Contraception and Family Planning Practice Questions

Q: Which of the following is a benefit of third-generation oral contraceptive pills?

Decreased risk of myocardial infarction. **Explanation:** Oral contraceptive pills (OCPs) have evolved through generations primarily by modifying the type of progestogen used. Third-generation OCPs contain progestogens like **Desogestrel, Gestodene, or Norgestimate**. **Why Option B is Correct:** Third-generation progestogens are more "selective" and possess **lower androgenic activity** compared to second-generation pills (like Levonorgestrel). This results in a more favorable lipid profile, specifically higher HDL (good cholesterol) and lower LDL levels. Consequently, they are associated with a **decreased risk of myocardial infarction (MI)** and stroke compared to older formulations. **Analysis of Incorrect Options:** * **A. Decreased risk of thromboembolism:** This is incorrect. Third-generation OCPs are associated with a **higher risk of Venous Thromboembolism (VTE)**—roughly double the risk of second-generation pills—due to their effect on hepatic synthesis of coagulation factors. * **C & D. Increased risk of breakthrough bleeding/More side effects:** These are incorrect. Because third-generation pills are more potent and less androgenic, they generally offer **better cycle control** (less breakthrough bleeding) and fewer androgenic side effects like acne, hirsutism, and weight gain. **High-Yield Clinical Pearls for NEET-PG:** * **1st Gen:** Norethynodrel (High dose, rarely used now). * **2nd Gen:** Levonorgestrel (Most common, lowest VTE risk, but more androgenic). * **3rd Gen:** Desogestrel, Gestodene (Lowest MI risk, but higher VTE risk). * **4th Gen:** Drospirenone (Anti-mineralocorticoid and anti-androgenic; excellent for PCOS and PMDD). * **Absolute Contraindication:** Smokers >35 years old (due to high MI/stroke risk).

Q: "Persna" is a method of

Natural contraceptive. **Explanation:** **Persona** (often misspelled as "Persna" in exams) is a modern, high-tech version of the **Natural Contraceptive** method. It is a handheld electronic monitor that tracks a woman's hormonal changes to identify the "fertile window." 1. **Why it is a Natural Contraceptive:** Persona works by monitoring levels of **Luteinizing Hormone (LH)** and **Estrone-3-glucuronide (E3G)** in the urine using disposable test sticks. By detecting the rise in these hormones, the device identifies the days of high and peak fertility. It does not use drugs, hormones, or physical barriers; instead, it relies on **periodic abstinence** during the identified fertile days, making it a sophisticated form of the "Sympto-thermal" or "Rhythm" method. 2. **Why other options are incorrect:** * **Hormonal Contraceptive:** These involve exogenous hormones (like OCPs, DMPA, or implants) to suppress ovulation. Persona only *monitors* endogenous hormones. * **Barrier Contraceptive:** These (like condoms or diaphragms) provide a physical block to sperm. Persona provides information to avoid intercourse. * **IUCD:** These are devices (like Cu-T or Mirena) inserted into the uterus to prevent implantation or fertilization. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Persona identifies the "Green Days" (safe for intercourse) and "Red Days" (high risk of pregnancy). * **Failure Rate:** It has a typical use failure rate of about **6%**, which is higher than hormonal methods but lower than traditional calendar methods. * **Prerequisite:** It is only suitable for women with regular menstrual cycles (23–35 days). * **Other Natural Methods to Remember:** Lactational Amenorrhea Method (LAM), Billings Ovulation Method (cervical mucus), and the Standard Days Method (using CycleBeads).

Q: Which of the following diseases is prevented by the use of condoms?

