00
Correct
00
Incorrect
00 : 00 : 0 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - A patient with amenorrhoea is seen in clinic. History and examination reveal the...

    Correct

    • A patient with amenorrhoea is seen in clinic. History and examination reveal the patient runs 10-20 miles every day and her BMI is 17.8. Which of the following is likely to explain her symptoms?

      Your Answer: WHO type I Ovulation Disorders

      Explanation:

      World Health Organization (WHO) Group I ovulation disorder is due to hypothalamic pituitary failure. This is sometimes termed hypothalamic amenorrhoea or hypogonadotropic hypogonadism. Women can improve frequency of ovulation, conception and an uncomplicated pregnancy by increasing their body weight (if BMI of <19) and/or moderating their exercise levels (if they undertake high levels of exercise). GnRH and LH may be administered in these patients. PCOS falls under type II ovulation disorders. WHO Group III ovulation disorder is due to ovarian failure.

    • This question is part of the following fields:

      • Endocrinology
      2
      Seconds
  • Question 2 - What is the typical volume increase of a non-pregnant uterus to term uterus?...

    Incorrect

    • What is the typical volume increase of a non-pregnant uterus to term uterus?

      Your Answer:

      Correct Answer: 10ml to 5000ml

      Explanation:

      Uterine blood flow increases 40-fold to approximately 700 mL/min at term. The uterus is 50–60 g with a volume of approximately 10ml prior to pregnancy and 1000 – 1200 g with a volume of 5000ml by term.

    • This question is part of the following fields:

      • Physiology
      0
      Seconds
  • Question 3 - A 52-year-old lady comes to your office with vaginal bleeding 7 hours after...

    Incorrect

    • A 52-year-old lady comes to your office with vaginal bleeding 7 hours after sexual intercourse. She hasn't had a menstrual period in over a year. A year ago, she had a normal pap smear. She has no other symptoms and appears to be in good condition.
      Which of the following is the most likely underlying cause of this woman's postcoital bleeding?

      Your Answer:

      Correct Answer: Vaginal atrophy

      Explanation:

      Vaginal atrophy (thinning of vaginal tissue): Oestrogen helps to keep this tissue healthy. After menopause, low oestrogen levels can cause your vaginal walls to become thin, dry, and inflamed. That often leads to bleeding after sex.

      Vaginal atrophy is the most common cause of post menopausal vaginal bleeding.

      With a normal pap smear a year ago, this patient is unlikely to develop cervical cancer.

      Cervical ectropions are not common in post-menopausal women.

      Endometrial cancer and cervical polyps are possible causes of postcoital bleeding, however, they are not as common as vaginal atrophy.

    • This question is part of the following fields:

      • Gynaecology
      0
      Seconds
  • Question 4 - Regarding the foetus, which one of the following statements is true? ...

    Incorrect

    • Regarding the foetus, which one of the following statements is true?

      Your Answer:

      Correct Answer: Fetal lie describes the long axis of the foetus to the long axis of the mother

      Explanation:

      Fetal lie describes the relationship of the long axis of the foetus with respect to the long axis of the mother.
      Coronal suture is the transverse suture separating the parietal bone from the frontal bone.
      Umbilical cord is composed of two arteries and one vein. the vein carries the oxygenated blood, whereas the arteries contain the deoxygenated blood.
      At the time of birth, the anterior fontanelle is open and appears as a soft jelly like structure.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 5 - After birth, all of the following vessels constrict, EXCEPT the: ...

    Incorrect

    • After birth, all of the following vessels constrict, EXCEPT the:

      Your Answer:

      Correct Answer: Hepatic portal vein

      Explanation:

      Immediately after birth the liver is deprived of the large flow of blood supplied during foetal development via the umbilical vein and portal sinus. Simultaneously the blood pressure in the portal sinus, previously as high as in the umbilical vein, falls.

    • This question is part of the following fields:

      • Physiology
      0
      Seconds
  • Question 6 - A 26-year-old woman with irregular menstrual cycle has a positive pregnancy test. She...

    Incorrect

    • A 26-year-old woman with irregular menstrual cycle has a positive pregnancy test. She wants to know the age of her baby.
      Which of the following methods is considered the most accurate for estimating gestational age?

