Contraception and Family Planning Practice Questions

Q: Which of the following is a side effect of oral contraceptive pills?

Carbohydrate intolerance. **Explanation:** **Carbohydrate intolerance** is a known metabolic side effect of Combined Oral Contraceptive Pills (COCPs). The progestogen component (especially older 19-nortestosterone derivatives) increases peripheral insulin resistance and decreases glucose tolerance. While modern low-dose pills have a minimal impact on healthy individuals, they can unmask latent diabetes or worsen glycemic control in predisposed women. **Analysis of Incorrect Options:** * **A. Dysmenorrhea:** COCPs are actually a **treatment** for dysmenorrhea. They inhibit ovulation and reduce endometrial prostaglandin production, leading to less painful menses. * **B. Hyperprolactinemia:** COCPs do not typically cause significant elevations in prolactin. While estrogen can stimulate lactotrophs, it does not lead to clinical hyperprolactinemia or galactorrhea in standard doses. * **D. Endometriosis:** COCPs are a **first-line medical management** for endometriosis. By inducing a pseudo-pregnancy state and causing endometrial atrophy, they reduce the growth and vascularity of ectopic endometrial tissue. **High-Yield Clinical Pearls for NEET-PG:** * **Lipid Profile:** Estrogen increases HDL (good) and decreases LDL, but it also increases **Triglycerides**. * **Cancer Risk:** COCPs **decrease** the risk of Ovarian and Endometrial cancers (protective effect persists for years) but may slightly **increase** the risk of Cervical and Breast cancers. * **Coagulation:** The estrogen component increases clotting factors (II, VII, IX, X) and decreases Antithrombin III, increasing the risk of **Venous Thromboembolism (VTE)**. * **Absolute Contraindications:** Undiagnosed vaginal bleeding, history of VTE, smokers >35 years, and active liver disease.

Q: A 19-year-old woman desires medical termination of pregnancy at 6 weeks of gestation. Which of the following is an appropriate procedure to perform this termination?

Suction and evacuation. **Explanation:** The patient is at **6 weeks of gestation**, which falls within the **first trimester** (up to 12 weeks). For surgical termination of pregnancy in the first trimester, **Suction and Evacuation (S&E)** is the gold standard and the procedure of choice. **1. Why Suction and Evacuation is Correct:** Suction and evacuation (also known as vacuum aspiration) is preferred because it is faster, safer, and associated with fewer complications (like uterine perforation or excessive blood loss) compared to traditional sharp curettage. At 6 weeks, the products of conception are small enough to be easily removed via a 5–6 mm Karman cannula or electric suction. **2. Why Other Options are Incorrect:** * **Dilation and Curettage (D&C):** This involves sharp curettage of the uterine walls. It is no longer recommended as a primary method for MTP due to higher risks of trauma, Asherman syndrome, and increased pain. * **Hypertonic extra-amniotic saline infusion:** This is a method used for **second-trimester** abortions (usually 16–20 weeks). It is rarely used today due to the risk of "water intoxication" and the availability of safer prostaglandins. * **15-methyl Beta-prostaglandin (Carboprost):** This is typically used for second-trimester inductions or for managing postpartum hemorrhage (PPH). It is not a primary standalone method for a 6-week MTP. **Clinical Pearls for NEET-PG:** * **MTP Act (India):** Medical termination is legal up to **24 weeks** under specific conditions. * **Medical MTP:** Up to **9 weeks (63 days)**, the regimen of choice is **Mifepristone (200mg oral) followed by Misoprostol (800mcg vaginal/oral)** 24–48 hours later. * **Surgical MTP:** Suction evacuation is the method of choice for **7–12 weeks**. * **Manual Vacuum Aspiration (MVA):** Can be performed up to 12 weeks and does not require electricity, making it ideal for low-resource settings.

Q: Which of the following is not used in emergency contraception?

