Contraception and Family Planning Practice Questions

Q: Which of the following is NOT a non-contraceptive advantage of oral contraceptive pills?

Reduced risk of hepatic adenoma. **Explanation:** Combined Oral Contraceptive Pills (COCPs) offer several health benefits beyond pregnancy prevention. However, **Hepatic Adenoma** is a known, albeit rare, **complication** of long-term COCP use, not a benefit. Estrogen in the pills can stimulate the growth of these benign liver tumors, which carry a risk of rupture and intraperitoneal hemorrhage. **Analysis of Options:** * **A. Reduced risk of Pelvic Inflammatory Disease (PID):** COCPs increase the viscosity of cervical mucus, creating a barrier that prevents the upward migration of pathogenic bacteria into the upper genital tract. * **C. Reduced risk of Benign Breast Disease:** COCPs are protective against fibroadenomas and fibrocystic breast disease (though they do not significantly reduce the risk of breast cancer). * **D. Reduced risk of Anemia:** By inhibiting ovulation and thinning the endometrial lining, COCPs reduce the volume and duration of menstrual bleeding (menorrhagia), thereby preventing iron-deficiency anemia. **High-Yield Clinical Pearls for NEET-PG:** * **Cancer Protection:** COCPs significantly reduce the risk of **Ovarian cancer** (by 50%) and **Endometrial cancer** (by 50%). This protection persists for 15–20 years after discontinuation. They also reduce the risk of **Colorectal cancer**. * **Cancer Risks:** COCPs are associated with a slight increase in the risk of **Cervical cancer** (especially with >5 years of use) and **Breast cancer**. * **Other Benefits:** Reduced risk of ectopic pregnancy, functional ovarian cysts, and improvement in acne and dysmenorrhea.

Q: Combined OCPs can be used in all conditions except which of the following?

Breast cancer. **Explanation:** The correct answer is **Breast cancer**. Combined Oral Contraceptive Pills (COCPs) are contraindicated in breast cancer because it is a **hormone-sensitive malignancy**. Estrogen and progesterone can stimulate the proliferation of breast cancer cells, potentially worsening the prognosis or causing recurrence. According to the WHO Medical Eligibility Criteria (MEC), current breast cancer is classified as **Category 4** (unacceptable health risk). **Analysis of Options:** * **Fibroadenoma:** This is a benign breast condition. COCPs are not contraindicated and, in some cases, may even reduce the risk of benign breast disease. * **Ectopic Pregnancy:** COCPs are highly effective at preventing pregnancy. By preventing ovulation, they significantly reduce the absolute risk of both intrauterine and ectopic pregnancies. A history of ectopic pregnancy is not a contraindication. * **Iron Deficiency Anemia:** COCPs are actually **beneficial** here. They reduce menstrual blood loss (menorrhagia) and induce withdrawal bleeds that are lighter and shorter, thereby helping to improve hemoglobin levels. **High-Yield Clinical Pearls for NEET-PG:** * **WHO MEC Category 4 (Absolute Contraindications):** Undiagnosed vaginal bleeding, smokers >35 years (>15 cigarettes/day), history of DVT/PE, ischemic heart disease, stroke, complicated valvular heart disease, and active liver disease (cirrhosis/tumors). * **Cancer Risks:** COCPs **increase** the risk of breast and cervical cancer but are **protective** against ovarian, endometrial, and colorectal cancers. * **Non-contraceptive benefits:** Reduced risk of PID, ectopic pregnancy, and functional ovarian cysts.

Q: An intrauterine pregnancy of approximately 10 weeks gestation is confirmed in a 30-year-old gravida 5, para 4 woman with an IUD in place. The patient expresses a strong desire for the pregnancy to be continued. On examination, the string of the IUD is noted to be protruding from the cervical os. What is the most appropriate course of action?

