Contraception and Family Planning Practice Questions

Q: Which is the most likely complication of an intrauterine device (IUD)?

Hypofibrinogenemia. **Explanation:** The correct answer is **Hypofibrinogenemia**. While this may seem counterintuitive compared to common side effects like bleeding or pain, it is a recognized systemic complication associated with the chronic inflammatory response triggered by an IUD. **1. Why Hypofibrinogenemia is correct:** Intrauterine devices, particularly non-medicated ones, induce a local sterile inflammatory reaction in the endometrium. This leads to an increase in vascular permeability and the release of lysosomal enzymes and plasminogen activators. The chronic increase in **fibrinolytic activity** within the uterine cavity can lead to the systemic consumption of fibrinogen, resulting in hypofibrinogenemia. This is often the underlying mechanism for the increased menstrual blood loss (menorrhagia) seen in IUD users. **2. Why other options are incorrect:** * **Sterility:** IUDs do not cause permanent sterility. Fertility returns immediately upon removal. While Pelvic Inflammatory Disease (PID) can lead to tubal factor infertility, the IUD itself is not a cause of sterility. * **Cervical tear:** This is a rare mechanical complication that may occur during the *insertion* process (usually due to the tenaculum), but it is not a complication of the device itself. * **None of the above:** Incorrect, as hypofibrinogenemia is a documented hematological association. **High-Yield NEET-PG Pearls:** * **Most common side effect of IUD:** Bleeding (Menorrhagia). * **Most common cause for IUD removal:** Bleeding. * **Second most common cause for removal:** Pain. * **Mechanism of action (Cu-T):** Primarily spermicidal (due to sterile inflammatory response and Cu ions). * **Ideal time for insertion:** Within 10 days of the start of menstruation (to ensure the patient is not pregnant and the cervix is slightly dilated).

Q: Menstrual regulation is done up to how many days of amenorrhea?

49 days of amenorrhea. **Explanation:** **Menstrual Regulation (MR)** is a procedure used to induce menstruation in a woman who has missed her period, typically before a pregnancy is clinically confirmed by conventional tests. According to standard clinical guidelines and the National Health Programs in India, Menstrual Regulation is performed up to **42 to 49 days (7 weeks)** from the first day of the last menstrual period (LMP). While some older texts mention 42 days, current clinical standards and the NEET-PG curriculum recognize **49 days** as the upper limit for MR. * **Why Option C is Correct:** The procedure involves the aspiration of the endometrial lining using a Karman’s cannula (4-6 mm) and a 60ml syringe (Manual Vacuum Aspiration). It is most effective and safest when performed within **49 days of amenorrhea**. Beyond this period, the products of conception become too large for simple MR, and the procedure is then classified as a first-trimester Medical Termination of Pregnancy (MTP). * **Why Other Options are Incorrect:** * **35 days (5 weeks):** This is too early; while MR can be done, it is not the upper limit. * **42 days (6 weeks):** This was the traditional limit in older protocols, but 49 days is now the accepted standard for the maximum duration. * **56 days (8 weeks):** At this stage, the procedure is strictly considered a formal MTP (Surgical or Medical) and requires larger cannulas or pharmacological intervention (Mifepristone/Misoprostol). **Clinical Pearls for NEET-PG:** * **Instrument:** Uses the **Karman’s Syringe/Cannula** (Manual Vacuum Aspiration). * **Confirmation:** MR is often done without a formal pregnancy test; however, if the test is positive, it is technically an early MTP. * **MTP Act (India):** Under the amended MTP Act, medical termination is now legal up to **24 weeks** for specific categories of women, but MR remains a specific subset for very early intervention (up to 7 weeks).

Q: What is the recommended lifespan of a Copper T 380A intrauterine device?

10 years. **Explanation:** The **Copper T 380A (CuT 380A)** is a highly effective, long-acting reversible contraceptive (LARC). The "380" refers to the surface area of copper wire (380 $mm^2$) wrapped around the vertical stem and the copper sleeves on the horizontal arms. This high copper content increases its efficacy and longevity. **Why Option D is Correct:** The FDA and the Government of India (under the National Family Planning Program) recommend a lifespan of **10 years** for the CuT 380A. The primary mechanism of action is the release of copper ions, which are spermicidal, inhibit sperm motility, and cause a sterile inflammatory response in the endometrium, preventing implantation. **Why Other Options are Incorrect:** * **Options A & C (3-4 years):** These are too short for modern copper IUDs. Older models like the Lippes Loop or CuT 200 had shorter durations, but they are no longer the standard of care. * **Option B (5 years):** This is the lifespan of the **CuT 375 (Multiload)** and the **Mirena (LNG-IUD)**. While Mirena is now often used for up to 8 years in some clinical guidelines, 5 years remains the standard duration for CuT 375. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Insertion Time:** Within 10 days of the onset of menstruation (to ensure the patient is not pregnant and the cervix is slightly dilated). * **Post-Placental Insertion:** Can be inserted within 48 hours of delivery (PPIUCD). * **Emergency Contraception:** CuT 380A is the **most effective** method of emergency contraception if inserted within 5 days (120 hours) of unprotected intercourse. * **Common Side Effects:** The most common side effect is **menorrhagia** (increased menstrual bleeding), followed by pelvic pain.

