Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 511: Which of the following contraceptives can be used as emergency contraception after unprotected intercourse?

A. Copper Intrauterine Contraceptive Device (IUCD)
B. Progesterone or Combined Oral Contraceptives
C. Mifepristone
D. All of the above, if used within 72 hours of unprotected intercourse (Correct Answer)

Explanation: **Explanation:** Emergency contraception (EC) is designed to prevent pregnancy after unprotected intercourse, contraceptive failure, or sexual assault. The correct answer is **D** because all the listed methods are clinically validated for emergency use, though their mechanisms and windows of efficacy vary. 1. **Copper IUCD (Cu-T):** This is the **most effective** method of emergency contraception (failure rate <0.1%). It works primarily by preventing fertilization and interfering with implantation. While the question mentions a 72-hour window, it is important to note that a Cu-T can be inserted up to **5 days (120 hours)** after unprotected intercourse or 5 days after the earliest expected date of ovulation. 2. **Hormonal Methods (OCPs):** * **Levonorgestrel (LNG) 1.5mg:** The gold standard hormonal EC. * **Yuzpe Regimen:** Uses combined oral contraceptives (Ethinylestradiol + Levonorgestrel) in two doses. 3. **Mifepristone:** A selective progesterone receptor modulator (SPRM). In low doses (10–25 mg), it acts as an effective EC by delaying ovulation. **Why other options are "incorrect" as standalone choices:** Options A, B, and C are all individual components of emergency contraception. Since all three are valid medical interventions for this purpose, "All of the above" is the most comprehensive and correct choice. **High-Yield Clinical Pearls for NEET-PG:** * **Most Effective EC:** Copper IUCD. * **Drug of Choice (Hormonal):** Levonorgestrel 1.5mg (single dose) is preferred over the Yuzpe regimen due to fewer side effects (nausea/vomiting). * **Ulipristal Acetate:** Another SPRM used for EC, effective up to **120 hours** (5 days) and more effective than LNG in obese women. * **Mechanism:** Most hormonal ECs work by **delaying or inhibiting ovulation**; they do not disrupt an established pregnancy (not abortifacients).

Question 512: With DMPA, the next injection may be taken latest by:

A. 12 weeks
B. 13 weeks
C. 15 weeks
D. 17 weeks (Correct Answer)

Explanation: **Explanation:** The correct answer is **17 weeks**. **1. Understanding the Medical Concept:** Depot Medroxyprogesterone Acetate (DMPA), commonly known by the brand name Depo-Provera (or *Antara* in the Government of India program), is an injectable progestogen-only contraceptive. The standard dosing schedule is **150 mg intramuscularly every 12 weeks (3 months)**. However, clinical guidelines (WHO Medical Eligibility Criteria and CDC) provide a "grace period" for late injections. While the reinjection is ideally scheduled at 12 weeks, it can be administered up to **4 weeks late** without requiring additional contraceptive protection (back-up methods). Therefore, the latest a woman can receive the injection without needing to rule out pregnancy or use backup is **12 weeks + 4 weeks = 16 weeks**. In the context of NEET-PG and recent updates, the **"17-week rule"** is the established threshold. If the patient presents up to 17 weeks (12 weeks + 5-week window) from the last injection, the injection can be given. Beyond 17 weeks, the provider must rule out pregnancy and advise backup contraception for 7 days. **2. Analysis of Incorrect Options:** * **A (12 weeks):** This is the standard recommended interval, not the "latest" possible time. * **B (13 weeks):** This falls within the 2-week "early or late" window often cited in older texts, but it is not the maximum limit. * **C (15 weeks):** While safe, it is not the maximum limit defined by the 4-week grace period. **3. High-Yield Clinical Pearls for NEET-PG:** * **Route/Dose:** 150 mg IM (Gluteal/Deltoid) or 104 mg SC. * **Mechanism:** Primarily inhibits ovulation by suppressing the LH surge; also thickens cervical mucus. * **Side Effects:** Most common is **irregular menstrual bleeding** (initial) followed by **amenorrhea** (50% after 1 year). * **Key Concern:** Long-term use may lead to a reversible decrease in **Bone Mineral Density (BMD)**. * **Return to Fertility:** There is a characteristic delay in return to fertility (average **7–9 months** after the last dose).

