Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 171: Which of the following statements about Nova T is true?

A. Effective for 10 years
B. More copper content
C. More chances of perforation
D. Silver core (Correct Answer)

Explanation: **Explanation:** **Nova T** is a second-generation copper-releasing intrauterine device (IUCD). The correct answer is **D (Silver core)** because the copper wire of Nova T contains a **silver core**. This design is specifically engineered to prevent the fragmentation of the copper wire, thereby increasing the device's durability and ensuring a steady release of copper ions over time. **Analysis of Options:** * **A. Effective for 10 years:** This is incorrect. Nova T is typically effective for **5 years**. The Cu-T 380A is the device famously known for its 10-year lifespan. * **B. More copper content:** This is incorrect. Nova T has a surface area of **200 $mm^2$** of copper. In contrast, the Cu-T 380A has significantly more copper (380 $mm^2$). * **C. More chances of perforation:** This is incorrect. The risk of uterine perforation (approx. 1 in 1000 insertions) is generally consistent across standard IUCDs and depends more on the provider's technique and the timing of insertion (e.g., postpartum) rather than the specific design of Nova T. **High-Yield Clinical Pearls for NEET-PG:** * **The Silver Advantage:** The silver core prevents "pitting" or corrosion of the copper wire, which was a common issue in older models. * **Surface Area Comparison:** * **Nova T / Cu-T 200:** 200 $mm^2$ (5 years) * **Cu-T 380A:** 380 $mm^2$ (10 years - Gold Standard) * **Multiload 375:** 375 $mm^2$ (5 years) * **Ideal Candidate:** IUCDs are best suited for parous women in stable monogamous relationships. * **Most Common Side Effect:** Bleeding (Menorrhagia) is the most common reason for removal, followed by pain.

Question 172: What is the failure rate of Copper Intrauterine Contraceptive Devices (IUCD)?

A. 3-4%
B. 0.01-0.03%
C. 0.5-1.5% (Correct Answer)
D. 4-5%

Explanation: **Explanation:** The failure rate of a contraceptive method is typically measured using the **Pearl Index**, which represents the number of unintended pregnancies per 100 woman-years of use. **1. Why Option C is Correct:** Copper Intrauterine Contraceptive Devices (IUCDs), such as the Cu-T 380A, are classified as **Long-Acting Reversible Contraceptives (LARC)**. They are highly effective because they eliminate the factor of user non-compliance. The typical failure rate for Copper T is approximately **0.5–1.5%**. Specifically, the Cu-T 380A has a failure rate of about 0.8% in the first year of use. Its primary mechanism involves creating a sterile inflammatory response in the endometrium and exerting a spermicidal effect by altering uterine and tubal fluids. **2. Why Other Options are Incorrect:** * **Option A (3-4%) and D (4-5%):** These rates are too high for IUCDs. Such failure rates are more characteristic of barrier methods (like condoms) or behavioral methods (like withdrawal) when used inconsistently. * **Option B (0.01-0.03%):** These rates are too low. While extremely effective, no reversible method is 100% foolproof. A failure rate of ~0.05% is more characteristic of permanent sterilization (Vasectomy) or the Etonogestrel implant (Implanon). **High-Yield Clinical Pearls for NEET-PG:** * **Most Effective Reversible Contraceptive:** The Progestogen-only implant (e.g., Implanon) actually has a lower failure rate (0.05%) than IUCDs. * **Lifespan:** Cu-T 380A is FDA-approved for **10 years** (often used for 12 years in practice). * **Ideal Candidate:** A parous woman in a stable monogamous relationship (to minimize PID risk). * **Emergency Contraception:** Copper IUCD is the **most effective** method of emergency contraception if inserted within 5 days (120 hours) of unprotected intercourse.

Question 173: Which of the following may be used for postcoital contraception?

