Contraception and Family Planning Practice Questions

Q: The IUCD Copper T 200 is named "Copper 200" because it:

Has 200 sq mm of surface area covered with copper. **Explanation:** The nomenclature of Intrauterine Contraceptive Devices (IUCDs) like the Copper T 200 is based on the **surface area of the copper wire** wrapped around the stem. In "Copper T 200," the number **200** represents **200 square millimeters (sq mm)** of copper surface area. This surface area is critical because the contraceptive efficacy of an IUCD is directly proportional to the amount of copper exposed to the uterine environment. Copper ions act as a spermicide by causing a local inflammatory response and altering the uterine milieu. **Analysis of Options:** * **Option A (200 mg):** While the device contains a specific weight of copper, the naming convention is strictly based on surface area, not mass. * **Option B (Correct):** This is the standard medical definition for the numbering of IUCDs. * **Option C (200 turns):** The number of turns is a manufacturing detail and does not define the clinical name. * **Option D (200 days):** The Copper T 200 is a long-acting reversible contraceptive (LARC) with an effective lifespan of **3 years**, far exceeding 200 days. **High-Yield Clinical Pearls for NEET-PG:** * **CuT 200:** Effective for **3 years**. * **CuT 380A:** The current "Gold Standard" in India; effective for **10 years**. (380 sq mm surface area). * **Multiload 375:** Effective for **5 years**. * **Mechanism:** Primarily prevents fertilization by reducing sperm motility and viability (spermicidal). * **Ideal Insertion Time:** Within 10 days of the start of menstruation (to ensure the patient is not pregnant and the cervix is slightly dilated). * **Most Common Side Effect:** Excessive menstrual bleeding (menorrhagia). * **Most Common Reason for Removal:** Pain and bleeding.

Q: A 30-year-old woman is on warfarin for deep vein thrombosis. Which contraceptive should be advised to her?

Intrauterine contraceptive device (IUCD). **Explanation:** The primary concern for a patient on **Warfarin** for Deep Vein Thrombosis (DVT) is the high risk of recurrent thromboembolism. In such cases, the selection of contraception is guided by the **WHO Medical Eligibility Criteria (MEC)**. **1. Why IUCD is the Correct Choice:** The **Intrauterine Contraceptive Device (IUCD)**, specifically the Copper-T (Cu-T), is categorized as **WHO MEC 1** (no restriction) for women with a history of DVT or those on anticoagulant therapy. It is a non-hormonal method that does not increase the risk of thrombosis. While anticoagulants can increase menstrual bleeding, the Cu-T remains the safest long-term option. Note: The Levonorgestrel-IUS (Mirena) is also an excellent choice as it reduces the heavy menstrual bleeding often caused by Warfarin. **2. Why Other Options are Incorrect:** * **Progesterone-only pills (POPs), Levonorgestrel implants, and Implanon:** These are generally categorized as **WHO MEC 2** for patients with current DVT or those on anticoagulants. While they do not contain estrogen (the primary culprit in thrombosis), they are considered secondary to IUCDs in this specific clinical scenario. * **Combined Oral Contraceptive Pills (COCPs):** (Though not an option here) These are strictly **Contraindicated (WHO MEC 4)** because estrogen increases clotting factors and the risk of recurrent DVT. **Clinical Pearls for NEET-PG:** * **Gold Standard:** For any patient with a history of thromboembolism, **Non-hormonal methods (Cu-T)** or **Progestogen-only methods** are preferred. * **MEC 4 (Absolute Contraindication) for COCPs:** History of DVT/PE, Migraine with aura, Smoking >15 cigarettes/day in women >35 years, and Breast Cancer. * **Warfarin & Pregnancy:** Warfarin is **teratogenic** (causes fetal warfarin syndrome/chondrodysplasia punctata); hence, highly effective contraception like an IUCD is mandatory.

Q: All of the following are used for contraception in patients with sickle cell anemia except?

