MCCQE Part I Contraception and sexual health Questions: 10 Free Practice MCQs

Ten MCCQE Part I-style contraception and sexual health questions with the answer and the reasoning behind it. They come from the CA.med bank, which has 27 contraception and sexual health questions and many more across every topic.

Free timed mock exam

1. 1 / 10

   A 29-year-old woman is exclusively breastfeeding her 6-week-old infant. She wants a contraceptive method and is concerned about anything that might affect her milk supply. Her physician considers a progestin-only pill.

   What does the SOGC position statement on progestin-only contraception say about this choice?

   • A. Progestin-only pills are contraindicated while breastfeeding
   • B. Progestin-only pills are useful only after menopause
   • C. Progestin-only pills are oestrogen-free and are particularly useful for recently postpartum or breastfeeding women
   • D. Progestin-only pills have a higher typical-use failure rate than depot medroxyprogesterone acetate
   Show answer

   Answer: C. Progestin-only pills are oestrogen-free and are particularly useful for recently postpartum or breastfeeding women

   Why: The SOGC position statement notes that progestin-only pills are oestrogen-free and are therefore particularly useful when oestrogen is contraindicated or less appropriate, including in recently postpartum, breastfeeding or perimenopausal women. The statement also notes that the older advice to take the pill at exactly the same time each day is not supported by the evidence. Reported typical-use failure rates are lower for these pills than for depot medroxyprogesterone acetate, so a progestin-only pill is a suitable option for this breastfeeding patient.

   • A. The statement identifies recently postpartum and breastfeeding women as a group for whom these pills are particularly useful rather than contraindicated.
   • B. Perimenopausal women are one group mentioned, but the statement also names recently postpartum and breastfeeding women among those who benefit.
   • D. Reported typical-use failure rates are lower for progestin-only pills than for depot medroxyprogesterone acetate, so this comparison is reversed.

   Sources: SOGC Position Statement: Managing Bleeding Patterns Associated with Progestin-Only Contraceptives (2025)

2. 2 / 10

   A 26-year-old woman has a laboratory-confirmed chlamydia infection. She asks whether the result will be shared beyond her care team and whether it must be reported.

   What does PHAC guidance state about reporting?

   • A. Chlamydia infections are nationally notifiable and reportable to local public health authorities in all provinces and territories
   • B. Reporting is required only for lymphogranuloma venereum
   • C. Reporting is voluntary and depends on the consent of the patient
   • D. Reporting is required only in provinces with a specific regulation, and only with the patient's written consent to share it
   Show answer

   Answer: A. Chlamydia infections are nationally notifiable and reportable to local public health authorities in all provinces and territories

   Why: PHAC states that C. trachomatis infections are nationally notifiable and are reportable by laboratories, physicians and designated health professionals to local public health authorities in all provinces and territories. Notification is a statutory duty that does not depend on the consent of the patient. Some provinces and territories distinguish lymphogranuloma venereum from other genotypes in their surveillance data, but reporting is not limited to that genotype and is not restricted to provinces with a specific regulation.

   • B. Some provinces distinguish lymphogranuloma venereum from other genotypes in their surveillance data, but reporting does not apply only to that genotype.
   • C. Notification is a statutory duty, so it does not rest on the consent of the patient.
   • D. The reporting requirement applies across all provinces and territories, not only where a specific regulation exists.

   Sources: Public Health Agency of Canada: Canadian Guidelines on Sexually Transmitted Infections, Chlamydia and LGV guide, treatment and follow-up

3. 3 / 10

   A 22-year-old woman presents to a walk-in clinic 36 hours after unprotected intercourse. She is not on any regular contraception. She is currently taking no medications. Her last menstrual period was 12 days ago (cycle length 28 days). She is not breastfeeding. She has no contraindications to hormonal therapy.

   What is the most appropriate emergency contraception option?

