MRCOG Part 2 – 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. Ulipristal Acetate 60MG
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.

8. 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?

9. 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?