Oral Contraceptive Pills

Oral Contraceptive Pills

Q. 1

The first step in the management of hirsutism due to stein leventhal syndrome is :

 A

OCP

 B

HMG

 C

Spironolactone

 D

Bromocriptine

Q. 1

The first step in the management of hirsutism due to stein leventhal syndrome is :

 A

OCP

 B

HMG

 C

Spironolactone

 D

Bromocriptine

Ans. A

Explanation:

Ans. is a i.e. OCP    

Friends, all the options given in the question are used for treatment of PCOS but only OCP and spironolactone are used for managing hirsutism.

The first step done in general practise in OPD’s when a patient of PCOS comes is :

Advise : Weight reduction.

‘Weight reduction in obese patients is the initial recommendation because it reduces insulin, SHBG and androgen levels (mainly calculated or bioavailable testosterone) and may restore ovulation either alone or combined with ovulation induction agents.”         

Drug therapy If a patient has hirsutism primary goal is lowering androgen levels to halt futher conversion of vellus hairs to terminal ones.

Drugs used are :

  1. i.   OCP’s ‑

“Combination OC’s decrease adrenal and ovarian steroid production and reduce hair growth in nearly two – third of hirsute patients.”                                                            

“Combined oral contraceptive – COC’s are effective in establishing regular menses and lowering ovarian androgen production. As an additional effect, the estrogen component of these pills leads to increased SHBG levels. With higher SHBG levels, a greater amount of free testosterone is bound and thus becomes biologically unavailable at the hair follicle.”         

  1. Gonadotropin releasing horomone agonists –

“GnRH agonists effectively lower Gonadotropin levels over time, and in turn subsequently lower androgen levels. Despite their effectiveness in treating hirsutism, administration of these agents is not a preferred long term treatment method due to associated bone loss. high cost and menopausal side effects.”

iii Androgne receptor antagonists – like spirono lactone, cyproterone acetate and flut amide. These antiandrogens are competitive inhibitors of androgen binding to the androgen receptor.

“Although these agents are effective in the treatment of hirsutism, they carry a risk of several side effects. Metrorrhagia may frequently develop. In addition, as antiandrogens, these drugs bear a theoretical risk of pseudo hermaphroditism in male fetuses of women using such medication in early pregnancy. None of these antiandrogen agents are approved by the FDA for treatment of hyperandrogenism and thus are used off-label.”

iv. 5 a reductase inhibitor : Conversion of testosterone to dihydro testosterone can be decreased by 5 a reductase inhibitor, Finasteride. It is modestly effective in treating hirsutism and similar to other antiandrogens the risk of male fetus teratogenecity is present.

So, friends after such a detailed discussion on the management of hirsutism. You can very well understand that the first line therapy for management of hirsutism are combined oral contraceptive pills.

Also know

Other methods of treating hirsutism :

  • Eflornithine hydrochloride cream : It is an irreversible inhibitor of ornithine decarboxylase enzyme. This enzyme is necessary for hair follicle cell division and function, and its inhibition results in slower hair growth. Its main disadvantage is that it does not permanantly remove hair.
  • Mechanical methods :

—   In includes :

depilation creams                                        Depilation methods i.e. hair removal           Epilation methods i.e. methods which remove the

above the skin surface eg. –                         entire hair shaft and root.

—   shaving                                                Mechanical methods                                 Thermal destruction using

—                                                               plucking                                                 electrolysis or laser

—    waxing

Note : While prescribing OCP’s in a case of hirsutism :

Do not prescribe OCP’s containing norgestrel and norethindrone acetate as they have androgenic activity. OCP’s containing Illr° generation progestins like gestodene, Desogestrel, norgestimate drospirenone are the best, as they have minimum androgenic activity.