   • A. Combined OCP, Yuzpe regimen (2 pills, repeated in 12 hours)
   • B. Ulipristal acetate (Ella) is preferred over levonorgestrel at all time points
   • C. Levonorgestrel 1.5 mg orally (Plan B / emergency contraceptive pill)
   • D. Copper IUD insertion, it is the only effective option beyond 24 hours
   Show answer

   Answer: C. Levonorgestrel 1.5 mg orally (Plan B / emergency contraceptive pill)

   Why: Emergency contraception (EC) options in Canada: (1) Levonorgestrel 1.5 mg (Plan B), OTC, effective 0-72h (89% if within 24h, decreases with time), no prescription needed; (2) Ulipristal acetate 30 mg (ella), requires prescription, superior 72-120h; (3) Copper IUD, most effective, inserted within 5 days, good for ongoing contraception. EC does NOT disrupt an existing pregnancy. Advance prescription of EC to at-risk patients is recommended (proactive counselling). Bridge to ongoing contraception.

   • A. The Yuzpe regimen (high-dose combined OCP) is a historical emergency contraception method with lower efficacy and higher side effect profile (nausea 50%) than levonorgestrel EC. It is rarely used today given superior alternatives.
   • B. Ulipristal acetate (ella) is as effective as levonorgestrel at 0-72 hours and is superior at 72-120 hours. However, it requires a prescription in Canada and is not universally available. At 36 hours, levonorgestrel is highly effective and more accessible for most patients.
   • D. Copper IUD is the most effective emergency contraception (>99% effective up to 5 days post-coitus) and provides ongoing long-term contraception. However, it requires a clinic visit and insertion, levonorgestrel EC is appropriate first-line here given its availability and the patient's stated preference for immediate oral treatment.

   Sources: Society of Obstetricians and Gynaecologists of Canada (SOGC) No. 280, Emergency Contraception 2012; Canadian Pharmacists Association, Plan B prescribing info

4. Like these? CA.med has a bank of 1500 questions, plus timed mock exams. Free to start: App Store · Google Play

5. 4 / 10

   A 34-year-old woman and her partner have completed their family and are considering permanent contraception. She asks whether tubal ligation and vasectomy are covered by provincial health insurance.

   According to the SOGC brief on contraception coverage, how are sterilisation procedures funded?

   • A. Both procedures are paid for entirely by the patient
   • B. Sterilisation such as tubal ligation and vasectomy is covered by provincial health insurance plans
   • C. Only vasectomy is covered, and tubal ligation is not
   • D. Neither procedure is covered because both are elective and must be paid for privately
   Show answer

   Answer: B. Sterilisation such as tubal ligation and vasectomy is covered by provincial health insurance plans

   Why: The SOGC brief on universal coverage of prescription contraception notes that sterilisation, such as vasectomies and tubal ligations, is covered by provincial health insurance plans, but adds that these procedures are only appropriate for people and couples who have finished growing their families. Most taxpayer-funded health plans in Canada do not cover prescription contraception apart from sterilisation, which is one reason the SOGC recommends universal coverage.

   • A. The SOGC brief states that provincial health insurance plans cover sterilisation, so patients do not pay for it in full.
   • C. The brief describes both vasectomy and tubal ligation as covered, so singling out one is incorrect.
   • D. The brief distinguishes these covered procedures from prescription contraception, which is generally not covered.

   Sources: SOGC brief - Universal coverage of prescription contraception in Canada (2023)

6. 5 / 10

   A 31-year-old woman is considering an injectable contraceptive after the birth of her second child. She dislikes taking a daily pill and asks how often the injection has to be given.

   According to the SOGC position statement on progestin-only contraception, how is depot medroxyprogesterone acetate administered in Canada?

   • A. Intramuscularly every 12 to 13 weeks
   • B. Intramuscularly every 4 weeks
   • C. Subcutaneously every 6 months
   • D. Orally once weekly
   Show answer

   Answer: A. Intramuscularly every 12 to 13 weeks

   Why: The SOGC position statement on managing bleeding patterns with progestin-only contraceptives notes that depot medroxyprogesterone acetate is currently the only injectable contraceptive available in Canada and is administered intramuscularly every 12 to 13 weeks. A subcutaneous formulation exists but is not marketed in Canada. Its main side effect is disruption of menstrual bleeding, with irregular bleeding or amenorrhoea causing some users to stop the method, so counselling about expected bleeding changes supports continuation.