      Your Answer:

      Correct Answer: Transvaginal ultrasound at 8 weeks

      Explanation:

      Ultrasound has emerged as the more accurate method of assessing fetal gestational age, especially in the first trimester. Both transvaginal and transabdominal probe assessments are used to obtain a more accurate measurement of gestational age. Transvaginal is more helpful in first trimester pregnancies.

      A transvaginal ultrasound exam should not be performed in a pregnant patient with vaginal bleeding and known placenta previa, a pregnant patient with premature rupture of membranes, and a patient who refuses exam despite informed discussion.

      Sonographic assessment within the first 13 weeks and 6 days will provide the most accurate estimate of gestational age. Both transvaginal and transabdominal approaches may be used. However, the transvaginal approach may provide a more clear and accurate view of early embryonic structures. Although the gestational sac and yolk sac are the first measurable markers visible on ultrasound, these poorly correlate with gestational age.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 7 - What percentage of pregnant women have asymptomatic vaginal colonisation with candida? ...

    Incorrect

    • What percentage of pregnant women have asymptomatic vaginal colonisation with candida?

      Your Answer:

      Correct Answer: 40%

      Explanation:

      Vulvovaginal candidiasis is the most common genital infections and it is caused by candida albicans in 80-92% of the cases. It colonise the vaginal flora in 20% of non pregnant and 40% pregnant women.

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 8 - A 46 year old lady presents to the gynaecology clinic with a one...

    Incorrect

    • A 46 year old lady presents to the gynaecology clinic with a one month history of vulval soreness and lumps. She smokes several packs of tobacco cigarettes a day. A biopsy confirms vulvar intraepithelial neoplasia. What is her risk of developing squamous cell carcinoma?

      Your Answer:

      Correct Answer: 15%

      Explanation:

      Vulvar Intraepithelial Neoplasia (VIN) is a non-invasive squamous type lesion that carries a 15% chance of developing into squamous cell carcinoma of the vulva. Human Papillomavirus (HPV) infection, or chronic inflammatory conditions such as lichen sclerosis and lichen planus, can cause changes in the basal cells of the vulvar epithelium. Other risk factors of VIN include multiple sexual partners, cigarette smoking, and immunocompromised states. Diagnosis is by clinical examination and a biopsy confirms neoplasia.

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 9 - What is the most common Type II congenital thrombophilia? ...

    Incorrect

    • What is the most common Type II congenital thrombophilia?

      Your Answer:

      Correct Answer: Factor V Leiden mutation

      Explanation:

      The most common congenital thrombophilia is Factor V Leiden mutation. Other congenital causes are JAK-2 mutations and the Prothrombin G20210A mutation. Protein C and S deficiencies are type 1 and antiphospholipid syndrome is not congenital it is an acquired thrombophilia.

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 10 - How many seminiferous tubules would you typically expect to find in a testicular...

    Incorrect

    • How many seminiferous tubules would you typically expect to find in a testicular lobule?

      Your Answer:

      Correct Answer: 2

      Explanation:

      There are between 250 and 400 lobules in each testis. The lobule is a structural unit of the testis with each lobule contained in one of the intervals between fibrous septa which extend between the mediastinum testis and the tunica albuginea. Each lobule contains 1 to 3 seminiferous tubules.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 11 - What percentage of testosterone is bound to SHBG? ...

    Incorrect

    • What percentage of testosterone is bound to SHBG?

      Your Answer:

      Correct Answer: 70%

      Explanation:

      About 97% of the testosterone that is secreted loosely binds to the SHBG and circulates in the blood for several hours in this bound state until it is transported to the target organs.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 12 - Which of the following is a double stranded RNA virus? ...

    Incorrect

    • Which of the following is a double stranded RNA virus?

      Your Answer:

      Correct Answer: Rotavirus

      Explanation:

      RNA viruses are almost always single stranded whilst DNA viruses are almost always double stranded. The exceptions are rotavirus and Parvovirus B19 respectively.

    • This question is part of the following fields:

      • Microbiology
      0
      Seconds
  • Question 13 - A 27 year old women presents with a history of vaginal spotting and...

