Contraception and Family Planning Practice Questions

Q: A mother of 3 children had unprotected sexual intercourse last night. She wishes to avoid conception as her youngest child is only 7 months old. Which of the following is NOT used for emergency contraception?

Danazol. **Explanation:** The correct answer is **Danazol**. While Danazol is a synthetic androgen used in the treatment of endometriosis and hereditary angioedema, it has **no role** in emergency contraception (EC). Historically, high doses were studied, but it was found to be ineffective compared to modern methods and is not recommended by any current clinical guidelines. **Analysis of Options:** * **Intrauterine Device (IUD):** The Copper-T (Cu-T) is the **most effective** method of emergency contraception. It can be inserted up to 5 days (120 hours) after unprotected intercourse and provides the added benefit of long-term contraception. * **Ethinyl Estradiol and Levonorgestrel:** This combination is known as the **Yuzpe Regimen**. It involves taking two doses (100 mcg EE + 0.5 mg LNG each) 12 hours apart. While effective, it is now less preferred due to a high incidence of nausea and vomiting compared to LNG-only pills. * **Mifepristone:** A selective progesterone receptor modulator (SPRM). In low doses (10 mg or 25 mg), it is highly effective as an emergency contraceptive by delaying ovulation. (Note: High doses are used for medical abortion). **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard (Most Effective):** Copper IUD (Failure rate <0.1%). * **Drug of Choice (Hormonal):** Levonorgestrel (LNG) 1.5 mg single dose (effective up to 72 hours). * **Ulipristal Acetate:** Currently considered the most effective *oral* EC, effective up to 120 hours (5 days). * **Mechanism:** Most hormonal ECs work primarily by **delaying or inhibiting ovulation**; they do not disrupt an established pregnancy (not abortifacients).

Q: Assertion: Spermicides containing non-oxynol-9 provide effective protection against STDs. Reason: Non-oxynol 9 has apoptotic effects on HIV, gonococci and chlamydia.

Both assertion and reason are false. **Explanation:** The correct answer is **D (Both assertion and reason are false)**. **1. Why the Assertion and Reason are False:** While Non-oxynol-9 (N-9) is a potent surfactant that disrupts the cell membranes of spermatozoa, it does **not** provide protection against STDs. In fact, clinical trials have shown that N-9 can increase the risk of HIV transmission. The reason is also false because N-9 does not have "apoptotic effects." Instead, it acts via **detergent-like disruption** of cell membranes. This non-specific action causes micro-abrasions and inflammation in the vaginal and rectal epithelium. These lesions act as portals of entry for pathogens like HIV, *Neisseria gonorrhoeae*, and *Chlamydia trachomatis*, thereby increasing rather than decreasing the risk of infection. **2. Analysis of Incorrect Options:** * **Option A & B:** Incorrect because the assertion is false. N-9 is strictly a contraceptive and is contraindicated for individuals at high risk of STDs/HIV. * **Option C:** Incorrect because the reason is scientifically inaccurate. The mechanism is membrane disruption (cytotoxicity), not programmed cell death (apoptosis). **3. High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Spermicides (N-9) inhibit sperm motility and oxygen uptake by disrupting the lipoprotein membrane. * **Failure Rate:** The typical use failure rate is high (~28%), making it one of the least effective standalone methods. * **WHO Recommendation:** The WHO explicitly states that N-9 should not be used for STD/HIV prevention and should not be used as a lubricant during anal intercourse. * **Ideal Usage:** It is most effective when used in combination with barrier methods like diaphragms or condoms.

Q: Which of the following is NOT true about centchroman?

Failure rate is 10 per 100 women-years. **Explanation:** Centchroman (Ormeloxifene) is a unique **Selective Estrogen Receptor Modulator (SERM)** developed by CDRI, Lucknow. It is marketed under the trade names **Saheli** or **Chhaya** and is part of India’s National Family Planning Programme. **Why Option D is the correct answer (The False Statement):** The failure rate of Centchroman is significantly lower than 10 per 100 women-years. With typical use, the Pearl Index is approximately **1.83 to 2.84 per 100 women-years**. A failure rate of 10 would be unacceptably high for a modern contraceptive method. **Analysis of Incorrect Options:** * **A. Anti-estrogenic:** Centchroman acts as an estrogen antagonist in the uterus (preventing implantation) and breast, while having weak estrogenic effects elsewhere. Its primary contraceptive mechanism is altering the endometrium to make it unreceptive to a fertilized ovum. * **B. Not a teratogen:** Unlike many hormonal contraceptives, Centchroman is non-steroidal and has no reported teratogenic effects. If a woman conceives while taking it, there is no risk of fetal malformation. * **C. Long-acting pill:** It has a long half-life (approx. 170 hours), allowing for infrequent dosing. The standard regimen is **twice weekly for the first 3 months**, followed by **once weekly** thereafter. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** Ideal for lactating mothers as it does not affect the quantity or quality of breast milk. * **Non-Contraceptive Benefits:** Used in the management of Abnormal Uterine Bleeding (AUB) and mastalgia. * **Side Effects:** The most common side effect is **delayed periods** (prolonged cycles), which occurs in about 8-10% of users. * **Contraindications:** Polycystic Ovarian Syndrome (PCOS), cervical dysplasia, and recent history of jaundice or liver disease.

