Birth Control - PCOS Quiz Flashcards
A 16 yo F inquires about emergency contraception and wants to have a prescription. She states that she had unprotected intercourse 3 days earlier and is worried about becoming pregnant. Which one of the following is the best response to her request?
A) Provide EC now and give her an extra supply in case she has another emergency
B) Recommend against the use of EC now and tell her to obtain an EC prescription for future use
C) Provide EC now, as well as a supply of condoms for future use
D) Provide EC with a prescription and instructions to take it asap
D
Which preparation is likely to be effective for post-coital contraception?
A) Clomiphene
B) Tamoxifen
C) Mifepristone
D) Diethylstilbestrol
C - mifepristone is an antagonist of progesterone and glucocorticoids. It has a luteolytic action and is effective as a post coital contraceptive. When combined with a prostaglandin it is used as an abortifacient.
3 years later this patient is now 19 yo and was initiated on low-dose combined oral contraceptive containing 20 mcg of ethinyl estradiol (EE). She went out of town for the weekend and missed two doses. It is the third week of her cycle and she is a day 1 starter. She asks your opinion on how she should handle the situation. Which one of the following is the most appropriate recommendation for this patient?
A) Take an active tablet as soon as possible (2 tablets on that day) and then continue taking 1 tablet daily. No additional contraceptive protection is recommended
B) Discard the current pack and start a new pack that same day. Use condoms or abstain from sex until tablets have been taken for 7 days in a row.
C) Discard the current pack, allow bleeding to occur, and then restart a new pack, taking 1 tablet daily. No additional contraceptive protection is recommended.
D) Take an active tablet asap (2 tablets on that day) and then continue taking 1 tablet daily Use condoms or abstain from sex until tablets have been taken for 7 days in a row.
B
Your patient developed venous thromboembolism after taking a COC last year. She is sexually active and reports using condoms with intercourse. In addition to the condoms, she would like a more reliable form of contraception to prevent pregnancy. Which one of the following is the best recommendation for your patient?
A) Discuss the advantages and disadvantages of a mirena IUD with your patient
B) Prescribe the ortho-evra patch
C) Prescribe a progestin-only oral contraceptive
D) Prescribe Nuva ring
A
16 year old girls presents to you for an annual physical. She is concerned about her oily skin, acne, and excessive facial hair growth. Her BMI is 24 and her menstrual cycles occur at regular 28-30 day intervals. She requests treatment for her acne and facial hair but does not want to use oral contraceptives because she does not think her mother will approve. Which one of the following is the best choice for her treatment?
A) Flutamide 250 mg PO daily
B) Elfornithine topically as directed
C) Spironolactone 25 mg PO BID and assess response and tolerability. Titrate dosage upwards if necessary to a max of 100 mg BID.
D) Clomiphene 50 mg PO daily for 5 days at the beginning of each menstrual cycle
C
Your patient today is a 23 year old woman inquiring about combined oral hormonal contraceptives. For which of the following conditions should she use an alternative form of contraception?
A) Evidence of hirsutism
B) History of GERD and using omeprazole to manage symptoms
C) History of PID
D) History positive for migraines successfully managed with sumatriptan
D - estrogen containing hormonal contraceptives increase the risk and frequency for migraine headaches
A young woman complains of abdominal pain at the time of menstruation. Careful evaluation indicates significant endometrial deposits on the pelvic peritoneum. Identify the appropriate medical therapy for this patient.
A) Flutamide
B) Medroxyprogesterone acetate
C) Norgestrel IUD
D) Ralofixfene
B - suppression of ovarian function and production of gonadal steroids is the treatment goal in endometriosis. Medroxyprogesterone acetate, when given in large doses as an IM injection, can suppress ovarian function for up to 3 months due to inhibition of pituitary production of gonadotropins.
Opill is an oral OTC (non prescription) contraceptive. Which of the following statements is correct?
A) It is a combination low dose estrogen and norgestrel (a progestin)
B) It is used as an emergency contraceptive
C) Its efficacy is similar to the efficacy of prescription only oral hormonal contraceptives
D) All of the above
C - O pill is progestin ONLY and is taken daily, not as EC