    Incorrect

    • A 27 year old women presents with a history of vaginal spotting and cramping abdominal pain. She has an 8 week history of amenorrhoea. On examination urine pregnancy test is positive and the cervix is closed. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Threatened Miscarriage

      Explanation:

      Miscarriage is a pregnancy that ends spontaneously before the foetus reaches the age of viability i.e. before 24 weeks of gestation. In a threatened miscarriage the USG findings are of a foetus present in the uterus and on speculum examination the cervical OS is closed, in an inevitable miscarriage the cervical OS is opened. In an incomplete miscarriage the uterus contains the retained products of conception and the cervical OS is open. complete miscarriage contains no retained products of conception and the cervix is closed as the bleeding as resolved.

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 14 - All of the following statements are considered correct regarding Down syndrome screening in...

    Incorrect

    • All of the following statements are considered correct regarding Down syndrome screening in a 40-year-old pregnant woman, except:

      Your Answer:

      Correct Answer: Dating ultrasound along with second trimester serum screening test has detection rate of 97 percent

      Explanation:

      Second-trimester ultrasound markers have low sensitivity and specificity for detecting Down syndrome, especially in a low-risk population.

      The highest detection rate is acquired with ultrasound markers combined with gross anomalies. Although the detection rate with this combination of markers is high in a high-risk population (50 to 75 percent), false-positive rates are also high (22 percent for a 100 percent Down syndrome detection rate).

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 15 - Which one of the following statements regarding the fetal head is true? ...

    Incorrect

    • Which one of the following statements regarding the fetal head is true?

      Your Answer:

      Correct Answer: Considered to be engaged when the biparietal diameter passes the level of the pelvic inlet

      Explanation:

      The fetal head is engaged when the head of the foetus or the presenting part enters the pelvic inlet or pelvic brim. It usually occurs at 38 weeks of gestation.
      The Spalding sign refers to the overlapping of the fetal skull bones caused by collapse of the fetal brain. It appears usually a week or more after fetal death in utero.
      In brow presentation the scalp is deflexed as the foetus is looking upward. Normally the head is inflexed such that the chin is touching the chest.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 16 - A newborn male infant, born to a 30-year-old gravida 3 para 0 aborta...

    Incorrect

    • A newborn male infant, born to a 30-year-old gravida 3 para 0 aborta 2 woman, who did not receive any prenatal care, is evaluated in the neonatal intensive care unit for growth restriction.The mother who presented for labor at approximately 38 weeks of gestation, had a forceps-assisted vaginal delivery due to fetal heart rate abnormalities.
      The newborn's Apgar scores were 6 and 8 at 1 and 5 minutes, respectively and his weight was 2.5 kg. Physical examination shows microcephaly, a wide anterior fontanelle, cleft palate and hypoplasia of the distal phalanges.
      A history of which of the following will be obtained on further evaluation of the mother?

      Your Answer:

      Correct Answer: Phenytoin use

      Explanation:

      This infant will most likely be diagnosed as having fetal hydantoin syndrome, which occurs due to an in utero exposure to antiepileptic drugs like phenytoin, carbamazepine, valproate etc. 

      Multiple antiepileptics, due to their ability to cross placenta, have teratogenic effects which will result in low folate and high oxidative metabolite levels in the fetus. This likely combined effect results deformities like cleft lip and palate, wide anterior fontanelle, distal phalangeal hypoplasia and cardiac anomalies like pulmonary stenosis, aortic stenosis etc in the fetus. There will be developmental delay and poor cognitive outcomes as a result of neural tube defects and microcephaly associated with this. Therefore, prior to conception, those patients who require antiepileptics for seizure control during pregnancy should titrate it to the lowest dose and must started on high-dose (4 mg) folic acid supplementation to minimize the risk of such congenital malformations.

      Fetal alcohol syndrome commonly presents with microcephaly and midfacial hypoplasia, but is not association with cleft lip or palate.

      Cocaine use during pregnancy can be associated with preterm delivery, abruptio placentae and fetal growth restriction; but there is no evidence to prove its association with congenital defects.

      Fetal renal failure with associated oligohydramnios that results in pulmonary hypoplasia, growth restriction, and limb defects are the complications associated with the use of lisinopril and other angiotensin-converting enzyme inhibitors during pregnancy; but it does not cause cleft lip or palate.

      Most infants with congenital syphilis are asymptomatic at birth and those with symptoms typically have rhinitis or “snuffles, hepatomegaly and a maculopapular rash none of which are seen in this patient.

