Contraception and Family Planning Practice Questions

Q: What is the recommended dose of mifepristone for medical abortion?

600 mg. **Explanation:** The correct answer is **600 mg** because this is the dosage currently recommended under the **MTP (Medical Termination of Pregnancy) Act of India** for medical abortion up to 63 days (9 weeks) of gestation. **Medical Rationale:** Mifepristone is an anti-progestational agent that binds to progesterone receptors with high affinity, leading to decidual breakdown, cervical softening, and increased uterine sensitivity to prostaglandins. While clinical trials (and WHO guidelines) suggest that 200 mg is equally effective, the **statutory dose** prescribed by the Drug Controller General of India (DCGI) and the MTP Act remains **600 mg orally**, followed 48 hours later by 400 mcg of Misoprostol (either orally or vaginally). **Analysis of Options:** * **Option A (600 mg):** The standard legal and academic answer for NEET-PG based on Indian national guidelines. * **Option B (200 mg):** Though globally recommended by the WHO as the "evidence-based" dose to reduce cost and side effects, it is not the standard answer for Indian competitive exams unless "WHO guidelines" are specifically mentioned. * **Option C & D (400 mg / 100 mg):** These are sub-therapeutic or incorrect doses for the purpose of medical abortion. 400 mcg is, however, the standard dose for the second drug, Misoprostol. **High-Yield Clinical Pearls for NEET-PG:** * **MTP Act Limit:** Medical abortion is permitted up to **9 weeks (63 days)** of gestation. * **Mechanism:** Mifepristone (Antiprogestin) + Misoprostol (PGE1 analogue). * **Emergency Contraception:** A single dose of **10 mg** mifepristone can be used as an emergency contraceptive. * **Other uses:** Mifepristone is also used in the management of Cushing’s syndrome and uterine fibroids.

Q: Thromboembolism is primarily associated with which component of oral contraceptive pills (OCPs)?

Estrogen. **Explanation:** The correct answer is **Estrogen**. **1. Why Estrogen is Correct:** The association between Combined Oral Contraceptive Pills (COCPs) and venous thromboembolism (VTE) is primarily attributed to the **Estrogen** component (usually Ethinyl Estradiol). Estrogen exerts a pro-thrombotic effect by altering the hepatic synthesis of clotting factors. Specifically, it: * **Increases** levels of clotting factors II, VII, IX, and X. * **Decreases** levels of natural anticoagulants like Antithrombin III and Protein S. * **Increases** platelet aggregation. This shift in the balance toward a hypercoagulable state significantly increases the risk of deep vein thrombosis (DVT) and pulmonary embolism. **2. Why Other Options are Incorrect:** * **Progesterone:** While some third-generation progestins (e.g., Desogestrel) may slightly modulate the risk when combined with estrogen, the primary causative agent for the hypercoagulable state is estrogen. Progesterone-only pills (POPs) are generally considered safe for patients with a history of VTE. * **Iron:** Iron is often added to the 7-day placebo phase of OCP packs (e.g., Mala-N) to prevent iron-deficiency anemia; it has no effect on the coagulation cascade. * **FSH:** FSH is a gonadotropin produced by the pituitary, not a component of OCPs. OCPs actually work by *suppressing* FSH and LH. **3. NEET-PG High-Yield Pearls:** * **Dose-Dependency:** The risk of VTE is dose-dependent; modern "low-dose" pills ( 35 years, and migraine with aura are absolute contraindications for Estrogen-containing OCPs (WHO Eligibility Criteria Category 4). * **Surgery:** OCPs should ideally be stopped **4 weeks prior** to major elective surgery to reduce postoperative VTE risk.

Q: Which of the following is NOT a contraindication for insertion of an IUCD?