Oral contraceptive pills. **Explanation:** The primary concern in managing contraception for patients with **Sickle Cell Anemia (SCA)** is the risk of triggering a vaso-occlusive crisis or thromboembolic events. **1. Why Oral Contraceptive Pills (OCPs) are the Correct Answer:** Combined Oral Contraceptive Pills contain **Estrogen**, which is known to increase the synthesis of clotting factors and enhance platelet aggregation. In patients with SCA, who are already at a baseline hypercoagulable state and prone to vascular stasis, the addition of estrogen significantly increases the risk of **thromboembolism and stroke**. Therefore, estrogen-containing methods are generally avoided (WHO MEC Category 4 or 3 depending on severity). **2. Analysis of Other Options:** * **IUCD (Option B):** Copper IUCDs are safe as they are non-hormonal. However, Levonorgestrel-IUS (Mirena) is often preferred as it reduces menstrual blood loss, helping with the anemia common in SCA. * **Progestin-only Pills (Option C) & Progesterone Implants (Option D):** Progesterone-only methods do not carry the same thromboembolic risks as estrogen. In fact, **Depot Medroxyprogesterone Acetate (DMPA)** is often considered a "gold standard" for SCA because it has been shown to stabilize red cell membranes and reduce the frequency of painful crises. **Clinical Pearls for NEET-PG:** * **Best Choice:** DMPA (Injectable) is highly recommended for SCA as it reduces sickling and crises. * **Avoid:** Any combined hormonal contraceptive (Pills, Patch, Ring) due to the estrogen component. * **WHO MEC:** For Sickle Cell Disease, Combined Hormonal Contraceptives are Category 4 (Unacceptable health risk).

Q: Which of the following is NOT a complication of oral contraceptive pills?

Weight loss. **Explanation:** The correct answer is **Weight loss**. Combined Oral Contraceptive Pills (COCPs) are more commonly associated with **weight gain** rather than weight loss. This occurs due to the anabolic effects of progestogens and estrogen-induced sodium and water retention. **Why the other options are complications:** * **Hyperlipidemia:** Estrogen increases the synthesis of hepatic triglycerides and VLDL. While it may raise HDL (the "good" cholesterol), the overall effect on the lipid profile can be significant, especially in women with pre-existing dyslipidemia. * **Hypertension:** COCPs stimulate the hepatic production of angiotensinogen (renin substrate) via the mineralocorticoid effect of estrogen, leading to the activation of the Renin-Angiotensin-Aldosterone System (RAAS). This can cause a mild to moderate rise in blood pressure in susceptible individuals. * **Depression:** Progestogens in the pills can influence neurotransmitters like serotonin. Mood swings and depressive symptoms are documented side effects that often lead to the discontinuation of the pill. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect:** Breakthrough bleeding (spotting), especially in the first few months of use. * **Most serious side effect:** Venous Thromboembolism (VTE) and increased risk of stroke/MI (especially in smokers >35 years). * **Protective effects:** COCPs significantly reduce the risk of **Ovarian cancer** and **Endometrial cancer** (protection lasts for years after discontinuation). * **Absolute Contraindications:** Undiagnosed vaginal bleeding, history of thromboembolism, estrogen-dependent tumors (Breast CA), and active liver disease.

Q: Which method of sterilization is least suited for recanalisation?