Q. 2

In a 45 years old lady with polymenorrhoea for 6 months duration best line of management is :

 A

Progesterone for 6 months

 B

OCP for 6 months

 C

Dilation and curettage

 D

Hysterectomy

Q. 2

In a 45 years old lady with polymenorrhoea for 6 months duration best line of management is :

 A

Progesterone for 6 months

 B

OCP for 6 months

 C

Dilation and curettage

 D

Hysterectomy

Ans. B

Explanation:

Ans is b i.e. OCP’s for 6 months


Q. 3

True about Ca cervix

 A

90% associated with HPV

 B

Immunocompromised patients

 C

OCP

 D

All

Q. 3

True about Ca cervix

 A

90% associated with HPV

 B

Immunocompromised patients

 C

OCP

 D

All

Ans. D

Explanation:

Ans. is a, b and c i.e. 90% associated with HPV; OCP; and Immunocompromised Patients 

Risk factors for development of Ca cervix :

  1. Coitus before the age of 18 years.°
  2. Multiple sex partners.°
  3. Delivery of V baby before 20 years of age.°
  4. Poor personal hygiene.°
  5. Poor socioeconomic status.
  6. Smoking°, Alcohol, Drug abuse.
  7. Women with STD°, HIV infection°, HSV-20, HPV infection° or condyloma
  8. Immunocompromised individuals°
  9. Women with H/O Preinvasive lesions°
  10. OCP° and progesterone use over long periods.°

“HPV is central to the development of cervical neoplasia. HPV – DNA is found in 95% of all squamous cell carcinoma & 90% of all adenocarcinomas.”


Q. 4

Reversible methods of contraception are :

 A

Barrier

 B

OCP

 C

IUCD

 D

All

Q. 4

Reversible methods of contraception are :

 A

Barrier

 B

OCP

 C

IUCD

 D

All

Ans. D

Explanation:

Ans. is a, b, c i.e. OCP; IUCD; Barrier; and Depot injection

Methods of contraception (can be classified as)

Temporary methods                                                                Permanent methods

(used to postpone pregnancy or space births) (Surgical methods are to purposefully and permanently

  • Barrier method°                                                   destroy the Reproductive capacity of an individual)
  • Natural contraception°                                                                   1
  • Oral contraceptive pills
  • Injectables                                                              Female                                      Male
  • Implants                                                                                                                                                                                                                          .1.
  • Devices like IUCD’s                                            Tubectomy                                Vasectomy Levonorgestrel IUCD’s

Q. 5

Non contraceptive use of OCPs are all except :

 A

Ca endometrium

 B

Ca breast

 C

Rheumatoid arthritis

 D

Endometriosis

Q. 5

Non contraceptive use of OCPs are all except :

 A

Ca endometrium

 B

Ca breast

 C

Rheumatoid arthritis

 D

Endometriosis

Ans. B

Explanation:

Ans. is b i.e. Ca breast

OCP’s are protective against Benign Breast diseases, but as far as Carcinoma breast is concerned their role is controversial. OCP’s are considered in the etiology of Ca breast.

“The most credible metanalysis of oral contraceptive use suggest that these agents cause little if any increased risk of breast cancer. By contrast, oral contraceptives offer a substantial protective effect against ovarian epithelial tumors and endometrial cancer.”


Q. 6

OCP gives protection against following cancers :

 A

Endometrial

 B

Ovary

 C

Cervix

 D

a and b

Q. 6

OCP gives protection against following cancers :

 A

Endometrial

 B

Ovary

 C

Cervix

 D

a and b

Ans. D

Explanation:

Ans. is a and b i.e. Endometrium; and Ovary


Q. 7

OCPs cause

 A

Hepatic adenoma

 B

Cancer Cervix

 C

Hepatic vein thrombosis

 D

All

Q. 7

OCPs cause

 A

Hepatic adenoma

 B

Cancer Cervix

 C

Hepatic vein thrombosis

 D

All

Ans. D

Explanation:

Ans. is a, b and c i.e. Hepatic adenoma; Cancer cervix; and Hepatic vein thrombosis

Lets, see the causes of Hepatic vein thrombosis (Budd-Chiari syndrome).

