Contraception and Family Planning Practice Questions

Q: The 'banana sign' is seen in which of the following conditions?

Neural tube defect. The **'Banana Sign'** is a classic sonographic marker of **Open Neural Tube Defects (ONTD)**, specifically **Spina Bifida**. ### **Explanation of the Correct Answer** In Spina Bifida, there is a defect in the spinal column that leads to the leakage of cerebrospinal fluid (CSF). This creates a "suction effect" (downward displacement) on the hindbrain, pulling the cerebellum into the posterior fossa. This process, known as the **Arnold-Chiari II malformation**, causes the cerebellum to lose its typical "dumbbell" shape and wrap around the brainstem, appearing curved like a **banana** on a transverse ultrasound view of the fetal head. ### **Analysis of Incorrect Options** * **B. Hydrops fetalis:** Characterized by abnormal fluid accumulation in at least two fetal compartments (e.g., ascites, pleural effusion, skin edema). It does not involve cerebellar displacement. * **C. Twins:** Ultrasound findings focus on chorionicity (e.g., 'Lambda' or 'T' signs) and fetal growth, not specific cerebellar deformities. * **D. Intrauterine demise:** Associated with signs like **Spalding’s sign** (overlapping of skull bones) or **Robert’s sign** (gas in the fetal heart/vessels), occurring due to fetal maceration. ### **High-Yield Clinical Pearls for NEET-PG** * **Lemon Sign:** Also seen in Spina Bifida; refers to the scalloping or inward flattening of the frontal bones. * **Ventriculomegaly:** Often accompanies the banana sign due to obstructive hydrocephalus. * **Screening:** Maternal Serum Alpha-Fetoprotein (MSAFP) is elevated in open NTDs. * **Prevention:** 400 mcg of Folic Acid daily (pre-conceptionally) reduces the risk of NTDs; 4 mg is used for women with a previous affected pregnancy.

Q: Which of the following is NOT a side effect of oral contraceptives?

Increased risk of ovarian cancer. **Explanation:** The correct answer is **D. Increased risk of ovarian cancer**. In fact, Combined Oral Contraceptive Pills (COCPs) are highly **protective** against ovarian cancer. **Why Option D is correct:** 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. Using COCPs for 5 years reduces the risk of ovarian cancer by approximately 50%, and this protective effect persists for up to 15–20 years after discontinuation. **Why other options are incorrect:** * **A. Irregular bleeding:** Breakthrough bleeding or spotting is the most common side effect, especially during the first few months of use (progestogen-induced endometrial instability). * **B. Headache:** Estrogen can trigger or worsen migraines. New-onset focal headaches or migraines with aura are contraindications due to the increased risk of stroke. * **C. Thrombosis:** The estrogen component (Ethinylestradiol) increases the synthesis of clotting factors (II, VII, IX, X) in the liver, significantly increasing the risk of Venous Thromboembolism (VTE). **High-Yield NEET-PG Pearls:** * **Protective Effects:** COCPs reduce the risk of **Ovarian, Endometrial, and Colorectal cancers**. * **Increased Risks:** COCPs slightly increase the risk of **Breast and Cervical cancers**, as well as Hepatic Adenomas. * **Non-contraceptive benefits:** Reduced incidence of Pelvic Inflammatory Disease (PID), ectopic pregnancy, and benign breast disease. * **Absolute Contraindication:** Smokers >35 years old (>15 cigarettes/day) due to high cardiovascular risk.

Q: Levonorgestrel-containing IUCD prevents pregnancy primarily due to which mechanism?

Making the endometrium unreceptive. **Explanation:** The **Levonorgestrel-releasing Intrauterine System (LNG-IUS)**, such as Mirena, primarily acts through local progestogenic effects. The high local concentration of levonorgestrel leads to profound **endometrial atrophy** and down-regulation of estrogen receptors, making the **endometrium unreceptive** to implantation. This is considered its most significant mechanism of action. **Analysis of Options:** * **A (Correct):** As mentioned, the primary mechanism is the induction of a thin, atrophic endometrium that prevents a fertilized egg from implanting. * **B (Incorrect):** While some systemic absorption occurs, ovulation is maintained in the majority of cycles (about 75-85%). It is not the primary contraceptive mechanism. * **C (Incorrect):** This is the primary mechanism for **Copper-containing IUCDs**, which cause a sterile inflammatory response and are spermicidal. LNG-IUS relies on hormonal changes rather than inflammation. * **D (Incorrect):** Progestogens make the cervical mucus **thick and viscid** (not thin), which creates a barrier to sperm penetration. While this is a secondary mechanism of LNG-IUS, endometrial changes remain the primary factor. **High-Yield Clinical Pearls for NEET-PG:** * **Life span:** LNG-IUS (Mirena) is FDA-approved for up to 8 years (previously 5). * **Non-contraceptive use:** It is the **Gold Standard** (First-line) medical management for **Heavy Menstrual Bleeding (HMB)** and Adenomyosis. * **Failure Rate:** It has one of the lowest failure rates (0.2%), comparable to surgical sterilization. * **Pearl:** Unlike Copper-T, LNG-IUS typically reduces menstrual blood flow and may lead to amenorrhea, which is often a desired therapeutic effect.