Remove the IUD immediately. **Explanation:** The management of a pregnancy with an Intrauterine Device (IUD) in situ depends on the visibility of the strings and the gestational age. **1. Why Option C is Correct:** When a woman becomes pregnant with an IUD and the **strings are visible**, the most appropriate action is to **remove the IUD immediately** (ideally before 12 weeks). Leaving the IUD in place significantly increases the risk of: * **Spontaneous Abortion:** Risk increases by up to 50%. * **Septic Abortion:** A life-threatening infection. * **Preterm Labor and Delivery:** Risk increases fourfold. Removal of the IUD reduces these risks, although the risk of miscarriage remains slightly higher than in a normal pregnancy. **2. Why Incorrect Options are Wrong:** * **Options A & B:** Leaving the IUD in place (with or without antibiotics) exposes the patient to a high risk of chorioamnionitis and septic abortion. Prophylactic antibiotics do not mitigate the mechanical and infectious risks posed by the foreign body. * **Option D:** Pregnancy termination is not mandatory. If the patient desires to continue the pregnancy, removal of the IUD is the standard of care. The risk of congenital malformations is not increased by the presence of an IUD. **High-Yield Clinical Pearls for NEET-PG:** * **Strings NOT visible:** If strings are not seen, perform an ultrasound. If the IUD is intrauterine, it should be **left alone** to avoid disrupting the pregnancy. * **Ectopic Risk:** While IUDs are highly effective, if a pregnancy *does* occur, the **probability** of it being an ectopic pregnancy is higher (approx. 1 in 20) compared to the general population. * **Teratogenicity:** There is no evidence that IUDs cause birth defects. * **Actinomyces:** If *Actinomyces* is found on a PAP smear in an asymptomatic IUD user, the IUD does **not** need to be removed.

Q: At the Primary Health Centre (PHC) level, a woman who complains of spotting following Intrauterine Contraceptive Device (IUCD) insertion should be advised:

Iron supplements and observation. **Explanation:** The most common side effect of Intrauterine Contraceptive Devices (IUCDs) like Cu-T 380A is **increased menstrual blood loss and intermenstrual spotting**. This typically occurs during the first 3–6 months following insertion as the endometrium adjusts to the foreign body. **Why Iron Supplements and Observation?** At the PHC level, the primary goal is to manage side effects without discontinuing a highly effective method of contraception. Since chronic spotting or heavy bleeding can lead to a depletion of iron stores and subsequent anemia, the standard protocol is to provide **Iron and Folic Acid (IFA) supplements**. Reassurance and observation are key, as spotting usually subsides spontaneously after a few cycles. **Analysis of Incorrect Options:** * **Analgesics (A):** While NSAIDs (like Mefenamic acid) are effective for managing IUCD-induced *cramping* or heavy bleeding by reducing prostaglandin levels, they are not the primary management for isolated spotting at the PHC level. * **Antibiotics (B):** Spotting is a mechanical/hormonal side effect, not an infectious one. Antibiotics are only indicated if there are signs of Pelvic Inflammatory Disease (PID). * **Removal of IUCD (D):** This is a last resort. Removal is only indicated if the bleeding is persistent, severe, or if the patient is unwilling to continue despite counseling. **NEET-PG High-Yield Pearls:** * **Most common side effect of IUCD:** Bleeding (spotting or menorrhagia). * **Most common reason for removal:** Bleeding and pain. * **Ideal time for insertion:** Within 10 days of the start of the menstrual cycle (to ensure the patient is not pregnant). * **Mechanism of Cu-T:** Primarily spermicidal; causes a sterile inflammatory response in the endometrium.

Q: Which contraceptive method is contraindicated in an HIV-positive patient?