A. Copper-T (Cu-T)
B. Mifepristone (RU 486)
C. High-dose estrogen
D. All of the above (Correct Answer)

Explanation: **Explanation:** Postcoital (emergency) contraception is designed to prevent pregnancy after unprotected intercourse or contraceptive failure. The correct answer is **All of the above** because each option utilizes a different pharmacological or mechanical mechanism to inhibit ovulation or prevent implantation. 1. **Copper-T (Cu-T):** This is the **most effective** method of emergency contraception (failure rate <0.1%). It acts by causing a sterile inflammatory response in the endometrium that is toxic to sperm and ova, and prevents implantation. It can be inserted up to **5 days** after unprotected intercourse. 2. **Mifepristone (RU 486):** An anti-progestin that, in low doses (10–25 mg), acts as an emergency contraceptive by delaying or inhibiting ovulation. It is highly effective with fewer side effects than hormonal regimens. 3. **High-dose Estrogen:** Historically, high doses of estrogens (e.g., Ethinylestradiol 5mg for 5 days) were used to alter the endometrium and tubal motility. While effective, this method is now largely obsolete due to significant side effects like severe nausea and vomiting. **Why other options are not "wrong":** In a "Multiple Choice Question" format, since A, B, and C are all documented methods of postcoital contraception, "All of the above" is the most accurate choice. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard/Most Effective:** Copper-T 380A. * **Most Common Method:** Levonorgestrel (LNG) 1.5 mg single dose (Pill-72). It must be taken within 72 hours. * **Ulipristal Acetate:** A selective progesterone receptor modulator (SPRM) effective up to **120 hours (5 days)**; it is currently the hormonal drug of choice for efficacy at later time points. * **Yuzpe Regimen:** Uses combined oral contraceptive pills (Ethinylestradiol + Levonorgestrel) in two doses, 12 hours apart.

Question 174: Which of the following are reversible methods of contraception?

A. Oral Contraceptive Pills (OCP)
B. Intrauterine Contraceptive Device (IUCD)
C. Barrier methods
D. Depot injection (Correct Answer)

Explanation: **Explanation:** The question asks to identify a reversible method of contraception among the given options. However, it is important to note that **all four options (A, B, C, and D) are actually reversible methods of contraception.** In the context of standard medical classification, contraception is divided into **Reversible (Temporary)** and **Irreversible (Permanent/Surgical)** methods. **1. Why Depot Injection (Option D) is correct:** Depot injections, such as **DMPA (Depot Medroxyprogesterone Acetate)**, are highly effective progestogen-only reversible contraceptives. They work by inhibiting ovulation, thickening cervical mucus, and thinning the endometrium. While they offer long-term protection (typically 3 months), fertility returns once the drug is cleared from the system (though there may be a delay of 7–9 months). **2. Analysis of other options:** * **A. Oral Contraceptive Pills (OCP):** These are temporary hormonal methods. Fertility returns almost immediately (within 1–3 months) after discontinuation. * **B. Intrauterine Contraceptive Device (IUCD):** These are Long-Acting Reversible Contraceptives (LARC). Fertility returns immediately upon removal of the device. * **C. Barrier methods:** These (condoms, diaphragms) are temporary methods used per act of intercourse and have no lasting effect on future fertility. **Note on Question Framing:** In many competitive exams, if a question asks "Which of the following is..." and all options are technically correct, the "best" answer often refers to the specific topic being tested in that module or a potential typo in the question stem (e.g., it might have intended to ask for an *irreversible* method or a *long-acting* one). **High-Yield Clinical Pearls for NEET-PG:** * **Irreversible methods:** Vasectomy (Male) and Tubectomy (Female). * **DMPA (Antara Program):** Dose is 150 mg IM every 3 months. Common side effect: Amenorrhea and weight gain. * **LARC:** IUCDs and Implants are the most effective reversible methods due to high user compliance. * **Centchroman (Saheli):** The only non-steroidal, once-a-week oral pill developed in India (CDRI, Lucknow).

Question 175: Hypokalemic paralysis is a side effect of which of the following?

