Contraception and Family Planning — MCQs
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Which of the following statements about the calendar method of contraception is false?
A patient who works as a nurse in the surgery intensive care unit at a local community hospital plans to discontinue her oral contraceptives to attempt pregnancy in the next few months. She has questions regarding updating her immunizations and whether they can be administered during pregnancy. Which of the following statements regarding immunizations and pregnancy is FALSE?
Gossypol is:
Oral contraceptive pills (OCPs) decrease the risk of which of the following cancers?
Which method of contraception is not used in a patient with active syphilis?
Which one of the following is an adverse effect associated with combined oral contraceptives?
Which contraceptive is contraindicated during lactation?
A single tablet of levonorgestrel 0.75 mg has been taken for effective post-coital contraception. When should the second tablet be taken?
Which of the following is the primary clinical use of Mifepristone?
What is the best contraceptive method for a 20-year-old nulliparous woman?
Contraception and Family Planning Indian Medical PG Practice Questions and MCQs
Question 271: Which of the following statements about the calendar method of contraception is false?
- A. Abstinence is needed for only a few days in a month.
- B. It is associated with no cost.
- C. The fertile period can also be estimated using the basal body temperature, rhythm, or cervical mucus methods.
- D. Ectopic pregnancy is a reported complication. (Correct Answer)
Explanation: **Explanation:** The **Calendar (Rhythm) Method** is a natural family planning technique based on predicting ovulation by tracking the menstrual cycle. **Why Option D is the correct (false) statement:** Ectopic pregnancy is **not** a complication of the calendar method. Ectopic pregnancy occurs when a fertilized egg implants outside the uterus. While the calendar method has a high failure rate (typical use failure rate ~24%), a failure simply results in a **normal intrauterine pregnancy**. In contrast, methods like the Progestin-only pill (POP), Levonorgestrel-IUD, or tubal ligation—which prevent intrauterine implantation more effectively than they prevent ovulation or tubal transport—are associated with a higher *relative* risk of ectopic pregnancy if they fail. **Analysis of other options:** * **Option A:** True. Abstinence is only required during the "fertile window" (calculated as the shortest cycle minus 18 days to the longest cycle minus 11 days). * **Option B:** True. It is a behavioral method requiring no devices, hormones, or clinical procedures, thus incurring no financial cost. * **Option C:** True. These are complementary "Fertility Awareness-Based Methods" (FABM). Basal Body Temperature (BBT) identifies the post-ovulatory rise, and the Billings method tracks changes in cervical mucus (spinnbarkeit). **High-Yield Clinical Pearls for NEET-PG:** * **Pearl 1:** The calendar method is unreliable for women with irregular cycles. * **Pearl 2:** The **Standard Days Method** is a simplified version of the calendar method suitable for women with cycles between 26–32 days (abstinence on days 8–19). * **Pearl 3:** Natural methods do not protect against STIs/HIV. * **Pearl 4:** **Lactational Amenorrhea Method (LAM)** is only effective for up to 6 months postpartum, provided the mother is exclusively breastfeeding and remains amenorrheic.
Question 272: A patient who works as a nurse in the surgery intensive care unit at a local community hospital plans to discontinue her oral contraceptives to attempt pregnancy in the next few months. She has questions regarding updating her immunizations and whether they can be administered during pregnancy. Which of the following statements regarding immunizations and pregnancy is FALSE?
- A. The patient should be checked for immunity against the rubella virus prior to conception because the rubella vaccine is a live virus and should not be given during pregnancy.
- B. The patient should be given the tetanus toxoid vaccination prior to becoming pregnant because it is a live virus that has been associated with multiple fetal anomalies when administered during pregnancy. (Correct Answer)
- C. The Centers for Disease Control and Prevention recommends that all pregnant women should be vaccinated against the influenza virus after the first trimester.
- D. If the patient does not have a history of having chickenpox in the past, she should be screened for immunity because most people without a history of the infection are immune; if the patient is nonimmune, she should be given the vaccine prior to achieving pregnancy because the vaccine is a live virus.
