Contraceptive method selection, counseling, and complication recognition scenarios tested on USMLE Step 2 CK.
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- What is the primary mechanism of action of combined oral contraceptives (COCs)?
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Suppression of the hypothalamic-pituitary-ovarian axis to prevent ovulation (blocks the LH surge).- Which category of reversible contraception has the lowest typical-use failure rates?
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Long-acting reversible contraception (LARC): IUDs and the subdermal implant.- What is the mechanism of action of the copper IUD?
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Copper ions are toxic to sperm and ova and cause a local inflammatory reaction, preventing fertilization.- How long is a copper IUD approved to remain in place?
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Up to 10 to 12 years.- What is the single most effective method of emergency contraception?
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Placement of a copper IUD.- Within how many days after unprotected intercourse can a copper IUD be placed for emergency contraception?
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Up to 5 days (120 hours).- What is the mechanism of levonorgestrel emergency contraception?
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It delays or inhibits ovulation by suppressing the LH surge.- Within how many hours after intercourse is levonorgestrel emergency contraception FDA-labeled to be taken?
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Within 72 hours.- What is the mechanism of action of ulipristal acetate as emergency contraception?
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It is a selective progesterone receptor modulator that delays ovulation.- Up to how many hours after intercourse is ulipristal acetate effective for emergency contraception?
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Up to 120 hours (5 days).- A prior history of venous thromboembolism (VTE) is an absolute contraindication to which type of contraceptive?
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Estrogen-containing (combined hormonal) contraceptives.- By what mechanism does estrogen in combined hormonal contraceptives raise thrombosis risk?
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It increases hepatic synthesis of clotting factors, producing a hypercoagulable state.- Migraine with aura is an absolute contraindication to which type of contraceptive, due to stroke risk?
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Estrogen-containing (combined hormonal) contraceptives.- Why are combined hormonal contraceptives contraindicated in smokers over age 35?
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Markedly increased risk of venous thromboembolism and cardiovascular events.- What is the key counseling point about timing for the progestin-only pill?
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It must be taken at the same time every day, within about a 3-hour window.
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