Contraception and Family Planning Practice Questions

Q: Oral contraceptive pills are contraindicated in:

Hepatadenoma. **Explanation:** The correct answer is **Hepatadenoma (Hepatic Adenoma)**. Combined Oral Contraceptive Pills (COCPs) are absolute contraindications in patients with benign or malignant liver tumors because the estrogen component can stimulate the growth of these tumors and increase the risk of rupture and life-threatening intraperitoneal hemorrhage. **Why the other options are incorrect:** * **Premenstrual Tension (PMT):** COCPs are often used as a **treatment** for PMT/PMS. By suppressing ovulation and stabilizing hormonal fluctuations throughout the cycle, they help alleviate physical and emotional symptoms. * **Endometriosis:** COCPs are a **first-line medical management** strategy. They induce a state of "pseudopregnancy," causing atrophy of the ectopic endometrial tissue and reducing dysmenorrhea. * **Pelvic Inflammatory Disease (PID):** COCPs are actually considered **protective** against PID. They increase the viscosity of cervical mucus, making it difficult for ascending pathogens (like *N. gonorrhoeae*) to enter the upper reproductive tract. **High-Yield NEET-PG Pearls:** * **WHO Eligibility Criteria Category 4 (Absolute Contraindications):** * Smokers >35 years (≥15 cigarettes/day). * History of Thromboembolism (DVT/PE) or Stroke. * Current Breast Cancer. * Decompensated Cirrhosis, Hepatoma, or Viral Hepatitis (Active). * Migraine with Aura (increased risk of ischemic stroke). * Uncontrolled Hypertension (>160/100 mmHg). * **Key Benefit:** COCPs significantly reduce the risk of **Ovarian and Endometrial cancers** (protective effect lasts years after discontinuation).

Q: All of the following are recognized effects of combined oral contraceptives except?

Increased risk of colon cancer. **Explanation:** Combined Oral Contraceptive Pills (COCPs) exert a wide range of systemic effects, both beneficial and adverse. The correct answer is **D** because COCPs are actually associated with a **decreased risk of colorectal cancer** (approximately 15-20% reduction), rather than an increased risk. **Analysis of Options:** * **Option D (Correct):** Epidemiological studies consistently show that COCP use is a protective factor against colon cancer. Therefore, stating it increases the risk is factually incorrect. * **Option A (Incorrect):** Breakthrough bleeding (spotting) is the most common side effect of COCPs, especially during the first few months of use or with low-dose estrogen formulations. * **Option B (Incorrect):** COCPs provide significant protection against endometrial cancer (by suppressing endometrial proliferation) and ovarian cancer. This protection persists for years after discontinuation. * **Option C (Incorrect):** Estrogen increases the synthesis of clotting factors and can cause endothelial changes. This leads to a slightly increased risk of venous thromboembolism (VTE), myocardial infarction, and ischemic stroke, particularly in women who smoke or have hypertension. **NEET-PG High-Yield Pearls:** 1. **Cancer Protection:** COCPs decrease the risk of three cancers: **Ovarian, Endometrial, and Colorectal.** 2. **Cancer Risk:** COCPs are associated with a slight increase in the risk of **Cervical and Breast cancer.** 3. **Non-Contraceptive Benefits:** Reduced incidence of Pelvic Inflammatory Disease (PID), ectopic pregnancy, benign breast disease, and improvement in dysmenorrhea/menorrhagia. 4. **Absolute Contraindications:** Smokers >35 years (>15 cigarettes/day), history of thromboembolism, migraine with aura, and undiagnosed abnormal uterine bleeding.

Q: Which vaccine is contraindicated in pregnancy?

