OB/Gyn Flashcards
A 36-year-old woman is in the clinic for her 2-week postpartum checkup, wanting to know which contraceptive method she should use. She had to stop breastfeeding when she was 5 days postpartum, after she had a stroke. Her medical history is significant for morbid obesity, a tilted and bicornate uterus, allergic rhinitis, and a cerebrovascular accident (5 days postpartum). She is allergic to latex. Current medications are lisinopril 5 mg/day, hydrochlorothiazide 12.5 mg/day, simvastatin 20 mg every night, and aspirin 81 mg/day (all medications initiated 1.5 weeks ago). Which is the best contraceptive recommendation for
this woman?
A. Depot medroxyprogesterone acetate.
B. Levonorgestrel intrauterine device (LNG-IUD).
C. Contraceptive sponge.
D. Male polyurethane condom.
Depot medroxyprogesterone acetate (Answer A) causes
considerable weight gain, making it a less-than-optimal
choice for this patient. Cerebrovascular accident is also
a relative contraindication (medical eligibility criteria
category 3) for progestin-only contraceptives of depot
medroxyprogesterone and continuation of POPs and
implants. The levonorgestrel IUD (Answer B) should not
be used because the patient has structural abnormalities of
the uterus. The contraceptive sponge (Answer C) should
be avoided because of the patient’s uterine structural
abnormalities and because she is recently postpartum.
The polyurethane condom (Answer D) is the best option
because the patient has no contraindications or allergies
that would prohibit its use.
Correct Answer: D
A 36-year-old woman is in the clinic for her 2-week postpartum checkup, wanting to know which contraceptive method she should use. She had to stop breastfeeding when she was 5 days postpartum, after she had a stroke. Her medical history is significant for morbid obesity, a tilted and bicornate uterus, allergic rhinitis, and a cerebrovascular accident (5 days postpartum). She is allergic to latex. Current medications are lisinopril 5 mg/day, hydrochlorothiazide 12.5 mg/day, simvastatin 20 mg every night, and aspirin 81 mg/day (all medications initiated 1.5 weeks ago).
The patient calls to ask for another contraceptive
choice because she cannot afford the item you recommended. She states that the free clinic does not carry the item either. Of the alternative contraceptives that can be provided free from either your clinic or the free clinic, which is the best recommendation?
A. Female condom.
B. Male latex condom.
C. Yaz (ethinyl estradiol and drospirenone).
D. Ella (ulipristal).
The patient has no contraindications or allergies to the
female condom (Answer A). However, she has a latex
allergy, so the male latex condom (Answer B) would not
be a good choice. Estrogen-containing contraceptives
(Answer C) are contraindicated (medical eligibility criteria
category 4) for patients with stroke, according to the CDC
and the World Health Organization. Ulipristal (Answer D)
is a form of EC; it should not be used as a regular form of
contraception.
Correct Answer: A
A double-blind randomized trial is under way to
evaluate the effects of depot medroxyprogesterone,
leuprolide, and placebo on the bone mineral density of
600 patients with endometriosis. Which statistical test
is most appropriate?
A. Student t test.
B. Fisher exact test.
C. Kruskal-Wallis test.
D. Analysis of variance.
Analysis of variance (Answer D) would be most appropriate because the trial consists of more than two groups and
involves continuous data that are most likely normally distributed (n=600). Although the Student t test (Answer A)
is for continuous data, it should be used only if two groups
are being compared. Both the Fisher exact test (Answer B)
and the Kruskal-Wallis test (Answer C) are for nonparametric data.
Correct Answer: D
A 40-year-old woman asks to see the pharmacist after
her physician’s appointment. She states that she was
prescribed a new drug during her pregnancy. She is
uncomfortable taking medications during her pregnancy because her family said that they all carry risk. Which is the best information to include when educating the patient on the risks and benefits of the drug?
A. Rate of birth defects in studies of animals.
B. Gestational timing of risks and pregnancy.
C. Molecular weight of the drug.
D. Half-life of the medication.
Although molecular weight is important in determining
whether a drug will cross the placenta, the risk of malformations is not directly addressed (Answer C is incorrect).
Information from studies of animals helps determine the
potential risks of drugs in humans but does not confer
exact risks in humans (Answer A is incorrect). Educating
the patient on the gestational timing of risks and on the
current stage of pregnancy is imperative to understanding whether the patient has any chance of experiencing that birth defect (Answer B is correct). The half-life of a
medication does not affect the risk of medication exposure
during pregnancy (Answer D is incorrect)
Correct Answer: B
A 32-year-old woman who is 4 weeks postpartum calls
your office asking whether it is okay for her to start
terbinafine therapy for 6 months for toe onychomycosis that began during the pregnancy. She states that she consulted a podiatrist yesterday and that the podiatrist gave her this prescription. She reports no pain, redness, or difficulty walking but states she does not like how her toes look when wearing sandals. She is currently breastfeeding every 2 hours. You will find the following information regarding use in breastfeeding in the reference Medications & Mothers’ Milk (Hale 2019): milk/plasma ratio unknown; relative infant dose unknown; half-life 26 hours; 99% protein bound; and molecular weight 291 Da. Which is the best recommendation?
