Contraception and Family Planning Practice Questions

Q: Which of the following is a contraindication for the use of oral contraceptive pills?

Liver disease. **Explanation:** The correct answer is **Liver disease**. Combined Oral Contraceptive Pills (COCPs) contain estrogen and progesterone, both of which are metabolized in the liver. In patients with active liver disease (e.g., acute hepatitis, cirrhosis, or liver tumors), the liver’s ability to metabolize these hormones is impaired. This can lead to hormonal accumulation, potential hepatotoxicity, and worsening of the underlying condition. Furthermore, estrogen can increase the risk of cholestasis and gallbladder disease. **Analysis of Incorrect Options:** * **Pelvic Inflammatory Disease (PID):** COCPs are not contraindicated in PID. In fact, they may offer a protective effect by thickening cervical mucus, which prevents the upward migration of pathogens. (Note: PID is a contraindication for IUDs, not OCPs). * **Renal Disease:** Most renal diseases are not absolute contraindications for COCPs. However, if renal failure is associated with severe hypertension or vascular complications, OCPs should be avoided due to the risk of stroke or MI. * **Epilepsy:** Epilepsy itself is not a contraindication. However, many anti-epileptic drugs (like Phenytoin or Carbamazepine) are enzyme inducers that decrease the efficacy of OCPs, leading to contraceptive failure. In such cases, a higher dose of estrogen or an alternative method is preferred. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications (WHO Category 4):** History of Thromboembolism (DVT/PE), Ischemic Heart Disease, Stroke, Breast Cancer, Smokers >35 years (>15 cigarettes/day), and Migraine with aura. * **OCPs and Cancer:** OCPs **increase** the risk of Breast and Cervical cancer but are **protective** against Ovarian and Endometrial cancer. * **Drug Interaction:** Rifampicin is the most potent enzyme inducer that reduces OCP efficacy.

Q: What is the 'Pearl-index' for accidental pregnancies failure per?

100 women-years of exposure. ### Explanation The **Pearl Index** is the standard statistical method used to express the effectiveness of a contraceptive method. It calculates the number of unintended pregnancies that occur per **100 woman-years of exposure**. **Why Option C is Correct:** The Pearl Index is defined by the formula: $$\text{Pearl Index} = \frac{\text{Total number of accidental pregnancies} \times 1200}{\text{Total months of exposure}}$$ The multiplier "1200" represents 100 women using a method for 12 months (1 year) each. Therefore, a Pearl Index of 1 means that if 100 women use a specific contraceptive method for one year, one woman will likely become pregnant. **Why Other Options are Incorrect:** * **Options A & B (10 and 12 women-years):** These are too small a sample size to provide statistically significant data for public health and clinical efficacy. * **Option D (120 women-years):** While 120 is often used in calculations involving months (10 years), the international standard for reporting contraceptive failure is always normalized to a base of 100 women over one year. **High-Yield Clinical Pearls for NEET-PG:** * **Lowest Pearl Index (Most Effective):** Implants (e.g., Nexplanon) have the lowest Pearl Index (~0.05), followed by Vasectomy and IUCDs. * **Highest Pearl Index (Least Effective):** Barrier methods (Condoms) and behavioral methods (Withdrawal/Rhythm) have higher Pearl Indices due to "typical use" errors. * **Perfect Use vs. Typical Use:** Always distinguish between these two; the Pearl Index is significantly higher (worse) in "typical use" for user-dependent methods like OCPs. * **Alternative Measure:** The **Life Table Analysis** is considered more accurate than the Pearl Index as it calculates failure rates at specific intervals (e.g., at 6 months vs. 24 months).

Q: Which of the following can cause decreased or impaired ovulation?

All of the above. **Explanation:** The correct answer is **D. All of the above**, as each of these contraceptive methods can interfere with the hypothalamic-pituitary-ovarian (HPO) axis or local ovarian function to impair ovulation. 1. **Minipill (Progestogen-Only Pill - POP):** While the primary mechanism of POPs is thickening the cervical mucus, they suppress ovulation in approximately **40–60%** of cycles by inhibiting the mid-cycle LH surge. 2. **Norplant (Levonorgestrel Implants):** These provide a continuous, higher systemic dose of progestogen compared to the minipill. This consistently suppresses the LH surge, leading to anovulation in about **50–80%** of cycles, especially during the first two years of use. 3. **Intrauterine Contraceptive Device (IUCD):** While the primary mechanism of a Copper-T is its spermicidal effect and prevention of implantation, it also induces a local inflammatory response. Research indicates that IUCDs can cause **mild follicular dysfunction** or luteal phase defects in some users, leading to impaired or "sub-optimal" ovulation. (Note: If the option refers to the **LNG-IUS/Mirena**, it suppresses ovulation in about 15–25% of cycles). **High-Yield Clinical Pearls for NEET-PG:** * **Primary Mechanism of Progestogens:** Thickening of cervical mucus (most consistent effect). * **Combined Oral Contraceptive Pills (COCPs):** These are the most effective at suppressing ovulation (99%+) by inhibiting FSH and LH. * **DMPA (Injectable):** Consistently inhibits ovulation by suppressing the HPO axis. * **IUCD Fact:** The Copper-T is the most common cause of **menorrhagia** among contraceptives, whereas LNG-IUS is a treatment for it.

