Contraception and Family Planning Practice Questions

Q: What is the most suitable method for Medical Termination of Pregnancy (MTP) during the third month of gestation?

Suction and evacuation. **Explanation:** The "third month" of gestation corresponds to **9–12 weeks** of pregnancy. According to standard obstetric guidelines and the MTP Act, **Suction and Evacuation (S&E)** is the gold standard and most suitable method for termination in the first trimester (up to 12 weeks). * **Why Suction and Evacuation is correct:** It is a safe, rapid, and highly effective surgical procedure. It involves dilating the cervix and using a vacuum source (electric or manual) to remove the products of conception. It has a lower risk of uterine perforation and hemorrhage compared to traditional curettage. **Analysis of Incorrect Options:** * **A. Dilatation and Curettage (D&C):** This is an older technique involving sharp metal curettes. It is no longer preferred because it carries a higher risk of uterine trauma, Asherman syndrome, and increased blood loss compared to suction. * **B. Extra-amniotic Ethacridine:** This is a method used for **second-trimester** abortions (usually 15–20 weeks). It is not indicated for the first trimester as surgical evacuation is much simpler and safer at 12 weeks. * **C. Hysterectomy:** This is a major surgery involving the removal of the uterus. It is never a primary method for MTP unless there is a concurrent life-threatening pathology (e.g., intractable hemorrhage or uterine malignancy). **High-Yield NEET-PG Pearls:** * **Up to 7 weeks (49 days):** Medical MTP (Mifepristone + Misoprostol) is the preferred choice. * **Up to 12 weeks:** Suction and Evacuation is the surgical method of choice. * **13–24 weeks:** Medical induction (Prostaglandins/Misoprostol) or Dilatation and Evacuation (D&E) are used. * **MTP Act Update:** Pregnancy can now be terminated up to **24 weeks** for specific categories of women (e.g., survivors of sexual assault, minors, fetal abnormalities) with the opinion of two doctors.

Q: What is the lifespan of an LNG-IUD?

5 years. **Explanation:** The **Levonorgestrel-releasing Intrauterine Device (LNG-IUD)**, commonly known by the brand name **Mirena**, is a highly effective long-acting reversible contraceptive (LARC). It contains a reservoir of 52 mg of levonorgestrel which is released at an initial rate of 20 µg/day. 1. **Why 5 years is correct:** The reservoir is designed to maintain therapeutic hormone levels for a period of **5 years**. While recent studies suggest some models may remain effective for up to 7–8 years, the standard FDA-approved and textbook duration for the 52 mg LNG-IUD (Mirena) remains 5 years. It works primarily by thickening cervical mucus and causing endometrial atrophy. 2. **Why other options are incorrect:** * **2 years:** No standard IUD has a lifespan this short; however, some injectable contraceptives or older implants had shorter durations. * **10 years:** This is the standard lifespan for the **Copper T 380A** (non-hormonal IUD). * **12 years:** While some studies suggest Copper T 380A can last this long, it is not the standard recommendation for LNG systems. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Candidate:** LNG-IUD is the **treatment of choice for Menorrhagia** (DUB) as it reduces menstrual blood loss by up to 90%. * **Non-contraceptive benefits:** Used in the management of endometriosis, adenomyosis, and endometrial hyperplasia. * **Pearl:** Unlike Copper-T, the LNG-IUD often leads to **amenorrhea** or oligomenorrhea, which should be explained to the patient beforehand. * **Other variants:** *Kyleena* (19.5 mg LNG) is also approved for 5 years, while *Skyla* (13.5 mg LNG) is approved for 3 years.

