Sexual and Reproductive Health EMQ

Option List:
A. Double dose of LNG
B. Single dose of LNG
C. Copper T
D. Condoms
E. LNG-IUS
F. DMPA
G. High dose combined contraceptive pill
H. Low dose combined contraceptive pill
I. Ulipristal Acetate
J. Sterilisation
K. Vasectomy
L. Implant
M. Do a pregnancy test
Choose the most appropriate method of emergency contraception for these following scenarios. Choose option once or more than once or not at all.

1. Ms X, an 18-year-old presents to you requesting emergency contraception. She has taken ulipristal acetate for emergency contraception 5 days before. Again she had multiple unprotected sexual intercourses last 4 days .H er last menstrual period was 12days back. She gets periods every 28 days .she is currently on antibiotics for a recent episode of PID.

2. Mrs A. 20 year old she has taken LNG for emergency contraception 5 days before, yesterday night condom broke during sex. She has a regular cycle of 28days her last menstrual period was 13days back. Otherwise, she is generally healthy
3. Ms Sweetie 21 year old got raped by a stranger 4day back, and she has undergone forensic examination which confirms the same. After counselling She has been given Postexposure prophylaxis for HIV (tenofovir, emtricitabine and raltegravir ) and Hepatitis B vaccination. She is asking for emergency contraception. But she doesn’t want copperT as she still recovering from trauma .otherwise she is generally fit and fine.
4. Ms Angelina 17-year-old in her 2nd week of her cycle. She has taken ulipristal acetate for emergency contraception 4 days back for UPSI .her cycles are regular -30 days cycle and last period was 15days back.

Option List:
A. Low vagina
B. Vulval swab
C. High vagina
D. Endocervical canal with gentle rotation
E. 1cm inside Endocervical canal with gentle rotation
F. Vigorous rotation inside Endocervical canal.
G. Both options D & E
H. Both options E & F
Choose the most appropriate site for vaginal swab to detect different vaginal infections. choose option once or more than once or not at all

5.Mrs. Katie, 36 year old in her second pregnancy. Now she is 35 weeks pregnant, In her first pregnancy, GBs carriage was identified and treated. Her first delivery was uneventful. She delivered a baby boy at 39 weeks. She is here for Bacteriological screening

6. Ms. Tina, 22 year old presents with lower abdominal pain, Dyspareunia and vaginal discharge .on examination - straw berry cervix noted. She agrees to take swab
7. Ms. Lui, 18 year old presents with Dyspareunia, vaginal discharge. She has 5 sexual partners in last 6months. On examination - uterus is normal size with bilateral forniceal tenderness notes.she agrees to take swab.

Option List:
A. Levonorgestrel two tablets stat
B. Reassurance
C. Levonorgestrel one tablet followed by a second tablet 12 hours later
D. Copper intrauterine contraceptive device
E. Contact tracing
F. Levonorgestrel-releasing intrauterine system
G. Resume pills
H. Copper IUCD and a pregnancy test in 2 weeks’ time
I. Levonorgestrel 1.5mg and a pregnancy test if there has been no period in 2 weeks’ time
J. Azithromycin 1 g stat
K. Yuzpe method
L. Levonorgestrel 1.5mg stat, offer a full sexually transmitted infection screen and a pregnancy test if there has been no period in 2 weeks’ time
M. Triple swabs
N. Pregnancy test
O. Intravenous antibiotics
For each description below, choose the single most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.

Q8. A 21-year-old girl attends the family planning clinic 6 hours after unprotected sexual intercourse with a stranger. Her periods are regular and the first day of her last menstrual period was 3 weeks ago. Her current contraceptive method is male condoms. She also recalls another episode of condom split 10 days ago. Her pregnancy test is negative. What is the most appropriate advice?

9. A 27-year-old lady attends the family planning clinic 4 days after unprotected sexual intercourse. Her menstrual cycles are very regular (3–4/28). Her last menstrual period was 2 weeks ago. What is the most appropriate option?
10. A 37-year-old woman attends the clinic 6 hours after unprotected sexual intercourse with her husband. She had STI screening and was found negative in that. She suffers from idiopathic thrombocytopenic purpura and is on long- term steroids. Her periods are regular but heavy, and the first day of her last menstrual period was 2 weeks ago. What is the most appropriate option?
Option List:
A. Bacterial vaginosis
B. Trichomonas vaginalis
C. Chlamydia
D. Gonococci
E. Herpes simplex virus
F. Human papilloma virus
G. Actinomycosis
H. Group B streptococcus
I. Staphylococcus Aureus

11. 24-year-old on COC presented with intermenstrual bleeding for the past 4 months. She has been repeatedly treated for UTI symptoms. All her urine culture testing was all negative. What is the most likely organism?

12. 26-year-old women was referred by the GP with complaints of post-coital bleeding and having a low-grade cervical smear abnormality. While taking a smear, there was a contact bleeding. The most likely organism is?
13. 32-year-old woman presented with symptoms of fever, excessive white discharge and severe abdominal pain. She had undergone termination of pregnancy for a missed miscarriage at 10 weeks of pregnancy during which, antibiotics were not given. Upon reviewing the notes, cervical smear done 6 weeks back showed “Clue Cells”.
14. 19-year-old referred by the GP with complaints of fever with acute retention of urine and non-specific lower abdominal pain and lymphadenopathy in the groin. The most likely organism is?
15. 36-year-old brought to emergency department with symptoms of fever, erythematous rash and altered sensorium and hypotension. Her partner says she was fit and fine. On examination found to have tampons in the vagina. What is the most likely organism?
16. 31-year-old women using CU- IUD, is being treated for PID, but is not responding to usual antibiotics. Three months back, cervical smear done had revealed presence of organism but the woman was asymptomatic and hence was not treated. The most likely organism is?
Option List:
A. Coxsackiae virus
B. Herpes simplex virus
C. Human papillomavirus
D. Syphilis
E. Varicella zoster virus
F. Chlamydia trachomatis
G. Haemophylus Ducrue 
H. Human papillomavirus
I. Treponema pallidum
J. Actinomyces Israeli 
K. Gardenella Vaginalis
Each of the following options describes various Pathological organisms causing various symptoms in woman presenting to sexual health clinic.
For each patient select the single most appropriate diagnosis from the list above. Each option may be used once, more than once or not at all

17. Ms. Sweetie,A 19-year-old attends A&E with acute urinary retention. She also describes myalgia, feeling feverish and headache, as well as pain when she urinates. When the nurse catheterises her she notices widespread labial blisters.

18. Ms. Tina, A 21-year-old female attends clinic with a 3-day history of a single, painless, genital ulcer. She has just returned from backpacking around South East Asia, where she had two sexual partners, both UK-born males.
What is the most likely causative organism?
19. Ms. Ruby , 30 year old lady presenting with excessive vaginal discharge white in colour  with fishy  odour Clue cells on microscopy of wet mount .pH of vaginal fluid 4.8.
20. Ms. Laura, 22 year old, presenting with fever and malaise .on local examination she has a sore which is painless, firm and round present in labia Majora.
21. Ms. Seena,  22 year old  has presented with dysparuenia, white discharge and fever. She also complains of  severe right upper quadrant pain. On examination she has mild jaundice, you are suspecting perihepatitis
22. A newborn baby develops sticky eyes 5 days after a vaginal delivery. His mother did not have any vaginal discharge although she had experienced dysuria and frequency a few months before pregnancy. She was having regular sexual intercourse during pregnancy with her partner of 2 years’ duration. On examination, both the baby’s eyes are sticky and have a yellowish discharge. The conjunctiva is inflamed.