Contraception and Family Planning Practice Questions

Q: Which of the following is NOT true about Nexplanon?

Is an estrogen subdermal implant. **Explanation:** **Nexplanon** is a long-acting reversible contraceptive (LARC) that consists of a single-rod subdermal implant. **Why Option C is correct:** Nexplanon is **not** an estrogen implant; it contains **68 mg of Etonogestrel**, which is a third-generation **progestin** (a derivative of desogestrel). It does not contain any estrogen, making it a safe alternative for women who have contraindications to estrogen-containing contraceptives (e.g., history of thromboembolism or breastfeeding). **Why the other options are incorrect:** Nexplanon works through a multi-modal mechanism of action typical of progestins: * **Option A (Suppresses ovulation):** This is the primary mechanism. It inhibits the LH surge required for ovulation. * **Option B (Induces endometrial atrophy):** Progestins alter the endometrial lining, making it thin and unfavorable for the implantation of a blastocyst. * **Option D (Increases cervical mucus viscosity):** It thickens the cervical mucus, creating a physical barrier that prevents sperm penetration into the upper reproductive tract. **High-Yield Clinical Pearls for NEET-PG:** * **Duration:** It is effective for **3 years**. * **Insertion Site:** Subdermally in the non-dominant upper arm (over the triceps). * **Radiopacity:** Unlike its predecessor (Implanon), Nexplanon is **radiopaque**, meaning it can be localized via X-ray or CT if it migrates or is difficult to palpate. * **Side Effects:** The most common side effect and reason for discontinuation is **irregular/unpredictable menstrual bleeding**. * **Failure Rate:** It is the most effective form of reversible contraception, with a Pearl Index of approximately 0.05.

Q: Which of the following is NOT an absolute contraindication for oral contraceptive pills?

Endometriosis. **Explanation:** The correct answer is **Endometriosis**. In fact, Combined Oral Contraceptive Pills (COCPs) are a **first-line medical treatment** for endometriosis. They work by inducing a state of "pseudopregnancy," leading to the atrophy of endometrial tissue and providing relief from dysmenorrhea and chronic pelvic pain. **Analysis of Options:** * **A. Pregnancy:** COCPs are absolutely contraindicated in pregnancy as they are unnecessary and pose a theoretical risk of hormonal interference with fetal development. * **B. Thromboembolic disorder:** Estrogen increases the synthesis of clotting factors (II, VII, IX, X) and decreases Antithrombin III. A history of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), or known thrombogenic mutations is a Category 4 contraindication (WHO MEC) due to the high risk of fatal recurrence. * **C. Hepatic failure:** Steroid hormones are metabolized in the liver. In active hepatic failure, hepatitis, or cirrhosis, the liver cannot process these hormones, leading to toxicity and further hepatic strain. **High-Yield Clinical Pearls for NEET-PG:** * **WHO Medical Eligibility Criteria (MEC) Category 4 (Absolute Contraindications):** * Smokers >35 years old (≥15 cigarettes/day). * History of Stroke or Ischemic Heart Disease. * Breast Cancer (current). * Migraine with Aura (due to increased stroke risk). * Uncontrolled Hypertension (>160/100 mmHg). * **Protective Effects:** COCPs significantly reduce the risk of **Ovarian and Endometrial cancers** (this protection persists for years after discontinuation). * **Non-contraceptive uses:** Management of PCOD, DUB, and Endometriosis.

Q: What is the optimal gestational age for pregnancy termination?

Second trimester. **Explanation:** The question refers to the **optimal timing for termination of pregnancy in cases of severe maternal medical complications** (such as severe pre-eclampsia or cardiac disease) or **lethal fetal anomalies** where the goal is to balance maternal safety with the technical ease of the procedure. **Why the Second Trimester is correct:** In clinical practice and competitive exams, the second trimester (specifically between 13–20 weeks) is often considered the "optimal" window for elective or therapeutic termination when early diagnosis was missed. While first-trimester procedures are technically simpler, many structural anomalies and genetic markers are only detectable via mid-trimester scans (Level II ultrasound) or amniocentesis. Furthermore, modern induction protocols (using Misoprostol) make second-trimester termination highly effective with lower risks of uterine perforation compared to late-term surgical interventions. **Analysis of Incorrect Options:** * **First Trimester:** While safest for the mother (lowest complication rate), it is often too early to diagnose many major fetal structural malformations. * **Third Trimester:** This is the least optimal time. The fetus has reached viability, making termination ethically and legally complex (MTP Act restrictions). Surgically, it carries the highest risk of hemorrhage and uterine rupture. **High-Yield Clinical Pearls for NEET-PG:** * **MTP Act (India) Update:** Termination is now legal up to **24 weeks** for specific categories (survivors of sexual assault, minors, fetal anomalies). * **Method of Choice:** For 12 weeks, **Medical Induction** (Misoprostol ± Mifepristone) or Dilatation & Evacuation (D&E) is used. * **Golden Rule:** The risk of maternal mortality increases by roughly 38% for each additional week of gestation beyond 8 weeks.

