Gynecology Trivia Quiz: What Do You Know About Contraception?
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Questions and Answers
- 1.
Which of the following is the most direct public health or socioeconomic effect of contraceptive use?
- A.
Improved socioeconomic status
- B.
Stabilized world population growth
- C.
Reduced maternal morbidity
- D.
Diminished incidence of fetal abnormalities
- E.
Decreased prevalence of sexually transmitted diseases (STDs)
Correct Answer
A. Improved socioeconomic statusExplanation
Contraceptive use can lead to an improved socioeconomic status. When individuals have access to and use contraceptives, they have greater control over their reproductive choices. This allows them to plan their families and have children when they are financially stable and ready. With fewer unintended pregnancies, individuals can invest more in their education, careers, and overall economic well-being. This can lead to increased income, improved living conditions, and better opportunities for themselves and their families, ultimately resulting in an improved socioeconomic status.Rate this question:
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- 2.
A premedical student presents requesting reversible contraception. She is healthy without any problems and a normal examination. As you review her options, she asks which method is most reliable. Which of the following contraceptive methods has the lowest pregnancy rate in 100 women using the method perfectly for 1 year (100 woman-years of use)?
- A.
Copper-containing intrauterine contraceptive device (IUCD)
- B.
Long-acting progestins (Depo-Provera)
- C.
Diaphragm
- D.
Oral contraceptives (OCs)
- E.
Spermicidal cream
Correct Answer
B. Long-acting progestins (Depo-Provera)Explanation
Long-acting progestins (Depo-Provera) have the lowest pregnancy rate in 100 women using the method perfectly for 1 year. This is because Depo-Provera is a highly effective contraceptive method that involves receiving an injection of progestin every three months. It is more reliable than other options such as the copper-containing intrauterine contraceptive device (IUCD), diaphragm, oral contraceptives (OCs), and spermicidal cream, which have higher failure rates due to factors like user error or lower efficacy. Therefore, Depo-Provera is the most reliable contraceptive method in terms of preventing pregnancy.Rate this question:
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- 3.
A 23-year-old woman and her husband wish to use natural family planning as their contraceptive method. Her menstrual cycle length is variable, ranging from 26 to 32 days. She does not plan to measure her basal body temperature (BBT). The time of her fertility, with the first day of menses defined as day 1, would be between which cycle days?
- A.
1 and 14
- B.
6 and 14
- C.
6 and 21
- D.
14 and 21
- E.
14 and 28
Correct Answer
B. 6 and 14Explanation
Given her variable menstrual cycle length ranging from 26 to 32 days and without measuring basal body temperature (BBT) or using other tracking methods, it's challenging to pinpoint the exact fertile window accurately. However, you can make a rough estimate based on typical fertile windows.
In a typical menstrual cycle, the fertile window often falls approximately between Day 10 and Day 17, with Day 1 being the first day of menstruation. Given her variable cycle lengths:
The earliest estimate for her fertility window would be between Day 6 and Day 14 (assuming a 26-day cycle).Rate this question:
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- 4.
A 23-year-old woman and her husband wish to use natural family planning as their contraceptive method. Her menstrual cycle length is variable, ranging from 26 to 32 days. She does not plan to measure her basal body temperature (BBT). You mention that by adding BBT curve, they may be able to determine more effectively when ovulation has occurred. Figure 17–1 on the following page shows the basal temperature graph made by the couple the previous month. Which letter most closely identifies when ovulation may have occurred?
- A.
Point A
- B.
Point B
- C.
Point C
- D.
Point D
- E.
Point E
Correct Answer
C. Point CExplanation
Adding the BBT curve can help determine when ovulation has occurred because there is a slight increase in basal body temperature after ovulation due to the release of progesterone. In Figure 17-1, point C shows a clear and significant increase in temperature compared to the previous days, indicating that ovulation may have occurred around that time.Rate this question:
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- 5.
One of the initial attempts at contraception involved placement of various items in the vagina to prevent sperm from reaching the uterus. Historically, these have included crocodile dung, honey, and preparations with mercury with varying success and complication. Currently available spermicides destroy spermatozoa primarily by which of the following methods?
