NOTCHTOP 2023 Flashcards
How many months after the repair of aortic stenosis should a woman become pregnant?
A. 24 months
B. 18 months
C. 12 months
D. 6 months
C. 12 months
Ratio: Patients who would benefit surgical repair of a lesion as in mitral or aortic stenosis should undergo surgical repair a year
or more before becoming pregnant.
Why is progestin still included in the hormonal replacement therapy (HRT) of menopausal women?
A. To prevent obesity
B. To prevent endometrial cancer
C. To prevent hypertension
D. To allow better control of T2DM
B. To prevent endometrial cancer
Ratio: If a woman wants to undergo HRT and has an intact uterus, she must have progesterone with estrogen to protect her uterus from endometrial hyperplasia or malignancy. If estrogen alone is used, it will cause the endometrial lining to grow while progesterone will stabilize the lining from proliferating abnormally.
Which of the following screening tests is highly correlated with the risk of developing neural tube defects?
A. Maternal serum alpha-fetoprotein
B. Serum levels of PAPP-A
C. Free beta-human chorionic gonadotropic
D. Free estriol level
A. Maternal serum alpha-fetoprotein
Ratio:
Maternal serum AFP is used for neural-tube defect screening. AFP is the major protein in fetal serum and defects in fetal integument (such as neural-tube and ventral-wall defects), permit AFP to leak into the amnionic fluid – resulting in increased maternal serum levels. According to ACOG, maternal serum AFP neural-tube defect detection rate is 95% for anencephaly and 80% for spina bifida.
What is NOT true regarding symptomatic gallbladder diseases in pregnancy?
A. Symptomatic cholelithiasis is common in pregnancy
B. Acute cholecystitis is common during pregnancy and in the puerperium
C. Cholecystectomy can be performed only during the first trimester of pregnancy
D. Laparoscopic cholecystectomy is the preferred surgical option for acute cholecystitis in pregnancy
C. Cholecystectomy can be performed only during the first trimester of pregnancy
Ratio:
>Symptomatic cholelithiasis is common in pregnancy (Choice A). Operative and endoscopic interventions are favored since conservative management is associated with more complications (multiple admissions, prolonged total parenteral nutrition, unplanned labor induction for worsening gallbladder symptoms).
>Acute cholecystitis is common during pregnancy and puerperium (Choice B). Acute disease in pregnancy may be complicated by sepsis, venous thromboembolism, pancreatitis, and bowel obstruction.
>Cholecystectomy can be performed safely in all trimesters. Cholecystectomy does not raise the risk of preterm labor or of maternal or fetal mortality. Laparoscopic cholecystectomy is the favored approach (Choice D).
Which of the following elements can deposit in the pituitary gland and may result in the destruction of the cells producing FSH & LH?
A. Copper
B. Iron
C. Selenium
D. Zinc
B. Iron
Ratio:
● Hemosiderosis can result in iron deposition in the pituitary gland, leading to destruction of the gonadotrophs that produce FSH and LH.
● All other choices are not known to deposit in the pituitary and cause destruction of gonadotrophs. Copper (Choice A) induces LH release and desensitization of pituitary gonadotrophs. Selenium (Choice C) supports prolactin release from the pituitary. Zinc (Choice D) promotes formation ofgrowth hormone dimer.
Which of the following is NOT true regarding kidney stone in pregnancy ?
A. Majority of pregnant patients with nephrolithiasis are asymptomatic
B. Sonography is the first line study to visualize stones, followed by MRI
C. Majority of symptomatic women will improve with conservative therapy
D. Most stones are diagnosed in the second and third trimesters of pregnancy
A. Majority of pregnant patients with nephrolithiasis are asymptomatic
Ratio:
● All other statements are true. Sonography is the first line. study to visualize stones, followed by MRI (Choice B). Most stones are diagnosed in the second and third trimesters of pregnancy (Choice D). 75% of symptomatic women will improve with conservative therapy (Choice C).