All of the above. **Explanation:** The primary mechanism of condoms in disease prevention is the creation of a **mechanical barrier** that prevents direct contact between infected genital secretions or skin lesions and the partner’s mucosa/skin. * **Carcinoma of the Cervix:** This cancer is almost exclusively caused by persistent infection with High-Risk **Human Papillomavirus (HPV)**, specifically types 16 and 18. By acting as a barrier against HPV transmission, condoms significantly reduce the risk of cervical intraepithelial neoplasia (CIN) and subsequent invasive carcinoma. * **Carcinoma of the Vulva:** Similar to cervical cancer, a significant subset of vulvar cancers (especially in younger women) is associated with HPV infection (Vulvar Intraepithelial Neoplasia). Condoms provide protection against the transmission of the virus to the vulvar skin. * **Genital Herpes Simplex (HSV):** HSV is transmitted through direct skin-to-skin contact or mucosal secretions. While condoms do not cover the entire perineal area (allowing for some risk of transmission from uncovered lesions), they significantly reduce the viral load and the likelihood of transmission during asymptomatic shedding or active outbreaks. **High-Yield Clinical Pearls for NEET-PG:** * **Dual Protection:** Condoms are the only contraceptive method that provides "dual protection"—preventing both unintended pregnancy and STIs (including HIV, Syphilis, Gonorrhea, and Chlamydia). * **Protective Effect on Cancers:** Condoms are considered protective against **Cervical Cancer**, whereas long-term use of Combined Oral Contraceptive Pills (COCPs) is a known risk factor for it. * **Failure Rate:** The typical use failure rate of male condoms is approximately **18%**, while the perfect use failure rate is **2%**. * **Non-Latex Options:** For patients with latex allergies, polyurethane or polyisoprene condoms are recommended.

Q: Which of the following contraceptive methods has a failure rate of less than 5 in 100 women?

Copper T. The core concept behind this question is the distinction between **"Typical Use"** and **"Perfect Use"** failure rates (Pearl Index) of various contraceptive methods. **1. Why Copper T is Correct:** The Copper T (IUCD) is a **Long-Acting Reversible Contraceptive (LARC)**. Its efficacy is high because it is independent of user compliance. The failure rate for Copper T 380A is approximately **0.8 per 100 women-years** (Typical Use). Since this is significantly less than 5 per 100, it is the correct choice. **2. Analysis of Incorrect Options:** * **Vaginal Sponge:** This is a barrier method with a high failure rate, especially in parous women. Typical use failure rates range from **12% (nulliparous) to 24% (parous)**. * **Diaphragm:** As a user-dependent barrier method requiring consistent and correct placement with spermicide, its typical failure rate is approximately **12 per 100 women-years**. * **Condom:** While effective against STIs, male condoms have a typical use failure rate of about **13–18 per 100 women-years** due to inconsistent use or breakage. **3. NEET-PG High-Yield Pearls:** * **Most Effective:** Implants (0.05%) > Vasectomy (0.1%) > IUCD (0.2–0.8%). * **Tier 1 Contraceptives:** Includes LARCs (IUCDs, Implants) and Permanent Sterilization. All have failure rates ** 12%**. * **Ideal IUCD Candidate:** Monogamous, parous women with no history of PID.

Q: In Cu 380A, what does the '380' represent?

Surface area of copper in sq. mm. ### Explanation **1. Why Option C is Correct:** In the nomenclature of Intrauterine Contraceptive Devices (IUCDs), the numerical value refers specifically to the **total surface area of the copper** (in square millimeters) available for the release of copper ions. In the **Cu 380A**, there is a total of 380 mm² of copper: 314 mm² is wound as wire around the vertical stem, and two copper sleeves of 33 mm² each are placed on the horizontal arms. The copper ions act as a spermicide by causing a sterile inflammatory response in the endometrium and altering cervical mucus. **2. Why Other Options are Incorrect:** * **Option A:** The number of turns is not standardized in the name; it varies by manufacturer to achieve the required surface area. * **Option B:** The surface area of the "Copper-T" (the plastic frame) is much larger than the copper itself. The name specifically tracks the active ingredient (copper). * **Option D:** While 380A has a long life, the number is not a measure of time. The effective life of Cu 380A is **10 years**, not 380 days or weeks. **3. Clinical Pearls for NEET-PG:** * **The 'A' in 380A:** Stands for **"Arms,"** indicating that copper is present on the horizontal arms as well as the stem. * **Mechanism of Action:** Primarily **pre-fertilization** (spermicidal); it is not an abortifacient. * **Most Effective Emergency Contraceptive:** Cu-T 380A is the most effective method of emergency contraception if inserted within 5 days of unprotected intercourse (Failure rate <0.1%). * **Ideal Candidate:** Multiparous women in a stable monogamous relationship. * **Common Side Effects:** The most common side effect is **bleeding** (menorrhagia), followed by pain. However, the most common reason for *removal* is bleeding.

Q: What is the duration of contraceptive effect for Depot Medroxyprogesterone Acetate (DMPA)?