Q: All of the following statements regarding benefits of combined oral contraceptive pills are TRUE, EXCEPT:

It decreases the risk of cervical cancer. **Explanation:** The correct answer is **B**, as Combined Oral Contraceptive Pills (COCPs) do **not** decrease the risk of cervical cancer; in fact, long-term use (typically >5 years) is associated with a slightly **increased risk** of cervical cancer. This is likely due to increased susceptibility to HPV infection or behavioral factors. **Analysis of Options:** * **Option A (Ectopic Pregnancy):** COCPs prevent ovulation. Since there is no ovum to fertilize, the absolute risk of both intrauterine and ectopic pregnancies is significantly reduced. * **Option C (Dysmenorrhea/Endometriosis):** COCPs suppress the menstrual cycle and induce a state of endometrial atrophy. This reduces prostaglandin production and prevents the cyclic growth of ectopic endometrial tissue, thereby alleviating pain. * **Option D (Acute Salpingitis):** COCPs decrease the risk of Pelvic Inflammatory Disease (PID). They thicken the cervical mucus, creating a barrier against ascending infections, and reduce menstrual flow, which limits the medium for bacterial growth. **High-Yield Clinical Pearls for NEET-PG:** * **Protective Effects (The "Big Three"):** COCPs significantly reduce the risk of **Ovarian cancer** (by 50%), **Endometrial cancer** (by 50%), and **Colorectal cancer**. * **Ovarian Cancer:** Protection is due to "ordered ovarian rest" (suppression of incessant ovulation). * **Endometrial Cancer:** Protection is due to the progestogen component preventing estrogen-induced hyperplasia. * **Increased Risks:** COCPs are associated with an increased risk of **Cervical cancer**, **Breast cancer**, and **Hepatic adenomas**. * **Non-Contraceptive Benefits:** They reduce the risk of functional ovarian cysts, benign breast disease, and iron-deficiency anemia.

Q: Which of the following is NOT a recommended treatment for a woman with an IUD in situ and a positive cervical cytology for Actinomyces infection?

Hysterectomy. **Explanation:** The presence of *Actinomyces-like organisms* (ALO) on a routine cervical Pap smear in an asymptomatic IUD user is a common clinical scenario. *Actinomyces israelii* is a Gram-positive, anaerobic bacterium that is a normal commensal of the female genital tract but can proliferate in the presence of a foreign body like an IUD. **Why Hysterectomy is the Correct Answer:** Hysterectomy is a radical surgical procedure and is **never** indicated for the mere presence of *Actinomyces* on cytology. Management is conservative unless the patient is symptomatic. Performing a hysterectomy for an incidental finding on a Pap smear would be a gross over-treatment and is medically contraindicated. **Analysis of Other Options:** * **Option A (No intervention needed):** This is the **current standard of care** for asymptomatic women. If the patient has no symptoms (no pelvic pain, discharge, or fever), the IUD can be left in situ, and the patient is simply monitored. * **Option D (Removal of IUD):** This is a valid management option if the patient is concerned or symptomatic. However, it is not mandatory if she is asymptomatic. * **Option C (Extended course of antibiotics):** While not routinely recommended for asymptomatic colonization, a course of Penicillin (the drug of choice) may be prescribed if the IUD is removed or if there are mild symptoms of Pelvic Inflammatory Disease (PID). **NEET-PG High-Yield Pearls:** 1. **Asymptomatic + Actinomyces on Pap smear:** Do nothing (No treatment, no IUD removal). 2. **Symptomatic (Pelvic pain/PID) + Actinomyces:** Remove IUD and start high-dose **Penicillin G** (or Doxycycline if allergic). 3. **Pelvic Actinomycosis:** Classically presents with "woody" pelvic induration and "sulfur granules" in the discharge. 4. The risk of *Actinomyces* colonization increases with the **duration** of IUD use (especially >5 years).

Q: Which of the following is a health benefit of using combined oral contraceptives in pre-menopausal women?

