Contraception and Family Planning Practice Questions

Q: Tubal ligation is reported to have decreased the risk of?

Ovarian cancer. **Explanation:** **Correct Answer: B. Ovarian Cancer** Tubal ligation is a significant protective factor against ovarian cancer, reducing the risk by approximately **30–50%**. The underlying medical concept involves two main theories: 1. **Prevention of Ascending Carcinogens:** It blocks the passage of potential carcinogens (like talc or asbestos) and inflammatory mediators from the lower genital tract to the ovaries. 2. **Origin of Serous Cancer:** Modern research suggests that many "ovarian" cancers (specifically High-Grade Serous Carcinomas) actually originate in the fimbrial end of the fallopian tube (STIC lesions). Tubal ligation disrupts this pathway and often involves partial salpingectomy, removing the tissue of origin. **Analysis of Incorrect Options:** * **A. Functional ovarian cysts:** Tubal ligation does not affect ovulation or the hormonal feedback loop; therefore, the incidence of functional cysts remains unchanged. * **C. Breast cancer:** There is no established physiological link between tubal sterilization and a decreased risk of breast cancer. * **D. Salpingitis:** While tubal ligation prevents ascending infection from reaching the peritoneal cavity (reducing the risk of Pelvic Inflammatory Disease/PID), it does not necessarily prevent infection of the proximal tubal stump itself (salpingitis). The reduction in **ovarian cancer** is the more classically tested and significant epidemiological association. **High-Yield Clinical Pearls for NEET-PG:** * **OCPs** also decrease the risk of ovarian cancer (by ~50% if used for >5 years). * **Hysterectomy** also provides a protective effect against ovarian cancer. * The most common site of ectopic pregnancy after failed tubal ligation is the **isthmus**. * **Failure rate (Pearl Index):** For Pomeroy’s technique, it is approximately 0.1–0.5%. The most common cause of failure is **recanalization**.

Q: Which of the following is NOT used as emergency contraception?

Danazol. **Explanation:** The correct answer is **Danazol**. While Danazol (an attenuated androgen) was historically investigated for various gynecological conditions like endometriosis, it has **no proven efficacy** as an emergency contraceptive (EC) and is not part of any standard EC protocol. **Analysis of Options:** * **Copper T 200B:** This is the **most effective** method of emergency contraception. If inserted within 5 days (120 hours) of unprotected intercourse, it prevents implantation by causing a sterile inflammatory reaction in the endometrium. * **RU486 (Mifepristone):** This is a potent anti-progestin. In low doses (10 mg or 25 mg), it acts as a highly effective EC by delaying or inhibiting ovulation. (Note: 600 mg is used for medical abortion). * **High-dose Estrogen:** Historically, high doses of estrogens (e.g., Ethinylestradiol 5mg for 5 days) were used as EC. While effective, they are no longer preferred due to severe side effects like nausea and vomiting. They have been largely replaced by the **Yuzpe Regimen** (Combined Pills) or Levonorgestrel (LNG). **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard/Most Effective EC:** Copper-T (Failure rate <0.1%). * **Drug of Choice (DOC):** Levonorgestrel (LNG) 1.5 mg single dose (effective up to 72 hours). * **Ulipristal Acetate (30 mg):** A selective progesterone receptor modulator (SPRM) effective up to **120 hours** (5 days) and is more effective than LNG in obese women. * **Yuzpe Regimen:** Consists of 100 mcg Ethinylestradiol + 0.5 mg Norgestrel, repeated after 12 hours.

Q: An Intrauterine Device (IUD) is not inserted during which of the following conditions?

