Contraception and Family Planning Practice Questions

Q: For effective protection after unprotected intercourse, one single tablet of levonorgestrel 0.75mg has already been taken. When should the next dose be taken?

1 tablet after 12 hours. **Explanation:** The question refers to the **Yuzpe regimen** or the traditional two-dose Levonorgestrel (LNG) emergency contraceptive protocol. **1. Why Option B is Correct:** The standard emergency contraceptive dose for Levonorgestrel is **1.5 mg**. When using the 0.75 mg formulation, the protocol requires two doses to reach the therapeutic threshold. The second 0.75 mg tablet must be taken exactly **12 hours** after the first dose. This timing ensures sustained hormonal levels to effectively delay or inhibit ovulation, which is the primary mechanism of action. **2. Why Other Options are Incorrect:** * **Options A & D:** Waiting 24 hours is incorrect because the plasma half-life and pharmacokinetics of LNG in this regimen are optimized for a 12-hour interval. Delaying the second dose reduces efficacy. * **Option C:** Taking two tablets (1.5 mg) 12 hours after an initial 0.75 mg dose would result in a total dose of 2.25 mg, which is unnecessary and increases the risk of side effects like nausea and vomiting without providing additional contraceptive benefit. **3. NEET-PG High-Yield Clinical Pearls:** * **The "Gold Standard" Change:** While the 12-hour split dose is the traditional method, the WHO now recommends a **single dose of 1.5 mg (e.g., i-Pill, 72-HOURS)** as it is equally effective and improves patient compliance. * **Time Window:** LNG is effective if taken within **72 hours** of unprotected intercourse, though efficacy is highest within the first 24 hours. * **Mechanism:** It primarily works by preventing the LH surge; it does **not** work if implantation has already occurred (it is not an abortifacient). * **Most Effective EC:** The **Copper-T (IUCD)** remains the most effective emergency contraceptive if inserted within 5 days. * **Ulipristal Acetate:** A selective progesterone receptor modulator (30 mg) is now preferred over LNG for use up to 120 hours (5 days).

Q: Oral contraceptive pills are contraindicated in all of the following conditions except:

Polycystic ovarian disease. **Explanation:** The correct answer is **Polycystic Ovarian Disease (PCOD/PCOS)**. In fact, Combined Oral Contraceptive Pills (COCPs) are considered the **first-line management** for PCOS. They help regulate menstrual cycles, provide endometrial protection against hyperplasia (by counteracting unopposed estrogen), and treat hyperandrogenism (hirsutism and acne) by increasing Sex Hormone Binding Globulin (SHBG), which lowers free testosterone levels. **Analysis of Contraindications (WHO Medical Eligibility Criteria - Category 4):** The other options represent absolute contraindications to COCPs due to the increased risk of thromboembolism and cardiovascular events associated with the estrogen component: * **Smoking in a patient ≥35 years:** Smoking significantly synergizes with estrogen to increase the risk of myocardial infarction and stroke. It is an absolute contraindication if the patient smokes ≥15 cigarettes/day and is over 35. * **Coronary Occlusion (Ischemic Heart Disease):** Estrogen increases the synthesis of clotting factors and promotes a pro-thrombotic state, which can exacerbate or trigger further coronary events. * **Cerebrovascular Disease:** A history of stroke or TIA is a Category 4 contraindication because COCPs increase the risk of ischemic stroke. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications (Mnemonic: ACHES):** **A**bdominal pain (Gallbladder disease/Tumors), **C**hest pain (IHD), **H**eadaches (Migraine with aura), **E**ye problems (Vascular disease), **S**evere leg pain (DVT). * **Breast Cancer:** COCPs are absolutely contraindicated in current breast cancer. * **Liver Disease:** Active viral hepatitis or decompensated cirrhosis are contraindications. * **PCOS Benefit:** COCPs containing **Cyproterone acetate** or **Drospirenone** are preferred in PCOS for their superior anti-androgenic properties.

Q: An intrauterine device (IUD) should not be inserted in which of the following conditions?