Reduced risk of ovarian cancer. **Explanation:** **Why the correct answer is right:** Combined Oral Contraceptives (COCs) provide significant non-contraceptive health benefits, most notably a **reduced risk of ovarian cancer**. The underlying mechanism is the **suppression of ovulation**. By preventing the monthly "incessant ovulation" and the subsequent repeated trauma and repair of the ovarian epithelium, COCs decrease the risk of epithelial ovarian tumors. This protective effect is duration-dependent (increasing with longer use) and persists for up to 30 years after discontinuation. COCs also significantly reduce the risk of **endometrial cancer** (due to progestogen-induced endometrial atrophy) and **colorectal cancer**. **Why the incorrect options are wrong:** * **A & D (DVT and Ischemic Stroke):** COCs actually **increase** the risk of venous thromboembolism (VTE) and arterial strokes. The estrogen component (Ethinyl Estradiol) increases the hepatic synthesis of clotting factors (II, VII, IX, X) and decreases antithrombin III, creating a pro-coagulant state. * **B (Migraine):** COCs can exacerbate migraines, particularly during the hormone-free interval (estrogen withdrawal). Furthermore, COCs are **contraindicated** in women with migraine with aura due to a significantly elevated risk of ischemic stroke. **High-Yield Clinical Pearls for NEET-PG:** * **Cancer Protection:** 50% reduction in Ovarian and Endometrial cancer risk. * **Benign Conditions:** COCs reduce the risk of Benign Breast Disease (e.g., fibroadenoma), Pelvic Inflammatory Disease (PID), and ectopic pregnancy. * **Menstrual Benefits:** Used to treat dysmenorrhea, menorrhagia, and PCOS. * **Absolute Contraindications (WHO Category 4):** Smokers >35 years (>15 cigarettes/day), history of VTE/Stroke, Migraine with aura, and Breast Cancer.

Q: Which of the following drugs is not used as emergency contraception?

Raloxifene. **Explanation:** The correct answer is **D. Raloxifene**. **Why Raloxifene is the correct answer:** Raloxifene is a **Selective Estrogen Receptor Modulator (SERM)** primarily used for the prevention and treatment of osteoporosis in postmenopausal women and to reduce the risk of invasive breast cancer. Unlike emergency contraceptives, it does not inhibit ovulation or prevent implantation. It has an anti-estrogenic effect on the breast and uterus but an estrogenic effect on the bone. **Analysis of Incorrect Options:** * **A. Levonorgestrel (LNG):** The most commonly used emergency contraceptive pill (ECP). It is a progestogen that works primarily by delaying or inhibiting ovulation. It is most effective when taken within 72 hours of unprotected intercourse. * **B. Mifepristone:** An anti-progestogen. In low doses (10–25 mg), it is highly effective as an emergency contraceptive by delaying ovulation and altering the endometrium. (Note: Higher doses are used for medical abortion). * **C. Ulipristal Acetate:** A Selective Progesterone Receptor Modulator (SPRM). It is currently considered the "gold standard" for hormonal emergency contraception because it is effective up to 120 hours (5 days) after intercourse and can inhibit ovulation even just before it occurs. **High-Yield Clinical Pearls for NEET-PG:** * **Most Effective Method:** The **Copper-T (IUCD)** is the most effective method of emergency contraception if inserted within 5 days. * **Yuzpe Regimen:** An older method using combined oral contraceptive pills (Ethinylestradiol + Levonorgestrel); it is less effective and causes more side effects (nausea/vomiting) than LNG alone. * **Dose of LNG:** 1.5 mg as a single dose (or two doses of 0.75 mg 12 hours apart). * **Mechanism:** Emergency contraceptives work by preventing fertilization; they are **not** abortifacients and do not work if implantation has already occurred.

Q: Which among the following is the ideal contraception for lactating mothers?

