Week 17 - contraception

Question1

With respect to interaction between anti-retroviral drugs and contraceptives

Ritonavir inhibits oestrogen metabolism

Nevirapine inhibits oestrogen metabolism

Anti-retroviral drugs do not affect the efficacy of the combined oral contraceptive pill

Women on anti-retroviral drugs should only use combined pills with 20 mcg ethinyl-oestradiol

Zidovudine does not affect the efficacy of the combined oral contraceptive pill        

Question2

Which anti-retroviral drug does not affect the metabolism of the combined oral contraceptive pill?

Lamivudine         

Indinavir

Ritonavir

Nevirapine

Atazanavir

Question3

Which one of these drugs does not induce hepatic P450 enzymes?

Carbamazepine

Sodium valproate                    

Phenytoin

Barbiturates

Primidone

Question4

Which drug has unrestricted use (UKMEC 1) in women taking the low dose (30 mcg ethinyl-oestradiol) combined oral contraceptive pill?

Lamotrigine

Carbamazepine

Phenytoin

Sodium valproate                 

Topiramate

Question5

Which drug should not be used without additional contraceptive measures (UKMEC 3) in women taking the low dose (20-30 mcg ethinyl-oestradiol) combined oral contraceptive pill?

Ampicillin

Co-amoxiclav

Sodium valproate

Rifampicin          

Fluconazole

Question6

A 33 year old woman wishes to discuss contraception following a spontaneous vaginal birth. She is known to be HIV positive on anti-retroviral drugs. The progestogen-only pill can be used without restriction (UKMEC 1) if she is taking which anti-retroviral drug(s)?

Indanivir

Nevirapine

Lamivudine        

Zidovudine + Efavirenz

Lamivudine + indanivir

Question7

Which drug should not be used without additional contraceptive measures (UKMEC 3) in women taking the progestogen-only contraceptive pill?

Ampicillin

Ketoconazol

Lamotrigine 

Phenytoin                      

Co-amoxiclav

Question8

A 34 year old woman has an elective caesarean section because she is HIV positive. She is taking anti-retroviral drugs and wishes to use depo-medroxyprogesterone acetate for contraception. Depo-medroxyprogesterone acetate can be used without restriction (UKMEC 1) in women taking which anti-retroviral drugs?

Indanivir

Nevirapine

Lamivudine      

Zidovudine + Efavirenz

All the drugs listed           

Question9

Depo-medroxyprogesterone acetate can be used without restriction (UKMEC1) in women taking which drugs

Phenytoin, carbamazepine and lamotrigine

Ampicillin, co-amoxiclav, rifampicin

Carbamazepine, ampicillin, co-amoxiclav

Phenytoin, lamotrigine, sodium valproate

All the drugs listed          

Question10

Progestogen-only contraceptive implants can be used without restriction (UKMEC 1) in women taking which drugs?

Zidovudine, ampicillin, lamotrigine       

Phenytoin, lamotrigine, zidovudine

Sodium valproate, phenytoin, indinavir

Co-amoxiclav, lamotrigine, phenytoin

Lamivudine, lamotrigine, phenytoin

Question11

With respect to UK medical eligibility criteria (UKMEC) for the progestogen-only implant

UKMEC 1 for women taking phenytoin

UKMEC 2 for women taking zidovudine

UKMEC 3 for women taking rifampicin

UKMEC 1 for women taking lamotrigine        

UKMEC 4 for women taking tetracycline long-term

Question12

The combined oral contraceptive pill

Should be started 6 weeks post-partum if the woman is not breast feeding

Can be started up to 7 days after the LMP without need for additional contraception

Should be started after 6 months if the woman is fully breast feeding       

Can be started within 14 days of medical termination of pregnancy without need for additional contraception

Can be started within 14 days of miscarriage without need for additional contraception

Question13

The progestogen-only pill

Can be started up to day 5 of the menstrual cycle without need for additional contraception            

Should ideally be started at the end of menstruation

Should not be used beyond the age of 50 years

Should be started within 7 days of delivery otherwise additional contraception will be needed for 48 hours

Must be started on the day of termination of pregnancy otherwise additional contraception will be required for 7 days

Question14

Depo-medroxyprogesterone acetate

Can be started 7 days after termination of pregnancy without need for additional contraception

Can be started 2 weeks post-partum in a woman who is not breast feeding without need for additional contraception       

