Contraception and Family Planning Practice Questions

Q: What is the dose of centchroman?

30 mg. **Explanation:** **Centchroman (Ormeloxifene)** is a non-steroidal, non-hormonal Selective Estrogen Receptor Modulator (SERM) developed by CDRI, Lucknow. It is marketed under the brand names **Saheli** and **Chhaya** in the National Family Planning Programme of India. **Why 30 mg is correct:** The standard contraceptive dose of Centchroman is **30 mg**. The dosage schedule follows a unique "loading phase" to achieve steady-state plasma levels: * **First 3 months:** 30 mg twice weekly (e.g., Sunday and Wednesday). * **From the 4th month onwards:** 30 mg once weekly, regardless of the menstrual cycle. **Analysis of incorrect options:** * **60 mg:** While 60 mg doses are sometimes used in the treatment of Abnormal Uterine Bleeding (AUB) or mastalgia, it is not the standard dose for contraception. * **120 mg & 240 mg:** These are supratherapeutic doses for contraception and are not used in clinical practice for this indication. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** It acts as an estrogen antagonist in the uterus (preventing implantation by altering the endometrium) and an agonist in the bones/CVS. It does not suppress ovulation. * **Side Effects:** The most common side effect is **delayed menstruation** (prolonged cycles), occurring in about 8% of users. * **Contraindications:** Polycystic Ovarian Syndrome (PCOS), cervical dysplasia, and recent history of jaundice or liver disease. * **Pearl:** It is the only contraceptive that does not interfere with the hypothalamic-pituitary-ovarian axis, making it safe for breastfeeding mothers (Category: L1/Safe).

Q: Tubal ligation is reported to have decreased the risk of?

Ovarian cancer. **Explanation:** **Correct Answer: B. Ovarian Cancer** Tubal ligation is a significant protective factor against ovarian cancer, reducing the risk by approximately **30–50%**. The underlying medical concept involves two main theories: 1. **Prevention of Ascending Carcinogens:** It blocks the passage of potential carcinogens (like talc or asbestos) and inflammatory mediators from the lower genital tract to the ovaries. 2. **Origin of Serous Cancer:** Modern research suggests that many "ovarian" cancers (specifically High-Grade Serous Carcinomas) actually originate in the fimbrial end of the fallopian tube (STIC lesions). Tubal ligation disrupts this pathway and often involves partial salpingectomy, removing the tissue of origin. **Analysis of Incorrect Options:** * **A. Functional ovarian cysts:** Tubal ligation does not affect ovulation or the hormonal feedback loop; therefore, the incidence of functional cysts remains unchanged. * **C. Breast cancer:** There is no established physiological link between tubal sterilization and a decreased risk of breast cancer. * **D. Salpingitis:** While tubal ligation prevents ascending infection from reaching the peritoneal cavity (reducing the risk of Pelvic Inflammatory Disease/PID), it does not necessarily prevent infection of the proximal tubal stump itself (salpingitis). The reduction in **ovarian cancer** is the more classically tested and significant epidemiological association. **High-Yield Clinical Pearls for NEET-PG:** * **OCPs** also decrease the risk of ovarian cancer (by ~50% if used for >5 years). * **Hysterectomy** also provides a protective effect against ovarian cancer. * The most common site of ectopic pregnancy after failed tubal ligation is the **isthmus**. * **Failure rate (Pearl Index):** For Pomeroy’s technique, it is approximately 0.1–0.5%. The most common cause of failure is **recanalization**.

Q: An X-ray pelvis in AP view shows the presence of:

Uterine sounding to check the position of a dislodged IUD. ***Uterine sounding to check the position of a dislodged IUD*** - On AP pelvis X-ray, a **metallic uterine sound** appears as a radiopaque linear structure within the uterine cavity used to locate the **dislodged IUD**. - The **IUD** itself appears as a radiopaque T-shaped or coil-shaped device that may be displaced from its normal intrauterine position. *Endoscopic removal of ureteric stones* - This procedure involves **cystoscopy** or **ureteroscopy**, which are not visible on plain X-ray imaging. - **Ureteric stones** may be visible on X-ray, but the endoscopic instruments are not radiopaque enough to be clearly seen. *Uterine sounding to check for the site of a uterine tear* - **Uterine perforation** or tears are **soft tissue injuries** that are not directly visible on plain X-ray. - Diagnosis of uterine tears typically requires **contrast studies** or **cross-sectional imaging** like CT or MRI. *Pelvic trauma* - While pelvic trauma can show **bone fractures** and **foreign objects** on X-ray, this option doesn't specifically relate to the procedural findings described. - **Traumatic injuries** would show different radiographic patterns like **fracture lines**, **hematomas**, or **displaced bone fragments**.