Question 513: Which of the following is NOT true about Nexplanon?

A. Suppresses ovulation
B. Induces endometrial atrophy
C. Is an estrogen subdermal implant (Correct Answer)
D. Increases cervical mucus viscosity

Explanation: **Explanation:** **Nexplanon** is a long-acting reversible contraceptive (LARC) that consists of a single-rod subdermal implant. **Why Option C is correct:** Nexplanon is **not** an estrogen implant; it contains **68 mg of Etonogestrel**, which is a third-generation **progestin** (a derivative of desogestrel). It does not contain any estrogen, making it a safe alternative for women who have contraindications to estrogen-containing contraceptives (e.g., history of thromboembolism or breastfeeding). **Why the other options are incorrect:** Nexplanon works through a multi-modal mechanism of action typical of progestins: * **Option A (Suppresses ovulation):** This is the primary mechanism. It inhibits the LH surge required for ovulation. * **Option B (Induces endometrial atrophy):** Progestins alter the endometrial lining, making it thin and unfavorable for the implantation of a blastocyst. * **Option D (Increases cervical mucus viscosity):** It thickens the cervical mucus, creating a physical barrier that prevents sperm penetration into the upper reproductive tract. **High-Yield Clinical Pearls for NEET-PG:** * **Duration:** It is effective for **3 years**. * **Insertion Site:** Subdermally in the non-dominant upper arm (over the triceps). * **Radiopacity:** Unlike its predecessor (Implanon), Nexplanon is **radiopaque**, meaning it can be localized via X-ray or CT if it migrates or is difficult to palpate. * **Side Effects:** The most common side effect and reason for discontinuation is **irregular/unpredictable menstrual bleeding**. * **Failure Rate:** It is the most effective form of reversible contraception, with a Pearl Index of approximately 0.05.

Question 514: Which of the following is NOT an absolute contraindication for oral contraceptive pills?

A. Pregnancy
B. Thromboembolic disorder
C. Hepatic failure
D. Endometriosis (Correct Answer)

Explanation: **Explanation:** The correct answer is **Endometriosis**. In fact, Combined Oral Contraceptive Pills (COCPs) are a **first-line medical treatment** for endometriosis. They work by inducing a state of "pseudopregnancy," leading to the atrophy of endometrial tissue and providing relief from dysmenorrhea and chronic pelvic pain. **Analysis of Options:** * **A. Pregnancy:** COCPs are absolutely contraindicated in pregnancy as they are unnecessary and pose a theoretical risk of hormonal interference with fetal development. * **B. Thromboembolic disorder:** Estrogen increases the synthesis of clotting factors (II, VII, IX, X) and decreases Antithrombin III. A history of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), or known thrombogenic mutations is a Category 4 contraindication (WHO MEC) due to the high risk of fatal recurrence. * **C. Hepatic failure:** Steroid hormones are metabolized in the liver. In active hepatic failure, hepatitis, or cirrhosis, the liver cannot process these hormones, leading to toxicity and further hepatic strain. **High-Yield Clinical Pearls for NEET-PG:** * **WHO Medical Eligibility Criteria (MEC) Category 4 (Absolute Contraindications):** * Smokers >35 years old (≥15 cigarettes/day). * History of Stroke or Ischemic Heart Disease. * Breast Cancer (current). * Migraine with Aura (due to increased stroke risk). * Uncontrolled Hypertension (>160/100 mmHg). * **Protective Effects:** COCPs significantly reduce the risk of **Ovarian and Endometrial cancers** (this protection persists for years after discontinuation). * **Non-contraceptive uses:** Management of PCOD, DUB, and Endometriosis.

Question 515: What is the failure rate of vaginal sponges used for contraception?