Immediate postpartum period. **Explanation:** The correct answer is **D. Immediate postpartum period**. This question focuses on the **WHO Medical Eligibility Criteria (MEC)** for contraceptive use. **Why Option D is correct:** According to WHO MEC Category 4 (Absolute Contraindication), an IUD should not be inserted between **48 hours and 4 weeks postpartum**. During this period, the risk of **expulsion** is highest due to uterine involution, and there is an increased risk of perforation. *Note: IUD insertion is safe within the first 48 hours (PPIUD) or after 4 weeks (interval insertion).* **Analysis of Incorrect Options:** * **A & C (Genital bleeding of unknown origin / Suspected cervical malignancy):** These are **Category 4** contraindications for *initiation* of an IUD. However, in the context of this specific question (often sourced from standard textbooks like Dutta), the "Immediate Postpartum Period" (48h–4wks) is highlighted as the specific temporal contraindication regarding the timing of insertion. * **B (Postpartum endometritis):** This is a **Category 4** contraindication. However, it is an infective complication rather than a physiological timing contraindication. **High-Yield NEET-PG Pearls:** * **WHO MEC Category 4 (Absolute Contraindications) for Cu-T:** 1. Pregnancy. 2. Unexplained vaginal bleeding (until evaluated). 3. Current PID or Purulent cervicitis. 4. Gestational Trophoblastic Disease (with high hCG). 5. Cervical or Endometrial Cancer (awaiting treatment). 6. Distorted uterine cavity (Fibroids). 7. Pelvic Tuberculosis. * **Ideal Time for Insertion:** 3–7 days of the menstrual cycle (to rule out pregnancy and ensure an open internal os). * **Most common side effect:** Bleeding (Menorrhagia). * **Most common reason for removal:** Pain and Bleeding.

Q: All of the following are considered procedures for female sterilization, EXCEPT?

Laparoscopic puerperal sterilization. **Explanation:** The core concept behind this question lies in the timing and physiological constraints of postpartum sterilization. **Why Option C is the correct answer:** **Puerperal sterilization** refers to tubal ligation performed within the first week (usually 24–48 hours) after delivery. During the early puerperium, the uterus is an abdominal organ (enlarged), and the fallopian tubes are easily accessible via a small sub-umbilical incision. Therefore, **Mini-laparotomy** is the preferred and standard method for puerperal sterilization. **Laparoscopy is contraindicated** in the immediate puerperium because the enlarged uterus increases the risk of injury during trocar insertion, and the increased vascularity of the pelvic organs poses a higher risk of bleeding. **Analysis of other options:** * **A. Mini-lap tubal ligation:** The most common method used in mass sterilization camps and for postpartum (puerperal) sterilization. It involves a small abdominal incision (Pomeroy’s technique is most common). * **B. Laparoscopic tubal ligation:** The gold standard for **interval sterilization** (performed 6 weeks after delivery). It uses Falope rings or Filshie clips. * **C. Hysteroscopic tubal occlusion:** A non-incisional method (e.g., Essure, though now largely discontinued) where micro-inserts are placed into the fallopian tubes via the cervix. **High-Yield NEET-PG Pearls:** * **Ideal time for Puerperal Sterilization:** 24–48 hours postpartum (not before 24 hours to allow for neonatal assessment). * **Preferred Technique:** Pomeroy’s method (Modified) is the most popular due to its simplicity and efficacy. * **Failure Rates:** Failure is highest in laparoscopic clips and lowest in surgical excision (Pomeroy). * **Interval Sterilization:** Best performed during the follicular phase of the menstrual cycle.

Q: Oral contraceptive pills are contraindicated in all except?

