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Challenges in Fertility Regulation – Multiple Choice Questions Only for Vol. 28, No. 6

1. Which of the following statements about abortion in the first trimester is/are true?
a) Mifepristone is more effective when given as a 600mcg dose compared with a 200mcg dose.
b) Surgical vacuum aspirations performed at less than 7 weeks gestation are five times more likely to fail to remove the gestation sac than those carried
out between 7 and 12 weeks.
c) Side-effects, such as vomiting and diarrhoea were reported more frequently by women receiving oral misoprostol compared with those who received
vaginal misoprostol.
d) Misoprostol is more effective if administered orally than vaginally.
e) Products of conception should be routinely sent for histological examination.

2. Which of the following is/are true about complications of abortions?

a) The risk of uterine perforation is 1 in 100.
b) There is a small increase in subsequent rates of breast cancer.
c) It is associated with ectopic pregnancy in future pregnancies.
d) Post-abortion infections are more common in the the presence of Chlamydia trachomatis , Neisseria gonorrhoea and bacterial vaginosis.
e) It is associated with infertility in subsequent pregnancies.

3. Which is of the following is/are true about pre-abortion assessment of women?

a) Determination of the women’s ABO and Rhesus blood group is mandatory.
b) All women should have a risk assessment for venous thromboembolism.
c) Ultrasound scanning is an essential prerequisite of abortion in all cases.
d) Universal antibiotic prophylaxis at the time of abortion is associated with a reduction in the risk of subsequent infective morbidity by around 50%.
e) All women should undergo a risk assessment for sexually transmitted infections and be screened for them as appropriate.

4. The following is/are recommended regimens for universal antibiotic prophylaxis for abortions:
a) Azithromycin 1 g orally on day of abortion, plus metronidazole 1 g rectally before or at the time of abortion.
b) Azithromycin 1g orally on day of abortion, plus metronidazole 800 mg orally before or at the time of abortion.
c) Doxycycline 100 mg on the day of abortion, plus metronidazole 800 mg orally prior to or at time of abortion.
d) Doxycycline 100 mg orally twice daily for 7 days starting on the day of abortion, plus metronidazole 1 g rectally before or at the time of abortion.
e) Doxycycline 100 mg orally twice daily for 7 days starting on the day of abortion, plus metronidazole 800 mg orally before or at the time of abortion.

5. Which of the following is/are true about the acceptability of male contraception?
a) Few men regard male methods as worth developing.
b) There is a clear preference for oral administration across all countries surveyed.
c) Few women would be happy for their partner to take contraceptive responsibility.
d) A range of administration methods will optimise uptake.
e) Reversibility is a key requirement.

6. Which of the following is/are true about hormonal methods tested so far?
a) Effective contraception requires azoospermia.
b) Rebound of spermatogenesis despite ongoing treatment can be an issue for contraceptive reliability.
c) Contraceptive efficacy is generally not as good as with condoms.
d) Adequate suppression generally takes several months to achieve.
e) Recovery is variable and incomplete.

7. Which of the following is/are true about hormonal contraception for men?
a) The basis for this approach is complete suppression of follicle-stimulating hormone (FSH) and but not luteinising hormone secretion.
b) Progestogens are effective suppressors of gonadotropins in men.
c) Side-effects generally reflect supraphysiological testosterone dosing.
d) GnRH antagonists provide an effective and convenient approach.
e) Non-suppression is related to identifiable pre-treatment characteristics.

8. Which of the following is/are true about the non-hormonal approach to male contraception?
a) Leydig cell function is often affected.
b) Epididymal function offers many specific biochemical targets.
c) Reliable animal models for human epididymal function can be used to explore these approaches.
d) The process of meiosis is a promising target.
e) Sperm motility uses specific biochemical processes not found elsewhere in the body.

9. The following is/are true regarding emergency contraception:

a) All hormonal methods of emergency contraception are not contraindicated in women who are smoking and older than 35 years of age.
b) If the levonorgestrel contraceptive pill fails and the woman gets pregnant, the pregnancy cannot be continued because of the likely adverse effects of the
drug on the ongoing pregnancy.
c) Low dose mifepristone (10 or 25 mg) has the best efficacy amongst all existing options of hormonal emergency contraception.
d) The levonorgestrel intrauterine device has the best efficacy among all existing options of emergency contraception.
e) Over-the-counter or advanced provision of emergency contraceptive pills to women should be discouraged because it may encourage abuse and risky
sexual behaviours, and compromise the compliance to regular contraceptive methods.

