Contraception and Family Planning Practice Questions

Q: Which of the following is used as emergency contraception?

All of the above. **Explanation:** Emergency contraception (EC) refers to methods used to prevent pregnancy after unprotected intercourse, contraceptive failure, or sexual assault. The correct answer is **"All of the above"** because each option represents a valid EC regimen used in clinical practice. 1. **Levonorgestrel (LNG) 0.75mg:** This is the progestogen-only pill (POP) method. The standard dose is **1.5 mg** taken as a single dose or two doses of **0.75 mg** 12 hours apart. It works primarily by delaying ovulation and is most effective when taken within 72 hours (up to 120 hours). 2. **Mala-N (Combined Oral Contraceptive Pills):** This represents the **Yuzpe Regimen**. While Mala-N is typically used for daily contraception, taking a specific high dose (100 mcg Ethinyl Estradiol + 0.5 mg LNG, repeated after 12 hours) acts as emergency contraception. Though less effective and associated with more nausea than LNG-only pills, it remains a recognized method. 3. **Copper T (Cu-IUD):** This is the **most effective** method of emergency contraception (failure rate <0.1%). It can be inserted up to 5 days after unprotected intercourse (or up to 5 days after the earliest expected date of ovulation) and provides the added benefit of long-term reversible contraception. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard/Most Effective EC:** Copper T 380A. * **Drug of Choice (Hormonal):** Levonorgestrel 1.5mg (Single dose). * **Ulipristal Acetate (30mg):** A Selective Progesterone Receptor Modulator (SPRM) that is more effective than LNG, especially between 72–120 hours. * **Mifepristone:** Can be used as EC in low doses (10–25 mg). * **Note:** EC prevents pregnancy; it is **not** an abortifacient and will not disrupt an established pregnancy.

Q: Which contraceptive method should be avoided in patients with epilepsy?

Oral contraceptives. **Explanation:** The primary concern in managing contraception for patients with epilepsy is the **pharmacokinetic interaction** between antiepileptic drugs (AEDs) and hormonal contraceptives. **1. Why Oral Contraceptives (OCPs) are avoided:** Most traditional AEDs (e.g., Phenytoin, Carbamazepine, Phenobarbital, Primidone) are **potent hepatic enzyme inducers** (Cytochrome P450 system). These enzymes accelerate the metabolism of estrogen and progesterone in OCPs, significantly reducing their serum concentrations. This leads to a high risk of **contraceptive failure** and unintended pregnancy. Conversely, OCPs can lower the serum levels of certain AEDs like **Lamotrigine**, potentially triggering breakthrough seizures. **2. Analysis of Incorrect Options:** * **Condoms (Barrier Methods):** These do not involve systemic hormones or hepatic metabolism; therefore, there is no drug interaction. * **Intrauterine Contraceptive Devices (IUCDs):** Copper T or Levonorgestrel-releasing IUS (Mirena) act locally. They are considered the **gold standard** for women on enzyme-inducing AEDs because their efficacy is not affected by liver enzymes. * **Post-coital pills:** While emergency contraception (EC) can be used, it is not "avoided" in the same sense as maintenance OCPs. However, a double dose (3mg Levonorgestrel) is often recommended if the patient is on enzyme-inducers. **Clinical Pearls for NEET-PG:** * **Drug of Choice:** The Copper IUCD or LNG-IUS are the most reliable methods for epileptic patients. * **DMPA (Injectable):** Can be used, but the injection interval is sometimes shortened to 10 weeks instead of 12. * **Non-inducing AEDs:** Valproate, Levetiracetam, and Gabapentin do not significantly interact with OCPs, but OCPs are still generally avoided as a first-line precaution in epilepsy management.

Q: What is the most ideal site for sterilization by tubectomy?

Isthmus. The **isthmus** is the most ideal site for tubal sterilization (tubectomy) because it is the narrowest and least vascular part of the Fallopian tube. ### Why Isthmus is the Correct Answer: 1. **Anatomical Advantage:** The isthmus has a thick muscular wall and a narrow lumen. This makes it technically easier to ligate and excise (as in the Pomeroy technique) or to apply mechanical devices like clips or rings. 2. **Vascularity:** It is relatively less vascular compared to the ampulla, minimizing the risk of intraoperative bleeding and hematoma formation. 3. **Reversibility:** Because the isthmus is narrow, a tubectomy here destroys the least amount of tubal tissue. If a patient requests tubal re-anastomosis (reversal) later, the isthmic-isthmic repair offers the highest success rates due to the matching luminal diameters. ### Why Other Options are Incorrect: * **Ampulla:** This is the widest and most vascular part of the tube. Sterilization here carries a higher risk of bleeding and requires destroying a larger segment of the tube, making future reversal difficult. * **Fimbriated extremity:** Removing the fimbria (fimbriectomy) is highly effective but makes the procedure virtually irreversible. * **Interstitial portion:** This is the segment that traverses the uterine wall. Surgery here is technically difficult, carries a high risk of uterine bleeding, and increases the risk of cornual pregnancy if failure occurs. ### Clinical Pearls for NEET-PG: * **Pomeroy’s Method:** The most common technique used worldwide; it involves ligating a loop of the isthmus with absorbable suture. * **Failure Rate:** The Pearl Index for tubectomy is approximately **0.5 per 100 woman-years**. * **Madlener Technique:** Avoided today due to high failure rates (re-canalization). * **Irving and Uchida Techniques:** Have the lowest failure rates but are surgically more complex.