- A.
Activating acrosomal enzymes
- B.
Disrupting cell membranes
- C.
Inhibiting glucose transport
- D.
altering vaginal enzymes
- E.
Increasing vaginal pH
Correct Answer
B. Disrupting cell membranesExplanation
Currently available spermicides destroy spermatozoa primarily by disrupting cell membranes. This means that they cause damage to the outer layer of the sperm cells, making them unable to function properly and preventing them from reaching the uterus. This method of action is effective in reducing the chances of pregnancy.Rate this question:
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- 6.
A 19-year-old woman and her boyfriend wish to use condoms as a barrier contraceptive method. This couple should be advised that the most common reason for failure (pregnancy or STD transmission) is which of the following?
- A.
Breakage
- B.
Inconsistent use
- C.
Leakage caused by spermicidal creams
- D.
Use without concomitant use of a spermicide
- E.
Spill of condom contents upon withdrawal
Correct Answer
B. Inconsistent useExplanation
The most common reason for failure of condoms as a barrier contraceptive method is inconsistent use. This means that the couple does not consistently and correctly use condoms during every sexual encounter. Inconsistent use can increase the risk of pregnancy or transmission of sexually transmitted diseases (STDs) because it leaves room for unprotected sexual contact. It is important for the couple to understand the importance of using condoms consistently and correctly to ensure their effectiveness as a contraceptive method.Rate this question:
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- 7.
An 18-year-old woman presents for care because a condom broke during sexual intercourse. Coitus occurred 1 day ago when she was at midcycle. She does not wish to be pregnant and will terminate the pregnancy if menses does not occur. Regarding her fear of pregnancy, which is the most appropriate next step in her management?
- A.
Advise her that unprotected midcycle coitus has a 5% risk of pregnancy
- B.
Prescribe intravaginal misoprostol (Cytotec)
- C.
Advise immediate douching
- D.
Prescribe a brief course of levonorgestrel
- E.
Advise her to await her next menses before taking any action
Correct Answer
D. Prescribe a brief course of levonorgestrelExplanation
Prescribing a brief course of levonorgestrel is the most appropriate next step in managing the fear of pregnancy in this case. Levonorgestrel is a progestin-only emergency contraceptive that can be taken within 72 hours of unprotected intercourse to prevent pregnancy. It is highly effective in reducing the risk of pregnancy when taken as directed. Advising the patient to await her next menses before taking any action may result in a missed opportunity for preventing an unwanted pregnancy. The other options, such as advising her about the risk of pregnancy or prescribing intravaginal misoprostol or immediate douching, are not supported by evidence and may not be effective in preventing pregnancy.Rate this question:
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- 8.
A 42-year-old patient (G3P3003) requests a diaphragm for contraception. When fitting the contraceptive diaphragm, it should sit comfortably between which of the following?
- A.
Anterior and posterior vaginal fornices
- B.
Anterior vaginal fornix and posterior urethrovesical angle
- C.
Pubic symphysis and anterior vaginal fornix
- D.
Pubic symphysis and posterior vaginal fornix
- E.
Pubic symphysis and posterior urethrovesical angle
Correct Answer
D. Pubic symphysis and posterior vaginal fornixExplanation
When fitting a contraceptive diaphragm, it should sit comfortably between the pubic symphysis (the front part of the pelvis) and the posterior vaginal fornix (the deepest part of the vagina towards the back). This ensures proper placement and effectiveness of the diaphragm as a contraceptive method. The other options mentioned in the question are incorrect as they do not describe the correct placement for the diaphragm.Rate this question:
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- 9.
A 23-year-old patient is considering contraceptive methods but is devoutly religious and will not accept a method that may “cause an abortion.” What is the primary mechanism by which IUCDs prevent pregnancy?
- A.
Creating chronic endometritis
- B.
Preventing fertilization
- C.
Inhibiting ovulation
- D.
Altering tubal motility
- E.
Destroying sperm
Correct Answer
B. Preventing fertilizationExplanation
IUCDs (Intrauterine Contraceptive Devices) primarily prevent pregnancy by preventing fertilization. These devices work by creating an environment in the uterus that is hostile to sperm, making it difficult for them to reach and fertilize an egg. They do not cause abortions as they do not interfere with a fertilized egg. Instead, they act as a barrier method, preventing sperm from reaching the egg in the first place.Rate this question:
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- 10.