MMR. **Explanation:** The core principle in obstetric immunization is that **Live Attenuated Vaccines** are generally **contraindicated** during pregnancy. This is due to the theoretical risk of the live virus crossing the placenta and causing fetal infection or teratogenic effects. **Why MMR is the Correct Answer:** The **MMR (Measles, Mumps, and Rubella)** vaccine contains live attenuated viruses. The Rubella component is of particular concern as it can theoretically cause **Congenital Rubella Syndrome (CRS)**. Therefore, MMR should be administered either before conception (with a recommendation to avoid pregnancy for 28 days/1 month post-vaccination) or in the immediate postpartum period. **Analysis of Incorrect Options:** * **Diphtheria:** This is a **toxoid** vaccine. It is safe and routinely administered during pregnancy (usually as Tdap) to provide passive immunity to the newborn against neonatal tetanus and pertussis. * **Hepatitis-B:** This is a **subunit (recombinant)** vaccine. It is safe and indicated for pregnant women at high risk of infection. * **Killed Polio Vaccine (IPV):** Inactivated (killed) vaccines do not pose a risk of replication or fetal infection. While IPV is not routinely given unless there is a high risk of exposure, it is not contraindicated like the live oral version (OPV). **High-Yield Clinical Pearls for NEET-PG:** 1. **Safe Vaccines:** All Inactivated/Killed vaccines (Flu shot, Rabies, IPV), Toxoids (Tetanus, Diphtheria), and Recombinant vaccines (Hep-B, HPV—though HPV is usually deferred). 2. **Contraindicated Vaccines:** "Live" vaccines—**MMR, Varicella, BCG, Yellow Fever, and Oral Polio (OPV).** 3. **Exception:** Yellow Fever vaccine may be given if the risk of disease outweighs the risk of vaccination (e.g., unavoidable travel to endemic zones). 4. **Best Time for Tdap:** Between **27 and 36 weeks** of gestation to maximize transplacental antibody transfer.

Q: Mifepristone and misoprostol are allowed for medical termination of pregnancy (MTP) until which gestational week?

9 weeks. **Explanation:** The medical termination of pregnancy (MTP) using a combination of **Mifepristone** (a progesterone antagonist) and **Misoprostol** (a prostaglandin E1 analogue) is approved for use up to **9 weeks (63 days)** of gestation. 1. **Why 9 weeks is correct:** According to the updated guidelines and the MTP Amendment Act, the medical regimen is highly effective (95-98%) up to 63 days. Mifepristone sensitizes the myometrium to prostaglandins and causes decidual necrosis, while Misoprostol induces uterine contractions and cervical ripening to expel the products of conception. 2. **Why other options are incorrect:** * **6 and 7 weeks:** While medical abortion is safe at these stages, it is not the upper limit. Earlier protocols (pre-2000s) sometimes cited 7 weeks, but current standards extend to 9 weeks. * **12 weeks:** Beyond 9 weeks, the efficacy of the standard medical regimen decreases, and the risk of incomplete abortion and heavy bleeding increases. For pregnancies between 9 and 12 weeks, surgical methods (like Suction & Evacuation) are generally preferred, although medical induction can be done in a hospital setting with different dosing schedules. **Clinical Pearls for NEET-PG:** * **The Regimen:** 200 mg Mifepristone (Oral) followed by 400 mcg Misoprostol (Oral/Vaginal/Sublingual) after 24–48 hours. * **MTP Act 2021 Update:** Pregnancy can be terminated up to **24 weeks** in specific categories of women (e.g., rape survivors, minors), but this usually requires surgical intervention or different medical protocols beyond the first trimester. * **Contraindications:** Suspected ectopic pregnancy, chronic adrenal failure, and long-term corticosteroid therapy. * **Golden Rule:** Always confirm the gestational age via ultrasound before initiating MTP to rule out ectopic pregnancy.

Q: Oral contraceptives increase the risk of all the following conditions except?

Ovarian cancer. **Explanation:** The correct answer is **Ovarian cancer** because Combined Oral Contraceptive Pills (COCPs) are actually **protective** against it. **1. Why Ovarian Cancer is the Correct Answer:** COCPs suppress ovulation by inhibiting the release of FSH and LH. According to the "Incessant Ovulation Theory," reducing the number of ovulatory cycles decreases repetitive trauma to the ovarian epithelium. This leads to a significant reduction (approx. 50%) in the risk of epithelial ovarian cancer. This protective effect begins after 3–6 months of use and persists for up to 15–20 years after discontinuation. **2. Analysis of Incorrect Options:** * **Breast Cancer:** Most studies indicate a slight, transient increase in the relative risk of breast cancer among current and recent users. The risk typically returns to baseline 10 years after stopping. * **Cervical Cancer:** Long-term use of COCPs (over 5 years) is associated with an increased risk of cervical cancer, likely due to hormonal influences on the transformation zone and a possible association with increased exposure to HPV. * **Liver Cancer:** COCPs are linked to an increased risk of benign liver tumors (Hepatic Adenoma) and, in rare cases, have been associated with an increased risk of Hepatocellular Carcinoma (HCC). **High-Yield Clinical Pearls for NEET-PG:** * **Protective Effects:** COCPs reduce the risk of **Ovarian, Endometrial, and Colorectal cancers.** * **Increased Risk:** COCPs increase the risk of **Breast, Cervical, and Liver cancers.** * **Non-Contraceptive Benefits:** They are used to manage dysmenorrhea, menorrhagia, and PCOS, and they decrease the incidence of Benign Breast Disease (BBD) and Pelvic Inflammatory Disease (PID).