Q: DMPA causes all the following except?

Thromboembolism. **Explanation:** **DMPA (Depot Medroxyprogesterone Acetate)** is a progestogen-only injectable contraceptive. The correct answer is **Thromboembolism** because, unlike combined oral contraceptives (COCs) which contain estrogen, progestogen-only methods like DMPA do not significantly increase the risk of venous thromboembolism (VTE), stroke, or myocardial infarction. Estrogen is the component responsible for increasing hepatic synthesis of clotting factors. **Analysis of Options:** * **Weight Gain (A):** This is a common side effect unique to DMPA compared to other hormonal methods. It is attributed to its glucocorticoid-like activity, which increases appetite and fat storage. * **Irregular Cycles (B):** In the initial months of use, the most common side effect is breakthrough bleeding or spotting due to the thinning of the endometrial lining. * **Amenorrhea (C):** This is a hallmark of long-term DMPA use. After one year, approximately 50-75% of users develop amenorrhea due to profound endometrial atrophy. **High-Yield Clinical Pearls for NEET-PG:** * **Dose:** 150 mg intramuscularly every 3 months (12 weeks). * **Mechanism:** Primarily inhibits ovulation by suppressing the LH surge. * **Bone Mineral Density (BMD):** DMPA causes a reversible decrease in BMD due to hypoestrogenism; hence, it should be used with caution in adolescents and women over 45. * **Return to Fertility:** There is a characteristic **delayed return to fertility** (average 7–10 months after the last injection). * **Non-contraceptive benefit:** Reduces the risk of endometrial cancer and pelvic inflammatory disease (PID).

Q: Which antiprogestin is used for emergency contraception?

Mifepristone. **Explanation:** **Mifepristone (Option A)** is a potent competitive progesterone receptor antagonist (antiprogestin). In the context of emergency contraception (EC), it works primarily by inhibiting or delaying ovulation. If taken post-ovulation, it may also alter the endometrium to prevent implantation. A single low dose (10 mg or 25 mg) is highly effective as an EC if taken within 120 hours (5 days) of unprotected intercourse. **Analysis of Incorrect Options:** * **Misoprostol (Option B):** A synthetic Prostaglandin E1 (PGE1) analog. It is used for medical abortion (in combination with Mifepristone), induction of labor, and management of PPH, but it has no role as an emergency contraceptive. * **Methotrexate (Option C):** A folate antagonist and cytotoxic drug. It is the medical treatment of choice for unruptured ectopic pregnancy and is used in some regimens for early medical abortion, but not for EC. * **Norethisterone (Option D):** A first-generation synthetic progestin. While progestins like **Levonorgestrel (LNG)** are used for EC, Norethisterone is typically used for cycle regulation, dysfunctional uterine bleeding, or as a daily oral contraceptive pill. **High-Yield NEET-PG Pearls:** * **Ulipristal Acetate:** A Selective Progesterone Receptor Modulator (SPRM) and currently the most effective oral EC, effective up to 120 hours. * **Levonorgestrel (LNG):** The most commonly used EC (1.5 mg single dose); most effective when taken within 72 hours. * **Copper T 380A:** The **most effective** method of emergency contraception overall if inserted within 5 days of unprotected intercourse. * **Yuzpe Regimen:** An older method using combined oral contraceptive pills (Ethinylestradiol + LNG); it is less effective and has more side effects (nausea/vomiting) than LNG-only pills.

Q: Which of the following neoplasms has been associated with the use of oral contraceptives?

Hepatic adenoma. **Explanation:** The correct answer is **Hepatic Adenoma**. Combined Oral Contraceptive Pills (COCPs) contain synthetic estrogen and progesterone. Estrogen, in particular, has a trophic effect on hepatocytes and the hepatic vasculature. Long-term use of COCPs is a well-established risk factor for the development of **Hepatic Adenoma** (a benign but potentially serious liver tumor). These tumors are highly vascular and carry a risk of spontaneous rupture and life-threatening intraperitoneal hemorrhage, especially during pregnancy or continued pill use. **Analysis of Incorrect Options:** * **Ovarian Cancer:** COCPs are actually **protective** against epithelial ovarian cancer. The suppression of "incessant ovulation" reduces the risk by approximately 50% after 5 years of use, and this protection persists for decades after discontinuation. * **Endometrial Cancer:** COCPs are **protective** against endometrial cancer. The progestogen component counteracts the proliferative effect of estrogen on the endometrium, reducing the risk by about 50%. * **Breast Cancer:** While there is a slight, transient increase in the relative risk of breast cancer diagnosis during current use (which returns to baseline 10 years after stopping), the association is less definitive and less "classically" linked in exam scenarios compared to the specific association with hepatic adenoma. **High-Yield NEET-PG Pearls:** * **Cancers Decreased by COCPs:** Ovarian, Endometrial, and Colorectal cancer. * **Cancers Increased by COCPs:** Cervical cancer (risk increases with >5 years of use) and Hepatic Adenoma. * **Management of Hepatic Adenoma:** Small adenomas (<5 cm) may regress upon discontinuation of COCPs; larger ones may require surgical resection due to the risk of rupture or malignant transformation to Hepatocellular Carcinoma (HCC).

