Contraception and Family Planning Practice Questions

Q: What is true about a complete mole?

Normal uterine size. **Explanation:** Hydatidiform mole is a gestational trophoblastic disease characterized by the proliferation of trophoblastic tissue. **1. Why the Correct Answer is Right:** In a **Complete Mole**, the uterine size is classically described as **"larger than the period of gestation"** in about 50% of cases due to exuberant trophoblastic proliferation and retained blood. However, in the remaining cases, the uterus can be **normal for dates** or even smaller than expected (if the mole is undergoing regression or evacuation). Among the given options, "Normal uterine size" is the most plausible clinical finding, as the other options contain definitive pathological inaccuracies. **2. Why the Incorrect Options are Wrong:** * **Option A:** Fetal parts and cardiac activity are **absent** in a complete mole. Complete moles are diploid (46,XX or 46,XY) and entirely paternal in origin, resulting in no fetal development. Fetal parts are only seen in **Partial Moles**. * **Option C:** In a molar pregnancy, Beta-hCG levels are **pathologically elevated** (often >100,000 mIU/mL) and do not follow the normal doubling time of 48–72 hours seen in early viable pregnancies. * **Option D:** While preeclampsia is a known complication of molar pregnancy, it typically presents **before 20 weeks** of gestation. Developing preeclampsia in the first or early second trimester is a classic "red flag" for a complete mole. **3. High-Yield Clinical Pearls for NEET-PG:** * **Genetics:** Complete Mole is 46,XX (90%, androgenetic); Partial Mole is Triploid (69,XXY). * **USG Sign:** "Snowstorm appearance" (Complete Mole) vs. "Swiss cheese appearance" of the placenta (Partial Mole). * **Theca Lutein Cysts:** Frequently associated with complete moles due to very high hCG levels. * **Risk of Malignancy:** Higher in Complete Mole (15–20%) compared to Partial Mole (<5%).

Q: Combined oral contraceptive pills act mainly by which mechanism?

Inhibition of ovulation. **Explanation:** **1. Why the Correct Answer is Right:** Combined Oral Contraceptive Pills (COCPs) contain both Estrogen (usually Ethinyl Estradiol) and Progestogen. Their primary mechanism of action is the **inhibition of ovulation** via negative feedback on the hypothalamo-pituitary-ovarian axis. * **Estrogen** suppresses **FSH** (Follicle Stimulating Hormone), which prevents the selection and maturation of a dominant follicle. * **Progestogen** suppresses the **LH surge** (Luteinizing Hormone), which is essential for the release of the ovum. While COCPs also cause thickening of cervical mucus and endometrial thinning, the **primary/main** mechanism is the suppression of ovulation. **2. Why Incorrect Options are Wrong:** * **Options B & C:** These are physiologically incorrect. COCPs actually **decrease** fallopian tube motility (due to the progestogen component), which slows the transport of the ovum. Early transport to the uterus would not prevent pregnancy; rather, a "hostile" endometrium or altered tubal transport are secondary effects, but they do not involve "increased motility." **3. NEET-PG High-Yield Pearls:** * **Most common side effect:** Breakthrough bleeding (especially with low-dose pills). * **Most serious side effect:** Venous Thromboembolism (VTE) due to the estrogen component (increases clotting factors II, VII, IX, and X). * **Non-contraceptive benefits:** Reduced risk of Ovarian and Endometrial cancers (protective effect persists for years), reduced PID, and improvement in dysmenorrhea. * **Drug Interactions:** Enzyme inducers like **Rifampicin** and anti-epileptics (Phenytoin, Carbamazepine) decrease the efficacy of COCPs. * **WHO Eligibility Criteria (Category 4 - Absolute Contraindication):** Smokers >35 years (>15 cigarettes/day), history of VTE, Migraine with aura, and Breast Cancer.

Q: Mifepristone is not used in which of the following conditions?

Threatened abortion. **Explanation:** **Mifepristone** is a potent **progesterone receptor antagonist**. Since progesterone is the "hormone of pregnancy" essential for maintaining the decidua and uterine quiescence, blocking its receptors leads to decidual breakdown, cervical softening, and increased uterine contractility. 1. **Why Threatened Abortion is the Correct Answer:** In a **threatened abortion**, the goal of management is to **save the pregnancy**. Progesterone supplementation is often used to support the pregnancy. Administering Mifepristone (an anti-progesterone) would actively promote the detachment of the embryo and induce uterine contractions, leading to an inevitable or complete abortion. Therefore, it is strictly contraindicated. 2. **Analysis of Other Options:** * **Fibroids (Leiomyoma):** Mifepristone is used off-label to reduce the size of fibroids and control heavy menstrual bleeding by inhibiting progesterone-dependent growth of the myoma. * **Ectopic Pregnancy:** While Methotrexate is the primary medical management, Mifepristone is sometimes used as an adjunct to increase the success rate of tubal resolution by causing trophoblastic degeneration. * **Molar Pregnancy:** Mifepristone can be used as a priming agent to soften the cervix before suction evacuation, although its use is more common in second-trimester terminations. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Competitive antagonist at progesterone and glucocorticoid receptors. * **Medical Abortion Regimen:** 200 mg Mifepristone (oral) followed by 800 mcg Misoprostol (vaginal/sublingual) after 24–48 hours. Effective up to 9 weeks (63 days) of gestation. * **Other Uses:** Emergency contraception (10 mg dose), induction of labor (in intrauterine fetal death), and management of Cushing’s Syndrome. * **Side Effects:** Nausea, abdominal cramps, and heavy bleeding.

