Adolescent Sexuality — MCQs
Transmission assessment survey (TAS) is done for which of the following purposes?
A male with hyperpigmentation tanner stage 5 presents with hypertension & precocious puberty. The causative defect is:
A 25-year-old woman presents with vaginal discharge and vulvovaginal irritation. Wet mount shows motile trichomonads. She mentions having a similar infection 2 months ago treated with single-dose metronidazole. What is the most likely explanation for her current infection?
The contraceptive which is contraindicated in DVT is?
Which of the following is not a long-acting reversible contraceptive method?
The Image shows the growth curve of different organs with age. Identify A in the graph.
A 14-year-old victim of sexual assault with 22 weeks gestation has been brought for Medical Termination of Pregnancy (MTP). Which of the following statements is true?
A sexually active 16-year-old presents for STI screening with recent assault history, multiple partners, inconsistent condom use. Which comprehensive prevention strategy is most appropriate?
What is the preferred method of contraception for a female with a family history of ovarian cancer?
What is the age range of adolescence?
Adolescent Sexuality Indian Medical PG Practice Questions and MCQs
Question 1: Transmission assessment survey (TAS) is done for which of the following purposes?
- A. To provide reliable estimates of birth rate, death rate and infant mortality rate
- B. For assessing primary immunization coverage
- C. All of the options
- D. To determine when infections have been reduced below target transmission thresholds (Correct Answer)
Explanation: ***To determine when infections have been reduced below these target thresholds*** - **Transmission assessment surveys (TAS)** are specifically designed to evaluate if the prevalence of a **neglected tropical disease (NTD)**, such as **lymphatic filariasis** or **trachoma**, has fallen below a critical threshold. - This assessment is crucial for determining whether to **stop mass drug administration (MDA)** campaigns and move towards post-MDA surveillance. *To provide reliable estimates of birth rate, death rate and infant mortality rate* - This function is typically associated with **demographic and health surveys (DHS)** or national vital statistics registration systems, not TAS. - These surveys focus on population-level health indicators and cannot determine infectious disease transmission levels. *For assessing primary immunization coverage* - Immunization coverage is assessed through specific **immunization coverage surveys (ICS)** or analysis of routine administrative data. - TAS is designed for infectious disease transmission, not vaccine uptake. *All of the options* - Only the first option accurately describes the specific purpose of a **Transmission Assessment Survey (TAS)**. - The other options relate to different types of public health surveys with distinct objectives.
Question 2: A male with hyperpigmentation tanner stage 5 presents with hypertension & precocious puberty. The causative defect is:
- A. 17 alpha hydroxylase deficiency
- B. 17 beta hydroxylase deficiency
- C. 11 beta hydroxylase deficiency (Correct Answer)
- D. 21 beta hydroxylase deficiency
Explanation: ***11 beta hydroxylase deficiency*** - This deficiency leads to an accumulation of **11-deoxycortisol** and **deoxycorticosterone (DOC)**, a potent mineralocorticoid [1]. - **DOC excess** causes **hypertension** and **hypokalemia**, while the shunting of precursors to the androgen pathway results in **precocious puberty** in males and virilization in females, along with **hyperpigmentation** due to increased ACTH [1]. *17 alpha hydroxylase deficiency* - This deficiency impairs the synthesis of **cortisol** and **sex steroids**, leading to an accumulation of **mineralocorticoid precursors (DOC and corticosterone)**. - Patients typically present with **hypertension**, **hypokalemia**, and **absent or rudimentary secondary sexual characteristics** (delayed puberty/sexual infantilism) due to the lack of androgens/estrogens, not precocious puberty. *17 beta hydroxylase deficiency* - This enzyme is crucial for the final step in sex steroid synthesis (e.g., testosterone from androstenedione). - A deficiency would lead to **impaired sexual development** and **ambiguous genitalia or undervirilization** in males, along with delayed puberty, completely contradictory to precocious puberty. *21 beta hydroxylase deficiency* - This is the **most common cause of congenital adrenal hyperplasia (CAH)**, leading to a profound deficiency in cortisol and aldosterone, and an excess in androgens [1]. - Patients typically present with **salt-wasting crises** (due to aldosterone deficiency) or **virilization** (due to androgen excess), but usually **hypotension** (due to salt wasting) or normal blood pressure, not hypertension alongside precocious puberty in this specific manner [1].