If started 10 days after first trimester miscarriage, additional contraception is needed for 72 hours

Should not be offered to women who are breast feeding

If started 6 weeks after delivery, additional contraception should be used for 72 hours

Question15

The levonorgestrel intra-uterine system

Can be inserted at any point in the menstrual cycle without need for additional contraception

Should not be inserted if the woman is menstruating

Can be inserted 21 days after spontaneous vaginal delivery

Can be inserted at the time of surgical termination of pregnancy         

Should not be inserted until 6 weeks after medical termination of pregnancy

Question16

A 34 year old mother of three children wishes to use the levonorgestrel intra-uterine system for contraception. When can she attend to have the device inserted?

Only in the first 5 days of her cycle

Only in the first 7 days of her cycle

At any time provided she is not pregnant          

Only in the last 5 days of her cycle

Only in the last 7 days of her cycle

Question17

The Copper intra-uterine contraceptive device

Should ideally be inserted on days 1-5 of the cycle

If inserted on day 7 of the cycle, additional contraception should be used for 7 days

Can be inserted at any point in the cycle and is effective immediately        

Should not be inserted immediately after surgical termination of pregnancy

Should be inserted at least 7 days after medical termination of pregnancy

Question18

A 23 year old woman requests emergency contraception. She is taking a low dose (20 mcg) combined oral contraceptive pill. Her LMP was 5 days ago and she has missed the 4^th pill. She has had unprotected intercourse about every other day in the last 2 weeks.

Reassure and take the next pill

Pregnancy test

Offer emergency contraception             

Take 2 pills at the same time then use condoms for the next 7 days

Offer emergency contraception plus pregnancy test in 7 days

Question19

A 23 year old woman requests emergency contraception. She has a regular 28 days cycle and is taking a low dose (20 mcg) combined oral contraceptive pill. Her LMP was 20 days ago and she has missed the 14^th pill. She has had unprotected intercourse about every other day in the last 2 weeks.

Reassure and take the next pill           

Pregnancy test

Offer emergency contraception           

Take 2 pills at the same time then use condoms for the next 7 days

Offer emergency contraception plus pregnancy test in 7 days

Question20

A 33 year old woman phones for advise because she has missed her oral contraceptive pill. She is taking a low dose (20 mcg ethinly-oestradiol) combined contraceptive pill. Her LMP was 20 days ago and she has a regular 28 day cycle. She missed pills on days 17 and 18. She has had unprotected intercourse in the last week.

Reassure and carry on as normal

Take the two missed pills as soon as possible

Use emergency contraception for the next 7 days

Omit pill-free interval and continue onto new pack            

Await pregnancy test if misses next period before starting new pack

D,A,B,D,D,C,D,E,E,A,D,C,A,B,D,A,C,A,A,D.

1-E  2-A  3-B  4-D  5-D  6-C  7-D  8-E  9-E  10-A  11-D  12-C  13-A  14-D  15-D  16-C  17-C  18-C  19-D  20-D 

1e) 2a) 3b) 4d) 5d) 6c) 7d) 8e) 9e) 10a) 11d) 12c) 13a) 14b) 15d) 16c) 17c) 18a) 19a) 20d)  

1a 2a 3b 4d 5d 6c 7d 8e 9e 10a 11d 12d 13a 14b 15d 16c 17c 18c 19a 20d

Dear Paul,

• Women who undergo hysterectomy and have incompletely excised CIN (or uncertain excision) should be followed-up should be as if their cervix remained in situ.
  1. CIN 1: vault cytology at six, 12 and 24 months
  2. CIN 2/3: vault cytology at six and 12 months, followed by nine annual vault cytology samples
  3. Incompletely excised CIN: follow-up continues to 65 years or until 10 years after surgery (whichever is later)

    In a woman who underwent hysterctomy at age 45 years and fits into above class of patient, annual cytology will finish at age 55 years . Then subseuent follow up will be in which way?

1. annual cytology till 65 years 

2. cytology 3 yearly till  65 years.

3. 5 yearly till 65 years.

Answers

1)   E

2)   A

3)   B

4)   D

5)   D

6)   C

7)   D

8)   E

9)   E

10)                  A

11)                  D

12)                  C

13)                  A

14)                  B

15)                  D

16)                  C

17)                  C

18)                  C

19)                  A

20)                  D

Dear Paul,

Thank You!