke, Valve disease, SLE, migraine with aura, Breast Ca, cirrhosis, Hepatocellular adenoma, malignant hepatoma.
When is progestin-only contraceptive desirable?
migraine HA, Age >35 and smoker, obesity, thromboembolic dx, Cardiac dx, cerebrovascular disease, early postpartum, HTN, SLE, hypertriglyceridemia.
