Contraception and Family Planning Practice Questions

Q: Use of OCPs is known to protect against the following malignancies except:

Carcinoma cervix. ***Carcinoma cervix*** - While oral contraceptive pills (OCPs) offer protection against some cancers, they are **not protective against cervical cancer**. - In fact, long-term use of OCPs is considered a **risk factor for cervical cancer**, especially in conjunction with human papillomavirus (HPV) infection. *Colorectal carcinomas* - OCP use has been consistently associated with a **reduced risk of colorectal cancer**. - The protective effect is thought to be mediated by various hormonal mechanisms, including their impact on **bile acid metabolism** and **estrogen receptors in the colon**. *Ovarian carcinoma* - OCPs provide significant and **long-lasting protection against ovarian cancer**. - This protective effect is believed to be due to the **suppression of ovulation**, thereby reducing the continuous trauma and repair of the ovarian epithelium. *Endometrial carcinoma* - OCPs are known to offer substantial **protection against endometrial cancer**. - The progestin component in combined OCPs effectively **counteracts the proliferative effects of estrogen** on the endometrium, reducing the risk of hyperplasia and subsequent cancer.

Q: Contraceptive of choice in a woman with Rheumatic heart disease.

IUCD. ***IUCD*** - **Intrauterine contraceptive devices (IUCDs)** are highly effective and do not involve systemic hormones, making them safe for women with **rheumatic heart disease**. - Both copper and hormonal IUCDs can be used, as they pose no additional risk of **thromboembolism** or worsen cardiac function. *Progesterone only pills* - While generally safer than combined oral contraceptives for women with cardiac issues, **progesterone-only pills** still carry a slight risk of **thrombosis**, especially in women with certain heart conditions. - Their effectiveness can be slightly lower than IUCDs, and adherence to strict daily timing is crucial for optimal contraception. *Condom with spermicidal jelly* - **Condoms with spermicidal jelly** are a barrier method and do not pose any direct risk to a woman with rheumatic heart disease. - However, they have a significantly **higher failure rate** compared to highly effective methods like IUCDs, making them less ideal as a primary contraceptive for a condition where pregnancy could be high-risk. *OCPs* - **Combined oral contraceptive pills (OCPs)** containing both estrogen and progestin are generally **contraindicated** in women with rheumatic heart disease, particularly those with valvular lesions or a history of **embolism**. - Estrogen increases the risk of **thromboembolic events**, which can be dangerous for individuals with compromised cardiac function.

Q: Which drug was traditionally used for extra-amniotic instillation in 2nd trimester medicolegal termination of pregnancy?

Ethacrydine lactate. ***Ethacrydine lactate*** - **Ethacrydine lactate** (Rivanol) is an acridine derivative that was **traditionally the agent of choice** for extra-amniotic instillation in second-trimester medical termination of pregnancy. - It is injected into the extra-amniotic space (between the chorion and uterine wall) where it acts locally to induce uterine contractions and cervical ripening. - The typical dose is 0.1% solution, 100-150 mL instilled extra-amniotically. - Though effective, it has been increasingly replaced by prostaglandins due to better safety profiles and ease of administration. *Hypertonic saline* - **Hypertonic saline** (20% NaCl) was historically used for second-trimester abortions but via **intra-amniotic injection**, NOT extra-amniotic route. - It carried significant risks including hypernatremia, disseminated intravascular coagulation (DIC), cerebral edema, and cardiovascular collapse. - Due to these severe maternal complications, it has been largely abandoned in modern practice. *Prostaglandin* - **Prostaglandins** (PGE2, PGF2α, misoprostol) are currently the **preferred agents** for second-trimester termination. - They can be administered via multiple routes including **extra-amniotic**, intra-amniotic, vaginal, oral, or sublingual. - While prostaglandins CAN be used extra-amniotically, the question asks specifically about the **traditional/classical agent** used for this route, which was ethacrydine lactate. - Modern protocols favor vaginal or oral misoprostol due to convenience and efficacy. *Glucose* - **Glucose** has no abortifacient properties and is not used for pregnancy termination. - It serves only as an energy source and has no effect on uterine contractility or cervical ripening.

