Contraception in Special Populations — MCQs
Which of the following statements about drug-induced SLE is NOT true?
A 28-year-old nonsmoking woman presents to discuss birth control methods. She requests a contraceptive option that is not associated with weight gain. She and her husband agree that they desire no children for the next few years. Her periods are regular, but heavy and painful, with severe lower abdominal cramping and back pain, requiring pad changes every 4 hours. This pattern of bleeding has been present since she was 15 years old. For a week before her period begins, she experiences uncharacteristic tearfulness, irritability, and depression, which are affecting her personal relationships. Her physical examination reveals blood pressure 110/75, BMI 22, and moderate acne on her face and neck. What recommendation would best address her mood, skin, and contraceptive needs?
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:
Which of the following is not used for postcoital contraception?
A 34-year-old woman presents at 6 weeks of delivery. She wants contraception for the next 3 years. What will be the best contraceptive method in this case?
Contraceptive of choice in a woman with Rheumatic heart disease.
Which one of the following is the most suitable situation for prescribing progestin only pill?
In a population of 5000, there are 19 % eligible couples. To achieve a couple protection rate (CPR) of 60 %, how many of these should be covered for family planning services?
The contraceptive choice for a 38 year old woman with chronic hypertension and history of dysmenorrhea and menorrhagia (malignancy ruled out) is:
Contraception in Special Populations Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following statements about drug-induced SLE is NOT true?
- A. Female: Male ratio=1:9 (Correct Answer)
- B. CNS involvement not common
- C. Renal involvement not common
- D. Anti-histone antibodies are negative
Explanation: ***Female: Male ratio=1:9*** - Drug-induced lupus erythematosus (DILE) typically has no significant **gender predilection**, unlike idiopathic SLE which has a marked female predominance (9:1 female: male ratio) [1]. - This statement is incorrect because the male:female ratio is closer to 1:1, or even male predominance, making the given ratio of 1:9 (female:male) false. *Anti-histone antibodies are negative* - **Anti-histone antibodies** are positive in 95% of patients with drug-induced lupus, making this statement incorrect. - The presence of anti-histone antibodies is a hallmark diagnostic feature of drug-induced lupus. *CNS involvement not common* - **Central nervous system (CNS) manifestations** are indeed uncommon in drug-induced lupus erythematosus. - This statement accurately reflects a key differentiating feature from idiopathic systemic lupus erythematosus (SLE), where CNS involvement can be significant [1]. *Renal involvement not common* - **Renal involvement** is rare in drug-induced lupus erythematosus. - This statement is true and helps distinguish drug-induced lupus from idiopathic SLE, where renal disease (lupus nephritis) is a frequent and serious complication [1].
Question 2: A 28-year-old nonsmoking woman presents to discuss birth control methods. She requests a contraceptive option that is not associated with weight gain. She and her husband agree that they desire no children for the next few years. Her periods are regular, but heavy and painful, with severe lower abdominal cramping and back pain, requiring pad changes every 4 hours. This pattern of bleeding has been present since she was 15 years old. For a week before her period begins, she experiences uncharacteristic tearfulness, irritability, and depression, which are affecting her personal relationships. Her physical examination reveals blood pressure 110/75, BMI 22, and moderate acne on her face and neck. What recommendation would best address her mood, skin, and contraceptive needs?