A 35-year-old woman wearing an IUCD complains of amenorrhea of 5 weeks’ duration. A serum pregnancy test is positive. Because of the presence of the IUCD, this patient is at a significantly increased likelihood of experiencing which of the following?
- A.
Ectopic pregnancy
- B.
Fetal malformations
- C.
Spontaneous abortion
- D.
Septic abortion
- E.
Placental abruption
Correct Answer
C. Spontaneous abortionExplanation
The presence of an intrauterine contraceptive device (IUCD) increases the risk of spontaneous abortion in this patient. This is because the IUCD can cause irritation or inflammation in the uterus, which can interfere with the implantation and development of the embryo. Additionally, the IUCD may disrupt the normal hormonal environment in the uterus, further increasing the risk of spontaneous abortion.Rate this question:
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- 11.
A patient presents requesting hormonal contraception. She has been researching her options on the Web and has become confused by the large variety of OC pills available, including monophasic, multiphasic, and progesterone only. She asks how the pill prevents pregnancy and why the variety of preparations. Which of the following is the primary mechanism by which OCs prevent pregnancy?
- A.
Inhibiting serum follicle-stimulating hormone (FSH) levels
- B.
inhibiting serum luteinizing hormone (LH) levels
- C.
inducing endometrial atrophy
- D.
Inducing lymphocytic endometritis
Correct Answer
A. Inhibiting serum follicle-stimulating hormone (FSH) levelsExplanation
The primary mechanism by which oral contraceptive pills (OCs) prevent pregnancy is by inhibiting serum follicle-stimulating hormone (FSH) levels. FSH is responsible for stimulating the growth and development of ovarian follicles. By suppressing FSH levels, OCs prevent the maturation of ovarian follicles, thereby preventing ovulation and the release of an egg for fertilization. This is the main way OCs prevent pregnancy. The other options mentioned in the question, such as inhibiting serum luteinizing hormone (LH) levels, inducing endometrial atrophy, and inducing lymphocytic endometritis, are not the primary mechanisms of action for OCs.Rate this question:
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- 12.
Over the years the estrogen component of the oral contraceptive pill has been dramatically decreased. This has, in turn, minimized certain side effects. Reducing the estrogen content of OCs has resulted in an increase in the rate of which of the following?
- A.
Pregnancy
- B.
Breakthrough bleeding (BTB)
- C.
Thromboembolic complications
- D.
Insulin resistance
- E.
Premenstrual symptoms
Correct Answer
B. Breakthrough bleeding (BTB)Explanation
The decrease in the estrogen component of the oral contraceptive pill has led to an increase in breakthrough bleeding (BTB). This is because estrogen helps to stabilize the lining of the uterus, and a decrease in estrogen can lead to shedding of the uterine lining and breakthrough bleeding. Therefore, reducing the estrogen content of oral contraceptives can result in an increased occurrence of breakthrough bleeding.Rate this question:
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- 13.
A 37-year-old obese woman wishes to use OCs for birth control. Her medical history is remarkable only for a 3-year history of diabetes that is controlled with diet and an oral agent. She smokes one pack of cigarettes daily. Her blood pressure is 140/90. Physical and pelvic examinations are normal. Total serum cholesterol is 275 mg/dL (normal <200 mg/dL). You advise her that combined OCs are primarily contraindi-cated because of which of the following known factors about her?
- A.
Age
- B.
Cholesterol
- C.
Hypertension
- D.
Smoking
- E.
Diabetes
Correct Answer
D. SmokingExplanation
Smoking is the primary contraindication for the use of combined oral contraceptives (OCs) in this case. Smoking increases the risk of cardiovascular complications, including blood clots, heart attacks, and strokes. The patient's blood pressure is also slightly elevated, which further increases the risk. The patient's age, cholesterol levels, hypertension, and diabetes are not the primary factors that contraindicate the use of OCs in this case.Rate this question:
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- 14.