Levonorgestrel intrauterine device. **Explanation:** The correct answer is **A. Levonorgestrel intrauterine device (LNG-IUD)**. In emergency contraception (EC), the goal is to prevent pregnancy *after* unprotected intercourse but *before* implantation. The LNG-IUD (e.g., Mirena) is **not** used for this purpose because its primary mechanism involves thickening cervical mucus and thinning the endometrial lining over time; it does not reliably prevent fertilization or implantation immediately after a single act of intercourse. **Analysis of Options:** * **Copper T intrauterine device (Option D):** This is the **most effective** method of EC (99% efficacy). It can be inserted up to 5 days (120 hours) after unprotected intercourse. It acts by causing a sterile inflammatory response that is toxic to sperm and ova, and prevents implantation. * **Oral Levonorgestrel (Option C):** Known as the "morning-after pill" (1.5 mg single dose), it is effective up to 72 hours. It works primarily by delaying or inhibiting ovulation. * **Oral Mifepristone (Option B):** In low doses (10–25 mg), this anti-progestogen is used as an effective EC by delaying ovulation and altering the endometrium. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** The Copper T 380A is the most effective EC and provides ongoing contraception for 10 years. * **Ulipristal Acetate:** A selective progesterone receptor modulator (30 mg) is now considered the first-line oral EC, effective up to 120 hours. * **Yuzpe Regimen:** An older method using combined OCPs (Ethinylestradiol + Levonorgestrel); it is less effective and has more side effects (nausea/vomiting) than LNG alone. * **Timing:** All oral ECs are more effective the sooner they are taken ("Time is Tissue").

Q: What is the most appropriate contraceptive method for a lactating mother during the first six months postpartum?

Progestin-only pills. **Explanation:** The choice of contraception in a lactating mother is primarily governed by the effect of hormones on breast milk production and the timing of postpartum recovery. **Why Progestin-only pills (POPs) are the correct choice:** POPs (also known as the "Minipill") are considered the ideal hormonal contraceptive during the first six months of lactation. Unlike estrogen, **progestins do not suppress lactation**; in fact, some studies suggest they may slightly increase milk volume. They do not affect the quality or composition of breast milk, making them safe for the infant. **Analysis of Incorrect Options:** * **Combined Oral Contraceptive Pills (COCPs):** These contain **estrogen**, which is known to suppress milk production (hypogalactia) and reduce the duration of lactation. They also increase the risk of thromboembolism in the early postpartum period. * **Intrauterine Contraceptive Device (IUCD):** While highly effective, the risk of uterine perforation is significantly higher (up to 6–10 times) in lactating mothers due to a soft, involuting uterus and high oxytocin levels. While it can be used, POPs are often preferred as the first-line hormonal choice in the early months. * **Rhythm Method:** This is highly unreliable during lactation because ovulation often precedes the return of menstruation, making it difficult to predict fertile windows. **High-Yield NEET-PG Pearls:** * **Lactational Amenorrhea Method (LAM):** Effective only if the mother is exclusively breastfeeding, is amenorrheic, and the baby is <6 months old. * **Timing:** POPs can be started at 6 weeks postpartum in breastfeeding women (WHO MEC Category 1). * **DMPA (Injectable):** Also safe for lactating mothers but may cause irregular bleeding. * **Postpartum IUCD (PPIUCD):** Best inserted within 48 hours of delivery or after 6 weeks to minimize expulsion/perforation risks.

Q: A 30-year-old woman who has had one pregnancy and one live birth desires contraception for 6 months. She experiences dysmenorrhea and has a history of complicated migraine. Ultrasound reveals multiple uterine fibroids. What is the most appropriate contraceptive method for her?