Question 3: A 25-year-old woman presents with vaginal discharge and vulvovaginal irritation. Wet mount shows motile trichomonads. She mentions having a similar infection 2 months ago treated with single-dose metronidazole. What is the most likely explanation for her current infection?
- A. Concurrent bacterial vaginosis
- B. Reinfection from untreated partner (Correct Answer)
- C. Metronidazole resistance
- D. Inadequate initial therapy
Explanation: ***Reinfection from untreated partner*** - **Trichomoniasis** is a sexually transmitted infection, and treatment of only one partner often leads to **reinfection** from the untreated partner. - The recurrence of symptoms within a short period (2 months) after successful treatment strongly suggests exposure to the pathogen again. *Concurrent bacterial vaginosis* - While **bacterial vaginosis** can cause discharge, it is a different infection, and its presence does not explain the recurrence of **trichomonads** found on the wet mount. - Co-occurrence is possible, but it doesn't account for the re-emergence of the *Trichomonas* organism. *Metronidazole resistance* - **Metronidazole resistance** in *Trichomonas vaginalis* is rare, especially after an initial successful treatment with a single dose. - Resistance is usually suspected if symptoms persist *despite* adequate treatment, rather than recurring after a period of being symptom-free. *Inadequate initial therapy* - A single-dose regimen of **metronidazole** is typically an effective and standard treatment for trichomoniasis. - If the initial treatment was truly inadequate, symptoms would likely have persisted or returned much sooner, rather than appearing 2 months later.
Question 4: The contraceptive which is contraindicated in DVT is?
- A. Barrier method
- B. Non hormonal IUCD
- C. Billing's method
- D. OCP (Correct Answer)
Explanation: ***OCP*** - **Oral contraceptive pills (OCPs)**, especially those containing estrogen, increase the risk of **venous thromboembolism (VTE)**, including deep vein thrombosis (DVT). - Estrogen promotes a **hypercoagulable state** by increasing clotting factors and decreasing natural anticoagulants. *Barrier method* - **Barrier methods** like condoms or diaphragms are non-hormonal and act physically to prevent sperm from reaching the egg. - They have **no systemic effects** on coagulation and are safe for individuals with DVT. *Non hormonal IUCD* - **Non-hormonal intrauterine contraceptive devices (IUCDs)**, such as copper IUCDs, prevent conception primarily by causing a local inflammatory reaction in the uterus. - They do not release hormones and therefore **do not affect coagulation** or increase DVT risk. *Billing's method* - The **Billing's ovulation method** (cervical mucus method) is a natural family planning technique based on observing changes in cervical mucus. - It involves no medications or devices and thus has **no impact on DVT risk**.
Question 5: Which of the following is not a long-acting reversible contraceptive method?
- A. Combined oral contraceptives (Correct Answer)
- B. Implanon
- C. Copper T
- D. Depo-Provera injection
Explanation: ***Combined oral contraceptives*** - While effective, **combined oral contraceptives** require daily adherence and are not typically classified as long-acting due to their need for frequent, consistent administration. - Their mechanism involves **exogenous hormones** that suppress ovulation and thicken cervical mucus, but their contraceptive effect relies on continuous daily intake. *Implanon* - **Implanon** (etonogestrel implant) is a **subdermal contraceptive implant** that provides effective contraception for up to three years. - It works by slowly releasing progestin, making it a **long-acting reversible contraceptive (LARC)**. *Copper T* - The **Copper T intrauterine device (IUD)** is a non-hormonal LARC that can prevent pregnancy for **up to 10 years**. - It acts by creating an inflammatory reaction in the uterus that is toxic to sperm and eggs, preventing fertilization. *Depo-Provera injection* - The **Depo-Provera injection** (medroxyprogesterone acetate) is a progestin-only contraceptive given every **3 months**. - While it offers extended protection, it is **not universally classified as a LARC** by major guidelines (WHO, ACOG, CDC), which typically reserve this designation for IUDs and implants that do not require regular clinic visits.
