Match each patient's clinical profile with the most appropriate contraceptive method based… — USMLE Step 2 CK

Match each patient's clinical profile with the most appropriate contraceptive method based on the World Health Organization Medical Eligibility Criteria (WHO MEC) and the patient's personal preferences.

A 30-year-old woman with a newly diagnosed hepatocellular adenoma who desires highly effective, long-acting, reversible contraception.Copper-containing intrauterine device
A 40-year-old woman with poorly controlled essential hypertension (blood pressure consistently $\ge 160/100$ mmHg) who strongly prefers a daily oral medication.Progestin-only pill
A 26-year-old woman with a significantly enlarged fibroid uterus that severely distorts her uterine cavity, seeking a 'fit-and-forget' contraceptive method.Etonogestrel subdermal implant
A 33-year-old woman with severe endometriosis and menorrhagia, seeking a highly effective, long-acting method that will also manage her pelvic pain.Levonorgestrel-releasing intrauterine device

Answer

The correct pairings align each patient's specific medical contraindications and preferences with the appropriate contraceptive method, ensuring adherence to the WHO Medical Eligibility Criteria.

Each correct pairing optimizes contraceptive efficacy while avoiding World Health Organization Medical Eligibility Criteria (WHO MEC) category 4 contraindications specific to the patient's comorbidities and preferences.

Step-by-Step Solution

Evaluate the patient with a hepatocellular adenoma.

Identify that liver tumors represent a MEC 4 contraindication for all hormonal methods, making the non-hormonal copper IUD the only appropriate choice among highly effective options.

Hormone exposure can accelerate the growth or lead to rupture of a hepatocellular adenoma.

Evaluate the patient with severe hypertension.

Identify that blood pressure

\ge 160/100

mmHg is a MEC 4 contraindication for estrogen. Match her preference for a daily pill with the progestin-only pill.

Estrogen significantly increases the risk of stroke and myocardial infarction in patients with uncontrolled hypertension.

Evaluate the patient with a distorted uterine cavity.

Note that cavity distortion is a MEC 4 contraindication for both copper and levonorgestrel IUDs. Select the subdermal implant as the appropriate long-acting alternative.

Distortion of the cavity prevents proper deployment of an IUD, leading to a high risk of expulsion or perforation.

Evaluate the patient with endometriosis and menorrhagia.

Determine that the levonorgestrel-releasing IUD provides excellent contraception while actively treating her heavy bleeding and dysmenorrhea.

Localized progestin thins the endometrium and downregulates inflammatory mediators, significantly improving endometriosis symptoms.

Key Concept

Application of the World Health Organization Medical Eligibility Criteria (WHO MEC) to select safe contraceptive methods in patients with specific medical comorbidities.

Estimated Time:1m 30s

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