Explanation: This question tests the fundamental knowledge of vaccine safety during pregnancy, a high-yield topic for NEET-PG. ### **Analysis of the Correct Option (B)** Option B is **FALSE** (and thus the correct answer) because the **Tetanus Toxoid (TT)** vaccine is an **inactivated (toxoid) vaccine**, not a live virus. It is not only safe but **routinely recommended** during pregnancy (usually as Tdap) to prevent neonatal tetanus and provide passive immunity to the newborn. It has no association with fetal anomalies. ### **Analysis of Incorrect Options** * **Option A:** This is a **true** statement. Rubella is a live-attenuated vaccine (MMR). It is contraindicated during pregnancy due to the theoretical risk of Congenital Rubella Syndrome. Women should be screened pre-conceptionally and advised to avoid pregnancy for 28 days after vaccination. * **Option C:** This is a **true** statement. The CDC and ACOG recommend the **inactivated influenza vaccine** for all pregnant women during any trimester of pregnancy during the flu season, as pregnancy increases the risk of severe maternal morbidity. * **Option D:** This is a **true** statement. Varicella is a live-attenuated vaccine. Since Varicella infection during pregnancy can cause Congenital Varicella Syndrome, non-immune women should be vaccinated before conception. ### **NEET-PG High-Yield Pearls** * **Live Vaccines (Contraindicated in Pregnancy):** "Rome Is My Best Vacation Place" — **R**ubella, **O**ral Polio (Sabin), **M**easles, **E**pdemic typhus, **I**nfluenza (Intranasal), **M**umps, **B**CG, **V**aricella, **P**lague/Yellow Fever. * **Safe Vaccines in Pregnancy:** Tetanus, Diphtheria, Pertussis (Tdap), Inactivated Influenza, Hepatitis B, and Rabies (post-exposure). * **Timing:** Tdap is ideally administered between **27 and 36 weeks** of gestation to maximize transplacental antibody transfer.
Question 273: Gossypol is:
- A. A new drug for fibroids
- B. A new drug for endometriosis
- C. An injectable contraception
- D. A contraceptive pill for males (Correct Answer)
Explanation: **Explanation:** **Gossypol** is a polyphenolic compound derived from the **seeds of the cotton plant** (*Gossypium herbaceum*). It is the most extensively studied non-hormonal **male oral contraceptive pill**. 1. **Why Option D is Correct:** Gossypol acts directly on the seminiferous tubules. It inhibits the enzyme **lactate dehydrogenase-X**, which is essential for the metabolism of sperm and spermatogenic cells. This results in **inhibited spermatogenesis** and reduced sperm motility (asthenozoospermia), leading to infertility without affecting testosterone levels or libido. 2. **Why Other Options are Incorrect:** * **Options A & B:** While drugs like Selective Progesterone Receptor Modulators (SPRMs) such as Ulipristal or GnRH agonists are used for fibroids and endometriosis, Gossypol has no established clinical role in treating these conditions. * **Option C:** Gossypol is administered **orally**, not as an injection. Common injectable contraceptives include DMPA (Antara) or NET-EN, which are female hormonal methods. **High-Yield Clinical Pearls for NEET-PG:** * **Side Effects:** The major clinical concern with Gossypol is **hypokalemia**, which can lead to transient muscle paralysis. * **Irreversibility:** A significant drawback is that infertility may become **permanent** (irreversible) in about 10–20% of men after prolonged use (usually >2 years). * **Efficacy:** It has an efficacy rate of over 99% in suppressing sperm counts to <4 million/mL. * **Other Male Contraceptives to remember:** RISUG (Injectable/Reversible), Centchroman (primarily female, but studied in males), and Testosterone-based hormonal injections.
Question 274: Oral contraceptive pills (OCPs) decrease the risk of which of the following cancers?
