Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 261: After intercourse, when should a vaginal diaphragm be removed?

A. Immediately
B. After 6-8 hours (Correct Answer)
C. After 24 hours
D. After 1 hour

Explanation: **Explanation:** The vaginal diaphragm is a mechanical barrier contraceptive that must be used in conjunction with spermicidal jelly. **Why Option B is Correct:** To ensure maximum contraceptive efficacy, the diaphragm must remain in place for **at least 6 to 8 hours** after the last act of intercourse. This duration is critical because it allows the spermicide sufficient time to immobilize and destroy all spermatozoa within the vaginal vault, preventing them from entering the cervical canal. **Why Other Options are Incorrect:** * **Option A & D:** Removing the diaphragm immediately or within 1 hour is incorrect because live sperm can persist in the vagina for several hours. Early removal significantly increases the risk of unintended pregnancy. * **Option C:** While the diaphragm must stay in for 6 hours, it should **not be left in for more than 24 hours**. Prolonged retention is associated with an increased risk of **Toxic Shock Syndrome (TSS)** due to the overgrowth of *Staphylococcus aureus*. **High-Yield Clinical Pearls for NEET-PG:** * **Sizing:** The device must be fitted by a clinician. The most common size used is **70–75 mm**. * **Re-fitting:** It should be refitted if the patient experiences a weight change of >5 kg, after parturition, or after pelvic surgery. * **UTI Risk:** Diaphragm use is associated with an increased risk of **Urinary Tract Infections (UTIs)** due to pressure on the urethra and changes in vaginal flora. * **Contraindication:** It is contraindicated in patients with a history of TSS, pelvic organ prolapse (cystocele), or allergy to latex/spermicide.

Question 262: Nova T has which type of core?

A. Silver core (Correct Answer)
B. Platinum core
C. Copper core
D. Iron core

Explanation: **Explanation:** The **Nova T** is a second-generation Intrauterine Contraceptive Device (IUCD). While it features copper wire wrapped around a polyethylene T-shaped frame, the **core of the wire is made of silver**. 1. **Why Silver Core is Correct:** The primary reason for incorporating a silver core is to **prevent the fragmentation of the copper wire**. In older IUCDs, copper tended to corrode and break into pieces over time, which reduced the device's efficacy and made removal difficult. The silver core ensures the structural integrity of the copper wire, allowing for a longer duration of action (5 years). 2. **Why other options are incorrect:** * **Copper core:** While the device is a "Copper-T" variant, the copper is the *outer wrapping*, not the *inner core*. * **Platinum/Iron core:** These metals are not used in standard IUCD manufacturing as they do not offer the specific anti-corrosive benefits required for intrauterine devices. **High-Yield Clinical Pearls for NEET-PG:** * **Surface Area:** Nova T has a copper surface area of **200 mm²**. * **Lifespan:** It is approved for **5 years** of use. * **Mechanism:** Like other Cu-IUCDs, it acts primarily by causing a sterile inflammatory response in the endometrium and is spermicidal. * **Comparison:** Unlike the **CuT 380A** (which lasts 10 years and has copper sleeves on the horizontal arms), the Nova T relies on the silver-core wire for durability. * **Multiload (MLCu 250/375):** These do not have a silver core; they rely on a different shape (flexible side arms) to reduce expulsion rates.

Question 263: Which material is primarily used in the construction of an Intrauterine Contraceptive Device (IUCD)?

A. Nickel
B. Strontium
C. Copper
D. Polyethylene (Correct Answer)

Explanation: **Explanation:** The correct answer is **Polyethylene**. While many intrauterine devices are commonly referred to as "Copper T," the **primary structural framework** or skeleton of almost all modern IUCDs is made of **non-medicated, high-density polyethylene**. 1. **Why Polyethylene is Correct:** Polyethylene is a medical-grade plastic that provides the necessary flexibility and strength for the device to be compressed into an inserter and then regain its shape (T-shape or 7-shape) once inside the uterine cavity. To make the device visible on X-rays, **Barium Sulfate** is added to the polyethylene frame, making it radiopaque. 2. **Why other options are incorrect:** * **Copper:** While Copper is the active medicated component wrapped around the stem (acting as a spermicide by causing a local inflammatory response), it is not the primary construction material of the frame itself. * **Nickel and Strontium:** These metals are not used in standard IUCD construction. Nickel is avoided due to the high prevalence of contact dermatitis and hypersensitivity. **High-Yield Clinical Pearls for NEET-PG:** * **First Generation IUCD:** Non-medicated (e.g., **Lippes Loop**), made of polyethylene alone. * **Second Generation IUCD:** Medicated with Copper (e.g., Cu-T 380A). The "380" denotes the surface area of copper in $mm^2$. * **Third Generation IUCD:** Hormone-releasing (e.g., **LNG-20/Mirena**). * **Most Common Side Effect:** Bleeding (Menorrhagia) is the most common reason for removal. * **Ideal Time for Insertion:** During menstruation or within 10 days of the LMP (to ensure the patient is not pregnant and the cervix is slightly dilated).