Q: Which of the following is a barrier method of contraception?

Condom. **Explanation:** **Barrier methods** of contraception work by creating a physical or chemical blockade that prevents sperm from entering the uterine cavity and reaching the oocyte. The **condom** (both male and female) is the most widely used barrier method. It acts as a mechanical sheath that traps semen, preventing direct contact between spermatozoa and the vaginal mucosa. **Analysis of Options:** * **A. Hormonal Contraceptives:** These work primarily by suppressing ovulation via the HPO (Hypothalamic-Pituitary-Ovarian) axis and thickening cervical mucus. They do not provide a physical barrier. * **B. Intrauterine Device (IUD):** These are long-acting reversible contraceptives (LARC). They work by causing a sterile inflammatory response in the endometrium (Copper-T) or thinning the lining and thickening mucus (LNG-IUS), making the environment hostile to sperm and implantation. * **D. Sterilization:** This is a permanent surgical method (Vasectomy/Tubectomy) that involves occluding the transport ducts (vas deferens or fallopian tubes). **High-Yield Clinical Pearls for NEET-PG:** 1. **Dual Protection:** Condoms are the **only** contraceptive method that provides protection against both unintended pregnancy and **Sexually Transmitted Infections (STIs)**, including HIV. 2. **Failure Rate:** The typical use failure rate of male condoms is approximately **13-18%**, whereas perfect use is **2%**. 3. **Other Barrier Methods:** Include the diaphragm, cervical cap, vaginal sponge, and chemical barriers (spermicides like Nonoxynol-9). 4. **Contraindication:** Oil-based lubricants should never be used with latex condoms as they cause degradation and breakage.

Question 1

Which is the most likely complication of an intrauterine device (IUD)?

Accepted Answer

Hypofibrinogenemia

Answer

Sterility

Answer

Cervical tear

Answer

None of the above

Question 2

What is the contraceptive method of choice in lactating mothers?

Accepted Answer

Progesterone-only pills

Answer

Barrier method

Answer

Combined oral contraceptive pills

Answer

Lactational amenorrhea

Question 3

What is the best method of contraception for a commercial sex worker?

Accepted Answer

Barrier methods

Answer

Intrauterine contraceptive device (IUCD)

Answer

Oral contraceptive pills (OCP)

Answer

Permanent sterilization

Question 4

Which of the following is a natural family planning method?

Accepted Answer

Basal Body Temperature (BBT) charting

Answer

Abstinence

Answer

Coitus interruptus

Answer

Safe period calculation

Question 5

Oral contraceptive pills offer protection against which of the following conditions?

Accepted Answer

Ovarian cancer

Answer

Sexually transmitted diseases (STDs)

Answer

Breast cancer

Answer

Hepatocellular carcinoma

Question 6

Peritoneum is opened in all of the following sterilization procedures except?

Accepted Answer

Vasectomy

Answer

Mini lap

Answer

Laparoscopy

Answer

Transvaginal tubectomy

Question 7

Menstrual regulation is done up to how many days of amenorrhea?

Accepted Answer

49 days of amenorrhea

Answer

35 days of amenorrhea

Answer

42 days of amenorrhea

Answer

56 days of amenorrhea

Question 8

Which of the following statements about the Rhythm method of contraception is false?

Accepted Answer

Anencephaly is a reported complication of the calendar method.

Answer

It is associated with no costs.

Answer

The safe period can also be observed using the temperature rhythm or mucous method.

Answer

Abstinence is needed for about 7-10 days.

Question 9

What is the recommended lifespan of a Copper T 380A intrauterine device?

Accepted Answer

10 years

Answer

4 years

Answer

5 years

Answer

3 years

Question 10

Which of the following is a barrier method of contraception?

Accepted Answer

Condom

Answer

Hormonal contraceptive

Answer

Intrauterine device (IUD)

Answer

Sterilization

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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