Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 681: Copper T is ideally inserted at-

A. Just before menstruation
B. On the 26th day
C. Just after menstruation (Correct Answer)
D. On the 14th day

Explanation: ***Just after menstruation*** - The **endometrium is thin** immediately after menstruation, making insertion easier and reducing the risk of pain and perforation. - Inserting it after menstruation also helps to ensure the woman is **not pregnant** at the time of insertion, as the uterus has shed its lining. *Just before menstruation* - The endometrium is typically **thicker and more vascular** just before menstruation, increasing the risk of bleeding and pain during insertion. - There is a higher possibility of **early pregnancy**, which would contraindicate IUD insertion. *On the 26th day* - The 26th day of the menstrual cycle is usually in the **luteal phase**, when the endometrium is highly vascularized and receptive, which could increase discomfort and bleeding during insertion. - This timing also carries a **higher risk of pregnancy**, making IUD insertion potentially hazardous if not confirmed otherwise. *On the 14th day* - The 14th day typically corresponds to the **ovulation period**, making it a high-risk time for conception if protection has not been used. - The uterus is also more sensitive during ovulation, potentially leading to increased discomfort or complications during insertion.

Question 682: Which of the following is a method of natural family planning that involves tracking basal body temperature?

A. Coitus interruptus (withdrawal method)
B. Safe period (calendar method)
C. Basal body temperature (BBT) method (Correct Answer)
D. Abstinence (not having sexual intercourse)

Explanation: ***Basal body temperature (BBT) method*** - The **basal body temperature** (BBT) method relies on a slight increase in a woman's resting body temperature, typically by 0.5 to 1.0°F, occurring after **ovulation**. - This temperature shift signals that ovulation has occurred, allowing couples to identify the **fertile window** and avoid intercourse during that time. - This method involves tracking daily basal body temperature to predict ovulation. *Coitus interruptus (withdrawal method)* - This method involves the male withdrawing his penis from the vagina just before **ejaculation**. - It does not involve tracking **basal body temperature** and has a higher failure rate compared to many other contraceptive methods due to potential pre-ejaculatory fluid containing sperm. *Safe period (calendar method)* - The calendar method, also known as the **rhythm method** or **Ogino-Knaus method**, estimates the fertile window based on the typical length of a woman's menstrual cycles. - This method relies on calculating the approximate times of ovulation and avoiding intercourse during those days; it does not involve daily **temperature tracking**. *Abstinence (not having sexual intercourse)* - **Abstinence** involves completely refraining from sexual intercourse and is the only 100% effective method of preventing pregnancy and sexually transmitted infections (STIs). - This method does not involve any form of physical tracking, such as **basal body temperature**, as there is no risk of conception.

Question 683: Which of the following is classified as a third generation Intrauterine Contraceptive Device (IUCD)?

A. Mirena (Correct Answer)
B. Nova-T
C. Lippe's loop
D. CuT-200

Explanation: ***Mirena*** - Mirena (levonorgestrel-releasing intrauterine system) is a **third-generation IUCD** that releases **progestin**, offering both contraceptive and therapeutic benefits. - Its mechanism of action involves **thickening cervical mucus**, thinning the uterine lining, and inhibiting sperm motility/viability. *Nova-T* - Nova-T is a **second-generation IUCD** that uses **copper** as its active contraceptive agent. - Copper IUCDs like Nova-T primarily work by causing a **sterile inflammatory reaction** in the uterus, making it spermicidal. *Lippe's loop* - Lippe's loop is a **first-generation IUCD** made of inert plastic, designed to **physically block** fertilization. - It is no longer widely used due to higher rates of expulsion and complications compared to newer generations. *CuT-200* - CuT-200 is a **second-generation IUCD** that releases **copper** to prevent pregnancy. - It works by producing a **local inflammatory response** in the uterus that is toxic to sperm and eggs.

Question 684: In which scenario is the I-pill (emergency contraceptive) most appropriately used?