Cervical discharge. **Explanation:** The correct answer is **Cervical discharge**. In clinical practice, the presence of physiological cervical discharge is not a contraindication for IUCD insertion. However, if the discharge is purulent and associated with an active infection (like cervicitis or PID), insertion should be delayed. According to WHO Medical Eligibility Criteria (MEC), a history of non-purulent discharge does not preclude IUCD use. **Analysis of Options:** * **PID (Pelvic Inflammatory Disease):** This is a **Category 4 contraindication** (absolute). Inserting an IUCD during active PID can exacerbate the infection and lead to complications like tubo-ovarian abscess or infertility. * **Presence of fibroids:** While not all fibroids are contraindications, those that **distort the uterine cavity** (e.g., submucosal fibroids) are a contraindication because they prevent proper placement, increase the risk of expulsion, and may cause heavy bleeding. * **Suspected pregnancy:** This is an absolute contraindication. Insertion during pregnancy can lead to septic abortion or miscarriage. **High-Yield Clinical Pearls for NEET-PG:** * **WHO MEC Category 4 (Absolute Contraindications):** Unexplained vaginal bleeding, current PID, current STI (cervicitis), gestational trophoblastic disease, and copper allergy (for Cu-T). * **Ideal time for insertion:** Within 10 days of the onset of menstruation (to ensure the patient is not pregnant and the cervical os is slightly dilated). * **Post-placental insertion:** Within 48 hours of delivery (though risk of expulsion is higher). * **Most common side effect:** Bleeding (menorrhagia) is the most common reason for removal. Pain is the second most common.

Q: In which of the following situations is it preferable NOT to insert an IUCD?

Immediately following a mid-trimester abortion. ### Explanation The correct answer is **D. Immediately following a mid-trimester abortion.** **1. Why Option D is Correct:** The risk of **expulsion** and **perforation** is significantly higher when an Intrauterine Contraceptive Device (IUCD) is inserted immediately after a mid-trimester (second trimester) abortion. During this period, the uterus is large, soft, and thin-walled. Furthermore, the cervix is dilated, making it easier for the device to be expelled as the uterus undergoes involution. Standard practice recommends waiting for **6 weeks** (post-involution) before insertion in such cases. **2. Analysis of Incorrect Options:** * **A. Postmenstrual:** This is the **ideal time** for insertion. The cervix is slightly open, the endometrium is thin (minimizing trauma/bleeding), and it confirms the patient is not pregnant. * **B. Emergency postcoital:** A Copper-T is the most effective method of emergency contraception if inserted within **5 days (120 hours)** of unprotected intercourse. * **C. Six weeks after delivery:** This is known as **Interval Insertion**. By 6 weeks, the uterus has returned to its normal size (involution complete), making it a safe and standard time for insertion. **3. High-Yield Clinical Pearls for NEET-PG:** * **PPIUCD (Postpartum IUCD):** Can be inserted within **48 hours** of delivery. If not done within 48 hours, wait for 6 weeks (due to high expulsion risk between 48 hours and 6 weeks). * **Post-Abortion:** IUCD can be inserted immediately after a **first-trimester** abortion (MTP/spontaneous), but should be delayed after a second-trimester abortion. * **Most Common Side Effect:** Bleeding (Menorrhagia). * **Most Common Reason for Removal:** Bleeding/Pain. * **Absolute Contraindication:** Undiagnosed vaginal bleeding, current PID, or suspected pregnancy.

Q: Which contraceptive method helps in preventing carcinoma of the cervix?

Barrier contraceptives. **Explanation:** **1. Why Barrier Contraceptives are Correct:** Carcinoma of the cervix is primarily caused by persistent infection with high-risk strains of **Human Papillomavirus (HPV)**, most commonly types 16 and 18. Since HPV is a sexually transmitted infection (STI), **barrier methods** (specifically male and female condoms) act as a physical shield. They prevent direct skin-to-skin and mucosal contact, thereby significantly reducing the transmission of HPV. By preventing the primary causative agent, barrier methods serve as a protective factor against cervical dysplasia and subsequent malignancy. **2. Analysis of Incorrect Options:** * **Intracervical/Intrauterine Devices (IUCDs):** While some studies suggest IUCDs might trigger a local immune response that helps clear HPV, they do not prevent the initial infection. Furthermore, they do not provide a physical barrier against STIs. * **Oral Contraceptive Pills (OCPs):** Long-term use of OCPs (typically >5 years) is actually associated with a **slight increase in the risk** of cervical cancer. This is attributed to hormonal influences on the transformation zone and the fact that OCP users are less likely to use barrier protection (confounding factor). **3. High-Yield Clinical Pearls for NEET-PG:** * **Protective Effect of OCPs:** OCPs are highly protective against **Ovarian** and **Endometrial** cancers (the "Rule of O": OCPs protect against Ovarian/Endometrial). * **IUCDs and Cancer:** IUCDs are associated with a decreased risk of **Endometrial cancer**. * **Primary Prevention of Cervical Cancer:** The most effective primary prevention is the **HPV Vaccine** (e.g., Gardasil-9), ideally administered before the onset of sexual activity. * **Secondary Prevention:** Regular screening via **Pap Smear** and **HPV DNA testing**.