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

Danazol. **Explanation:** The correct answer is **Danazol**. While Danazol (an attenuated androgen) was historically investigated for various gynecological conditions like endometriosis, it has **no proven efficacy** as an emergency contraceptive (EC) and is not part of any standard EC protocol. **Analysis of Options:** * **Copper T 200B:** This is the **most effective** method of emergency contraception. If inserted within 5 days (120 hours) of unprotected intercourse, it prevents implantation by causing a sterile inflammatory reaction in the endometrium. * **RU486 (Mifepristone):** This is a potent anti-progestin. In low doses (10 mg or 25 mg), it acts as a highly effective EC by delaying or inhibiting ovulation. (Note: 600 mg is used for medical abortion). * **High-dose Estrogen:** Historically, high doses of estrogens (e.g., Ethinylestradiol 5mg for 5 days) were used as EC. While effective, they are no longer preferred due to severe side effects like nausea and vomiting. They have been largely replaced by the **Yuzpe Regimen** (Combined Pills) or Levonorgestrel (LNG). **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard/Most Effective EC:** Copper-T (Failure rate <0.1%). * **Drug of Choice (DOC):** Levonorgestrel (LNG) 1.5 mg single dose (effective up to 72 hours). * **Ulipristal Acetate (30 mg):** A selective progesterone receptor modulator (SPRM) effective up to **120 hours** (5 days) and is more effective than LNG in obese women. * **Yuzpe Regimen:** Consists of 100 mcg Ethinylestradiol + 0.5 mg Norgestrel, repeated after 12 hours.

Q: An Intrauterine Device (IUD) is not inserted during which of the following conditions?

Immediately after delivery (within 48 hours). ### Explanation The timing of IUD insertion is critical to minimize risks of expulsion, perforation, and infection. **Why Option C is the Correct Answer:** While IUDs *can* be inserted immediately postpartum (PPIUD), the question asks when it is **not** typically inserted based on standard clinical guidelines regarding safety and efficacy. In the context of traditional teaching and many standard protocols, the period between **48 hours and 6 weeks postpartum** is considered a contraindication for insertion. This is because the uterus is undergoing rapid involution, significantly increasing the risk of **spontaneous expulsion** and **uterine perforation**. Therefore, if not inserted within the first 48 hours, one must wait until the involution is complete (6 weeks). **Analysis of Other Options:** * **A & B (During/Within 10 days of menstruation):** This is the **ideal time** for interval insertion. It ensures the patient is not pregnant, and the cervical os is slightly dilated, making insertion easier and less painful. * **D (6-8 weeks after delivery):** This is known as **Postpartum Interval Insertion**. By this time, the uterus has returned to its non-pregnant size (involution complete), making it a safe and standard time for insertion. **High-Yield NEET-PG Pearls:** * **Ideal Time for Interval IUD:** Within 10 days of the LMP. * **Post-Abortal Insertion:** Can be done immediately after first-trimester abortion (if no infection). * **PPIUD (Postpartum IUD):** Must be done within **48 hours** (ideally within 10 minutes of placental delivery) or delayed until **6 weeks**. * **Most Common Side Effect:** Bleeding (Menorrhagia). * **Most Common Reason for Removal:** Bleeding and Pain. * **Mechanism of Action (Cu-T):** Primarily spermicidal (causes a sterile inflammatory response).

Q: Replacement of a progestin-releasing intrauterine device should be done after how many years?

