Obgyn - Contraception and family planning Flashcards
OBG - 5.1
Which does not pruves the ovulation
A) BBT
B) pregnancy
C) progesteron level above 3 ng/l
D) secretory transformation of the endometrium
E) menstruation
ANSWER
E) menstruation
EXPLANATION
The rise in body basal temperature, pregnancy, present of corpus luteum, secretoric transformation of the endometrium are proof of ovulation. The presence of menstruation does not prove it, it could be anovulatoric bleeding also.
OBG - 5.2
Side effect of chemical and barrier contraception methods, except:
A) toxic shock syndrome
B) urogenital infection
C) pregnancy rate between 5–15%
D) fetal congenital malformations
E) salpingitis
ANSWER
E) salpingitis
EXPLANATION
The use of chemical spermicides or mechanical barriers can increase the risk of urogenital infection or nonmenstrual toxic shock syndrome. (Toxic shock syndrome is caused from intoxication by one of several related Staphylococcus aureus exotoxins, which colonized the vagina.) Due to the use of teratogenic chemicals may cause congenital malformation by the fetus. The efficacy of chemical or barrier contracpetion methods is not 100 %. Salpingitis do not occur with the use of barriers or spermicides.
OBG - 5.3
Contraception methods of spermicides are based on, except:
A) killing sperm
B) immobilizing the sperm
C) attacking the acrosomal membranes of the sperm
D) dissolving the external lipoprotein film
E) neutralizing the acid vaginal pH
ANSWER
E) neutralizing the acid vaginal pH EXPLANATION
Spermicides can decrease sperm motility, inactivate acrosome enzymes or solve the external lipoprotein layer. Neutralisation of the acidic vaginal pH does not have contraception effect
OBG - 5.4
Effects of combined hormonal contraception, except:
A) prevent ovulation
B) reduce sperm motility
C) inhibit secretion of FSH
D) supression of the LH surge
E) inhibit folliculogenesis
ANSWER
B) reduce sperm motility
EXPLANATION
Combined oral contraceptives prevent ovulation and the evolution of follicules due to inhibit the excretion of gonadotropin ((LH, FSH) hormones. It has no effect on sperm motility.
OBG - 5.7
Characteristic for combined oral contraceptives, except:
A) estrogen component is usually ethinyl estradiol
B) are either monophasic or multiphasic
C) each active pills contains the same dose of estrogen
D) one of the main mechanisms of contraceptive action is supression of the LH surge
ANSWER
C) each active pills contains the same dose of estrogen
EXPLANATION
Oral contraceptives (OC) contains also estrogen and progestin hormones. Different formulation are available containing estrogen, usually ethinyl estradiol. Preparation of OC-s are either monophasic (each active pills contains the same dose of hormones) or multiphasic (the dose of hormones varies among the pills in the package regarding to the physiological cycle based estrogen and progestin levels) One of the main mechanisms of contraceptive action is supression of the LH surge to prevent ovulation.
OBG - 5.8
Possible complications of Copper-IUD:
A) PID (pelvic inflammatory disease)
B) Ectopic pregnancy
C) Uterine perforation during insertion
D) Dysmenorrhea
E) All of the above
ANSWER
E) All of the above
EXPLANATION
Insertion of IUD’s can be associated infrequently with complications such as perforation or ectopic pregnancy and there is also a trasient increased risk of pelvic inflammatory disease due to endometrial contamination during device insertion. Copper IUDs may be associated with dysmenorrhea, therefore women with heavy menses or dysmenorrhea are better served by the hormonal IUS-s.
OBG - 5.9
Contraception methods that can be used during lactation:
A) multiphasic oral contrapectives
B) IUD
C) progestin only pills
D) B and C are both true
ANSWER
D) B and C are both true
EXPLANATION
During breastfeeding, the chance of getting pregnant is lower but not zero. There is a theoretical concern that hormonal contraceptives containing estrogen may impair lactation through their effect on the action of prolactin on the breast. Estrogen and progesterone combination inhibit prolactin activity. On the other side hormones ingested by the infant in breast milk may result in circulating levels that are higher than expected because of an immature liver that cannot metabolize the hormones, immature kidneys that may not be able to excrete the hormones, and a plasma-binding capacity that may be low, resulting in higher levels of free and biologically active hormones. Progestin-only oral contraceptives contain only a progestin and recommended during lactation.
OBG - 5.10Contraceptive typical failure rates within 1 year of use of combined oral contraceptives:
A) 3-10 %
B) 1-2%
C) 5%
D) 9.5%
E) 0.001%
ANSWER
A) 3-10 %
EXPLANATION
Contraceptive failure rates within 1 year of use of combined oral contraceptives: The failure rate (can be perfect or typical failure rate) represents the percentage of women who conceive in the first year of use the contraceptive method as instructed. Combined oral contraceptive methods are in the very effective group of methods with typical failure rate between 3% to 10 %.
