Contraception and Family Planning Practice Questions

Q: What is the pregnancy rate with a female condom compared to a male condom?

Higher than a male condom. The efficacy of contraceptive methods is measured by the **Pearl Index** (number of pregnancies per 100 woman-years of use). When comparing barrier methods, the female condom (FC1/FC2) consistently shows a higher failure rate than the male latex condom. ### **Explanation of the Correct Answer** The pregnancy rate for the female condom is **higher** than the male condom due to differences in both "perfect use" and "typical use" failure rates: * **Male Condom:** Typical use failure rate is approximately **13-18%**. * **Female Condom:** Typical use failure rate is approximately **21-27%**. The higher failure rate in female condoms is attributed to technical difficulties in insertion, the risk of the penis being inserted between the vaginal wall and the condom, and the potential for the external ring to be pushed into the vagina during intercourse. ### **Analysis of Incorrect Options** * **A & C:** These are incorrect because clinical trials and WHO data consistently rank the female condom as less effective than the male condom. * **D:** No contraceptive method (except total abstinence) has a zero pregnancy rate. Even surgical sterilization has a small failure rate. ### **High-Yield Clinical Pearls for NEET-PG** * **Material:** Most modern female condoms (FC2) are made of **nitrile** (synthetic rubber), making them safe for those with latex allergies and compatible with oil-based lubricants. * **Dual Protection:** Like male condoms, female condoms provide "dual protection" against both pregnancy and **STIs/HIV**. * **Pearl Index:** Always remember that the most effective reversible method is the **LARC** (Long-Acting Reversible Contraception) like IUCDs or Implants, while barrier methods have the highest typical-use failure rates among modern methods. * **Unique Feature:** The female condom can be inserted up to **8 hours** before intercourse, unlike the male condom which requires an erect penis and immediate application.

Q: What is the recommended dose of mifepristone for medical abortion?

600 mg. **Explanation:** The correct answer is **600 mg** because this is the dosage currently recommended under the **MTP (Medical Termination of Pregnancy) Act of India** for medical abortion up to 63 days (9 weeks) of gestation. **Medical Rationale:** Mifepristone is an anti-progestational agent that binds to progesterone receptors with high affinity, leading to decidual breakdown, cervical softening, and increased uterine sensitivity to prostaglandins. While clinical trials (and WHO guidelines) suggest that 200 mg is equally effective, the **statutory dose** prescribed by the Drug Controller General of India (DCGI) and the MTP Act remains **600 mg orally**, followed 48 hours later by 400 mcg of Misoprostol (either orally or vaginally). **Analysis of Options:** * **Option A (600 mg):** The standard legal and academic answer for NEET-PG based on Indian national guidelines. * **Option B (200 mg):** Though globally recommended by the WHO as the "evidence-based" dose to reduce cost and side effects, it is not the standard answer for Indian competitive exams unless "WHO guidelines" are specifically mentioned. * **Option C & D (400 mg / 100 mg):** These are sub-therapeutic or incorrect doses for the purpose of medical abortion. 400 mcg is, however, the standard dose for the second drug, Misoprostol. **High-Yield Clinical Pearls for NEET-PG:** * **MTP Act Limit:** Medical abortion is permitted up to **9 weeks (63 days)** of gestation. * **Mechanism:** Mifepristone (Antiprogestin) + Misoprostol (PGE1 analogue). * **Emergency Contraception:** A single dose of **10 mg** mifepristone can be used as an emergency contraceptive. * **Other uses:** Mifepristone is also used in the management of Cushing’s syndrome and uterine fibroids.

Q: Thromboembolism is primarily associated with which component of oral contraceptive pills (OCPs)?