Q: All of the following are features of progesterone-only pills except?

Failure rate is equal to that seen with combined oral contraceptive pills. **Explanation:** Progesterone-only pills (POPs), also known as the "mini-pill," function differently from Combined Oral Contraceptive Pills (COCPs) and have a distinct clinical profile. **Why Option C is the correct answer (The Exception):** The failure rate of POPs is **higher** than that of COCPs. In typical use, the failure rate of POPs is approximately **9%**, whereas COCPs have a failure rate of around **7%** (and significantly lower with perfect use). This is primarily because POPs have a very narrow margin for error; they must be taken at the exact same time every day (within a 3-hour window) to maintain efficacy, unlike COCPs which offer a more forgiving 12-hour window. **Analysis of Incorrect Options:** * **Option A:** This is the **primary mechanism of action** for POPs. They thicken the cervical mucus, making it hostile to sperm penetration. * **Option B:** While not the primary mechanism, POPs inhibit ovulation in approximately **40-60%** of cycles. (Note: Desogestrel-only pills inhibit ovulation in 97% of cycles, but traditional POPs do not do so consistently). * **Option C:** Irregular spotting or breakthrough bleeding is the **most common side effect** and the leading reason for discontinuation. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Candidates:** Lactating mothers (POPs do not suppress milk production), women with contraindications to estrogen (e.g., history of VTE, smokers >35 years, or migraine with aura). * **Time Sensitivity:** If a dose is missed by >3 hours (>12 hours for Desogestrel), backup contraception is required for the next 48 hours. * **Endometrial Effect:** POPs also cause endometrial thinning (atrophy), which prevents implantation.

Q: What is the most common side effect of progestin-only pills (POPs)?

Irregular bleeding. **Explanation:** The most common side effect of **Progestin-Only Pills (POPs)**, also known as the "mini-pill," is **irregular menstrual bleeding**. Unlike combined oral contraceptives (COCs), POPs do not contain estrogen. Estrogen is responsible for stabilizing the endometrium; without it, the endometrial lining becomes thin and unstable, leading to breakthrough bleeding, spotting, or amenorrhea. This is the primary reason for patient dissatisfaction and discontinuation of the method. **Analysis of Options:** * **A. Deep Vein Thrombosis (DVT):** This is a risk associated with **estrogen-containing** contraceptives. Estrogen increases the synthesis of clotting factors in the liver. Progestin-only methods do not significantly increase the risk of venous thromboembolism and are often the preferred choice for women with a history of DVT. * **C. Acne:** While some older progestins with androgenic activity can worsen acne, it is not the *most common* side effect. In fact, many modern progestins have minimal impact on skin. * **D. Hypertension:** Estrogen is the component primarily linked to blood pressure elevation via the renin-angiotensin-aldosterone system. POPs are generally considered safe for women with controlled hypertension. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** POPs primarily work by **thickening the cervical mucus**, preventing sperm penetration. They also cause endometrial thinning and, in some cycles, suppress ovulation. * **The "3-Hour Rule":** Traditional POPs (e.g., Norethindrone) must be taken at the same time every day. If a dose is delayed by **>3 hours**, it is considered a "missed pill," and backup contraception is required for 48 hours. * **Ideal Candidates:** POPs are the contraceptive of choice for **lactating mothers** (as they do not suppress milk production) and women with contraindications to estrogen (e.g., smokers >35 years, migraine with aura, or history of VTE).

Q: All of the following can be used for emergency contraception except?

Low dose oral contraceptive pills. **Explanation:** Emergency contraception (EC) is intended to prevent pregnancy after unprotected intercourse. The correct answer is **A (Low-dose OCPs)** because standard low-dose oral contraceptive pills, when taken in their usual daily dosage, do not provide the high hormonal concentration required to inhibit or delay ovulation effectively in an emergency window. While the **Yuzpe Regimen** uses combined OCPs for emergency contraception, it requires a specific **high dose** (100 mcg of Ethinyl Estradiol + 0.5 mg of Levonorgestrel, repeated after 12 hours). A single "low dose" pill is insufficient. **Analysis of other options:** * **Levonorgestrel (LNG):** The "Gold Standard" progestogen-only EC. It is most effective when taken within 72 hours (1.5 mg single dose or 0.75 mg two doses). * **Ulipristal Acetate:** A selective progesterone receptor modulator (SPRM). It is currently the most effective oral EC and can be used up to 120 hours (5 days) after intercourse. * **Mifepristone:** An anti-progestogen used in low doses (10–25 mg) for EC. It is highly effective with fewer side effects than the Yuzpe regimen. **High-Yield Clinical Pearls for NEET-PG:** * **Most Effective EC:** Copper-T 380A (IUD) inserted within 5 days is the most effective method overall (failure rate <0.1%). * **Mechanism of Action:** Most hormonal ECs work primarily by **inhibiting or delaying ovulation**. They do not disrupt an established pregnancy (not abortifacients). * **Time Frame:** LNG is preferred within 72 hours; Ulipristal and Copper-IUD are preferred up to 120 hours. * **Yuzpe Regimen Side Effect:** Nausea and vomiting are most common due to the high estrogen content.