Q: All of the following are true regarding menstrual regulation except:

It can be performed up to 12 weeks of gestation.. **Explanation:** **Menstrual Regulation (MR)** is a procedure used to terminate a suspected pregnancy before it is clinically confirmed by a pregnancy test or ultrasound. It involves the aspiration of the endometrial lining using a Karman’s cannula and a syringe (Manual Vacuum Aspiration). **1. Why Option C is the correct answer (The Exception):** Menstrual Regulation is strictly performed within **14 days of a missed period** (i.e., up to 6 weeks of gestation). It cannot be performed up to 12 weeks. Beyond 6–7 weeks, the procedure is classified as a standard MTP (Manual or Electric Vacuum Aspiration), as the products of conception become too large for the small-gauge cannulas used in MR. **2. Analysis of other options:** * **Option A:** In India, MR is legally governed by the **MTP Act**. Even though a pregnancy test might not be performed, the procedure must be documented and conducted by a registered medical practitioner at an approved center. * **Option B:** Because the procedure is done very early (within 2 weeks of a missed period), the gestational sac is tiny and the vascularity of the uterus is minimal, leading to **significantly less blood loss** compared to later-term abortions. * **Option D:** MR is a quick, outpatient procedure (taking 5–10 minutes). It is usually performed under **local anesthesia (paracervical block)** or no anesthesia at all; general anesthesia is not required. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** MR is done within 42 days from the Last Menstrual Period (LMP). * **Equipment:** Uses a **Karman’s Cannula** (usually 4–6 mm) and a 60cc syringe. * **Complication:** The most common complication is **incomplete evacuation** due to the very early stage of pregnancy. * **MTP Act Update:** Remember that under the 2021 amendment, the upper limit for MTP in specific categories is 24 weeks, but MR remains an early-intervention technique.

Q: Use of oral contraceptives increases the risk of which of the following cancers?

Breast cancer. Combined Oral Contraceptive Pills (COCPs) exert a dual effect on oncogenesis, acting as a protective factor for some cancers while slightly increasing the risk for others. **Why Breast Cancer is the Correct Answer:** The risk of **Breast Cancer** is slightly increased in current and recent users of COCPs (Relative Risk ≈ 1.24). This is attributed to the stimulatory effect of exogenous estrogen and progesterone on mammary epithelial cell proliferation. However, this risk is transient; it returns to baseline approximately 10 years after discontinuing the medication. Additionally, COCPs increase the risk of **Cervical Cancer** (linked to duration of use >5 years) and **Hepatocellular Adenoma/Carcinoma**. **Why Other Options are Incorrect:** * **Ovarian Cancer:** COCPs are highly **protective** against epithelial ovarian cancer. By suppressing ovulation ("ovarian rest"), they reduce repetitive trauma to the ovarian epithelium. This protection persists for up to 30 years after cessation. * **Colon Cancer:** COCPs are associated with a **reduced risk** (approx. 18-20% reduction) of colorectal cancer. The mechanism likely involves the reduction of bile acid synthesis and the presence of estrogen receptors in the colonic mucosa which may inhibit cell growth. * **Endometrial Cancer:** Though not listed, COCPs significantly **reduce** the risk of endometrial cancer due to the progestogen component antagonizing estrogen-induced endometrial hyperplasia. **High-Yield Clinical Pearls for NEET-PG:** * **Protective Effect:** Ovarian, Endometrial, and Colorectal cancers. * **Increased Risk:** Breast, Cervical, and Liver (Hepatic Adenoma) cancers. * **Benign Benefit:** COCPs significantly reduce the risk of **Benign Breast Disease** (e.g., fibroadenoma, cystic changes), despite the slight increase in malignant risk. * **Duration:** The protective effect against Ovarian and Endometrial cancers increases with the duration of use.

Q: What is the ideal contraceptive for a couple living in different cities who meet only occasionally?