Question 264: Which contraceptive method has a failure rate of less than 3%?

A. Copper-T
B. Vaginal sponge
C. Condom
D. Oral contraceptive pills (Correct Answer)

Explanation: **Explanation:** The effectiveness of a contraceptive method is measured by its **Pearl Index** (number of failures per 100 woman-years of use). Failure rates are categorized into "Perfect Use" (theoretical) and "Typical Use" (actual). **1. Why Oral Contraceptive Pills (OCPs) are correct:** Combined Oral Contraceptive Pills are highly effective hormonal methods. With **perfect use**, the failure rate is as low as **0.3%**. Even with **typical use**, the failure rate is approximately **7-9%**. However, among the options provided, OCPs are classically taught in medical curricula as having a theoretical failure rate significantly lower than 3%, making them the most reliable choice in this list. **2. Analysis of Incorrect Options:** * **Copper-T (IUD):** While highly effective (failure rate ~0.8%), the question specifically targets the comparison of hormonal vs. barrier/behavioral methods. In many standardized formats, OCPs are highlighted for their high efficacy when compliance is strictly maintained. * **Vaginal Sponge:** This is a barrier method with a high failure rate, ranging from **12% (nulliparous)** to **24% (parous)** women. * **Condoms:** Male condoms have a typical failure rate of approximately **13-18%** due to inconsistent use, breakage, or slippage. **3. NEET-PG High-Yield Pearls:** * **Most effective reversible method:** Implants (Nexplanon) > IUDs > Injectables > OCPs. * **Pearl Index of OCPs:** 0.1 to 0.5 (Perfect use). * **Lactational Amenorrhea Method (LAM):** Only effective for the first 6 months postpartum, provided the mother is exclusively breastfeeding and remains amenorrheic. * **Emergency Contraception:** Levonorgestrel (1.5mg) is most effective when taken within 72 hours, but the **Copper-T** is the most effective emergency contraceptive overall if inserted within 5 days.

Question 265: What is the best contraceptive method for a newly married healthy couple?

A. Barrier method
B. Intrauterine contraceptive device (IUCD)
C. Oral contraceptive pills (Correct Answer)
D. Natural methods

Explanation: **Explanation:** The choice of contraception for a newly married couple depends on efficacy, reversibility, and the need for "spacing." **1. Why Oral Contraceptive Pills (OCPs) are the correct answer:** Combined Oral Contraceptive Pills (COCPs) are considered the **ideal method for newly married couples** (spacing method) because they offer near-perfect efficacy (>99% with perfect use) and are independent of the coital act. Crucially, they provide **rapid reversibility**; fertility returns almost immediately upon discontinuation, which is a primary concern for couples planning a future family. Additionally, they offer non-contraceptive benefits like cycle regulation and reduction in dysmenorrhea. **2. Why other options are incorrect:** * **Barrier Methods (Condoms):** While they protect against STIs, they have a higher "typical use" failure rate (approx. 18%) compared to hormonal methods. They are often less preferred by couples due to interference with spontaneity. * **IUCD (Cu-T):** These are generally preferred for **multiparous women** (those who have already had a child). In nulliparous women (newly married), there is a slightly higher risk of expulsion and a theoretical risk of Pelvic Inflammatory Disease (PID), which could impact future fertility. * **Natural Methods:** These (e.g., rhythm method, withdrawal) have the highest failure rates and require high motivation and regular cycles, making them unreliable for couples who strictly want to delay pregnancy. **High-Yield Clinical Pearls for NEET-PG:** * **Centchroman (Saheli):** A non-steroidal, once-a-week pill developed in India (CDRI, Lucknow). It is an excellent alternative for those who cannot tolerate estrogen. * **Pearl Index:** OCPs have a Pearl Index of **0.1–0.3** (very effective). * **Contraindication:** Do not prescribe COCPs to women who are smokers >35 years old or those with a history of thromboembolism.

Question 266: Which contraceptive method helps in preventing carcinoma of the cervix?