● More than 90% of pregnant women with nephrolithiasis present with pain. Gross hematuria is less common than in non-pregnant women.
Which of the following conditions does NOT warrant an evaluation of primary amenorrhea?
A. Menarche has not occurred 5 years after breast development
B. No menarche by the age of 15 years
C. No thelarche by age 13
D. No menarche by the age of 13 years
D. No menarche by the age of 13 years
Ratio:
● Primary amenorrhea is defined as:
o The absence of menses in a woman who has never menstruated by the age of 15 years (Choice B)
o Girls who have no menstruated within 5 years of breast development, if occurring by age 10 (Choice A)
● Breast development should occur by age 13 or otherwise, it would require evaluation (Choice C)
Which of the following is NOT an endocrine feature of polycystic ovarian syndrome?
A. Elevated levels of androgens and estrogens
B. High luteinizing hormone follicle stimulating hormone ratio
C. Decrease production of sex hormone binding globulin
D. Increase levels of sex hormone binding globulins
D. Increase levels of sex hormone binding globulins
Ratio:
● In cases of PCOS, chronic anovulation leads to elevated levels of estrogen and androgen (Choice A). The elevated androgens released from the ovaries and the adrenal cortex is converted peripherally into estrone. The elevated androgens lead to a decrease in the production of sex hormone binding globulin, resulting in higher levels of free estrogens and androgens (Choice C).
● High estrogen leads to an increased LH:FSH ratio, atypical follicular development, anovulation, and increased androgen production (Choice B).
Which of the following antibiotics is the recommended first-line treatment for granuloma inguinale?
A. Azithromycin
B. Amoxicillin with clavulanic acid
C. Ampicillin-sulbactam
D. Trimethoprim-sulfamethoxazole
A. Azithromycin
Ratio:
>Current recommendation for management (WHO, CDC) is Azithromycin 1g orally once a week or 500 mg daily for 3 weeks and until all lesions have healed.
> Alternative regimens include the following:
o Doxycycline
o Erythromycin
o Trimethoprim-sulfamethoxazole (Choice D)
Which of the following does prematurity increase the risk most for?
A. Birth injuries
B. Blood loss
C. Future infertility
D. Infection
D. Infection
Ratio: The management of PROM varies depending on the gestational age of the fetus. The rationale for the management of PPROM is that between 32 and 36 weeks, the risk from prematurity is equal to the risk of infection.
Which of the following cases may indicate a threatened abortion?
A. First trimester vaginal bleeding with abdominal pain
B. First trimester vaginal bleeding with fever, uterine tenderness, and foul vaginal discharge
C. Rupture of membrane is noted at the second trimester
D. Painless cervical dilation in the second trimester
A. First trimester vaginal bleeding with abdominal pain
Ratio:
> Vaginal bleeding or abdominal pain in early pregnancy should prompt hematocrit and blood type assessment. Goals involve exclusion of ectopic pregnancy and determination of intrauterine pregnancy viability. One of the diagnosis to consider is a threatened abortion, defined as bleeding through a closed cervical os in the first 20 weeks of pregnancy and with a live embryo or fetus.
> First trimester vaginal bleeding with fever, uterine tenderness, and foul vaginal discharge (Choice B) indicates septic abortion
>Rupture of membrane is noted at the second trimester (Choice C) indicated preterm premature rupture of
membranes.
>Painless cervical dilation in the second trimester (Choice D) indicates cervical insufficiency.
Which of the following infections is NOT associated with a vaginal pH of 6-7?
A. Candida albicans
B. Genital mycoplasms
C. Trichomonas vaginalis
D. None of the above?
A. Candida albicans
Ratio:
Vaginal infection with a pH of <4.5 is candidiasis.
>Candida albicans is the etiologic agent for 90% of cases of candidiasis. It presents with thick, curdy discharge,
dysuria, pruritus, and increased odor.
Vaginal infections that have a pH >4.5 include bacterial
vaginosis and trichomoniasis.