- A. Progesterone intrauterine device (IUD)
- B. Depo-Provera (medroxyprogesterone acetate) shots every 3 months
- C. Combination oral contraceptive pill with drospirenone and ethinyl estradiol (Correct Answer)
- D. Tubal ligation (permanent sterilization)
Explanation: ***Combination oral contraceptive pill with drospirenone and ethinyl estradiol*** - This combination addresses **contraception**, **dysmenorrhea**, **heavy menstrual bleeding**, **premenstrual dysphoric disorder (PMDD)**, and **acne**. Drospirenone has anti-androgenic effects, improving acne and potentially reducing fluid retention. - The patient's symptoms of irregular mood and irritability before her period are consistent with **PMDD**, which is effectively treated by **combination oral contraceptives** (COCs). *Progesterone intrauterine device (IUD)* - While effective for **contraception** and reducing **heavy menstrual bleeding** and **dysmenorrhea**, it does not typically improve acne or PMDD symptoms. - It works primarily locally in the uterus and does not have the systemic anti-androgenic or mood-stabilizing effects of COCs. *Depo-Provera (medroxyprogesterone acetate) shots every 3 months* - This method is effective for contraception and can reduce menstrual bleeding and dysmenorrhea, but it is often associated with **weight gain**, which the patient wants to avoid. - It can also cause **worsening of mood symptoms** and **acne** in some individuals, conflicting with her specific concerns. *Tubal ligation (permanent sterilization)* - This method provides permanent **contraception** but does not address her heavy, painful periods, PMDD, or acne. - The patient only desires to avoid pregnancy for a few years, making a permanent method like tubal ligation inappropriate at this time.
Question 3: 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 4: 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.
Question 5: Which of the following is not used for postcoital contraception?
- A. CuT
- B. Ru 486
- C. High dose estrogen
- D. Danazol (Correct Answer)
Explanation: ***Danazol*** - **Danazol** is an androgen derivative primarily used to treat conditions like **endometriosis** and **fibrocystic breast disease** due to its ability to suppress gonadotropin secretion. - It is **not effective** as a postcoital contraceptive as it does not reliably prevent ovulation, fertilization, or implantation when taken after unprotected intercourse. *CuT* - The **copper-T intrauterine device (CuT IUD)** can be inserted within **5 days** of unprotected intercourse as an effective form of emergency contraception. - Its mechanism involves releasing **copper ions** that are toxic to sperm and eggs, inhibiting fertilization and implantation. *Ru 486* - **Mifepristone (RU 486)** is an **anti-progestin** that can be used for emergency contraception (often referred to as the morning-after pill). - It works by delaying or inhibiting ovulation and preventing implantation by altering the **endometrium**. *High dose estrogen* - High doses of **estrogen**, often in combination with progestin (**Yuzpe regimen**), can be used as emergency contraception. - This method primarily works by **disrupting ovulation** and altering the endometrium to prevent implantation.
Question 6: A 34-year-old woman presents at 6 weeks of delivery. She wants contraception for the next 3 years. What will be the best contraceptive method in this case?
- A. Nothing besides lactation amenorrhea
- B. IUCD with progesterone
- C. Injectable progesterone
- D. Copper T (Correct Answer)
Explanation: ***Copper T*** - A **Copper T intrauterine device (IUD)** is an excellent choice for long-term contraception (up to 10 years), making it suitable for her 3-year requirement. - It's **non-hormonal**, making it safe for breastfeeding mothers and avoiding potential hormonal side effects. *Nothing besides lactation amenorrhea* - **Lactational amenorrhea method (LAM)** is effective for only the first six months postpartum, provided the mother is exclusively breastfeeding and her periods have not returned. - It is not a reliable method for contraception beyond six months postpartum or for the requested 3-year duration. *IUCD with progesterone* - An **intrauterine device (IUD) with progesterone** (e.g., Mirena) can be a good long-term option, but it releases hormones which can potentially affect breastfeeding, especially if initiated very early postpartum. - While generally safe for breastfeeding, a non-hormonal option like the copper T is often preferred if there are concerns about hormonal exposure or side effects. *Injectable progesterone* - **Injectable progesterone** (e.g., Depo-Provera) is an effective contraceptive, but it needs to be administered every 3 months. - While safe for breastfeeding, it's not considered as convenient for a 3-year duration as a single-insertion IUD, and some women experience side effects like irregular bleeding or weight gain.
Question 7: 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 8: Which one of the following is the most suitable situation for prescribing progestin only pill?