Estrogen. **Explanation:** The correct answer is **Estrogen**. **1. Why Estrogen is Correct:** The association between Combined Oral Contraceptive Pills (COCPs) and venous thromboembolism (VTE) is primarily attributed to the **Estrogen** component (usually Ethinyl Estradiol). Estrogen exerts a pro-thrombotic effect by altering the hepatic synthesis of clotting factors. Specifically, it: * **Increases** levels of clotting factors II, VII, IX, and X. * **Decreases** levels of natural anticoagulants like Antithrombin III and Protein S. * **Increases** platelet aggregation. This shift in the balance toward a hypercoagulable state significantly increases the risk of deep vein thrombosis (DVT) and pulmonary embolism. **2. Why Other Options are Incorrect:** * **Progesterone:** While some third-generation progestins (e.g., Desogestrel) may slightly modulate the risk when combined with estrogen, the primary causative agent for the hypercoagulable state is estrogen. Progesterone-only pills (POPs) are generally considered safe for patients with a history of VTE. * **Iron:** Iron is often added to the 7-day placebo phase of OCP packs (e.g., Mala-N) to prevent iron-deficiency anemia; it has no effect on the coagulation cascade. * **FSH:** FSH is a gonadotropin produced by the pituitary, not a component of OCPs. OCPs actually work by *suppressing* FSH and LH. **3. NEET-PG High-Yield Pearls:** * **Dose-Dependency:** The risk of VTE is dose-dependent; modern "low-dose" pills ( 35 years, and migraine with aura are absolute contraindications for Estrogen-containing OCPs (WHO Eligibility Criteria Category 4). * **Surgery:** OCPs should ideally be stopped **4 weeks prior** to major elective surgery to reduce postoperative VTE risk.

Q: Which of the following is NOT a contraindication for insertion of an IUCD?

Cervical discharge. **Explanation:** The correct answer is **Cervical discharge**. In clinical practice, the presence of physiological cervical discharge is not a contraindication for IUCD insertion. However, if the discharge is purulent and associated with an active infection (like cervicitis or PID), insertion should be delayed. According to WHO Medical Eligibility Criteria (MEC), a history of non-purulent discharge does not preclude IUCD use. **Analysis of Options:** * **PID (Pelvic Inflammatory Disease):** This is a **Category 4 contraindication** (absolute). Inserting an IUCD during active PID can exacerbate the infection and lead to complications like tubo-ovarian abscess or infertility. * **Presence of fibroids:** While not all fibroids are contraindications, those that **distort the uterine cavity** (e.g., submucosal fibroids) are a contraindication because they prevent proper placement, increase the risk of expulsion, and may cause heavy bleeding. * **Suspected pregnancy:** This is an absolute contraindication. Insertion during pregnancy can lead to septic abortion or miscarriage. **High-Yield Clinical Pearls for NEET-PG:** * **WHO MEC Category 4 (Absolute Contraindications):** Unexplained vaginal bleeding, current PID, current STI (cervicitis), gestational trophoblastic disease, and copper allergy (for Cu-T). * **Ideal time for insertion:** Within 10 days of the onset of menstruation (to ensure the patient is not pregnant and the cervical os is slightly dilated). * **Post-placental insertion:** Within 48 hours of delivery (though risk of expulsion is higher). * **Most common side effect:** Bleeding (menorrhagia) is the most common reason for removal. Pain is the second most common.

Q: In Cu T-200, what does the number denote?

Surface area. In the nomenclature of Intrauterine Contraceptive Devices (IUCDs) like **Cu T-200**, the numerical value refers specifically to the **surface area of the copper wire** (in square millimeters) wrapped around the vertical stem of the device. ### **Explanation of Options:** * **A. Surface Area (Correct):** The efficacy of a copper IUCD is directly proportional to the surface area of copper exposed to the uterine environment. In Cu T-200, there are **200 mm²** of copper. This surface area facilitates the release of copper ions, which act as a spermicide by inhibiting sperm motility and viability. * **B & C. Weight:** While the copper wire has a specific weight, the naming convention is standardized by area, not mass. For example, the Cu T-380A has 380 mm² of copper, which provides higher efficacy and a longer lifespan than the 200 model. * **D. Effective Half-life:** The number does not represent time. The "life" of the device is determined by the rate of copper fragmentation; Cu T-200 is typically effective for **3 years**, whereas Cu T-380A is effective for **10 years**. ### **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily **pre-fertilization** (spermicidal). It causes a sterile inflammatory response in the endometrium, increasing prostaglandins and white blood cells. * **Cu T-380A (ParaGard):** The "A" signifies that the copper is also present on the horizontal arms (sleeves), increasing the surface area to 380 mm². It is currently the "Gold Standard" IUCD. * **Ideal Candidate:** Multiparous women in a stable monogamous relationship. * **Most Common Side Effect:** Excessive menstrual bleeding (menorrhagia). * **Most Common Reason for Removal:** Pain and bleeding.

Q: In which of the following situations is it preferable NOT to insert an IUCD?