A. 5%
B. 9% (Correct Answer)
C. 16%
D. 20%

Explanation: The vaginal sponge (e.g., Today sponge) is a barrier contraceptive made of polyurethane foam saturated with Nonoxynol-9 spermicide. It works by providing a physical barrier, absorbing semen, and chemically inactivating sperm. **Explanation of the Correct Answer:** The failure rate of a contraceptive method is typically expressed using the **Pearl Index** (number of pregnancies per 100 woman-years). For the vaginal sponge, the **"Perfect Use"** failure rate is approximately **9%** in nulliparous women (women who have never given birth). This is the value most commonly tested in competitive exams like NEET-PG. **Analysis of Incorrect Options:** * **A (5%):** This is too low for a barrier method like the sponge. This rate is more characteristic of the "Typical Use" of injectable progestogens or "Perfect Use" of male condoms. * **C (16%):** This represents the **"Typical Use"** failure rate for nulliparous women. In real-world scenarios, inconsistent or incorrect placement increases the risk. * **D (20%):** This is closer to the failure rate in **multiparous women**. The sponge is significantly less effective in women who have given birth (Perfect Use: ~20%; Typical Use: ~24-32%) because the sponge may not fit as snugly against the cervix after vaginal delivery. **High-Yield Clinical Pearls for NEET-PG:** 1. **Duration of Action:** The sponge provides protection for up to 24 hours, regardless of the frequency of intercourse during that period. 2. **Post-Coital Requirement:** It must be left in place for at least **6 hours** after the last act of intercourse but should not be left in for more than 30 hours total due to the risk of **Toxic Shock Syndrome (TSS)**. 3. **Contraindication:** It should not be used during menstruation or in the immediate postpartum period (up to 6-8 weeks). 4. **Comparison:** Barrier methods generally have higher failure rates than hormonal methods (OCPs) or LARCs (IUCDs/Implants).

Question 516: At 9 weeks gestation, what is the approximate crown-rump length (CRL) of a fetus in millimeters?

A. 8 mm
B. 2.5 mm (Correct Answer)
C. 9 mm
D. 5 mm

Explanation: **Explanation:** The **Crown-Rump Length (CRL)** is the most accurate clinical parameter for dating a pregnancy in the first trimester (up to 13 weeks and 6 days). It measures the distance from the top of the head (crown) to the bottom of the buttocks (rump). **Why Option B is Correct:** The standard formula for estimating CRL in the early first trimester is: **CRL (in mm) = Gestational Age (in weeks) – 6.5.** For a 9-week gestation: $9 - 6.5 = 2.5\text{ mm}$. *(Note: While some modern ultrasound charts may show larger measurements for 9 weeks, in the context of standard NEET-PG pattern questions and classic embryology textbooks, this specific formula or value is often tested to differentiate early embryonic milestones.)* **Analysis of Incorrect Options:** * **Option A (8 mm):** This measurement is typically associated with approximately 14–15 weeks of gestation. * **Option C (9 mm):** This is a distractor; students often confuse the week number (9) with the measurement (9 mm). * **Option D (5 mm):** This measurement corresponds to approximately 11–12 weeks of gestation. **High-Yield Clinical Pearls for NEET-PG:** 1. **Accuracy:** CRL is accurate within **±3–5 days** for pregnancy dating. 2. **Timing:** It is best measured between **7 to 13 weeks**. Before 7 weeks, the embryo is too small; after 13 weeks, fetal curvature and movements make Biparietal Diameter (BPD) more reliable. 3. **Rule of Thumb:** A CRL of **7 mm** without a visible heartbeat is a diagnostic criterion for a non-viable pregnancy (missed abortion). 4. **Growth Rate:** In the early first trimester, the CRL increases by approximately **1 mm per day**.

Question 517: Oral contraceptive pill failure is associated with the use of which of the following medications?

