Contraception and Family Planning Practice Questions

Q: Air embolism occurs in which method of abortion?

Criminal abortion. ***Criminal abortion (Correct Answer)*** - **Air embolism** is a life-threatening complication classically associated with **criminal/unsafe abortions** performed by unskilled individuals using unsanitary techniques - **Mechanism**: Air can be deliberately or accidentally introduced into the **uterine venous sinuses** through intrauterine insufflation, use of unsterile instruments, or syringe-based procedures - The air enters the systemic circulation through open venous channels in the uterus, potentially causing cardiovascular collapse and death - This is one of the most serious complications distinguishing unsafe abortion from medically supervised procedures *Spontaneous abortion (Incorrect)* - **Spontaneous abortion** (miscarriage) is a natural termination of pregnancy resulting from genetic abnormalities, hormonal imbalances, or maternal health issues - No iatrogenic intervention occurs, so air embolism is not a risk - Complications may include hemorrhage or infection, but not air embolism *Induced abortion with saline injection (Incorrect)* - **Hypertonic saline** is injected into the amniotic sac to induce fetal demise and labor - Complications include **hypernatremia, DIC, hemorrhage**, and rarely **cardiovascular shock** - The mechanism involves chemical irritation and prostaglandin release, not air introduction - Air embolism is not a characteristic complication of this method *Medical Termination of Pregnancy (Incorrect)* - **MTP** performed under safe, legal conditions uses either **medical methods** (mifepristone + misoprostol) or **surgical methods** (suction evacuation) by trained professionals - Modern techniques and protocols specifically prevent introduction of air into the uterine cavity - Conducted under sterile conditions with appropriate equipment, making air embolism extremely rare - This represents the gold standard for safe pregnancy termination

Q: Contraceptive of choice in a woman with Rheumatic heart disease.

IUCD. ***IUCD*** - **Intrauterine contraceptive devices (IUCDs)** are highly effective and do not involve systemic hormones, making them safe for women with **rheumatic heart disease**. - Both copper and hormonal IUCDs can be used, as they pose no additional risk of **thromboembolism** or worsen cardiac function. *Progesterone only pills* - While generally safer than combined oral contraceptives for women with cardiac issues, **progesterone-only pills** still carry a slight risk of **thrombosis**, especially in women with certain heart conditions. - Their effectiveness can be slightly lower than IUCDs, and adherence to strict daily timing is crucial for optimal contraception. *Condom with spermicidal jelly* - **Condoms with spermicidal jelly** are a barrier method and do not pose any direct risk to a woman with rheumatic heart disease. - However, they have a significantly **higher failure rate** compared to highly effective methods like IUCDs, making them less ideal as a primary contraceptive for a condition where pregnancy could be high-risk. *OCPs* - **Combined oral contraceptive pills (OCPs)** containing both estrogen and progestin are generally **contraindicated** in women with rheumatic heart disease, particularly those with valvular lesions or a history of **embolism**. - Estrogen increases the risk of **thromboembolic events**, which can be dangerous for individuals with compromised cardiac function.

Q: GATHER approach of counselling is used for

Contraceptives. ***Contraceptives*** - The **GATHER approach** (Greet, Ask, Tell, Help, Explain, Return) is a structured counseling model specifically designed for **family planning** and contraceptive guidance. - It ensures a comprehensive discussion that empowers individuals to make informed choices about their **contraceptive methods**. *Breaking any bad news* - Counseling for breaking bad news often utilizes models like **SPIKES (Setting, Perception, Invitation, Knowledge, Emotions, Strategy and Summary)**, which focus on empathy and managing patient reactions. - The GATHER approach is not specifically tailored for delivering difficult news, as its structure is more focused on information exchange and shared decision-making regarding a medical intervention. *Communication of breast cancer prognosis* - Communicating prognosis for serious illnesses like breast cancer requires a sensitive and nuanced approach, often integrating elements of **empathy, hope, and realistic expectations**. - While general communication skills are important, the GATHER model's steps are not specifically designed for the delicate nature of discussing a cancer prognosis. *All of the options* - The GATHER model is a specialized tool, and while its principles may overlap with good communication in general, it is not universally applicable to all counseling scenarios. - It is specifically optimized for guiding discussions and decisions related to **family planning and contraceptive use**.

Q: Which drug was traditionally used for extra-amniotic instillation in 2nd trimester medicolegal termination of pregnancy?