A. When a contraceptive method fails
B. After unprotected sexual intercourse
C. As a regular contraceptive method
D. In case of contraceptive failure or unprotected sex (Correct Answer)

Explanation: ***In case of contraceptive failure or unprotected sex*** - This is the **most comprehensive and appropriate answer** as it covers **both major indications** for emergency contraception. - The **I-pill (levonorgestrel)** is indicated when there has been unprotected intercourse OR when a contraceptive method has failed (e.g., condom breakage, missed pills, dislodged IUD). - It should be taken as soon as possible, ideally within **72 hours** of the event, though it can be used up to 120 hours with reduced efficacy. - This option correctly encompasses the full scope of emergency contraception use. *After unprotected sexual intercourse* - While this is a **valid indication**, it only covers one scenario and is not as comprehensive as the correct answer. - This option misses situations of contraceptive failure where intercourse was technically "protected" but the method failed. *When a contraceptive method fails* - This is also a **valid indication** but only covers contraceptive accidents (condom breakage, missed pills). - It excludes situations where no contraceptive was used at all. - Like the previous option, it is incomplete compared to the correct answer. *As a regular contraceptive method* - The I-pill is **not intended for routine contraception** due to higher hormone doses and lower efficacy compared to regular methods. - It has a higher side effect profile with frequent use and does not protect against sexually transmitted infections. - Emergency contraception should only be used occasionally in emergency situations.

Question 685: What is the maximum gestational age (from LMP) for performing medical termination of early pregnancy using mifepristone and misoprostol?

A. 7 weeks (Correct Answer)
B. 21 days
C. 4 weeks
D. 14 days

Explanation: ***7 weeks (49 days)*** - Medical termination of pregnancy using **mifepristone and misoprostol** is most effective up to **49 days (7 weeks) of gestation** from the first day of the last menstrual period (LMP). - This is the **FDA-approved and WHO-recommended timeframe** for medical abortion with optimal efficacy (95-98% success rate). - The **MTP Act in India** allows medical methods up to **63 days (9 weeks)**, but 49 days represents the timeframe with highest efficacy and lowest complication rates. - Beyond this period, success rates decline and surgical methods may be more appropriate. *21 days* - This is only **3 weeks of gestation**, far too early and restrictive for medical abortion guidelines. - Most women wouldn't have confirmed pregnancy by this time. - This is not aligned with any standard medical abortion protocol. *4 weeks* - At **4 weeks gestation**, pregnancy has just been missed (around time of expected period). - This is too restrictive and not the maximum allowable timeframe for medical abortion. - Medical abortion can safely be performed well beyond this point. *14 days* - This is only **2 weeks of gestation** (around the time of ovulation in a typical cycle). - Pregnancy cannot even be reliably detected at this point. - This timeframe has no relevance to medical abortion guidelines.

Question 686: Which IUD is preferred for menorrhagia?

A. NOVA T
B. Cu IUD
C. Mirena (Correct Answer)
D. Gynefix

Explanation: ***Mirena*** - The **Mirena** IUD contains **levonorgestrel**, a progestin, which significantly reduces menstrual blood loss by causing endometrial atrophy. - It is FDA-approved for the treatment of **menorrhagia** and is highly effective in reducing heavy menstrual bleeding. *NOVA T* - **NOVA T** is a **copper IUD**, which can actually *increase* menstrual blood loss and dysmenorrhea, making it unsuitable for menorrhagia. - Copper IUDs work primarily by inducing a **local inflammatory reaction** in the uterus that is spermicidal and prevents fertilization. *Cu IUD* - Like NOVA T, **copper IUDs (Cu IUDs)** are known to exacerbate **heavy menstrual bleeding** and cramping. - They are used for contraception but are generally contraindicated in women with pre-existing menorrhagia. *Gynefix* - **Gynefix** is a frameless copper IUD designed to reduce the side effects of traditional T-shaped copper IUDs. - While it may cause less cramping than other copper IUDs, it still contains copper and can **increase menstrual flow**, making it a poor choice for menorrhagia.

Question 687: What is the lifespan of the Copper T 380A intrauterine device (IUD)?

A. 10 years (Correct Answer)
B. 20 years
C. 1 year
D. 5 years

Explanation: ***10 years*** - The **Copper T 380A IUD** is approved for a maximum duration of **10 years** for contraception. - Its long lifespan is a key advantage, offering highly effective and reversible contraception for a prolonged period. *20 years* - While some studies have explored extending the use of Copper T 380A beyond 10 years, it is currently **not approved for 20 years** of continuous use. - **Official guidelines and manufacturer recommendations** typically limit its use to 10 years to ensure optimal efficacy and safety. *1 year* - A lifespan of **1 year** is far too short for a Copper T 380A IUD, as it is designed for **long-term contraception**. - **Shorter-acting contraceptive methods** or some other types of IUDs (e.g., hormonal IUDs with lower progestin doses) might be effective for shorter periods, but not the Copper T 380A. *5 years* - While some hormonal IUDs have a lifespan of **5 years**, the **Copper T 380A IUD** is approved for a longer duration. - This option incorrectly states the lifespan for this specific device, which is known for its extended effectiveness.