Immediately after delivery (within 48 hours). ### Explanation The timing of IUD insertion is critical to minimize risks of expulsion, perforation, and infection. **Why Option C is the Correct Answer:** While IUDs *can* be inserted immediately postpartum (PPIUD), the question asks when it is **not** typically inserted based on standard clinical guidelines regarding safety and efficacy. In the context of traditional teaching and many standard protocols, the period between **48 hours and 6 weeks postpartum** is considered a contraindication for insertion. This is because the uterus is undergoing rapid involution, significantly increasing the risk of **spontaneous expulsion** and **uterine perforation**. Therefore, if not inserted within the first 48 hours, one must wait until the involution is complete (6 weeks). **Analysis of Other Options:** * **A & B (During/Within 10 days of menstruation):** This is the **ideal time** for interval insertion. It ensures the patient is not pregnant, and the cervical os is slightly dilated, making insertion easier and less painful. * **D (6-8 weeks after delivery):** This is known as **Postpartum Interval Insertion**. By this time, the uterus has returned to its non-pregnant size (involution complete), making it a safe and standard time for insertion. **High-Yield NEET-PG Pearls:** * **Ideal Time for Interval IUD:** Within 10 days of the LMP. * **Post-Abortal Insertion:** Can be done immediately after first-trimester abortion (if no infection). * **PPIUD (Postpartum IUD):** Must be done within **48 hours** (ideally within 10 minutes of placental delivery) or delayed until **6 weeks**. * **Most Common Side Effect:** Bleeding (Menorrhagia). * **Most Common Reason for Removal:** Bleeding and Pain. * **Mechanism of Action (Cu-T):** Primarily spermicidal (causes a sterile inflammatory response).

Q: Replacement of a progestin-releasing intrauterine device should be done after how many years?

5 years. **Explanation:** The correct answer is **5 years**. **1. Why 5 years is correct:** The most common progestin-releasing intrauterine device (IUCD) is the **Levonorgestrel-releasing Intrauterine System (LNG-IUS)**, commercially known as Mirena. It contains 52 mg of Levonorgestrel, which is released at an initial rate of 20 µg/day. While the hormone levels gradually decline over time, the device maintains high contraceptive efficacy and therapeutic benefits (such as reducing menstrual blood loss) for a period of **5 years**. After this duration, the reservoir of progestin is depleted to a level where its reliability decreases, necessitating replacement. **2. Why the other options are incorrect:** * **1 year:** Progestasert (an older progesterone-only IUD) required annual replacement, but it is largely obsolete. Modern LNG-IUS devices are designed for long-term use. * **3 years:** This is the typical duration for the **progestin subdermal implant (Nexplanon)** or the lower-dose LNG-IUS (Skyla/Jaydess), but not the standard LNG-IUS. * **10 years:** This is the replacement interval for the **Copper T 380A**, which is a non-hormonal IUCD. **3. High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily works by thickening cervical mucus (preventing sperm penetration) and causing endometrial atrophy (preventing implantation). * **Non-contraceptive uses:** It is the **Gold Standard (Medical management)** for Menorrhagia and Adenomyosis. * **Failure Rate:** It has a Pearl Index of approximately 0.2, making it as effective as sterilization. * **Recent Update:** While the FDA has recently approved Mirena for up to 8 years for contraception, for the purpose of NEET-PG and standard textbooks (Dutta/Williams), **5 years** remains the standard answer for replacement.

Q: Which of the following drugs is not helpful in the treatment of ectopic pregnancy?

Misoprostol. **Explanation:** The primary goal of medical management in ectopic pregnancy is to inhibit the rapidly dividing trophoblastic cells, leading to the involution of the pregnancy. **Why Misoprostol is the Correct Answer:** **Misoprostol** is a synthetic Prostaglandin E1 (PGE1) analogue. Its primary action is to induce uterine contractions and cervical ripening. While it is highly effective for medical abortion in **intrauterine pregnancies**, it has no effect on the fallopian tubes or extrauterine tissues. Therefore, it cannot terminate an ectopic pregnancy and is not used in its management. **Analysis of Incorrect Options:** * **Methotrexate (Option A):** The drug of choice for medical management. It is a folic acid antagonist that inhibits Dihydrofolate Reductase, stopping DNA synthesis in actively dividing trophoblastic cells. * **Actinomycin-D (Option C):** An antitumor antibiotic that inhibits RNA synthesis. While rarely used today due to toxicity, it was historically used as a second-line agent for ectopic pregnancy and remains a treatment for gestational trophoblastic neoplasia. * **RU486 / Mifepristone (Option D):** An anti-progestational agent. Since progesterone is essential for maintaining any pregnancy (including ectopic), RU486 can be used as an adjunct to Methotrexate to increase success rates. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Candidate for Methotrexate:** Hemodynamically stable, tubal mass <3.5 cm, no fetal cardiac activity, and baseline β-hCG <5000 mIU/mL. * **Dosing:** Most common regimen is a single dose of **50 mg/m²** IM. * **Contraindication:** Ruptured ectopic pregnancy (requires immediate surgery). * **Follow-up:** Monitor β-hCG on days 4 and 7; a drop of <15% between these days requires a second dose.