>Decreased lactobacilli-dominant flora and increased in
mixed flora including genital mycoplasmas (Choice B), Gardnerella vaginalis, and anaerobes lead to bacterial vaginosis. Presents with thin, whitish gray, homogeneous discharge and increased odor.
>Trichomonas vaginalis (Choice C) is the etiologic agent for trichomoniasis. Presents with yellow, frothy discharge, with or without vaginal or cervical erythema, increased odor, dysuria, and pruritus.
Which of the following antiseptics has shown evidence in decreasing the risk for post-operative endometritis?
A. Potassium permanganate
B. Chlorhexidine
C. Hydrogen peroxide
D. Hypochlorous solution
B. Chlorhexidine
Ratio:
According to a systematic review by Hass et al. (2020) on the vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections, vaginal cleansing with either povidone-iodine or chlorhexidine solutions before cesarean delivery can reduce the incidence of post-cesarean endometritis, fever, and wound infections. Reduction in the rate of endometritis from 7.2% to 3.4% was observed.
Which of the following is NOT included in the triple screening test for aneuploidy?
A. MSAFP
B. B-hCG
C. Inhibin A
D. Estriol
C. Inhibin A
Aneuploidy screening using B-hCG (Choice B) and estriol (Choice D) along with MSAFP (Choice A) is called the triple screen. When Inhibin A is added to enhance the ability to detect abnormalities, it is known as the quad screen.
What does the flexion of the fetal head during labor do?
A. Allows the fetal head to distend the perineum and the occiput to pass beneath the symphysis pubis
B. Allows the vertex to rotate from transverse to either anterior or posterior position
C. Allows the smallest diameter of the fetal head to negotiate downward through the pelvis
D. Allows passage of the biparietal diameter through the pelvic inlet
C. Allows the smallest diameter of the fetal head to negotiate downward through the pelvis
● Flexion – the descending head meets resistance (from the cervix, pelvic walls, pelvic floor) and flexes. The fetal chin is drawn closer to the fetal thorax and the shorter suboccipitobregmatic diameter replaces the long occipitofrontal diameter.
● Allows the fetal head to distend the perineum and the occiput to pass beneath the symphysis pubis (Choice A) is describing EXTENSION.
● Allows the vertex to rotate from transverse to either anterior or posterior position (Choice B) is describing INTERNAL ROTATION.
● Allows passage of the biparietal diameter through the pelvic inlet (Choice D) is describing ENGAGEMENT.
Which of the following is NOT an indication of hormone replacement therapy (HRT) in menopausal women?
A. Treatment of vasomotor symptoms of menopause
B. Treatment vaginal and vulvar atrophy
C. Prevention of osteoporosis
D. Promote regular cyclical bleeding
D. Promote regular cyclical bleeding
● Hormone replacement therapy (HRT) is supplementing women with hormones lost during the menopausal transition –includes an estrogen and progesterone. Indications of use include:
o Treatment of vasomotor symptoms of menopause (Choice A)
o Treatment of genitourinary syndrome of menopause (vaginal and vulvar atrophy) (Choice B)
o Prevention of osteoporosis (Choice C)
Which of the following infections must also be ruled out in pregnant women with chancroid?
A. Gonorrhea
B. Syphilis
C. Granuloma inguinale
D. Lymphogranuloma
B. SYPHILIS
● Chancroid is caused by Haemophilus ducreyi. Around 10% of persons who have chancroid are coinfected with T. pallidum
(syphilis) or herpes simplex virus.
● Syphillis is important to rule out in pregnant women since neonatal infections usually result from contact with spirochetes from lesions at delivery or across the placental membranes. Maternal infection can lead to congenital infection, preterm labor, low birthweight, and fetal or
neonatal death.
● Although chancroid and gonorrhea (Choice A) are common sexually transmitted infections, co-occurrence is not common. Granuloma inguinale (Choice C) and Lymphogranuloma (Choice D) are more chronic infections and co-infection with
chancroid is not frequently reported as well.