Question 6: The Image shows the growth curve of different organs with age. Identify A in the graph.
- A. Brain Growth
- B. Somatic Growth
- C. Lymphoid Growth (Correct Answer)
- D. Gonadal Growth
- E. Reproductive Growth
Explanation: ***Lymphoid Growth*** - Curve 'A' shows a rapid increase in size during **childhood**, peaking around **10-12 years of age**, and then declining to adult levels. - This pattern is characteristic of **lymphoid tissues** (e.g., thymus, lymph nodes, tonsils), which are larger relative to body size in childhood and undergo involution post-puberty. *Brain Growth* - **Neural growth** (like the brain) typically shows very rapid growth in early childhood, reaching close to adult size by about 6-7 years of age, and then leveling off. - Curve 'A' continues to grow rapidly much longer than expected for brain development and then shows a distinct decline. *Somatic Growth* - **General somatic growth** (e.g., body as a whole) shows a sigmoid curve, with rapid growth in infancy and adolescence, and a plateau in adulthood. - Curve 'A' peaks significantly above the 100% mark and then declines, which is not characteristic of overall somatic growth. *Gonadal Growth* - **Genital (gonadal) growth** remains relatively flat until puberty, after which it experiences a rapid increase. - Curve 'A' shows significant growth in early childhood and a peak before puberty, which is inconsistent with typical gonadal development. *Reproductive Growth* - **Reproductive growth** follows the same pattern as gonadal growth, remaining minimal until puberty with subsequent rapid increase. - Curve 'A' demonstrates early childhood growth and pre-pubertal peak, which does not match the reproductive growth pattern.
Question 7: A 14-year-old victim of sexual assault with 22 weeks gestation has been brought for Medical Termination of Pregnancy (MTP). Which of the following statements is true?
- A. One doctor is involved
- B. MTP done in 2nd trimester only when mother's life is in danger
- C. MTP can be carried out up to 24 weeks (Correct Answer)
- D. MTP cannot be more than 20 weeks
Explanation: ***MTP can be carried out up to 24 weeks*** - The **Medical Termination of Pregnancy (Amendment) Act, 2021**, allows termination of pregnancy up to **24 weeks** for certain vulnerable groups, including survivors of sexual assault and minors. - As a 14-year-old victim of sexual assault, she falls under the category which permits MTP up to 24 weeks. *One doctor is involved* - For pregnancies between 12 and 20 weeks, the opinion of **two registered medical practitioners** is required for MTP. - Beyond 20 weeks up to 24 weeks, as in this case, the opinion of **two registered medical practitioners** is also mandatory. *MTP done in 2nd trimester only when mother's life is in danger* - While danger to the mother's life is a valid reason for MTP, the **MTP Act 2021** has expanded the grounds for MTP in the second trimester (beyond 12 weeks) to include other categories like **sexual assault survivors** and **minors**, even if the mother's life is not immediately in danger. - The primary consideration here is the **vulnerability** of the pregnant person, not solely imminent danger to life. *MTP cannot be more than 20 weeks* - This statement is incorrect as per the **Medical Termination of Pregnancy (Amendment) Act, 2021**. - The Act raised the upper gestation limit from 20 to **24 weeks** for specific categories of women, including victims of sexual assault and minors, aligning with the current case.
Question 8: A sexually active 16-year-old presents for STI screening with recent assault history, multiple partners, inconsistent condom use. Which comprehensive prevention strategy is most appropriate?