- A. Young patients
- B. Emergency contraception
- C. Lactating mother (Correct Answer)
- D. Woman with unexplained vaginal bleeding
Explanation: ***Lactating mother*** - Progestin-only pills (POPs) are preferred for **breastfeeding mothers** as they do not affect **milk supply** or composition, unlike combined oral contraceptives containing estrogen. - They also eliminate the risk of estrogen exposure to the infant, which is generally avoided during **lactation**. *Young patients* - While young patients can use POPs, there isn't a specific indication making them "most suitable" compared to other contraceptive methods. - Often, combined oral contraceptives are also an appropriate choice for young patients, depending on their individual health profile. *Emergency contraception* - Progestin-only pills are a type of contraception, but they are not the primary or most effective form of **emergency contraception**; dedicated high-dose progestin pills (like levonorgestrel) or copper IUDs are used for this purpose. - Regular POPs are designed for daily use and are not formulated for a single, high-dose emergency contraceptive effect. *Woman with unexplained vaginal bleeding* - **Unexplained vaginal bleeding** is a **contraindication** for starting any hormonal contraceptive, including POPs, until the cause is identified. - It is crucial to rule out serious conditions like **endometrial cancer** or other gynecological pathologies before initiating hormonal therapy.
Question 9: In a population of 5000, there are 19 % eligible couples. To achieve a couple protection rate (CPR) of 60 %, how many of these should be covered for family planning services?
- A. 550
- B. 530
- C. 590
- D. 570 (Correct Answer)
Explanation: ***570*** - First, calculate the total number of **eligible couples**: 19% of 5000 = (19/100) * 5000 = **950 couples**. - To achieve a **Couple Protection Rate (CPR) of 60%**, calculate 60% of the eligible couples: 60% of 950 = (60/100) * 950 = **570 couples**. *550* - This option indicates a protection rate of approximately **57.9%** (550/950 * 100), which is less than the target of 60%. - It does not meet the specified target for **Couple Protection Rate**. *530* - This option would result in a protection rate of approximately **55.8%** (530/950 * 100), which is significantly lower than the desired 60%. - This value is an underestimation of the number of couples needed to achieve the target CPR. *590* - This option indicates a protection rate of approximately **62.1%** (590/950 * 100), which exceeds the target of 60%. - While protecting more couples is generally good, the question asks for how many *should* be covered to achieve *60%* specifically, making 570 the exact answer.
Question 10: The contraceptive choice for a 38 year old woman with chronic hypertension and history of dysmenorrhea and menorrhagia (malignancy ruled out) is:
- A. Copper intrauterine device
- B. Sterilization
- C. Combined oral contraceptive pills
- D. Levonorgestrel intrauterine device (Correct Answer)
Explanation: ***Levonorgestrel intrauterine device*** - The **Levonorgestrel IUD** is an excellent choice as it provides effective contraception while also treating menorrhagia and dysmenorrhea due to its local progesterone release. - It is safe for women with **hypertension** as it is a **non-estrogen-containing method**, avoiding the increased risk of thrombotic events associated with estrogen. *Copper intrauterine device* - While an effective non-hormonal contraceptive, the **copper IUD** can worsen **dysmenorrhea** and **menorrhagia**, which are existing concerns for the patient. - It does not offer any therapeutic benefits for her heavy and painful periods. *Sterilization* - Although it provides permanent and highly effective contraception, **sterilization** does not address the patient's symptoms of **dysmenorrhea** and **menorrhagia**. - It is an irreversible procedure and typically considered when no further childbearing is desired and symptomatic relief is not a primary concern for the contraceptive method itself. *Combined oral contraceptive pills* - **Combined oral contraceptive pills (COCs)** are generally contraindicated or used with caution in women with uncontrolled **hypertension** due to the estrogen component, which can increase the risk of cardiovascular events, including thrombosis. - While COCs can improve dysmenorrhea and menorrhagia, the cardiovascular risks in a 38-year-old with chronic hypertension outweigh these benefits.
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