Q: Which of the following statements about the calendar method of contraception is false?

Ectopic pregnancy is a reported complication.. **Explanation:** The **Calendar (Rhythm) Method** is a natural family planning technique based on predicting ovulation by tracking the menstrual cycle. **Why Option D is the correct (false) statement:** Ectopic pregnancy is **not** a complication of the calendar method. Ectopic pregnancy occurs when a fertilized egg implants outside the uterus. While the calendar method has a high failure rate (typical use failure rate ~24%), a failure simply results in a **normal intrauterine pregnancy**. In contrast, methods like the Progestin-only pill (POP), Levonorgestrel-IUD, or tubal ligation—which prevent intrauterine implantation more effectively than they prevent ovulation or tubal transport—are associated with a higher *relative* risk of ectopic pregnancy if they fail. **Analysis of other options:** * **Option A:** True. Abstinence is only required during the "fertile window" (calculated as the shortest cycle minus 18 days to the longest cycle minus 11 days). * **Option B:** True. It is a behavioral method requiring no devices, hormones, or clinical procedures, thus incurring no financial cost. * **Option C:** True. These are complementary "Fertility Awareness-Based Methods" (FABM). Basal Body Temperature (BBT) identifies the post-ovulatory rise, and the Billings method tracks changes in cervical mucus (spinnbarkeit). **High-Yield Clinical Pearls for NEET-PG:** * **Pearl 1:** The calendar method is unreliable for women with irregular cycles. * **Pearl 2:** The **Standard Days Method** is a simplified version of the calendar method suitable for women with cycles between 26–32 days (abstinence on days 8–19). * **Pearl 3:** Natural methods do not protect against STIs/HIV. * **Pearl 4:** **Lactational Amenorrhea Method (LAM)** is only effective for up to 6 months postpartum, provided the mother is exclusively breastfeeding and remains amenorrheic.

Q: Oral contraceptive pills (OCPs) decrease the risk of which of the following cancers?

Endometrial cancer. **Explanation:** Combined Oral Contraceptive Pills (OCPs) exert a significant protective effect against certain gynecological malignancies, most notably **endometrial cancer**. **Why Endometrial Cancer is the Correct Answer:** The primary mechanism is the **progestogenic effect**, which antagonizes the action of estrogen on the endometrium. Progesterone prevents endometrial hyperplasia by limiting the proliferative phase and inducing secretory changes. Long-term OCP use reduces the risk of endometrial cancer by approximately 50%, and this protective effect persists for up to 15–20 years after discontinuation. **Analysis of Incorrect Options:** * **Cervical Cancer:** OCPs are actually associated with a **slight increase** in the risk of cervical cancer, particularly with use exceeding 5 years. This may be due to biological changes in the transformation zone or behavioral factors (decreased barrier contraceptive use). * **Vaginal Cancer:** There is no established protective link between OCP use and vaginal cancer. * **Liver Carcinoma:** OCPs are associated with a rare but specific risk of **Hepatic Adenoma** (benign). While the link to Hepatocellular Carcinoma (HCC) is debated, OCPs certainly do not decrease its risk. **High-Yield Clinical Pearls for NEET-PG:** * **The "Rule of Two":** OCPs decrease the risk of **two** main cancers: **Endometrial** and **Ovarian** (specifically epithelial ovarian cancer). * **Ovarian Cancer Protection:** OCPs reduce risk by suppressing ovulation ("incessant ovulation" theory). * **Colorectal Cancer:** Emerging evidence suggests OCPs also decrease the risk of colorectal cancer. * **Breast Cancer:** OCPs are associated with a very slight, transient increase in breast cancer risk, which returns to baseline 10 years after stopping.

Q: A 28-year-old woman at 13 weeks of gestation presents with ultrasound findings of anencephaly and requests medical termination of pregnancy (MTP). Which of the following is NOT a preferred method of MTP in this condition?