A. Gossypol (Correct Answer)
B. DMPA
C. Testosterone enanthate
D. Cyproterone acetate

Explanation: **Explanation:** **Gossypol** is a polyphenolic compound derived from the cotton plant (*Gossypium*) used as a male oral contraceptive. Its primary mechanism involves inhibiting sperm production (spermatogenesis) and reducing sperm motility. The correct answer is **Gossypol** because its most significant and notorious side effect is **hypokalemia**, which can lead to **hypokalemic periodic paralysis**. This occurs because gossypol affects the renal tubules, leading to excessive potassium excretion. Furthermore, gossypol is associated with a high rate of **irreversible azoospermia** (permanent infertility) in about 10–20% of users, which has limited its clinical use. **Analysis of Incorrect Options:** * **DMPA (Depot Medroxyprogesterone Acetate):** A progestogen-only injectable contraceptive. Its primary side effects include menstrual irregularities, weight gain, and a reversible decrease in bone mineral density (BMD). It does not affect potassium levels. * **Testosterone enanthate:** An injectable androgen used for male contraception (via negative feedback on the HPO axis). Side effects include acne, weight gain, and changes in lipid profile, but not hypokalemia. * **Cyproterone acetate:** An anti-androgen used in the treatment of hirsutism or as part of combined oral contraceptives (e.g., Diane-35). It is more likely to cause liver toxicity or fatigue rather than electrolyte imbalances like hypokalemia. **High-Yield Clinical Pearls for NEET-PG:** * **Gossypol's "Two Big Side Effects":** Hypokalemia (paralysis) and Irreversibility. * **Mechanism:** It inhibits the enzyme lactate dehydrogenase-X in the testes. * **Centchroman (Saheli):** Another high-yield contraceptive topic; it is a SERM (Selective Estrogen Receptor Modulator) and is non-hormonal, non-steroidal.

Question 176: Which of the following statements is FALSE regarding laparoscopic sterilization?

A. It is used for interval ligation.
B. Unipolar cautery is associated with less morbidity than bipolar cautery. (Correct Answer)
C. Commonly employed procedures include rings and clips.
D. Laparotomy is preferred over laparoscopy in patients with co-existing abdominal pathology.

Explanation: **Explanation:** **Why Option B is the correct (False) statement:** In laparoscopic sterilization, **bipolar cautery is safer than unipolar cautery.** Unipolar cautery carries a significantly higher risk of accidental thermal injury to adjacent structures (like the bowel or ureter) due to "stray current" or "capacitive coupling." Bipolar cautery limits the electrical current to the tissue held between the forceps, thereby reducing morbidity. Therefore, the statement that unipolar is associated with less morbidity is incorrect. **Analysis of other options:** * **Option A:** Laparoscopy is the gold standard for **interval sterilization** (performed 6 weeks or more after delivery). It is generally avoided in the immediate postpartum period due to the enlarged, vascular uterus and the risk of injury. * **Option C:** Mechanical occlusion methods like **Falope rings** (Silastic bands) and **Hulka-Clemens or Filshie clips** are the most common laparoscopic techniques. They avoid thermal injury and have better reversibility potential. * **Option D:** In patients with significant abdominal pathology (e.g., extensive adhesions, large pelvic masses, or severe cardiopulmonary disease), the risks of pneumoperitoneum and trocar injury make **laparotomy** (or mini-laparotomy) a safer choice. **High-Yield Clinical Pearls for NEET-PG:** * **Failure Rates:** The Filshie clip has the lowest failure rate among mechanical methods, while the Spring-loaded clip (Hulka) has the highest. * **Most Common Site of Occlusion:** The isthmic portion of the Fallopian tube. * **Post-Procedure:** Patients should be advised that sterilization is effective immediately (unlike vasectomy, which requires a 3-month follow-up). * **Complication:** The most common serious complication of laparoscopic sterilization is **bowel injury** (either thermal or mechanical).