- A. Cervical cancer
- B. Endometrial cancer (Correct Answer)
- C. Vaginal cancer
- D. Liver carcinoma
Explanation: **Explanation:** Combined Oral Contraceptive Pills (OCPs) exert a significant protective effect against certain gynecological malignancies, most notably **endometrial cancer**. **Why Endometrial Cancer is the Correct Answer:** The primary mechanism is the **progestogenic effect**, which antagonizes the action of estrogen on the endometrium. Progesterone prevents endometrial hyperplasia by limiting the proliferative phase and inducing secretory changes. Long-term OCP use reduces the risk of endometrial cancer by approximately 50%, and this protective effect persists for up to 15–20 years after discontinuation. **Analysis of Incorrect Options:** * **Cervical Cancer:** OCPs are actually associated with a **slight increase** in the risk of cervical cancer, particularly with use exceeding 5 years. This may be due to biological changes in the transformation zone or behavioral factors (decreased barrier contraceptive use). * **Vaginal Cancer:** There is no established protective link between OCP use and vaginal cancer. * **Liver Carcinoma:** OCPs are associated with a rare but specific risk of **Hepatic Adenoma** (benign). While the link to Hepatocellular Carcinoma (HCC) is debated, OCPs certainly do not decrease its risk. **High-Yield Clinical Pearls for NEET-PG:** * **The "Rule of Two":** OCPs decrease the risk of **two** main cancers: **Endometrial** and **Ovarian** (specifically epithelial ovarian cancer). * **Ovarian Cancer Protection:** OCPs reduce risk by suppressing ovulation ("incessant ovulation" theory). * **Colorectal Cancer:** Emerging evidence suggests OCPs also decrease the risk of colorectal cancer. * **Breast Cancer:** OCPs are associated with a very slight, transient increase in breast cancer risk, which returns to baseline 10 years after stopping.
Question 275: Which method of contraception is not used in a patient with active syphilis?
- A. Intrauterine contraceptive device (IUCD) (Correct Answer)
- B. Oral contraceptive pills
- C. Barrier devices
- D. Calendar method
Explanation: **Explanation:** The correct answer is **A. Intrauterine contraceptive device (IUCD)**. **Why IUCD is contraindicated:** In the context of active syphilis (a Sexually Transmitted Infection), the primary concern with IUCD insertion is the risk of **Pelvic Inflammatory Disease (PID)**. Inserting an IUCD through an infected cervix or in the presence of an active STI can facilitate the ascent of pathogens into the upper genital tract, potentially leading to severe pelvic infection. According to the **WHO Medical Eligibility Criteria (MEC)**, the initiation of an IUCD is classified as **Category 4** (unacceptable health risk) for patients with current purulent cervicitis or known chlamydial/gonorrheal infection; while syphilis is a systemic infection, the presence of active genital lesions (chancres) and the high risk of co-infection with other STIs make IUCD insertion unsafe until the infection is treated and resolved. **Analysis of incorrect options:** * **B. Oral contraceptive pills:** These are hormonal methods and do not interfere with the course of syphilis or increase the risk of pelvic infection. * **C. Barrier devices:** These are actually **recommended** in patients with syphilis as they provide protection against further transmission and co-infection with other STIs (like HIV). * **D. Calendar method:** While it has a high failure rate for contraception, it does not pose a medical risk or contraindication in a patient with syphilis. **High-Yield Clinical Pearls for NEET-PG:** * **WHO MEC Category 4 for IUCD:** Active PID, current STI (cervicitis/gonorrhea/chlamydia), and unexplained vaginal bleeding. * **IUCD and HIV:** If a patient is already using an IUCD and develops an STI, the device does not necessarily need to be removed, but treatment must be started immediately. * **Syphilis Screening:** The standard screening for syphilis in pregnancy/contraception clinics is the **VDRL/RPR** test, confirmed by **TPHA/FTA-ABS**.
Question 276: Which one of the following is an adverse effect associated with combined oral contraceptives?