Which of the following modifiable risk factors is associated with early menopause?
A. Coffee
B. Sodas
C. Red meat
D. Smoking
D. SMOKING
● Early age at menopause is more common in women with a history of cigarette smoking, short menstrual cycles, nulliparity, type 1 diabetes, and family history of early menopause.
●Coffee (Choice A) is not known to be associated with increased risk of menopause, but rather, it is associated with increased vasomotor symptoms in menopausal women. High intake of soda (Choice B) has no known effect of risk, but it is associated with low mineral bone density in postmenopausal women. Recent studies showed ‘red meat and processed meat’ pattern predicted an increased risk (7%) of later menopause (Choice
C).
How is a seizure differentiated from a vasovagal event?
A. There is no difference between the two
B. Seizure is always tonic clonic in pregnancy
C. Toxicity is an outstanding feature in vasovagal events
D. Presence of postictal period in seizure
D. Presence of postictal period in seizure
Many vasovagal events are misdiagnosed as a seizure because the patient may have several tonic-clonic movements. One of the key ways to differentiate between the two is the presence of a postictal period after the event.
Which of the following types of cervical mucus indicates that a woman is post-ovulatory?
A. Opaque
B. Pearly
C. Thin
D. Thick
D. Thick
Billings Method: (Hormone; Ferning; Description)
PRE OVULATORY - Estrogen; Good; Thin, watery, copious
POST OVULATORY - Progesterone; None; Thick, scanty, viscous
Nearly 95% of ectopic pregnancies implant into which of the following structures?
A. Peritoneum
B. Fallopian tube
C. Horn of the uterus
D. Right ovary
B. Fallopian tube
Ratio: Implantation occurs in the fallopian tube in 95% of patients with an ectopic pregnancy. The ampulla is the most frequent site (70%), followed by the isthmus (12%), fimbriae (11%), interstitial (2%). Nontubal pregnancies are the remaining 5% and implant in the ovary (Choice D), peritoneal cavity (Choice A), cervix, or prior cesarean scar.
Which of the following comorbidities may be related to menstrual disorders?
A. Adrenal insufficiency
B. Diabetes mellitus
C. Hypertension
D. Myocardial ischemia
A. Adrenal insufficency
Ratio: Disruption in the hypothalamaic-pituitary-gonadal axis at any level can result to menstrual disorders and infertility due to the impairment in folliculogenesis, ovulation, and endometrial maturation. Among the choices, only adrenal insufficiency directly affects the pituitary gland and typically has reproductive complaints including amenorrhea, loss of libido, and decreased axillary and pubic hair.
Which of the following conditions will render the Billings method unreliable to use?
A. Nulliparity
B. PCOS
C. Cervicitis
D. Diabetes
C. Cervicitis
The cervical mucus method (Billings method) is based on the observation of changes in the cervical mucus and sensation of “wetness” and “dryness” in relation with the day of the menstrual cycle.
Which of the following describes the relation of the fetal head to the ischial spines the female pelvis?
A. Lie
B. Station
C. Engagement
D. Presentation
B. Station
● Fetal station - presenting fetal part’s leading edge in the birth canal in relationship to the ischial spines. Station zero (0) is when the lowermost portion of the presenting fetal part reaches the spines.
● Fetal lie – relationship of the fetal long axis to that of the mother
● Fetal presentation – portion of the fetal body either within or in closet proximity to the birth canal
● Fetal attitude – characteristic posture of the fetus. Generally, the fetus forms an ovoid mass that corresponds roughly to the shape of the uterine cavity
● Fetal position – relationship of a defined portion of the fetal presenting part to either the right or left of the birth canal
● Engagement – passage of the biparietal diameter
Which of the following is referred to as mature cystic teratomas?
A. Dermoid cyst
B. Granulosa cell tumor
C. Hilus cell tumor
D. Thecoma
A. Dermoid cyst
> Benign (Mature) Cystic Teratoma – also known as dermoid cyst, is the most common type of germ cell tumor, accounting for 25% of all ovarian neoplasms. Teratomas have the ability to produce adult tissue (skin, bone, teeth, hair, and dermal tissue).