Question 688: Which contraceptive method has the lowest pregnancy failure rate (typical use)?

A. Diaphragm
B. Condom
C. Intrauterine Contraceptive Device (IUCD) (Correct Answer)
D. Oral Contraceptive Pills (OCP)

Explanation: ***Intrauterine Contraceptive Device (IUCD)*** - **IUCDs** are highly effective, with a **pregnancy failure rate of less than 1%** in typical use due to their long-acting and reversible nature, requiring no daily action from the user. - They are **fit-and-forget methods**, eliminating user error inherent in other forms of contraception, leading to very low typical use failure rates. *Diaphragm* - The **diaphragm** has a significantly higher typical use failure rate (around 12-16%) because its effectiveness depends on **correct placement** and consistent use with spermicide before each intercourse. - It is a **user-dependent method**, making its efficacy susceptible to improper use or non-use during sexual activity. *Condom* - **Condoms** have a typical use failure rate of about 13-18%, largely due to **incorrect use**, breakage, or slippage. - Their effectiveness relies heavily on **consistent and proper application** with every act of intercourse. *Oral Contraceptive Pills (OCP)* - **Oral Contraceptive Pills (OCPs)** have a typical use failure rate of approximately 7-9%, primarily because effectiveness is dependent on **daily adherence** at roughly the same time. - **Missed pills** are a common reason for failure, significantly increasing the risk of pregnancy compared to methods that do not require daily action.

Question 689: The mechanism of action of emergency contraception includes the following except:

A. Degeneration of corpus luteum (Correct Answer)
B. Prevention of implantation of fertilized egg.
C. Inhibition of fertilization
D. By preventing or delaying ovulation

Explanation: ***Degeneration of corpus luteum*** - Emergency contraception primarily works by interfering with ovulation and fertilization. It does **not directly cause degeneration of the corpus luteum**. - The **corpus luteum** forms after ovulation, and its degradation is a natural process (luteolysis) if pregnancy does not occur. Emergency contraception acts earlier in the reproductive process and does not target the corpus luteum. - This is the **correct answer** as it is NOT a mechanism of emergency contraception. *By preventing or delaying ovulation* - This is the **primary mechanism** of action for most forms of emergency contraception, particularly those containing **levonorgestrel (LNG)** and **ulipristal acetate (UPA)**. - By delaying the release of an egg from the ovary, it prevents the possibility of fertilization. - This is the most established and clinically significant mechanism. *Inhibition of fertilization* - Emergency contraception may affect fertilization by altering **cervical mucus** thickness, making it less penetrable to sperm. - Some evidence suggests effects on **sperm motility** or function, though this mechanism is less well-established than ovulation inhibition. - This represents a possible secondary mechanism. *Prevention of implantation of fertilized egg* - **Current evidence does NOT support this as a mechanism** for levonorgestrel or ulipristal acetate emergency contraception. - Studies by **WHO, ACOG, FIGO, and ICMR** have shown that LNG-EC is ineffective once fertilization has occurred. - The **copper IUD** used for emergency contraception may have some anti-implantation effects due to its inflammatory action on the endometrium. - However, for hormonal EC (the most common form), prevention of implantation is **not an established mechanism** based on current medical evidence.

Question 690: Yuzpe regimen should be administered within a maximum of -------

A. 3 hours
B. 12 hours
C. 24 hours
D. 72 hours (Correct Answer)

Explanation: ***72 hours*** - The **Yuzpe regimen**, an older form of emergency contraception, is most effective when initiated within **72 hours** (3 days) of unprotected intercourse. - It involves taking two doses of combined **estrogen and progestin pills 12 hours apart**. *3 hours* - This timeframe is too short for the general recommendation of the **Yuzpe regimen**, which has a wider window of effectiveness. - While earlier administration is better, 3 hours is not the maximum recommended time frame. *12 hours* - This timeframe incorrectly represents the recommended window for the **Yuzpe regimen**, which extends much longer. - 12 hours is often the interval between the two doses of the Yuzpe regimen, not the maximum time for the initial dose. *24 hours* - While administering the Yuzpe regimen within **24 hours** is highly effective, it is not the *maximum* time frame within which it can still be used. - The regimen's efficacy significantly decreases after 72 hours, but it can still be considered up to that point.

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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