Q: Depot progestins are administered by which route?

Both subcutaneous and intramuscular route. **Explanation:** Depot progestins, primarily **Depot Medroxyprogesterone Acetate (DMPA)**, are long-acting reversible contraceptives (LARCs) designed for slow release into the systemic circulation. Traditionally, DMPA was administered exclusively via the **intramuscular (IM)** route (150 mg every 3 months) [1]. However, a newer formulation, **DMPA-SC 104**, is specifically designed for **subcutaneous (SC)** administration (104 mg every 3 months). Therefore, both routes are clinically utilized [1]. * **Why Option D is Correct:** DMPA is available in two preparations: 1. **DMPA-IM:** Injected into the gluteal or deltoid muscle. 2. **DMPA-SC:** Injected into the anterior thigh or abdomen. The SC version allows for easier self-administration and carries a lower dose while maintaining efficacy for 13 weeks. * **Why Option B is Incorrect:** Progestins are never given intravenously for contraception. The "depot" effect relies on the formation of a drug reservoir in muscle or fat for slow absorption; an IV bolus would cause immediate metabolism and lack the required duration of action. * **Why Options A & C are Incorrect:** While both are used, selecting only one would be incomplete. In the context of modern medical practice and NEET-PG patterns, the inclusion of the SC route is a high-yield update. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily inhibits ovulation by suppressing the LH surge; it also thickens cervical mucus. * **The "Antara" Program:** Under India’s National Family Planning Program, DMPA is provided free of cost under the brand name **Antara**. * **Side Effects:** Menstrual irregularities (most common), weight gain, and a reversible decrease in **Bone Mineral Density (BMD)** [2]. * **Return to Fertility:** There is a characteristic delay in the return to fertility (average 7–10 months) after the last injection.

Q: Which of the following is NOT an abdominal laparoscopic technique for tubal ligation?

Essure. **Explanation:** The question asks to identify the technique that is **not** an abdominal laparoscopic method for tubal ligation. **1. Why Essure is the correct answer:** Essure is a **hysteroscopic** (transcervical) sterilization technique, not an abdominal or laparoscopic one. It involves the insertion of micro-inserts (made of nickel-titanium and polyethylene fibers) into the fallopian tubes via the vagina and cervix. These inserts trigger a chronic inflammatory response, leading to fibrosis and complete tubal occlusion over 3 months. *Note: Essure was discontinued globally due to safety concerns, but remains a high-yield topic for identifying non-surgical routes.* **2. Analysis of incorrect options (Abdominal/Laparoscopic methods):** * **Pomeroy (Option A):** The most common method. A loop of the tube is ligated with absorbable suture and the knuckle is excised. * **Parkland (Option B):** Involves ligating the tube at two points and excising the intervening segment, ensuring the ends are separated to prevent recanalization. * **Irving (Option C):** The most effective method (lowest failure rate). The proximal end of the severed tube is buried into the posterior wall of the uterus. **Clinical Pearls for NEET-PG:** * **Most common method worldwide:** Pomeroy’s technique. * **Method with the lowest failure rate:** Irving’s technique. * **Madlener’s technique:** Ligation without excision (highest failure rate due to fistula formation). * **Uchida technique:** Involves subserosal injection and resection; very effective but complex. * **Timing:** Postpartum sterilization is ideally performed 24–48 hours after delivery.

Q: Non-contraceptive benefits of oral contraceptive pills may be seen in all of the following conditions except?

