Contraception and Family Planning Practice Questions

Q: What is the advantage of laparoscopic sterilization over mini-laparotomy sterilization?

Very small scar. **Explanation:** Female sterilization can be performed via **Laparoscopy** or **Mini-laparotomy** (the most common method used in postpartum sterilization, e.g., Pomeroy’s technique). The primary advantage of laparoscopic sterilization is its **superior cosmetic outcome**. It requires only one or two tiny incisions (usually 0.5–1 cm), resulting in a **very small scar** compared to the 2–5 cm incision required for a mini-laparotomy. Additionally, laparoscopy offers a faster recovery time and shorter hospital stay. **Analysis of Options:** * **A. Lower failure rate:** Incorrect. Both methods have similar long-term efficacy. The failure rate for tubal sterilization is approximately 0.5 per 100 women (1 in 200). * **B. Less blood loss:** Incorrect. While laparoscopy is minimally invasive, the blood loss in a standard mini-laparotomy is already negligible (usually <10-20 ml). Therefore, this is not a significant clinical advantage. * **D. Easier procedure:** Incorrect. Laparoscopy is technically more demanding. It requires specialized equipment (insufflators, laparoscope), general anesthesia, and specific surgical training. Mini-laparotomy is simpler, cheaper, and can be performed under local anesthesia or sedation. **High-Yield Pearls for NEET-PG:** * **Ideal Time:** Laparoscopic sterilization is the method of choice for **interval sterilization** (non-pregnant state). * **Contraindication:** Laparoscopy is generally avoided in the immediate postpartum period due to the enlarged, friable uterus and increased risk of injury; **Mini-laparotomy** is preferred then. * **Most Common Site of Occlusion:** The **Isthmus** of the fallopian tube. * **Failure:** If pregnancy occurs after sterilization, there is a high risk of it being an **Ectopic Pregnancy**.

Q: A couple had unprotected intercourse and they are worried about pregnancy. What is the progesterone of choice for emergency contraception?

Levonorgestrel. **Explanation:** **Levonorgestrel (LNG)** is the gold standard progesterone for emergency contraception (EC). The primary mechanism of action is the **inhibition or delay of ovulation** by suppressing the Luteinizing Hormone (LH) surge. It is most effective when taken as soon as possible, ideally within 72 hours of unprotected intercourse, though it may be used up to 120 hours. **Why Levonorgestrel is correct:** * It is the most widely studied and recommended progestogen-only EC pill (POEC). * The standard dose is a single **1.5 mg tablet** (or two 0.75 mg doses 12 hours apart). * It has a superior safety profile and higher efficacy compared to older methods like the Yuzpe regimen. **Analysis of Incorrect Options:** * **A. Norethisterone:** Primarily used for menstrual cycle regulation, dysfunctional uterine bleeding, and endometriosis. It is not used for emergency contraception. * **B. Medroxyprogesterone acetate (DMPA):** Used as an injectable contraceptive (Depo-Provera) for long-term protection (3 months), not for post-coital emergency use. * **D. Desogestrel:** A third-generation progestogen used in daily Combined Oral Contraceptive Pills (COCPs) or Progestogen-Only Pills (POPs), but not as a dedicated emergency contraceptive. **High-Yield Clinical Pearls for NEET-PG:** * **Window of Efficacy:** LNG is effective up to 72–120 hours, but **Ulipristal acetate** (a selective progesterone receptor modulator) is more effective between 72–120 hours. * **Most Effective EC:** The **Copper-T (IUCD)** is the most effective method of emergency contraception if inserted within 5 days. * **Failure Rate:** LNG-EC has a failure rate of approximately 1–3%. It does not work if implantation has already occurred and is not an abortifacient. * **Vomiting:** If the patient vomits within 2 hours of taking the LNG pill, the dose must be repeated.

Q: What is the most common side effect of Intrauterine Devices (IUDs)?

Increased vaginal bleeding. **Explanation:** The most common side effect of non-hormonal Intrauterine Devices (IUDs), such as Cu-T 380A, is **increased vaginal bleeding** (menorrhagia or polymenorrhea). This occurs due to a local inflammatory response in the endometrium, which increases vascularity and capillary permeability, often accompanied by an increase in local fibrinolytic activity. **Analysis of Options:** * **B. Increased vaginal bleeding (Correct):** This is the leading cause of IUD discontinuation. It typically manifests as heavier or prolonged menstrual periods, especially during the first 3–6 months of use. * **A. Abdominal pain:** This is the **second** most common side effect. It usually presents as colicky pain or dysmenorrhea due to uterine contractions attempting to expel the foreign body. * **C. Abortion:** While an IUD increases the risk of spontaneous abortion if pregnancy occurs *with* the device in situ, it is a complication of failure, not a common side effect of the device itself. * **D. Pelvic inflammation:** Pelvic Inflammatory Disease (PID) is a serious complication but is relatively rare. The risk is highest only during the first 20 days post-insertion, usually due to pre-existing asymptomatic infections (e.g., Chlamydia). **High-Yield NEET-PG Pearls:** * **Most common side effect:** Bleeding. * **Second most common side effect:** Pain. * **Most common cause for removal:** Bleeding. * **Most common complication:** Expulsion (most likely in the first year, especially during the first three months). * **Ectopic Pregnancy:** IUDs provide high protection against all pregnancies; however, if a woman *does* get pregnant with an IUD in situ, the **likelihood** of that pregnancy being ectopic is higher compared to a non-user. * **Mirena (LNG-IUS):** Unlike Copper-T, the most common side effect of the hormonal IUD is **amenorrhea** or spotting, making it a treatment for menorrhagia.