5 years. **Explanation:** The correct answer is **5 years**. **1. Why 5 years is correct:** The most common progestin-releasing intrauterine device (IUCD) is the **Levonorgestrel-releasing Intrauterine System (LNG-IUS)**, commercially known as Mirena. It contains 52 mg of Levonorgestrel, which is released at an initial rate of 20 µg/day. While the hormone levels gradually decline over time, the device maintains high contraceptive efficacy and therapeutic benefits (such as reducing menstrual blood loss) for a period of **5 years**. After this duration, the reservoir of progestin is depleted to a level where its reliability decreases, necessitating replacement. **2. Why the other options are incorrect:** * **1 year:** Progestasert (an older progesterone-only IUD) required annual replacement, but it is largely obsolete. Modern LNG-IUS devices are designed for long-term use. * **3 years:** This is the typical duration for the **progestin subdermal implant (Nexplanon)** or the lower-dose LNG-IUS (Skyla/Jaydess), but not the standard LNG-IUS. * **10 years:** This is the replacement interval for the **Copper T 380A**, which is a non-hormonal IUCD. **3. High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily works by thickening cervical mucus (preventing sperm penetration) and causing endometrial atrophy (preventing implantation). * **Non-contraceptive uses:** It is the **Gold Standard (Medical management)** for Menorrhagia and Adenomyosis. * **Failure Rate:** It has a Pearl Index of approximately 0.2, making it as effective as sterilization. * **Recent Update:** While the FDA has recently approved Mirena for up to 8 years for contraception, for the purpose of NEET-PG and standard textbooks (Dutta/Williams), **5 years** remains the standard answer for replacement.

Q: Which contraceptive method is medically contraindicated for a patient with a known latex allergy?

Condoms. **Explanation:** **Correct Option: C. Condoms** The primary material used in the manufacturing of most standard male and female condoms is **natural rubber latex**. In patients with a known latex allergy, exposure can trigger hypersensitivity reactions ranging from localized contact dermatitis and pruritus to life-threatening systemic anaphylaxis. For these patients, non-latex alternatives such as polyurethane, polyisoprene, or nitrile condoms must be used. **Analysis of Incorrect Options:** * **A. Oral Contraceptives:** These are hormonal medications (estrogen and/or progestogen) administered systemically. They do not contain latex and have no cross-reactivity with latex proteins. * **B. Intrauterine Device (IUD):** Copper T (Cu-T) and Levonorgestrel-releasing IUDs (Mirena) are composed of plastic (polyethylene), barium sulfate, and copper or hormones. They are latex-free and safe for these patients. * **C. Laparoscopic Tubal Ligation:** This is a surgical procedure. While surgical gloves were historically latex-based, the procedure itself (and the clips/rings used for occlusion) does not inherently involve latex. In modern practice, latex-free gloves are used for allergic patients. **High-Yield Clinical Pearls for NEET-PG:** * **Latex-Fruit Syndrome:** Patients allergic to latex often show cross-reactivity with certain fruits, most commonly **Avocado, Banana, Kiwi, and Chestnut**. * **Diaphragms and Cervical Caps:** Like condoms, these are often made of latex and are also contraindicated. * **Non-Latex Condoms:** Polyurethane condoms are thinner and provide good sensitivity but have a higher breakage and slippage rate compared to latex. * **Spermicides:** Nonoxynol-9 is the most common spermicide used with barrier methods; it does not contain latex but can cause vaginal irritation.

Q: Non-contraceptive benefits of oral contraceptive agents are against the development of all of the following except?

Cervical carcinoma. Combined Oral Contraceptive Pills (COCPs) provide significant non-contraceptive health benefits by suppressing ovulation and regulating hormonal fluctuations. However, they do not protect against **Cervical Carcinoma**; in fact, long-term use (typically >5 years) is associated with a slightly increased risk of cervical cancer, likely due to increased susceptibility to HPV infection and lifestyle factors. ### Why the other options are incorrect: * **Ectopic Pregnancy:** COCPs prevent ectopic pregnancy by the primary mechanism of inhibiting ovulation. If there is no ovum, fertilization cannot occur, virtually eliminating the risk of any pregnancy. * **Endometrial Carcinoma:** The progestogen component in COCPs opposes the proliferative effect of estrogen on the endometrium, leading to atrophy. This reduces the risk of endometrial cancer by approximately 50%, a benefit that persists for years after discontinuation. * **Ovarian Carcinoma:** By suppressing ovulation, COCPs reduce "incessant ovulation" and the repeated trauma to the ovarian epithelium. This reduces the risk of epithelial ovarian cancer by about 40-50%. ### High-Yield Clinical Pearls for NEET-PG: * **Protective Effect:** COCPs are protective against **Endometrial, Ovarian, and Colorectal cancers**, as well as Benign Breast Disease and Pelvic Inflammatory Disease (PID). * **Increased Risk:** COCPs are associated with an increased risk of **Cervical cancer, Breast cancer, and Hepatic adenoma**. * **Therapeutic Uses:** They are first-line treatments for Dysmenorrhea, Menorrhagia (DUB), and Polycystic Ovary Syndrome (PCOS). * **Duration:** The protective effect against ovarian and endometrial cancer increases with the duration of use and lasts for up to 15–20 years after stopping the pill.