3-6 months. **Explanation:** **Depot Medroxyprogesterone Acetate (DMPA)**, commonly known by the brand name **Antara** in the Government of India’s family planning program, is a progestogen-only injectable contraceptive. 1. **Why Option A is Correct:** The standard dosing schedule for DMPA is **150 mg intramuscularly every 3 months (12 weeks)**. While the primary contraceptive efficacy is maintained for 12–13 weeks, the pharmacological effect and suppression of ovulation can persist for a variable period. In clinical practice and for exam purposes, the duration of the contraceptive effect is considered to be **3 to 6 months**. This window accounts for the "grace period" (up to 2–4 weeks) and the delayed return to fertility often seen after the last injection. 2. **Why Other Options are Incorrect:** * **Options B, C, and D:** These durations significantly exceed the pharmacological half-life of a single 150 mg dose. While DMPA is notorious for a **delayed return to fertility** (averaging 7–10 months after the last dose), it cannot be relied upon for active contraception beyond the 6-month mark. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily inhibits ovulation by suppressing the LH surge; it also thickens cervical mucus and thins the endometrium. * **Administration:** Given deep IM in the gluteal or deltoid muscle. Do **not** massage the site (accelerates absorption). * **Side Effects:** Most common is **irregular menstrual bleeding** (spotting); long-term use is associated with **amenorrhea** and a reversible decrease in **Bone Mineral Density (BMD)**. * **Return to Fertility:** There is a characteristic lag; it may take 12–18 months for fertility to return to baseline. * **NET-EN (Norethisterone Enanthate):** Another injectable given every **2 months (8 weeks)**.

Q: Which progestin is present in Sino-Implant II?

Levonorgestrel. **Explanation:** **Sino-Implant II** (marketed under brand names like **Levoplant** or **Trust**) is a long-acting reversible contraceptive (LARC) consisting of two flexible rods. Each rod contains **75 mg of Levonorgestrel (LNG)**, totaling 150 mg. It is designed to provide highly effective contraception for up to 3 to 4 years by inhibiting ovulation and thickening cervical mucus. **Analysis of Options:** * **Levonorgestrel (Correct):** This is a second-generation synthetic progestin. It is the active ingredient in Sino-Implant II, Jadelle (two rods, 5 years), and Norplant (six capsules, 5-7 years). * **Etonogestrel (Incorrect):** This is the active metabolite of desogestrel. It is the progestin used in **single-rod** implants like **Implanon** and **Nexplanon**, which typically provide 3 years of protection. * **Norethisterone (Incorrect):** This is a first-generation progestin commonly used in oral contraceptive pills (OCPs) and the injectable **Net-En** (Norethisterone Enanthate), administered every 2 months. * **Desogestrel (Incorrect):** A third-generation progestin used primarily in "minipills" (POP) or combined oral contraceptives to reduce androgenic side effects. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Implants work primarily by suppressing the LH surge (preventing ovulation) and increasing the viscosity of cervical mucus. * **Failure Rate:** Implants have the lowest typical-use failure rate (~0.05%), making them more effective than sterilization. * **Comparison:** * **Sino-Implant II/Levoplant:** 2 rods, 150mg LNG, 3-4 years. * **Jadelle:** 2 rods, 150mg LNG, 5 years. * **Nexplanon:** 1 rod, 68mg Etonogestrel, 3 years (Radio-opaque).

Q: What is the recognized method for identifying a missed Intrauterine Device (IUD)?

Ultrasound (USG). **Explanation:** The management of a "missed IUD" (when strings are not visible on per-vaginal examination) follows a specific diagnostic hierarchy. **1. Why Ultrasound (USG) is the Correct Answer:** USG is the **first-line investigation** of choice for a missed IUD. It is highly sensitive, non-invasive, and does not involve ionizing radiation. The primary clinical goal is to determine if the IUD is **intrauterine** (malpositioned or rotated) or **extrauterine** (perforated into the peritoneal cavity). If the USG shows an empty uterine cavity, the IUD is considered "lost," and further imaging is required. **2. Analysis of Incorrect Options:** * **X-ray (Abdomen/Pelvis):** This is the **second-line** investigation. It is performed only if the USG fails to locate the IUD within the uterus. An X-ray helps identify an extrauterine IUD (perforation) but cannot definitively confirm if an IUD is inside the uterine cavity versus behind it. * **Barium Meal:** This is used to visualize the upper gastrointestinal tract (esophagus, stomach, duodenum). It has no role in pelvic imaging or IUD localization. * **CT Scan:** While highly accurate, it is not the "recognized" initial method due to high cost and significant radiation exposure. It is reserved for complex cases of organ perforation. **Clinical Pearls for NEET-PG:** * **Step 1:** Check for strings. If absent, perform **USG**. * **Step 2:** If USG is empty, perform **X-ray Erect Abdomen & Pelvis** (to rule out expulsion vs. perforation). * **X-ray Marker:** If an IUD is seen on X-ray, a lateral view or a uterine sound insertion during X-ray can help localize its relation to the uterus. * **Pregnancy:** Always rule out pregnancy in cases of a missed IUD, as the device may have been expelled or the pregnancy may have displaced the strings.

