Contraception and Family Planning Practice Questions

Q: Which of the following is NOT a method for inducing mid-trimester abortions?

Menstrual regulation. **Explanation:** The key to answering this question lies in understanding the definition of "mid-trimester." The mid-trimester (second trimester) refers to the period between **13 and 28 weeks** of gestation. **Why Menstrual Regulation (MR) is the correct answer:** Menstrual Regulation is a method used for **very early first-trimester** abortions. It involves the aspiration of the uterine contents using a Karman cannula or a syringe, typically performed within **6 weeks of the Last Menstrual Period (LMP)** (up to 14 days of a missed period). Since it is restricted to the early first trimester, it cannot be used for mid-trimester abortions. **Analysis of incorrect options:** * **Intra-amniotic Saline:** This is a classical method for mid-trimester induction (16–20 weeks). Hypertonic saline (20%) acts by causing fetal demise and releasing endogenous prostaglandins, leading to uterine contractions. * **Intra-amniotic Prostaglandins:** Prostaglandins (like PGF2α) are potent uterine stimulants. Intra-amniotic or extra-amniotic administration is a standard pharmacological approach for second-trimester termination. * **Hysterotomy:** This is a surgical method (similar to a mini-cesarean section) used for mid-trimester abortion when medical induction fails or is contraindicated. **High-Yield Clinical Pearls for NEET-PG:** * **MVA (Manual Vacuum Aspiration):** Used up to 12 weeks (first trimester). * **Medical Method of Abortion (MMA):** Mifepristone + Misoprostol is the gold standard for early medical abortion (up to 9 weeks/63 days as per Indian RMP guidelines). * **Most common method for 2nd-trimester abortion:** Dilatation and Evacuation (D&E) or Medical Induction with Misoprostol. * **Complication of Saline:** Hypernatremia and Coagulopathy (DIC).

Q: For emergency contraception, a single tablet of 0.75 mg of LNG was taken. It should be followed by which of the following?

A single dose of 0.75 mg after 12 hours. **Explanation:** The standard regimen for Levonorgestrel (LNG)-only emergency contraception consists of a total dose of **1.5 mg**. This can be administered in two ways: 1. **Split Dose (Yuzpe-style modification):** Two doses of **0.75 mg taken 12 hours apart**. 2. **Single Dose:** A one-time dose of 1.5 mg (now more commonly preferred for better compliance). Since the question specifies that a single tablet of 0.75 mg has already been taken, the protocol dictates that the second 0.75 mg tablet must be taken **12 hours later** to complete the required 1.5 mg dosage. **Analysis of Options:** * **Option A (Correct):** Completes the 1.5 mg total dose requirement by following the 12-hour interval protocol. * **Option B & C (Incorrect):** These would result in a total dose of 2.25 mg or 3.0 mg, respectively. Exceeding the 1.5 mg threshold does not increase efficacy but significantly increases side effects like nausea and vomiting. * **Option D (Incorrect):** A single 0.75 mg dose is sub-therapeutic for emergency contraception and has a higher failure rate. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily acts by **delaying or inhibiting ovulation**. It is *not* an abortifacient and does not work if implantation has already occurred. * **Time Window:** Most effective when taken within **72 hours** of unprotected intercourse, though it can be used up to 120 hours (with declining efficacy). * **Efficacy:** If vomiting occurs within **2 hours** of intake, the dose must be repeated. * **Gold Standard:** The most effective emergency contraceptive is the **Copper-T (IUCD)**, which can be inserted up to 5 days after intercourse.

Q: A pregnant woman at 8 weeks gestation with an intrauterine contraceptive device (Cu T) in place and three living children requires management. What is the most suitable treatment?