Q: Which one of the following is the most suitable situation for prescribing the progestin-only pill for the purpose of contraception?

Lactational mother. **Explanation:** The **Progestin-Only Pill (POP)**, also known as the "mini-pill," is the contraceptive of choice for **lactating mothers** (Option C). Unlike Combined Oral Contraceptives (COCs), POPs do not contain estrogen. Estrogen is known to suppress prolactin, thereby decreasing the quantity and quality of breast milk. Progestins, however, have no adverse effect on lactation and are safe for the infant, making them ideal for use starting 6 weeks postpartum. **Analysis of Incorrect Options:** * **Active Liver Disease (Option B):** This is a **strict contraindication** for almost all hormonal contraceptives, including POPs. Steroid hormones are metabolized in the liver; impaired hepatic function can lead to hormone accumulation and further liver stress. * **Perimenopausal Patients (Option A):** While POPs can be used, they are often not the "most suitable" due to the high incidence of irregular spotting and breakthrough bleeding—side effects that can mask endometrial pathology (like hyperplasia or malignancy) common in this age group. * **Diabetes (Option D):** While POPs are generally safe in diabetics without vascular complications, they are not specifically "indicated" for them over other methods. In fact, certain progestins can slightly affect carbohydrate metabolism. **High-Yield NEET-PG Pearls:** * **Mechanism of Action:** POPs primarily work by thickening cervical mucus (preventing sperm penetration) and making the endometrium atrophic. They do not consistently inhibit ovulation (unlike COCs). * **The "3-Hour Rule":** POPs must be taken at the same time every day. A delay of more than 3 hours is considered a "missed pill." * **Ideal Candidate:** Women with contraindications to estrogen (e.g., breastfeeding, smokers >35 years, history of DVT, or migraine with aura).

Q: What is the dose of ulipristal acetate when used for emergency contraception?

30 mg. **Explanation:** Ulipristal acetate (UPA) is a selective progesterone receptor modulator (SPRM) and is currently considered the most effective oral emergency contraceptive (EC). **1. Why 30 mg is correct:** The standard dose for emergency contraception is a **single 30 mg tablet** taken orally. Its primary mechanism of action is the inhibition or delay of ovulation. Unlike Levonorgestrel (LNG), which is only effective before the LH surge begins, Ulipristal can delay ovulation even after the LH surge has started (but before it peaks), making it effective for up to **120 hours (5 days)** after unprotected intercourse. **2. Why other options are incorrect:** * **300 mg (Option A):** This is a massive overdose for EC. Higher doses of UPA (e.g., 5-10 mg daily) are used for the medical management of uterine fibroids, but 300 mg is not a standard clinical dose. * **300 µg and 30 µg (Options C & D):** These doses are far too low to inhibit ovulation. For comparison, the "Minipill" (Progestogen-only pill) typically contains doses in the microgram range (e.g., Levonorgestrel 30 µg), but emergency contraception requires a much higher "stat" dose to be effective. **High-Yield Clinical Pearls for NEET-PG:** * **Window of Efficacy:** Ulipristal is effective up to 120 hours (5 days), whereas LNG is ideally taken within 72 hours. * **Efficacy in Obesity:** Ulipristal is more effective than LNG in women with a BMI >30 kg/m². * **Breastfeeding Caution:** Women should avoid breastfeeding for **one week** after taking Ulipristal (express and discard milk), unlike LNG which is safe during lactation. * **Drug Interaction:** Do not start hormonal contraception (like OCPs) for at least 5 days after taking UPA, as they may interfere with each other's efficacy.

Q: All the following are contraindications for copper-containing IUCDs except?