  • Polycythemia rubra vera, Myeloproliferative syndromes, paroxysmal nocturnal hemoglobinuria
  • OCP use
  • Other hypercoagulable states
  • Invasion of IVC by tumor, such as Renal cell or Hepatocellular Ca
  • Idiopathic.

Q. 8

OCP’s are contraindicated in A/E :

 A

Smoking 35 years

 B

Coronary occlusion

 C

Polycystic ovarian ds

 D

Cerebro vascular ds

Q. 8

OCP’s are contraindicated in A/E :

 A

Smoking 35 years

 B

Coronary occlusion

 C

Polycystic ovarian ds

 D

Cerebro vascular ds

Ans. C

Explanation:

Ans. is c i.e. Polycystic ovarian disease


Q. 9

Complication of OCP are all EXCEPT :

 A

Weight loss

 B

Hyperlipidemia

 C

Hypertension

 D

Depression

Q. 9

Complication of OCP are all EXCEPT :

 A

Weight loss

 B

Hyperlipidemia

 C

Hypertension

 D

Depression

Ans. A

Explanation:

Weight loss


Q. 10

Which of the following has LEAST pregnancy failure rate :

 A

OCP

 B

IUCD

 C

Diaphragm

 D

Condom

Q. 10

Which of the following has LEAST pregnancy failure rate :

 A

OCP

 B

IUCD

 C

Diaphragm

 D

Condom

Ans. A

Explanation:

OCP


Q. 11

Estrogen in the OCP causes all the following except :

 A

Carcinoma in situ cervix

 B

Breast carcinoma

 C

Endometrial carcinoma

 D

Thromoembolism

Q. 11

Estrogen in the OCP causes all the following except :

 A

Carcinoma in situ cervix

 B

Breast carcinoma

 C

Endometrial carcinoma

 D

Thromoembolism

Ans. A

Explanation:

Carcinoma in situ cervix


Q. 12

OCP’s are contraindicated in all except :

 A

Intermittent vaginal bleeding

 B

Uterine fibroids

 C

H/0 thromboembolism

 D

Cardiac abnormalities

Q. 12

OCP’s are contraindicated in all except :

 A

Intermittent vaginal bleeding

 B

Uterine fibroids

 C

H/0 thromboembolism

 D

Cardiac abnormalities

Ans. B

Explanation:

Uterine fibroids


Q. 13 OCP fail when used with any of the following except:
 A Ethoxsuccimide
 B Phenytoin
 C Rifampin
 D Tetracycline
Q. 13 OCP fail when used with any of the following except:
 A Ethoxsuccimide
 B Phenytoin
 C Rifampin
 D Tetracycline
Ans. D

Explanation:

Tetracycline


Q. 14

Which of the following statements about Chlamydia trachomatis is true:

 A

May be isolated on artificial media by culture of purulent endocervical discharge

 B

Most genital chlamydial infections are symptomatic

 C

Use of OCP is associated with increased risk of asymptomatic chlamydial infection

 D

Penicillin is the drug of choice for treatment

Q. 14

Which of the following statements about Chlamydia trachomatis is true:

 A

May be isolated on artificial media by culture of purulent endocervical discharge

 B

Most genital chlamydial infections are symptomatic

 C

Use of OCP is associated with increased risk of asymptomatic chlamydial infection

 D

Penicillin is the drug of choice for treatment

Ans. C

Explanation:

Patients on treatment with oral contraceptives have a increased risk of asymptomatic chlamydial infections.

Ref: Clinical Obstetrics and Gynaecology by Brian A. Magowan, Philip Owen, James Drife, Pages 126-128.


Q. 15

Drug which interferes effectiveness of OCP are all, EXCEPT:

 A

Aspirin

 B

Phenobarbital

 C

Rifampicin

 D

Primidone

Q. 15

Drug which interferes effectiveness of OCP are all, EXCEPT:

 A

Aspirin

 B

Phenobarbital

 C

Rifampicin

 D

Primidone

Ans. A

Explanation:

Contraceptive failure may occur if the following drugs are used concurrently:

Enzyme inducers like Phenytoin, Phenobarbital, primidone, carbamazepine, rifampin.

