Contraception and Family Planning Practice Questions

Q: Which of the following is not an absolute contraindication for OC pills?

Old STD. ***Old STD*** - A *past* history of a sexually transmitted disease (STD) that has been successfully treated and is no longer active is generally **not an absolute contraindication** for initiating oral contraceptive pills (OCPs). - The primary concern with STDs and OCPs relates to potential *co-infection with HIV* or active infections that could cause complications, but an old, resolved STD on its own does not prohibit OCP use. *Suspicious vaginal bleeding* - **Undiagnosed abnormal vaginal bleeding** is an absolute contraindication (WHO Category 4) for starting OCPs because it could be a symptom of a serious underlying condition, such as **endometrial hyperplasia or cancer**, which needs to be excluded before hormonal therapy is initiated. - Introducing OCPs without investigation could **mask the underlying pathology** and delay diagnosis and appropriate treatment. *Cervical cancer* - **Known or suspected cervical cancer** is an absolute contraindication (WHO Category 4) for OCP use. - OCPs are avoided in these cases to prevent potential progression and to allow for proper evaluation and treatment of the malignancy. *Active viral hepatitis* - **Acute or flare of viral hepatitis** is an absolute contraindication (WHO Category 4) for OCP use. - The liver metabolizes steroid hormones, and introducing OCPs during active hepatitis could worsen liver function and delay recovery. - OCPs can be considered once liver function normalizes and acute phase resolves.

Q: What is the most common infection associated with long-term IUCD use?

Actinomycosis. ***Actinomycosis*** - *Actinomyces* species are **opportunistic anaerobic bacteria** that are part of the normal flora of the female genital tract. - Long-term presence of an **intrauterine contraceptive device (IUCD)** can create a favorable environment for their overgrowth, leading to pelvic **actinomycosis**. *Mucormycosis* - This is a rare but severe invasive fungal infection typically seen in **immunocompromised individuals**, especially those with uncontrolled diabetes or neutropenia. - It is not specifically associated with IUCD use. *Aspergillosis* - This is another fungal infection, commonly affecting the respiratory tract, and also generally seen in **immunocompromised patients**. - There is no direct link between IUCD use and an increased risk of aspergillosis. *Candidiasis* - While *Candida* infections are common in the female genital tract (vaginal yeast infections), they are not specifically associated with IUCD use as a long-term complication in the way **Actinomycosis** is. - IUCDs do not significantly increase the risk of recurrent or severe candidiasis.

Q: Copper IUCD as a contraceptive measure can be used maximum till what time after unprotected intercourse?

5 days. ***5 days*** - A **copper IUCD** (intrauterine contraceptive device) can be effectively inserted for **emergency contraception** up to **5 days** after unprotected sexual intercourse. - This method is highly effective because it prevents **implantation** by creating a spermicidal and hostile uterine environment. *2 days* - While some emergency contraceptive pills might be effective within a shorter window, **2 days** is too early to be the maximum time for **copper IUCD** insertion according to guidelines for emergency contraception. - The efficacy window for the copper IUCD extends beyond this period, offering a longer post-coital option. *3 days* - **3 days** is a common window for some emergency contraceptive pills like those containing levonorgestrel, but the **copper IUCD** offers a longer timeframe for effective use. - The mechanism of action of the copper IUCD is different, allowing it to be effective for a longer duration after intercourse. *4 days* - Although closer to the correct answer, **4 days** is still not the maximum recommended time for **copper IUCD** insertion for emergency contraception. - Clinical guidelines and evidence support its use for an additional day beyond this point for optimal effectiveness.

Q: In the calendar method of contraception, assuming a shortest menstrual cycle of 28 days, what is the first day of the fertile period?

10th day of the shortest menstrual cycle. ***10th day of the shortest menstrual cycle*** - The **calendar method** (rhythm method) estimates the fertile window by subtracting 18 days from the shortest cycle length to find the first fertile day. - For a 28-day shortest cycle, 28 - 18 = **10th day**. *18th day of the shortest menstrual cycle* - Subtracting 11 days from the shortest cycle length determines the **last fertile day**, not the first. - This option incorrectly identifies the calculation for the beginning of the fertile window. *10th day of the longest menstrual cycle* - The first day of the fertile period is calculated based on the **shortest menstrual cycle**, not the longest. - Using the longest cycle length for this calculation would incorrectly postpone the estimated start of the fertile window. *18th day of the longest menstrual cycle* - This calculation (subtracting 11 days from the longest cycle) is used to determine the **last fertile day**. For example, for a 30-day longest cycle, 30 - 11 = 19, making the 19th day the last fertile day. - This option refers to the **longest cycle** and approximates the end of the fertile window, neither of which is relevant for the first fertile day of the shortest cycle.