Ethacrydine lactate. ***Ethacrydine lactate*** - **Ethacrydine lactate** (Rivanol) is an acridine derivative that was **traditionally the agent of choice** for extra-amniotic instillation in second-trimester medical termination of pregnancy. - It is injected into the extra-amniotic space (between the chorion and uterine wall) where it acts locally to induce uterine contractions and cervical ripening. - The typical dose is 0.1% solution, 100-150 mL instilled extra-amniotically. - Though effective, it has been increasingly replaced by prostaglandins due to better safety profiles and ease of administration. *Hypertonic saline* - **Hypertonic saline** (20% NaCl) was historically used for second-trimester abortions but via **intra-amniotic injection**, NOT extra-amniotic route. - It carried significant risks including hypernatremia, disseminated intravascular coagulation (DIC), cerebral edema, and cardiovascular collapse. - Due to these severe maternal complications, it has been largely abandoned in modern practice. *Prostaglandin* - **Prostaglandins** (PGE2, PGF2α, misoprostol) are currently the **preferred agents** for second-trimester termination. - They can be administered via multiple routes including **extra-amniotic**, intra-amniotic, vaginal, oral, or sublingual. - While prostaglandins CAN be used extra-amniotically, the question asks specifically about the **traditional/classical agent** used for this route, which was ethacrydine lactate. - Modern protocols favor vaginal or oral misoprostol due to convenience and efficacy. *Glucose* - **Glucose** has no abortifacient properties and is not used for pregnancy termination. - It serves only as an energy source and has no effect on uterine contractility or cervical ripening.

Q: MTP cannot be done after:

28 weeks. ***28 weeks*** - The Medical Termination of Pregnancy (MTP) Act was amended in 2021, and the upper gestation limit for MTP was increased to **24 weeks** in special cases. However, MTP at 28 weeks' gestation is **not permitted**, as fetal viability is significantly higher, and legal restrictions are stricter. - Beyond 24 weeks, an MTP is only permitted in cases of **substantial fetal anomalies** diagnosed by a Medical Board, making 28 weeks generally non-permissible for routine MTP. *20 weeks* - The initial MTP Act of 1971 allowed MTP up to **20 weeks of gestation** with specific conditions, including a risk to the mother's life or health, or fetal abnormalities. - This limit was extended in certain circumstances by the 2021 amendment, but 20 weeks is generally within the permissible limit for MTP. *12 weeks* - MTP can be performed up to **12 weeks of gestation** based on the opinion of one registered medical practitioner under the MTP Act. - This period is considered safer and less complex for termination procedures. *24 weeks* - The MTP (Amendment) Act of 2021 expanded the gestation limit for MTP to **24 weeks** for specific categories of women, including survivors of sexual assault, minors, women with disabilities, and those with a change in marital status during pregnancy. - This limit requires the opinion of **two registered medical practitioners**.

Q: False about MTP is -

Consent of husband is must. ***Consent of husband is must*** - The **Medical Termination of Pregnancy (MTP) Act** (amended in 2021) in India explicitly states that **only the consent of the pregnant woman** is required for an abortion. - The husband's consent is **not legally necessary** and cannot be a barrier to accessing MTP services. - **This statement is FALSE**, making it the correct answer to this negation question. *Requires opinion of at least two registered medical practitioners when pregnancy exceeds 12 weeks* - This statement is **TRUE**; for pregnancies between **12 and 20 weeks**, the opinion of **two registered medical practitioners** is required. - For pregnancies between **20 and 24 weeks**, two registered medical practitioners are required for specific vulnerable categories of women. *>16 weeks, hysterotomy can be done* - **Hysterotomy** is a surgical procedure similar to a mini-C-section, used in specific cases for MTP, often in later gestations or when other methods are contraindicated. - While exact gestational limits vary by clinical judgment and local regulations, it is indeed a method considered for **later second-trimester terminations**, including those beyond 16 weeks, under proper medical indication. - **This statement is TRUE**. *Illegal if >20 weeks of pregnancy* - This statement was largely true under the **MTP Act of 1971**, which set the upper limit for MTP at 20 weeks. - However, the **MTP (Amendment) Act of 2021** has expanded this limit, allowing termination up to **24 weeks for specific categories of women** and in cases of substantial fetal abnormalities, there is **no upper gestational limit** for termination. - **This statement is now FALSE** as per the 2021 amendments, though it requires contextual understanding.

Q: Which of the following is NOT used as an emergency contraceptive?

Danazol. ***Danazol*** - **Danazol** is an **androgen derivative** primarily used to treat **endometriosis** and **fibrocystic breast disease**, not for emergency contraception. - Its mechanism involves suppressing **ovarian function** and creating an anovulatory state, which is not suitable for immediate post-coital intervention. *RU 486* - **RU 486 (Mifepristone)** is a **progesterone receptor modulator** that can be used as an emergency contraceptive, especially at higher doses. - It acts by **blocking progesterone receptors**, preventing implantation or inducing abortion if pregnancy has already occurred. *Copper T* - The **Copper T (intrauterine device - IUD)** is a highly effective method of emergency contraception if inserted within 5 days of unprotected intercourse. - It works by causing a **spermicidal effect** and preventing fertilization or implantation by inducing an inflammatory reaction in the uterus. *OCpill* - **OCPills (oral contraceptive pills)**, usually a combination of estrogen and progestin, can be used as emergency contraception when taken in higher doses. - This method, known as the **Yuzpe regimen**, involves taking two doses of combined oral contraceptives within 72 hours of unprotected intercourse to inhibit ovulation or fertilization.

Q: A 32-year-old P2L2 presents with heavy menstrual bleeding. Ultrasound shows 3cm intramural fibroid. Which management option is associated with the highest long-term patient satisfaction?