Q: Congenital vaginal foam tablet contains ______

Nonoxynol 9. **Explanation:** **Nonoxynol-9 (N-9)** is the primary active ingredient in most spermicidal preparations, including the **Congenital vaginal foam tablet**. It is a non-ionic surfactant that acts by disrupting the integrity of the sperm cell membrane (acrosome and midpiece), leading to loss of motility and eventual cell death. It also provides a mechanical barrier when it foams, preventing sperm from entering the cervical canal. **Analysis of Options:** * **Option A (Correct):** Nonoxynol-9 is the most widely used spermicide globally. In India, it is the active component of the "Congenital" brand of foam tablets. * **Option B (Incorrect):** **Octoxynol-8** (and Octoxynol-9) are also surfactants used as spermicides (e.g., in Ortho-Gynol), but they are not the constituents of the specific brand mentioned in the question. * **Option C (Incorrect):** **Menfegol** is a foaming agent and spermicide used in some vaginal tablets (popular in Japan and parts of Europe), but it is not the ingredient in Congenital tablets. **High-Yield Clinical Pearls for NEET-PG:** 1. **Failure Rate:** Spermicides have a high typical-use failure rate (approx. 18–28%), making them less effective than hormonal or intrauterine methods. 2. **HIV/STI Risk:** Contrary to earlier beliefs, N-9 does **not** protect against HIV/STIs. Frequent use can cause vaginal irritation and micro-abrasions, which may actually **increase** the risk of HIV transmission. 3. **Application:** Foam tablets must be inserted high into the vagina at least **10–15 minutes before intercourse** to allow for adequate dispersion. 4. **Other Spermicides:** Benzalkonium chloride and Chlorhexidine are other agents occasionally used in spermicidal formulations.

Q: Which of the following progestins is preferred in combination with estrogen in low-dose oral contraceptive pills?

Desogestrel. **Explanation:** The evolution of oral contraceptive pills (OCPs) has focused on reducing the dose of estrogen (to minimize thromboembolic risks) and developing progestins with higher potency and lower androgenic activity. **Why Desogestrel is the Correct Answer:** Desogestrel is a **third-generation progestin**. In low-dose OCPs, it is preferred because it possesses **high progestational activity** with **minimal androgenic side effects**. Unlike older generations, third-generation progestins do not adversely affect the lipid profile (they may actually increase HDL) and do not cause weight gain, acne, or hirsutism, making them highly tolerable for long-term use. **Analysis of Incorrect Options:** * **B. Norethisterone:** A first-generation progestin. It has lower potency and requires higher doses, often leading to breakthrough bleeding and mild androgenic effects. * **C. Norgestrel:** A second-generation progestin. While potent, it is a racemic mixture containing both active and inactive isomers, leading to a higher side-effect profile compared to pure isomers. * **D. Levonorgestrel:** The active isomer of norgestrel (second-generation). While widely used and safe, it retains significant **androgenic activity**, which can cause oily skin and acne in sensitive patients. **High-Yield Clinical Pearls for NEET-PG:** * **Generations:** 1st (Norethisterone), 2nd (Levonorgestrel), 3rd (Desogestrel, Gestodene, Norgestimate), 4th (Drospirenone). * **Drospirenone:** An analogue of spironolactone; it is anti-androgenic and anti-mineralocorticoid (helps prevent water retention). * **The "Third-Generation Paradox":** While they have fewer androgenic side effects, third-generation progestins carry a slightly higher risk of **Venous Thromboembolism (VTE)** compared to second-generation pills. * **Standard Low-Dose OCP:** Usually contains 30–35 µg of Ethinyl Estradiol. Ultra-low dose contains 20 µg.

