EC, Sexual assault- General Gynaecology module part2

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An 18-year-old girl has presented to family planning clinic requesting emergency
contraception.
The following is true:

A) Levonelle can be given upto 5 days (120 hours) after intercourse

B) Ella One can be given upto 5 days (120 hours) after intercourse

C) Copper IUCD can be used upto 3 days (72 hours) after intercourse

D) All are equally effective in preventing pregnancy if used properly

E) Failure rate is 1-2/100 women year

1 During a woman’s fertile period, the pregnancy risk following a single episode of unprotected
sexual intercourse (UPSI) has been estimated to be up to:

A) 10%

B) 20%

C) 30%

D) 40%

A 17-year-old girl comes to the accident and emergency department. She had unpro- tected
intercourse four days previously. She was not very keen on an intrauterine device (IUD).
What other alternatives do you wish to offer?

A) Double-dose Levonelle tablet.

B) Single dose of 30 mg micronized ulipristal acetate (ellaOne®).

C) IUD can offer her long-term reversible contraception

D) Single-dose 150 mg Levonelle tablet.

E) Two combined oral contraceptive tablets

The Cu-IUD is the most effective method of EC. A 2012 systemic review reported an overall
pregnancy rate of:

A) . <0.01%

B) <0.1%

C) <1%

D) <10%

Which of the following is true? UPA-EC may be less effective if a woman:
a.

A) Has severe asthma managed with oral glucocorticoids.

B) Is taking truvada and raltegravir given for post-exposure HIV prophylaxis after sexual exposure (PEPSE).

C) Commences a hormonal contraceptive on the same day.

D) Takes UPA-EC between 0 and 72 hours after UPSI

Which of the following statements is false? EC providers should consider ulipristal acetate EC
(UPA-EC) as first-line oral EC for a woman who:

A) Has had UPSI 96–120 hours ago (even if she has also had UPSI within the last 96 hours).

B) Has had UPSI within the last 5 days and it is likely to have taken place during the 5 days prior to ovulation.

C) Has a weight >70 kg and BMI >26 kg/m2.

D) Has had UPSI 2 days ago, on Day 3 of a regular, 28-day cycle and is keen to have Nexplanon insertion today.

An IS-year-old woman attends the family planning clinic. She is very anxious because she had
unprotected sexual intercourse with a stranger 3 days ago. She is worried that she will get
pregnant but was not able to come to the clinic before this. She has epilepsy, which is well
controlled with phenytoin.
Which contraceptive method will you recommend?

A) Copper coil

B) Copper coil and start a combined oral contraceptive

C) Levonorgestrel1.5 mg

D) Levonorgestrel3 mg

E) Uliprtstal acetate

Contraindications to the insertion of a Cu-IUD for EC are the same as those for routine IUD
insertion. Which of the following is a relative contraindication?

A) Between 48 hours and 28 days after childbirth

B) Risk of sexually transmitted infection

C) Previous ectopic pregnancy

D) Young age and nulliparity

9) Regarding oral EC, which of the following is false?

A) Regular contraception should be started as soon as possible after EC because of the risk of pregnancy due to delayed ovulation in the same cycle.

B) Oral EC can be offered if there has been UPSI or oral EC has already been given earlier in the same cycle.

C) Use of LNG-EC rather than UPA-EC may be considered if the woman has taken any progestogen in the week prior to EC.

D) If LNG-EC is used, progestogen-containing drugs should not be restarted for 5 days afterwards.

10)

A 48-year-old woman vaginally and anally penetrated a 32-year-old woman with her fingers
and an object without the consent of the 32-year-old woman
A

A) Assault by penetration

B) Not chargeable by the Sexual Offences Act 2003

C) Rape

D) Sexual assault

E) None of the above

11) Regarding oral EC, which of the following is false?

A) 10% of women experience side effects of headache, nausea and dysmenorrhoea.

B) Repeat EC should be given if a woman vomits within 3 hours of taking oral EC.

C) After UPA-EC, 75% of women will have their next menstrual period within 7 days of the expected time.

D) . After LNG-EC, 30% of women will have a delay in their menstruation by more than 7 days.

12)

An IS-year-old woman attends the family planning clinic. She had unprotected
sexualintercoursewithastranger5daysagoandisveryworriedshewillget pregnant. She was not able
to come to the clinic for advice before this. She has no significant past medical history and is not
taking any medication.
Which one of the following emergency contraceptive methods is appropriate?

A) Copper coil

B) Copper coil and start a combined oral contraceptive

C) Levonorgestrel1.5 mg

D) Levonorgestrel3 mg

E) Ulipristal acetate

A woman presents for a Cu-IUD for EC after using her combined hormonal contraception
incorrectly only during Week 1. A Cu-IUD can be inserted for EC up to how many days after the

13) start of the hormone-free interval?

A) 5 days

B) 10 days

C) 13 days

D) 15 days

14) 2 How does emergency contraception (EC) work? Which of the following statements is false?

A) The primary mechanism of contraceptive action of the copper intrauterine device (Cu-IUD) is inhibition of fertilisation by its toxic effect on sperm and ova.

B) If fertilisation does occur, the local endometrial inflammatory reaction resulting from the presence of the Cu-IUD prevents implantation.

C) Given that the earliest implantation is believed to occur 6 days after ovulation, a Cu-IUD can be inserted up to 6 days after the first UPSI in a cycle.

D) The mechanism of contraceptive action of oral EC is to delay or inhibit ovulation for at least 5 days.

15)

A 19-year-old man had consensual vaginal intercourse with a 16-year-old girl. He believed she
was 18 as they met at the student union bar
A

A) Assault by penetration

B) . Sexual activity with a child

C) . Sexual assault

D) Rape of a child

E) . None of the above

16)

A woman requesting EC is taking hepatic enzyme-inducing drugs. Which of the following
statements is false:

A) A single dose of 60 mg UPA-EC (double the licensed dose) can be used off-licence.

B) The effectiveness of UPA-EC and levonorgestrel EC (LNG-EC) could be reduced.

C) A Cu-IUD should be recommended if the criteria for use are met.

D) A single dose of 3 mg LNG (double the licensed dose) can be used off-licence.

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