Contraception and Family Planning Practice Questions

Q: Which intrauterine device (IUD) is most commonly associated with expulsion?

Lippes loop. **Explanation:** The expulsion rate of an intrauterine device (IUD) is primarily influenced by its shape, size, and the material's interaction with the uterine cavity. **Why Lippes Loop is the Correct Answer:** The **Lippes Loop** is a non-medicated, first-generation IUD made of polyethylene. It has the **highest expulsion rate** among all IUDs. This is because it is a large, bulky device that lacks a rigid frame to anchor it effectively against the uterine walls. Its presence often triggers significant uterine contractions (myometrial activity) as the uterus attempts to expel the foreign body, leading to a higher incidence of spontaneous displacement compared to modern, smaller, T-shaped devices. **Analysis of Incorrect Options:** * **T Cu-200 & T Cu-380A:** These are second and third-generation medicated IUDs. Their **T-shape** is designed to conform better to the uterine cavity, significantly reducing the risk of expulsion compared to the S-shaped Lippes Loop. * **LNG-IUD (Mirena):** This hormone-releasing system also uses a T-shaped frame. Additionally, the progestogen (Levonorgestrel) causes endometrial atrophy and reduces uterine contractility, further lowering the risk of expulsion compared to non-medicated devices. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect of IUDs:** Bleeding (Menorrhagia). * **Most common reason for removal:** Bleeding (for Copper T) and Pain. * **Ideal time for insertion:** During menstruation or within 10 days of the cycle (to ensure the patient is not pregnant and the cervix is slightly dilated). * **Expulsion Risk:** Highest in the first year of use and during the first few months post-insertion. * **PPIUD (Postpartum IUD):** Has a higher expulsion rate than interval insertion, but is still a recommended public health strategy.

Q: Which of the following statements is true regarding mifepristone (RU 486)?

It causes delayed menstruation.. **Explanation:** **Mifepristone (RU-486)** is a potent synthetic steroid with high affinity for **progesterone receptors**, where it acts as a competitive antagonist. 1. **Why Option D is correct:** When used as emergency contraception (EC), mifepristone primarily acts by **inhibiting or delaying ovulation** through the suppression of the LH surge. If taken during the luteal phase, it can disrupt the endometrium. This hormonal interference frequently results in a **delay of the next menstrual period** (usually by a few days), which is a common clinical observation and a key point for patient counseling. 2. **Why other options are incorrect:** * **Option A:** Mifepristone does not prevent fertilization; it prevents pregnancy primarily by interfering with ovulation or preventing implantation (post-fertilization). * **Option B:** It has a high affinity for **progesterone and glucocorticoid receptors**, but negligible affinity for estrogen receptors. In fact, it exhibits anti-progestational and anti-glucocorticoid activity. * **Option C:** While a single dose is effective, the standard low-dose for emergency contraception is **10 mg**, but its efficacy is approximately **85%**; more importantly, the dose-response relationship in literature varies, and the "90%" figure is not a standardized clinical hallmark compared to the definitive side effect of menstrual delay. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism in Medical Abortion:** It causes decidual breakdown and sensitizes the myometrium to prostaglandins (like Misoprostol). * **Dose for Medical Abortion:** 200 mg orally (followed by Misoprostol 800 mcg 36–48 hours later) up to 9 weeks (63 days) of gestation. * **Dose for Emergency Contraception:** A single 10 mg dose is effective up to 72–120 hours post-coitus. * **Other Uses:** Cushing’s syndrome (due to anti-glucocorticoid action), fibroids, and endometriosis.

Q: How is contraception efficacy measured?

Pearl index and life table analysis. To measure the efficacy of a contraceptive method, we primarily look at the **failure rate**. In clinical research and public health, two standard statistical tools are used: **1. Pearl Index (PI):** This is the most common method. it calculates the number of unintended pregnancies per 100 woman-years of exposure. * *Formula:* (Total accidental pregnancies × 1200) / (Total months of exposure). * *Limitation:* It assumes a constant failure rate over time, which is often inaccurate as failure rates usually decrease the longer a method is used. **2. Life Table Analysis:** This is a more sophisticated method that calculates the failure rate at specific intervals (e.g., at 6 months, 12 months). It accounts for "drop-outs" and recognizes that the risk of pregnancy changes over time, making it more accurate than the Pearl Index for long-term studies. ### Analysis of Options: * **Option A:** Incorrect because while the Pearl Index is standard, it is not the *only* measure; Life Table analysis provides a more longitudinal perspective. * **Option C & D:** Incorrect because the **Couple Protection Rate (CPR)** is a public health indicator used to monitor the performance of family planning programs in a population. It measures the proportion of eligible couples protected by any contraceptive method; it does **not** measure the efficacy of the method itself. ### High-Yield NEET-PG Pearls: * **Most effective contraceptive (Lowest Pearl Index):** Implant (Nexplanon) ~0.05. * **Least effective (Highest Pearl Index):** No contraception (~85) or Barrier methods (with typical use). * **Perfect Use vs. Typical Use:** Pearl Index is always lower (better) for "perfect use" compared to "typical use" (which accounts for human error). * **Denominator of Pearl Index:** 100 woman-years (equivalent to 1,200 months or 1,300 cycles).