      Fetal hydantoin syndrome results from the in-utero exposure to antiepileptic drugs like phenytoin, carbamazepine etc and is usually presented with microcephaly, a wide anterior fontanelle, cleft lip and palate, and distal phalangeal hypoplasia.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 17 - A 50-year-old woman presents with moderately severe pain in her left groin and...

    Incorrect

    • A 50-year-old woman presents with moderately severe pain in her left groin and thigh. She had recently travelled by airplane from overseas and is at 18 weeks of gestation of her second pregnancy. The only incidence of trauma she can think of is when she hit her left knee on a table yesterday.
      On physical examination, it is found that she has some swelling of her left ankle that is not present on the right side. Her first pregnancy was unremarkable except for development of some symptoms that were believed to be related to pelvic symphyseal separation around 28 weeks of gestation.
      Which one of the following is the mostly cause for this patient's pain?

      Your Answer:

      Correct Answer: deep venous Thrombosis (DVT) in her left leg

      Explanation:

      For this pregnant patient who recently travelled overseas most likely has a deep venous thrombosis (DVT). It would also be expected that the patient would have oedema in the symptomatic leg and account for the swelling described.

      Though they could cause unilateral leg pain, neither symphyseal separation nor sciatica due to a prolapsed intervertebral disc usually occur as early as 18 weeks of gestation. This patient’s symptoms also do not suggest either diagnosis.

      Pain due to trauma would usually be maximal at the site where the trauma took place, which would be in the knee for this patient. Traumatic pain and house cleaning also would not cause the pain described or result in ankle swelling.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 18 - A 32-year-old female at 28 weeks of pregnancy presented with heavy vaginal bleeding....

    Incorrect

    • A 32-year-old female at 28 weeks of pregnancy presented with heavy vaginal bleeding. On examination, she was tachycardic, hypotensive and her uterus was tender. She was resuscitated. Which of following is the most important investigation to arrive at a diagnosis?

      Your Answer:

      Correct Answer: US

      Explanation:

      The presentation is antepartum haemorrhage. Ultrasound should be performed to find the reason for bleeding and assess the fetal well being.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 19 - A 16 year old girl has been referred as she has amenorrhoea. She...

    Incorrect

    • A 16 year old girl has been referred as she has amenorrhoea. She reports never having periods. Her mother and 2 sisters menarche was at age 12. On examination you note the patient is 152cm tall and BMI 29.0 and secondary sexual characteristics are not developed. Her FSH is elevated. Prolactin is normal. What is the suspected diagnosis?

      Your Answer:

      Correct Answer: Turner Syndrome

      Explanation:

      Turner syndrome is the most common chromosomal abnormality in females occurring in 1 in 2500 live births. It is characterised by short stature, webbed neck and wide carrying angle. It is also associated with renal, endocrine and CVS abnormalities. In this condition the ovaries do not completely develop and do not produce oestrogen or oocytes, thus no secondary sexual characteristic develop and neither does the girl starts menstruating.

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 20 - A 24 year old patient in A&E is 34 weeks pregnant and her...

    Incorrect

    • A 24 year old patient in A&E is 34 weeks pregnant and her blood pressure is 147/96. Dipstick shows protein 2+. You send for a protein:creatinine ratio and this shows a ratio of 36 mg/mmol. What is the appropriate course of action?

      Your Answer:

      Correct Answer: Admit for observation

      Explanation:

      The patient could be suffering from pre-eclampsia. A BP of 140/100 with proteinuria should be admitted immediately for observation and if the symptoms do not improve then managed immediately. According to the NICE guidelines BP should be monitored 4 times daily. A BP of 140/90 to 149/99 mmHg is classed as mild hypertension. Without proteinuria this can be monitored once weekly and the patient can be discharged.

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 21 - Which of the following increases in pregnancy? ...

    Incorrect

    • Which of the following increases in pregnancy?

      Your Answer:

      Correct Answer: Th2

      Explanation:

      T-Helper cells type 2 increase during pregnancy. They secret cytokines IL-4,5,9,10 and 13.

    • This question is part of the following fields:

      • Immunology
      0
      Seconds
  • Question 22 - The juxtaglomerular apparatus (JGA) lies within which part of the kidney? ...

    Incorrect

    • The juxtaglomerular apparatus (JGA) lies within which part of the kidney?