- A. Cerebral stroke (Correct Answer)
- B. Aggravation of asthma
- C. Peripheral neuropathy
- D. Nephrotic syndrome
Explanation: **Explanation:** The correct answer is **Cerebral stroke**. Combined Oral Contraceptive Pills (COCPs) contain both estrogen (usually Ethinyl Estradiol) and progestogen. The estrogen component increases the hepatic synthesis of clotting factors (II, VII, IX, X) and decreases antithrombin III, leading to a **hypercoagulable state**. This significantly increases the risk of thromboembolic phenomena, including deep vein thrombosis (DVT), pulmonary embolism, and arterial thrombosis leading to myocardial infarction or **ischemic cerebral stroke**. The risk is further potentiated in women who smoke, are over 35 years old, or have underlying hypertension. **Analysis of Incorrect Options:** * **B. Aggravation of asthma:** COCPs do not typically aggravate asthma. In fact, some studies suggest that hormonal stabilization may improve premenstrual asthma exacerbations in certain patients. * **C. Peripheral neuropathy:** There is no established clinical link between COCP use and peripheral neuropathy. * **D. Nephrotic syndrome:** COCPs are not a cause of nephrotic syndrome. However, they are generally avoided in patients with severe renal disease due to the associated cardiovascular risks and potential for fluid retention. **High-Yield NEET-PG Pearls:** * **Most common side effect:** Breakthrough bleeding (spotting), especially in the first few months. * **Most serious side effect:** Venous Thromboembolism (VTE). * **Protective effects:** COCPs significantly reduce the risk of **Ovarian cancer** (by 50%) and **Endometrial cancer** (by 50%). They also reduce the risk of Benign Breast Disease and Pelvic Inflammatory Disease (PID). * **WHO Category 4 (Absolute Contraindications):** Smokers >35 years (>15 cigarettes/day), history of VTE/Stroke, Migraine with aura, and Breast cancer.
Question 277: Which contraceptive is contraindicated during lactation?
- A. Combined Oral Contraceptive Pill (OCP) (Correct Answer)
- B. Intrauterine Device (IUD)
- C. Progesterone-only pill
- D. None of the above
Explanation: **Explanation:** The primary reason **Combined Oral Contraceptive Pills (COCPs)** are contraindicated during lactation (specifically within the first 6 months) is the **Estrogen** component. Estrogen suppresses the production of prolactin, leading to a significant reduction in both the quantity and quality of breast milk. Furthermore, there is a theoretical risk of estrogen being excreted in milk, potentially affecting the infant. According to WHO Medical Eligibility Criteria (MEC), COCPs are categorized as **MEC 4** (unacceptable health risk) if used <3 weeks postpartum and **MEC 3** between 3 weeks to 6 months if breastfeeding. **Analysis of Incorrect Options:** * **B. Intrauterine Device (IUD):** Both Cu-T and LNG-IUS are safe during lactation. They do not interfere with milk production. While the risk of perforation is slightly higher in lactating women due to a soft uterus, they remain a first-line postpartum contraceptive (PPIUCD). * **C. Progesterone-only pill (POP):** Also known as the "Minipill," this is the **contraceptive of choice** for lactating mothers. Progesterone does not suppress lactation; in some studies, it has been shown to slightly increase milk volume. **NEET-PG High-Yield Pearls:** * **Ideal time to start POPs:** 6 weeks postpartum (though can be started earlier as per recent guidelines). * **Lactational Amenorrhea Method (LAM):** Effective only if the mother is exclusively breastfeeding, is amenorrheic, and the baby is <6 months old. * **DMPA (Injectable):** Safe during lactation; usually administered after 6 weeks postpartum to ensure lactation is well-established. * **Centchroman (Saheli):** A non-steroidal SERM; it is safe during lactation and does not affect milk yield.
Question 278: A single tablet of levonorgestrel 0.75 mg has been taken for effective post-coital contraception. When should the second tablet be taken?