Vaginal diaphragm. ### Explanation The correct answer is **C. Vaginal diaphragm**. **1. Why Vaginal Diaphragm is the Correct Choice:** The patient requires short-term contraception (6 months) and has several contraindications to other methods. A vaginal diaphragm is a barrier method that provides non-hormonal, temporary protection. It is ideal here because it does not interfere with her menstrual cycle or exacerbate her underlying medical conditions (migraine and fibroids). **2. Why Other Options are Incorrect:** * **Copper T 200 (IUD):** This is contraindicated because the patient has **dysmenorrhea** and **uterine fibroids**. Copper IUDs typically increase menstrual blood flow and worsen cramping. Furthermore, fibroids can distort the uterine cavity, making IUD insertion difficult or increasing the risk of expulsion. * **Oral Contraceptive Pills (OCPs):** The patient has a history of **complicated migraine** (migraine with aura). Combined OCPs are **Category 4 (Absolute Contraindication)** according to WHO Medical Eligibility Criteria due to the significantly increased risk of ischemic stroke. * **Tubal Sterilization:** This is a permanent method of contraception. The patient specifically requested contraception for only **6 months**, making surgical sterilization inappropriate. **3. Clinical Pearls for NEET-PG:** * **WHO MEC Category 4 (Absolute Contraindication) for OCPs:** Age >35 and smoking ≥15 cigarettes/day, history of DVT/PE, ischemic heart disease, stroke, and **migraine with aura**. * **Fibroids & Contraception:** Distorted uterine cavity is a Category 4 contraindication for both Copper IUDs and LNG-IUS (Mirena). * **Barrier Methods:** These are the safest options for women with multiple systemic comorbidities, though they have higher "typical use" failure rates compared to LARC (Long-Acting Reversible Contraception).

Q: All except one is recommended for use in emergency contraception?

Selective oestrogen receptor modulators. **Explanation:** Emergency contraception (EC) is intended to prevent pregnancy after unprotected intercourse or contraceptive failure. The correct answer is **Selective Estrogen Receptor Modulators (SERMs)**, as they are not used for emergency contraception; rather, they are primarily used in the treatment of breast cancer (Tamoxifen) or infertility (Clomiphene). **Why the other options are used:** * **Combined Oral Contraceptives (Option A):** Known as the **Yuzpe Regimen**, this involves two doses of ethinyl estradiol (100 mcg) and levonorgestrel (0.5 mg) taken 12 hours apart. It is less commonly used now due to high rates of nausea and vomiting. * **Progestin-only Regimens (Option B):** The **Levonorgestrel (LNG) 1.5 mg** single dose (or two 0.75 mg doses) is the most widely used hormonal EC. It works primarily by delaying ovulation. * **Antiprogestins (Option D):** **Ulipristal acetate (30 mg)** is a selective progesterone receptor modulator (SPRM) and is currently considered the most effective hormonal EC, effective up to 120 hours (5 days) after intercourse. **Mifepristone** (low dose) is also an effective antiprogestin used for EC. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** The **Copper-T 380A IUD** is the most effective method of emergency contraception (failure rate <0.1%) and can be inserted up to 5 days after intercourse. * **Time Window:** Hormonal methods are most effective within 72 hours, though Ulipristal is effective up to 120 hours. * **Mechanism:** EC prevents or delays ovulation; it is **not** an abortifacient and will not disrupt an established pregnancy. * **Drug of Choice:** Levonorgestrel is the DOC for lactating mothers and is available over-the-counter.

Q: The drug being given is:

Ethacrydine lactate (0.1%). ***Ethacrydine lactate (0.1%)*** - **Ethacrydine lactate** (Rivanol) is easily identifiable by its characteristic **yellow color** when used as an intra-amniotic injection. - It is a commonly used **abortifacient** for **mid-trimester pregnancy termination** via intra-amniotic instillation. *20% mannitol* - **Mannitol** is a **colorless solution** used as an osmotic diuretic, not for pregnancy termination. - It lacks the distinctive **yellow coloration** that would make it identifiable in this clinical context. *50% Urea* - **Urea** solutions are **colorless** and were historically used for intra-amniotic abortion but are less commonly used now. - Does not have the **characteristic yellow appearance** that helps identify the drug being administered. *Misoprostol* - **Misoprostol** is a **prostaglandin E1 analog** available as **oral or vaginal tablets**, not as an injectable solution. - It is **white/off-white in color** and would not present as a colored liquid for injection.

Q: Which of the following is NOT a side effect of progesterone-only pills?