      Your Answer:

      Correct Answer: Renal Cortex

      Explanation:

      The juxtaglomerular apparatus is the main site for the production of renin. It plays an important role in the regulation of the blood pressure. These structures are mainly located in the cortex of the kidneys.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 23 - All the following are possible causes of polyhydramnios, EXCEPT: ...

    Incorrect

    • All the following are possible causes of polyhydramnios, EXCEPT:

      Your Answer:

      Correct Answer: IUGR

      Explanation:

      An underlying disease is only found in 17 % of cases in mild polyhydramnios. In contrast, an underlying disease is detected in 91 % of cases in moderate to severe polyhydramnios. The literature lists the following potential aetiologies: fetal malformations and genetic anomalies (8–45 %), maternal diabetes mellitus (5–26 %), multiple pregnancies (8–10 %), fetal anaemia (1–11 %), other causes, e.g. viral infections, Bartter syndrome, neuromuscular disorders, maternal hypercalcemia. Viral infections which can lead to polyhydramnios include parvovirus B19, rubella, and cytomegalovirus. Other infections, e.g. toxoplasmosis and syphilis, can also cause polyhydramnios.

    • This question is part of the following fields:

      • Physiology
      0
      Seconds
  • Question 24 - When does ovulation occur? ...

    Incorrect

    • When does ovulation occur?

      Your Answer:

      Correct Answer: 36 hours after LH surge

      Explanation:

      Ovulation occurs in the mid stage of the menstrual cycle, usually 36 hours after the LH surge. It is this LH surge which is necessary for the ovulation to occur.

    • This question is part of the following fields:

      • Physiology
      0
      Seconds
  • Question 25 - A mother typically becomes aware of fetal movements at what gestation? ...

    Incorrect

    • A mother typically becomes aware of fetal movements at what gestation?

      Your Answer:

      Correct Answer: 18-20 weeks

      Explanation:

      Foetal movements often become apparent at about 18-20 weeks gestation. This phenomenon is also called quickening. The Foetal movements continue to increase in frequency and force until 32 weeks where they plateau. Foetal movements can be used to monitor the wellbeing of the foetus, alerting the mother and healthcare providers to a problem.

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 26 - A 27-year-old primigravida female presents to the emergency department at full term.
    6...

    Incorrect

    • A 27-year-old primigravida female presents to the emergency department at full term.
      6 hours ago, she spontaneously began labour. The membranes ruptured two hours ago and the liquor was stained with meconium.
      On cardiotocography (CTG) was conducted and it showed some intermittent late decelerations, from 140 to 110 beats/min.
      On vaginal examination, her cervix is 5 cm dilated. The foetus is in cephalic presentation, in the left occipitotransverse (LOT) position, with the bony head at the level of the ischial spines (IS).
      Due to the deceleration pattern, a fetal scalp pH estimation was performed and the pH was measured at 7.32.
      An hour later, the CTG showed the following pattern over a period of 30 minutes:
      Baseline 140/min,
      Baseline variability 1/min,
      Accelerations None evident,
      Decelerations: Two decelerations were evident, with the heart rate falling to 80/min, and with each lasting 4 minutes.
      Another vaginal examination is conducted and her cervix is now 8cm dilated, but otherwise unchanged from one hour previously.
      What would be the next best line management?

      Your Answer:

      Correct Answer: Immediate delivery by Caesarean section.

      Explanation:

      The next best line of management is immediate delivery via Caesarean section ( C section).

      This is because of the change in cardiotocography (CTG). The pattern became much more severe with a virtual lack of short-term variability and prolonged decelerations. These changes indicate the necessity for an immediate C section as the cervix is not fully dilated.

      As immediate delivery is indicated, another pH assessment is unnecessary as it would delay delivery and increase the likelihood of fetal hypoxia.

      Delivery by ventose, in a primigravida where the cervix is only 8cm dilated is not indicated as it would allow the labour to proceed or augmenting with Syntocinon.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 27 - During a speculum examination, a lady was found to have a firm, 12mm...

    Incorrect

    • During a speculum examination, a lady was found to have a firm, 12mm ulcerated, indurated lesion on her cervix. She was otherwise asymptomatic. Most likely cause would be?

      Your Answer:

      Correct Answer: Treponema pallidum

      Explanation:

      This lady is most likely suffering from primary syphilis. Since the chancre is asymptomatic, it is often only found on deep examination of the vulvo-vaginal mucosa. The chief organism causing syphilis is Treponema Pallidum which is a spirochete and one of the most widely distributed sexually transmitted infections.