Q: Which of the following is NOT an absolute contraindication for the use of an Intra Uterine Contraceptive Device (IUD)?

Uterine malformation. ***Uterine malformation*** - While a **uterine malformation** can make IUD placement difficult or increase the risk of expulsion, it is generally considered a **relative contraindication**, not an absolute one. - The decision to place an IUD in such cases depends on the specific type of malformation and the experience of the clinician. *Pregnancy* - **Pregnancy** is an **absolute contraindication** because an IUD offers no protection against pregnancy in an already conceived state and can lead to complications such as miscarriage or ectopic pregnancy if inserted. - Inserting an IUD into a pregnant uterus can cause significant harm to both the mother and the fetus. *Active pelvic infection* - An **active pelvic infection** (e.g., **pelvic inflammatory disease, cervicitis**) is an **absolute contraindication** due to the risk of exacerbating the infection and spreading it further into the uterus and fallopian tubes. - IUD insertion during an active infection can lead to severe complications. *Known allergy to IUD components* - A **known allergy** to any component of the IUD (e.g., copper, plastic) is an **absolute contraindication** to avoid severe allergic reactions. - Allergic reactions can range from localized irritation to systemic responses.

Q: Which of the following is not used for postcoital contraception?

Danazol. ***Danazol*** - **Danazol** is an androgen derivative primarily used to treat conditions like **endometriosis** and **fibrocystic breast disease** due to its ability to suppress gonadotropin secretion. - It is **not effective** as a postcoital contraceptive as it does not reliably prevent ovulation, fertilization, or implantation when taken after unprotected intercourse. *CuT* - The **copper-T intrauterine device (CuT IUD)** can be inserted within **5 days** of unprotected intercourse as an effective form of emergency contraception. - Its mechanism involves releasing **copper ions** that are toxic to sperm and eggs, inhibiting fertilization and implantation. *Ru 486* - **Mifepristone (RU 486)** is an **anti-progestin** that can be used for emergency contraception (often referred to as the morning-after pill). - It works by delaying or inhibiting ovulation and preventing implantation by altering the **endometrium**. *High dose estrogen* - High doses of **estrogen**, often in combination with progestin (**Yuzpe regimen**), can be used as emergency contraception. - This method primarily works by **disrupting ovulation** and altering the endometrium to prevent implantation.

Q: What is the use of the instrument shown in the image?

Laparoscopic sterilization. ***Laparoscopic sterilization*** - The image depicts a **laparoscopic clip applicator**, specifically designed for placing clips on structures like the **fallopian tubes** during laparoscopic sterilization procedures. - This instrument is used to permanently occlude the fallopian tubes, preventing the passage of eggs and sperm for effective **contraception**. *Surgical removal of ectopic pregnancy* - While an ectopic pregnancy can be removed laparoscopically, the instrument shown is a **clip applicator**, not typically used for dissecting or excising tissue in such a procedure. - Surgical removal of an ectopic pregnancy often involves **laparoscopic salpingostomy** or **salpingectomy**, which require cutting, grasping, and coagulating instruments. *Induction of abortion* - **Abortion induction** is typically performed using medical methods (medications) or surgical procedures like **dilation and curettage (D&C)** or **manual vacuum aspiration (MVA)**, none of which involve the specific instrument shown. - This instrument is designed for **occlusion** rather than tissue removal related to abortion. *Creating pneumoperitoneum for laparoscopic procedures* - **Pneumoperitoneum** is created using a **Veress needle** to insufflate carbon dioxide into the abdominal cavity, providing a working space for laparoscopic instruments. - The instrument shown is a **clip applicator**, not a needle for gas insufflation.

Q: A 20 year old woman presented at 7 weeks of gestation, unwilling to continue the pregnancy. What are the drugs used for medical termination of pregnancy in this patient?

Misoprostol and Mifepristone. ***Misoprostol and Mifepristone*** - This combination is the **standard and most effective medical regimen** for termination of pregnancy in the first trimester (up to 9-10 weeks). - **Mifepristone** (200mg) is an **antiprogestin** that blocks progesterone receptors, essential for maintaining pregnancy, followed 24-48 hours later by **Misoprostol** (800mcg), a **prostaglandin analog** that causes cervical ripening and strong uterine contractions. - This regimen has a **95-98% success rate** and is the WHO-recommended protocol. *Misoprostol and Medroxyprogesterone* - **Medroxyprogesterone** is a **progestin**, which would **support and maintain pregnancy** rather than terminate it, making this combination ineffective for medical abortion. - Medroxyprogesterone is used for contraception and menstrual regulation, not pregnancy termination. *Mifepristone and Medroxyprogesterone* - **Medroxyprogesterone** is a progestin and would **directly antagonize the antiprogestin action of Mifepristone**, preventing pregnancy termination. - This combination is pharmacologically contradictory and would not achieve abortion. *Mifepristone and Methotrexate* - **Mifepristone and Methotrexate are not used together** in medical abortion protocols. - **Methotrexate** (antimetabolite) is occasionally used with **Misoprostol** (not Mifepristone) as an alternative regimen, but it is much slower (7-14 days vs 24-48 hours), less effective, and primarily reserved for ectopic pregnancy management. - The standard combination for intrauterine pregnancy termination is Mifepristone + Misoprostol, not Mifepristone + Methotrexate.

