Contraception and Family Planning Practice Questions

Q: All of the following are beneficial effects of oral contraceptive pills, EXCEPT:

Decreased blood pressure. **Explanation:** **Why Option C is the Correct Answer:** Combined Oral Contraceptive Pills (COCPs) do **not** decrease blood pressure; in fact, they are known to cause a mild increase in blood pressure in some women. This occurs because the estrogen component (Ethinyl Estradiol) stimulates the hepatic production of **angiotensinogen**, which activates the Renin-Angiotensin-Aldosterone System (RAAS), leading to sodium and water retention. Hypertension is a known side effect and a relative contraindication for COCP use. **Analysis of Incorrect Options:** * **A. Decreased risk of ectopic pregnancies:** COCPs prevent ovulation. Since no ovum is released, the absolute risk of both intrauterine and ectopic pregnancies is significantly reduced compared to women not using contraception. * **B. Prevention of atherogenesis:** Estrogen in COCPs increases HDL (good cholesterol) and decreases LDL (bad cholesterol), which can have a protective effect against the formation of fatty plaques in the arteries. * **D. Increase in bone density:** The estrogen component inhibits osteoclast activity, thereby reducing bone resorption. Long-term use is associated with higher bone mineral density, offering protection against osteoporosis. **NEET-PG High-Yield Pearls:** * **Protective Effects (The "Big Three"):** COCPs significantly reduce the risk of **Ovarian cancer** (by 50%), **Endometrial cancer** (by 50%), and **Colorectal cancer**. * **Benign Conditions:** They reduce the risk of Pelvic Inflammatory Disease (PID), Benign Breast Disease, and functional ovarian cysts. * **Menstrual Benefits:** They are used to treat menorrhagia, dysmenorrhea, and PCOS. * **Contraindications:** History of Thromboembolism (VTE), undiagnosed vaginal bleeding, breast cancer, and smokers >35 years old.

Q: Which of the following is NOT a method for inducing mid-trimester abortions?

Menstrual regulation. **Explanation:** The key to answering this question lies in understanding the definition of "mid-trimester." The mid-trimester (second trimester) refers to the period between **13 and 28 weeks** of gestation. **Why Menstrual Regulation (MR) is the correct answer:** Menstrual Regulation is a method used for **very early first-trimester** abortions. It involves the aspiration of the uterine contents using a Karman cannula or a syringe, typically performed within **6 weeks of the Last Menstrual Period (LMP)** (up to 14 days of a missed period). Since it is restricted to the early first trimester, it cannot be used for mid-trimester abortions. **Analysis of incorrect options:** * **Intra-amniotic Saline:** This is a classical method for mid-trimester induction (16–20 weeks). Hypertonic saline (20%) acts by causing fetal demise and releasing endogenous prostaglandins, leading to uterine contractions. * **Intra-amniotic Prostaglandins:** Prostaglandins (like PGF2α) are potent uterine stimulants. Intra-amniotic or extra-amniotic administration is a standard pharmacological approach for second-trimester termination. * **Hysterotomy:** This is a surgical method (similar to a mini-cesarean section) used for mid-trimester abortion when medical induction fails or is contraindicated. **High-Yield Clinical Pearls for NEET-PG:** * **MVA (Manual Vacuum Aspiration):** Used up to 12 weeks (first trimester). * **Medical Method of Abortion (MMA):** Mifepristone + Misoprostol is the gold standard for early medical abortion (up to 9 weeks/63 days as per Indian RMP guidelines). * **Most common method for 2nd-trimester abortion:** Dilatation and Evacuation (D&E) or Medical Induction with Misoprostol. * **Complication of Saline:** Hypernatremia and Coagulopathy (DIC).

Q: A pregnant woman at 8 weeks gestation with an intrauterine contraceptive device (Cu T) in place and three living children requires management. What is the most suitable treatment?