Bipolar cauterization. **Explanation:** The success of tubal recanalization (reversal of sterilization) depends primarily on the **length of the healthy fallopian tube remaining** and the **degree of tissue destruction** caused during the initial procedure. **Why Bipolar Cauterization is the correct answer:** Bipolar cauterization involves passing an electric current through a segment of the fallopian tube. This causes extensive **thermal damage** and lateral heat spread, leading to significant necrosis and scarring of the tubal tissue. Typically, 2–3 cm of the tube is destroyed. Because the damage is widespread and the blood supply is often compromised, there is insufficient healthy tissue left for a successful end-to-end anastomosis, making it the least suited for recanalization. **Analysis of Incorrect Options:** * **Clips (e.g., Hulka-Clemens, Filshie):** These cause the **least amount of damage** (approx. 4 mm of the tube). They have the highest success rates for recanalization. * **Fallopian Rings (Silastic bands):** These cause intermediate damage (approx. 2 cm) by causing ischemic necrosis of a small loop. Recanalization success is better than cauterization but lower than clips. * **Pomeroy’s Technique:** This is a surgical method involving ligation and excision of a mid-segment loop. While it removes a segment of the tube, the remaining ends are usually healthy and not thermally damaged, allowing for relatively successful surgical reversal. **High-Yield Clinical Pearls for NEET-PG:** * **Best method for recanalization:** Clips (Minimal tissue destruction). * **Most common method used in India:** Minilap with Pomeroy’s technique. * **Most common method used globally (Laparoscopic):** Falope rings. * **Ideal length of tube for successful reversal:** At least 4 cm of healthy tube must remain. * **Site of reversal:** The **isthmus-isthmus** anastomosis yields the highest pregnancy rates.

Question 1

The IUCD Copper T 200 is named "Copper 200" because it:

Accepted Answer

Has 200 sq mm of surface area covered with copper

Answer

Contains 200 mg of copper

Answer

Has 200 copper turns

Answer

Can be retained for 200 days

Question 2

The progestogenic emergency contraceptive pills act by:

Accepted Answer

Anti-implantation effect

Answer

Altered cervical secretion

Answer

Inhibition of ovulation

Answer

Inhibition of LH secretion

Question 3

A 25-year-old woman with an IUD inserted 2 years ago presents with fever. On examination, actinomyces is positive in cervical cytology. What would you advise regarding the IUD?

Accepted Answer

Remove the IUD and give intensive antibiotic therapy.

Answer

Continue some contraception; no need for treatment.

Answer

Hysterectomy

Answer

Leave the IUD in place and start an antibiotic course.

Question 4

A 30-year-old woman is on warfarin for deep vein thrombosis. Which contraceptive should be advised to her?

Accepted Answer

Intrauterine contraceptive device (IUCD)

Answer

Progesterone-only pills

Answer

Levonorgestrel implant

Answer

Implanon

Question 5

Which of the following best describes conventional contraceptives?

Accepted Answer

Contraceptives that require action at the time of intercourse

Answer

Contraceptives discovered before 1960

Answer

Contraceptives that require action after intercourse

Answer

Contraceptives that require action before intercourse

Question 6

All of the following are mechanisms of action of intrauterine contraceptive devices (IUCD) except:

Accepted Answer

Production of anti-sperm antibodies

Answer

Impeding sperm transport and inhibiting their capacitation

Answer

Foreign body reaction in the endometrium

Answer

Inhibition of ovulation

Question 7

All of the following are used for contraception in patients with sickle cell anemia except?

Accepted Answer

Oral contraceptive pills

Answer

Intrauterine contraceptive device (IUCD)

Answer

Progestin-only pills

Answer

Progesterone implants

Question 8

Which of the following is NOT a complication of oral contraceptive pills?

Accepted Answer

Weight loss

Answer

Hyperlipidemia

Answer

Hypertension

Answer

Depression

Question 9

A 26-year-old female on a progestin-only pill contraceptive attends the gynecology OPD concerned about not taking her pill at the same time every day. She took her pill daily at 10 a.m. except for one day when she took it at 5 p.m. What is your advice?

Accepted Answer

Use an additional form of contraceptive for the next 48 hours.

Answer

No need to worry, continue the same contraceptive.

Answer

Change over to combined oral contraceptive pills.

Answer

Take a double dose of the pill the next morning.

Question 10

Which method of sterilization is least suited for recanalisation?

Accepted Answer

Bipolar cauterization

Answer

Clips

Answer

Fallopian rings

Answer

Pomeroys technique

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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