Q: A 24 year old lactating female with an 18 month old child comes with a history of irregular, heavy bleeding seeking contraceptive advice. Which is the contraceptive of choice?

Progestin-only pill. ***Progestin-only pill*** - The **progestin-only pill (POP)** is the contraceptive of choice for lactating women because it does not affect **breast milk supply** or composition. - It works by thickening cervical mucus and thinning the **endometrium**, which can help reduce heavy bleeding and provide effective contraception. *Copper IUD* - While the **copper IUD** is a highly effective contraceptive, it is known to potentially increase **menstrual bleeding** and cramping. - Given the patient's history of **heavy bleeding**, a copper IUD might worsen her symptoms. *Progestin-only injection* - **Progestin-only injections** like DMPA are highly effective and safe for lactating women, but they can cause **irregular bleeding patterns** initially and are associated with a slower return to fertility. - While an option, the **progestin-only pill** offers more immediate control over menstrual patterns and easier discontinuation if side effects are problematic. *Combined oral contraceptive pill* - **Combined oral contraceptive pills (COCs)** contain both estrogen and progestin. Estrogen can negatively impact **milk production** and may not be suitable for breastfeeding mothers, especially in the first 6 months postpartum. - COCs are generally avoided in lactating women until breastfeeding is well-established or after 6 months to prevent interference with **lactation**.

Question 1

Which of the following statements about intra-uterine devices (IUDs) is incorrect?

Accepted Answer

Multiload Cu-375 is a third generation intra-uterine device (IUD)

Answer

Copper devices are effective as post-coital contraceptives

Answer

Pregnancy rates of Lippes Loop and T Cu-200 are similar

Answer

LNG-20 (Mirena) has an effective life of 5 years

Question 2

Which of the following is not an absolute contraindication for OC pills?

Accepted Answer

Old STD

Answer

Suspicious vaginal bleeding

Answer

Cervical cancer

Answer

Active viral hepatitis

Question 3

What is the most common infection associated with long-term IUCD use?

Accepted Answer

Actinomycosis

Answer

Mucormycosis

Answer

Aspergillosis

Answer

Candidiasis

Question 4

Copper IUCD as a contraceptive measure can be used maximum till what time after unprotected intercourse?

Accepted Answer

5 days

Answer

2 days

Answer

3 days

Answer

4 days

Question 5

In the calendar method of contraception, assuming a shortest menstrual cycle of 28 days, what is the first day of the fertile period?

Accepted Answer

10th day of the shortest menstrual cycle

Answer

18th day of the shortest menstrual cycle

Answer

10th day of the longest menstrual cycle

Answer

18th day of the longest menstrual cycle

Question 6

Which of the following is NOT an absolute contraindication for the use of an Intra Uterine Contraceptive Device (IUD)?

Accepted Answer

Uterine malformation

Answer

Pregnancy

Answer

Active pelvic infection

Answer

Known allergy to IUD components

Question 7

Which of the following is not used for postcoital contraception?

Accepted Answer

Danazol

Answer

CuT

Answer

Ru 486

Answer

High dose estrogen

Question 8

What is the use of the instrument shown in the image?

Accepted Answer

Laparoscopic sterilization

Answer

Surgical removal of ectopic pregnancy

Answer

Induction of abortion

Answer

Creating pneumoperitoneum for laparoscopic procedures

Question 9

A 20 year old woman presented at 7 weeks of gestation, unwilling to continue the pregnancy.    What are the drugs used for medical termination of pregnancy in this patient?

Accepted Answer

Misoprostol and Mifepristone

Answer

Misoprostol and Medroxyprogesterone

Answer

Mifepristone and Medroxyprogesterone

Answer

Mifepristone and Methotrexate

Question 10

A 24 year old lactating female with an 18 month old child comes with a history of irregular,    heavy bleeding seeking contraceptive advice. Which is the contraceptive of choice?

Accepted Answer

Progestin-only pill

Answer

Copper IUD

Answer

Progestin-only injection

Answer

Combined oral contraceptive pill

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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