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Preconception Care and Contraception for HIV Infected Women

Preconception Care and Contraception

1. Which of the following is a goal of preconception care?

A. Prevent unintended pregnancy.

B. Prevent mother-to-child transmission of HIV.

C. Prevent transmission of HIV to an uninfected sexual partner while trying to conceive.

D. All of the above.

2. HIV care providers should be proactive in addressing reproductive needs and desires, as many women may not feel comfortable in raising these issues for fear of being judged harshly or discouraged.

A. True

B. False

3. When taken during pregnancy, HIV medications can decrease the risk of transmitting HIV to the baby to:

A. 1% - 2%

B. 5% - 10%

C. 25%

D. 50%

4. If a woman does not meet current CD4+ cell count criteria, initiation of ART prior to conception should not be considered.

A. True

B. False

5. Genital tract inflammation is associated with increased HIV shedding in the genital tract, even when plasma VL is fully suppressed, and if untreated, genital tract infections may increase the risk of adverse pregnancy outcomes and potential MTCT.

A. True

B. False

6. If both partners are HIV infected, condom use is not needed.

A. True

B. False

7. Semen analysis should be considered because HIV is associated with a higher prevalence of semen abnormalities.

A. True

B. False

8. HIV appears to have an adverse effect on fertility in which of the following?

A. Symptomatic women

B. Asymptomatic women

C. Both symptomatic and asymptomatic women

D. None of the above

9. Which of the following is a reason for unintended pregnancy?

A. Power imbalance in a sexual relationship

B. Belief that one cannot become pregnant

C. Lack of awareness of contraception options

D. All of the above

10. All of the following women are at an increased risk for unintended pregnancy, except for:

A. Aged less than 40 years

B. Unmarried but cohabiting

C. Abusers of drugs or alcohol

D. Those with HIV-associated cognitive impairment

11. The high proportion of HIV infected women who report unintended pregnancy or who conceive while using contraception suggests that counseling regarding contraceptive options is not taking place or is not sufficient.

A. True

B. False

12. When appropriate, it is desirable to include the partner in the conversation about contraceptive choice because partner involvement may increase successful and sustainable use of the method.

A. True

B. False

13. Which of the following is a factor to consider when helping a woman choose the best method of contraception for herself and her partner?

A. Childbearing plans

B. Convenience and ease of use

C. Drug interactions

D. All of the above

14. When choosing the best method of contraception, a patient’s patterns of adherence to ART and other medications as well as her adherence with clinic visits may service as predictors of her success with particular contraceptive methods.

A. True

B. False

15. EFV is the only current ARV agent that is a proven teratogen.

A. True

B. False

16. The female condom is more likely than the male condom to break or leak during sex, and intrusion of the outer vaginal ring that covers the introitus into the vagina occurs in 2% of cases.

A. True

B. False

17. All of the following alter estrogen and/or progestin levels and may reduce the effectiveness of HC, except for:

A. Anticonvulsant agents

B. Tricyclic antidepressants

C. Rifampin or rifabutin

D. St. Johns wort

18. Data suggest that in women with chronic hepatitis, combined hormone use increases the rate of severity of cirrhotic fibrosis and increases the risk for hepatocellular carcinoma.

A. True

B. False

19. ACOG has stated that “due to concerns regarding the effect of DMPA on bone mineral density, use of DMPA should be limited to 2 consecutive years.”

A. True

B. False

20. The emergency contraception dose should be repeated if vomiting occurs within _____ of ingestion.

A. 30 minutes

B. 60 minutes

C. 2 hours

D. 4 hours

HIV and Pregnancy

21. For currently or recently sexually active women, pregnancy testing is indicated in which of the following circumstances?

A. New onset of pelvic pain

B. Enlarged uterus or adnexal mass on exam

C. Before instituting new therapies

D. All of the above

22. Absolute number of CD4+ cells, rather than percentage, may be a more accurate measure of immune function for HIV infected pregnant women.

A. True

B. False

23. HIV infected pregnant women may be particularly susceptible to yeast infections.

A. True

B. False

24. Bacterial vaginosis has been associated with all of the following adverse pregnancy outcomes, except for:

A. Preterm labor and birth

B. Pre-eclampsia

C. Premature rupture of membranes

D. Perinatal HIV transmission

25. Approximately _____ of survivors of neonatal herpes have long-term neurologic sequelae.

A. 10%

B. 20%

C. 30%

D. 40%

26. Reactivation of HSV in labor occurs more frequently in the setting of HIV infection.

A. True

B. False

27. When should a pregnant woman be counseled to avoid unprotected genital and oral sexual contact during pregnancy?

A. If her sexual partner has a history of oral HSV infection.

B. If her sexual partner has a history of genital HSV infection.

C. If her sexual partner’s infection status is unknown.

D. All of the above.

28. Visceral HSV disease is more likely to occur during pregnancy and can be fatal in rare cases.

A. True

B. False

29. For pregnant women with recurrences of genital herpes, suppressive therapy with either acyclovir or valacyclovir is recommended starting at _____ weeks’ gestation to reduce the need for CS delivery.