Q: The Yuzpe method is used for what purpose?

Post-coital hormonal contraception. **Explanation:** The **Yuzpe method** is a traditional form of **emergency (post-coital) hormonal contraception**. It involves the use of combined oral contraceptive (COC) pills containing both Estrogen and Progestogen to prevent pregnancy after unprotected intercourse. **Why Option A is Correct:** The regimen consists of two doses of combined pills: each dose containing **100 mcg of Ethinyl Estradiol and 0.5 mg of Levonorgestrel**. The first dose must be taken within 72 hours of unprotected coitus, followed by a second dose 12 hours later. It works primarily by inhibiting or delaying ovulation. **Analysis of Incorrect Options:** * **Option B (Intrauterine contraception):** This refers to long-term reversible methods like the Cu-T or LNG-IUS, which are not part of the Yuzpe hormonal protocol. * **Option C (Post-coital IUD):** While a Copper-T IUD can be used as emergency contraception (and is actually more effective than the Yuzpe method), it is a mechanical intervention, not the "Yuzpe method." * **Option D (Tubal ligation):** This is a permanent surgical sterilization method, not an emergency post-coital measure. **High-Yield Clinical Pearls for NEET-PG:** * **Timeframe:** Most effective within 72 hours (though some guidelines suggest up to 5 days, efficacy drops significantly). * **Side Effects:** Nausea (50%) and vomiting (20%) are very common due to the high estrogen content. Prophylactic anti-emetics are often recommended. * **Comparison:** The Yuzpe method is now largely replaced by the **Levonorgestrel-only pill (1.5 mg single dose)**, which is more effective and has fewer side effects. * **Failure Rate:** Approximately 2-3% (higher than the LNG-only pill).

Question 1

Which of the following is a benefit of third-generation oral contraceptive pills?

Accepted Answer

Decreased risk of myocardial infarction

Answer

Decreased risk of thromboembolism

Answer

Increased risk of breakthrough bleeding

Answer

More side effects

Question 2

A woman has shortest menstrual cycles of 26 days and longest cycle of 31 days. Calculate her unsafe period using the Rhythm method?

Accepted Answer

21st of cycle to 24th of cycle

Answer

20th of cycle to 23rd of cycle

Answer

19th of cycle to 22nd of cycle

Answer

22nd of cycle to 25th of cycle

Question 3

"Persna" is a method of

Accepted Answer

Natural contraceptive

Answer

Hormonal contraceptive

Answer

Barrier contraceptive

Answer

Intrauterine contraceptive device (IUCD)

Question 4

Which of the following diseases is prevented by the use of condoms?

Accepted Answer

All of the above

Answer

Carcinoma of the cervix

Answer

Carcinoma of the vulva

Answer

Genital herpes simplex

Question 5

Which of the following contraceptive methods has a failure rate of less than 5 in 100 women?

Accepted Answer

Copper T

Answer

Vaginal sponge

Answer

Diaphragm

Answer

Condom

Question 6

In Cu 380A, what does the '380' represent?

Accepted Answer

Surface area of copper in sq. mm

Answer

Number of turns of copper wire

Answer

Surface area of copper-T in sq. mm

Answer

Effective life of copper-T in years

Question 7

What is the duration of contraceptive effect for Depot Medroxyprogesterone Acetate (DMPA)?

Accepted Answer

3-6 months

Answer

6-8 months

Answer

8-12 months

Answer

More than 1 year

Question 8

Which progestin is present in Sino-Implant II?

Accepted Answer

Levonorgestrel

Answer

Etonogestrel

Answer

Norethisterone

Answer

Desogestrel

Question 9

What is the recognized method for identifying a missed Intrauterine Device (IUD)?

Accepted Answer

Ultrasound (USG)

Answer

X-ray

Answer

Barium meal

Answer

CT Scan

Question 10

The Yuzpe method is used for what purpose?

Accepted Answer

Post-coital hormonal contraception

Answer

Intrauterine contraception

Answer

Post-coital intrauterine device insertion

Answer

Tubal ligation

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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