Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 641: Air embolism occurs in which method of abortion?

A. Criminal abortion (Correct Answer)
B. Spontaneous abortion
C. Induced abortion with saline injection
D. Medical Termination of pregnancy

Explanation: ***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

Question 642: Contraceptive of choice in a woman with Rheumatic heart disease.

A. Progesterone only pills
B. IUCD (Correct Answer)
C. Condom with spermicidal jelly
D. OCPs

Explanation: ***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.

Question 643: GATHER approach of counselling is used for

A. Breaking any bad news
B. Communication of breast cancer prognosis
C. Contraceptives (Correct Answer)
D. All of the options

Explanation: ***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**.

Question 644: Which drug was traditionally used for extra-amniotic instillation in 2nd trimester medicolegal termination of pregnancy?

A. Ethacrydine lactate (Correct Answer)
B. Hypertonic saline
C. Prostaglandin
D. Glucose

Explanation: ***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.

Question 645: MTP cannot be done after:

A. 20 weeks
B. 28 weeks (Correct Answer)
C. 12 weeks
D. 24 weeks

Explanation: ***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**.

Question 646: False about MTP is -

A. Requires opinion of at least two registered medical practitioners when pregnancy exceeds 12 weeks
B. Consent of husband is must (Correct Answer)
C. >16 weeks, hysterotomy can be done
D. Illegal if >20 weeks of pregnancy

Explanation: ***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.

Question 647: Which of the following is NOT used as an emergency contraceptive?

A. RU 486
B. Danazol (Correct Answer)
C. Copper T
D. OCpill

Explanation: ***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.

Question 648: Which of the following cannot be used as Post-coital contraceptive?

A. A device that prevents fertilization and implantation (e.g., CuT 200)
B. A hormonal method that disrupts ovulation (e.g., high-dose estrogens)
C. A drug primarily used for endometriosis and fibrocystic breast disease (e.g., Danazol) (Correct Answer)
D. A progesterone receptor blocker used within 72 hours (e.g., RU 486)

Explanation: ***A drug primarily used for endometriosis and fibrocystic breast disease (e.g., Danazol)*** - **Danazol** is an **androgen derivative** primarily used to treat endometriosis and fibrocystic breast disease due to its *anti-estrogenic* and *anti-progestational* effects. - It does not have a primary role as a **post-coital contraceptive** and is not approved for this indication. *A device that prevents fertilization and implantation (e.g., CuT 200)* - The **CuT 200 (copper T intrauterine device)** can be inserted as an **emergency contraceptive** within five days of unprotected intercourse. - It works by causing a **spermicidal effect** within the uterus and preventing implantation if fertilization occurs. *A hormonal method that disrupts ovulation (e.g., high-dose estrogens)* - High-dose **estrogens alone** or in combination with progesterone can be used as **emergency contraception** (e.g., the Yuzpe method). - These hormones disrupt the hormonal cascade necessary for **ovulation** or alter the endometrial lining to prevent implantation. *A progesterone receptor blocker used within 72 hours (e.g., RU 486)* - **RU 486 (Mifepristone)** is a **progesterone receptor blocker** that can be used as an emergency contraceptive within 72 (or sometimes up to 120) hours of unprotected intercourse. - It works by **delaying or inhibiting ovulation** and by altering the endometrium, making it unsuitable for implantation.

Question 649: 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?

A. Tranexamic acid
B. Levonorgestrel IUD (Correct Answer)
C. GnRH analogues
D. Oral contraceptive pills

Explanation: ***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.

Question 650: A 16-year-old girl, not sexually active, came for vaccination against cervical cancer. Which vaccine should be given?

A. Gardasil (Correct Answer)
B. Biovac
C. Rubavac
D. Tdap

Explanation: ***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

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free