Lactational amenorrhoea method. **Explanation:** The **Lactational Amenorrhoea Method (LAM)** is considered the ideal and most natural first-line contraceptive for breastfeeding mothers in the early postpartum period. **Why LAM is the Correct Answer:** LAM relies on the physiological suppression of ovulation caused by high levels of **Prolactin**. Suckling inhibits the release of Gonadotropin-Releasing Hormone (GnRH) from the hypothalamus, which in turn suppresses LH and FSH, preventing follicular development and ovulation. It is highly effective (>98%) if three criteria are met: 1. The mother is in the first 6 months postpartum. 2. She is practicing **exclusive breastfeeding** (day and night, no supplements). 3. She remains **amenorrhoeic**. **Analysis of Incorrect Options:** * **Combined Oral Contraceptive Pills (COCPs):** These are **contraindicated** in the first 6 weeks of lactation because estrogen suppresses milk production (hypogalactia) and increases the risk of thromboembolism in the early postpartum period. * **Progesterone-only Pill (POP):** While POPs are the hormonal method of choice for lactating women (as they do not affect milk volume), they are usually started only after 6 weeks or if LAM criteria are no longer met. * **Barrier Method:** While safe, they have higher failure rates compared to LAM and are generally used as a backup rather than the primary "ideal" physiological method. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal time to start IUCD:** Postpartum IUCD (PPIUCD) can be inserted within 48 hours of delivery or after 6 weeks (involution). * **DMPA (Injectable):** Should be avoided before 6 weeks postpartum in lactating mothers. * **Centchroman (Saheli):** A non-steroidal SERM; it is safe during lactation and is part of the National Family Planning Program (Antara program focuses on DMPA, Chhaya focuses on Centchroman).

Question 1

What is the best contraceptive method for a female with diabetes?

Accepted Answer

Condom used by husband

Answer

Oral contraceptive pills

Answer

Intrauterine contraceptive device (IUCD)

Answer

Vaginal sponge

Question 2

What is the most suitable method for Medical Termination of Pregnancy (MTP) during the third month of gestation?

Accepted Answer

Suction and evacuation

Answer

Dilatation and curettage

Answer

Extra-amniotic ethacridine

Answer

Hysterectomy

Question 3

What is the lifespan of an LNG-IUD?

Accepted Answer

5 years

Answer

2 years

Answer

10 years

Answer

12 years

Question 4

All of the following statements regarding benefits of combined oral contraceptive pills are TRUE, EXCEPT:

Accepted Answer

It decreases the risk of cervical cancer

Answer

It decreases the risk of ectopic pregnancy

Answer

It improves dysmenorrhea from endometriosis

Answer

It decreases the incidence and severity of acute salpingitis

Question 5

Which of the following is NOT a recommended treatment for a woman with an IUD in situ and a positive cervical cytology for Actinomyces infection?

Accepted Answer

Hysterectomy

Answer

No intervention needed

Answer

Extended course of antibiotics

Answer

Removal of IUD

Question 6

A 28-year-old P1L1 had a Copper-T inserted 2 years ago. On examination, Copper-T threads are not seen. Ultrasound shows the Copper-T partly in the abdominal cavity. What is the method of removal?

Accepted Answer

Laparoscopy

Answer

Hysteroscopy

Answer

No removal needed (wait and watch)

Answer

IUCD hook

Question 7

Which of the following is a health benefit of using combined oral contraceptives in pre-menopausal women?

Accepted Answer

Reduced risk of ovarian cancer

Answer

Reduced risk of deep vein thrombosis

Answer

Reduced risk of migraine

Answer

Reduced risk of ischemic stroke

Question 8

Which of the following drugs is not used as emergency contraception?

Accepted Answer

Raloxifene

Answer

Levonorgestrel

Answer

Mifepristone

Answer

Ulipristal acetate

Question 9

Which of the following statements is NOT true regarding progestin-only contraceptives?

Accepted Answer

The pill is taken on alternate days.

Answer

Also known as mini-pills.

Answer

Have minimal effect on carbohydrate metabolism.

Answer

Associated with a high incidence of irregular bleeding.

Question 10

Which among the following is the ideal contraception for lactating mothers?

Accepted Answer

Lactational amenorrhoea method

Answer

Barrier method

Answer

Combined oral contraceptive pill

Answer

Progesterone-only pill

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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