    • This question is part of the following fields:

      • Microbiology
      0
      Seconds
  • Question 28 - Regarding the closure of the ductus arteriosus (DA) after birth which of the...

    Incorrect

    • Regarding the closure of the ductus arteriosus (DA) after birth which of the following most accurately describes the mechanisms leading to closure of the DA?

      Your Answer:

      Correct Answer: Increased arterial pO2, increased bradykinin & decreased Prostaglandin E2

      Explanation:

      Normal closure of the ductus arteriosus (DA) is brought about by a number of mechanisms. Upon delivery the new born babies first breath inflates the lungs and this causes a rise in pO2. Oxygen is known to cause constriction of the DA in vivo and in vitro. In addition the decreased vascular resistance means the pressure within the lumen of the DA drops aiding closure. In addition on inflation of the lungs, the lungs produce bradykinin which stimulates smooth muscle constriction of the ductus. The most important factor is thought to be the drop in Prostaglandin E2. Prostaglandin E2 maintains patency of the Ductus in the unborn child but after birth is metabolised in the lungs and its levels fall rapidly within 3 hours of birth.

    • This question is part of the following fields:

      • Embryology
      0
      Seconds
  • Question 29 - A 27-year-old woman at her 37 weeks of gestation is diagnosed with primary...

    Incorrect

    • A 27-year-old woman at her 37 weeks of gestation is diagnosed with primary genital herpetic lesions at multiple sites in the genital area.
      What is the most appropriate management in this case?

      Your Answer:

      Correct Answer: Prophylactic antiviral before 4 days before delivery

      Explanation:

      This woman at her 37 weeks of gestation, has developed multiple herpetic lesions over her genitals. In every case were the mother develops herpes simplex infection after 28 weeks of pregnancy, chances for intrapartum and vertical transmission of the infection to the neonate is considered to be very high.

      Risk factors of intrapartum herpes simplex infection of the child includes premature labour, premature rupture of membrane, primary herpes simplex infection and multiple lesion in the genital area.

      The most appropriate methods for managing this case includes:
      – checking for herpes simplex infection using PCR testing of a cervical swab.
      – starting prophylactic antiviral therapy for the mother from 38 weeks of gestation until delivery.
      – preferring a cesarean section delivery if there are active lesions present in the cervix and/or vulva.

      Cesarean delivery is advised in this case along with maternal antiviral therapy before delivery to minimise the risk of vertical transmission.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 30 - What is the contraception of choice for epileptics on enzyme inducing antiepileptic drugs?...

    Incorrect

    • What is the contraception of choice for epileptics on enzyme inducing antiepileptic drugs?

      Your Answer:

      Correct Answer: Levonorgestrel-releasing intrauterine contraceptive device

      Explanation:

      Clinical decision making which contraceptive regimen is optimal for an individual woman with epilepsy is one of the most challenging tasks when taking care of women with epilepsy. The bidirectional interactive potential of antiepileptic drugs (AEDs) and hormonal contraceptives needs to be taken into account. Enzyme inducing (EI)-AEDs may reduce the contraceptive efficacy of hormonal contraceptives.

      If combined oral contraceptives (COCs) are used in combination with EI-AEDs, it is recommended to choose a COC containing a high progestin dose, well above the dose needed to inhibit ovulation, and to take the COC pill continuously (“long cycle therapy”). But even with the continuous intake of a COC containing a higher progestin dose contraceptive safety cannot be guaranteed, thus additional contraceptive protection may be recommended.

      Progestin-only pills (POPs) are likely to be ineffective, if used in combination with EI-AEDs.

      Subdermal progestogen implants are not recommended in patients on EI-AEDs, because of published high failure rates.

      Depot medroxyprogesterone-acetate (MPA) injections appear to be effective, however they may not be first choice due to serious side effects (delayed return to fertility, impaired bone health).

      The use of intrauterine devices is an alternative method of contraception in the majority of women, with the advantage of no relevant drug–drug interactions. The levonorgestrel intrauterine system (IUS) appears to be effective, even in women taking EI-AEDs. Likelihood of serious side effects is low in the IUS users.

    • This question is part of the following fields:

      • Gynaecology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Passmed