Contraception and Family Planning Practice Questions

Q: A 32-year-old woman presents for contraception counseling. Which of the following is a contraindication to the use of combined oral contraceptive pills?

Migraine with aura. ***Migraine with aura*** - Combined oral contraceptive pills are contraindicated in patients with migraine with aura due to a significant increase in the risk of **ischemic stroke**. - The use of **estrogen** in these patients is associated with vascular events, leading to a categorization of **Category 4 (unacceptable health risk)** by the CDC Medical Eligibility Criteria. *Iron deficiency anemia* - COCPs are often beneficial for patients with iron deficiency anemia because they reduce the duration and volume of **menstrual blood loss**. - This is not a contraindication; in fact, the **progestin component** helps to regulate and often decrease menses. *Polycystic ovarian syndrome* - COCPs are a first-line treatment for managing symptoms of PCOS, such as **menstrual irregularities**, acne, and hirsutism. - The estrogen component increases **sex hormone-binding globulin (SHBG)** levels, which helps lower free testosterone levels. *Dysmenorrhea* - COCPs are frequently prescribed as a therapeutic option for dysmenorrhea because they suppress **ovulation** and thin the **endometrial lining**. - By decreasing the production of **prostaglandins** in the endometrium, they effectively reduce uterine cramping during menses.

Q: A woman had a LNG -IUCD inserted. She has been experiencing bleeding since the day of insertion, which is affecting her daily activities, and she demands removal. What is the appropriate management?

Remove the IUCD. ***Remove the IUCD*** - Patient autonomy is a fundamental principle in medical ethics; when a patient experiences bothersome side effects that significantly impact their quality of life and they explicitly demand the removal of the device, this request should be honored. - While minor bleeding is a common side effect of levonorgestrel intrauterine contraceptive devices (LNG-IUCDs), the provider-patient relationship and trust are preserved by respecting the patient's decision to discontinue the method when symptoms become intolerable. *Reassure and continue IUCD* - While reassurance is appropriate for patients with manageable, minor spotting, it is dismissive and inappropriate when the patient reports that the bleeding is affecting her daily activities and she has explicitly requested removal. - Ignoring the patient's distress and request can lead to medical mistrust and may result in the patient attempting unauthorized or unsafe removal. *Give NSAIDs / short course of combined oral contraceptive and continue IUCD* - Although these medications can be used to manage unscheduled bleeding associated with hormonal IUDs, this approach assumes the patient is willing to continue the method. - Since the patient has already demanded removal, attempting a trial of medication without addressing her immediate desire to discontinue the IUD is not the most appropriate initial step. *Evaluate for pregnancy or pelvic infection and manage accordingly* - While it is good practice to rule out underlying causes like infection or pregnancy in cases of abnormal uterine bleeding, the clinical vignette focuses on the patient's demand for removal due to persistent bleeding since insertion. - Evaluation is secondary to respecting the patient's request; furthermore, the context implies the bleeding is a known side effect of the device rather than a new pathology emerging later.

Q: Which contraception is contraindicated in a woman with hypertension?

OCPs. ***OCPs*** - Combined Oral Contraceptive Pills containing **estrogen** are contraindicated in patients with hypertension because estrogen promotes a **prothrombotic state** and can further elevate blood pressure, increasing the risk of **stroke** and **myocardial infarction**. - According to medical eligibility criteria, OCPs should be avoided or used with extreme caution in women with uncontrolled or severe **hypertension** (systolic ≥160 or diastolic ≥100 mmHg). *CuT* - The **Copper T (CuT)** is a non-hormonal intrauterine device that works primarily by creating a local **inflammatory reaction** in the endometrium that is toxic to sperm. - It has no systemic metabolic effects and is considered a perfectly safe and **first-line contraceptive choice** for women with underlying conditions like hypertension. *LNG -IUCD* - The **Levonorgestrel-releasing intrauterine system (LNG-IUCD)** releases hormones locally and has minimal systemic absorption, making it safe for women with **cardiovascular risk factors**. - Unlike systemic hormonal contraceptives, it is generally not associated with significant increases in blood pressure or coagulopathy. *DMPA* - **Depot Medroxyprogesterone Acetate (DMPA)** is a progestin-only injectable contraceptive and is generally considered safe for use in patients with **hypertension**. - While there is some ongoing research regarding slight long-term metabolic impacts, it is not contraindicated in the same way as **combined oral contraceptives** are in hypertensive patients.

Q: What is the permanent method used for sterilization in females?