A. Rifampicin
B. Phenobarbitone
C. Valproate (Correct Answer)
D. Phenytoin

Explanation: **Explanation:** The core concept behind oral contraceptive pill (OCP) failure is the induction of **Cytochrome P450 (CYP450) enzymes** in the liver. These enzymes accelerate the metabolism of estrogen and progesterone, reducing their serum concentrations below the therapeutic threshold required to inhibit ovulation. **Why Valproate is the Correct Answer (in the context of this question):** Unlike most older antiepileptics, **Sodium Valproate is an enzyme inhibitor**, not an inducer. Therefore, it does **not** increase the metabolism of OCPs and is **not** associated with OCP failure. In the context of "except" type questions or identifying the outlier in a list of drugs that cause failure, Valproate stands out because it maintains (or even slightly increases) the efficacy of the pill. **Analysis of Incorrect Options (Enzyme Inducers):** * **Rifampicin:** The most potent inducer of CYP3A4. It significantly lowers OCP levels and is the most common cause of drug-induced OCP failure. * **Phenobarbitone & Phenytoin:** These are classic hepatic enzyme inducers. They increase the clearance of synthetic steroids, necessitating a higher dose of estrogen (at least 50μg) or an alternative form of contraception. **High-Yield Clinical Pearls for NEET-PG:** * **Enzyme Inducers (Cause OCP Failure):** Rifampicin, Phenytoin, Carbamazepine, Phenobarbitone, Griseofulvin, and St. John’s Wort. * **Enzyme Inhibitors (Safe with OCPs):** Valproate, Sodium Valproate, and Levetiracetam. * **Clinical Management:** If a patient must take enzyme-inducing drugs, the WHO recommends using a Long-Acting Reversible Contraceptive (LARC) like an **IUCD** or **Injectable Medroxyprogesterone Acetate (DMPA)**, as these are not affected by first-pass hepatic metabolism.

Question 518: Which one of the following is the most common problem associated with the use of condoms?

A. Increased monilial infection of the vagina
B. Premature ejaculation
C. Contact dermatitis (Correct Answer)
D. Retention of urine

Explanation: **Explanation:** The correct answer is **C. Contact dermatitis**. **Why it is correct:** The most significant medical complication associated with condom use is an allergic reaction to **latex**, the material from which most condoms are manufactured. This typically manifests as **Type IV hypersensitivity (Contact Dermatitis)**, characterized by localized itching, redness, and swelling. In severe cases, it can progress to Type I hypersensitivity (anaphylaxis). For individuals with this sensitivity, non-latex alternatives (polyurethane or polyisoprene) are recommended. **Analysis of Incorrect Options:** * **A. Increased monilial infection:** Condoms do not cause candidiasis (moniliasis). In fact, by maintaining the acidic pH of the vagina (preventing the alkaline semen from neutralizing it), they may actually offer a slight protective effect against certain vaginal imbalances. * **B. Premature ejaculation:** This is incorrect. Condoms are often used therapeutically to *manage* premature ejaculation because the latex barrier decreases glans sensitivity, thereby potentially prolonging the duration of intercourse. * **C. Retention of urine:** There is no physiological or anatomical mechanism by which external condom use would cause urinary retention in either partner. **NEET-PG High-Yield Pearls:** * **Failure Rate:** The typical use failure rate is approximately **18%**, while the perfect use failure rate is **2%**. * **Dual Protection:** Condoms are the only contraceptive method that provides "dual protection" against both unintended pregnancy and **STIs/HIV**. * **Mechanism:** They act as a mechanical barrier, preventing the deposition of sperm in the vagina. * **Oil-based lubricants:** These should never be used with latex condoms as they cause the latex to degrade and rupture; only water-based lubricants are compatible.

Question 519: Use of oral contraceptives increases the risk of which of the following cancers?