A college student has been “surfing the Web” as she is considering initiating OCP for contraception and cycle control. However, after reading a number of blogs and Web postings, she is frightened that the pill is more dangerous than a pregnancy. You reassure her that the pill has many benefits but can rarely increase the risk of which of the following conditions?
- A.
Fibrocystic breast disease
- B.
Hepatic adenoma
- C.
Salpingitis
- D.
Ovarian cancer
- E.
Endometrial cancer
Correct Answer
B. Hepatic adenomaExplanation
The correct answer is hepatic adenoma. While the pill has many benefits, it can rarely increase the risk of developing hepatic adenoma.Rate this question:
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- 15.
An 18-year-old woman requests OCs for birth control. She is healthy but occasionally experiences severe migraine headaches. Her menses occur at monthly intervals. Her grandmother has recently been treated for breast cancer. Her brother has juvenile-onset diabetes mel-litus. Her physical and pelvic examinations are normal. A serum total cholesterol level is 195 mg/dL (normal, <200 mg/dL). You advise her that based on her history, OC use will increase her risk of which of the following?
- A.
Breast cancer
- B.
Migraine headache
- C.
Diabetes mellitus
- D.
Stroke
- E.
“postpill” amenorrhea
Correct Answer
B. Migraine headacheExplanation
Based on the given information, the woman occasionally experiences severe migraine headaches. It is known that oral contraceptive (OC) use can increase the frequency and severity of migraines in some individuals. Therefore, advising her that OC use will increase her risk of migraine headache is the correct answer.Rate this question:
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- 16.
A 36-year-old obese woman comes to your clinic for an annual examination. She has no complaints and is sexually active with multiple partners. She uses OCs for birth control. There is a strong family history of heart disease. Based on risk factors present in this patient, which of the following is indicated?
- A.
prophylactic antibiotic treatment for possible infection by Chlamydia trachomatis
- B.
Fasting serum cholesterol
- C.
3-hour glucose tolerance test
- D.
Electrocardiogram (ECG)
- E.
Screening colposcopy
Correct Answer
B. Fasting serum cholesterolExplanation
Based on the risk factors present in this patient, such as obesity, a strong family history of heart disease, and being sexually active with multiple partners, the indicated test would be a fasting serum cholesterol. This is because these risk factors increase the likelihood of developing cardiovascular disease, and measuring the fasting serum cholesterol can help assess the patient's risk for developing heart disease.Rate this question:
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- 17.
Compared to users of combination OCs, users of progestin-only OCs (minipills) are less likely to experience which of the following?
- A.
intrauterine pregnancy
- B.
Irregular vaginal bleeding
- C.
Gonadotropin suppression
- D.
Ectopic pregnancies
- E.
Mood swings
Correct Answer
C. Gonadotropin suppressionExplanation
Progestin-only OCs (minipills) are less likely to cause gonadotropin suppression compared to combination OCs. Gonadotropins are hormones that stimulate the ovaries to produce eggs and regulate the menstrual cycle. Combination OCs contain both estrogen and progestin, which can suppress the release of gonadotropins and inhibit ovulation. However, progestin-only OCs primarily work by thickening the cervical mucus and thinning the lining of the uterus, making it less likely for fertilization and implantation to occur. Therefore, users of progestin-only OCs are less likely to experience gonadotropin suppression.Rate this question:
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- 18.
A 36-year-old multiparous woman and her husband request information regarding permanent sterilization. When you advise them about vasectomy in comparison to female sterilization, which of the following is more accurate regarding vasectomy?
- A.
Has a lower failure (pregnancy) rate
- B.
Requires a longer stay in the hospital
- C.
Is effective sooner
- D.
Carries a higher mortality rate
- E.
Is less reversible
Correct Answer
A. Has a lower failure (pregnancy) rateExplanation
Vasectomy has a lower failure (pregnancy) rate compared to female sterilization. This means that the chances of a woman getting pregnant after her partner undergoes a vasectomy are lower than the chances of a woman getting pregnant after undergoing female sterilization.Rate this question:
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- 19.
The administration of RU-486 (mifepristone) results in which of the following?
- A.