It will increase the metabolism of estrogenic as well as progestational component.

Suppression of intestinal microflora: Tetracyclines and ampicillin etc. No deconjugation of estrogens excreted in bile-their enterohepatic circulation is interrupted-blood levels fall.

Also Know:
Absolute Contraindication of OCP:

  • Thromboembolic, coronary and cerebrovascular disease or history of it
  • Moderate to severe hypertension
  • Hyperlipidemia
  • Active liver disease
  • Hepatoma
  • H/o of jaundice during past pregnancy
  • Malignancy of Breast/genitalis
  • Porphyria
  • Impending major surgery- to avoid postoperative thromboembolism.
Ref: K.D.T. 6th Ed Page 317

Q. 16

All of the following drugs were found to reduce the efficacy of combined OCP when used together, EXCEPT:

 A

Rifampin

 B

Penicillin

 C

Griseofulvin

 D

Carbamazepine

Q. 16

All of the following drugs were found to reduce the efficacy of combined OCP when used together, EXCEPT:

 A

Rifampin

 B

Penicillin

 C

Griseofulvin

 D

Carbamazepine

Ans. B

Explanation:

Penicillin was found to have no association with the efficacy of OCP when used together. It is excreted through kidney. Drugs which induce Cyt P450 was found to lower the efficacy of OCPs when combined together.
 
Drugs which induce Cyt P450 are:
  • Rifampin
  • Griseofulvin
  • Phenytoin, mephenytoin
  • Phenobarbital
  • Primidone
  • Carbamazepine
  • Ethosuximide
Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 32. Contraception.

Q. 17

All of the following statements regarding benefits of combined OCP are TRUE, EXCEPT:

 A

It decreases the risk of ectopic pregnancy

 B

It decreases the risk of cervical cancer

 C

It improves dysmenorrhea from endometriosis

 D

It decreases the incidence and severity of acute salpingitis

Q. 17

All of the following statements regarding benefits of combined OCP are TRUE, EXCEPT:

 A

It decreases the risk of ectopic pregnancy

 B

It decreases the risk of cervical cancer

 C

It improves dysmenorrhea from endometriosis

 D

It decreases the incidence and severity of acute salpingitis

Ans. B

Explanation:

In current combined OCP users the risk of developing cervical dysplasia and cervical cancer is increased, but this risk declines after the use is discontinued. 
 
Benefits of use of combined OCP are:
  • Improvement of acne
  • Prevention of atherogenesis
  • Inhibition of hirsutism progression
  • Decreases risk of ectopic pregnancy
  • Decreases activity of rheumatoid arthritis
  • Improves dysmenorrhea from endometriosis
  • Decreases risk of endometrial and ovarian cancer
  • Reduces various benign breast diseases
  • Reduces menstrual blood loss and anemia
  • Decreases the incidence and severity of acute salpingitis
Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 32. Contraception.

 


Q. 18

In which of the following condition is OCP contraindicated ?

 A

Heart disease

 B

Thromboembolism

 C

Breast cancer

 D

All of the above

Q. 18

In which of the following condition is OCP contraindicated ?

 A

Heart disease

 B

Thromboembolism

 C

Breast cancer

 D

All of the above

Ans. D

Explanation:

ABSOLUTE CONTRAINDICATIONS OF OCP:

Known or suspected breast cancer

Severe hypertriglyceridemia/hypercholestrolemia

Undiagnosed vaginal bleeding

Thrombophlebitis/thromboembolism , cerebral and cardiac disorders

Pregnancy

Hypertension (moderate to severe)

Impaired liver

RELATIVE CONTRAINDICATIONS OF OCP:

Migraine with aura

Diabetes mellitus/gestational diabetes

Hypertension

Smoking

Uterine lieomyoma

Elective surgery

Seizure disorder

Sickle cell disease

Gall bladder disease

SLE

Mitral valve prolapse

Hyperlipidemia

Hepatic disease


Q. 19

Which is the ideal contraceptive for a newly married couple who wants to plan their family after 6 months?