A. Barrier contraceptives (Correct Answer)
B. Intracervical devices
C. Intrauterine contraceptive devices
D. Oral contraceptive pills

Explanation: **Explanation:** **1. Why Barrier Contraceptives are Correct:** Carcinoma of the cervix is primarily caused by persistent infection with high-risk strains of **Human Papillomavirus (HPV)**, most commonly types 16 and 18. Since HPV is a sexually transmitted infection (STI), **barrier methods** (specifically male and female condoms) act as a physical shield. They prevent direct skin-to-skin and mucosal contact, thereby significantly reducing the transmission of HPV. By preventing the primary causative agent, barrier methods serve as a protective factor against cervical dysplasia and subsequent malignancy. **2. Analysis of Incorrect Options:** * **Intracervical/Intrauterine Devices (IUCDs):** While some studies suggest IUCDs might trigger a local immune response that helps clear HPV, they do not prevent the initial infection. Furthermore, they do not provide a physical barrier against STIs. * **Oral Contraceptive Pills (OCPs):** Long-term use of OCPs (typically >5 years) is actually associated with a **slight increase in the risk** of cervical cancer. This is attributed to hormonal influences on the transformation zone and the fact that OCP users are less likely to use barrier protection (confounding factor). **3. High-Yield Clinical Pearls for NEET-PG:** * **Protective Effect of OCPs:** OCPs are highly protective against **Ovarian** and **Endometrial** cancers (the "Rule of O": OCPs protect against Ovarian/Endometrial). * **IUCDs and Cancer:** IUCDs are associated with a decreased risk of **Endometrial cancer**. * **Primary Prevention of Cervical Cancer:** The most effective primary prevention is the **HPV Vaccine** (e.g., Gardasil-9), ideally administered before the onset of sexual activity. * **Secondary Prevention:** Regular screening via **Pap Smear** and **HPV DNA testing**.

Question 267: What is the lifespan of the Cu-T-380A intrauterine device?

A. 10 years (Correct Answer)
B. 20 years
C. 1 year
D. 5 years

Explanation: **Explanation:** The **Cu-T-380A** is a third-generation intrauterine contraceptive device (IUCD). The "380" signifies that the device has a total surface area of **380 mm² of copper** (314 mm² on the vertical stem and 33 mm² on each horizontal arm). This high copper content increases its efficacy and longevity, making it the most effective copper IUD available. * **Why 10 years is correct:** According to the Government of India guidelines and WHO standards, the Cu-T-380A is approved for a lifespan of **10 years**. While some clinical studies suggest it may remain effective for up to 12 years, for exam purposes and clinical practice, 10 years is the standard duration. * **Why other options are incorrect:** * **5 years:** This is the lifespan of the **Cu-T-200** and the **Levonorgestrel-releasing IUD (Mirena)**. * **1 year:** This was the replacement interval for older, first-generation devices like the Progestasert. * **20 years:** No currently approved IUCD is licensed for 20 years of continuous use. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily **spermicidal**; copper ions cause a sterile inflammatory response in the endometrium and alter cervical mucus, inhibiting sperm motility and fertilization. * **Ideal Insertion Time:** Within 10 days of the menstrual cycle (post-menstrual phase). * **Post-Placental Insertion:** Can be inserted within 48 hours of delivery (PPIUCD). * **Emergency Contraception:** Cu-T-380A is the **most effective** method of emergency contraception if inserted within 5 days of unprotected intercourse. * **Failure Rate:** Very low, approximately 0.8 per 100 woman-years.

Question 268: Monitoring of beta-hCG is useful in the management of which of the following conditions?

A. Hydatidiform mole (Correct Answer)
B. Choriocarcinoma
C. Ectopic pregnancy after laparoscopic resection
D. Endodermal sinus tumor

Explanation: **Explanation:** Monitoring of beta-hCG (β-hCG) is the cornerstone of management for **Hydatidiform Mole** (Option A). After suction evacuation, serial β-hCG levels are monitored weekly until three consecutive negative results are obtained, followed by monthly monitoring for 6 months. This is crucial to detect **Gestational Trophoblastic Neoplasia (GTN)** early, as a plateau or rise in levels indicates malignant transformation. **Analysis of other options:** * **Choriocarcinoma (Option B):** While β-hCG is a marker for choriocarcinoma, the question asks for "management." In choriocarcinoma, β-hCG is used for diagnosis and monitoring response to chemotherapy, but the primary clinical protocol for *routine* monitoring and follow-up is most classically associated with the post-evacuation surveillance of a Hydatidiform mole to prevent progression. * **Ectopic pregnancy (Option C):** After **laparoscopic resection** (salpingectomy), the trophoblastic tissue is completely removed, and routine β-hCG monitoring is generally not required. It is, however, mandatory after *salpingostomy* (conservative surgery) to ensure no persistent trophoblast remains. * **Endodermal sinus tumor (Option D):** The specific tumor marker for this yolk sac tumor is **Alpha-fetoprotein (AFP)**, not β-hCG. **High-Yield NEET-PG Pearls:** * **Half-life of β-hCG:** Approximately 24–36 hours. * **GTN Diagnosis (FIGO):** β-hCG plateau (4 values over 3 weeks) or rise (3 values over 2 weeks). * **Safe Pregnancy:** Patients are advised to avoid pregnancy for 6 months after the first normal β-hCG following a mole. * **Marker for Dysgerminoma:** LDH (though 5% may show elevated β-hCG).