10. Which of the following is/are true in relation to copper intrauterine devices (Cu-IUD)?
a) Cu-IUDs should only be inserted during menstruation.
b) Previous caesarean section is a contraindication
c) Gyne-fix is designed to cause less dysmenorrhea and fewer expulsions, especially in nulliparous women
d) The risk of pelvic infection 4 weeks after insertion is higher than the background risk for non-IUD users
e) Any Cu-IUD inserted in a woman over the age of 40 can be left in place until after the menopause

11. Which of the following is/are true in relation to the levonorgestrel-releasing intrauterine system (LNG-IUS)?
a) The failure rate is comparable to female sterilisation
b) Users should be warned to expect PV spotting in the early months of use
c) It primarily works by inhibiting ovulation
d) The majority of women will have amenorrhea within 12 months of use
e) Is effective immediately if inserted in the first 5 days of the menstrual cycle

12. Which of the following is/are true about intrauterine contraception (IUC)?
a) IUC is often a cause of post-coital bleeding
b) As soon as ‘lost threads’ are diagnosed, pregnancy must be excluded
c) The rate of ectopic pregnancy is higher in IUC users compared to non-users
d) IUC is contraindicated in diabetics
e) Women who have never had a baby should be discouraged from having IUC

13. Which of the following is/are true in relation to emergency post-coital contraception?
a) A woman presents on day 18 of her 28-day cycle having had unprotected sex on days 7, 10 and 13 of her cycle. A Cu-IUD can be fitted.
b) A follow-up appointment should always be offered after emergency contraception is issued
c) A Cu-IUD fitted for emergency contraception can either be removed after the woman’s next menses or retained for long-term use
d) The LNG-IUS can be used as a method of emergency contraception
e) A woman presents on day 18 of her 28-day cycle having had unprotected sex on days 7, 10 and 13 of her cycle. LNG oral emergency contraception can
be prescribed

14. Which of the following is/are true in relation to IUC?

a) A previous ectopic pregnancy is an absolute contraindication to having a LNG-IUS
b) A previous history of pelvic inflammatory disease is a contraindication to Cu-IUD insertion
c) The failure rate of Cu-IUDs depends in part on the surface area of the copper which they contain
d) A Cu-IUD inserted when the woman is over 40 years of age should give her effective contraception until she is post-menopausal
e) The LNG-IUS has a 3- year license.

15. Which of the following statement(s) about changes in menstrual bleeding patterns with injectables and implants is/are correct?
a) Most women experience irregular bleeding patterns with the use of injectables.
b) Implants induce less menstrual irregularity than combined hormonal methods.
c) Changes in menstrual bleeding patterns with injectables cannot be predicted for any specific user.
d) Changes in menstrual bleeding patterns with implant use are a main cause of method discontinuation.
e) Changes in menstrual bleeding patterns with injectables are a good predictor of the same occurring with the implant.

16. Which of the following categories of women should not use injectables or implants?
a) Nulligravid women
b) Adolescents
c) Postpartum women
d) Women who wish to limit further childbearing.
e) Women with past Chlamydia infection

17. Which of the following statement(s) about human immunodeficiency virus (HIV) and hormonal contraceptive use is/are true, based on epidemiologic
assessments of current data:
a) Use of combined oral contraceptives does not seem to increase HIV acquisition.
b) Use of injectable contraception may or may not increase the risk of HIV acquisition.
c) DMPA seems to increase risk of HIV disease progression in women living with HIV.
d) Some antiretroviral medications (e.g., efavirenz and nevirapine) may reduce implant effectiveness.
e) Some antiretroviral medications (e.g., efavirenz and nevirapine) may reduce injectable DMPA effectiveness.

18. Which of the following is/are true about contraception after medically induced abortion?
a) It is not required for 21 days after taking mifepristone.
b) Starting the combined oral contraceptive pill (COCP) after medical abortion can reduce the number of days of bleeding.
c) It should be delayed until a follow-up visit to confirm the success of the procedure.
d) It can be commenced as soon as mifepristone has been taken.
e) Mifepristone interacts with hormonal contraceptives in the first month and may reduce their efficacy.

19. Which of the following is/are true about insertion of the intrauterine device or intrauterine system at first trimester surgical abortion?
a) It is associated with a 20% risk of expulsion.
b) It is associated with similar rates of infection than at other times.
c) It is associated with higher rates of perforation than at other times.
d) It is associated with similar rates of uptake than if the insertion is scheduled for a later date.
e) It is associated with greater bleeding than at other times.

