EBCOG Part 1 2 Weeks Crash Course Oncology,FSRH,BAASH Day 2

1.A 26-year-old woman sought contraceptive advice, and after considering all her options, she decided to start on the combined oral contraceptive pill. As you have to advise her on the best method of using these pills, you are giving her some directions.Which of the following statements is incorrect in this regard?

A. If you start the pill on the first day of your period, you will be protected from pregnancy immediately
B. If you start the pill at any other time in your menstrual cycle, you will need to use additional contraception, such as condoms, for the first 7 days of pills taking
C. If you miss one pill anywhere in your pack or start the new pack 1 day late, you will need to use additional contraception, such as condoms, for the first 7 days of pill taking.
D. You can also start the pill up to, and including, the fifth day of your period and you will be protected from pregnancy immediately.
E. You can start the pill any time in your menstrual cycle if you are sure you are not pregnant

2.Which one of the following drugs, if given in combination with the combined oral contraceptive (COC), will reduce the contraceptive efficacy of COC?

A. Ampicillin
B. Doxycycline
C. Erythromycin
D. Rifampicin
E. Sodium valproate

3. Which one of the following is characteristically associated with the use of combined oral contraceptive pill?

A. Contraceptive failure is more likely if miss 2 pills mid-packet than beginning or end of a packet’.
B. Contraindicated if previous personal history of hydatidiform mole
C. Decreases the risk of ovarian and endometrial cancer.
D. Reduces the risk of breast and cervical cancer.
E. Routine thrombophilia testing is required prior to commencing COC because of it increasing the risk of thromboembolism

4. You have to counsel a 28-year-old woman for an appropriate method of contraception. She had a complete molar pregnancy which was evacuated last week.What is the correct advice you can give her?

A. Barrier contraceptives have a low failure rate
B. Barrier methods provide the added advantage of preventing sexually transmitted infections
C. Combined oral contraceptive pills are absolutely contraindicated for her
D. Combined oral contraceptive pills can be started if hCG levels show a decreasing trend
E. Intrauterine devices can be used even if hCG levels are high.

5. Which of the following is true regarding Qlaira?

A. Qlaira contains estradiol valerate and Desogestrel
B. Qlaira has continuous 28 days' cycle with 26 active pills with decreasing oestrogen and increasing progesterone dose followed by 2 placebos
C. There are clinically significant benefits over the pills containing synthetic oestrogen
D. This is a triphasic pill
E. While taking Qlaira if the pills are missed, the same pills rules apply as other combined oral contraceptive pills

6. A woman switches from a COC pill containing ethinyloestradiol and levonorgestrel to a different pill containing ethinyloestradiol and desogestrel. The dose of ethinyloestradiol is the same in both preparations.Approximately, by how many times will she have increased her risk of VTE?

A. 2
B. 5
C. 10
D. 15
E. 20

7. A 36-year-old woman consults you about her contraception. She is seeking a method with the lowest risk of thrombosis. She has a family history of venous thromboembo- lism (VTE) in a first-degree relative aged under 45 years. She is not keen on any intrauterine devices.How will you counsel her?

A. All methods have a risk of VTE.
B. If she herself has no personal history of any clotting, then all methods have the same risk.
C. If she has a family history of VTE, she should have a thrombophilia screen first.
D. It is safe to use any progestogen-only method.
E. Permanent long-acting contraception is her only option.

Q8. A 28-year-old patient is referred from the A&E department with lower abdominal pain and vaginal discharge. On examination she has a temperature of 37.3°C, a pulse of 86 bpm and a BP of 120/83 mm Hg. Her abdomen is slightly tender in the LIF region. On vaginal examination there is a mild corresponding adnexal tenderness, the IUCD threads are seen and a swab of mucopurulent discharge is taken. She mentions that she has a new sexual partner and has not used barrier contraception.What is the most appropriate next step in her management?

A. Intravenous PID-targeted antibiotics + IUCD removal immediately.
B. Oral PID-targeted antibiotics + IUCD removal immediately.
C. Oral PID-targeted antibiotics and, if no improvement in symptoms, remove IUCD in 24 hours.
D. Oral PID-targeted antibiotics and, if no improvement in symptoms, remove IUCD in 48 hours.
E. Oral PID-targeted antibiotics and, if no improvement in symptoms, remove IUCD in 72 hours.

Q9. Ms. XY is 35 years old with a Mirena IUD in situ. She presents to the colposcopy clinic with her latest smear showing Actinomyces-like organisms (ALO). She complains of pelvic pain, deep dyspareunia and vaginal discharge for a week. She is not sexually active presently.Which of the following treatment options are best suited to her?

A. PID outpatient antibiotics (ceftriaxone IM followed by doxycycline and metronidazole).
B. Remove Mirena and send for culture + PID outpatient antibiotics.
C. Remove Mirena and send for culture + amoxicillin PO.
D. Triple swabs (STI) and treat after culture results.
E. Triple swabs(STI)+PID outpatient antibiotics.

Q10. Mrs XY is a 35-year-old woman who is a known case of congenital heart disease with a single ventricular physiology and on regular follow-up with the cardiologist. She is stable in regard to her cardiac condition and wants an intrauterine contraceptive device (IUCD) inserted. Her cardiologist has given his consent for the same after reviewing her case. Which of the following is appropriate regarding the arrangements for the IUCD insertion in this case?