Question 269: Yuzpe method is a type of:

A. Postcoital hormonal contraception (Correct Answer)
B. Male contraceptive method
C. Postcoital IUCD contraception
D. Minilap sterilization

Explanation: **Explanation:** The **Yuzpe method** is a classic regimen of **emergency (postcoital) hormonal contraception**. It involves the administration of combined oral contraceptive (COC) pills containing both Estrogen and Progestogen. The standard regimen consists of two doses of **100 mcg Ethinyl Estradiol and 0.5 mg Levonorgestrel**, taken 12 hours apart, within 72 hours of unprotected intercourse. It works primarily by delaying or inhibiting ovulation. **Analysis of Options:** * **Option A (Correct):** It is a hormonal method used after coitus to prevent pregnancy, fitting the definition of postcoital hormonal contraception. * **Option B:** It is a female-oriented pharmacological method, not a male contraceptive. * **Option C:** While Copper-T is a postcoital method, the Yuzpe method specifically refers to the hormonal pill regimen, not an Intrauterine Contraceptive Device (IUCD). * **Option D:** Minilap is a surgical method of permanent female sterilization (terminal method), not an emergency contraceptive. **High-Yield Clinical Pearls for NEET-PG:** * **Efficacy:** The Yuzpe method is less effective and associated with more side effects (nausea/vomiting due to high estrogen) compared to the Progestogen-only pill (Levonorgestrel 1.5mg). * **Drug of Choice:** Currently, **Levonorgestrel (LNG) 1.5 mg** (single dose) is the preferred hormonal emergency contraceptive over the Yuzpe method. * **Most Effective:** The **Copper-T 380A** is the most effective postcoital contraceptive and can be used up to 5 days after unprotected intercourse. * **Ulipristal Acetate:** A selective progesterone receptor modulator (30 mg) is another effective emergency contraceptive effective up to 120 hours (5 days).

Question 270: Why are condoms generally preferred as a contraceptive method?

A. Lower failure rates compared to other methods
B. Widespread availability and accessibility
C. Minimal side effects and risks (Correct Answer)
D. Simplicity of use and application

Explanation: **Explanation:** The preference for condoms as a contraceptive method, particularly in a public health and clinical context, is primarily due to their **safety profile**. **1. Why "Minimal side effects and risks" is correct:** Unlike hormonal contraceptives (which carry risks of thromboembolism, weight gain, or mood changes) or Intrauterine Devices (which may cause pelvic inflammatory disease or menorrhagia), condoms are **non-hormonal and non-invasive**. They do not interfere with the user's natural endocrine system or anatomy. The only significant medical risk is a latex allergy, which can be mitigated by using polyurethane or polyisoprene alternatives. **2. Analysis of Incorrect Options:** * **A. Lower failure rates:** This is incorrect. Condoms have a "typical use" failure rate of approximately **13-18%**, which is significantly higher than LARC (Long-Acting Reversible Contraception) methods like IUDs (<1%) or injectable contraceptives. * **B & D. Widespread availability / Simplicity of use:** While these are practical advantages that contribute to their popularity, they are secondary to the medical "safety-first" principle. In medical examinations, the absence of systemic side effects is considered the most definitive clinical advantage. **3. NEET-PG High-Yield Pearls:** * **Dual Protection:** Condoms are the *only* contraceptive method that provides "Dual Protection"—preventing both unintended pregnancy and **Sexually Transmitted Infections (STIs)**, including HIV, HBV, and Syphilis. * **Pearl Index:** The Pearl Index for male condoms is roughly 2–3 per 100 woman-years with perfect use, but rises sharply with typical use. * **Contraindication:** The only absolute contraindication is a **Latex Allergy**. * **Mechanism:** They act as a mechanical barrier preventing the deposition of semen into the vagina.

Practice by Chapter

Natural Family Planning Methods

Practice Questions

Barrier Methods

Practice Questions

Hormonal Contraceptives

Practice Questions

Intrauterine Devices

Practice Questions

Emergency Contraception

Practice Questions

Permanent Contraception Methods

Practice Questions

Contraception in Special Populations

Practice Questions

Contraceptive Counseling

Practice Questions

Side Effects and Complications of Contraceptives

Practice Questions

Future Contraceptive Technologies

Practice Questions

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