Barrier method. **Explanation:** The choice of contraceptive method depends heavily on the frequency of intercourse and the lifestyle of the couple. For a couple living in different cities who meet only occasionally, the **Barrier method (Condoms)** is the ideal choice. **1. Why Barrier Method is Correct:** The primary medical concept here is **"Coitus-dependent contraception."** Since the couple meets infrequently, they do not require continuous systemic hormonal levels or semi-permanent devices. Barrier methods are used only during the act of intercourse, avoiding unnecessary side effects of long-term medications. Additionally, they provide protection against Sexually Transmitted Infections (STIs), which is a crucial consideration for couples living apart. **2. Why Other Options are Incorrect:** * **IUCD (Option B):** These are Long-Acting Reversible Contraceptives (LARC). While highly effective, they are generally preferred for couples seeking long-term spacing (3–10 years) who have frequent intercourse. * **OCP (Option C):** These require strict daily compliance. Taking a daily systemic hormone for a couple that meets only once every few months is considered unnecessary hormonal exposure. * **DMPA (Option D):** This is an injectable contraceptive given every 3 months. Like OCPs, it provides continuous systemic suppression of ovulation, which is not "need-based" for occasional contact. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Contraceptive for Newly Married:** OCPs (Centchroman/Chhaya is also a popular choice in India). * **Ideal Contraceptive for Lactating Mothers:** Progestogen-only pills (POPs) or Lactational Amenorrhea Method (LAM) for the first 6 months. * **Pearl Index:** Condoms have a higher failure rate (typical use) compared to IUCDs/OCPs, but they are the only method that prevents STIs. * **Emergency Contraception:** Should be advised as a backup for this couple in case of barrier failure (condom rupture).

Q: All of the following are contraceptive implants except?

Mesigyna. **Explanation:** The correct answer is **D. Mesigyna**. **1. Why Mesigyna is the correct answer:** Mesigyna is a **Combined Injectable Contraceptive (CIC)**, not an implant. It contains an estrogen (Estradiol valerate 5 mg) and a progestogen (Norethisterone enanthate 50 mg). It is administered intramuscularly once every month. In contrast, contraceptive implants are sub-dermal devices that provide long-term reversible contraception (LARC). **2. Analysis of incorrect options (Implants):** * **Norplant:** The first-generation implant system. It consists of **6 silastic capsules** containing Levonorgestrel (LNG), effective for 5 years. * **Jadelle:** A second-generation implant (often called Norplant-2). It consists of **2 rods** containing Levonorgestrel, effective for 5 years. It is easier to insert and remove than Norplant. * **Implanon:** A third-generation, **single-rod** implant containing Etonogestrel (68 mg). It is effective for 3 years. (Note: Nexplanon is the newer, radiopaque version of Implanon). **3. NEET-PG High-Yield Pearls:** * **Mechanism of Action (Implants):** Primarily work by suppressing ovulation and thickening cervical mucus. * **Most Common Side Effect:** The most frequent reason for discontinuation of implants is **irregular menstrual bleeding** (amenorrhea or spotting). * **Failure Rate:** Implants have the lowest failure rate among all contraceptive methods (Pearl Index ~0.05), making them more effective than permanent sterilization. * **Anticonvulsants:** Enzyme-inducing drugs (e.g., Phenytoin, Carbamazepine) can decrease the efficacy of hormonal implants.

Q: What is the rate of release of levonorgestrel into the uterus from Mirena, a progestin-releasing intrauterine device?

20 mcg/day. **Explanation:** **Mirena** is a Levonorgestrel-releasing Intrauterine System (LNG-IUS) that contains a total of 52 mg of Levonorgestrel. The correct answer is **20 mcg/day** because this is the initial steady-state release rate of the hormone into the uterine cavity. This local release causes endometrial thickening, cervical mucus changes, and inhibition of sperm motility, providing highly effective contraception for up to 5–8 years. **Analysis of Options:** * **A (20 mcg/day):** This is the standard initial release rate for Mirena. Over time, this rate gradually declines (reaching approximately 10 mcg/day after 5 years), but 20 mcg/day is the definitive value tested in exams. * **B (30 mcg/day):** This value does not correspond to any standard LNG-IUS. Progestin-only pills (Minipills) like Levonorgestrel 0.03 mg contain 30 mcg, but the IUD release rate is lower. * **C & D (50 & 70 mcg/day):** These values are significantly higher than the physiological dose required for local intrauterine action and would lead to increased systemic side effects. Progestasert (an older, now obsolete IUD) released Progesterone at 65 mcg/day. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Primarily local action (endometrial atrophy); it is **not** primarily anovulatory. * **Non-contraceptive use:** It is the "Gold Standard" medical management for **Heavy Menstrual Bleeding (HMB)** and is used in Endometrial Hyperplasia. * **Other LNG-IUS:** * **Kylena:** Releases ~17.5 mcg/day (smaller frame). * **Jaydess/Skyla:** Releases ~14 mcg/day (3-year duration). * **Failure Rate:** 0.2%, comparable to tubal ligation.