Q: Unsuccessfulness of Depot Medroxyprogesterone Acetate (DMPA) has been primarily because of which of the following?

Breakthrough bleeding. **Explanation:** The primary reason for the "unsuccessfulness" of DMPA (marketed as Antara in India) refers to its **high discontinuation rate** rather than its contraceptive efficacy. 1. **Why Breakthrough Bleeding (BTB) is correct:** DMPA is a progestogen-only injectable. The lack of estrogen leads to an unstable endometrium, causing irregular spotting or breakthrough bleeding, especially in the first 3–6 months. This side effect is the most common reason women stop using the method, leading to its perceived "unsuccessfulness" in long-term family planning programs. Over time, this usually progresses to amenorrhea, which can also be a cause for discontinuation due to cultural myths or fear of pregnancy. 2. **Analysis of Incorrect Options:** * **Effect on lactation:** DMPA is actually the **contraceptive of choice in lactating mothers** (after 6 weeks postpartum) as it does not affect the quality or quantity of breast milk. * **Delay in return of fertility:** While DMPA causes a significant delay (average 7–10 months after the last dose), it is a known pharmacological profile of the drug. While it may deter some users, it is not the leading cause of mid-treatment discontinuation compared to bleeding. * **Failure rate:** DMPA is highly effective. Its Pearl Index is **0.2–0.3**, making it one of the most reliable reversible contraceptives. **High-Yield Clinical Pearls for NEET-PG:** * **Dosage:** 150 mg intramuscularly every 3 months (12 weeks). * **Mechanism:** Primarily inhibits ovulation by suppressing the LH surge. * **Side Effects:** Weight gain (most common metabolic side effect) and a reversible decrease in **Bone Mineral Density (BMD)**. * **Amenorrhea:** By the end of 1 year, approximately 50–60% of users develop amenorrhea.

Question 1

What is the dose of centchroman?

Accepted Answer

30 mg

Answer

60 mg

Answer

120 mg

Answer

240 mg

Question 2

What is a contraindication for the use of an intrauterine contraceptive device (IUCD)?

Accepted Answer

All of the above

Answer

Previous cesarean section

Answer

Pelvic inflammatory disease (PID)

Answer

Uterine malformation

Question 3

Tubal ligation is reported to have decreased the risk of?

Accepted Answer

Ovarian cancer

Answer

Functional ovarian cysts

Answer

Breast cancer

Answer

Salpingitis

Question 4

An X-ray pelvis in AP view shows the presence of:

Accepted Answer

Uterine sounding to check the position of a dislodged IUD

Answer

Endoscopic removal of ureteric stones

Answer

Uterine sounding to check for the site of a uterine tear

Answer

Pelvic trauma

Question 5

Which of the following is NOT used as emergency contraception?

Accepted Answer

Danazol

Answer

Copper T 200B

Answer

RU486

Answer

High dose Estrogen

Question 6

An Intrauterine Device (IUD) is not inserted during which of the following conditions?

Accepted Answer

Immediately after delivery (within 48 hours)

Answer

During menstruation

Answer

Within 10 days of the beginning of menstruation

Answer

6-8 weeks after delivery

Question 7

Replacement of a progestin-releasing intrauterine device should be done after how many years?

Accepted Answer

5 years

Answer

1 year

Answer

3 years

Answer

10 years

Question 8

Which contraceptive method is medically contraindicated for a patient with a known latex allergy?

Accepted Answer

Condoms

Answer

Oral contraceptives

Answer

Intrauterine device (IUD)

Answer

Laparoscopic tubal ligation

Question 9

Non-contraceptive benefits of oral contraceptive agents are against the development of all of the following except?

Accepted Answer

Cervical carcinoma

Answer

Ectopic pregnancy

Answer

Endometrial carcinoma

Answer

Ovarian carcinoma

Question 10

Unsuccessfulness of Depot Medroxyprogesterone Acetate (DMPA) has been primarily because of which of the following?

Accepted Answer

Breakthrough bleeding

Answer

Effect on lactation

Answer

Delay in return of fertility

Answer

Failure rate

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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