Contraception

Question 1

32yo F on OCPs for 3 months, BP elevated. Most appropriate next step?

Answer 1

Discontinue OCPs and recommend barrier method

Both estrogen and progesterone are known to cause BP elevation

Question 2

Most commonly sited as the reason for discontinuing OCPs?

Answer 2

Irregular bleeding

Nausea, breast tenderness, fluid retention are also common SE

Question 3

Risk associated w/ OCP use?

Answer 3

Increased risk of VTE

They are protective of Ovarian and Endometrial cancers

Question 4

Pt forgets to take regular dose of OCPs and had intercourse. Next step?

Answer 4

Use emergency contraception immediately and restart her pills the following day

If an active pill is missed at any time, and no intercourse has occurred in the past 5 days, two pills should be taken immediately and a backup method should be used for 7 days.

If intercourse occurred in the previous 5 days, emergency contraception should be used immediately and pills should be restarted the following day. A backup method should be used for 5 days.

Question 5

29yo obese F w/ T2DM asks about progestin only pills. What about them?

Answer 5

Have to take everyday

Prevents contraception via:

• thickening of cervical mucous
• suppression of ovulation
• alteration of endometrium
• inhibition of tubal transport

Question 6

36yo F smokes one pack per day, 145lbs, no other health concerns. Not in monogamous relationship. What is best method of contraception?

Answer 6

Injectable form of long-acting progestin

OCPs, intravaginal ring, transdermal patch are contraindicated in smokers >35yo

IUDs increase risk for STI and PID

Question 7

How are emergency contraception pills (ECP) used?

Answer 7

Within 72 hours, when no contraception was used (sexual assault) or contraceptive failure.

No medical contraindication
Does not disrupt already implanted pregnancy
Does not cause birth defects

Question 8

Child w/ multiple malformations of unknown etiology. What type of testing would be best for identifying the dx?

Answer 8

Cytogenetic analysis (trisomies)

Direct DNA testing (already know gene, i.e., CF)
Biochemical tests (identify or quantify metabolites or enzymes, metabolism d/o)
Linkage analysis (identify genetic sequences that are physically in close proximity to a disease gene of interest)