Granulosa cell tumor – tumor consisting of primarily granulosa cells and a varying portion of theca cells, fibroblasts, or both. Histologically, they demonstrate Call- Exner bodies (eosinophilic bodies surrounded by granulosa cells). Produce increased levels of estrogen, present with uterine bleeding, and associated with endometrial hyperplasia that may lead to endometrial carcinoma.
Hilus cell tumor – these tumors occur after menopause and best managed by bilateral salpingo- oophorectomy and total abdominal hysterectomy
Thecoma – benign tumor that consists entirely of stroma (theca) cells. Associated with estrogen production but not as often as granulosa cell tumors.
Which of the following statements is CORRECT regarding managing infertile couples?
A. In women over 35 years old, infertility is the inability to conceive after 12 months of unprotected intercourse
B. In women under 35 years old, infertility is the inability to conceive after 12 months of unprotected intercourse
C. Infertility workup should only be started after 12 months regardless of the age of the female
D. If the couple is known to have male factor infertility, workup for infertility will still begin after 12 months
B. In women under 35 years old, infertility is the inability to conceive after 12 months of unprotected intercourse
By definition, infertility is the inability of a couple to conceive after 1 year of trying. For women older than 35 years old, the
timeline should be after 6 months of trying (Choice A, C).
Early investigation is also warranted if any of the following are present: oligomenorrhea or amenorrhea, known tubal obstruction, uterine disease, or known male factor infertility
Which type of breech presentation is the most commonly associated with cord prolapse?
A. Footling breech
B. Frank breech
C. Complete breech
D. All have equal chance of cord prolapse
A. Footling breech
● Breech presentation occurs in 2-3% of singleton pregnancies. Complete breech is when the hips are flexed and one or both knees are flexed. Incomplete or footling breech is when one or both of the hips are extended. Frank breech is when hips are flexed and knees are extended.
● Incomplete or footling breech has the highest risk of cord prolapse at 15% to 18% (Choice A), followed by complete breech at 4% to 6% (Choice C), and frank breech at 0.5% (Choice B).
Which of the following situations puts the woman at risk for hepatitis B virus infection during pregnancy?
A. Previous history of home delivery
B. Uncircumcised sex partner
C. No prenatal care
D. Having an HBsAg (+) sex partner
D. Having an HBsAg (+) sex partner
● Those with a positive hepatitis B surface antigen (HBsAg test) are likely to have acute disease and are at risk for transmission (Choice D)
● Although the absence prenatal care (Choice C) and a history of previous home delivery (Choice A) would indicate that the patient was not screened for Hepatitis B in the past, it does not necessarily increase her risk for acquiring the infection. Having an uncircumcised sex partner (Choice B) has no known increased risk of acquiring Hepatitis B infection.
Which of the following chemical preparations when added can accentuate the fishy amine odor produced by Gardnerella vaginalis?
A. 10% potassium hydroxide
B. 10% potassium permanganate
C. 20% acetic acid
D. 20% normal saline solution
A. 10% potassium hydroxide
Recall that Gardnerella vaginalis is one of the increased vaginal flora in patients with bacterial vaginosis (see item #12). Diagnosis of bacterial vaginosis can be made using Amsel criteria, which requires that 3 out of 4 criteria are present:
(1) presence of thin, white, homogenous discharge coating the vaginal walls
(2) an amine odor noted with addition of 10% KOH
(3) pH > 4.5
(4) presence of >20% of clue cells on microscopic examination.
Which of the following non-pharmacologic interventions is the best recommendation in a 58- year-old woman with a T-score of -1.1?
A. Water aerobics
B. Ballroom dancing
C. Functional weight-bearing exercise
D. Indoor cycling
C. Functional weight-bearing exercise
● Weight-bearing exercise (such as walking, hiking, and stair- climbing) and muscle-strengthening exercise have been found to decrease the risk of falls and fractures. This can be explained by Wolff’s Law where bones will adapt based on the stress or demands placed on them.