Immediately following a mid-trimester abortion. ### Explanation The correct answer is **D. Immediately following a mid-trimester abortion.** **1. Why Option D is Correct:** The risk of **expulsion** and **perforation** is significantly higher when an Intrauterine Contraceptive Device (IUCD) is inserted immediately after a mid-trimester (second trimester) abortion. During this period, the uterus is large, soft, and thin-walled. Furthermore, the cervix is dilated, making it easier for the device to be expelled as the uterus undergoes involution. Standard practice recommends waiting for **6 weeks** (post-involution) before insertion in such cases. **2. Analysis of Incorrect Options:** * **A. Postmenstrual:** This is the **ideal time** for insertion. The cervix is slightly open, the endometrium is thin (minimizing trauma/bleeding), and it confirms the patient is not pregnant. * **B. Emergency postcoital:** A Copper-T is the most effective method of emergency contraception if inserted within **5 days (120 hours)** of unprotected intercourse. * **C. Six weeks after delivery:** This is known as **Interval Insertion**. By 6 weeks, the uterus has returned to its normal size (involution complete), making it a safe and standard time for insertion. **3. High-Yield Clinical Pearls for NEET-PG:** * **PPIUCD (Postpartum IUCD):** Can be inserted within **48 hours** of delivery. If not done within 48 hours, wait for 6 weeks (due to high expulsion risk between 48 hours and 6 weeks). * **Post-Abortion:** IUCD can be inserted immediately after a **first-trimester** abortion (MTP/spontaneous), but should be delayed after a second-trimester abortion. * **Most Common Side Effect:** Bleeding (Menorrhagia). * **Most Common Reason for Removal:** Bleeding/Pain. * **Absolute Contraindication:** Undiagnosed vaginal bleeding, current PID, or suspected pregnancy.

Question 1

What is the pregnancy rate with a female condom compared to a male condom?

Accepted Answer

Higher than a male condom

Answer

Lower than a male condom

Answer

Same as a male condom

Answer

Zero

Question 2

In combined oral contraceptive pills, the contraceptive effect of the estrogenic component is primarily related to which of the following?

Accepted Answer

Suppression of follicle-stimulating hormone (FSH) secretion

Answer

Conversion of ethinyl estradiol to mestranol

Answer

Suppression of cervical mucus secretion

Answer

Suppression of growth hormone-releasing hormone secretion

Question 3

What is the recommended dose of mifepristone for medical abortion?

Accepted Answer

600 mg

Answer

200 mg

Answer

400 mg

Answer

100 mg

Question 4

All of the following statements regarding the mechanism of action of combined oral contraceptive drugs are TRUE, EXCEPT:

Accepted Answer

Estrogen modifies tubal and uterine contractions and prevents fertilization.

Answer

Progestins prevent ovulation by suppressing LH release.

Answer

Progestins cause thickening of cervical mucus and prevent sperm passage.

Answer

Estrogen makes the endometrium hyperproliferative and hypersecretory, preventing implantation.

Question 5

Thromboembolism is primarily associated with which component of oral contraceptive pills (OCPs)?

Accepted Answer

Estrogen

Answer

Progesterone

Answer

Iron

Answer

Follicle Stimulating Hormone (FSH)

Question 6

Regarding the removal of a cervical cap, what is true?

Accepted Answer

The cervical cap must be left in place for at least 8 hours after intercourse.

Answer

The cervical cap should be left in place for the entire cycle length.

Answer

The cervical cap can be removed immediately, followed by vaginal douching.

Answer

The cervical cap should be left until the next menstruation starts.

Question 7

Which of the following is NOT a characteristic feature of an ideal IUCD candidate?

Accepted Answer

Has borne at least two children

Answer

Has no history of pelvic disease

Answer

Has normal menstrual periods

Answer

Is willing to check the IUCD tail

Question 8

Which of the following is NOT a contraindication for insertion of an IUCD?

Accepted Answer

Cervical discharge

Answer

PID

Answer

Presence of fibroids

Answer

Suspected pregnancy

Question 9

In Cu T-200, what does the number denote?

Accepted Answer

Surface area

Answer

Weight in micrograms

Answer

Weight in milligrams

Answer

Effective half-life in weeks

Question 10

In which of the following situations is it preferable NOT to insert an IUCD?

Accepted Answer

Immediately following a mid-trimester abortion

Answer

Postmenstrual

Answer

Emergency postcoital

Answer

Six weeks after delivery

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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