OBG - 5.12
Characteristic of Levonorgestrel-releasing intrauterine system (LNG-IUS), except:
A) releases the oestrogen directly into the uterus
B) prevents pregnancy primarily by maintaining impenetrable cervical mucus and has a local effect on endometrium
C) results 70% to 90% reduction of menstrual blood loss
D) appropiate nulliparous women
E) approved for up to 5 years
ANSWER
A) releases the oestrogen directly into the uterus
EXPLANATION
The LNG-IUS (levonorgestrel-releasing intrauterine system) released daily certain amount of levonorgestrel and not estrogen. Due to a local endometrial atrophic effect and maintain thick impenetrable cervical mucus prevents pregnancy. IUS can be approved for nulliparous and for up to 5 years.
OBG - 5.13
Contraindications of hormonal contraception, except for:
A) pregnancy
B) deep venous thrombosis
C) smoking after the age 35
D) age under 18 years
E) liver disorders
ANSWER
D) age under 18 years
EXPLANATION
OCs, due to their estrogen containt also affects the cardiovascular system, central nervous system, lipid metabolism. Potential medical contraindications were defined as history of hypertension, myocardial infarction, cerebral vascular accidents, migraines with aura, any migraine and age 35 years or older, smoking in women older than 35 years, venous thromboembolism, or liver disease. The age under 18 without any other risk factor is not a contraindication for use.
OBG - 5.14
Hormonal Contraception Methods, except ?
A) Implant
B) Vaginal ring
C) Female condom
D) Intramuscular Injection
E) Transdermal Patch
ANSWER
C) Female condom
EXPLANATION
Different formulations are available containing estrogen and/or progestin such as: Oral contraceptive pills, implants, vaginal ring, transdermal patch, or depot injection. Female condom is a barrier contraceptive method without any hormones.
OBG - 5.16
The life span of the mature human oocyte is:
A) 6–12 hours
B) 12–24 hours
C) 24–48 hours
D) 24–72 hours
ANSWER
B) 12–24 hours
EXPLANATION
The lifespan of the egg after ovulation is just 12-24 hours
OBG - 5.17
Which is not the indication for intrauterine Insemination (IUI)?
A) unexplained infertility
B) cervical factor
C) ovulation dysfunction
D) mild oligozoospermy
E) tubal occlusion both side
ANSWER
E) tubal occlusion both side
EXPLANATION
Unexplained infertility, sperm abnormalities, ovulatory or cervical factors are the indication of intrauterine insemination. Tubal occlusion on the both side requires in –vitro fertilization. (IVF)
OBG - 5.20
Which content is responsible for the risk of deep vein thromboembolism in combined oral contraceptives?
A) gestogen
B) oestrogen
C) both of them
D) none of them
ANSWER
B) oestrogen
EXPLANATION
Estrogen containing oral contraceptives increase the risk for VTE because estrogen among others increase the plasma concentration of clotting factors (II, VII, X, XII, factor VIII, and fibrinogen). Since the introduction of the first birth controll pill the doses of estrogen have decreased from 50 ug to 20 ug per tablet.
OBG - 5.21
Absolute contraindications to the use of estrogen –containing contraceptives, except:
A) endometrial cancer
B) lupus erythematosus
C) ulcerative colitis
D) fibroid
ANSWER
C) ulcerative colitis
EXPLANATION
Fibroids have more estrogen receptors than has the nearby normal myometrium and estrogen can cause uterine fibroids to grow larger. Carcinoma of the endometrium or other known or suspected estrogen-dependent neoplasia are absolute contraindication of OC use. Estrogen-containing hormonal contraceptives are contraindicated in patients with positive antiphospholipid antibodies (aPL) in systemic lupus erythematosus. Theres is no known association between OC use and ulcerative colitis progression
OBG - 5.22
Efficacy of contraception methods from high to low effective:
A) oral contraceptives, IUD, condom
B) condom, IUD, oral contraceptives
C) IUD, oral contraceptives, condom
D) all of them represents the same efficacy
ANSWER
A) oral contraceptives, IUD, condom
EXPLANATION
The highly effective methods are the combined hormonal methods of contraceptions and the last group includes all the barriers. From high to low: OCs-IUD-condom
OBG - 5.23
Recommended contraceptive method for women suffering dysmenorrhea:
A) IUD
B) combined oral contraceptive pills
C) barrier methods
D) emergency contraception
ANSWER
B) combined oral contraceptive pills
EXPLANATION
Women lose less blood with menses and suffer less dysmenorrhea with cyclic OC use.
OBG - 5.23
Recommended contraceptive method for women suffering dysmenorrhea:
A) IUD
B) combined oral contraceptive pills
C) barrier methods
D) emergency contraception
ANSWER
B) combined oral contraceptive pills
EXPLANATION
Women lose less blood with menses and suffer less dysmenorrhea with cyclic OC use.
OBG - 5.24
The lifespan of the Copper-IUD device:
A) 1 years
B) 3 years
C) 5 years
D) 20 years
ANSWER
C) 5 years
EXPLANATION
The Copper IUD is approved for up to 5 years use.