Q: Which contraceptive method is contraindicated in an HIV-positive patient?

Intrauterine contraceptive device (IUCD). ### Explanation The correct answer is **A. Intrauterine contraceptive device (IUCD)**. **Why IUCD is the correct answer:** In the context of HIV and contraception, the primary concern is the risk of **Pelvic Inflammatory Disease (PID)** and the potential for increased menstrual bleeding. While the WHO Medical Eligibility Criteria (MEC) generally allows IUCD use in stable HIV patients (Category 2), it is strictly **contraindicated (MEC Category 4)** for **initiation** in patients with **AIDS who are not on antiretroviral therapy (ART)** or those who are clinically unwell. The risk of secondary infections and the potential for increased viral shedding in vaginal secretions due to IUCD-induced menorrhagia make it the least preferred option among the choices provided in a standard examination context. **Analysis of Incorrect Options:** * **B. Combined Oral Contraceptive Pills (COCPs):** These are safe (MEC Category 1) but require caution due to drug interactions. Certain Protease Inhibitors can decrease the efficacy of COCPs by inducing liver enzymes. * **C. Minipill (Progestogen-only pill):** These are safe and do not carry the thromboembolic risks associated with estrogen, making them a viable option for HIV patients. * **D. Barrier Methods:** Condoms are the **method of choice** for HIV-positive patients. They provide "dual protection" by preventing both pregnancy and the transmission of HIV/STIs to partners. **High-Yield Clinical Pearls for NEET-PG:** * **Dual Protection:** Always counsel HIV patients to use a barrier method (condoms) in addition to another highly effective contraceptive. * **WHO MEC Category 4 for IUCD:** Includes current PID, purulent cervicitis, and initiation in patients with advanced HIV/AIDS (CD4 <200 cells/mm³). * **Drug Interaction:** Ritonavir (a Protease Inhibitor) is a potent enzyme inducer that significantly reduces the levels of ethinyl estradiol in COCPs.

Q: Use of oral contraceptive pills decreases which of the following?

Glucose tolerance. Combined Oral Contraceptive Pills (COCPs) exert systemic metabolic effects due to their estrogen and progestogen components. **Why Glucose Tolerance Decreases (Correct Answer):** COCPs, particularly the progestogen component, induce a state of **insulin resistance**. Progestogens decrease the number of insulin receptors and impair peripheral glucose uptake. Estrogen can also interfere with glucose metabolism by affecting cortisol levels. This results in a "diabetogenic" effect, leading to **decreased glucose tolerance**. While clinically insignificant in healthy women, it is a critical consideration for those with pre-diabetes or gestational diabetes history. **Analysis of Incorrect Options:** * **B. Binding Globulins:** Estrogen stimulates the liver to **increase** the synthesis of transport proteins. COCPs increase Sex Hormone-Binding Globulin (SHBG), Thyroid-Binding Globulin (TBG), and Cortisol-Binding Globulin (CBG). * **C. High-density lipoprotein (HDL):** Estrogen generally **increases** HDL (the "good" cholesterol) and decreases LDL. While some older progestogens could oppose this, modern low-dose formulations typically result in a net increase or neutral effect on HDL. * **D. Triglycerides:** Estrogen **increases** the hepatic synthesis of triglycerides. Therefore, COCPs are contraindicated in patients with severe hypertriglyceridemia due to the risk of pancreatitis. **High-Yield Clinical Pearls for NEET-PG:** * **Protective Effects:** COCPs **decrease** the risk of Ovarian cancer, Endometrial cancer, and Benign Breast Disease. * **Increased Risks:** COCPs **increase** the risk of Cervical cancer (with long-term use), Breast cancer (slight), and Hepatic Adenoma. * **Coagulation:** COCPs increase Factors VII, X, and Fibrinogen, leading to a hypercoagulable state (increased VTE risk). * **Blood Pressure:** They may cause a slight increase in BP due to the stimulation of the Renin-Angiotensin-Aldosterone System (RAAS).

Q: Which of the following is seen in the infant of a diabetic mother?

Polycythemia. **Explanation:** Infants of Diabetic Mothers (IDM) face unique metabolic and physiological challenges due to maternal hyperglycemia. **Why Polycythemia is the correct answer:** Maternal hyperglycemia leads to fetal hyperglycemia, which stimulates fetal insulin production (hyperinsulinism). This hypermetabolic state increases fetal oxygen consumption, leading to **fetal hypoxemia**. In response to chronic hypoxia, fetal erythropoietin levels rise, stimulating the bone marrow to produce more red blood cells, resulting in **polycythemia** (Hematocrit >65%). This can lead to hyperviscosity, vascular thrombosis, and hyperbilirubinemia as the excess cells break down. **Analysis of Incorrect Options:** * **A. Hyperkalemia:** IDMs are more prone to **hypokalemia**, often secondary to insulin-driven shifts of potassium into cells or associated with neonatal respiratory distress. * **B. Hypercalcemia:** IDMs typically experience **hypocalcemia** (usually within the first 24–72 hours). This is attributed to delayed parathyroid hormone synthesis and functional hypoparathyroidism, often exacerbated by maternal magnesium loss leading to fetal hypomagnesemia. * **C. Macrocytic anemia:** As explained above, these infants present with **polycythemia**, not anemia. If anemia occurs, it is usually a late complication of hemolysis or blood loss, but it is not a classic feature of IDM. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cardiac anomaly:** Ventricular Septal Defect (VSD). * **Most specific cardiac anomaly:** Transposition of Great Arteries (TGA). * **Most characteristic anomaly:** Caudal Regression Syndrome (Sacral Agenesis). * **Metabolic Profile:** Hypoglycemia (most common), Hypocalcemia, Hypomagnesemia, and Hyperbilirubinemia. * **Respiratory:** Increased risk of Respiratory Distress Syndrome (RDS) because hyperinsulinism inhibits surfactant production by interfering with cortisol action.

