Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 521: Which of the following are emergency contraceptive drugs?

A. Levonorgestrel
B. Estrogen + progesterone
C. Mifepristone
D. All of the above (Correct Answer)

Explanation: **Explanation:** Emergency contraception (EC) is used to prevent pregnancy after unprotected intercourse or contraceptive failure. The correct answer is **"All of the above"** because various hormonal regimens and anti-progestogens are clinically effective for this purpose. 1. **Levonorgestrel (Option A):** This is the most commonly used EC (e.g., Pill 72). It works primarily by delaying or inhibiting ovulation. The standard dose is **1.5 mg** as a single dose (or two doses of 0.75 mg, 12 hours apart) taken within 72 hours. 2. **Estrogen + Progesterone (Option B):** Known as the **Yuzpe Regimen**, this involves taking high doses of combined oral contraceptive pills (100 mcg Ethinyl Estradiol + 0.5 mg Levonorgestrel, repeated after 12 hours). While effective, it is less preferred today due to high rates of nausea and vomiting compared to LNG-only pills. 3. **Mifepristone (Option C):** A selective progesterone receptor modulator (SPRM). In low doses (**10–25 mg**), it is highly effective as an EC by preventing ovulation and altering the endometrium. (Note: Higher doses of 200–600 mg are used for medical abortion). **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard/Most Effective EC:** The **Copper T 380A (IUCD)** is the most effective emergency contraceptive if inserted within 5 days (120 hours) of unprotected intercourse. * **Ulipristal Acetate (30 mg):** Currently considered the most effective *oral* EC, effective up to 120 hours (5 days). * **Timeframe:** While most oral ECs are licensed for 72 hours, they can be used off-label up to 120 hours, though efficacy decreases over time. * **Mechanism:** ECs prevent pregnancy; they are **not abortifacients** as they do not work once implantation has occurred.

Question 522: Progestasert needs to be replaced after how much time?

A. 1 year (Correct Answer)
B. 5 years
C. 3 years
D. 6 months

Explanation: **Explanation:** **Progestasert** is a first-generation hormone-releasing intrauterine device (IUCD). It is a T-shaped device that contains a reservoir of **38 mg of Progesterone**, which is released at a rate of **65 µg per day**. 1. **Why 1 Year is Correct:** The daily release of 65 µg of progesterone is relatively high compared to the total reservoir capacity. Consequently, the hormone supply is exhausted within approximately 12 to 14 months. To ensure contraceptive efficacy and prevent breakthrough bleeding or unintended pregnancy, it must be replaced strictly **every 1 year**. 2. **Why Other Options are Incorrect:** * **5 Years:** This is the lifespan of the **Mirena (LNG-IUS)**, which contains 52 mg of Levonorgestrel and releases it at a slower, more sustained rate (initially 20 µg/day). * **3 Years:** This is the lifespan of newer LNG-IUS variants like **Jaydess** or the contraceptive implant **Nexplanon**. * **6 Months:** No standard IUCD requires replacement as frequently as 6 months; this would be clinically impractical. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Progestasert works primarily by making the endometrium unfavorable for implantation, thickening cervical mucus, and inducing ciliary dysfunction in the fallopian tubes. * **Comparison:** Unlike Mirena (which uses Levonorgestrel), Progestasert uses **natural progesterone**. * **Side Effects:** The most common reason for removal is irregular uterine bleeding and intermenstrual spotting. * **Current Status:** Progestasert is largely obsolete in many markets, having been replaced by the more long-acting LNG-IUS (Mirena), but it remains a classic "fact-based" question for competitive exams.

Question 523: Which of the following is an intrauterine contraceptive device?