Q: Which intrauterine contraceptive device (IUCD) has the shortest lifespan?

Progestasert. **Explanation:** The lifespan of an Intrauterine Contraceptive Device (IUCD) is determined by the rate at which its active component (copper or hormone) is depleted or by its design. **Why Progestasert is correct:** Progestasert is a first-generation **hormone-releasing IUCD** that releases progesterone at a rate of 65 µg/day. Because it contains a limited reservoir of natural progesterone (38 mg) which is released relatively rapidly, it has a lifespan of only **1 year**. This necessitates annual replacement, making it the IUCD with the shortest clinical duration. **Analysis of Incorrect Options:** * **Lippes Loop:** This is a non-medicated (inert) IUCD made of polyethylene. Since it does not rely on the depletion of a drug or metal, it can theoretically remain in the uterus **indefinitely** (as long as it is tolerated). * **Copper-T:** The most common variant, Cu-T 380A, has a lifespan of **10 years**. Other variants like Cu-T 200 last for 3 years. * **Multiload Device:** The Multiload-250 typically lasts for 3 years, while the Multiload-375 is effective for **5 years**. **High-Yield Clinical Pearls for NEET-PG:** * **Mirena (LNG-20):** Unlike Progestasert, Mirena releases Levonorgestrel and has a much longer lifespan of **5–8 years**. * **Mechanism of Action:** Progestasert works primarily by thickening cervical mucus and causing endometrial atrophy. * **Ideal Candidate:** IUCDs are best suited for parous women in stable monogamous relationships. * **Most common side effect:** For Copper-T, it is **bleeding** (menorrhagia); for Progestasert/Mirena, it is often **intermenstrual spotting** or amenorrhea.

Question 1

Progestogen-only pills (POPs) carry a risk of:

Accepted Answer

Ectopic pregnancy

Answer

Hypertension

Answer

Embolism

Answer

Irregular bleeding

Question 2

Which one of the following is the ideal contraceptive for a patient with heart disease?

Accepted Answer

Diaphragm

Answer

IUCD

Answer

Depo-Provera

Answer

Oral contraceptive pills

Question 3

Which of the following is used as emergency contraception?

Accepted Answer

All of the above

Answer

Mala-N

Answer

0.75mg Levonorgestrel (LNG)

Answer

Copper T

Question 4

Which contraceptive method should be avoided in patients with epilepsy?

Accepted Answer

Oral contraceptives

Answer

Condoms

Answer

Intrauterine contraceptive devices

Answer

Post-coital pills

Question 5

A 26-year-old G1, P0 presents to the OBGYN department with a complaint of moderate vaginal bleeding noticed while bathing. On examination, there are no uterine contractions, pain, or abdominal cramps. Vital signs are: Blood pressure 120/76 mmHg, Pulse rate 84/min, temperature 37.6°C, Respiratory rate 16/min. Speculum examination reveals a small clot at the vault, with no active bleeding or abnormal mass. The cervix is closed. Bimanual examination is unremarkable. What is the most likely diagnosis?

Accepted Answer

Threatened abortion

Answer

Missed abortion

Answer

Inevitable abortion

Answer

Incomplete abortion

Question 6

What is the most ideal site for sterilization by tubectomy?

Accepted Answer

Isthmus

Answer

Ampulla

Answer

Fimbriated extremity

Answer

Interstitial portion

Question 7

DMPA causes all the following except?

Accepted Answer

Thromboembolism

Answer

Weight gain

Answer

Irregular cycles

Answer

Amenorrhea

Question 8

Which antiprogestin is used for emergency contraception?

Accepted Answer

Mifepristone

Answer

Misoprostal

Answer

Methotrexate

Answer

Norethisterone

Question 9

Which of the following neoplasms has been associated with the use of oral contraceptives?

Accepted Answer

Hepatic adenoma

Answer

Breast cancer

Answer

Ovarian cancer

Answer

Endometrial cancer

Question 10

Which intrauterine contraceptive device (IUCD) has the shortest lifespan?

Accepted Answer

Progestasert

Answer

Lippes loop

Answer

Copper-T

Answer

Multiload device

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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