A. 36

B. 37

C. 38

D. 39

30. CS is recommended to prevent neonatal exposure to HPV.

A. True

B. False

31. Manifestations of congenital syphilis in the newborn include which of the following?

A. Mucocutaneous lesions

B. Hepatosplenomegaly

C. Osteochondritis / periostitis

D. All of the above

32. All pregnant women should have serologic testing for syphilis at all of the following time points, except for:

A. At the beginning of prenatal care

B. At 28 weeks’ gestation

C. At 36 weeks’ gestation

D. At delivery

33. Concurrent syphilis infection in the mother has been associated with increased risk for perinatal transmission of HIV.

A. True

B. False

34. Congenital infection of toxoplasmosis is more common when infection in the mother occurs during the:

A. First trimester

B. Second trimester

C. Third trimester

D. The rate of congenital infection is equal for all trimesters

35. To prevent T. gondii exposure, pregnant women should be counseled to do all of the following, except for:

A. Avoid eating raw or undercooked meat.

B. Avoid eating unpasteurized dairy and soft cheeses.

C. Wash hands after contact with raw meat or with soil.

D. Thoroughly wash fruits and vegetables before eating them raw.

36. In most studies, the incidence of HCV transmission from mother to infant increases if the mother is co-infected with HIV, with transmission rates between 20% and 40%.

A. True

B. False

37. The most common causes of ARV resistance are all of the following, except for:

A. The prescription of ineffective regimens.

B. Starting the ARV regimen with VL >10,000 copies/mL.

C. Lack of adherence.

D. All of the above are the most common causes of ARV resistance.

38. Which of the following is a factor unique to pregnancy that may increase risk for the development of ARV resistance?

A. If prophylactic regimens include drugs with significant half-life differences, such as NVP or EFV combined with two nucleoside analogue drugs, then postpartum discontinuation of all regimen components simultaneously may result in persistent subtherapeutic drug levels and increase risk for the development of NNRTI resistance.

B. Problems such as nausea and vomiting in early pregnancy may compromise adherence or absorption.

C. Pharmacokinetic changes during pregnancy, such as increased plasma volume and renal clearance, may lead to subtherapeutic drug levels that increase risk of resistance.

D. All of the above.

39. Recommendations for preventing ARV resistance include all of the following, except:

A. Use of an effective combination ARV regimen.

B. Emphasis on and reinforcement of the importance of good adherence at each patient visit.

C. Addition of single-dose NVP to a combination ARV regimen.

D. All of the above are recommendations for preventing ARV resistance.

40. When evaluating anemia in a pregnant women who is taking ZDV, the presence of macrocytosis should exclude consideration of typical causes of macrocytic anemia, such as folate or B12 deficiency.

A. True

B. False

41. Which of the following is a sign or symptom of ARV toxicity?

A. Extreme fatigue

B. Elevated blood pressure

C. Severe headache

D. Cognitive dysfunction

42. During the fetal movement assessment, the perception of _____ distinct movements in a period of up to 2 hours is reassuring.

A. 5

B. 10

C. 15

D. 20

43. Antepartum fetal testing should be repeated if:

A. The condition prompting testing persists.

B. The mother’s medical condition deteriorates significantly.

C. There is an acute decrease in fetal movement.

D. All of the above.

44. Recent data suggest that pregnancy may increase risk of female-to-male HIV transmission.

A. True

B. False

45. Treatment changes during pregnancy increase the risk of incomplete viral suppression at the end of pregnancy.

A. True

B. False

46. A period of at least _____ is recommended between stopping an NNRTI and stopping other ARVs.

A. 3 days

B. 7 days

C. 14 days

D. 30 days

47. Women on antiretroviral regimens who have detectable virus at any time during pregnancy using ultrasensitive assays should be:

A. Evaluated for resistant virus if plasma HIV RNA is >500 - 1,000 copies/mL.

B. Assessed for adherence, tolerability, incorrect dosing, or potential problems with absorption.

C. Considered for ARV regimen modification.

D. All of the above.

48. Scheduled cesarean delivery is recommended for HIV-infected pregnant women who have HIV RNA levels _____ near the time of delivery.

A. >50 copies/mL

B. >250 copies/mL

C. >400 copies/mL

D. >1,000 copies/mL

49. An immune reconstitution inflammatory syndrome-related flare of HBV activity during pregnancy can occur even among women with relatively high CD4+ cell counts.

A. True

B. False

50. Both women and men of childbearing potential who are receiving ribavirin should be counseled about the need to use effective contraception during therapy and for _____ after completion.

A. 6 months

B. 3 months

C. 30 days

D. 14 days

51. Most studies that have included both HIV infected and uninfected pregnant women with HCV have found that elective CS delivery reduces the risk of perinatal HCV transmission.

A. True

B. False

52. HIV-2 is more infectious than HIV-1, with a 5-fold higher rate of sexual transmission and a 20 to 30-fold higher rate of vertical transmission.

A. True

B. False

53. NNRTIs and ENF are not active against HIV-2 and should not be used for treatment or prophylaxis.

A. True

B. False

54. Pregnant HIV infected women should be informed about the availability of and offered participation in clinical trials for which they are eligible.

A. True

B. False

Pharmacologic Considerations in HIV Infected Pregnant Patients

55. Women with lower CD4+ cell counts appear to be at the greatest risk for symptomatic, potentially fatal, and often rash-associated liver toxicity associated with NVP.

A. True

B. False

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