- A. HPV vaccination, counseling, PrEP evaluation, and regular screening (Correct Answer)
- B. Condoms and annual screening
- C. Single STI screen and treatment if needed
- D. Abstinence counseling only
Explanation: ***HPV vaccination, counseling, PrEP evaluation, and regular screening*** - This option offers a **comprehensive approach** addressing multiple risk factors and potential exposures, including **vaccination** for HPV, **counseling** for risk reduction, **PrEP evaluation** for HIV prevention due to multiple partners and inconsistent condom use, and **regular screening** for early detection. - The patient's history of **sexual assault**, **multiple partners**, and **inconsistent condom use** necessitates a multi-faceted prevention strategy that goes beyond basic screening. *Condoms and annual screening* - While **condoms** are essential for preventing STIs, and **annual screening** is important, this strategy is not comprehensive enough given the patient's high-risk profile (multiple partners, inconsistent condom use, sexual assault history). - It omits important preventive measures like **HPV vaccination** and consideration for **PrEP**, which are crucial for this patient's age and risk factors. *Single STI screen and treatment if needed* - A **single STI screen** is insufficient as it only provides a snapshot of current infections and does not incorporate **prevention strategies** for future encounters or address the ongoing risk factors. - This approach fails to provide **proactive protection** through vaccination or PrEP and does not include ongoing counseling for risk reduction. *Abstinence counseling only* - While **abstinence** is the most effective way to prevent STIs, relying solely on **abstinence counseling** is often unrealistic and insufficient for a sexually active individual, especially one with a history of sexual assault and current high-risk behaviors. - This option completely disregards the need for **medical interventions** like vaccination, PrEP, and regular screening that are vital for this patient's health.
Question 9: What is the preferred method of contraception for a female with a family history of ovarian cancer?
- A. Progestin-only pills (POP)
- B. Copper intrauterine device (Cu IUCD)
- C. Condoms
- D. Combined oral contraceptive pills (OCP) (Correct Answer)
Explanation: ***Combined oral contraceptive pills (OCP)*** - **OCPs** have been shown to significantly **reduce the risk of ovarian cancer by 30-50%**, with the protective effect increasing with duration of use. - This protection is attributed to **suppression of ovulation**, reducing repetitive ovulation-related epithelial damage and inflammation that contributes to ovarian cancer development. - The benefit **persists for years after discontinuation** and is particularly important for individuals with a family history of ovarian cancer, as it addresses a key modifiable risk factor. - **First-line recommendation** for contraception in women with family history of ovarian cancer. *Progestin-only pills (POP)* - While **POPs** are effective contraceptives and generally safe, they do **not offer the same well-established protective effect against ovarian cancer** as combined hormonal contraceptives. - Their primary mechanism is through thickening cervical mucus and suppressing ovulation, without the estrogen component. - Evidence for ovarian cancer protection is limited compared to combined OCPs. *Copper intrauterine device (Cu IUCD)* - The **Cu IUCD** provides highly effective contraception by creating a local inflammatory response in the uterus that is spermicidal. - It is a **non-hormonal method** and therefore does not impact the risk of ovarian cancer. - Excellent contraceptive option for other indications, but not specifically protective against ovarian cancer. *Condoms* - **Condoms** primarily prevent pregnancy by blocking sperm from reaching the egg and are effective in preventing sexually transmitted infections. - They are a **barrier method** and provide no hormonal protection against ovarian cancer. - Useful for STI prevention but not relevant to ovarian cancer risk reduction.
Question 10: What is the age range of adolescence?
- A. 10-14 years
- B. 6-10 years
- C. 14-20 years
- D. 10-19 years (Correct Answer)
Explanation: ***10-19 years*** - This is the **universally accepted definition of adolescence** by the **World Health Organization (WHO)**, which is the international standard used globally for medical education and practice. - This range encompasses all three stages: **early adolescence (10-13 years)**, **middle adolescence (14-16 years)**, and **late adolescence (17-19 years)**. - It captures the complete spectrum of **pubertal development, physical maturation, cognitive development, and psychosocial changes** characteristic of adolescence. - Recognized by major pediatric bodies including the **Indian Academy of Pediatrics (IAP)**, **UNICEF**, and **American Academy of Pediatrics (AAP)**. *14-20 years* - This range excludes **early adolescence (10-13 years)**, missing the critical onset of puberty and early developmental changes. - While it extends to 20 years, it omits a significant portion of the adolescent period recognized by WHO. - Not a standard medical definition used in pediatric practice or competitive examinations. *10-14 years* - This represents only **early adolescence**, not the complete age range. - Misses middle and late adolescence, which are crucial periods for identity formation and psychosocial development. - Too narrow to be considered the full adolescent period. *6-10 years* - This age range corresponds to **middle childhood**, not adolescence. - Occurs before the onset of puberty and the hormonal changes that define adolescence. - Children in this stage are in the **concrete operational stage** of cognitive development, distinct from adolescent development.
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