Remove the Cu T and perform permanent sterilization.. ### Explanation The management of a pregnancy with an intrauterine contraceptive device (IUCD) in situ depends on the patient’s desire to continue the pregnancy and the visibility of the IUCD strings. **Why Option B is Correct:** In this scenario, the patient already has **three living children**, which is a significant factor in clinical decision-making regarding family planning. Since the pregnancy is at an early stage (8 weeks), the standard protocol is to **remove the Cu T** immediately to reduce the risk of septic abortion, chorioamnionitis, and preterm labor. Given her parity (three children), she has likely completed her family size. Therefore, **permanent sterilization** (Tubectomy) is the most suitable long-term contraceptive advice to prevent further unintended pregnancies. **Analysis of Incorrect Options:** * **Option A:** Continuing the pregnancy with the Cu T in situ increases the risk of spontaneous abortion (up to 50%) and severe maternal sepsis. If strings are visible, the device should always be removed in the first trimester. * **Option C:** While removing the Cu T is a necessary immediate step, it is an incomplete management plan for a patient with three children who has already experienced a contraceptive failure. It fails to address her future reproductive needs. **NEET-PG High-Yield Pearls:** * **Risk of Ectopic Pregnancy:** While IUCDs do not *cause* ectopic pregnancy, if a woman becomes pregnant with an IUCD in situ, the **relative risk** of that pregnancy being ectopic is higher (approx. 3–4%). * **Strings Visible vs. Not Visible:** If strings are visible in the first trimester, remove the IUCD. If strings are not visible, perform an ultrasound; if the IUCD is intrauterine, it is generally left alone to avoid disrupting the pregnancy. * **Teratogenicity:** There is no evidence that Cu T causes congenital malformations in the fetus.

Question 1

All of the following are beneficial effects of oral contraceptive pills, EXCEPT:

Accepted Answer

Decreased blood pressure

Answer

Decreased risk of ectopic pregnancies

Answer

Prevention of atherogenesis

Answer

Increase in bone density

Question 2

All of the following are non-contraceptive benefits of oral contraceptive pills except?

Accepted Answer

Decreased risk for venous thrombosis

Answer

Reduces dysmenorrhea

Answer

Reduces fibroadenomas

Answer

Reduces ovarian cancer risk

Question 3

What is an absolute contraindication for Cu-T insertion?

Accepted Answer

Undiagnosed vaginal bleeding

Answer

Patient unmotivated for contraception

Answer

Previous ectopic pregnancy

Answer

Previous history of abortion

Question 4

What is the best mode of contraception for a newly married lady with rheumatic heart disease?

Accepted Answer

Condom

Answer

Oral pills

Answer

Norplant

Answer

IUCD

Question 5

Which of the following is the best contraceptive option in a 30-year-old woman with heart disease?

Accepted Answer

Intrauterine contraceptive device (IUCD)

Answer

Sterilization

Answer

Steroid contraceptive

Answer

Barrier methods

Question 6

Which of the following is the safest method of sterilization in the immediate postpartum period?

Accepted Answer

Minilaparotomy

Answer

Laparoscopy

Answer

Hysteroscopic method

Answer

None of the above

Question 7

Which of the following is NOT a method for inducing mid-trimester abortions?

Accepted Answer

Menstrual regulation

Answer

Intra-amniotic saline

Answer

Intra-amniotic prostaglandins

Answer

Hysterotomy

Question 8

What is the best contraceptive method for a 22-year-old married nulliparous woman?

Accepted Answer

Oral Contraceptive Pills (OCPs)

Answer

Condom

Answer

Tubectomy

Answer

Rhythm method

Question 9

A pregnant woman at 8 weeks gestation with an intrauterine contraceptive device (Cu T) in place and three living children requires management. What is the most suitable treatment?

Accepted Answer

Remove the Cu T and perform permanent sterilization.

Answer

Continue the pregnancy and remove the Cu T during delivery.

Answer

Remove the Cu T.

Answer

None of the above.

Question 10

What is the main mechanism of combined oral contraceptive pills (OCPs)?

Accepted Answer

Feedback inhibition of the pituitary, preventing the LH surge

Answer

Changes in cervical mucus

Answer

Decreased motility and secretion of the fallopian tube

Answer

Prevention of ovulation

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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