Abortion when given in early pregnancy
- B.
Delayed menses when given during the mid-luteal phase
- C.
Menses when given during the follicular phase
- D.
Resistance to prostaglandin inhibitors
- E.
Induction of progesterone receptors in the endometrium
Correct Answer
A. Abortion when given in early pregnancyExplanation
The administration of RU-486 (mifepristone) results in abortion when given in early pregnancy. RU-486 is a medication used to terminate a pregnancy by blocking the hormone progesterone, which is necessary for maintaining pregnancy. By blocking progesterone, RU-486 causes the lining of the uterus to break down, leading to the expulsion of the embryo and termination of the pregnancy.Rate this question:
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- 20.
A 33-year-old woman cannot feel the string of her IUCD. Her last menstrual period was 1 week ago. A serum pregnancy test is negative. The most appropriate next step in the management of this patient is to do which of the following?
- A.
Obtain an abdominal radiogram
- B.
Probe the cervical canal gently to pull down the string
- C.
Obtain a pelvic ultrasound
- D.
Perform a hysterosalpingogram
- E.
Insert another IUCD to replace the lost one
Correct Answer
B. Probe the cervical canal gently to pull down the stringExplanation
In this scenario, the woman is unable to feel the string of her IUCD, indicating that the IUCD may have migrated or become displaced. Since her serum pregnancy test is negative, it is unlikely that the IUCD has been expelled due to pregnancy. The most appropriate next step would be to probe the cervical canal gently to locate and pull down the string. This will help determine the position of the IUCD and assess if any further intervention is required. Obtaining an abdominal radiogram, pelvic ultrasound, or performing a hysterosalpingogram may be considered if the IUCD cannot be located or if there are other concerns. Inserting another IUCD should only be done after confirming the position of the existing one.Rate this question:
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- 21.
Toxic shock syndrome has been associated with which of the following contraceptive methods?
- A.
OCs
- B.
Progestin-only pill (the minipill)
- C.
Male condoms
- D.
Cervical cap
- E.
IUCD
Correct Answer
D. Cervical capExplanation
Toxic shock syndrome has been associated with the use of cervical caps. This is because cervical caps are inserted into the vagina and cover the cervix, creating a potential breeding ground for bacteria. If the cap is not properly cleaned and maintained, harmful bacteria can grow and release toxins, leading to toxic shock syndrome. Other contraceptive methods listed, such as OCs, progestin-only pills, male condoms, and IUCDs, have not been specifically linked to toxic shock syndrome.Rate this question:
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- 22.
A 24-year-old G2P2 is requesting contraception 6 weeks postpartum. Her history is unremarkable except for significant primary dysmenorrhea. Which of the following contraceptive methods is most closely associated with an increase in dysmenorrhea?
- A.
OCs
- B.
Progestin-only pill (the minipill)
- C.
Male condoms
- D.
Cervical cap
- E.
Copper-containing IUCD
Correct Answer
E. Copper-containing IUCDExplanation
The copper-containing IUCD is most closely associated with an increase in dysmenorrhea. The IUCD, also known as the copper coil or copper T, is a form of long-acting reversible contraception that is inserted into the uterus. The copper in the IUCD acts as a spermicide and prevents fertilization. However, it can also cause heavier and more painful periods, which can exacerbate dysmenorrhea symptoms. This is why it is important to consider the patient's history of dysmenorrhea when choosing a contraceptive method.Rate this question:
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- 23.
A 17-year-old woman with a history of ectopic pregnancy presents for contraceptive counseling. Which of the following contraceptive methods would be relatively or absolutely con-traindicated?
- A.
OCs
- B.
Progestin-only pill (the minipill)
- C.
Male condoms
- D.
Cervical cap
- E.
IUCD
Correct Answer
E. IUCDExplanation
The correct answer is IUCD. An IUCD (intrauterine contraceptive device) would be relatively or absolutely contraindicated in a woman with a history of ectopic pregnancy. This is because the presence of an IUCD can increase the risk of recurrent ectopic pregnancies. Therefore, alternative contraceptive methods should be considered for this patient.Rate this question:
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- 24.