Question 177: Menstrual regulation is typically performed up to how many weeks of gestation?

A. 10 weeks
B. 18 weeks
C. 6 weeks (Correct Answer)
D. 20 weeks

Explanation: **Explanation:** **Menstrual Regulation (MR)** is a procedure used to induce menstruation in a woman who has missed her period and suspects pregnancy, but where pregnancy has not been clinically confirmed. It is essentially an early vacuum aspiration performed without a positive pregnancy test. 1. **Why 6 weeks is correct:** The standard clinical definition for Menstrual Regulation is the aspiration of the endometrial cavity within **14 days of a missed period** (i.e., up to **6 weeks** of gestational age). At this stage, the procedure is performed using a Karman’s cannula (4–6 mm) and a manual vacuum syringe. It is highly effective and carries a lower risk of complications compared to later surgical abortions. 2. **Why the other options are incorrect:** * **10 weeks:** This is the upper limit for **Medical Methods of Abortion** (using Mifepristone and Misoprostol) as per the latest MTP Act amendments. * **18 weeks:** This falls into the second trimester. Procedures at this stage require more invasive surgical methods (Dilation and Evacuation) or medical induction. * **20/24 weeks:** These are the legal limits for **Medical Termination of Pregnancy (MTP)** in India under specific conditions, not for Menstrual Regulation. **Clinical Pearls for NEET-PG:** * **Instrument:** MR is typically performed using the **Manual Vacuum Aspiration (MVA)** technique with a 50cc or 60cc syringe. * **Confirmation:** Since MR is done before a pregnancy test is mandatory, it is often termed "pre-emptive abortion." * **MTP Act:** While MR is a form of early abortion, all providers must still comply with the documentation requirements of the MTP Act in India. * **Complication:** The most common risk of MR is **incomplete evacuation** if performed too early (before 4 weeks) or if the cannula misses the gestational sac.

Question 178: Which IUCD acts for 10 years?

A. Cu-T 200B
B. Nova-T
C. Cu-T 380A (Correct Answer)
D. Multiload-250

Explanation: **Explanation:** The duration of action of an Intrauterine Contraceptive Device (IUCD) is primarily determined by the surface area of the copper wire and the thickness of the copper filament. **Why Cu-T 380A is correct:** The **Cu-T 380A** is the "Gold Standard" of non-hormonal IUCDs. The "380" signifies that it has a total copper surface area of 380 $mm^2$ (distributed as a copper wire on the vertical stem and copper sleeves on the horizontal arms). This high copper content allows for a slow, consistent release of copper ions, providing effective contraception for **10 years**. It is currently the only IUCD approved for a decade of use. **Analysis of Incorrect Options:** * **Cu-T 200B:** Contains 200 $mm^2$ of copper. It is an older generation device with a shorter lifespan, typically effective for **3 years**. * **Nova-T:** This device contains 200 $mm^2$ of copper with a silver core to prevent fragmentation. Its effective lifespan is **5 years**. * **Multiload-250:** As the name suggests, it has 250 $mm^2$ of copper. It is designed for **3 years** of use (whereas Multiload-375 lasts for 5 years). **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Copper ions are spermicidal; they cause a sterile inflammatory response in the endometrium and alter cervical mucus. * **Ideal Insertion Time:** Within 10 days of the start of the menstrual cycle (to ensure the patient is not pregnant). * **Emergency Contraception:** Cu-T 380A is the **most effective** method of emergency contraception if inserted within 5 days of unprotected intercourse. * **LNG-IUD (Mirena):** Acts for **5 years** and is the treatment of choice for Menorrhagia (DUB).

Question 179: All of the following are contraindications of diaphragm usage except?