   • B. A four-week interval would give the injection far more often than the recommended schedule, which is measured in weeks within each quarter.
   • C. A subcutaneous formulation exists but is not available in Canada, and the dosing interval is measured in weeks rather than months.
   • D. Depot medroxyprogesterone acetate is an injectable product, not an oral preparation taken once a week.

   Sources: SOGC Position Statement: Managing Bleeding Patterns Associated with Progestin-Only Contraceptives (2025)

7. 6 / 10

   A 30-year-old woman finds it difficult to remember a daily pill and dislikes the idea of a device inside the uterus. She would prefer a method that is given at infrequent visits by a health professional.

   Which method is given by intramuscular injection every 12 to 13 weeks?

   • A. Etonogestrel subdermal implant
   • B. Combined contraceptive patch
   • C. Annual vaginal ring
   • D. Depot medroxyprogesterone acetate
   Show answer

   Answer: D. Depot medroxyprogesterone acetate

   Why: Depot medroxyprogesterone acetate is the injectable progestin contraceptive available in Canada and is given into the muscle every 12 to 13 weeks, which is four times a year. Because it contains no oestrogen and does not depend on a daily routine, it suits women who find pills, patches or rings difficult to manage. The subdermal implant, the patch and the vaginal ring all follow different schedules.

   • A. That is a flexible rod placed under the skin of the upper arm which provides contraception for up to three years.
   • B. The patch is applied to the skin and changed weekly, so it does not match the schedule she has asked for.
   • C. The ring is worn in the vagina for three weeks at a time and needs no injection.

   Sources: SOGC Position Statement - Managing bleeding patterns associated with progestin-only contraception; SOGC SexAndU.ca - Hormonal Contraception

8. 7 / 10

   A 27-year-old woman in British Columbia asks her family physician whether she must pay for her contraceptive pill. A colleague mentions that one province was the first to make prescription contraception free.

   Which province was the first to provide free prescription contraception, and when did this start?

   • A. Alberta, on January 1, 2022
   • B. Quebec, on September 1, 2021
   • C. Nova Scotia, on April 1, 2024
   • D. British Columbia, on April 1, 2023
   Show answer

   Answer: D. British Columbia, on April 1, 2023

   Why: The SOGC brief on universal coverage of prescription contraception states that British Columbia became the first Canadian province to make prescription birth control free to women as of April 1, 2023, and that about 188,000 people accessed free contraceptive methods after the change. Manitoba's government later indicated its intent to make prescription birth control free, and a private member's bill on coverage was presented in Ontario. The SOGC recommends a universal federal policy so that access does not depend on where a person lives.

   • A. The SOGC brief names a different province as the first to fund prescription contraception.
   • B. Quebec is not the province identified in the SOGC brief as the first to make prescription contraception free.
   • C. The brief describes a province that acted in 2023, not Nova Scotia in 2024.

   Sources: SOGC brief - Universal coverage of prescription contraception in Canada (2023)

9. 8 / 10

   A 6-year-old girl is seen with vaginal discharge and is found to have Chlamydia trachomatis infection. There is no known history of consensual exposure and the infection appears to have been acquired recently.

   According to the Public Health Agency of Canada guidelines, what should the clinician consider and do?

   • A. Treat with doxycycline and arrange routine follow up in one month
   • B. Regard the infection as perinatally acquired and take no further action at all
   • C. Consider sexual abuse and report the suspected abuse to the local child protection agency
   • D. Defer testing of family members until the child is 12 years old
   Show answer

   Answer: C. Consider sexual abuse and report the suspected abuse to the local child protection agency

   Why: The Public Health Agency of Canada chlamydia guide states that when a chlamydial infection is diagnosed in any prepubertal child, sexual abuse should be considered. It also states that suspected sexual abuse of children must be reported to the local child protection agency. Simply treating the infection, assuming perinatal acquisition, or deferring assessment of household members does not meet this obligation.