Remove the Cu T and perform permanent sterilization.. ### Explanation The management of a pregnancy with an intrauterine contraceptive device (IUCD) in situ depends on the patient’s desire to continue the pregnancy and the visibility of the IUCD strings. **Why Option B is Correct:** In this scenario, the patient already has **three living children**, which is a significant factor in clinical decision-making regarding family planning. Since the pregnancy is at an early stage (8 weeks), the standard protocol is to **remove the Cu T** immediately to reduce the risk of septic abortion, chorioamnionitis, and preterm labor. Given her parity (three children), she has likely completed her family size. Therefore, **permanent sterilization** (Tubectomy) is the most suitable long-term contraceptive advice to prevent further unintended pregnancies. **Analysis of Incorrect Options:** * **Option A:** Continuing the pregnancy with the Cu T in situ increases the risk of spontaneous abortion (up to 50%) and severe maternal sepsis. If strings are visible, the device should always be removed in the first trimester. * **Option C:** While removing the Cu T is a necessary immediate step, it is an incomplete management plan for a patient with three children who has already experienced a contraceptive failure. It fails to address her future reproductive needs. **NEET-PG High-Yield Pearls:** * **Risk of Ectopic Pregnancy:** While IUCDs do not *cause* ectopic pregnancy, if a woman becomes pregnant with an IUCD in situ, the **relative risk** of that pregnancy being ectopic is higher (approx. 3–4%). * **Strings Visible vs. Not Visible:** If strings are visible in the first trimester, remove the IUCD. If strings are not visible, perform an ultrasound; if the IUCD is intrauterine, it is generally left alone to avoid disrupting the pregnancy. * **Teratogenicity:** There is no evidence that Cu T causes congenital malformations in the fetus.

Q: Which of the following does a natural membrane condom protect against?

Conception. **Explanation:** The correct answer is **Conception**. Natural membrane condoms (also known as "lambskin" condoms) are made from the intestinal cecum of lambs. While they are effective as a mechanical barrier against sperm, they possess microscopic pores (approximately 1.5 µm in diameter). These pores are small enough to block sperm (which are about 3 µm wide), thereby preventing **conception**, but they are large enough to allow the passage of much smaller viral pathogens. **Analysis of Options:** * **Option A (Correct):** They provide effective contraception by acting as a physical barrier to sperm. * **Option B (Incorrect):** They do **not** protect against STIs, particularly viral infections like HIV, Hepatitis B, and HSV. These viruses are significantly smaller (0.1 µm) than the pores in the natural membrane. * **Option C (Incorrect):** Since they fail to provide a barrier against viral STIs, this option is false. Only latex or synthetic (polyurethane/polyisoprene) condoms protect against both. * **Option D (Incorrect):** They are an FDA-approved method for pregnancy prevention. **High-Yield Clinical Pearls for NEET-PG:** * **Latex Condoms:** The "Gold Standard" for dual protection (conception + STIs). They are degraded by oil-based lubricants (use water-based only). * **Polyurethane Condoms:** Thinner and stronger than latex; compatible with oil-based lubricants; safe for patients with latex allergies. * **Failure Rate:** The typical use failure rate for male condoms is approximately **13-18%**, while the perfect use failure rate is **2%**. * **Nonoxynol-9:** A spermicide often added to condoms; however, it may increase the risk of HIV transmission by causing vaginal/rectal mucosal irritation.

Q: What contraceptive advice is appropriate for a lactating mother?

All of the above. **Explanation:** The choice of contraception in a lactating mother depends primarily on the **timing postpartum** and the **effect of hormones on breast milk** (quantity and quality). 1. **Barrier Methods (Option C):** These are the safest and most preferred initial methods as they are non-hormonal and do not interfere with lactation. They can be started at any time postpartum. 2. **Mini Pill / Progesterone Only Pill (Option B):** POPs are the hormonal method of choice during lactation. Unlike estrogen, progesterone does not suppress milk production. According to WHO MEC criteria, they can be started after 6 weeks postpartum in breastfeeding women (though many guidelines allow earlier use). 3. **Combined Oral Contraceptive Pill (Option A):** While COCPs are generally avoided in the early postpartum period because estrogen can decrease milk volume and increase the risk of VTE, they are **not absolutely contraindicated** forever. Once lactation is well-established (usually after 6 months), COCPs can be prescribed if the mother desires, making them a valid "appropriate" option depending on the clinical timeline. Since all three methods can be used at different stages of the postpartum period, **"All of the above"** is the most appropriate answer. **High-Yield NEET-PG Pearls:** * **Lactational Amenorrhea Method (LAM):** Effective only if the mother is exclusively breastfeeding, is amenorrheic, and the baby is <6 months old. * **IUCD (Cu-T):** Can be inserted within 48 hours (Postpartum IUCD) or after 6 weeks (Interval IUCD). * **DMPA (Injectable):** Best started at 6 weeks postpartum to avoid theoretical concerns regarding neonatal liver metabolism of steroids. * **Ideal Time for Sterilization:** Minilap is ideally done 24 hours to 7 days postpartum.