A. CuT 200
B. Multiload 375 (Correct Answer)
C. CuT 380A
D. LNG-IUS

Explanation: **Explanation:** The question asks to identify a specific intrauterine contraceptive device (IUCD) from the given options. While all options listed are technically types of IUCDs, in the context of standard medical examinations, this question often tests the classification of **Second-generation vs. Third-generation** devices or specific branding. **Why Multiload 375 is the correct answer:** The **Multiload 375 (MLCu-375)** is a classic example of a **Second-generation Copper IUCD**. It features a flexible polyethylene frame with two flexible arms containing serrations that help anchor the device high in the uterine fundus, reducing the risk of expulsion. It has a surface area of 375 $mm^2$ of copper wire and an effective life of **5 years**. **Analysis of Incorrect Options:** * **CuT 200:** This is an older, first-generation copper device with a smaller surface area (200 $mm^2$). It is largely obsolete in modern clinical practice due to higher failure rates compared to newer models. * **CuT 380A:** While this is a highly effective second-generation IUCD (the "Gold Standard"), it is often categorized separately in exams as the "long-acting" copper T (effective for **10 years**). * **LNG-IUS (Mirena):** This is a **Third-generation IUCD** (Hormonal). It releases levonorgestrel and is primarily used not just for contraception but also for treating Menorrhagia and Endometriosis. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Time for Insertion:** Within 10 days of the beginning of the menstrual cycle (to ensure the patient is not pregnant and the cervix is slightly dilated). * **Mechanism of Action:** Copper IUCDs cause a sterile inflammatory response in the endometrium and are **spermicidal**. * **Most Common Side Effect:** Excessive menstrual bleeding (Menorrhagia). * **Most Common Reason for Removal:** Pain and bleeding. * **Post-Coital Contraception:** CuT 380A is the most effective method of emergency contraception if inserted within 5 days of unprotected intercourse.

Question 524: Replacement of etonogestrel implant is normally done after how many years?

A. 2 years
B. 3 years (Correct Answer)
C. 4 years
D. 5 years

Explanation: **Explanation:** The etonogestrel implant (commonly known by the brand names **Nexplanon** or **Implanon**) is a long-acting reversible contraceptive (LARC). It consists of a single, non-biodegradable rod that is inserted subdermally in the inner upper arm. **Why Option B is correct:** The implant contains **68 mg of etonogestrel** (a progestin). It works primarily by suppressing ovulation and thickening cervical mucus. It is FDA-approved and clinically validated for a duration of **3 years**. After this period, the hormone release rate declines below the threshold required for consistent contraceptive efficacy, necessitating replacement. **Analysis of Incorrect Options:** * **Option A (2 years):** This is too short; the device maintains high efficacy well beyond this timeframe. * **Option C (4 years):** While some studies suggest efficacy may extend into the fourth year, the standard clinical recommendation and manufacturer guidelines remain 3 years. * **Option D (5 years):** This is the duration for the **Levonorgestrel-releasing intrauterine system (LNG-IUS 52mg/Mirena)** or the older **Jadelle** (two-rod) implant system. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Primarily inhibits ovulation (suppresses LH surge). * **Failure Rate:** It is the most effective form of reversible contraception (Pearl Index ~0.05), even more effective than vasectomy or tubal ligation. * **Side Effect:** The most common reason for discontinuation is **irregular/unpredictable menstrual bleeding**. * **Radiopacity:** Nexplanon is radiopaque (visible on X-ray), whereas the older Implanon was not. * **Quick Return to Fertility:** Ovulation typically resumes within 3–4 weeks after removal.

Question 525: At what week of gestation can anencephaly be accurately diagnosed by ultrasound?

A. 6 weeks of gestation
B. 8 weeks of gestation
C. 10 weeks of gestation
D. 14 weeks of gestation (Correct Answer)

Explanation: **Explanation:** Anencephaly is a lethal neural tube defect characterized by the absence of the cranial vault (acrania) and the cerebral hemispheres. The correct answer is **14 weeks of gestation** because the diagnosis relies on the failure of the fetal skull bones to ossify. 1. **Why 14 weeks is correct:** While the precursor to anencephaly (exencephaly) begins earlier, the **ossification of the fetal calvarium** (skull vault) is only reliably complete and visible on ultrasound by the end of the first trimester (12–14 weeks). Before this period, the lack of mineralization makes it difficult to distinguish a normal skull from a defective one. By 14 weeks, the "frog-eye appearance" (due to absent frontal bone and prominent orbits) becomes diagnostic. 2. **Why other options are incorrect:** * **6 weeks:** At this stage, the embryo is just developing a heartbeat; the head is not yet distinct enough for structural evaluation. * **8–10 weeks:** Although the rhombencephalon (a normal cystic space in the hindbrain) is visible, the skull vault has not yet ossified. Diagnosing anencephaly this early carries a high risk of false positives. **High-Yield Clinical Pearls for NEET-PG:** * **Screening:** Maternal Serum Alpha-Fetoprotein (MSAFP) is significantly **elevated** in open neural tube defects like anencephaly. * **Ultrasound Signs:** Look for the **"Frog-eye appearance"** or **"Mickey Mouse sign"** (in the exencephaly stage). * **Associated Condition:** Polyhydramnios is common in the third trimester due to the fetus's inability to swallow amniotic fluid. * **Management:** Since it is a lethal anomaly, termination of pregnancy is offered regardless of the gestational age.

Question 526: What is the ideal contraceptive for a couple living in different cities who meet only occasionally?