 A

Barrier method

 B

Combined OCP

 C

IUCD

 D

Progesterone only pill

Q. 19

Which is the ideal contraceptive for a newly married couple who wants to plan their family after 6 months?

 A

Barrier method

 B

Combined OCP

 C

IUCD

 D

Progesterone only pill

Ans. B

Explanation:

Best contraceptive for newly married couple is combined oral contraceptive pill (COC).

In combined OCP the commonly used progestins are either levonorgestrel or norethisterone or desogestrel and the oestrogens principally used are either ethinyl estradiol or mestranol. It has a very low failure rate of 0.1 HWY.
 
Failure rate of progesterone only pill is 0.5 – 2 per 100 women years of use.
 
Failure rate of IUCD is 0.1 – 2 HWY.

Q. 20

A newly married couple approached their physician for contraceptive measures. They chose oral contraceptive pills (OCPs). What is the ABSOLUTE contraindication of OCPs?

 A

Dysmenorrhoea

 B

Carcinoma of the breast

 C

Hypertension

 D

Endometriosis

Q. 20

A newly married couple approached their physician for contraceptive measures. They chose oral contraceptive pills (OCPs). What is the ABSOLUTE contraindication of OCPs?

 A

Dysmenorrhoea

 B

Carcinoma of the breast

 C

Hypertension

 D

Endometriosis

Ans. B

Explanation:

Absolute contraindications for combination oral contraceptive use: 

  • The presence or history of thromboembolic disease
  • Cerebrovascular disease
  • Myocardial infarction
  • Coronary artery disease
  • Congenital hyperlipidemia
  • Known or suspected carcinoma of the breast
  • Carcinoma of the female reproductive tract
  • Abnormal undiagnosed vaginal bleeding
  • Known or suspected pregnancy
  • Past or present liver tumors or impaired liver function.
Relative contraindications:
  • Migraine headaches
  • Hypertension
  • Diabetes mellitus
  • Obstructive jaundice of pregnancy or prior oral contraceptive use
  • Gallbladder disease
 
Ref: Levin E.R., Hammes S.R. (2011). Chapter 40. Estrogens and Progestins. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12e.

Q. 21

Candidiasis is associated with all except-

 A

OCP user

 B

IUCD user

 C

Diabetes

 D

Pregnancy

Q. 21

Candidiasis is associated with all except-

 A

OCP user

 B

IUCD user

 C

Diabetes

 D

Pregnancy

Ans. B

Explanation:

Ans. is ‘b’ i.e., IUCD user


Q. 22

Thromboembolism is due to which component of OCP

 A

Progesterone

 B

Estrogen

 C

Iron

 D

FSH

Q. 22

Thromboembolism is due to which component of OCP

 A

Progesterone

 B

Estrogen

 C

Iron

 D

FSH

Ans. B

Explanation:

Ans. is ‘b’ i.e., Estrogen

o Estrogen is responsible for venous thromboembolism, i.e. leg vein and pulmonary thrombosis.

o Both estrogen and progesterone are responsible for arterial phenomena, i.e. coronary, and cerebral thrombosis —> MI and stroke


Q. 23

Which of the following is/are benefits of combined OCPs use ?

 A

Hepatocellular adenoma

 B

PID

 C

Ovarian cysts

 D

b and c

Q. 23

Which of the following is/are benefits of combined OCPs use ?

