Gyne II

Question 1

What is the mechanism of action of Plan B?

Answer 1

To delay/prevent ovulation, not to prevent implantation

Question 2

What contraception method should be avoided for those who experience migraines with aura?

Answer 2

Combined hormonal contraceptives (estrogen component)

Question 3

When is Plan B considered to be most effective?

Answer 3

Within 72 hours of unprotected or inadequately protected sex. Provides efficacy up to 5 days (just less)

Question 4

If a patient starts their contraceptive at any day of the week (as soon as they pick it up- quick start), is back up contraception needed?

Answer 4

Yes, for 7 days

Question 5

If a patient starts their contraceptive the first Sunday after their period starts (Sunday start), is back up contraception required?

Answer 5

Yes, for 7 days

Question 6

If a patient starts their contraceptive on the first day of their menstrual period, is back up contraception required?

Answer 6

No

Question 7

A patient presents with low back pain at 20 weeks pregnant, what is the safest pharmacologic option to recommend?

Answer 7

Acetaminophen

Question 8

What amount of ethinyl estradiol in CHC is associated with decreased BMD in adolescents?

Answer 8

Equal or below 20 mcg

Question 9

What antibiotic is cautioned in pregnancy?

Answer 9

Sulfamethoxazole/trimethoprim and fluoroquinolones

Question 10

What antibiotic is contraindicated in pregnancy?

Answer 10

Tetracycline

Question 11

What classes of antibiotics are generally considered safe in pregnancy?

Answer 11

Cephalosporins, penicillins, clindamycin

Question 12

What are some pros to combined oral conctracepties?

Answer 12

Good for acne control, provides cycle control

Question 13

What are contraindications for combined oral contraceptives?

Answer 13

35 and older + smoking 15 or more cigarettes/day, high CVD risk, uncontrolled HTN, current or past VTE, unexplained vaginal bleeding, migraines with aura, liver dysfunction, diabetes with end-organ damage, breast cancer

Question 14

What generation of oral combined contraceptives have the lowest androgenic component?

Answer 14

Fourth generation (Yasmin, Yaz, Nextstellis). Have none

Question 15

How often is the combined contraceptive transdermal patch (ex: EVRA) changed?

Answer 15

Weekly x3 weeks, then one week off

Question 16

How often is the combined contraceptive vaginal ring (NUVARING) changed?

Answer 16

Monthly. Have inserted for 3 weeks, take out for one week, insert new one

Question 17

Do progestin-only contraceptives provide cycle control?

Answer 17

No. Usually result in breakthrough bleeding and often amenorrhea

Question 18

What are the CI for progestin-only contraceptives?

Answer 18

Current breast cancer, unexplained vaginal bleeding, current VTE, liver disease. Caution in uncontrolled HTN and CVD

Question 19

What method of contraception can result in a delay to fertility?

Answer 19

Depot injection (can be delayed for up to 18 months)

Question 20

What are the CI for IUDs?

Answer 20

Pelvic inflammatory disease, STI, ovarian cancer

Question 21

When is medical abortion considered appropriate?

Answer 21

Termination of a pregnancy 10 weeks or less

Question 22

What is the combination of medications for medical abortion? (Mifegymiso)

Answer 22

Misoprostolol + mifepristone

Question 23

What is the administration for medical abortion?

Answer 23

Take 1 tab (200 mg) of mifepristone first and then 24-48 hours after, take 4 tabs buccally (800 mg) of misoprostolol (2 tabs in each cheek)

Question 24

What are the CI for medical abortion?

Answer 24

Ectopic pregnancy, chronic adrenal failure, severe asthma, polrphyria

Question 25

When should a patient undergoing a medical abortion seek follow up care?

Answer 25

If warning signs, or 3 days after and then again 7-14 days after to ensure completion of abortion

Question 26

What patient education should be provided re: symptoms to expect after taking misoprostolol and mifepristone?

Answer 26

Mifepristone: light bleeding, misoprostolol: strong/painful cramps and bleeding with lemon sized clots 3 hours after, n/v/d and dizziness 24 hours after and may experience light bleeding for up to 2 weeks

Question 27

When is it advised patients seek care after (Mifegymiso)?

Answer 27

Soaking 2 maxi pads an hour for more than 2 hours, have fever/nausea/vomiting/weakness <24 hours after taking misoprostolol

Question 28

Based on risk, what is the recommended folic acid dosage for pregnant individuals?

Answer 28

0.4 mg PO daily for most, 1 mg PO daily for moderate risk and 4-5 mg PO daily for high risk

Question 29

For diabetic patients who are pregnant, what is the recommended A1C?

Answer 29

<6.5% if safe, otherwise <7%

Question 30

For diabetic patients, what medications may need to be altered during pregnancy?

Answer 30

Insulin (often need less when postpartum), statin and ACEi/ARB should be discontinued

Question 31

What is the first line antihypertensive agent for pregnant women?

Answer 31

Labetalol 100-400 mg PO BID-TID, nifedipine XL 20-60 mg PO daily-BID or methyldopa 250-500 mg PO BID-QID

Question 32

What is key to remember about hyperthyroid medications during pregnancy?

Answer 32

PTU safe for first trimester, then need to switch to MMU for 2nd/3rd

Question 33

When is a medication most likely to result in structual damage during fetal development?

Answer 33

During the embryonic period (18-60 days after conception)

Question 34

What are known tetarogenic agents?

Answer 34

ACEi/ARBs, carbamazepine, systemic corticosteroids, ethanol, coumarin anticoagulants, folic acid antagnosts, hydantoins, lithium, retinoids, tetracyclines, thalidomide, valproic acid, topiramate

Question 35

What are possible tetarogenic agents/caution should be used?

Answer 35

Statins, benzos, fluconazole, methimazole, sulfamethoxazole/trimothoprim

Question 36

What is recommended for calorie intake while pregnant?

Answer 36

Increase calories slightly, increase by 340 calories/day during second trimester and by 450 calories/day for the 3rd trimester

Question 37

What is the preferred analgesic to use during pregnancy?

Answer 37

Acetaminophen, avoid NSAIDs (especially after 20 weeks)

Question 38

Which of the following levels of ethinyl estradiol in combined hormonal contraceptives is associated with decreased bone mineral density in adolescents?

Answer 38

Equal to or below 20 mcg