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

Blocking the fimbrial ostia. **Explanation:** The mechanism of action of Combined Oral Contraceptive Pills (COCPs) is multi-factorial, primarily targeting the Hypothalamic-Pituitary-Ovarian (HPO) axis and the female reproductive tract environment. **Why Option D is Correct:** **Blocking the fimbrial ostia** is a mechanical/anatomical barrier. This occurs during surgical procedures like **Tubal Ligation** (e.g., Pomeroy’s technique) or due to pathological conditions like Salpingitis/PID. OCPs are pharmacological agents and do not physically obstruct the fallopian tubes. **Why the other options are incorrect (Mechanisms of OCPs):** * **Option B (Primary Mechanism):** The estrogen and progestogen components provide negative feedback to the hypothalamus and anterior pituitary. This suppresses **GnRH, FSH, and LH**, preventing the mid-cycle LH surge. Without the LH surge, ovulation does not occur, resulting in an **anovulatory cycle**. * **Option A:** Progestogen increases the viscosity and thickness of the **cervical mucus**, making it "hostile" and impenetrable to sperm. * **Option C:** OCPs cause the endometrium to become thin, atrophic, and out of sync with the menstrual cycle (decidualization), which **prevents the implantation** of a blastocyst should fertilization occur. **High-Yield Clinical Pearls for NEET-PG:** * **Most potent component for ovulation inhibition:** Progestogen (suppresses LH). * **Role of Estrogen:** Primarily inhibits FSH (preventing follicle selection) and provides cycle control (prevents breakthrough bleeding). * **Failure Rate:** The Pearl Index for perfect use of COCPs is **0.1 per 100 woman-years**. * **Non-contraceptive benefits:** Reduced risk of Ovarian and Endometrial cancers (protective effect persists for years after discontinuation).

Q: All of the following drugs have been used for medical abortion except?

Atosiban. **Explanation:** The correct answer is **Atosiban** because it is a **tocolytic agent**, not an abortifacient. Its primary clinical use is to delay imminent preterm birth by inhibiting uterine contractions. **Why Atosiban is the correct answer:** Atosiban is a competitive **Oxytocin receptor antagonist**. By blocking these receptors in the myometrium, it decreases the frequency of contractions and uterine tone. In the context of pregnancy management, it is used to "stop" labor (tocolysis), which is the functional opposite of medical abortion. **Why the other options are incorrect:** * **Mifepristone (RU-486):** An anti-progestational agent. It blocks progesterone receptors, leading to decidual necrosis, cervical softening, and increased uterine sensitivity to prostaglandins. It is the first step in the standard medical abortion regimen. * **Misoprostol:** A Prostaglandin E1 (PGE1) analogue. It causes cervical ripening and potent uterine contractions to expel the products of conception. It is typically administered 24–48 hours after Mifepristone. * **Methotrexate:** A folate antagonist that inhibits dihydrofolate reductase. It targets rapidly dividing cells (trophoblastic tissue) and is used medically for early unruptured ectopic pregnancies and occasionally in combination with misoprostol for early induced abortion. **High-Yield Clinical Pearls for NEET-PG:** * **Standard Regimen (WHO/GOI):** Mifepristone 200 mg orally followed by Misoprostol 800 mcg (vaginal/buccal/sublingual) for up to 9 weeks (63 days) of gestation. * **MTP Act 2021 Update:** Medical abortion is legal up to 24 weeks under specific conditions, but the "pills-only" method is most effective in the first trimester. * **Atosiban Side Effects:** Generally well-tolerated; most common are nausea, headache, and tachycardia (less than beta-mimetics).

Question 1

Which of the following contraceptive methods have a failure rate of less than 5%?

Accepted Answer

Copper T, Oral Contraceptive Pills, Condom

Answer

Copper T, Oral Contraceptive Pills, Tubectomy

Answer

Vaginal sponge, Tubectomy, Oral Contraceptive Pills

Answer

Copper T, Condom

Question 2

What is the advantage of laparoscopic sterilization over mini-laparotomy sterilization?

Accepted Answer

Very small scar

Answer

Lower failure rate

Answer

Less blood loss

Answer

Easier procedure

Question 3

Centchroman is a?

Accepted Answer

Female oral contraceptive

Answer

Male contraceptive

Answer

Tocolytic

Answer

Oxytocic

Question 4

A couple had unprotected intercourse and they are worried about pregnancy. What is the progesterone of choice for emergency contraception?

Accepted Answer

Levonorgestrel

Answer

Norethisterone

Answer

Medroxyprogesterone acetate

Answer

Desogestrel

Question 5

What is the most common side effect of Intrauterine Devices (IUDs)?

Accepted Answer

Increased vaginal bleeding

Answer

Abdominal pain

Answer

Abortion

Answer

Pelvic inflammation

Question 6

Congenital vaginal foam tablet contains ______

Accepted Answer

Nonoxynol 9

Answer

Octoxynol 8

Answer

Menfegol

Answer

None of the above

Question 7

Oral contraceptive pills (OCPs) do not offer protection against which of the following conditions?

Accepted Answer

Cervical cancer

Answer

Endometrial cancer

Answer

Ovarian cancer

Answer

Breast cancer

Question 8

Which of the following progestins is preferred in combination with estrogen in low-dose oral contraceptive pills?

Accepted Answer

Desogestrel

Answer

Norethisterone

Answer

Norgestrel

Answer

Levonorgestrel

Question 9

Which of the following is NOT a mechanism of action of oral contraceptive pills?

Accepted Answer

Blocking the fimbrial ostia

Answer

Inhibiting sperm penetration into the cervical mucus

Answer

Inducing an anovulatory cycle

Answer

Preventing blastocyst implantation

Question 10

All of the following drugs have been used for medical abortion except?

Accepted Answer

Atosiban

Answer

Mifepristone

Answer

Misoprostol

Answer

Methotrexate

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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