Barrier Methods Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Barrier Methods. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Barrier Methods Indian Medical PG Question 1: The best method of evacuation of a missed abortion in uterus of more than 12 weeks:
- A. Intramuscular prostaglandin (15 methyl PGF2a)
- B. Oxytocin infusion
- C. Suction evacuation
- D. Prostaglandin E1 vaginal misoprostol followed by evacuation of the uterus (Correct Answer)
Barrier Methods Explanation: ***Prostaglandin E1 vaginal misoprostol followed by evacuation of the uterus***
- For **missed abortions** beyond 12 weeks of gestation, **misoprostol** (a prostaglandin E1 analogue) is highly effective in inducing cervical ripening and uterine contractions.
- This step facilitates the subsequent **evacuation of retained products of conception** (ERPC) via suction or manual vacuum aspiration, a safer approach than direct instrumental evacuation in a less softened cervix.
*Intramuscular prostaglandin (15 methyl PGF2a)*
- While intramuscular prostaglandins can induce uterine contractions, **15-methyl PGF2a** is associated with significant gastrointestinal side effects like nausea, vomiting, and diarrhea.
- Its use often results in a less controlled induction compared to vaginal misoprostol, which offers better patient tolerance and titration.
*Oxytocin infusion*
- **Oxytocin** is primarily used to induce labor in viable pregnancies or to manage postpartum hemorrhage; its effectiveness in inducing uterine contractions for missed abortion before term is limited.
- The uterus typically lacks sufficient oxytocin receptors to respond effectively to an infusion for expulsion of a missed abortion before the third trimester.
*Suction evacuation*
- **Direct suction evacuation** beyond 12 weeks of gestation without prior cervical preparation carries a higher risk of cervical injury and uterine perforation.
- The larger fetal size and less pliable cervix at this stage necessitate a controlled induction to reduce complications associated with instrumental removal.
Barrier Methods Indian Medical PG Question 2: Which drug is used as a spermicidal cream in contraceptives?
- A. Gossypol
- B. Clomiphene
- C. Nonoxynol-9 (Correct Answer)
- D. Centchroman
Barrier Methods Explanation: **Nonoxynol-9**
- **Nonoxynol-9** is a common **spermicide** used in many contraceptive products like creams, foams, and gels.
- It works by damaging the **sperm cell membrane**, effectively immobilizing and killing sperm.
*Gossypol*
- **Gossypol** is a natural compound found in cotton plants that has been studied for its potential as a **male contraceptive**.
- It works by inhibiting **spermatogenesis** but has not been approved for widespread use due to toxicity concerns like **hypokalemia**.
*Clomiphene*
- **Clomiphene** is a **selective estrogen receptor modulator (SERM)** used to induce ovulation in women who are infertile due to anovulation.
- It stimulates the release of **gonadotropins** (FSH and LH) from the pituitary gland, leading to follicular development.
*Centchroman*
- **Centchroman** (also known as Ormeloxifene) is a **non-steroidal oral contraceptive** used in India.
- It acts as a **selective estrogen receptor modulator** in the uterus, disrupting the implantation process.
Barrier Methods Indian Medical PG Question 3: Which of the following reduces the efficacy of oral contraceptives?
- A. Griseofulvin (Correct Answer)
- B. Disulfiram
- C. Erythromycin
- D. Cimetidine
Barrier Methods Explanation: ***Griseofulvin***
- **Griseofulvin** is an antifungal agent known to induce liver enzymes, specifically the **cytochrome P450 system**.
- Enzyme induction accelerates the metabolism and clearance of **oral contraceptives**, leading to lower plasma concentrations and reduced efficacy.
*Erythromycin*
- **Erythromycin** is a macrolide antibiotic that typically inhibits liver enzymes rather than inducing them.
- While it can interfere with the metabolism of some drugs, it usually **increases** rather than decreases the plasma levels of co-administered medications, and is not known to reduce oral contraceptive efficacy.
*Disulfiram*
- **Disulfiram** is used to treat chronic alcoholism and inhibits aldehyde dehydrogenase.
- It does not significantly interact with the metabolism of **oral contraceptives** via the cytochrome P450 system or other mechanisms that would reduce their efficacy.
*Cimetidine*
- **Cimetidine** is an H2 receptor antagonist that is known to inhibit cytochrome P450 enzymes.
- This inhibition would likely **increase** the plasma concentration of drugs metabolized by these enzymes, such as oral contraceptives, rather than reducing their efficacy.
Barrier Methods Indian Medical PG Question 4: Which of the following is an example of a barrier method of contraception?