Pomeroy method. ***Pomeroy method*** - This technique involves **ligation and resection** of a segment of the fallopian tube, commonly performed during a **tubal ligation** procedure. - It is one of the most widely used and effective methods for **permanent female sterilization**. *Salpingectomy* - This involves the **complete surgical removal** of one or both fallopian tubes. - While it causes sterilization, it is generally considered a surgical procedure for pathology (e.g., **ectopic pregnancy**, **tubal malignancy**) or risk reduction rather than the standard approach for elective sterilization. *Salpingotomy* - This refers to an **incision** made into the fallopian tube, most often used to evacuate an **ectopic pregnancy**. - It preserves the tube's anatomical integrity rather than destroying it, so it is not a sterilization method. *Salpingostomy* - This involves creating a **new opening** in the fallopian tube, typically to treat a **hydrosalpinx** or for distal tubal obstruction. - It is a reconstructive procedure intended to **restore fertility**, effectively the opposite of a sterilization procedure.

Q: Which of the following statements regarding the HPV vaccine is correct?

Primary target age is 9-14 years. ***Primary target age is 9-14 years*** - The **World Health Organization (WHO)** recommendations prioritize girls aged 9–14 years to receive the vaccine before the onset of **sexual activity**. - Vaccinating at this age provides the most robust **immunogenic response** compared to older age groups. *One dose can be given instead of two* - While some regions have recently explored single-dose schedules based on emerging data, the standard **WHO-recommended** schedule remains a two-dose series for the 9-14 age group. - A single dose is not yet the universal standard of care; most guidelines still insist on the **two-dose regimen** for optimal long-term efficacy. *Live HPV vaccine is 100% protective for all HPV variants* - The HPV vaccine is a **recombinant, non-infectious** vaccine composed of virus-like particles, not a **live attenuated vaccine**. - It does not protect against all HPV types, but rather covers the most oncogenic strains, typically **types 16 and 18**, and sometimes others like 6 and 11 depending on the specific vaccine (e.g., Gardasil 9). *90% of 15-year-old girls to be vaccinated* - While 90% is a commendable goal for vaccination coverage, the **WHO's

Q: What is the ideal contraceptive for a couple who lives in different cities and meets only occasionally?

Barrier method. **Explanation:** The choice of contraceptive method depends on the frequency of intercourse, the need for long-term protection, and the patient's lifestyle. **Why Barrier Method is Correct:** For couples who meet **infrequently or occasionally**, the **Barrier method (Condoms)** is the ideal choice. This is because it is a "user-dependent, coitus-related" method. It does not require continuous medication or invasive procedures for a couple who does not need daily protection. Additionally, it provides the added benefit of protection against Sexually Transmitted Infections (STIs), which is a crucial consideration for couples living apart. **Why Other Options are Incorrect:** * **IUCD (Option B):** These are Long-Acting Reversible Contraceptives (LARC) best suited for couples seeking long-term spacing (3–10 years) with frequent intercourse. It is an invasive procedure and unnecessary for occasional use. * **OCPs (Option C):** Oral pills require strict daily compliance to maintain efficacy. For a couple meeting only occasionally, taking a daily hormone pill is an unnecessary systemic burden. * **DMPA (Option D):** This is an injectable contraceptive given every 3 months. Like OCPs, it provides continuous hormonal suppression, which is not indicated for infrequent exposure. **NEET-PG High-Yield Pearls:** * **Ideal for Newly Married:** OCPs (Centchroman/Chhaya is often preferred in the Indian government program). * **Ideal for Lactating Mothers:** Progestogen-only pills (POPs) or IUCD (Cu-T 380A). * **Post-Coital (Emergency) Choice:** Levonorgestrel (1.5mg) within 72 hours or Cu-T within 5 days. * **Pearl Index:** Used to measure contraceptive failure rates (Lower index = Higher efficacy). Condoms have a higher typical-use failure rate compared to LARC.

Q: What is the most common side effect of IUD insertion?

