Contraception and Family Planning Practice Questions

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

Silver core. **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.

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

0.5-1.5%. **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.

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

All of the above. **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.

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

Gossypol. **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.

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

6 weeks. **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.

Q: Which IUCD acts for 10 years?

Cu-T 380A. **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).

Q: All of the following are contraindications of diaphragm usage except?

Multiple sex partners. **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 1

Which of the following statements about Nova T is true?

Accepted Answer

Silver core

Answer

Effective for 10 years

Answer

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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