Q: MTP cannot be done after:

28 weeks. ***28 weeks*** - The Medical Termination of Pregnancy (MTP) Act was amended in 2021, and the upper gestation limit for MTP was increased to **24 weeks** in special cases. However, MTP at 28 weeks' gestation is **not permitted**, as fetal viability is significantly higher, and legal restrictions are stricter. - Beyond 24 weeks, an MTP is only permitted in cases of **substantial fetal anomalies** diagnosed by a Medical Board, making 28 weeks generally non-permissible for routine MTP. *20 weeks* - The initial MTP Act of 1971 allowed MTP up to **20 weeks of gestation** with specific conditions, including a risk to the mother's life or health, or fetal abnormalities. - This limit was extended in certain circumstances by the 2021 amendment, but 20 weeks is generally within the permissible limit for MTP. *12 weeks* - MTP can be performed up to **12 weeks of gestation** based on the opinion of one registered medical practitioner under the MTP Act. - This period is considered safer and less complex for termination procedures. *24 weeks* - The MTP (Amendment) Act of 2021 expanded the gestation limit for MTP to **24 weeks** for specific categories of women, including survivors of sexual assault, minors, women with disabilities, and those with a change in marital status during pregnancy. - This limit requires the opinion of **two registered medical practitioners**.

Q: Which one of the following methods of MTP is associated with the complication of coagulopathy:

Hypertonic saline. ***Hypertonic saline*** - Intra-amniotic instillation of **hypertonic saline** can lead to **disseminated intravascular coagulation (DIC)** due to its toxic effect on fetal endothelial cells and release of thromboplastin-like substances from the placenta. - This method is associated with a higher risk of **coagulopathy**, specifically a decrease in fibrinogen levels, which is a severe complication. - This technique is now largely abandoned due to these serious complications. *Ethacridine lactate (Rivanol)* - **Ethacridine lactate** is an **antiseptic and abortifacient** used for second-trimester MTP via intra-amniotic instillation. - While it can cause prolonged labor and cervical trauma, it is **not primarily associated with coagulopathy** as a major complication compared to hypertonic saline. - Its main adverse effects include fever, gastrointestinal disturbances, and prolonged induction-abortion interval. *Aspirotomy (Vacuum aspiration)* - **Vacuum aspiration** is a surgical method to empty the uterus, and while it carries general risks of infection or uterine perforation, it is **not directly linked to coagulopathy**. - It is one of the safer and more common methods for first-trimester termination. *Prostaglandins* - **Prostaglandins** such as misoprostol or dinoprostone are commonly used for medical and surgical abortion, inducing uterine contractions. - While they have various side effects (nausea, vomiting, diarrhea), they are **not primarily associated with systemic coagulopathy** as a direct complication.

Q: MVA syringe is used for?

First trimester MTP. ***First trimester MTP*** - A **manual vacuum aspiration (MVA) syringe** is specifically designed for performing vacuum aspiration procedures during the first trimester of pregnancy. - It creates a **negative pressure** to gently remove uterine contents, commonly used for **medical termination of pregnancy (MTP)** or management of miscarriage. *2nd trimester MTP* - For **second-trimester MTP**, procedures like **dilatation and evacuation (D&E)** or **induction with medication** are typically preferred over manual vacuum aspiration due to larger fetal size and increased uterine wall fragility. - The **MVA syringe** may not provide sufficient suction or capacity for safe and complete evacuation in the second trimester. *Vacuum delivery* - **Vacuum delivery** is a procedure used during childbirth to assist in vaginal delivery by applying suction to the fetal head. - This procedure uses a **vacuum extractor cup** and a specialized pump, not an MVA syringe. *All of the options* - The MVA syringe is only appropriate for **first-trimester MTP** and early miscarriage management, not for late-trimester procedures or vacuum-assisted delivery. - Therefore, choosing "All of the options" would be incorrect.

Q: Which of the following is NOT used as an emergency contraceptive?

Danazol. ***Danazol*** - **Danazol** is an **androgen derivative** primarily used to treat **endometriosis** and **fibrocystic breast disease**, not for emergency contraception. - Its mechanism involves suppressing **ovarian function** and creating an anovulatory state, which is not suitable for immediate post-coital intervention. *RU 486* - **RU 486 (Mifepristone)** is a **progesterone receptor modulator** that can be used as an emergency contraceptive, especially at higher doses. - It acts by **blocking progesterone receptors**, preventing implantation or inducing abortion if pregnancy has already occurred. *Copper T* - The **Copper T (intrauterine device - IUD)** is a highly effective method of emergency contraception if inserted within 5 days of unprotected intercourse. - It works by causing a **spermicidal effect** and preventing fertilization or implantation by inducing an inflammatory reaction in the uterus. *OCpill* - **OCPills (oral contraceptive pills)**, usually a combination of estrogen and progestin, can be used as emergency contraception when taken in higher doses. - This method, known as the **Yuzpe regimen**, involves taking two doses of combined oral contraceptives within 72 hours of unprotected intercourse to inhibit ovulation or fertilization.

Q: The depicted instrument (Fallopian ring applicator) is used in which procedure?