Q: Third generation oral contraceptive pills containing norgestrel and gestodene along with estrogens:

Are more lipid friendly. **Explanation:** Third-generation oral contraceptive pills (OCPs) were developed to minimize the androgenic side effects associated with earlier generations. They contain progestogens like **Desogestrel, Gestodene, and Norgestimate**. **1. Why Option A is Correct:** Third-generation progestogens are highly selective and possess **minimal androgenic activity**. Unlike older progestins (like Levonorgestrel), they do not antagonize the beneficial effects of estrogen on the lipid profile. Consequently, they are **"lipid-friendly"** because they tend to increase HDL (good cholesterol) and decrease LDL (bad cholesterol), reducing the overall metabolic impact on the liver. **2. Analysis of Incorrect Options:** * **Option B:** Third-generation OCPs actually **increase the risk of Venous Thromboembolism (VTE)** compared to second-generation pills. This is a classic high-yield fact; the risk of VTE is roughly double that of second-generation formulations. * **Option C:** Because these progestogens have high endometrial potency, they generally provide **better cycle control** and *decrease* the risk of breakthrough bleeding compared to older, low-dose formulations. * **Option D:** Desogestrel and other third-generation progestins *can* be used in various contraceptive formats, though Levonorgestrel remains the gold standard for progestin-only emergency contraception. **3. NEET-PG High-Yield Pearls:** * **1st Generation:** Norethynodrel (Historical). * **2nd Generation:** Levonorgestrel (Most common, lowest VTE risk, but most androgenic—causes acne/hirsutism). * **3rd Generation:** Desogestrel, Gestodene (Lipid-friendly, less acne, but **highest VTE risk**). * **4th Generation:** Drospirenone (Anti-mineralocorticoid and anti-androgenic; excellent for PCOS and PMDD). * **Drug of choice for PCOS with hirsutism:** OCPs containing Cyproterone acetate or Drospirenone.

Q: Mestranol acts as a contraceptive by:

Inhibiting FSH secretion. **Explanation:** **Mestranol** is a synthetic estrogen and a prodrug of ethinyl estradiol, commonly used in combined oral contraceptive pills (COCPs). **1. Why Option A is Correct:** The primary mechanism of the **estrogen component** (like Mestranol) in COCPs is the **suppression of Follicle Stimulating Hormone (FSH)** via negative feedback on the anterior pituitary. By inhibiting FSH, the recruitment and maturation of ovarian follicles are prevented, ensuring there is no dominant follicle to release an egg. **2. Why Other Options are Incorrect:** * **Option B (Inhibiting LH secretion):** This is the primary mechanism of the **Progestogen component**. Progesterone suppresses Luteinizing Hormone (LH) surge, thereby preventing ovulation. While estrogen contributes to this, its hallmark action is FSH suppression. * **Option C (Inhibiting tubal motility):** This is a secondary effect of **Progesterone**, which alters the contractility of the fallopian tubes to slow down ovum/zygote transport. * **Option D (Inhibiting nidation):** This refers to making the endometrium unfavorable for implantation, another secondary effect primarily mediated by **Progesterone** (causing early secretory changes and subsequent atrophy). **Clinical Pearls for NEET-PG:** * **Mestranol vs. Ethinyl Estradiol:** Mestranol is less potent because it must be converted to ethinyl estradiol in the liver. * **The "Double Lock" Mechanism:** COCPs are highly effective because they inhibit ovulation through two pathways: Estrogen (FSH suppression) + Progesterone (LH surge suppression). * **Hostile Cervical Mucus:** The most important contraceptive effect of progestogen-only pills (Mini-pills) is thickening the cervical mucus to prevent sperm penetration.

Q: Which contraceptive method is medically contraindicated for a patient with a known latex allergy?