Intrauterine contraceptive device (IUCD). ### Explanation The correct answer is **A. Intrauterine contraceptive device (IUCD)**. **Why IUCD is the correct answer:** In the context of HIV and contraception, the primary concern is the risk of **Pelvic Inflammatory Disease (PID)** and the potential for increased menstrual bleeding. While the WHO Medical Eligibility Criteria (MEC) generally allows IUCD use in stable HIV patients (Category 2), it is strictly **contraindicated (MEC Category 4)** for **initiation** in patients with **AIDS who are not on antiretroviral therapy (ART)** or those who are clinically unwell. The risk of secondary infections and the potential for increased viral shedding in vaginal secretions due to IUCD-induced menorrhagia make it the least preferred option among the choices provided in a standard examination context. **Analysis of Incorrect Options:** * **B. Combined Oral Contraceptive Pills (COCPs):** These are safe (MEC Category 1) but require caution due to drug interactions. Certain Protease Inhibitors can decrease the efficacy of COCPs by inducing liver enzymes. * **C. Minipill (Progestogen-only pill):** These are safe and do not carry the thromboembolic risks associated with estrogen, making them a viable option for HIV patients. * **D. Barrier Methods:** Condoms are the **method of choice** for HIV-positive patients. They provide "dual protection" by preventing both pregnancy and the transmission of HIV/STIs to partners. **High-Yield Clinical Pearls for NEET-PG:** * **Dual Protection:** Always counsel HIV patients to use a barrier method (condoms) in addition to another highly effective contraceptive. * **WHO MEC Category 4 for IUCD:** Includes current PID, purulent cervicitis, and initiation in patients with advanced HIV/AIDS (CD4 <200 cells/mm³). * **Drug Interaction:** Ritonavir (a Protease Inhibitor) is a potent enzyme inducer that significantly reduces the levels of ethinyl estradiol in COCPs.

Q: Use of oral contraceptive pills decreases which of the following?

Glucose tolerance. Combined Oral Contraceptive Pills (COCPs) exert systemic metabolic effects due to their estrogen and progestogen components. **Why Glucose Tolerance Decreases (Correct Answer):** COCPs, particularly the progestogen component, induce a state of **insulin resistance**. Progestogens decrease the number of insulin receptors and impair peripheral glucose uptake. Estrogen can also interfere with glucose metabolism by affecting cortisol levels. This results in a "diabetogenic" effect, leading to **decreased glucose tolerance**. While clinically insignificant in healthy women, it is a critical consideration for those with pre-diabetes or gestational diabetes history. **Analysis of Incorrect Options:** * **B. Binding Globulins:** Estrogen stimulates the liver to **increase** the synthesis of transport proteins. COCPs increase Sex Hormone-Binding Globulin (SHBG), Thyroid-Binding Globulin (TBG), and Cortisol-Binding Globulin (CBG). * **C. High-density lipoprotein (HDL):** Estrogen generally **increases** HDL (the "good" cholesterol) and decreases LDL. While some older progestogens could oppose this, modern low-dose formulations typically result in a net increase or neutral effect on HDL. * **D. Triglycerides:** Estrogen **increases** the hepatic synthesis of triglycerides. Therefore, COCPs are contraindicated in patients with severe hypertriglyceridemia due to the risk of pancreatitis. **High-Yield Clinical Pearls for NEET-PG:** * **Protective Effects:** COCPs **decrease** the risk of Ovarian cancer, Endometrial cancer, and Benign Breast Disease. * **Increased Risks:** COCPs **increase** the risk of Cervical cancer (with long-term use), Breast cancer (slight), and Hepatic Adenoma. * **Coagulation:** COCPs increase Factors VII, X, and Fibrinogen, leading to a hypercoagulable state (increased VTE risk). * **Blood Pressure:** They may cause a slight increase in BP due to the stimulation of the Renin-Angiotensin-Aldosterone System (RAAS).

Q: Prostaglandins can be used for medical termination of pregnancy by all routes except?