 A

Hepatocellular adenoma

 B

PID

 C

Ovarian cysts

 D

b and c

Ans. D

Explanation:

Ans. is ‘b’ i.e., PID, ‘c’ i.e., Ovarian 


Q. 24

Most common cause of stroke in young women in India among OCP users:

 A

Cortical vein thrombosis

 B

Moyamoya disease

 C

Atherosclerosis

 D

HT

Q. 24

Most common cause of stroke in young women in India among OCP users:

 A

Cortical vein thrombosis

 B

Moyamoya disease

 C

Atherosclerosis

 D

HT

Ans. A

Explanation:

Answer is A (Cortical vein thrombosis):

Young women on OCPs are predisposed to stroke due to venous thrombosis of lateral saggital sinus or small cortical veins (cortical vein thrombosis)

`Venous sinus thrombosis of the lateral or saggital sinus or small cortical veins (cortical vein thrombosis) occurs as complication of oral contraceptive use, pregnancy and postpartum period, inflammatory bowel disease, intracranial infections (meningitis) and dehydration’ – Harrison


Q. 25

Which of the following is an absolute CONTRAINDI­CATION to OCP use:      

March 2013 (d)

 A

Chronic renal disease

 B

DVT

 C

Diabetes mellitus

 D

History of amenorrhea

Q. 25

Which of the following is an absolute CONTRAINDI­CATION to OCP use:      

March 2013 (d)

 A

Chronic renal disease

 B

DVT

 C

Diabetes mellitus

 D

History of amenorrhea

Ans. B

Explanation:

Ans. B i.e. DVT

Contraindications to combined oral contraceptives

  • They are generally accepted to be contraindicated in women with pre-existing cardiovascular disease, in women who have a familial tendency to form blood clots/ thrombosis (such as familial factor V Leiden), women with severe obesity and/or hypercholesterolemia (high cholesterol level), and in smokers over age 40.
  • COCP are also contraindicated for women with liver tumors, hepatic adenoma or severe cirrhosis of the liver, and for those with known or suspected breast cancer.

Q. 26

OCP protects against all EXCEPT: 

September2012

 A

Hepatic adenoma

 B

Fibroadenoma breast

 C

Carcinoma ovary

 D

Uterine malignancy

Q. 26

OCP protects against all EXCEPT: 

September2012

 A

Hepatic adenoma

 B

Fibroadenoma breast

 C

Carcinoma ovary

 D

Uterine malignancy

Ans. A

Explanation:

Ans. A i.e. Hepatic adenoma

OCP’s administration may result in hepatic adenoma.

Oral contraceptive pills
Protects against:

– Uterine Ca,

– Ovarian Ca,

– RA,

– Endometriosis etc.


Q. 27

NOT an established risk factor of Carcinoma shown in the image

 A

 OCP

 B

 Early menstruation

 C

 Family history

 D

Late menopause

Q. 27

NOT an established risk factor of Carcinoma shown in the image

 A

 OCP

 B

 Early menstruation

 C

 Family history

 D

Late menopause

Ans. A

Explanation:

Ans:A.)OCP

Carcinoma shown: Breast cancer

Risk factors for the development of invasive breast cancer include:

  • Female gender: The incidence of breast cancer in women exceeds that in men.
  • Age: Risk increases with age between the third and eighth decades.
  • Age at birth of first child: If aged 30 years or older, relative risk is 2 times that of patients who gave birth when younger
    than 20 years.So first child at early age is protective. Nulliparous women is more prone for breast carcinoma.
  • Personal history of breast cancer: This factor depends on patient age at time of diagnosis. Risk is increased for younger women.
  • Noninvasive carcinoma (ductal carcinoma in situ (DCIS)/lobular carcinoma in situ (LCIS)) on previous biopsy: This also is a marker for development of invasive lesions.
  • Benign proliferative changes with atypical hyperplasia: These may increase relative risk by 4 times.
  • Early menarche and late menopause: These also are associated weakly with increased relative risk of breast cancer.
  • Menopausal hormone replacement therapy: the combination use of estrogen with progestin has been associated with an greater risk of breast cancer, particularly of lobular carcinoma. Increased risk is also related to increased duration of use; this risk can be reduced over time, following the termination of hormone replacement therapy.
  • Family history: Degree of relativity of the family member with breast cancer affects individual risk.
  • Genetic predisposition: Approximately 5-10% of breast cancer cases are primarily attributable to inherited factors. The risk of breast cancer in carriers of BRCA1 mutation is estimated to be 36-87%.


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