Barrier Methods — MCQs
The best method of evacuation of a missed abortion in uterus of more than 12 weeks:
Which drug is used as a spermicidal cream in contraceptives?
Which of the following reduces the efficacy of oral contraceptives?
Which of the following is an example of a barrier method of contraception?
Which of the following cannot be used as Post-coital contraceptive?
A woman comes after 96 hours post coitus. Best contraceptive of choice is?
All of the following are postcoital contraception methods except?
Contraceptive of choice in a woman with Rheumatic heart disease.
The contraceptive which is contraindicated in DVT is?
Best long-acting reversible contraception (LARC) that can be inserted immediately postpartum in a lactating mother is:
Barrier Methods Indian Medical PG Practice Questions and MCQs
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)
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.
Question 2: Which drug is used as a spermicidal cream in contraceptives?
- A. Gossypol
- B. Clomiphene
- C. Nonoxynol-9 (Correct Answer)
- D. Centchroman
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.
Question 3: Which of the following reduces the efficacy of oral contraceptives?
- A. Griseofulvin (Correct Answer)
- B. Disulfiram
- C. Erythromycin
- D. Cimetidine
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.
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
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.
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)
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.
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
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.
Question 7: All of the following are postcoital contraception methods except?
- A. IUD
- B. Levonorgestrel
- C. Mifepristone
- D. Barrier methods (Correct Answer)
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.
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
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.
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)
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 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
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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