Uterine fibroids. **Explanation:** Combined Oral Contraceptive Pills (COCPs) contain estrogen and progesterone, which significantly influence systemic physiology. Understanding their contraindications is crucial for NEET-PG. **Why Uterine Fibroids is the Correct Answer:** Uterine fibroids are **not** a contraindication for COCPs. In fact, COCPs are often used as a medical management strategy for fibroids to control the associated heavy menstrual bleeding (menorrhagia). While estrogen can theoretically stimulate fibroid growth, low-dose modern pills do not typically cause significant enlargement and provide the benefit of cycle regulation. **Analysis of Incorrect Options (Contraindications):** * **Intermittent Vaginal Bleeding:** Undiagnosed abnormal vaginal bleeding is an absolute contraindication. COCPs can mask the symptoms of underlying malignancies (like endometrial or cervical cancer) which must be ruled out before starting hormonal therapy. * **History of Thromboembolism:** Estrogen increases the synthesis of clotting factors in the liver and decreases anticoagulants like Protein S. A history of DVT or pulmonary embolism is a Category 4 contraindication (unacceptable health risk) due to the high risk of recurrence. * **Cardiac Abnormalities:** Conditions such as ischemic heart disease, complicated valvular disease, or severe hypertension are contraindications because the estrogen component increases the risk of stroke and myocardial infarction. **High-Yield Clinical Pearls for NEET-PG:** * **WHO Medical Eligibility Criteria (MEC) Category 4 (Absolute Contraindications):** Smoker >35 years (≥15 cigarettes/day), History of Thromboembolism, Migraine with aura, Breast cancer (current), and Liver tumors. * **Benefit:** COCPs are **protective** against Ovarian and Endometrial cancers. * **Drug Interaction:** Rifampicin is the most potent inducer of hepatic enzymes that decreases COCP efficacy.

Q: The depicted instrument is used in which procedure?

Tubectomy (Female Sterilization). ***Tubectomy (Female Sterilization)*** - The depicted instrument is a **Falope ring applicator** or **Filshie clip applicator** specifically designed for **tubal occlusion** during female sterilization procedures. - It is widely used in **laparoscopic tubectomy** procedures as part of **family planning programs** in India, providing permanent contraception by blocking the fallopian tubes. *Punch Biopsy* - Punch biopsy instruments are **circular cutting tools** with sharp edges used to obtain **skin or tissue samples**. - They are much smaller, handheld devices that create **cylindrical tissue cores**, unlike the specialized tubal occlusion instrument shown. *Bone marrow biopsy set* - Bone marrow biopsy requires **Jamshidi needles** or **trephine needles** that are long, hollow instruments for accessing the **bone marrow cavity**. - These instruments are designed for **penetrating bone** and aspirating marrow, completely different from tubal sterilization equipment. *Trocar and cannula for laparoscopy* - **Trocars** are sharp, pointed instruments used to create **initial entry ports** in the abdomen for laparoscopic surgery. - They are **straight, spike-like instruments** with cannulas, not specialized applicators for tubal rings or clips as depicted.

Q: Which of the following is NOT a side effect of oral contraceptives?

Increased risk of ovarian cancer. **Explanation:** The correct answer is **D. Increased risk of ovarian cancer**. In fact, Combined Oral Contraceptive Pills (COCPs) are highly **protective** against ovarian cancer. **Why Option D is correct:** COCPs suppress ovulation by inhibiting the release of FSH and LH. According to the "Incessant Ovulation Theory," reducing the number of ovulatory cycles decreases repetitive trauma to the ovarian epithelium. Using COCPs for 5 years reduces the risk of ovarian cancer by approximately 50%, and this protective effect persists for up to 15–20 years after discontinuation. **Why other options are incorrect:** * **A. Irregular bleeding:** Breakthrough bleeding or spotting is the most common side effect, especially during the first few months of use (progestogen-induced endometrial instability). * **B. Headache:** Estrogen can trigger or worsen migraines. New-onset focal headaches or migraines with aura are contraindications due to the increased risk of stroke. * **C. Thrombosis:** The estrogen component (Ethinylestradiol) increases the synthesis of clotting factors (II, VII, IX, X) in the liver, significantly increasing the risk of Venous Thromboembolism (VTE). **High-Yield NEET-PG Pearls:** * **Protective Effects:** COCPs reduce the risk of **Ovarian, Endometrial, and Colorectal cancers**. * **Increased Risks:** COCPs slightly increase the risk of **Breast and Cervical cancers**, as well as Hepatic Adenomas. * **Non-contraceptive benefits:** Reduced incidence of Pelvic Inflammatory Disease (PID), ectopic pregnancy, and benign breast disease. * **Absolute Contraindication:** Smokers >35 years old (>15 cigarettes/day) due to high cardiovascular risk.

Q: Levonorgestrel-containing IUCD prevents pregnancy primarily due to which mechanism?