● Although water aerobics (Choice A), ballroom dancing (Choice B), and indoor cycling (Choice D), can be recommended, the most benefit to decrease risk of fractures would be functional weight-bearing exercises.
Which of the following types of abortion is associated with a dilated cervix and no expulsion of the products of conception?
A. Threatened abortion
B. Missed abortion
C. Inevitable abortion
D. Incomplete abortion
C. INEVITABLE ABORTION
● Inevitable abortion – no expulsion of any products of conception but with vaginal bleeding and dilation of the cervix such that maintaining pregnancy is unlikely, (+) cervical dilation, (+/-) fetal heart tones
● Threatened abortion – any bleeding < 20 weeks AOG, (-) cervical dilation, (-) expulsion of any products of conception, (+) fetal heart tones
● Missed abortion - dead products of conception have been retained for days or weeks, (-) cervical dilation, (-) fetal heart tones
● Incomplete abortion – partial expulsion of some, but not all products of conception in <20 weeks AOG, (+) cervical dilation, (-) fetal heart tones
● Complete abortion – complete expulsion of all products of conception in < 20 weeks AOG, closed cervix, no fetal heart tones
What is the target fasting blood glucose value of patients with gestational diabetes mellitus?
A. Less than or equal to 95 mg/dl
B. Less than or equal to 120 mg/dL
C. Less than or equal to 140 mg/dL
D. More than or equal to 180 mg/dL
A. Less than or equal to 95 mg/dl
● Glucose targets for pregnant women include:
o FBS <95 mg/dL (5.3 mmol/L)
o 1 hour post-prandial glucose <140 mg/dL (7.8 mmol/L) (Choice C)
o 2 hours post-prandial glucose <120 mg/dL (6.7 mmol/L) (Choice B)
● Diagnosis of gestational diabetes mellitus (IADPSG Recommendations)
o FBS > 92 mg/dL
o 1 hour 75g OGTT >180 mg/dL (Choice D)
o 2 hour 75g OGTT >153 mg/dL
Which of the following tests should be done if there is a suspicion of gonorrhea infection in a pregnant woman?
A. Culture and sensitivity
B. Gram stain of vaginal smear
C. Nucleic acid amplification test
D. Pap smear
C. Nucleic acid amplification test
● Screening for gonorrhea in women is by culture or nucleic acid amplification (NAAT). NAATs have replaced culture in most laboratories and kits are available for specific collection from the vagina, endocervix, or urine.
● NAAT of the urine or vaginal secretions are over 95% sensitive and specific and are the most sensitive and specific
diagnostic tool for identifying gonorrheal infections.
● Culture and sensitivity (Choice A) can be done but it will take days before a diagnosis will be made. Gram staining (Choice B) can identify presence of gram-negative intracellular diplococci and polymorhpnuclear leukocytes but is not the gold standard. Pap smear (Choice C) will not be able to identify the specific etiologic agent as compared to NAAT.
Which of the following is the MOST common obstetrical complication of a macrosomic fetus?
A. Cord prolapse
B. Hypertonic uterine contraction
C. Prolonged second stage of labor
D. Shoulder dystocia
D. Shoulder dystocia
● Fetal macrosomia describes fetuses whose estimated weight exceeds a threshold of >4000-5000g. Macrosomic fetuses have a higher risk of shoulder dystocia, obstetrical brachial plexus injuries, and birth fractures.
● Although there is a higher rate of cesarean delivery in women with macrosomic fetuses due to failure to progress in labor (Choice C), shoulder dystocia is more common.
● Cord prolapse (Choice A) is associated more with fooling breech presentation. Hypertonic uterine contraction (Choice B) is associated with high concentrations of oxytocin.
Which of the following statements is the CORRECT advice for a 48-year-old woman who has been experiencing menopausal symptoms especially hot flushes if she does not take hormone replacement therapy?
