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Your patient calls the clinic stating that she forgot to take her oral contraceptive for a second day. Which of these instructions is most accurate? A. Take your usual dose immediately, and use 2 forms of birth control until the next cycle B. Double your dose today and tomorrow then continue taking the usual dose, and use 2 forms of birth control until the next cycle. C. Throw away the package start over at the next cycle and use 2 forms of birth control until then D. Take a double dose for the next five days, then continue taking the usual dose, and use 2 forms of birth control until the next cycle Correct ans - B All of the following are key educational inclusions when prescribing an oral contraceptive except: A. What to do when you miss a dose B. Common side effects C. Unusual or concerning side effects D. Dietary restrictions Correct ans - D Your patient calls your office and states that she thinks that her NuvaRing "fell out" she asks about reinserting it. You know that the maximal amount of time that the NuvaRing can be outside the body before needing to be discarded for lack of efficacy is: A. 3 hours B. 6 hours C. 12 hours D. 24 hours Correct ans - A A good choice for long acting reversible contraception for a 30 year old who already has two children could be any of the following except: A. Diaphragm B. Implanon C. Intrauterine device D. Depo-vera Correct ans - A An acceptable option for birth control for an obese 25 year old smoker would be:
A. Cervical cap B. Ortho Evra patch C. Depo-vera D. Mini pill Correct ans - A - because there is no hormones in a cervical cap so less risk as this patient is overweight and smokes All of the following are mechanical barrier methods of contraception except: A. Diaphragm with spermicidal gel B. The sponge C. Condoms D. Depo Provera injections Correct ans - D. Dep-Provera is the brand name for depot medroxyprogesterone acetate (DMPA). It is given intramuscular. A college student has missed two days of her birth control pills in a row during the second week of her pill cycle. You should advice her: A. Start a new pill pack and dispose of the old one B. Take two today and two tomorrow and utilize a condom for the rest of the pill cycle C. Stop taking the pills and start a new pill cycle D. Take one pill now and two the next day Correct ans - B Which effect is seen in every women using Depo Provera for more than four years? A. Melasma B. Amenorrhea C. Weight loss D. Headaches Correct ans - B Which of the following hormones induces ovulation: A. FSH B. LH C. Estrodiol D. Progesterone Correct ans - B. LH originates in the anterior pituatary gland. An acute rise in LH triggers ovulation and the development of the corpus luteum. Which of the following are responsible for symptoms of dysmenorrhea? A. Estrogen B. Human chorionic gonadotropin C. Prostaglandins D. Progestin Correct ans - C. Prostaglandins - During endometrial sloughing the disintegrating endometrial cells release prostaglandins as menstration begins. Prostaglandins stimulate myometrial contractures, ischemia, and senstization of the nerve endings.
Which of the following is not an absolute contraindication for the utilization of birth control pills: A. Smoking under 35 with a history of a DVT B. Family history of migraine with aura C. Depression and history of gallbladder disease in pregnancy D. Controlled hypertension with diabetes mellitus with vascular changes Correct ans - B. Family history of migraine is not the same thing as a personal history of migraine with aura. All of the following are mechanical barrier mechanisms of contraception except: A. diaphragm with spermacide B. Sponge C. Condoms D. Depo-provera injections Correct ans - D. Depo-Provera is an I.M. injection All of the following are absolute contraindications of the birth control pill except: A. Benign hematoma B. History of embolism C. Family history of migraine with aura D. History of gallbladder disease during pregnancy Correct ans - C. Family history of migraine with aura may not be indicative of a personal history. This would be a relative contraindication. Sharon tells you that she has been douching after sex and believes this is an effective birth control option. You should tell her: A. Douching prevents sperm from entering the uterus B. Douching should be done once monthly after menses C. Douching is a reliable form of contraception D. Douching may increase her risk of ectopic pregnancy Correct ans - D. Sperm enters the cervical canal as soon as fifteen seconds after ejaculation. Douching has been associated with both pelvic infections as well as ectopic pregnancy and should never be used. Emergency contraception refers to: A. Induced abortion in the emergency room B. Quickly starting birth control pills in anticipation of sexual intercourse C. Having a Depo-Provera injection every twelve weeks D. Utilizing plan B, emergency contraceptive pills Correct ans - D. Plan B keeps the fertilized egg from attaching to the uterus. Which of the following conditions is contraindicated with utilizing a copper IUD? A. History of ectopic pregnancy