Q: What are the benefits of Levonorgestrel-releasing intrauterine devices (LNG-IUDs)?

All the above. **Explanation:** The Levonorgestrel-releasing Intrauterine System (LNG-IUS), such as Mirena, is a highly effective long-acting reversible contraceptive (LARC) that works primarily by thickening cervical mucus and causing endometrial atrophy. **Why "All the above" is correct:** 1. **Management of Menorrhagia (Option A):** The LNG-IUD is the **medical gold standard** for treating Heavy Menstrual Bleeding (HMB). The local release of progestogen causes profound endometrial suppression, leading to a 70–90% reduction in menstrual blood loss and often resulting in amenorrhea. 2. **Contraceptive Effect (Option B):** It is one of the most effective forms of contraception, with a Pearl Index comparable to sterilization (approx. 0.2). It provides protection for 5–8 years depending on the specific device. 3. **Hormone Replacement Therapy (Option C):** In postmenopausal women receiving Estrogen Replacement Therapy (ERT), the LNG-IUD is used to provide **endometrial protection**. It prevents estrogen-induced endometrial hyperplasia and malignancy, serving as the progestogen component of HRT. **High-Yield Clinical Pearls for NEET-PG:** * **Non-contraceptive benefits:** It is also used in the management of endometriosis, adenomyosis, and endometrial hyperplasia without atypia. * **Mechanism:** Primarily local action; it does not consistently inhibit ovulation (unlike OCPs). * **Side Effects:** The most common reason for discontinuation in the first few months is **irregular spotting/breakthrough bleeding**. * **Ideal Candidate:** A woman with menorrhagia who also desires long-term contraception.

Q: A mother of 3 children had unprotected sexual intercourse last night. She wishes to avoid conception as her youngest child is only 7 months old. Which of the following is NOT used for emergency contraception?

Danazol. **Explanation:** The correct answer is **Danazol**. While Danazol is a synthetic androgen used in the treatment of endometriosis and hereditary angioedema, it has **no role** in emergency contraception (EC). Historically, high doses were studied, but it was found to be ineffective compared to modern methods and is not recommended by any current clinical guidelines. **Analysis of Options:** * **Intrauterine Device (IUD):** The Copper-T (Cu-T) is the **most effective** method of emergency contraception. It can be inserted up to 5 days (120 hours) after unprotected intercourse and provides the added benefit of long-term contraception. * **Ethinyl Estradiol and Levonorgestrel:** This combination is known as the **Yuzpe Regimen**. It involves taking two doses (100 mcg EE + 0.5 mg LNG each) 12 hours apart. While effective, it is now less preferred due to a high incidence of nausea and vomiting compared to LNG-only pills. * **Mifepristone:** A selective progesterone receptor modulator (SPRM). In low doses (10 mg or 25 mg), it is highly effective as an emergency contraceptive by delaying ovulation. (Note: High doses are used for medical abortion). **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard (Most Effective):** Copper IUD (Failure rate <0.1%). * **Drug of Choice (Hormonal):** Levonorgestrel (LNG) 1.5 mg single dose (effective up to 72 hours). * **Ulipristal Acetate:** Currently considered the most effective *oral* EC, effective up to 120 hours (5 days). * **Mechanism:** Most hormonal ECs work primarily by **delaying or inhibiting ovulation**; they do not disrupt an established pregnancy (not abortifacients).

Q: Assertion: Spermicides containing non-oxynol-9 provide effective protection against STDs. Reason: Non-oxynol 9 has apoptotic effects on HIV, gonococci and chlamydia.