Intravenous. **Explanation:** The correct answer is **Intravenous (A)**. **Medical Rationale:** Prostaglandins (PGs) are potent stimulators of uterine smooth muscle. While they are highly effective for medical termination of pregnancy (MTP), the **intravenous route** is avoided because it leads to a rapid, systemic surge of the drug. This causes severe, intolerable side effects due to the contraction of smooth muscles in other organ systems, leading to intense nausea, vomiting, explosive diarrhea, bronchospasm, and significant hypertension or pyrexia. Consequently, the IV route has no clinical place in modern obstetric practice for MTP. **Analysis of Other Options:** * **Intramuscular (B):** 15-methyl PGF2α (Carboprost) is frequently administered intramuscularly. It is highly effective for mid-trimester abortions and the management of postpartum hemorrhage (PPH). * **Extra-amniotic (C):** PGF2α or PGE2 can be instilled into the space between the uterine wall and the fetal membranes via a catheter. This allows for a high local concentration with slower systemic absorption, reducing side effects. * **Intra-amniotic (D):** Injection of PGs (usually PGF2α) into the amniotic sac is a classic method for second-trimester induction. It ensures a sustained local effect on the myometrium. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** For first-trimester medical abortion, the combination of **Mifepristone (Oral)** and **Misoprostol (Vaginal/Sublingual/Buccal)** is the gold standard. * **Misoprostol (PGE1):** Unique because it is stable at room temperature and can be administered via oral, vaginal, sublingual, or rectal routes. * **Side Effect Profile:** The most common side effect of prostaglandins is GI upset (diarrhea), while the most specific contraindication for PGF2α (Carboprost) is **Asthma** (due to bronchoconstriction).

Q: What is the primary mechanism of action of the progestogen-only pill?

Increases cervical mucus viscosity. **Explanation:** The **Progestogen-Only Pill (POP)**, also known as the "mini-pill," primarily functions by altering the female reproductive tract environment rather than consistently suppressing the hypothalamic-pituitary-ovarian axis. **1. Why Option A is Correct:** The primary and most consistent mechanism of action of POPs is **increasing the viscosity and thickness of cervical mucus**. Under the influence of continuous low-dose progestogen, the mucus becomes scanty, thick, and cellular. This creates a "hostile" environment that acts as a physical barrier, preventing sperm penetration into the upper reproductive tract. **2. Why Other Options are Incorrect:** * **Option B (Inhibits ovulation):** While POPs can suppress ovulation in some cycles (approximately 40–60% of the time), it is **not** the primary or reliable mechanism. In contrast, the Combined Oral Contraceptive Pill (COCP) primarily works by inhibiting ovulation via FSH and LH suppression. * **Option C (Antispermicidal effects):** POPs do not contain spermicidal agents. They hinder sperm transport through mechanical (mucus) and functional (endometrial/tubal) changes rather than direct chemical destruction of sperm. **3. High-Yield Clinical Pearls for NEET-PG:** * **Secondary Mechanisms:** POPs also cause endometrial thinning (making it unfavorable for implantation) and alter fallopian tube motility. * **The "3-Hour Rule":** Traditional POPs have a very short half-life; if a dose is delayed by more than **3 hours**, contraceptive efficacy is significantly reduced. * **Ideal Candidates:** POPs are the contraceptive of choice for **lactating mothers** (as they do not affect milk quantity/quality) and women in whom estrogen is contraindicated (e.g., history of VTE, smokers >35 years, or migraine with aura). * **Side Effects:** The most common side effect is **irregular menstrual bleeding** or spotting.

Q: Which of the following is an absolute contraindication for combined oral contraceptive pills, EXCEPT?