Menstrual regulation. **Explanation:** The correct answer is **A. Menstrual regulation**. **1. Why Menstrual Regulation is NOT preferred:** Menstrual regulation (MR) is a procedure used for the termination of pregnancy very early in the first trimester, typically within **6 weeks of the last menstrual period (LMP)** or up to 14 days of a missed period. It involves manual vacuum aspiration of the uterine contents. Since the patient in this scenario is at **13 weeks of gestation** (early second trimester), MR is technically inappropriate and unsafe due to the size of the fetus and the advanced gestational age. **2. Analysis of Other Options (Second Trimester MTP Methods):** * **B. Intra-amniotic instillation (Urea/PGF2α):** This is a recognized method for second-trimester termination. Hypertonic solutions or prostaglandins are injected into the amniotic sac to induce uterine contractions and fetal expulsion. * **C. Extraovular instillation (Ethacridine lactate):** Also known as the "Emcredil" method, a Foley catheter is used to instill the solution into the space between the uterine wall and the fetal membranes. It is a classic method for mid-trimester MTP. * **D. Parenteral administration of PGF2α:** Systemic administration (IM or IV) of prostaglandins (like Carboprost) is a highly effective pharmacological method to induce labor in the second trimester. **Clinical Pearls for NEET-PG:** * **MTP Act (India):** Termination is legal up to **24 weeks** for specific categories (including fetal anomalies like anencephaly). * **First Trimester (up to 12 weeks):** Preferred methods are Medical (Mifepristone + Misoprostol) or Surgical (Suction Evacuation). * **Second Trimester (13–24 weeks):** Preferred methods include Dilatation and Evacuation (D&E) or Medical Induction (Prostaglandins/Oxytocin). * **Anencephaly:** This is a lethal neural tube defect; once diagnosed, MTP is indicated regardless of gestational age (within legal limits).

Question 1

What is the recommended dose of mifepristone for medical abortion?

Accepted Answer

600 mg

Answer

200 mg

Answer

400 mg

Answer

100 mg

Question 2

Thromboembolism is primarily associated with which component of oral contraceptive pills (OCPs)?

Accepted Answer

Estrogen

Answer

Progesterone

Answer

Iron

Answer

Follicle Stimulating Hormone (FSH)

Question 3

Regarding the removal of a cervical cap, what is true?

Accepted Answer

The cervical cap must be left in place for at least 8 hours after intercourse.

Answer

The cervical cap should be left in place for the entire cycle length.

Answer

The cervical cap can be removed immediately, followed by vaginal douching.

Answer

The cervical cap should be left until the next menstruation starts.

Question 4

Which of the following is NOT a characteristic feature of an ideal IUCD candidate?

Accepted Answer

Has borne at least two children

Answer

Has no history of pelvic disease

Answer

Has normal menstrual periods

Answer

Is willing to check the IUCD tail

Question 5

Which of the following is NOT a contraindication for insertion of an IUCD?

Accepted Answer

Cervical discharge

Answer

PID

Answer

Presence of fibroids

Answer

Suspected pregnancy

Question 6

In which of the following situations is it preferable NOT to insert an IUCD?

Accepted Answer

Immediately following a mid-trimester abortion

Answer

Postmenstrual

Answer

Emergency postcoital

Answer

Six weeks after delivery

Question 7

Which contraceptive method helps in preventing carcinoma of the cervix?

Accepted Answer

Barrier contraceptives

Answer

Intracervical devices

Answer

Intrauterine contraceptive devices

Answer

Oral contraceptive pills

Question 8

Which of the following statements about the calendar method of contraception is false?

Accepted Answer

Ectopic pregnancy is a reported complication.

Answer

Abstinence is needed for only a few days in a month.

Answer

It is associated with no cost.

Answer

The fertile period can also be estimated using the basal body temperature, rhythm, or cervical mucus methods.

Question 9

Oral contraceptive pills (OCPs) decrease the risk of which of the following cancers?

Accepted Answer

Endometrial cancer

Answer

Cervical cancer

Answer

Vaginal cancer

Answer

Liver carcinoma

Question 10

A 28-year-old woman at 13 weeks of gestation presents with ultrasound findings of anencephaly and requests medical termination of pregnancy (MTP). Which of the following is NOT a preferred method of MTP in this condition?

Accepted Answer

Menstrual regulation

Answer

Intra-amniotic instillation of urea and PGF2α

Answer

Extraovular instillation of ethacridine lactate

Answer

Parenteral administration of PGF2α

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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