Condoms. **Explanation:** **Correct Option: C. Condoms** The primary material used in the manufacturing of most standard male and female condoms is **natural rubber latex**. In patients with a known latex allergy, exposure can trigger hypersensitivity reactions ranging from localized contact dermatitis and pruritus to life-threatening systemic anaphylaxis. For these patients, non-latex alternatives such as polyurethane, polyisoprene, or nitrile condoms must be used. **Analysis of Incorrect Options:** * **A. Oral Contraceptives:** These are hormonal medications (estrogen and/or progestogen) administered systemically. They do not contain latex and have no cross-reactivity with latex proteins. * **B. Intrauterine Device (IUD):** Copper T (Cu-T) and Levonorgestrel-releasing IUDs (Mirena) are composed of plastic (polyethylene), barium sulfate, and copper or hormones. They are latex-free and safe for these patients. * **C. Laparoscopic Tubal Ligation:** This is a surgical procedure. While surgical gloves were historically latex-based, the procedure itself (and the clips/rings used for occlusion) does not inherently involve latex. In modern practice, latex-free gloves are used for allergic patients. **High-Yield Clinical Pearls for NEET-PG:** * **Latex-Fruit Syndrome:** Patients allergic to latex often show cross-reactivity with certain fruits, most commonly **Avocado, Banana, Kiwi, and Chestnut**. * **Diaphragms and Cervical Caps:** Like condoms, these are often made of latex and are also contraindicated. * **Non-Latex Condoms:** Polyurethane condoms are thinner and provide good sensitivity but have a higher breakage and slippage rate compared to latex. * **Spermicides:** Nonoxynol-9 is the most common spermicide used with barrier methods; it does not contain latex but can cause vaginal irritation.

Question 1

Which of the following are benefits of combined oral contraceptive pills use?

Accepted Answer

Pelvic inflammatory disease, Ovarian cysts, Ectopic pregnancy

Answer

Pelvic inflammatory disease, Ovarian cysts, Fibrocystic disease of the breast

Answer

Hepatocellular adenoma, Pelvic inflammatory disease, Ovarian cysts

Answer

Hepatocellular adenoma, Ovarian cysts, Ectopic pregnancy

Question 2

Which contraceptive is supplied free of cost by the government?

Accepted Answer

Mala-N

Answer

Minipill

Answer

Norplant

Answer

Centchroman

Question 3

Tubal ligation is reported to have decreased the risk of?

Accepted Answer

Ovarian cancer

Answer

Functional ovarian cysts

Answer

Breast cancer

Answer

Salpingitis

Question 4

Which of the following is NOT used as emergency contraception?

Accepted Answer

Danazol

Answer

Copper T 200B

Answer

RU486

Answer

High dose Estrogen

Question 5

An Intrauterine Device (IUD) is not inserted during which of the following conditions?

Accepted Answer

Immediately after delivery (within 48 hours)

Answer

During menstruation

Answer

Within 10 days of the beginning of menstruation

Answer

6-8 weeks after delivery

Question 6

Replacement of a progestin-releasing intrauterine device should be done after how many years?

Accepted Answer

5 years

Answer

1 year

Answer

3 years

Answer

10 years

Question 7

Which of the following drugs is not helpful in the treatment of ectopic pregnancy?

Accepted Answer

Misoprostol

Answer

Methotrexate

Answer

Actinomycin-D

Answer

RU486

Question 8

Third generation oral contraceptive pills containing norgestrel and gestodene along with estrogens:

Accepted Answer

Are more lipid friendly

Answer

Decrease the risk of venous thromboembolism

Answer

Increase the risk of breakthrough bleeding

Answer

Are not used for emergency contraception

Question 9

Mestranol acts as a contraceptive by:

Accepted Answer

Inhibiting FSH secretion

Answer

Inhibiting LH secretion

Answer

Inhibiting tubal motility

Answer

Inhibiting nidation

Question 10

Which contraceptive method is medically contraindicated for a patient with a known latex allergy?

Accepted Answer

Condoms

Answer

Oral contraceptives

Answer

Intrauterine device (IUD)

Answer

Laparoscopic tubal ligation

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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