Breast cancer. **Explanation:** Combined Oral Contraceptive Pills (COCPs) offer several non-contraceptive benefits due to their ability to suppress ovulation and regulate the hormonal milieu. However, their relationship with breast cancer is a notable exception. **Why Breast Cancer is the Correct Answer:** COCPs do **not** provide a protective effect against breast cancer. In fact, most epidemiological studies suggest a **slight increase in the relative risk** of breast cancer among current and recent users. This risk is generally considered to return to baseline 10 years after discontinuing the pill. Therefore, it is not a "benefit." **Analysis of Other Options:** * **Endometrial Cancer:** COCPs provide a significant protective effect (approx. 50% reduction in risk) by preventing estrogen-driven endometrial hyperplasia through the progestogen component. This protection persists for years after stopping the pill. * **Rheumatoid Arthritis:** High-yield evidence suggests that COCPs may reduce the risk of developing severe rheumatoid arthritis and can ameliorate the progression of the disease. * **Endometriosis:** COCPs are a first-line medical management for endometriosis. They induce decidualization and subsequent atrophy of endometrial tissue, thereby reducing dysmenorrhea and pelvic pain. **High-Yield Clinical Pearls for NEET-PG:** * **Cancer Protection:** COCPs significantly reduce the risk of **Ovarian cancer** (by 40-80%) and **Endometrial cancer**. They also reduce the risk of **Colorectal cancer**. * **Increased Risk:** COCPs are associated with an increased risk of **Cervical cancer** (especially with >5 years of use) and **Hepatocellular adenoma**. * **Benign Conditions:** They reduce the incidence of Benign Breast Disease (e.g., fibroadenoma), Pelvic Inflammatory Disease (PID), and Iron Deficiency Anemia (due to reduced menstrual flow).

Question 1

A mother of 3 children had unprotected sexual intercourse last night. She wishes to avoid conception as her youngest child is only 7 months old. Which of the following is NOT used for emergency contraception?

Accepted Answer

Danazol

Answer

Intrauterine device (IUD)

Answer

Ethinyl estradiol and levonorgestrel

Answer

Mifepristone

Question 2

Assertion: Spermicides containing non-oxynol-9 provide effective protection against STDs.
Reason: Non-oxynol 9 has apoptotic effects on HIV, gonococci and chlamydia.

Accepted Answer

Both assertion and reason are false

Answer

Both assertion and reason are true independently

Answer

Assertion is true, reason is false

Answer

Assertion is false, reason is true

Question 3

Which of the following is NOT true about centchroman?

Accepted Answer

Failure rate is 10 per 100 women-years

Answer

Anti-estrogenic

Answer

Not a teratogen

Answer

Long-acting pill

Question 4

A 32-year-old multipara with an intrauterine contraceptive device (Cu-T) in place presents for a regular checkup. Her urine pregnancy test is positive, and a 10-week intrauterine gestation is confirmed on ultrasonography. She wishes to continue the pregnancy. Which of the following management strategies is recommended in this patient?

Accepted Answer

Remove the IUD and plan expectant pregnancy management.

Answer

Remove the IUD and evacuate the uterine contents.

Answer

Leave the IUD in place and plan expectant pregnancy management.

Answer

Leave the IUD in place and administer broad-spectrum antibiotics for the next 4 weeks.

Question 5

Depot progestins are administered by which route?

Accepted Answer

Both subcutaneous and intramuscular route

Answer

Subcutaneous route

Answer

Intravenous route

Answer

Intramuscular route

Question 6

What is the technique used for Cu-T insertion?

Accepted Answer

Pushing

Answer

Surgery under local anesthesia

Answer

Surgery under general anesthesia

Answer

Laparotomy

Question 7

Which of the following is NOT an abdominal laparoscopic technique for tubal ligation?

Accepted Answer

Essure

Answer

Pomeroy

Answer

Parkland

Answer

Irving

Question 8

Non-contraceptive benefits of oral contraceptive pills may be seen in all of the following conditions except?

Accepted Answer

Breast cancer

Answer

Endometrial cancer

Answer

Rheumatoid arthritis

Answer

Endometriosis

Question 9

All of the following are complications of IUCD except:

Accepted Answer

Genital malignancy

Answer

Bleeding

Answer

Actinomycosis

Answer

Vaginal discharge

Question 10

In combined oral contraceptive pills, the contraceptive effect of the estrogenic component is primarily related to which of the following?

Accepted Answer

Suppression of follicle-stimulating hormone (FSH) secretion

Answer

Conversion of ethinyl estradiol to mestranol

Answer

Suppression of cervical mucus secretion

Answer

Suppression of growth hormone-releasing hormone secretion

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

On this page

Practice by Chapter

Want unlimited practice?