A. Multiple sex partners (Correct Answer)
B. Recurrent infections
C. Uterine prolapse
D. Herpes vaginitis

Explanation: **Explanation:** The **diaphragm** is a mechanical barrier contraceptive that covers the cervix. The correct answer is **Multiple sex partners (Option A)** because the diaphragm does not increase the risk for individuals with multiple partners; in fact, barrier methods are generally encouraged to reduce the risk of Pelvic Inflammatory Disease (PID), although they are less effective than condoms at preventing STIs. **Why the other options are contraindications:** * **Recurrent Urinary Tract Infections (Option B):** The rim of the diaphragm presses against the urethra, causing mechanical irritation and stasis, which predisposes the user to recurrent UTIs. * **Uterine Prolapse (Option C):** A diaphragm requires adequate vaginal muscle tone and a stable pubic symphysis for proper placement. In cases of pelvic floor laxity or prolapse (cystocele/rectocele), the device will not stay in position, leading to contraceptive failure. * **Herpes Vaginitis/Local Infections (Option D):** Any active vaginal or cervical infection (e.g., Herpes, severe vaginitis) is a contraindication as the device can cause local irritation, pain, and potentially worsen the infection or interfere with healing. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** The diaphragm must be kept in place for at least **6 hours** after the last act of intercourse but should not be left in for more than 24 hours (due to the risk of **Toxic Shock Syndrome**). * **Spermicide:** It must always be used with a spermicidal jelly for maximum efficacy. * **Refitting:** The device must be refitted if the patient gains or loses >5 kg, or following a term delivery or second-trimester abortion. * **Side Effects:** The most common side effect is an increased risk of UTIs.

Question 180: What is the best contraceptive method for a female with diabetes?

A. Oral contraceptive pills
B. Intrauterine contraceptive device (IUCD)
C. Condom used by husband (Correct Answer)
D. Vaginal sponge

Explanation: **Explanation:** In the context of diabetes mellitus, the selection of a contraceptive method depends on the presence of vascular complications and the need to avoid metabolic interference. **Why Option C is Correct:** The **Condom (Barrier Method)** is considered the best and safest choice for a diabetic woman because it is **metabolically neutral**. It does not affect blood glucose levels, lipid profiles, or blood pressure. Furthermore, it provides protection against Pelvic Inflammatory Disease (PID), which is crucial as diabetic patients are more prone to infections. **Analysis of Incorrect Options:** * **A. Oral Contraceptive Pills (OCPs):** Combined OCPs are generally avoided or used with extreme caution. The estrogen component can impair glucose tolerance and increase the risk of thromboembolism, while progestins can adversely affect the lipid profile. They are contraindicated if the patient has diabetic complications like nephropathy, retinopathy, or neuropathy. * **B. Intrauterine Contraceptive Device (IUCD):** While modern guidelines (WHO MEC) suggest IUCDs are safe for diabetics, they are traditionally considered a second-line choice in exam patterns because diabetics have a higher risk of pelvic infections and delayed healing. * **D. Vaginal Sponge:** This method has a high failure rate and provides inadequate protection compared to other methods; it is not a preferred clinical recommendation. **NEET-PG High-Yield Pearls:** * **WHO Medical Eligibility Criteria (MEC):** For diabetes without vascular disease, most methods are MEC Category 1 or 2. However, if **nephropathy, retinopathy, or neuropathy** is present, Combined Hormonal Contraceptives are **MEC Category 3/4 (Contraindicated)**. * **Progesterone-only pills (POPs)** or **LNG-IUD (Mirena)** are better hormonal alternatives than OCPs for diabetics as they have minimal impact on carbohydrate metabolism. * **Sterilization** is the best permanent method if the family is complete and vascular complications are severe.

Practice by Chapter

Natural Family Planning Methods

Practice Questions

Barrier Methods

Practice Questions

Hormonal Contraceptives

Practice Questions

Intrauterine Devices

Practice Questions

Emergency Contraception

Practice Questions

Permanent Contraception Methods

Practice Questions

Contraception in Special Populations

Practice Questions

Contraceptive Counseling

Practice Questions

Side Effects and Complications of Contraceptives

Practice Questions

Future Contraceptive Technologies

Practice Questions

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