Making the endometrium unreceptive. **Explanation:** The **Levonorgestrel-releasing Intrauterine System (LNG-IUS)**, such as Mirena, primarily acts through local progestogenic effects. The high local concentration of levonorgestrel leads to profound **endometrial atrophy** and down-regulation of estrogen receptors, making the **endometrium unreceptive** to implantation. This is considered its most significant mechanism of action. **Analysis of Options:** * **A (Correct):** As mentioned, the primary mechanism is the induction of a thin, atrophic endometrium that prevents a fertilized egg from implanting. * **B (Incorrect):** While some systemic absorption occurs, ovulation is maintained in the majority of cycles (about 75-85%). It is not the primary contraceptive mechanism. * **C (Incorrect):** This is the primary mechanism for **Copper-containing IUCDs**, which cause a sterile inflammatory response and are spermicidal. LNG-IUS relies on hormonal changes rather than inflammation. * **D (Incorrect):** Progestogens make the cervical mucus **thick and viscid** (not thin), which creates a barrier to sperm penetration. While this is a secondary mechanism of LNG-IUS, endometrial changes remain the primary factor. **High-Yield Clinical Pearls for NEET-PG:** * **Life span:** LNG-IUS (Mirena) is FDA-approved for up to 8 years (previously 5). * **Non-contraceptive use:** It is the **Gold Standard** (First-line) medical management for **Heavy Menstrual Bleeding (HMB)** and Adenomyosis. * **Failure Rate:** It has one of the lowest failure rates (0.2%), comparable to surgical sterilization. * **Pearl:** Unlike Copper-T, LNG-IUS typically reduces menstrual blood flow and may lead to amenorrhea, which is often a desired therapeutic effect.

Question 1

For effective protection after unprotected intercourse, one single tablet of levonorgestrel 0.75mg has already been taken. When should the next dose be taken?

Accepted Answer

1 tablet after 12 hours

Answer

1 tablet after 24 hours

Answer

2 tablets after 12 hours

Answer

2 tablets after 24 hours

Question 2

Oral contraceptive pills are contraindicated in all of the following conditions except:

Accepted Answer

Polycystic ovarian disease

Answer

Smoking in a patient 35 years or older

Answer

Coronary occlusion

Answer

Cerebrovascular disease

Question 3

An intrauterine device (IUD) should not be inserted in which of the following conditions?

Accepted Answer

Immediate postpartum period

Answer

Genital bleeding of unknown origin

Answer

Postpartum endometritis

Answer

Suspected cervical malignancy

Question 4

All of the following are considered procedures for female sterilization, EXCEPT?

Accepted Answer

Laparoscopic puerperal sterilization

Answer

Mini-lap tubal ligation

Answer

Laparoscopic tubal ligation

Answer

Hysteroscopic tubal occlusion

Question 5

Oral contraceptive pills are contraindicated in all except?

Accepted Answer

Uterine fibroids

Answer

Intermittent vaginal bleeding

Answer

History of thromboembolism

Answer

Cardiac abnormalities

Question 6

Tubectomy in a heart patient who has recently delivered is best done after which period?

Accepted Answer

1 week

Answer

48 hours

Answer

2 weeks

Answer

Immediately

Question 7

The depicted instrument is used in which procedure?

Accepted Answer

Tubectomy (Female Sterilization)

Answer

Punch Biopsy

Answer

Bone marrow biopsy set

Answer

Trocar and cannula for laparoscopy

Question 8

Which of the following is NOT a side effect of oral contraceptives?

Accepted Answer

Increased risk of ovarian cancer

Answer

Irregular bleeding

Answer

Headache

Answer

Thrombosis

Question 9

Levonorgestrel-containing IUCD prevents pregnancy primarily due to which mechanism?

Accepted Answer

Making the endometrium unreceptive

Answer

Suppressing ovulation

Answer

Initiating inflammatory changes within the endometrium

Answer

Making cervical mucus thin

Question 10

Which of the following is NOT a mechanism of action for an Intrauterine Contraceptive Device (IUCD)?

Accepted Answer

Constriction of the fallopian tubes

Answer

Thickening of cervical mucus

Answer

Inducing a local foreign body reaction

Answer

Making the endometrium unfavorable for implantation

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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