   • A. Treatment alone does not address the guide's instruction to consider sexual abuse when chlamydia is diagnosed in a prepubertal child.
   • B. Perinatally acquired C. trachomatis can persist for up to three years, but the guide still directs clinicians to consider sexual abuse in any prepubertal child with a chlamydial infection.
   • D. There is no basis for deferring family assessment to age 12, because the guide directs reporting of suspected abuse.

   Sources: Public Health Agency of Canada (PHAC). PHAC Canadian STI guidelines - Chlamydia/LGV treatment and follow-up (incl. pregnancy regimens).

10. 9 / 10

    A 26-year-old woman who is not pregnant and not lactating tests positive for Chlamydia trachomatis after presenting with cervicitis. She has no drug allergies.

    According to the Public Health Agency of Canada guidelines, which treatment is recommended?

    • A. Doxycycline 100 mg orally twice daily for 3 days
    • B. Azithromycin 500 mg orally in a single dose
    • C. Levofloxacin 500 mg orally once daily for 14 days, as fluoroquinolones are preferred
    • D. Doxycycline 100 mg orally twice daily for 7 days or azithromycin 1 g orally in a single dose
    Show answer

    Answer: D. Doxycycline 100 mg orally twice daily for 7 days or azithromycin 1 g orally in a single dose

    Why: The Public Health Agency of Canada chlamydia guide lists doxycycline 100 mg PO BID for 7 days or azithromycin 1 g PO in a single dose as the preferred treatment for anogenital chlamydia in non-pregnant, non-lactating adults. Levofloxacin 500 mg once daily for 7 days is an alternative. Azithromycin may be preferred when poor compliance is anticipated. A shortened doxycycline course and a 500 mg azithromycin dose do not match the recommended regimens.

    • A. The recommended duration of doxycycline is 7 days, not 3 days.
    • B. The single-dose azithromycin regimen in the national guide uses 1 g, not 500 mg.
    • C. Levofloxacin is listed as an alternative regimen at 500 mg once daily for 7 days, not 14 days.

    Sources: Public Health Agency of Canada (PHAC). PHAC Canadian STI guidelines - Chlamydia/LGV treatment and follow-up (incl. pregnancy regimens).

11. 10 / 10

    A 24-year-old woman is 6 weeks postpartum and is not breastfeeding. She asks to start the combined oral contraceptive pill and wants to understand how it works before she begins taking it.

    According to SexAndU.ca (SOGC), how does the oral contraceptive pill prevent pregnancy?

    • A. It works only by thickening the cervical mucus, without any effect on ovulation or the uterine lining
    • B. It prevents the ovary from releasing an egg, thickens the cervical mucus and changes the uterine lining
    • C. It destroys sperm in the vagina
    • D. It prevents implantation only
    Show answer

    Answer: B. It prevents the ovary from releasing an egg, thickens the cervical mucus and changes the uterine lining

    Why: The SexAndU.ca (SOGC) resource states that the oral contraceptive pill works by preventing the ovary from releasing an egg, thickening the cervical mucus so that sperm find it harder to reach the egg, and changing the lining of the uterus so that implantation is difficult. Any single one of these mechanisms therefore understates how the method works, and the pill does not act as a vaginal spermicide. The resource adds that the pill is suitable for most healthy women regardless of age and can be used long-term.

    • A. Cervical mucus change is only one of three mechanisms, alongside prevention of ovulation and alteration of the uterine lining.
    • C. The pill does not act as a spermicide in the vagina; its effects are on ovulation, cervical mucus and the endometrium.
    • D. Changes in the uterine lining are a secondary effect, and the primary mechanism is prevention of ovulation.

    Sources: SexAndU.ca (SOGC): Hormonal Contraception

Exam-style questions written by MedHub for practice. They are not official exam questions.