Both assertion and reason are false. **Explanation:** The correct answer is **D (Both assertion and reason are false)**. **1. Why the Assertion and Reason are False:** While Non-oxynol-9 (N-9) is a potent surfactant that disrupts the cell membranes of spermatozoa, it does **not** provide protection against STDs. In fact, clinical trials have shown that N-9 can increase the risk of HIV transmission. The reason is also false because N-9 does not have "apoptotic effects." Instead, it acts via **detergent-like disruption** of cell membranes. This non-specific action causes micro-abrasions and inflammation in the vaginal and rectal epithelium. These lesions act as portals of entry for pathogens like HIV, *Neisseria gonorrhoeae*, and *Chlamydia trachomatis*, thereby increasing rather than decreasing the risk of infection. **2. Analysis of Incorrect Options:** * **Option A & B:** Incorrect because the assertion is false. N-9 is strictly a contraceptive and is contraindicated for individuals at high risk of STDs/HIV. * **Option C:** Incorrect because the reason is scientifically inaccurate. The mechanism is membrane disruption (cytotoxicity), not programmed cell death (apoptosis). **3. High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Spermicides (N-9) inhibit sperm motility and oxygen uptake by disrupting the lipoprotein membrane. * **Failure Rate:** The typical use failure rate is high (~28%), making it one of the least effective standalone methods. * **WHO Recommendation:** The WHO explicitly states that N-9 should not be used for STD/HIV prevention and should not be used as a lubricant during anal intercourse. * **Ideal Usage:** It is most effective when used in combination with barrier methods like diaphragms or condoms.

Question 1

What is true for Pomeroy's technique of tubal ligation?

Accepted Answer

It is the commonly used technique for open/minilaparotomy tubal ligation.

Answer

The failure rate is higher than other methods.

Answer

It involves ligation and burying the proximal end of the tube.

Answer

The site of ligation is the distal one-third of the tube.

Question 2

How is contraception failure defined?

Accepted Answer

Per 100 woman-years

Answer

Per woman-year

Answer

Per 10 woman-years

Answer

Per 1000 woman-years

Question 3

The 'banana sign' is seen in which of the following conditions?

Accepted Answer

Neural tube defect

Answer

Hydrops fetalis

Answer

Twins

Answer

Intrauterine demise

Question 4

Which of the following is NOT a side effect of oral contraceptives?

Accepted Answer

Increased risk of ovarian cancer

Answer

Irregular bleeding

Answer

Headache

Answer

Thrombosis

Question 5

Levonorgestrel-containing IUCD prevents pregnancy primarily due to which mechanism?

Accepted Answer

Making the endometrium unreceptive

Answer

Suppressing ovulation

Answer

Initiating inflammatory changes within the endometrium

Answer

Making cervical mucus thin

Question 6

What are the benefits of Levonorgestrel-releasing intrauterine devices (LNG-IUDs)?

Accepted Answer

All the above

Answer

Management of menorrhagia

Answer

Contraceptive effect

Answer

Hormone replacement therapy after menopause

Question 7

Which of the following is NOT a mechanism of action for an Intrauterine Contraceptive Device (IUCD)?

Accepted Answer

Constriction of the fallopian tubes

Answer

Thickening of cervical mucus

Answer

Inducing a local foreign body reaction

Answer

Making the endometrium unfavorable for implantation

Question 8

A mother of 3 children had unprotected sexual intercourse last night. She wishes to avoid conception as her youngest child is only 7 months old. Which of the following is NOT used for emergency contraception?

Accepted Answer

Danazol

Answer

Intrauterine device (IUD)

Answer

Ethinyl estradiol and levonorgestrel

Answer

Mifepristone

Question 9

Assertion: Spermicides containing non-oxynol-9 provide effective protection against STDs.
Reason: Non-oxynol 9 has apoptotic effects on HIV, gonococci and chlamydia.

Accepted Answer

Both assertion and reason are false

Answer

Both assertion and reason are true independently

Answer

Assertion is true, reason is false

Answer

Assertion is false, reason is true

Question 10

All of the following statements concerning methods limiting family size are true, except:

Accepted Answer

The barrier methods (condoms and diaphragms) are perhaps the most effective at limiting family size.

Answer

Women who do not breastfeed are much more likely to become pregnant than those who do.

Answer

Globally, the number of tubectomies far exceeds the number of vasectomies.

Answer

All anovulatory drugs are particularly likely to cause effects in women over 35 years of age and women who smoke.

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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