B. Nulliparity C. Treated cervical dysplasia D. Heart disease Correct ans - D. Heart disease because a copper IUD may put the patient at risk for bacterial endocarditis. Dysplasia: Abnormality of development or an epithelial anomaly of growth and differentiation Cervical dysplasia: abnormal changes in the cells on the surface of the cervix. How long can a Nuvaring be out of the vagina before a second form of contraception is necessary? A. 12 hours B. 24 hours C. 1 hour D. 3 hours Correct ans - D. Nuvaring is a soft transparent flexible ring of ethylene vinyl acetate copolymer. Releases 120 mcg of etongestrel and 15 mcg of ethinly estradiol daily. Placed in every 28 days and is removed after 21 days for withdrawl bleed. If it is accidently expelled for less than 3 hours instruct the patient to rinse it off with luke warm H20 and reinstert - no back up is needed. If it has been out of the vagina for more than 3 hours instruct the patient to discard the ring and instert a new ring and utilize a backup method of birth control for seven days or have a withdrawl bleed and insert a new ring no later than 7 days from the time when the last ring was removed. Lynne, comes into your office in tears. She reports to you that she had sex last night unprotected and forgot to take her birth control pill. She wants to know ab0ut the morning after pill. You tell her: A. If your period does not start at the regular time come back and see me. B. I will go ahead and order you the estrogen only postcoital contraceptive pill. C. If you utilize over the counter levonorgestrel 1.5 mg within 72 hours of unprotected sex it will reduce your chance of pregnancy by 75%. S. I will refer you to a gynocologist Correct ans - C. Emergency contraception should be taken within 72 hours of having unprotected sex. There are 3 regimens available in the U.S.A. (1) Yuzpe regimen - two pills within 72 hours and two 12 hours later is 75% effective (2) Progesterone only levonorgestrel 1.5 mg should be used within 72 hours of unprotected sex - can be purchased over the counter (3) Insertion of copper IUD up to seven days after unprotected sex. Plan B: is 1.5 mg levonorgestrel that will delay or prevent ovulation or interfere with the fertilization of the egg. Plan B One-Step can be purchased over the counter at drugstores without a prescription or proof of age. Because it is most effective when taken as soon as possible (up to 72 hours after sex), consider having a ready supply in your medicine cabinet. If you
D. Depo-Provera is an estrogen based form of contraception given by I.M. injection every three months Correct ans - D. Depo-Provera is a progesterone only form of contraception All of the following are correct in regards to Implanon except: A. Lasts for five years B. Is a better choice for women with multiple sex partners then an IUD because there is less of a chance of pelvic inflammatory disease C. It is a safe form of birth control for lactating women D. Works by supressing ovulation, thinning the endometrial lining, and thickening the cervical mucus Correct ans - A. Implanon is a radio opaque that will last for three years if not removed. If not removed after three years it will no longer be active against pregnancy. It is safe during lactation because it is a progesterone only form of contraception. All of the following are true of the Transdermal contraceptive patch except: A. Contains ethinyl and estradiol and noregestromin B. Is applied to a fatty area and stays on for 1 week intervals for three consecutive weeks of the month then is kept off for one week to allow for endometrial sloughing. C. Is not as effective as oral contraceptives in preventing pregnancy. D. All of the above Correct ans - C. The transdermal contraceptive patch is as effective as birth control pills in preventing pregnancy. The advantage of the patch over the pill is that the patient does not have to remember to take a pill at the same time everyday. A 24 year old female asks you about what to do after forgetting to change her patch on the seventh day and she is now on day nine with the same patch on. What advice should you give her? A. If you apply your patch late during the first week then apply a new patch as soon as you remember and make that your new patch day. Use a backup form of birth control for seven days after you apply the new patch. B. If you apply your patch late during week two or three and are one or two days late change it as soon as you remember and utilize a backup form of birth control for seven days C. If you are more than two days late in the second or third week change the patch as soon as you remember and utilize this new day as the day you change your patch. Utilize a secondary form of birth control for seven days. D. All of the above Correct ans - D. All of the above. If a patient realizes that her patch has fallen off for less than one day and cannot get the patch to restick to her skin then she should apply a new patch and make that her new patch day. She should use a backup method of birth control for seven days.