Q: Oral contraceptive pills are known to prevent which of the following conditions, except?

Cervical cancer. **Explanation:** The correct answer is **Cervical cancer**. While Combined Oral Contraceptive Pills (COCPs) offer significant protection against several malignancies, they are associated with an **increased risk** of cervical cancer, especially with long-term use (typically >5 years) in women who are HPV-positive. The risk is thought to be due to hormonal influences on the cervical transformation zone, making it more susceptible to persistent HPV infection. **Analysis of Options:** * **Colon cancer (A):** COCPs are known to have a protective effect against colorectal cancer. Studies suggest a risk reduction of approximately 15-20% among ever-users. * **Endometrial cancer (B):** This is one of the most significant benefits of COCPs. The progestogen component antagonizes the proliferative effect of estrogen on the endometrium, reducing the risk by nearly 50%. This protection persists for decades after discontinuation. * **Anorectal cancer (C):** Similar to colon cancer, epidemiological data indicates that oral contraceptives reduce the risk of cancers of the rectum and anus. **High-Yield NEET-PG Pearls:** 1. **Protective Effects:** COCPs reduce the risk of **Ovarian cancer** (by 40-50%), **Endometrial cancer**, and **Colorectal cancer**. They also protect against Benign Breast Disease (BBD), Pelvic Inflammatory Disease (PID), and ectopic pregnancy. 2. **Increased Risks:** COCPs are associated with an increased risk of **Cervical cancer**, **Breast cancer** (slight increase while using), and **Hepatic adenoma**. 3. **Ovarian Cancer:** The protection against epithelial ovarian cancer is one of the most high-yield facts; the longer the duration of use, the greater the protection. 4. **Contraindication:** COCPs are strictly contraindicated in patients with a history of breast cancer or undiagnosed vaginal bleeding.

Question 1

What is true about a complete mole?

Accepted Answer

Normal uterine size

Answer

Presence of fetal parts and cardiac activity

Answer

Beta-hCG doubling time is 7-10 days

Answer

Preeclampsia at <24 weeks

Question 2

Combined oral contraceptive pills act mainly by which mechanism?

Accepted Answer

Inhibition of ovulation

Answer

Increased motility of fallopian tubes

Answer

Early transport of the sperm and ovum to the uterine cavity

Answer

None of the above

Question 3

Which contraceptive method should be avoided in patients with epilepsy?

Accepted Answer

Oral contraceptive pills (OCPs)

Answer

Condom

Answer

Intrauterine contraceptive device (IUCD)

Answer

Levonorgestrel-releasing intrauterine system (Mirena)

Question 4

Mifepristone is not used in which of the following conditions?

Accepted Answer

Threatened abortion

Answer

Fibroid

Answer

Ectopic pregnancy

Answer

Molar pregnancy

Question 5

Oral contraceptive pills intake causes all EXCEPT:

Accepted Answer

Increased risk of fibroadenoma

Answer

Decreased risk of ovarian tumor

Answer

Increased risk of fibroadenosis

Answer

Increased risk of liver adenoma

Question 6

All of the following are features of progesterone-only pills except?

Accepted Answer

Failure rate is equal to that seen with combined oral contraceptive pills

Answer

Alters cervical mucous secretion

Answer

Inhibits ovulation

Answer

Irregular bleeding is a known complication

Question 7

What is the most common side effect of progestin-only pills (POPs)?

Accepted Answer

Irregular bleeding

Answer

Deep vein thrombosis (DVT)

Answer

Acne

Answer

Hypertension

Question 8

Oral contraceptive pills should be initiated on which day of the menstrual cycle?

Accepted Answer

The 1st day

Answer

The 5th day

Answer

The 3rd day

Answer

When menses cease

Question 9

All of the following can be used for emergency contraception except?

Accepted Answer

Low dose oral contraceptive pills

Answer

Levonorgestrel

Answer

Mifepristone

Answer

Ulipristal

Question 10

Oral contraceptive pills are known to prevent which of the following conditions, except?

Accepted Answer

Cervical cancer

Answer

Colon cancer

Answer

Endometrial cancer

Answer

Anorectal cancer

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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