A. Delay treatment until finished with breastfeeding.
B. Change to itraconazole.
C. Use topical terbinafine.
D. Schedule doses right after feedings.
The best recommendation is to delay the treatment until
after she stops breastfeeding (Answer A is correct). The
drug is likely to cross into breast milk, but exact concentrations are unknown. Because of its long half-life and therapy
duration, the infant would be exposed to the drug. The
patient, who is currently asymptomatic, is seeking treatment only for cosmetic reasons. Itraconazole is an option
for treating onychomycosis; however, it has decreased efficacy compared with terbinafine (Answer B is incorrect).
Topical terbinafine is not effective for treating onychomycosis (Answer C is incorrect). Scheduling the doses right
after feedings is recommended to minimize infant exposure; however, because the half-life is long and the baby is
feeding every 2 hours, this recommendation is unlikely to
decrease infant exposure (Answer D is incorrect).
Correct Answer: A
A 21-year-old woman is in the office for a follow-up of
her dysmenorrhea. She states that because ibuprofen
has only slightly improved her pain, she would like
something else. She is currently in a monogamous
relationship and would like contraceptive protection
as well. Her vital signs today include the following:
height 63 inches, weight 99 kg (220 lb), blood pressure 118/68 mm Hg, and heart rate 72 beats/minute.
Which is the best recommendation?
A. Ethinyl estradiol and norelgestromin (Xulane):
Apply one patch every week for 3 weeks; then
repeat after a 1-week hormone-free interval.
B. Ethinyl estradiol and norelgestromin (Xulane):
Apply one patch every week for 11 weeks; then
repeat after a 1-week hormone-free interval.
C. Ethinyl estradiol 35 mcg and ethynodiol diacetate
1 mg (Kelnor 1/35): Take one tablet every day for
3 weeks; then repeat after a 7-day hormone-free
interval.
D. Ethinyl estradiol 35 mcg and ethynodiol diacetate
1 mg (Kelnor 1/35): Take one tablet every day for
11 weeks; then repeat after a 7-day hormone-free
interval.
Because the patient has a BMI >30, Xulane is not recommended because of decreased efficacy and increased
thromboembolic risk, making Answer A and Answer B
incorrect. Estrogen-progestin contraceptives (Answer C
and Answer D) are second-line agents after NSAIDs for
treating dysmenorrhea because they can decrease menstrual length and volume. Extended-interval dosing is
preferred because it decreases the frequency of menses,
making Answer D correct.
Correct Answer: D
A 49-year-old woman is initiating therapy with
estradiol valerate and dienogest (Natazia) for perimenopausal symptoms and contraceptive needs. You are asked to educate her about this product. Which option provides the best information for the patient regarding the minimal time a backup method of contraception should be used after initiation?
A. 48 hours.
B. 7 days.
C. 9 days.
D. 28 days.
Natazia is a quadriphasic hormonal contraceptive that
requires 9 days of backup contraception. The first two pills
contain only estrogen, and ovulation protection does not
occur until after the seventh dose. The egg is only viable
for up to 48 hours after ovulation, so 9 days (Answer C) are
required to provide pregnancy protection.
Correct Answer: C
A 38-year-old woman is calling because of the intolerable vasomotor symptoms she is experiencing, which interfere with her daily activities. Her medical history includes breast cancer (diagnosed 3 months ago). She takes trastuzumab. She notes that the physician told her that her treatment caused menopause. She states her hot flashes occur at least 12 times a day and cause her to change clothes often. She would like additional therapy. Blood pressure is 104/64 mm Hg, and heart rate is 66 beats/minute. Which is the best recommendation?
A. Conjugated equine estrogens.
B. Venlafaxine.
C. Clonidine.
D. Black cohosh.
Estrogens should be avoided because of the patient’s
active breast cancer (Answer A is incorrect). Venlafaxine
has shown efficacy in decreasing vasomotor symptoms in
patients with and without breast cancer (Answer B is correct). Clonidine improves vasomotor symptoms but may
not be the best choice because this patient’s blood pressure is low (Answer C is incorrect). Black cohosh has not been
effective in reducing vasomotor symptoms in patients with
breast cancer (Answer D is incorrect).
Correct Answer: B
A 25-year-old woman was recently given a diagnosis
of endometriosis. She is having trouble coping with
the diagnosis and wants to find a support group. Which is the best resource for finding local support groups?
A. Association of Reproductive Health Professionals.
B. American College of Obstetricians and
Gynecologists (ACOG).
C. Endometriosis Association.
D. National Women’s Health Network.
The Endometriosis Association (Answer C) provides
contact information for local support groups and patient
information. The Association of Reproductive Health
Professionals (Answer A), ACOG (Answer B), and the
National Women’s Health Network (Answer D) provide
patient information and health care–related information.
Correct Answer: C