A. Her own GP can do it in his clinic.
B. It does not matter where the IUCD is inserted as long as someone experienced does it.
C. It should be done in the hospital setting with involvement of the cardiologist.
D. The main concern here is to prevent any infection.
E. Women with cardiac disease should not be encourage to use the IUCD.

Q11. What is the primary mode of action of the progestogen-only injectable method of contraception (Depo Provera)?

A. Endometrial atrophy
B. Inhibition of ovulation
C. Prevention of fertilisation
D. Prevention of implantation
E. Thickening of cervical mucus

Q12. Which form of progestogen-only contraception is most strongly associated with loss of bone mineral density?

A. Depo medroxyprogesterone acetate
B. Depo norethisterone enantate
C. Etonorgestrel-containing subdermal implant
D. Levonorgestrel-containing intrauterine system
E. Progestogen-only pill

Q13. Which form of long-acting reversible contraception is least suitable for use in adolescents?

A. COC pill
B. Copper intrauterine device
C. Depo medroxyprogesterone acetate
D. Etonorgestrel-containing subdermal implant
E. Levonorgestrel-containing intrauterine system

Q14. The general practitioner calls you to ask about one of his patients who is on progesterone-only implant contraception. She will be started on an enzyme-inducing drug. He says this new medication is expected to be taken long term.What will you tell him?

A. Continue with her current progesterone-only contraceptive but double the dose.
B. She should change to another long-term reversible contraceptive.
C. She can use the new progestogen desogestrel because it may be more effective.
D. She can request tubal ligation.
E. She can start on combined oral contraception.

Q15.Which of the following statements is appropriate for contraceptive advice to women with infl ammatory bowel disease?

A. Condoms are the preferred method in women who are on medication for IBD as its efficacy cannot be affected by them
B. Laparoscopic sterilization is an appropriate method of contraception for women with IBD who have had previous pelvic or abdominal surgery
C. Women can be informed that there is a causal association between combined oral contraception (COC) use and onset or exacerbation of IBD so it is best avoided
D. Women should be advised that the efficacy of oral contraception is unlikely to be reduced by large bowel disease but may be reduced in women with Crohn’s disease who have small bowel disease and malabsorption
E. Women suffers IBD should not use combined hormonal contraception

16.You see a 35-year-old para 3 in your outpatient hysteroscopy clinic. She wants to be sterilized and undergoes hysteroscopic sterilization using the Essure device. What post procedure advice will you offer her?

A. Backup contraceptive cover for 3 months.
B. Backup contraceptive cover for 1 month.
C. Backup contraceptive cover is unnecessary.
D. Tubal occlusion should be confirmed in 6 weeks.
E. Tubal occlusion confirmatory test is unnecessary.

17. Ms. XY is 35 years old. She is a Para 3 with two previous caesarean sections and desires permanent contraception. She has opted to have a laparoscopic tubal occlusion / sterilisation procedure. Her BMI is 33. She has had two failed attempts at Veress needle insertion through the umbilical route. Which of the following treatment options are best suited to her?

A. Abandon the procedure.
B. Direct trocar insertion.
C. Hysteroscopic Essure sterilisation (also permanent).
D. Palmer’s point entry.
E. Third attempt by a different operator.

Q18. Vasectomy failure rate is quoted as approximately 1 in 2000 (0.05%) after clearance has been given. By how many months post procedure should the vasectomy be considered a failure if motile sperm are still observed in a fresh semen sample?

A. 3 months
B. 4 months
C. 5 months
D. 6 months
E. 7 months

Q19. Your consultant has successfully carried out a hysteroscopic tubal occlusion (Essure ESS305 microinsert. © Bayer). You are asked to review the patient before discharge. What is the most important advice to give the patient prior to discharge?

A. She should come for a review after her next period.
B. She should seek medical advice if she misses her next period.
C. She should come for an X-ray after her next period to confirm proper placement of the occlusion device.
D. She should avoid intercourse until she has her next period.
E. She should use a reliable method of contraception for three months and until proper placement of the device is confirmed.

Q20. All are true regarding abortion care except

A. Healthcare professionals should not allow their personal beliefs to delay access to abortion
B. Health professionals can allow their personal beliefs to delay access to abortion
C. Commissioners should consider upfront funding for travel and accommodation if required
D. ensure all trainees have the training, unless they opt out due to a conscientious objection
E.who need pharmacological thromboprophylaxis, consider low-molecular-weight heparin for at least 7 days after the abortion.

Q21. 28 year old with 7 weeks of pregnancy options medical termination because of social reasons. she is wanting to know her future risks ,all are true except

A. increased risk of infertility,
B. No effect on breast cancer
C. Variable Range of emotions
D. No increased risk on mental health issues

Q22. Regarding antibiotic prophylaxis all are true except?

A. Offer Tab. Doxycycline 100mg Twice a day for three days after all medical TOP
B. Its is given After surgical abortion
C. Not to be given for low risk woman after medical abortion
D. Tab. Doxycycline to prevent infection after surgical TOP

Q23 . 22year old woman primiparous at 14 weeks requesting for medical termination of pregnancy. Her blood group is A Positive ,she has undergone counselling as well and she is sure of her decision. The recommended regimen all are true except

A. Tab. Mifepristone 200mg start
B. Misoprostol 800mcg vaginally after 24-48 hours after mifepristone
C. Misoprostol 800 mcg per rectally
D. Repeat 400mcg every 3hrs till expulsion

EBCOG Part 1 2 Weeks Crash Course Oncology,FSRH,BAASH Day 2

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