Levonorgestrel IUD. ***Levonorgestrel IUD*** - The **levonorgestrel IUD** is highly effective in reducing menstrual blood loss and is associated with high long-term satisfaction due to its continuous, localized hormone release and minimal systemic side effects. - It offers contraception and therapeutic benefits for up to 5 years, making it a convenient and durable solution for **heavy menstrual bleeding** (HMB) caused by fibroids. *Tranexamic acid* - **Tranexamic acid** is an antifibrinolytic agent that reduces menstrual blood loss by inhibiting clot breakdown. - While effective for acute heavy bleeding, it does not address the underlying cause (fibroid) and requires administration during each menstrual cycle, leading to lower long-term satisfaction. *GnRH analogues* - **GnRH analogues** induce a temporary menopausal state, effectively reducing fibroid size and menstrual bleeding. - However, their long-term use is limited by significant side effects (e.g., hot flashes, bone loss) and recurrence of symptoms once treatment is stopped, leading to lower long-term satisfaction. *Oral contraceptive pills* - **Oral contraceptive pills** can reduce menstrual bleeding by thinning the endometrial lining and regulating cycles. - They require daily adherence and may have systemic side effects, which can contribute to lower long-term satisfaction compared to the sustained effect of an IUD.

Q: A 16-year-old girl, not sexually active, came for vaccination against cervical cancer. Which vaccine should be given?

Gardasil. ***Gardasil*** - **Gardasil** is a **quadrivalent HPV vaccine** approved for the prevention of **cervical cancer** caused by HPV types 6, 11, 16, and 18 - It is recommended for adolescents, typically between ages **9-14 years**, ideally before potential exposure to HPV through sexual activity - **For a 16-year-old not sexually active**, Gardasil is the appropriate choice among the given options for cervical cancer prevention - The vaccine provides protection against both high-risk oncogenic HPV types (16, 18) and low-risk types (6, 11) that cause genital warts *Biovac* - **Biovac** is not a recognized or widely used vaccine for cervical cancer prevention - This option serves as a distractor without specific medical vaccine correlation in the context of HPV immunization *Rubavac* - **Rubavac** is a vaccine specifically designed to protect against the **rubella virus** (German measles) - It is part of routine childhood immunization, usually given as part of the **MMR vaccine (measles, mumps, rubella)** - Has no role in cervical cancer prevention *Tdap* - **Tdap** is a combination vaccine that protects against **tetanus, diphtheria, and pertussis (whooping cough)** - Given as a booster for adolescents and adults to maintain immunity against these bacterial infections - Has no role in cervical cancer prevention

Question 1

Air embolism occurs in which method of abortion?

Accepted Answer

Criminal abortion

Answer

Spontaneous abortion

Answer

Induced abortion with saline injection

Answer

Medical Termination of pregnancy

Question 2

Contraceptive of choice in a woman with Rheumatic heart disease.

Accepted Answer

IUCD

Answer

Progesterone only pills

Answer

Condom with spermicidal jelly

Answer

OCPs

Question 3

GATHER approach of counselling is used for

Accepted Answer

Contraceptives

Answer

Breaking any bad news

Answer

Communication of breast cancer prognosis

Answer

All of the options

Question 4

Which drug was traditionally used for extra-amniotic instillation in 2nd trimester medicolegal termination of pregnancy?

Accepted Answer

Ethacrydine lactate

Answer

Hypertonic saline

Answer

Prostaglandin

Answer

Glucose

Question 5

MTP cannot be done after:

Accepted Answer

28 weeks

Answer

20 weeks

Answer

12 weeks

Answer

24 weeks

Question 6

False about MTP is -

Accepted Answer

Consent of husband is must

Answer

Requires opinion of at least two registered medical practitioners when pregnancy exceeds 12 weeks

Answer

>16 weeks, hysterotomy can be done

Answer

Illegal if >20 weeks of pregnancy

Question 7

Which of the following is NOT used as an emergency contraceptive?

Accepted Answer

Danazol

Answer

RU 486

Answer

Copper T

Answer

OCpill

Question 8

Which of the following cannot be used as Post-coital contraceptive?

Accepted Answer

A drug primarily used for endometriosis and fibrocystic breast disease (e.g., Danazol)

Answer

A device that prevents fertilization and implantation (e.g., CuT 200)

Answer

A hormonal method that disrupts ovulation (e.g., high-dose estrogens)

Answer

A progesterone receptor blocker used within 72 hours (e.g., RU 486)

Question 9

A 32-year-old P2L2 presents with heavy menstrual bleeding. Ultrasound shows 3cm intramural fibroid. Which management option is associated with the highest long-term patient satisfaction?

Accepted Answer

Levonorgestrel IUD

Answer

Tranexamic acid

Answer

GnRH analogues

Answer

Oral contraceptive pills

Question 10

A 16-year-old girl, not sexually active, came for vaccination against cervical cancer. Which vaccine should be given?

Accepted Answer

Gardasil

Answer

Biovac

Answer

Rubavac

Answer

Tdap

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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