Q: Non-medicated Intrauterine Devices (IUDs) are called as?

1st generation IUDs. ### Explanation **Correct Option: A (1st generation IUDs)** Intrauterine devices are classified into generations based on their composition and mechanism of action. **1st generation IUDs** are **non-medicated, inert devices** typically made of polyethylene or other polymers. They act primarily by inducing a sterile inflammatory response (foreign body reaction) in the endometrium, which is spermicidal and prevents implantation. The most classic example is the **Lippes Loop**, which is S-shaped and contains barium sulfate for radiopacity. **Analysis of Incorrect Options:** * **B. 2nd generation IUDs:** These are **medicated devices containing copper** (e.g., Cu-T 200, Cu-T 380A, Multiload 250/375). The addition of copper increases contraceptive efficacy by enhancing the spermicidal effect. * **C. 3rd generation IUDs:** These are **hormone-releasing devices** (e.g., Progestasert, LNG-20/Mirena). They release levonorgestrel, which thickens cervical mucus and thins the endometrial lining. * **D. Multi-load devices:** These are specific types of 2nd generation copper IUDs characterized by flexible side arms that reduce the risk of expulsion. **High-Yield Clinical Pearls for NEET-PG:** * **Lippes Loop:** The most common 1st generation IUD; it is no longer the first line due to higher rates of bleeding and expulsion compared to newer generations. * **Cu-T 380A (ParaGard):** The current "Gold Standard" copper IUD; it is effective for **10 years**. * **Mirena (LNG-20):** The 3rd generation IUD of choice for **Menorrhagia** (DUB) and provides protection for **5 years**. * **Mechanism of Action:** All IUDs primarily act by preventing fertilization (pre-conceptive), not as abortifacients.

Question 1

Which of the following is NOT a method for inducing mid-trimester abortions?

Accepted Answer

Menstrual regulation

Answer

Intra-amniotic saline

Answer

Intra-amniotic prostaglandins

Answer

Hysterotomy

Question 2

For emergency contraception, a single tablet of 0.75 mg of LNG was taken. It should be followed by which of the following?

Accepted Answer

A single dose of 0.75 mg after 12 hours

Answer

Two doses of 0.75 mg, 12 hours apart

Answer

Three doses of 0.75 mg, 12 hours apart

Answer

None of the above

Question 3

What is the best contraceptive method for a 22-year-old married nulliparous woman?

Accepted Answer

Oral Contraceptive Pills (OCPs)

Answer

Condom

Answer

Tubectomy

Answer

Rhythm method

Question 4

A pregnant woman at 8 weeks gestation with an intrauterine contraceptive device (Cu T) in place and three living children requires management. What is the most suitable treatment?

Accepted Answer

Remove the Cu T and perform permanent sterilization.

Answer

Continue the pregnancy and remove the Cu T during delivery.

Answer

Remove the Cu T.

Answer

None of the above.

Question 5

Which of the following does a natural membrane condom protect against?

Accepted Answer

Conception

Answer

Sexually Transmitted Infections (STIs)

Answer

Both conception and Sexually Transmitted Infections (STIs)

Answer

None of the above

Question 6

What contraceptive advice is appropriate for a lactating mother?

Accepted Answer

All of the above

Answer

Combined pill

Answer

Mini pill

Answer

Barrier method

Question 7

Which of the following situations is an exception where an Intrauterine Device (IUD) is NOT recommended for a woman?

Accepted Answer

Has multiple sexual partners

Answer

Has one child

Answer

Has a normal menstrual cycle

Answer

Has access to follow-up care

Question 8

What is the failure rate after tubal sterilization using the Pomeroy technique?

Accepted Answer

0.40%

Answer

Zero

Answer

0.10%

Answer

1.00%

Question 9

Non-medicated Intrauterine Devices (IUDs) are called as?

Accepted Answer

1st generation IUDs

Answer

2nd generation IUDs

Answer

3rd generation IUDs

Answer

Multi-load devices

Question 10

What is the main mechanism of combined oral contraceptive pills (OCPs)?

Accepted Answer

Feedback inhibition of the pituitary, preventing the LH surge

Answer

Changes in cervical mucus

Answer

Decreased motility and secretion of the fallopian tube

Answer

Prevention of ovulation

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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