A. Barrier method (Correct Answer)
B. Intrauterine contraceptive device (IUCD)
C. Oral contraceptive pill (OCP)
D. DMPA (Depot medroxyprogesterone acetate)

Explanation: **Explanation:** The choice of contraceptive method depends heavily on the frequency of intercourse and the lifestyle of the couple. For a couple living in different cities who meet only occasionally, the **Barrier method (Condoms)** is the ideal choice. **1. Why Barrier Method is Correct:** The primary medical concept here is **"Coitus-dependent contraception."** Since the couple meets infrequently, they do not require continuous systemic hormonal levels or semi-permanent devices. Barrier methods are used only during the act of intercourse, avoiding unnecessary side effects of long-term medications. Additionally, they provide protection against Sexually Transmitted Infections (STIs), which is a crucial consideration for couples living apart. **2. Why Other Options are Incorrect:** * **IUCD (Option B):** These are Long-Acting Reversible Contraceptives (LARC). While highly effective, they are generally preferred for couples seeking long-term spacing (3–10 years) who have frequent intercourse. * **OCP (Option C):** These require strict daily compliance. Taking a daily systemic hormone for a couple that meets only once every few months is considered unnecessary hormonal exposure. * **DMPA (Option D):** This is an injectable contraceptive given every 3 months. Like OCPs, it provides continuous systemic suppression of ovulation, which is not "need-based" for occasional contact. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Contraceptive for Newly Married:** OCPs (Centchroman/Chhaya is also a popular choice in India). * **Ideal Contraceptive for Lactating Mothers:** Progestogen-only pills (POPs) or Lactational Amenorrhea Method (LAM) for the first 6 months. * **Pearl Index:** Condoms have a higher failure rate (typical use) compared to IUCDs/OCPs, but they are the only method that prevents STIs. * **Emergency Contraception:** Should be advised as a backup for this couple in case of barrier failure (condom rupture).

Question 527: All of the following are contraceptive implants except?

A. Norplant
B. Implanon
C. Jadelle
D. Mesigyna (Correct Answer)

Explanation: **Explanation:** The correct answer is **D. Mesigyna**. **1. Why Mesigyna is the correct answer:** Mesigyna is a **Combined Injectable Contraceptive (CIC)**, not an implant. It contains an estrogen (Estradiol valerate 5 mg) and a progestogen (Norethisterone enanthate 50 mg). It is administered intramuscularly once every month. In contrast, contraceptive implants are sub-dermal devices that provide long-term reversible contraception (LARC). **2. Analysis of incorrect options (Implants):** * **Norplant:** The first-generation implant system. It consists of **6 silastic capsules** containing Levonorgestrel (LNG), effective for 5 years. * **Jadelle:** A second-generation implant (often called Norplant-2). It consists of **2 rods** containing Levonorgestrel, effective for 5 years. It is easier to insert and remove than Norplant. * **Implanon:** A third-generation, **single-rod** implant containing Etonogestrel (68 mg). It is effective for 3 years. (Note: Nexplanon is the newer, radiopaque version of Implanon). **3. NEET-PG High-Yield Pearls:** * **Mechanism of Action (Implants):** Primarily work by suppressing ovulation and thickening cervical mucus. * **Most Common Side Effect:** The most frequent reason for discontinuation of implants is **irregular menstrual bleeding** (amenorrhea or spotting). * **Failure Rate:** Implants have the lowest failure rate among all contraceptive methods (Pearl Index ~0.05), making them more effective than permanent sterilization. * **Anticonvulsants:** Enzyme-inducing drugs (e.g., Phenytoin, Carbamazepine) can decrease the efficacy of hormonal implants.

Question 528: What is the rate of release of levonorgestrel into the uterus from Mirena, a progestin-releasing intrauterine device?