Q: Which of the following is NOT a contraindication for medical abortion?

Age more than 35 years. ### Explanation Medical abortion (using Mifepristone and Misoprostol) is a safe procedure, but its success and safety depend on identifying specific contraindications. **1. Why "Age more than 35 years" is the correct answer:** Age alone is **not** a contraindication for medical abortion. While advanced maternal age may increase risks in surgical procedures or pregnancy complications, medical abortion remains safe for women over 35, provided they do not have co-morbidities like heavy smoking (which increases cardiovascular risk) or uncontrolled hypertension. **2. Why the other options are contraindications:** * **Hemoglobin < 8 gm% (Severe Anemia):** Medical abortion involves significant vaginal bleeding (often heavier than a normal period). In patients with severe anemia, this blood loss can lead to hypovolemic shock or the need for emergency transfusion. * **Undiagnosed Adnexal Mass:** This is a major contraindication because it raises the suspicion of an **Ectopic Pregnancy**. Medical abortion drugs will not terminate a tubal pregnancy, and a rupture could be life-threatening. * **Uncontrolled Seizure Disorder:** Patients with uncontrolled epilepsy are generally excluded because the stress of the procedure, potential drug interactions, or the physiological changes during cramping and bleeding could trigger seizures. **3. High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications:** Confirmed/suspected ectopic pregnancy, chronic adrenal failure, long-term corticosteroid therapy, inherited coagulopathy, or allergy to Mifepristone/Misoprostol. * **IUD Presence:** An IUD is a contraindication *unless* it is removed before the medical abortion begins. * **MTP Act (India) Update:** Medical abortion is legal up to **9 weeks (63 days)** of gestation under the MTP Act. * **Standard Regimen:** 200 mg Mifepristone (Oral) followed by 400 mcg Misoprostol (Oral/Vaginal/Sublingual) after 24–48 hours.

Question 1

Which of the following is NOT true about Nexplanon?

Accepted Answer

Is an estrogen subdermal implant

Answer

Suppresses ovulation

Answer

Induces endometrial atrophy

Answer

Increases cervical mucus viscosity

Question 2

Which of the following is NOT an absolute contraindication for oral contraceptive pills?

Accepted Answer

Endometriosis

Answer

Pregnancy

Answer

Thromboembolic disorder

Answer

Hepatic failure

Question 3

What is the optimal gestational age for pregnancy termination?

Accepted Answer

Second trimester

Answer

First trimester

Answer

Third trimester

Answer

None of the above

Question 4

All of the following are true regarding menstrual regulation except:

Accepted Answer

It can be performed up to 12 weeks of gestation.

Answer

It comes under the Medical Termination of Pregnancy (MTP) Act.

Answer

Blood loss is typically less compared to other methods.

Answer

General anesthesia is generally not required.

Question 5

Use of oral contraceptives increases the risk of which of the following cancers?

Accepted Answer

Breast cancer

Answer

Colon cancer

Answer

Ovarian cancer

Answer

All of the above

Question 6

What is the ideal contraceptive for a couple living in different cities who meet only occasionally?

Accepted Answer

Barrier method

Answer

Intrauterine contraceptive device (IUCD)

Answer

Oral contraceptive pill (OCP)

Answer

DMPA (Depot medroxyprogesterone acetate)

Question 7

All of the following are contraceptive implants except?

Accepted Answer

Mesigyna

Answer

Norplant

Answer

Implanon

Answer

Jadelle

Question 8

What is the rate of release of levonorgestrel into the uterus from Mirena, a progestin-releasing intrauterine device?

Accepted Answer

20 mcg/day

Answer

30 mcg/day

Answer

50 mcg/day

Answer

70 mcg/day

Question 9

Which of the following statements is true regarding RU-486?

Accepted Answer

It is used for inducing abortion in the early weeks of pregnancy.

Answer

It can be used in conjunction with a contraceptive pill.

Answer

It acts on the cytoplasmic receptor.

Answer

It is used for preventing ectopic implantation.

Question 10

Which of the following is NOT a contraindication for medical abortion?

Accepted Answer

Age more than 35 years

Answer

Hemoglobin less than 8 gm%

Answer

Undiagnosed adnexal mass

Answer

Uncontrolled seizure disorder

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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