Tubectomy (Female Sterilisation). ***Tubectomy (Female Sterilisation)*** - The **Fallopian ring applicator** is a specialized instrument designed for applying **Silastic bands** (Fallopian rings) to the fallopian tubes. - This procedure, known as **laparoscopic tubal ligation** or **female sterilization**, involves occluding the fallopian tubes to prevent the union of sperm and egg. *Punch Biopsy* - A **punch biopsy** uses a circular blade to remove a core of tissue, primarily for **skin or mucosal lesions**. - The instruments involved are a **punch biopsy tool**, forceps, and scissors, which are distinctly different from an applicator. *Bone marrow biopsy set* - A **bone marrow biopsy set** typically includes a specialized needle (e.g., Jamshidi needle) for aspirations and biopsies from the **iliac crest**. - These instruments are designed for obtaining samples from bone and marrow, not for occluding tubular structures. *Trocar and cannula (used for general laparoscopy)* - A **trocar and cannula** system is used to create an access port into a body cavity for **laparoscopic surgery**. - While it facilitates the entry for instruments like the Fallopian ring applicator, it is a general entry tool and not the specific instrument depicted for the tubectomy itself.

Q: Which contraceptive method provides protection against ovarian cancer?

Oral contraceptive pills. ***Oral contraceptive pills*** - **Combined oral contraceptives** significantly decrease the risk of **ovarian cancer** due to the suppression of ovulation, which reduces the number of ovulatory cycles and subsequent epithelial microtrauma. - The protective effect increases with the **duration of use** and persists for many years after discontinuation. *Depo-Provera* - Depo-Provera (medroxyprogesterone acetate) is a **progestin-only injectable contraceptive** that primarily prevents ovulation. - While it offers highly effective contraception, its protective effect against ovarian cancer is **less established and not as robust** as that of combined oral contraceptives. *Intrauterine device* - **Intrauterine devices (IUDs)**, whether hormonal (levonorgestrel-releasing) or copper, primarily prevent pregnancy by altering the uterine environment or affecting sperm motility. - They do **not provide significant protection** against ovarian cancer, although hormonal IUDs have shown some possible association with reduced endometrial cancer risk. *Barrier methods* - **Barrier methods** like condoms or diaphragms physically block sperm from reaching the egg, preventing pregnancy. - They offer **no direct biological mechanism** to reduce the risk of ovarian cancer.

Question 1

Use of OCPs is known to protect against the following malignancies except:

Accepted Answer

Carcinoma cervix

Answer

Colorectal carcinomas

Answer

Ovarian carcinoma

Answer

Endometrial carcinoma

Question 2

Contraceptive of choice in a woman with Rheumatic heart disease.

Accepted Answer

IUCD

Answer

Progesterone only pills

Answer

Condom with spermicidal jelly

Answer

OCPs

Question 3

Which drug was traditionally used for extra-amniotic instillation in 2nd trimester medicolegal termination of pregnancy?

Accepted Answer

Ethacrydine lactate

Answer

Hypertonic saline

Answer

Prostaglandin

Answer

Glucose

Question 4

MTP cannot be done after:

Accepted Answer

28 weeks

Answer

20 weeks

Answer

12 weeks

Answer

24 weeks

Question 5

Which one of the following methods of MTP is associated with the complication of coagulopathy:

Accepted Answer

Hypertonic saline

Answer

Ethacrydine lactate

Answer

Aspirotomy

Answer

Prostaglandins

Question 6

MVA syringe is used for?

Accepted Answer

First trimester MTP

Answer

2nd trimester MTP

Answer

Vacuum delivery

Answer

All of the options

Question 7

Which of the following is NOT used as an emergency contraceptive?

Accepted Answer

Danazol

Answer

RU 486

Answer

Copper T

Answer

OCpill

Question 8

Which of the following cannot be used as Post-coital contraceptive?

Accepted Answer

A drug primarily used for endometriosis and fibrocystic breast disease (e.g., Danazol)

Answer

A device that prevents fertilization and implantation (e.g., CuT 200)

Answer

A hormonal method that disrupts ovulation (e.g., high-dose estrogens)

Answer

A progesterone receptor blocker used within 72 hours (e.g., RU 486)

Question 9

The depicted instrument (Fallopian ring applicator) is used in which procedure?

Accepted Answer

Tubectomy (Female Sterilisation)

Answer

Punch Biopsy

Answer

Bone marrow biopsy set

Answer

Trocar and cannula (used for general laparoscopy)

Question 10

Which contraceptive method provides protection against ovarian cancer?

Accepted Answer

Oral contraceptive pills

Answer

Depo-Provera

Answer

Intrauterine device

Answer

Barrier methods

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

On this page

Practice by Chapter

Want unlimited practice?