A. 20 mcg/day (Correct Answer)
B. 30 mcg/day
C. 50 mcg/day
D. 70 mcg/day

Explanation: **Explanation:** **Mirena** is a Levonorgestrel-releasing Intrauterine System (LNG-IUS) that contains a total of 52 mg of Levonorgestrel. The correct answer is **20 mcg/day** because this is the initial steady-state release rate of the hormone into the uterine cavity. This local release causes endometrial thickening, cervical mucus changes, and inhibition of sperm motility, providing highly effective contraception for up to 5–8 years. **Analysis of Options:** * **A (20 mcg/day):** This is the standard initial release rate for Mirena. Over time, this rate gradually declines (reaching approximately 10 mcg/day after 5 years), but 20 mcg/day is the definitive value tested in exams. * **B (30 mcg/day):** This value does not correspond to any standard LNG-IUS. Progestin-only pills (Minipills) like Levonorgestrel 0.03 mg contain 30 mcg, but the IUD release rate is lower. * **C & D (50 & 70 mcg/day):** These values are significantly higher than the physiological dose required for local intrauterine action and would lead to increased systemic side effects. Progestasert (an older, now obsolete IUD) released Progesterone at 65 mcg/day. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Primarily local action (endometrial atrophy); it is **not** primarily anovulatory. * **Non-contraceptive use:** It is the "Gold Standard" medical management for **Heavy Menstrual Bleeding (HMB)** and is used in Endometrial Hyperplasia. * **Other LNG-IUS:** * **Kylena:** Releases ~17.5 mcg/day (smaller frame). * **Jaydess/Skyla:** Releases ~14 mcg/day (3-year duration). * **Failure Rate:** 0.2%, comparable to tubal ligation.

Question 529: Which method has the least failure rate in sterilization?

A. Falope ring
B. Bipolar cautery
C. Unipolar cauterization (Correct Answer)
D. Hulka clip

Explanation: **Explanation:** The effectiveness of female sterilization depends on the degree of tubal destruction and the risk of recanalization or fistula formation. **Why Unipolar Cauterization is Correct:** Unipolar cauterization has the **lowest failure rate (0.23 per 1000 procedures)** among laparoscopic sterilization methods. It works by passing an electrical current through the tube to a ground plate on the patient's body. This causes extensive tissue destruction (3-5 cm of the tube) and effectively occludes the lumen through both thermal injury and fibrosis. Because it destroys a larger segment of the tube compared to mechanical methods, the chances of spontaneous recanalization are minimal. **Analysis of Incorrect Options:** * **Bipolar Cautery:** While safer than unipolar (less risk of accidental bowel burns), it is less effective because the current is restricted between the two poles of the forceps, resulting in less extensive tissue damage. * **Falope Ring (Silastic Band):** This mechanical method carries a higher failure rate than unipolar cautery (approx. 1.7%). It can slip, or the tube may undergo necrosis and re-anastomose. * **Hulka Clip (Spring-loaded Clip):** This has the **highest failure rate** among the options (approx. 3.7%). It destroys the smallest amount of tissue (only 3-4 mm), making it the most reversible but the least reliable. **High-Yield Pearls for NEET-PG:** * **Most effective overall:** Vasectomy (Male sterilization) is more effective and safer than female sterilization. * **CREST Study:** This landmark study established the long-term failure rates of various sterilization methods. * **Ectopic Pregnancy Risk:** If a woman becomes pregnant after sterilization, the risk of it being an **ectopic pregnancy** is highest with **bipolar cautery**. * **Gold Standard (Laparoscopic):** The Falope ring is the most commonly used method in mass camps in India, but Unipolar cautery remains the most effective.

Question 530: Oral contraceptive pills decrease the incidence of all of the following conditions except?

A. Salpingitis
B. Hepatic adenoma (Correct Answer)
C. Ovary CA
D. Fibroadenosis

Explanation: **Explanation:** The correct answer is **Hepatic adenoma**. Combined Oral Contraceptive Pills (COCPs) are known to have several non-contraceptive benefits; however, they are a well-documented **risk factor** for the development of hepatic adenomas (benign liver tumors). The risk increases with higher estrogen doses and prolonged duration of use. Therefore, OCPs do not decrease, but rather **increase** the incidence of this condition. **Analysis of other options:** * **Salpingitis (Pelvic Inflammatory Disease):** OCPs decrease the risk of symptomatic PID. The progestogen component thickens cervical mucus, creating a barrier that prevents the upward migration of pathogens into the fallopian tubes. * **Ovary CA:** OCPs provide significant protection against epithelial ovarian cancer by inhibiting ovulation ("ceaseless ovulation" theory). This protective effect increases with the duration of use and persists for years after discontinuation. * **Fibroadenosis (Benign Breast Disease):** OCPs are known to reduce the incidence of benign breast diseases, including fibroadenosis and fibrocystic changes, likely due to the stabilization of hormonal fluctuations. **High-Yield Clinical Pearls for NEET-PG:** * **Cancer Protection:** OCPs decrease the risk of **Ovarian** and **Endometrial** cancers (by 50%) and **Colorectal** cancer. * **Cancer Risk:** OCPs are associated with a slight increase in the risk of **Breast** and **Cervical** cancer. * **Other Benefits:** They reduce the risk of ectopic pregnancy, iron deficiency anemia (due to reduced menstrual flow), and functional ovarian cysts. * **Absolute Contraindication:** History of thromboembolism, undiagnosed vaginal bleeding, and smokers >35 years of age.

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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