A 22-year-old woman presents for routine care, having been using depot medroxyprogesterone acetate (DMPA) for contraception for the past 2 years. She has been amenorrheic for the past 6 months and would like to continue the DMPA. Additional history and the physical examination are unremarkable. What is the most appropriate management of this patient at this time?
- A.
Change to an alternate contraceptive method
- B.
add cyclic estrogen supplementation
- C.
Measure serum calcium concentration
- D.
Obtain a dual-energy x-ray absorptiometry (DXA) scan
Correct Answer
D. Obtain a dual-energy x-ray absorptiometry (DXA) scanExplanation
The most appropriate management for this patient is to obtain a dual-energy x-ray absorptiometry (DXA) scan. Depot medroxyprogesterone acetate (DMPA) is known to cause bone loss, and the patient's amenorrhea for the past 6 months may indicate decreased estrogen levels, which can further contribute to bone loss. Therefore, a DXA scan is necessary to assess her bone mineral density and determine if any interventions are needed to prevent osteoporosis.Rate this question:
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- 25.
A 28-year-old multiparous woman transfers her care to you and presents for an annual examination and contraceptive counseling. She has used OCs in the past but has not been in a sexual relationship for the past 5 years. She would like to restart contraception now. She has no ongoing medical illnesses and takes no medications. Physical examination reveals a 12–14-week, irregular uterus suggestive of uterine leiomyomata. Based on these findings, the most appropriate contraceptive method for this patient would be which of the following?
- A.
Monophasic combination OCs
- B.
Polyphasic combination OCs
- C.
DMPA
- D.
Cervical cap
- E.
IUCD
Correct Answer
C. DMPAExplanation
The most appropriate contraceptive method for this patient would be DMPA (depot medroxyprogesterone acetate). This is because the patient has a 12-14 week, irregular uterus suggestive of uterine leiomyomata (fibroids). DMPA is a progestin-only contraceptive method that can help to control the growth of fibroids and reduce symptoms such as heavy menstrual bleeding. It is an injectable contraceptive that is given every 3 months and does not contain estrogen, making it a suitable option for women with fibroids.Rate this question:
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- 26.
A patient currently on OCs is being scheduled to undergo a laparoscopic tubal ligation. Regarding the perioperative management of her OCs, you should counsel her to do which of the following?
- A.
Discontinue her contraceptives at least 30 days prior to surgery
- B.
Discontinue her contraceptives 14 days prior to surgery
- C.
Discontinue her contraceptives 7 days prior to surgery
- D.
Discontinue her contraceptives the day of the surgery
- E.
Continue her current use until after the procedure
Correct Answer
E. Continue her current use until after the procedureExplanation
The correct answer is to continue her current use until after the procedure. This is because oral contraceptives (OCs) do not increase the risk of deep vein thrombosis (DVT) or pulmonary embolism (PE) in the perioperative period. Therefore, there is no need to discontinue OCs prior to the surgery.Rate this question:
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- 27.
Emergency contraception can be effective if administered up until how long after intercourse?
- A.
24 hours
- B.
48 hours
- C.
72 hours
- D.
4 days
- E.
5 days
Correct Answer
E. 5 daysExplanation
Emergency contraception can be effective if administered up until 5 days after intercourse. This means that if someone has had unprotected sex or their usual method of contraception has failed, they can still take emergency contraception within this timeframe to reduce the risk of pregnancy. It is important to note that the effectiveness of emergency contraception decreases with time, so it is best to take it as soon as possible after intercourse.Rate this question:
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- 28.
In the United States, what is the most common contraceptive method used by women of reproductive age (15–44 years) and their partners?
- A.
OCs
- B.
Male condom
- C.
Injectable contraceptives
- D.
IUCD
- E.
Sterilization
Correct Answer
E. SterilizationExplanation
Sterilization is the most common contraceptive method used by women of reproductive age and their partners in the United States. Sterilization involves permanent contraception through surgical procedures such as tubal ligation for women and vasectomy for men. This method is highly effective and provides long-term contraception, making it a popular choice for individuals who do not want to have children in the future. It eliminates the need for other temporary contraceptive methods and allows for a worry-free sexual experience.Rate this question:
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