- A. 12 hours after the first tablet
- B. 24 hours after the first tablet (Correct Answer)
- C. 36 hours after the first tablet
- D. 48 hours after the first tablet
Explanation: **Explanation:** The correct answer is **B. 24 hours after the first tablet.** **Understanding the Concept:** Levonorgestrel (LNG) is a progestogen-only emergency contraceptive pill (ECP). The standard regimen for emergency contraception using 0.75 mg tablets involves a total dose of 1.5 mg. According to the **World Health Organization (WHO)** and standard clinical guidelines, if the 0.75 mg formulation is used, the two doses should be taken **24 hours apart**. While earlier protocols suggested a 12-hour interval, current evidence and updated guidelines (including those often cited in NEET-PG) emphasize the 24-hour interval for optimal efficacy and convenience. Alternatively, both tablets (1.5 mg total) can be taken as a single stat dose. **Analysis of Options:** * **Option A (12 hours):** This was the traditional Yuzpe regimen timing, but it is no longer the preferred interval for LNG-only pills as per updated guidelines. * **Options C & D (36 and 48 hours):** These intervals are too long. Delaying the second dose significantly reduces the efficacy of the hormonal surge required to inhibit or delay ovulation. **High-Yield Clinical Pearls for NEET-PG:** * **Window of Efficacy:** LNG-ECP should ideally be taken within 72 hours of unprotected intercourse, though it has some efficacy up to 120 hours. * **Mechanism of Action:** Primarily acts by **inhibiting or delaying ovulation**. It does not disrupt an established pregnancy (not an abortifacient). * **Single Dose Trend:** The most common current practice is a single dose of **1.5 mg LNG** (e.g., i-Pill or 72-H) as it improves compliance without increasing side effects. * **Most Effective EC:** The **Copper-T 380A** is the most effective emergency contraceptive if inserted within 5 days. * **Drug of Choice:** **Ulipristal acetate (30 mg)** is now considered more effective than LNG, especially between 72–120 hours.
Question 279: Which of the following is the primary clinical use of Mifepristone?
- A. Emergency contraception (Correct Answer)
- B. Hormone replacement therapy
- C. Regular contraception
- D. Prostate cancer
Explanation: ***Emergency contraception*** - Mifepristone is a **progesterone receptor antagonist** that can prevent **implantation** when used within 72 hours after unprotected intercourse. - It works by blocking **progesterone action** on the endometrium, making it less receptive to embryo implantation for emergency contraception. *Hormone replacement therapy* - Mifepristone **blocks progesterone receptors** rather than providing hormonal replacement, making it unsuitable for HRT. - HRT requires **estrogen and progestin supplementation**, not progesterone receptor antagonism. *Regular contraception* - Mifepristone is not used for **routine contraception** due to its mechanism as an **antiprogestin** rather than a regular hormonal contraceptive. - Regular contraceptives work through **consistent hormonal suppression** of ovulation, while mifepristone is used episodically. *Prostate cancer* - Mifepristone has **no role in prostate cancer treatment**, which typically involves **androgen receptor antagonists** or **GnRH agonists**. - Prostate cancer therapy targets **testosterone pathways**, not progesterone receptors that mifepristone blocks.
Question 280: What is the best contraceptive method for a 20-year-old nulliparous woman?
- A. Intrauterine contraceptive device (IUCD)
- B. Oral contraceptive pills (Correct Answer)
- C. Condoms
- D. Vaginal foam tablets
Explanation: **Explanation:** The choice of contraception in a young, nulliparous woman is guided by efficacy, reversibility, and non-contraceptive benefits. **Oral Contraceptive Pills (OCPs)** are considered the best choice for this demographic because they are highly effective, easy to use, and provide significant non-contraceptive advantages such as regulation of the menstrual cycle, reduction in dysmenorrhea, and decreased risk of iron-deficiency anemia—issues commonly faced by young women. **Analysis of Options:** * **A. IUCD:** While modern guidelines (like WHO MEC) state that IUCDs can be used in nulliparous women, they are generally not the *first* choice due to higher expulsion rates in a small, nulliparous uterus and the potential risk of Pelvic Inflammatory Disease (PID) in individuals with multiple sexual partners, which could impact future fertility. * **C. Condoms:** These have a high "typical use" failure rate (approx. 18%) compared to OCPs. While excellent for preventing STIs, they are less reliable as a primary method for pregnancy prevention. * **D. Vaginal foam tablets:** These are barrier methods with high failure rates and are rarely recommended as a primary contraceptive method. **Clinical Pearls for NEET-PG:** * **Combined OCPs (COCPs)** reduce the risk of **Ovarian and Endometrial cancers** (protective effect persists for years after discontinuation). * **Contraindications for COCPs:** History of DVT/Thromboembolism, Migraine with aura, Smokers >35 years, and Active Liver disease. * **Drug Interactions:** Rifampicin and Antiepileptics (Phenytoin, Carbamazepine) decrease the efficacy of OCPs by inducing hepatic enzymes. * **Ideal Contraceptive for a Lactating Mother:** Progestogen-only pills (POPs) or Centchroman (Saheli).
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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