Q: What is the primary mechanism of action of the progestogen-only pill?

Increases cervical mucus viscosity. **Explanation:** The **Progestogen-Only Pill (POP)**, also known as the "mini-pill," primarily functions by altering the female reproductive tract environment rather than consistently suppressing the hypothalamic-pituitary-ovarian axis. **1. Why Option A is Correct:** The primary and most consistent mechanism of action of POPs is **increasing the viscosity and thickness of cervical mucus**. Under the influence of continuous low-dose progestogen, the mucus becomes scanty, thick, and cellular. This creates a "hostile" environment that acts as a physical barrier, preventing sperm penetration into the upper reproductive tract. **2. Why Other Options are Incorrect:** * **Option B (Inhibits ovulation):** While POPs can suppress ovulation in some cycles (approximately 40–60% of the time), it is **not** the primary or reliable mechanism. In contrast, the Combined Oral Contraceptive Pill (COCP) primarily works by inhibiting ovulation via FSH and LH suppression. * **Option C (Antispermicidal effects):** POPs do not contain spermicidal agents. They hinder sperm transport through mechanical (mucus) and functional (endometrial/tubal) changes rather than direct chemical destruction of sperm. **3. High-Yield Clinical Pearls for NEET-PG:** * **Secondary Mechanisms:** POPs also cause endometrial thinning (making it unfavorable for implantation) and alter fallopian tube motility. * **The "3-Hour Rule":** Traditional POPs have a very short half-life; if a dose is delayed by more than **3 hours**, contraceptive efficacy is significantly reduced. * **Ideal Candidates:** POPs are the contraceptive of choice for **lactating mothers** (as they do not affect milk quantity/quality) and women in whom estrogen is contraindicated (e.g., history of VTE, smokers >35 years, or migraine with aura). * **Side Effects:** The most common side effect is **irregular menstrual bleeding** or spotting.

Question 1

Which of the following is a contraindication for the use of oral contraceptive pills?

Accepted Answer

Liver disease

Answer

Pelvic inflammatory disease

Answer

Renal disease

Answer

Epilepsy

Question 2

What is the 'Pearl-index' for accidental pregnancies failure per?

Accepted Answer

100 women-years of exposure

Answer

10 women-years of exposure

Answer

12 women-years of exposure

Answer

120 women-years of exposure

Question 3

Which of the following can cause decreased or impaired ovulation?

Accepted Answer

All of the above

Answer

Minipill (progesterone-only pill)

Answer

Intrauterine contraceptive device (IUCD)

Answer

Norplant

Question 4

Mifepristone (RU-486) is:

Accepted Answer

Anti-progestin

Answer

Anti-androgen

Answer

Anti-estrogen

Answer

Androgen

Question 5

A young lady can be counselled for sterilization operation in all circumstances except?

Accepted Answer

A woman having no or few children

Answer

A woman with HIV, whether on antiretroviral therapy or not

Answer

When the husband's consent is present

Answer

A lactating woman over 25 years of age

Question 6

Which contraceptive method is contraindicated in an HIV-positive patient?

Accepted Answer

Intrauterine contraceptive device (IUCD)

Answer

Combined oral contraceptive pills (COC pills)

Answer

Minipill

Answer

Barrier methods

Question 7

Use of oral contraceptive pills decreases which of the following?

Accepted Answer

Glucose tolerance

Answer

Binding globulins

Answer

High-density lipoprotein (HDL) cholesterol

Answer

Triglycerides

Question 8

Which of the following is seen in the infant of a diabetic mother?

Accepted Answer

Polycythemia

Answer

Hyperkalemia

Answer

Hypercalcemia

Answer

Macrocytic anemia

Question 9

What is the primary mechanism of action of the progestogen-only pill?

Accepted Answer

Increases cervical mucus viscosity

Answer

Inhibits ovulation

Answer

Has antispermicidal effects

Answer

None of the above

Question 10

A patient with poorly compensated cardiac disease, who has delivered 2 days ago, should be advised to:

Accepted Answer

Suggest her husband undergo vasectomy

Answer

Undergo sterilization (tubectomy) after 1 week

Answer

Undergo sterilization after 6 weeks

Answer

Take oral contraceptive pills after 6 months

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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