- A. Hormonal contraceptive
- B. IUD
- C. Condom (Correct Answer)
- D. Sterilization
Barrier Methods Explanation: ***Condom***
- A **condom** acts as a physical barrier, preventing sperm from reaching the egg.
- Both male and female condoms are examples of **barrier contraception**.
*Hormonal contraceptive*
- **Hormonal contraceptives** work by preventing ovulation, thickening cervical mucus, or altering the uterine lining, not by physically blocking sperm.
- Examples include oral contraceptive pills, patches, and vaginal rings.
*IUD*
- An **intrauterine device (IUD)**, whether hormonal or copper, primarily prevents conception by creating an inhospitable environment for sperm or by preventing implantation.
- It is a long-acting reversible contraceptive, not a barrier method.
*Sterilization*
- **Sterilization** (e.g., tubal ligation or vasectomy) is a permanent method of contraception that prevents the transport of eggs or sperm, respectively.
- It does not involve a physical barrier to block sperm during intercourse.
Barrier Methods Indian Medical PG Question 5: Which of the following cannot be used as Post-coital contraceptive?
- A. A device that prevents fertilization and implantation (e.g., CuT 200)
- B. A hormonal method that disrupts ovulation (e.g., high-dose estrogens)
- C. A drug primarily used for endometriosis and fibrocystic breast disease (e.g., Danazol) (Correct Answer)
- D. A progesterone receptor blocker used within 72 hours (e.g., RU 486)
Barrier Methods Explanation: ***A drug primarily used for endometriosis and fibrocystic breast disease (e.g., Danazol)***
- **Danazol** is an **androgen derivative** primarily used to treat endometriosis and fibrocystic breast disease due to its *anti-estrogenic* and *anti-progestational* effects.
- It does not have a primary role as a **post-coital contraceptive** and is not approved for this indication.
*A device that prevents fertilization and implantation (e.g., CuT 200)*
- The **CuT 200 (copper T intrauterine device)** can be inserted as an **emergency contraceptive** within five days of unprotected intercourse.
- It works by causing a **spermicidal effect** within the uterus and preventing implantation if fertilization occurs.
*A hormonal method that disrupts ovulation (e.g., high-dose estrogens)*
- High-dose **estrogens alone** or in combination with progesterone can be used as **emergency contraception** (e.g., the Yuzpe method).
- These hormones disrupt the hormonal cascade necessary for **ovulation** or alter the endometrial lining to prevent implantation.
*A progesterone receptor blocker used within 72 hours (e.g., RU 486)*
- **RU 486 (Mifepristone)** is a **progesterone receptor blocker** that can be used as an emergency contraceptive within 72 (or sometimes up to 120) hours of unprotected intercourse.
- It works by **delaying or inhibiting ovulation** and by altering the endometrium, making it unsuitable for implantation.
Barrier Methods Indian Medical PG Question 6: A woman comes after 96 hours post coitus. Best contraceptive of choice is?
- A. Progesterone only pills
- B. OCP
- C. IUCD (Correct Answer)
- D. Mifepristone
Barrier Methods Explanation: ***IUCD***
- An **intrauterine contraceptive device (IUCD)** can be inserted up to **5 days (120 hours)** after unprotected intercourse or within 5 days of the earliest estimated ovulation.
- It is the **most effective form of emergency contraception**, offering approximately **99% efficacy**.
- Provides **immediate ongoing contraception** after insertion, making it the optimal choice at 96 hours post-coitus.
*Progesterone only pills*
- **Progesterone-only emergency contraceptive pills** (e.g., levonorgestrel) are most effective when taken within **72 hours (3 days)** of unprotected intercourse.
- At **96 hours**, their efficacy is **significantly reduced**, making them suboptimal compared to IUCD.
*OCP*
- **Combined oral contraceptive pills (OCPs)** used for emergency contraception (Yuzpe method) are less effective and have more side effects than other emergency contraceptive methods.
- Their effectiveness also significantly declines after **72 hours** post-coitus.
*Mifepristone*
- **Mifepristone** is an **anti-progestin** that can be used for emergency contraception within **120 hours (5 days)** of unprotected intercourse.
- While effective within this timeframe at **96 hours**, the **IUCD remains superior** due to its higher efficacy (>99% vs ~98%) and provision of ongoing contraception.
Barrier Methods Indian Medical PG Question 7: All of the following are postcoital contraception methods except?
- A. IUD
- B. Levonorgestrel
- C. Mifepristone
- D. Barrier methods (Correct Answer)
Barrier Methods Explanation: ***Barrier methods***
- **Barrier methods** like condoms or diaphragms are used *during* intercourse to prevent pregnancy and STIs.
- They are not a form of **postcoital contraception** as they do not act *after* unprotected sex has occurred.