Ischemic heart disease. **Explanation:** The correct answer is **Ischemic Heart Disease (IHD)**. According to the WHO Medical Eligibility Criteria (MEC), IHD is classified as **Category 1** for Copper IUCDs (Cu-IUD), meaning there is no restriction for its use. Unlike hormonal contraceptives (like OCPs), Cu-IUDs do not contain estrogen or progestogens, which are associated with thromboembolic risks and adverse lipid profiles. Therefore, they are safe for women with cardiovascular conditions. **Analysis of Contraindications:** * **Wilson’s Disease (Option A):** This is a specific contraindication for **Copper-containing** IUCDs because the device can potentially interfere with copper metabolism or exacerbate the systemic copper burden in these patients. (Note: LNG-IUS is an alternative here). * **Pregnancy (Option B):** This is an absolute contraindication (MEC Category 4). Insertion during pregnancy can lead to septic abortion, pelvic infection, or preterm labor. * **Undiagnosed Genital Bleeding (Option C):** This is a Category 4 contraindication. Insertion must be delayed until a serious underlying pathology (like endometrial or cervical malignancy) is ruled out, as the IUCD may worsen bleeding or complicate the diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **MEC Category 4 (Absolute Contraindications):** Current PID, unexplained vaginal bleeding, copper allergy (for Cu-IUD), and gestational trophoblastic disease with high hCG levels. * **Ideal Candidate:** A parous woman in a stable monogamous relationship with no history of PID. * **Most Common Side Effect:** Increased menstrual blood loss (menorrhagia) and dysmenorrhea. * **Most Common Reason for Removal:** Excessive menstrual bleeding. * **Post-exposure Prophylaxis:** Cu-IUD is the most effective emergency contraceptive if inserted within 5 days of unprotected intercourse.

Question 1

Which of the following is NOT a contraindication or consideration for contraception methods in patients with liver disease?

Accepted Answer

Progestin-only contraception is the preferred method for patients with liver disease.

Answer

Combined oral contraceptive pills (OCPs) should not be initiated in women with active hepatitis.

Answer

Combined OCPs can be continued in women experiencing an acute flare-up of liver disease while already taking them.

Answer

Discontinuing OCPs can resolve symptoms of cholestasis.

Question 2

Oral contraceptive pills are contraindicated in:

Accepted Answer

Hepatadenoma

Answer

Premenstrual tension

Answer

Endometriosis

Answer

Pelvic inflammatory disease

Question 3

All of the following are recognized effects of combined oral contraceptives except?

Accepted Answer

Increased risk of colon cancer

Answer

Breakthrough bleeding

Answer

Decreased risk of endometrial cancer

Answer

Increased risk of ischemic stroke

Question 4

Which vaccine is contraindicated in pregnancy?

Accepted Answer

MMR

Answer

Diphtheria

Answer

Hepatitis-B

Answer

Killed polio vaccine

Question 5

Mifepristone and misoprostol are allowed for medical termination of pregnancy (MTP) until which gestational week?

Accepted Answer

9 weeks

Answer

6 weeks

Answer

7 weeks

Answer

12 weeks

Question 6

Oral contraceptives increase the risk of all the following conditions except?

Accepted Answer

Ovarian cancer

Answer

Breast cancer

Answer

Cervical cancer

Answer

Liver cancer

Question 7

Which one of the following is the most suitable situation for prescribing the progestin-only pill for the purpose of contraception?

Accepted Answer

Lactational mother

Answer

Perimenopausal patients

Answer

Active liver disease

Answer

Diabetes

Question 8

Which is the ideal contraceptive for a couple who have infrequent coital frequency due to professional commitments?

Accepted Answer

Barrier method

Answer

Intrauterine contraceptive device (IUCD)

Answer

Oral contraceptive pill (OCP)

Answer

Depot medroxyprogesterone acetate (DMPA)

Question 9

What is the dose of ulipristal acetate when used for emergency contraception?

Accepted Answer

30 mg

Answer

300 mg

Answer

300 µg

Answer

30 µg

Question 10

All the following are contraindications for copper-containing IUCDs except?

Accepted Answer

Ischemic heart disease

Answer

Wilson's disease

Answer

Pregnancy

Answer

Undiagnosed genital bleeding

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

On this page

Practice by Chapter

Want unlimited practice?