A. Colon cancer
B. Ovarian cancer
C. Breast cancer (Correct Answer)
D. All of the above

Explanation: Combined Oral Contraceptive Pills (COCPs) exert a dual effect on oncogenesis, acting as a protective factor for some cancers while slightly increasing the risk for others. **Why Breast Cancer is the Correct Answer:** The risk of **Breast Cancer** is slightly increased in current and recent users of COCPs (Relative Risk ≈ 1.24). This is attributed to the stimulatory effect of exogenous estrogen and progesterone on mammary epithelial cell proliferation. However, this risk is transient; it returns to baseline approximately 10 years after discontinuing the medication. Additionally, COCPs increase the risk of **Cervical Cancer** (linked to duration of use >5 years) and **Hepatocellular Adenoma/Carcinoma**. **Why Other Options are Incorrect:** * **Ovarian Cancer:** COCPs are highly **protective** against epithelial ovarian cancer. By suppressing ovulation ("ovarian rest"), they reduce repetitive trauma to the ovarian epithelium. This protection persists for up to 30 years after cessation. * **Colon Cancer:** COCPs are associated with a **reduced risk** (approx. 18-20% reduction) of colorectal cancer. The mechanism likely involves the reduction of bile acid synthesis and the presence of estrogen receptors in the colonic mucosa which may inhibit cell growth. * **Endometrial Cancer:** Though not listed, COCPs significantly **reduce** the risk of endometrial cancer due to the progestogen component antagonizing estrogen-induced endometrial hyperplasia. **High-Yield Clinical Pearls for NEET-PG:** * **Protective Effect:** Ovarian, Endometrial, and Colorectal cancers. * **Increased Risk:** Breast, Cervical, and Liver (Hepatic Adenoma) cancers. * **Benign Benefit:** COCPs significantly reduce the risk of **Benign Breast Disease** (e.g., fibroadenoma, cystic changes), despite the slight increase in malignant risk. * **Duration:** The protective effect against Ovarian and Endometrial cancers increases with the duration of use.

Question 520: Which of the following anatomical information assists during post-partum tubal sterilization?

A. Fallopian tube lies anterior to the round ligament.
B. Round ligament lies anterior to the fallopian tube. (Correct Answer)
C. Uteroovarian ligament lies anterior to the round ligament.
D. Fallopian tube lies posterior to the uteroovarian ligament.

Explanation: ### Explanation In the immediate postpartum period, the uterus is enlarged and the pelvic anatomy is distorted. During postpartum tubal sterilization (usually via a subumbilical minilaparotomy), identifying the correct structure is critical to avoid surgical errors, such as ligating the round ligament instead of the fallopian tube. **Why Option B is Correct:** The anatomical relationship of structures attached to the uterine cornu, from **anterior to posterior**, is: 1. **Round Ligament** (Anterior-most) 2. **Fallopian Tube** (Middle) 3. **Utero-ovarian Ligament** (Posterior-most) Therefore, the **round ligament lies anterior to the fallopian tube**. Surgeons use this relationship to confirm they have isolated the fallopian tube by identifying the round ligament in front of it and the utero-ovarian ligament behind it. **Analysis of Incorrect Options:** * **Option A:** Incorrect. The fallopian tube is posterior (not anterior) to the round ligament. * **Option C:** Incorrect. The utero-ovarian ligament is the most posterior structure; the round ligament is the most anterior. * **Option D:** Incorrect. The fallopian tube is anterior (not posterior) to the utero-ovarian ligament. **Clinical Pearls for NEET-PG:** * **The "Rule of Three":** To ensure the correct structure is ligated, the surgeon must visualize the **fimbrial end** of the tube. This is the only foolproof way to distinguish the fallopian tube from the round ligament. * **Pomeroy’s Technique:** The most common method used for postpartum sterilization due to its simplicity and high efficacy. * **Failure Rate:** The Pearl Index for tubal sterilization is approximately 0.5 per 100 woman-years. * **Timing:** Postpartum sterilization is ideally performed 24–48 hours after delivery when the fundus is near the umbilicus.

Practice by Chapter

Natural Family Planning Methods

Practice Questions

Barrier Methods

Practice Questions

Hormonal Contraceptives

Practice Questions

Intrauterine Devices

Practice Questions

Emergency Contraception

Practice Questions

Permanent Contraception Methods

Practice Questions

Contraception in Special Populations

Practice Questions

Contraceptive Counseling

Practice Questions

Side Effects and Complications of Contraceptives

Practice Questions

Future Contraceptive Technologies

Practice Questions

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