Bleeding. **Explanation:** The most common side effect of Intrauterine Device (IUD) insertion is **Bleeding** (specifically menorrhagia or intermenstrual spotting). This occurs due to a local inflammatory response in the endometrium, increased vascularity, and the release of prostaglandins and enzymes that interfere with local clotting mechanisms. In the case of Copper-T, it typically manifests as heavier or prolonged menstrual periods. **Analysis of Options:** * **A. Bleeding (Correct):** It is the #1 reason for the discontinuation of IUDs. * **B. Pain:** This is the **second most common** side effect. It usually presents as low-backache or pelvic cramping, often occurring during insertion or during the first few menstrual cycles post-insertion. * **C. Pelvic Inflammatory Disease (PID):** While there is a slight risk of infection within the first 20 days of insertion (due to the introduction of vaginal flora into the uterus), it is a **rare complication**, not a common side effect. * **D. Ectopic Pregnancy:** IUDs actually reduce the absolute risk of ectopic pregnancy because they are highly effective contraceptives. However, if a woman *does* become pregnant with an IUD in situ, the **relative risk** (proportion) of that pregnancy being ectopic is higher. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect:** Bleeding. * **Second most common side effect:** Pain. * **Most common cause of removal:** Bleeding. * **Most common complication:** Expulsion (most likely to occur in the first year, particularly during the first 3 months). * **Ideal time for insertion:** Within 10 days of the beginning of menstruation (to ensure the patient is not pregnant and the cervix is slightly dilated).

Question 1

A 32-year-old woman presents for contraception counseling. Which of the following is a contraindication to the use of combined oral contraceptive pills?

Accepted Answer

Migraine with aura

Answer

Iron deficiency anemia

Answer

Polycystic ovarian syndrome

Answer

Dysmenorrhea

Question 2

A woman had a LNG -IUCD inserted. She has been experiencing bleeding since the day of insertion, which is affecting her daily activities, and she demands removal. What is the appropriate management?

Accepted Answer

Remove the IUCD

Answer

Reassure and continue IUCD

Answer

Give NSAIDs / short course of combined oral contraceptive and continue IUCD

Answer

Evaluate for pregnancy or pelvic infection and manage accordingly

Question 3

Which contraception is contraindicated in a woman with hypertension?

Accepted Answer

OCPs

Answer

CuT

Answer

LNG -IUCD

Answer

DMPA

Question 4

What is the permanent method used for sterilization in females?

Accepted Answer

Pomeroy method

Answer

Salpingectomy

Answer

Salpingotomy

Answer

Salpingostomy

Question 5

Which of the following statements regarding the HPV vaccine is correct?

Accepted Answer

Primary target age is 9-14 years

Answer

One dose can be given instead of two

Answer

Live HPV vaccine is 100% protective for all HPV variants

Answer

90% of 15-year-old girls to be vaccinated

Question 6

A 26-year-old woman with 6 weeks of amenorrhea presents to the emergency department with right iliac fossa pain and mild vaginal spotting. Her serum beta-hCG is 2400 mIU/mL. A transvaginal ultrasound is performed and is shown in Image 2, demonstrating an adnexal ring sign with an empty uterine cavity and no fetal cardiac activity on the right side. Her vital signs are: BP 112/74 mmHg, HR 88 bpm, she is hemodynamically stable. She has no contraindications to methotrexate (normal renal, hepatic, and hematologic function; no active pulmonary disease; no breastfeeding) and confirms she is able to comply with close outpatient follow-up. Which of the following is the most appropriate next step in management?

Accepted Answer

A. Administer a single intramuscular dose of methotrexate (50 mg/m²) after confirming eligibility criteria

Answer

B. Perform immediate diagnostic laparoscopy without further workup

Answer

C. Repeat serum beta-hCG in 48 hours and repeat ultrasound if beta-hCG rises above the discriminatory zone

Answer

D. Administer mifepristone followed by misoprostol for medical management

Question 7

What is the ideal contraceptive for a couple who lives in different cities and meets only occasionally?

Accepted Answer

Barrier method

Answer

Intrauterine contraceptive device (IUCD)

Answer

Oral contraceptive pills (OCP)

Answer

Depot medroxyprogesterone acetate (DMPA)

Question 8

Which of the following is NOT an ideal candidate for insertion of an Intrauterine Contraceptive Device (IUCD)?

Accepted Answer

Cancer of the Cervix

Answer

Has normal menstrual periods

Answer

No history of Pelvic Inflammatory Disease (PID)

Answer

Has at least one child

Question 9

IUCD must not be used in a woman with which of the following conditions?

Accepted Answer

Pelvic tuberculosis

Answer

Genital herpes with severe non-purulent discharge

Answer

AIDS on ARV therapy

Answer

Recto-vaginal fistula

Question 10

What is the most common side effect of IUD insertion?

Accepted Answer

Bleeding

Answer

Pain

Answer

Pelvic inflammatory disease

Answer

Ectopic pregnancy

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

On this page

Practice by Chapter

Want unlimited practice?