20. Postpartum insertion of the progestogen only implant has been shown to:
a) Adversely affect the composition of breast milk.
b) Increase the time to lactation interval.
c) Have a greater effect on vaginal bleeding pattern if inserted immediately postpartum than if inserted at a later stage.
d) Be associated with high continuation rates amongst young mothers at 1 year.
e) Prevent rapid repeat pregnancy in young mothers.

21. Which of the following contraceptive methods should not be offered to women living with HIV who are not clinically well?
a) Combined oral contraceptive
b) Depot medroxyprogesterone acetate (DMPA)
c) Intra-uterine device
d) Contraceptive patch
e) Progesterone only pill

22. Which of the following contraceptive methods is/are least likely to interact with antiretrovirals (ARVs)?
a) Depot medroxyprogesterone acetate (DMPA)
b) Copper intra-uterine device
c) Combined oral contraceptive
d) Levonorgestrel progestin-only contraceptive implant
e) Condoms

23. Which of the following contraceptive methods is/are recommended for use by HIV sero-discordant couples to prevent onward HIV transmission?
a) Condoms, male or female, with nonoxynol-9
b) Condoms, male or female
c) Depot medroxyprogesterone acetate (DMPA)
d) Female sterilization
e) Male sterilization

24. The following is/are true regarding the risk of pelvic infection after insertion of an IUD?
a) It is highest during the first 20 days after insertion
b) It is constant for the first year and then decreases in subsequent years
c) It is highest in Africa compared to other countries
d) It is lowest in Western Europe compared to other geographical areas
e) It is inversely associated with age

25. Which of the following is/are correct concerning emergency contraception?

a) The most effective emergency contraceptive is the Yuzpe-method.
b) A Copper IUD can be inserted up to 5 days after the expected date of ovulation.
c) Ulipristal acetate (ellaOne ® ) 30mg is a selective oestrogen receptor modulator (SERM) and is a very powerful in delaying ovulation and is thus
effective for up to 120 hours.
d) Levonorgestrel 1.5mg is given as a single dose or in two doses of 0.75mg twelve hours apart.
e) Levonorgestrel 1.5mg is thought to delay ovulation if taken on day 18 of a 28 day cycle.

26. Which of the following contraceptive methods is/are long-acting reversible?

a) Combined hormonal oral contraceptives
b) Subdermal contraceptive implants
c) Transdermal contraceptive patch
d) DMPA injections
e) LNG-IUS

27. Which of the following statements about the contraceptive injectable Depo-Provera is/are true?
a) Depo-Provera can reduce heavy menstrual bleeding in older users.
b) Depo-Provera should be avoided by women in their forties because of the risk of post-menopausal fractures.
c) Depo-Provera suppresses the rise in follicle-stimulating hormone (FSH) level, which occurs when women become menopausal.
d) Depo-Provera would be suitable for contraception for a woman of 45 years with a past history of a possible deep vein thrombosis.
e) Depo-Provera is associated with amenorrhoea rates of 40% after 1 year of use.

28. Combined hormonal contraception (COC) offers which of the following non-contraceptive benefit(s) to peri-menopausal women?
a) Osteoporotic fracture prevention.
b) A lower risk of cervical cancer compared to non-users.
c) Reduced risk of breast cancer in women carrying the BRCA 2 mutation.
d) Protection against ovarian cancer which lasts into the post-menopause.
e) Treatment of dysfunctional peri-menopausal bleeding.

29. Which of the following is/are true about stopping contraception?

a) CHC should be continued until withdrawal bleeds stop.
b) If inserted after the age of 35 years, a copper intrauterine device remains in situ unchanged until the menopause.
c) An IUS inserted in a woman of 42 years does not need to be changed until removal at the time of the menopause.
d) A woman with a sub-dermal contraceptive implant must change to another method at the age of 50 years.
e) The progestogen-only pill is safe to continue until the age of 55 years.

30. Which of the following is/are true about safe prescribing contraception for an older woman?
a) The combined transdermal contraceptive patch is a safer option than combined oral contraception in respect of VTE.
b) The vaginal ring offers no benefit in terms of reduced risk of arterial disease compared to combined oral contraception.
c) Combined oral contraceptive preparations containing natural oestradiol esters rather than ethinylestradiol have less effect on breast cancer risk.
d) Inserting a subdermal implant is contraindicated in a woman of 45 years who has uncontrolled hypertension because of the risk of arterial disease.
e) Progestogen only contraception can be safely used in women with a history of breast cancer.

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Nov 8, 2017 | Posted by drzezo in OBSTETRICS | Comments Off on Challenges in Fertility Regulation – Multiple Choice Questions Only for Vol. 28, No. 6

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