A woman eight weeks post partum comes to your office asking about birth control. She is breastfeeding and wants a reliable birth control method that will not interfere with lactation. You recommend: A. Oral contraceptives B. The Mini pill C. The transdermal contraceptive patch D. The Nuvaring Correct ans - B. The mini pill is the only option that is progesterone only. All other choices contain estrogen which cannot be given during lactation. Must be given on time everyday and can be given in the absence of menstration. It is 100% effective to prevent pregnancy in lactating women if utilized properly and can be immediately reversed by the patient at anytime making it a better option then Depo-Provera, IUD, or Implanon. You have recently started you patient on oral contraceptives. She followed your instructions and started her first pill on the Sunday after she started her period. She is in your office today for her three month follow-up visit and is complaining of breakthrough bleeding during the first two weeks of her pill cycle. Your next course of action would be: A. Reassure the patient that this is normal and she should continue taking her pill at the same time everyday for the first 21 days of every month. B. Increase the estrogen component of her pill. C. Increase the progesterone component of her pill. D. Lower the progesterone component of the pill. E. Decrease the estrogen component of her pill. Correct ans - B. Increase the estrogen component of her pill. Breakthrough bleeding from day 1 to 14 of a woman's menstrual cycle indicates that the estrogen component is not high enough. Bleeding irregularities should go away within the first three months of utilizing oral contraception. Combined oral contraception is an effective method of preventing pregnancy. Which of the following conditions not related to pregnancy may warrant the use of birth control pills in a woman? A. Acne B. Ovarian Cancer C. Endometriosis D. All of the above Correct ans - D. All of the above. Combined oral contraception can decrease a woman's risk for pelvic inflammatory disease, decrease menstrual flow, decrease risk of ovarian cancer, decrease risk of ovarian cysts, decrease hirsutism, decrease incidence of endometrial cancer and endometriosis, decrease risk of pelvic inflammatory disease, decrease risk of osteoporosis. All of the following are absolute contraindications of utilizing combined oral contraception in a woman except: A. Smoking
B. After forty eight hours C. After one week D. In one month Correct ans - A. Mirena gives five years protection. It can be inserted anytime during the menstrual cycle but if inserted within the first seven days of menstration it is effective immediately. If inserted any other time during the month another form of birth control should be used for seven consecutive days after insertion. Sydney is a 21 year old patient who is taking oral contraception. She comes to your office today complaining of acne. How should you adjust the estrogen component of the birth control pill? A. Increase the estrogen content B. Decrease the estrogen content C. Delete the estrogen content D. No adjustment should be made in the estrogen content Correct ans
- A. Patients suffering from acne should have an increase in the estrogen component of the birth control pill or a decrease in the progesterone component. Remember progesterone is androgenic. Women who utilize oral contraceptives are less likely to experience: A. Human papilloma virus B. Migraine headaches C. Iron deficiency anemia D. Herpes simplex virus Correct ans - C. Iron deficiency anemia: oral contraceptives cause less menstrual bleeding. A twenty six year old female comes into your office to discuss her options for birth control. Her history includes migraines with aura when on combination oral contraceptives in the past. Which would you advise: A. Combination hormone contraceptive pills B. Ortho Evra Patch C. Mirena IUD D. Vaginal Nuvaring Correct ans - C. Mirena IUD is the only progesterone only choice. All the other choices contain estrogen. Estrogen can cause migraine headaches with aura. Which of the following drugs may have there effects enhanced when used while taking oral contraceptives? A. Beta Blockers B. Oral anticoagulants C. Antacids D. Anticonvulsants Correct ans - A. Beta blockers, antidepressants, benzodiazepine, corticosteroids, theophyline, and valium may be enhanced when taken in conjunction with combined oral contraceptives.