Q: Oral contraceptive pills decrease the incidence of all of the following conditions except:

Hepatic adenoma. **Explanation:** Combined Oral Contraceptive Pills (COCPs) are known for several non-contraceptive health benefits, but they are also associated with specific risks. **Why Hepatic Adenoma is the correct answer:** Hepatic adenoma is a rare, benign liver tumor that is a known **complication** of long-term COCP use. The estrogen component in the pill promotes the growth of these vascular tumors. Therefore, COCPs **increase** the incidence of hepatic adenoma rather than decreasing it. If an adenoma is detected, the first step in management is often the discontinuation of the pill. **Why the other options are incorrect:** * **Salpingitis (Pelvic Inflammatory Disease):** COCPs decrease the risk of symptomatic PID. The progestogen component thickens the cervical mucus, creating a barrier that prevents the upward migration of pathogens into the fallopian tubes. * **Ovary CA:** COCPs provide significant protection against epithelial ovarian cancer by suppressing ovulation ("incessant ovulation" theory). This protective effect increases with the duration of use and persists for years after discontinuation. * **Fibroadenosis:** COCPs reduce the incidence of benign breast diseases, including fibroadenosis and fibrocystic disease, by stabilizing hormonal fluctuations. **NEET-PG High-Yield Pearls:** * **Cancer Protection:** COCPs decrease the risk of **Ovarian** and **Endometrial** cancers (by ~50%). They also reduce the risk of **Colorectal** cancer. * **Cancer Risks:** COCPs are associated with a slight increase in the risk of **Cervical** and **Breast** cancers. * **Other Benefits:** They reduce the risk of ectopic pregnancy, iron-deficiency anemia (due to reduced menstrual flow), and functional ovarian cysts.

Q: Which of the following are considered Long Acting Reversible Contraceptives (LARC)?

All of the above. **Explanation:** **Long-Acting Reversible Contraceptives (LARC)** are defined as methods of birth control that provide effective contraception for an extended period without requiring daily or frequent user action. The hallmark of LARCs is their high efficacy (comparable to sterilization) and their "forget-ability," which eliminates the risk of user error. 1. **Why the answer is "All of the above":** * **IUCDs (Option C):** Both Copper-T (e.g., Cu-T 380A, effective for 10 years) and Levonorgestrel-releasing systems (e.g., Mirena, effective for 5–8 years) are classic LARCs. * **Implants (Option A):** Subdermal implants (e.g., Nexplanon/Implanon) provide continuous hormone release for 3 years and are considered the most effective reversible method available. * **Injections (Option B):** While some international guidelines (like the CDC) categorize only IUCDs and Implants as LARCs due to their multi-year duration, the **WHO and Indian National Health Programs** often include Injectable Contraceptives (e.g., DMPA/Antara) under the LARC umbrella because they provide protection for 3 months per dose, significantly longer than daily pills or coitus-dependent methods. 2. **Clinical Pearls for NEET-PG:** * **Most Effective Contraceptive:** Subdermal Implant (Failure rate ~0.05%). * **LARC vs. Permanent:** LARCs are as effective as tubal ligation but are fully reversible. * **Postpartum IUCD (PPIUCD):** Should be inserted within 48 hours of delivery; if missed, wait until 6 weeks (involution). * **DMPA (Antara):** Given every 13 weeks (IM). A common side effect is menstrual irregularity followed by amenorrhea and a potential delay in the return of fertility (up to 7–10 months). * **Ideal Candidate:** LARCs are now recommended as first-line options for both nulliparous and multiparous women, including adolescents.

Question 1

Which intrauterine device (IUD) is most commonly associated with expulsion?

Accepted Answer

Lippes loop

Answer

T Cu-200

Answer

T Cu-380

Answer

LNG-IUD

Question 2

Which of the following statements is true regarding mifepristone (RU 486)?

Accepted Answer

It causes delayed menstruation.

Answer

It prevents fertilization.

Answer

It has affinity for estrogen receptors.

Answer

A single dose of 10mg prevents pregnancy in 90% of cases.

Question 3

What is an absolute contraindication for Cu-T insertion?

Accepted Answer

Undiagnosed vaginal bleeding

Answer

Patient unmotivated for contraception

Answer

Previous ectopic pregnancy

Answer

Previous history of abortion

Question 4

What is the best mode of contraception for a newly married lady with rheumatic heart disease?

Accepted Answer

Condom

Answer

Oral pills

Answer

Norplant

Answer

IUCD

Question 5

Which of the following is the best contraceptive option in a 30-year-old woman with heart disease?

Accepted Answer

Intrauterine contraceptive device (IUCD)

Answer

Sterilization

Answer

Steroid contraceptive

Answer

Barrier methods

Question 6

How is contraception efficacy measured?

Accepted Answer

Pearl index and life table analysis

Answer

Pearl index only

Answer

Life table analysis and couple protection rate

Answer

Couple protection rate and Pearl index

Question 7

Which of the following drugs can be safely used in early pregnancy to treat rheumatoid arthritis, except:

Accepted Answer

Leflunomide

Answer

Sulfasalazine

Answer

NSAIDs

Answer

Adalimumab

Question 8

Oral contraceptive pills decrease the incidence of all of the following conditions except:

Accepted Answer

Hepatic adenoma

Answer

Salpingitis

Answer

Ovary CA

Answer

Fibroadenosis

Question 9

Which of the following are considered Long Acting Reversible Contraceptives (LARC)?

Accepted Answer

All of the above

Answer

Implants

Answer

Injections

Answer

Intrauterine contraceptive devices (IUCD)

Question 10

Which of the following is the safest method of sterilization in the immediate postpartum period?

Accepted Answer

Minilaparotomy

Answer

Laparoscopy

Answer

Hysteroscopic method

Answer

None of the above

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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