A. They are normal are rarely interfere with her well-being
B. They can begin several years before actual menopause
C. Hot flushes are the first manifestation of menopause
D. They usually will spontaneously resolve within 1 year of the last menses
B. THEY CAN BEGIN SEVERAL YEARS BEFORE ACTUAL MENOPAUSE
● In Filipina women, the average age of menopause is 47-48. Subtle changes in endocrine and menstrual function can occur
for up to 3 years before menopause (Choice B).
● Hot flushes usually occur for 2 years after the onset of estrogen deficiency but can persist for more that 10 years which may cause irritability and affect quality of life (Choice A, D).
● The earliest sign of impending menopause is a change change in menstrual length (Choice C).
Which of the following is a term used to describe the fluttery sensation experienced by pregnant women when they first feel fetal movements?
A. Softening
B. Show
C. Quickening
D. Lightening
C. Quickening
● Quickening – maternal perception of fetal movement.
o For primigravid, at 18-20 weeks
o For multigravidas, 16-18 weeks
● Softening (Choice A) – initial stage of cervical remodeling that begins during phase 1 of parturition
Which of the following should be given to a menopausal woman taking estrogen who still has uterus in situ?
A. Tamoxifen
B. Estradiol
C. Estrone
D. Progestin
D. Progestin
If a woman wants to undergo HRT and has an intact uterus, she must have progesterone with estrogen to protect her uterus from endometrial hyperplasia or malignancy. If estrogen alone is used, it will cause the endometrial lining to grow while progesterone will stabilize the lining from proliferating abnormally.
Which of the following is a permanent contraceptive method for females that blocks the meeting of the egg and sperm?
A. Combined oral contraceptives
B. Implanon
C. Bilateral tubal ligation
D. Vasectomy
C. Bilateral tubal ligation
● Bilateral tubal ligation – permanent sterilization involving surgical occlusion of both fallopian tubes to prevent the ovum and sperm from uniting.
● Combined oral contraceptives (Choice A) interfere with the pulsatile release of FSH and LH from the anterior pituitary. This ‘pseudopregnancy’ state suppresses ovulation and prevents pregnancy from occurring.
● Implanon (Choice B) or subdermal progestin implant – reversible contraceptive method that can provide 3 years of uninterrupted contraceptive coverage it acts by suppressing ovulation, altering the endometrium, and thickening cervical mucus
● Vasectomy (Choice D) – permanent sterilization for males involving ligation of the vas deferens. However, it is important to note that vasectomy is not immediately effective because sperm can remain viable in the proximal collecting system after the procedure. Therefore, additional contraception should still be used up to 6-8 weeks.
Which of the following is the MOST frequently used spermicide?
A. Nonoxynol-9
B. Menfegol
C. Benzalkonium chloride
D. Copper
A. Nonoxynol-9
● Most spermicides contain nonoxynol-9 and are sold over the counter as creams, jellies, suppositories, films, and foams.
● They provide a chemical spermicidal action and a physical
barrier to sperm penetration.
Which of the following conditions is NOT associated with a higher risk for ectopic pregnancy?
A. In vitro fertilization
B. History of sexually transmitted disease
C. Prior pelvic or abdominal surgery
D. Low folic acid intake
D. Low folic acid intake
● Risk factors for ectopic pregnancy include:
o History of STIs or PID (Choice B)
o Prior ectopic pregnancy
o Previous tubal surgery
o Prior pelvic or abdominal surgery resulting in adhesions (Choice C)
o Endometriosis
o Current use of exogenous hormones
o IVF or assisted reproductive technologies (Choice A)
o DES-exposed patients with congenital abnormalities
o use of IUD for birth control
o Smoking
● Low folic acid intake is associated more with neural tube defects. Leucovorin (Folinic acid) is used in the management of ectopic pregnancies, where is it added to medical therapies. It has folic acid activity that allows purine and pyrimidine synthesis to buffer side effects.