Which of the following drugs decreases the effectiveness of oral contraceptives? A. Beta Blockers B. oral anticoagulants C. Antibiotics D. Oral hypoglycemic agents Correct ans - C- antibiotics, antacids, anticonvulsants, and barbituates can decrease the effectiveness of oral contraceptives. Mrs. Henderson inquires about why she needs progesterone added to her estrogen hormone replacement therapy. You explain that women with intact uterus's need to add progesterone to prescribed estrogen because: A. It assists with stopping hot flashes B. Reduces the incidence of endometrial hyperplasia and cancer C. Decreases the risk of osteoporosis D.. Controls mood swings Correct ans - B. Endometrial hyperplasia and cancer are both associated with long term estrogen use. Joanne wants to use birth control until she gets married next year. She wants to be able to stop the birth control method after the wedding and wants her fertility restored almost immediately. You recommend: A. Birth control pills B. Vaginal ring C. Depo-provera D. Lea's sheild Correct ans - D. Lea's shield is the only device that does not contain hormones. It is similar to the diaphragm and the cap. It is dome shaped and silicone that covers the cervix allowing secretions to exit without sperm entering. Spermicide should be utilized with this form of birth control. Which lab test is important to obtain after a 10 year profile of oral contraceptives have been utilized by a patient: A. Liver profile B. Lipid profile C. CBC with diff D. Metabolic panel Correct ans - A. Liver profile A 17 year old high school student is considering Seasonale as her method of birth control. Which of the following statements is false regarding Seasonale: A. Taking seasonale will lesson your menses to four yearly B. A menstrual period will occur within seven days of stopping Seasonale C. Is a progesterone only pill D. Must be taken for 84 consecutive days followed by seven days of inert pills. Correct ans - C. Seasonale is an extended cycle birth control pill containing both levongestrel and estradiol. More spotting occurs in patients taking these pills for the first few months of their use.
A mechanism of action for progesterone only contraceptives includes thickening of the cervical mucus, production of a thin ednometrium, and ................................. A. Premature degeneration of the Corpus Luteum B. Inhibits FSH production C. Inhibits the LH surge D. Mechanically inhibits implantation Correct ans - C. Inhibits the LH surge The leading danger of IUDs and the major cause of morbidity associated with their use is: A. Increased menstrual bleeding B. Dysmenorrhea C. Uterine perforation D. Infection Correct ans - D. Infection: This is why this is not a good method of birth control for women who have multiple sexual partners. Your patient has been successfully using Depo Provera as birth control for the past six months. She was given an appointment 12 weeks after her last injection but forgot she had it. It is now 3 days past her scheduled appointment and she is requesting her injection. What should your action be? A. Come to the clinic today for another injection B. Wait until her next menstrual cycle starts to restart the Depo C. Use foam and condoms until a normal menses occurs, then come to the clinic for another injection. D. Counsel the patient on another birth control method since she is unreliable Correct ans - A. Depo Provera should be given every twelve weeks but can be given up to the thirteen week and still be considered a viable form of birth control. A woman who has experienced bleeding during the first two weeks on birth control pills for three consecutive months should be changed to an OCP that has: A. Lower progestational activity B. Higher progestational activity C. Lower estrogenic activity D. Higher estrogenic activity Correct ans - D. Of all the following contraceptive methods which has the least true life efficacy A. Oral contraceptives B. IUD C. Condoms alone
D. Vaginal contraceptive gel Correct ans - D. Vaginal contraceptive gels (spermacides) should be utilized in conjunction with things like the sponge, a condom, or a diaphragm. Recent literature on the long term use of Depo Provera has found that the concern over this topic may not be as much of a concern as previously thought but clinicians should still be aware of this major concern with the prolonged use of progesterone only contraception: A. Increased infection B. Loss of bone density C. Amenorrhea D. Delayed confirmation of pregnancy Correct ans - B. Loss of bone density In a normal menstrual cycle which of the following is produced primarily by the corpus luteum? A. Prolactin B. Estrogen C. Progesterone D. Testosterone Correct ans - C. Progesterone: During the luteal phase (final phase of the ovarian cycle) the pituitary hormones LH and FSH cause the remaining parts of the dominant follicle to transform into the corpus luteum which produces progesterone. Your 25 year old G1P1 patient is requesting oral contraceptives. She is normal weight and does not smoke or have any significant health factors. On history she notes that her menses are heavy and she has difficulty with her pregnancy due to nausea. Your exam reveals cystic breasts, but no other physical findings. The best OCP this patient would benefit from would be: A. High estrogenic activity B. Low estrogenic activity C. High progestational activity D. Low progestational activity Correct ans - B. Excessive estrogen effects include dysmenorrhea, nausea, chloasma (mask like appearance) CVA, DVT, Thromboembolitic disease, Pulmonary emboli, telangiectasia (spider vein appearance on face), Hepatic adenoma/adenocarcinoma, cervical changes, and breast tenderness secondary to increase of the size. One of the major side effects from this form of contraception is abnormal uterine bleed. A. Oral contraceptive pills B. NuvaRing C. Implanon D. Essure Correct ans - C. Implanon: Is an progesterone only product. Irregular bleeding is the most common side effect especially in the first six to twelve months. For most women periods become fewer and lighter. After one