Decreased lactation. **Explanation:** The correct answer is **C. Decreased lactation**. Progesterone-only pills (POPs), often called the "minipill," are the hormonal contraceptive of choice for breastfeeding mothers. Unlike combined oral contraceptive pills (COCs), which contain estrogen that suppresses prolactin and significantly reduces the quantity and quality of breast milk, **progesterone does not inhibit lactation**. In fact, some studies suggest POPs may slightly increase milk volume or have a neutral effect, making them safe to initiate in the immediate postpartum period. **Analysis of Incorrect Options:** * **A. Irregular bleeding:** This is the most common side effect of POPs. Because they do not contain estrogen to stabilize the endometrium, users often experience breakthrough bleeding or spotting. * **B. Amenorrhea:** Over time, the progestogen causes endometrial atrophy, leading to a cessation of menses in a significant percentage of users. * **C. Weight gain:** While less pronounced than with injectable contraceptives (like DMPA), mild weight gain is a documented side effect of progestogens due to their anabolic effects and potential for increased appetite. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** POPs primarily work by thickening cervical mucus (preventing sperm penetration) and causing endometrial atrophy. They do not consistently suppress ovulation (only in ~50% of cycles). * **The "3-Hour Rule":** Traditional POPs must be taken at the same time every day. A delay of more than 3 hours is considered a "missed pill," requiring backup contraception for 48 hours. * **Ideal Candidate:** Lactating women, women over 35 who smoke, and those with contraindications to estrogen (e.g., history of VTE, migraine with aura, or uncontrolled hypertension).

Question 1

Which of the following is a side effect of oral contraceptive pills?

Accepted Answer

Carbohydrate intolerance

Answer

Dysmenorrhea

Answer

Hyperprolactinemia

Answer

Endometriosis

Question 2

A 19-year-old woman desires medical termination of pregnancy at 6 weeks of gestation. Which of the following is an appropriate procedure to perform this termination?

Accepted Answer

Suction and evacuation

Answer

Dilation and curettage

Answer

Hypertonic extra-amniotic saline infusion

Answer

15-methyl Beta-prostaglandin injection

Question 3

Which of the following is not used in emergency contraception?

Accepted Answer

Levonorgestrel intrauterine device

Answer

Oral mifepristone

Answer

Oral levonorgestrel

Answer

Copper T intrauterine device

Question 4

What is the most appropriate contraceptive method for a lactating mother during the first six months postpartum?

Accepted Answer

Progestin-only pills

Answer

Intrauterine contraceptive device (IUCD)

Answer

Combined oral contraceptive pills

Answer

Rhythm method

Question 5

A 30-year-old woman who has had one pregnancy and one live birth desires contraception for 6 months. She experiences dysmenorrhea and has a history of complicated migraine. Ultrasound reveals multiple uterine fibroids. What is the most appropriate contraceptive method for her?

Accepted Answer

Vaginal diaphragm

Answer

Copper T 200 (IUD)

Answer

Oral contraceptive pills

Answer

Tubal sterilization

Question 6

Maximum risk of ectopic pregnancy is after reversal or failure of which of these female sterilization procedures?

Accepted Answer

Laparoscopic electrocoagulation

Answer

Laparoscopic clips

Answer

Laparoscopic rings

Answer

Pomeroys ligation

Question 7

All of the following conditions are contraindications for the use of a progestin-releasing intrauterine device, EXCEPT:

Accepted Answer

Women with menorrhagia

Answer

Carcinoma of the breast

Answer

Acute liver disease or tumor

Answer

Hypersensitivity to any component of this product

Question 8

All except one is recommended for use in emergency contraception?

Accepted Answer

Selective oestrogen receptor modulators

Answer

Combined oral contraceptives

Answer

Progestin only regimens

Answer

Antiprogestins

Question 9

The drug being given is:

Accepted Answer

Ethacrydine lactate (0.1%)

Answer

20% mannitol

Answer

50% Urea

Answer

Misoprostol

Question 10

Which of the following is NOT a side effect of progesterone-only pills?

Accepted Answer

Decreased lactation

Answer

Irregular bleeding

Answer

Amenorrhea

Answer

Weight gain

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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