Women aged greater than 35 years. This question tests your knowledge of the **WHO Medical Eligibility Criteria (MEC)** for contraceptive use. Combined Oral Contraceptive Pills (COCPs) contain estrogen, which increases the risk of thromboembolism and cardiovascular events. ### **Explanation of the Correct Answer** **Option B (Women aged >35 years)** is the correct answer because age alone is **not** an absolute contraindication. According to WHO MEC, age >35 in a non-smoker is categorized as **MEC 2** (Advantages generally outweigh risks). Therefore, a healthy, non-smoking 38-year-old woman can safely use COCPs. ### **Analysis of Incorrect Options (Absolute Contraindications)** * **A. Smoking women >35 years:** This is **MEC 4** (Absolute contraindication). The synergistic effect of age, smoking, and estrogen significantly spikes the risk of myocardial infarction and stroke. (Note: Smoking <15 cigarettes/day is MEC 3; ≥15 cigarettes/day is MEC 4). * **C. Lactation:** Estrogen suppresses prolactin and reduces milk quantity/quality. In the first **6 weeks postpartum**, it is **MEC 4** due to the high risk of VTE and lactation interference. * **D. Breast Cancer:** Current breast cancer is **MEC 4** because it is a hormone-sensitive tumor; estrogen may promote tumor growth. ### **High-Yield Clinical Pearls for NEET-PG** * **MEC 4 (Never Use):** Undiagnosed vaginal bleeding, history of DVT/PE, Migraine with aura, Ischemic heart disease, Liver cirrhosis/adenoma, and uncontrolled Hypertension (>160/100). * **MEC 3 (Exercise Caution):** Well-controlled hypertension, Migraine without aura (in women >35), and concurrent use of anticonvulsants (enzyme inducers). * **Drug of Choice:** For lactating mothers, the Progesterone Only Pill (POP) or Centchroman (Saheli) is preferred.

Question 1

Which of the following is NOT a non-contraceptive advantage of oral contraceptive pills?

Accepted Answer

Reduced risk of hepatic adenoma

Answer

Reduced risk of pelvic inflammatory disease

Answer

Reduced risk of benign breast disease

Answer

Reduced risk of anemia

Question 2

Combined OCPs can be used in all conditions except which of the following?

Accepted Answer

Breast cancer

Answer

Fibroadenoma

Answer

Ectopic pregnancy

Answer

Iron deficiency anemia

Question 3

An intrauterine pregnancy of approximately 10 weeks gestation is confirmed in a 30-year-old gravida 5, para 4 woman with an IUD in place. The patient expresses a strong desire for the pregnancy to be continued. On examination, the string of the IUD is noted to be protruding from the cervical os. What is the most appropriate course of action?

Accepted Answer

Remove the IUD immediately

Answer

Leave the IUD in place without any other treatment

Answer

Leave the IUD in place and continue prophylactic antibiotics throughout pregnancy

Answer

Terminate the pregnancy because of the high risk of infection

Question 4

At the Primary Health Centre (PHC) level, a woman who complains of spotting following Intrauterine Contraceptive Device (IUCD) insertion should be advised:

Accepted Answer

Iron supplements and observation

Answer

Analgesics and observation

Answer

Antibiotics and observation

Answer

Removal of IUCD

Question 5

Which contraceptive method is contraindicated in an HIV-positive patient?

Accepted Answer

Intrauterine contraceptive device (IUCD)

Answer

Combined oral contraceptive pills (COC pills)

Answer

Minipill

Answer

Barrier methods

Question 6

Use of oral contraceptive pills decreases which of the following?

Accepted Answer

Glucose tolerance

Answer

Binding globulins

Answer

High-density lipoprotein (HDL) cholesterol

Answer

Triglycerides

Question 7

Prostaglandins can be used for medical termination of pregnancy by all routes except?

Accepted Answer

Intravenous

Answer

Intramuscular

Answer

Extra-amniotic

Answer

Intra-amniotic

Question 8

What is the primary mechanism of action of the progestogen-only pill?

Accepted Answer

Increases cervical mucus viscosity

Answer

Inhibits ovulation

Answer

Has antispermicidal effects

Answer

None of the above

Question 9

A patient with poorly compensated cardiac disease, who has delivered 2 days ago, should be advised to:

Accepted Answer

Suggest her husband undergo vasectomy

Answer

Undergo sterilization (tubectomy) after 1 week

Answer

Undergo sterilization after 6 weeks

Answer

Take oral contraceptive pills after 6 months

Question 10

Which of the following is an absolute contraindication for combined oral contraceptive pills, EXCEPT?

Accepted Answer

Women aged greater than 35 years

Answer

Smoking women over 35 years of age

Answer

Lactation

Answer

Breast cancer

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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