*Mifepristone*
- **Mifepristone** can be used as an **emergency contraceptive** by delaying or inhibiting ovulation, or by altering the endometrium to prevent implantation.
- It works *after* unprotected intercourse and is an effective form of **postcoital contraception**.
*IUD*
- The **copper intrauterine device (IUD)** can be inserted as an **emergency contraceptive** up to 5 days after unprotected intercourse.
- It prevents pregnancy primarily by creating a **spermicidal inflammatory reaction** in the uterus, making it unsuitable for implantation.
*Levonorgestrel*
- **Levonorgestrel-only pills** are a common form of **emergency contraception**, sometimes known as the "morning-after" pill.
- They work by **delaying or inhibiting ovulation** and are effective when taken *within 72 hours* of unprotected sex.
Barrier Methods Indian Medical PG Question 8: Contraceptive of choice in a woman with Rheumatic heart disease.
- A. Progesterone only pills
- B. IUCD (Correct Answer)
- C. Condom with spermicidal jelly
- D. OCPs
Barrier Methods Explanation: ***IUCD***
- **Intrauterine contraceptive devices (IUCDs)** are highly effective and do not involve systemic hormones, making them safe for women with **rheumatic heart disease**.
- Both copper and hormonal IUCDs can be used, as they pose no additional risk of **thromboembolism** or worsen cardiac function.
*Progesterone only pills*
- While generally safer than combined oral contraceptives for women with cardiac issues, **progesterone-only pills** still carry a slight risk of **thrombosis**, especially in women with certain heart conditions.
- Their effectiveness can be slightly lower than IUCDs, and adherence to strict daily timing is crucial for optimal contraception.
*Condom with spermicidal jelly*
- **Condoms with spermicidal jelly** are a barrier method and do not pose any direct risk to a woman with rheumatic heart disease.
- However, they have a significantly **higher failure rate** compared to highly effective methods like IUCDs, making them less ideal as a primary contraceptive for a condition where pregnancy could be high-risk.
*OCPs*
- **Combined oral contraceptive pills (OCPs)** containing both estrogen and progestin are generally **contraindicated** in women with rheumatic heart disease, particularly those with valvular lesions or a history of **embolism**.
- Estrogen increases the risk of **thromboembolic events**, which can be dangerous for individuals with compromised cardiac function.
Barrier Methods Indian Medical PG Question 9: The contraceptive which is contraindicated in DVT is?
- A. Barrier method
- B. Non hormonal IUCD
- C. Billing's method
- D. OCP (Correct Answer)
Barrier Methods 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**.
Barrier Methods Indian Medical PG Question 10: Best long-acting reversible contraception (LARC) that can be inserted immediately postpartum in a lactating mother is:
- A. Post Partum IUCD (Correct Answer)
- B. Depot provera
- C. Combined oral contraceptive pills (OCPs)
- D. Calendar method
Barrier Methods Explanation: ***Post Partum IUCD***
- **Intrauterine contraceptive devices (IUCDs)** are highly effective long-acting reversible contraceptives (LARC) that can be inserted **immediately postpartum** (within 10 minutes of placental delivery) or within 48 hours of delivery.
- They are **safe for breastfeeding mothers** as copper IUCDs are non-hormonal and levonorgestrel-releasing IUCDs (LNG-IUS) have only localized hormonal effects.
- **WHO MEC Category 1** for breastfeeding women, with no interference with lactation or infant growth.
- Provide immediate, long-term protection (3-10 years depending on type) with high continuation rates.
*Depot provera*
- **Depot medroxyprogesterone acetate (DMPA)** is a progestin-only injectable contraceptive that is also safe for breastfeeding mothers (WHO MEC Category 1 after 6 weeks postpartum).
- However, it is **not a LARC method that can be inserted immediately postpartum** - it requires injection and has a 3-month duration requiring repeat visits.
- While effective for lactating women, it cannot be given in the immediate postpartum period like IUCD insertion.
*Combined oral contraceptive pills (OCPs)*
- **Combined OCPs** contain estrogen, which can **reduce milk supply** and alter milk composition, especially in the early postpartum period.
- **WHO MEC Category 3-4** for breastfeeding women (depending on timing postpartum), contraindicated in the first 6 weeks and generally avoided during lactation.
- Not recommended as first-line contraception for lactating mothers.
*Calendar method*
- The **calendar method** is a natural family planning method that relies on tracking menstrual cycles to predict fertile windows.
- It is **highly unreliable** in the postpartum period due to unpredictable ovulation and irregular cycles, especially during breastfeeding (lactational amenorrhea makes cycle tracking impossible).
- Not an effective contraceptive method for postpartum women.
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