obg: Contraception and Family Planning (share)

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

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.

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

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.

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

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.

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

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.

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

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.

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

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.

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

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.

Contraceptive 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%

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 %.

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

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.

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

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.

Hormonal Contraception Methods, except ?

A) Implant

B) Vaginal ring

C) Female condom

D) Intramuscular Injection

E) Transdermal Patch

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.

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

B) 12–24 hours

EXPLANATION

The lifespan of the egg after ovulation is just 12-24 hours

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

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)

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

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.

Absolute contraindications to the use of estrogen –containing contraceptives, except:

A) endometrial cancer

B) lupus erythematosus

C) ulcerative colitis

D) fibroid

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.

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

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

Recommended contraceptive method for women suffering dysmenorrhea:

A) IUD

B) combined oral contraceptive pills

C) barrier methods

D) emergency contraception

B) combined oral contraceptive pills

EXPLANATION

Women lose less blood with menses and suffer less dysmenorrhea with cyclic OC use.

The lifespan of the Copper-IUD device:

A) 1 years

B) 3 years

C) 5 years

D) 20 years

C) 5 years

EXPLANATION

The Copper IUD is approved for up to 5 years use.

Routine follow-up visit after IUD insertion is recommended:

A) not necessary

B) only by complains

C) after the first post insertion menses (usually 1 month)

D) every month

C) after the first post insertion menses (usually 1 month)

EXPLANATION

Normally, clients should return after the first post insertion menses, but not later than three months, for their first check up. Thereafter, there is no need for a fixed follow-up schedule.

Behavioral contraception methods (natural family planning) can be recommended to avoid pregnancy:

A) for women with well known, regular cycle

B) in case of vaginal discharge

C) with irregular menstruation cycle

D) during lactational amenorrhea

A) for women with well known, regular cycle

EXPLANATION

Behavioral contraception methods (natural family planning) can be recommended for women with well known, regular cycle to calculate fertile days accurately. The efficacy of this method is very poor by irregular cycle, by severe vaginal discharge or by lactational amenorrhea.

Contraindications of hormonal contraceptive, except:

A) cardiovascular disease

B) severe varicose veins

C) severe myopia

D) leiomyomas

C) severe myopia

EXPLANATION

Cardiovascular diseases, estrogen dependent neoplasms, severe varicose veins are contraindications. Hormonal contraceptive methods has no effect on myopia.

Recommended ages for hormonal contraception use:

A) from the first sexual intercourse until menopause or above 50 years

B) between 18–40 ages

C) before the first birth

D) no recommendation, use is irrespective for ages

B) between 18–40 ages

EXPLANATION

Healthy, reproductive-aged women without any contraindication can use hormonal contraceptive methods under 35 years. The newest contraception pills (the doses of progestin and estrogen decreased) provide the opportunity to use that methods for less than 18 or above 40 years.

Clomiphen, an orally active antiestrogen is used for:

1) anovulation form of PCO

2) hypoprolactinaemia

3) luteal phase defect

4) abnormal cervical factor

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only 4th answer is correct

E) all of the answers are correct

B) 1st and 3rd answers are correct

1) anovulation form of PCO

3) luteal phase defect

EXPLANATION

1., 3. Are true Clomiphen is an orally active antiestrogen. By inhibiting the negative feedback effect of endogenous estrogen, causes a rise of FSH and LH, stimulation of follicule maturation. Correction of the luteal phase defect is possible by use clomiphen (LH effect)

IVF treatment are recommended:

1) abnormal male coital factor

2) severe oligozoosperm

3) endometriosis

4) tubal occlusion on both sides

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only 4th answer is correct

E) all of the answers are correct

C) 2nd and 4th answers are correct

2) severe oligozoosperm

4) tubal occlusion on both sidesA) 1st, 2nd and 3rd answers are correct

EXPLANATION

2.,4. Are true. IVF procedure is preferable in cases of severe male factor infertility or in tubal occlusion. IVF is ineffective in the treatment of endometriosis or by coital abnormalities.

Side effects of combined hormonal contraceptives, regarding the estrogen contain:

1) increase plasma HDL level

2) decrease plasme HDL level

3) decrease plasma LDL level

4) increase plasma LDL level

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only 4th answer is correct

E) all of the answers are correct

B) 1st and 3rd answers are correct

1) increase plasma HDL level

3) decrease plasma LDL level

EXPLANATION

Synthetic and natural estrogens increase high density lipoprotein (HDL) cholesterol levels, while lower the LDL levels. Progestins lower such levels and increase slightly the LDL levels. The combined effects of oral contraceptives on plasma lipoproteins are: increase plasma HDL level and decrease plasma LDL level.

Complications of oral hormonal contraceptions:

1) post pill amenorrhea

2) pulmonary embolism

3) myocardiac infarction

4) bening hepatic tumors

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only 4th answer is correct

E) all of the answers are correct

E) all of the answers are correct

1) post pill amenorrhea

2) pulmonary embolism

3) myocardiac infarction

4) bening hepatic tumors

EXPLANATION

Complication of oral hormonal contraceptives could be deep vein thrombosis, pulmonary embolism, coronary vascular disease, cerebrovascular accident, post-pill amenorrhea and beging hepatic laesions. Fortunately serious complications are infrequent with the use of reduced hormonal doses.

Relative contraindication of oestrogen–containing contraceptives:

1) mild hypertension

2) leiomyomas

3) hypertriglyceridemia

4) breast cancer within last 5 years

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only 4th answer is correct

E) all of the answers are correct

A) 1st, 2nd and 3rd answers are correct

1) mild hypertension

2) leiomyomas

3) hypertriglyceridemia

EXPLANATION

Mild hypertension, leiomyomas, hypertriglicerdiaemia are only relative contraindication. Active breast cancer or breast cancer within 5 years are absolute contraindication of use.

Positive effects of vaginal ring (for example Nuvaring)

1) consistent hormone levels

2) provide uterine prolapse

3) lower hormonal dose compare to OCs

4) protection against STD-s

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only 4th answer is correct

E) all of the answers are correct

B) 1st and 3rd answers are correct

1) consistent hormone levels

3) lower hormonal dose compare to OCs

EXPLANATION

Nuvaring (vaginal ring) is a flexible plastic ring made with ethinyl estradiol ad etonogestrel. NuvaRing has the advantage of avoiding gastrointestinal absorption and hepatic first-pass metabolism, and serum hormone levels are consistent during administration of the ring. This ring is not kind of barrier method and has got no effect to protect against STDs. Uterine prolapse can not be prevent by using Nuvaring.

Positive effect of oral contraceptive pills:

1) reduce dysmenorrhea

2) has an boost effect on body power

3) reduce blood loss during menstruation

4) increase ’work mood ’

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only 4th answer is correct

E) all of the answers are correct

B) 1st and 3rd answers are correct

1) reduce dysmenorrhea

3) reduce blood loss during menstruation

EXPLANATION

Women lose less blood with menses and suffer less dysmenorrhea with cyclic OC use.

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