Contraception and Family Planning Practice Questions

Q: Which of the following is an absolute contraindication for intrauterine contraceptive devices (IUCDs)?

Puerperal sepsis. ***Puerperal sepsis*** - **Puerperal sepsis** is an **absolute contraindication** for IUCD insertion as it indicates an active, severe infection of the reproductive tract. - Inserting an IUCD in this context significantly increases the risk of spreading the infection, leading to more severe systemic complications like **septicemia**. *Current sexually transmitted disease (STD)* - While a **current STD** is a contraindication for IUCD insertion, it is generally considered a **relative contraindication**. - The IUCD can be inserted once the STD has been **diagnosed and appropriately treated**, reducing the risk of pelvic inflammatory disease (PID). *Uterine anomaly* - A **uterine anomaly** (e.g., severe bicornuate uterus) can make IUCD insertion difficult or ineffective, as it may prevent proper placement or increase the risk of expulsion. - This is typically a **relative contraindication**; suitability depends on the specific anomaly and can be assessed by a healthcare provider. *No absolute contraindications exist* - This statement is incorrect because several conditions, such as **pregnancy**, **active pelvic inflammatory disease (PID)**, and **puerperal sepsis**, are recognized as **absolute contraindications** for IUCD insertion. - These conditions pose significant health risks if an IUCD is inserted.

Q: Which of the following is an example of a barrier method of contraception?

Condom. ***Condom*** - A **condom** acts as a physical barrier, preventing sperm from reaching the egg. - Both male and female condoms are examples of **barrier contraception**. *Hormonal contraceptive* - **Hormonal contraceptives** work by preventing ovulation, thickening cervical mucus, or altering the uterine lining, not by physically blocking sperm. - Examples include oral contraceptive pills, patches, and vaginal rings. *IUD* - An **intrauterine device (IUD)**, whether hormonal or copper, primarily prevents conception by creating an inhospitable environment for sperm or by preventing implantation. - It is a long-acting reversible contraceptive, not a barrier method. *Sterilization* - **Sterilization** (e.g., tubal ligation or vasectomy) is a permanent method of contraception that prevents the transport of eggs or sperm, respectively. - It does not involve a physical barrier to block sperm during intercourse.

Q: With the use of DMPA contraceptive, the side effects are all of the following except:

Change in quantity and quality of breast milk. ***Change in quantity and quality of breast milk*** - **DMPA (depot medroxyprogesterone acetate)** has **no significant impact** on the quality or quantity of breast milk. It is considered safe for use in breastfeeding mothers. - Progestin-only contraceptives like DMPA do not interfere with lactation and can be used without affecting infant feeding or growth. - **WHO MEC Category 2** for breastfeeding women after 6 weeks postpartum, indicating benefits generally outweigh risks. *Weight gain* - **Weight gain** is a common side effect reported by many users of DMPA due to its hormonal effects, particularly increased appetite and fluid retention. - Studies have shown an average **weight increase of 2-5 kg** over the first year of use, with continued weight gain in long-term users. *Irregular bleeding* - **Irregular bleeding**, including spotting, prolonged bleeding, or amenorrhea, is a very common side effect, especially during the initial months of DMPA use. - This is due to the hormonal influence on the **endometrial lining**, causing unpredictable shedding. - Approximately **40-50% of users develop amenorrhea** by one year of use. *Decreased bone mineral density* - **Decreased bone mineral density (BMD)** is a well-documented side effect of DMPA, prompting an FDA black box warning. - The decrease is generally **reversible after discontinuation**, with BMD recovery occurring over 2-3 years. - This effect is due to the **hypoestrogenic state** induced by DMPA, affecting calcium metabolism and bone remodeling.

Q: What does the term 'CuT 200' refer to in the context of contraceptive devices?

200 square millimeters of copper surface area on the device. ***200 square millimeters of copper surface area on the device*** - The "200" in **CuT 200** specifically refers to the **total surface area** of copper in square millimeters available on the intrauterine device (IUD). - This surface area is crucial as it determines the amount of copper ions released, which provide the contraceptive effect by creating a cytotoxic inflammatory reaction in the uterus. *200 millimeters of copper over the loop* - The measurement is generally of the **surface area**, not a linear dimension "over the loop." - Using millimeters in this context would inaccurately describe the amount of copper involved in contraception. *The copper concentration remains unchanged for 200 days* - The number "200" does not refer to the **duration** of effectiveness or stability of copper concentration. - The device's efficacy extends for several years, not merely 200 days. *200 square centimeters of copper surface area on the device* - A surface area of **200 square centimeters** would be a significantly larger amount of copper than typically found on an IUD. - Common copper IUDs, like the CuT 200, use **square millimeters** for their surface area measurement, not square centimeters.

Q: Estrogen in the oral contraceptive pill causes all the following except:

Carcinoma in situ cervix. ***Carcinoma in situ cervix*** - While there is a slight increase in the risk of **cervical cancer** with long-term OCP use, it is generally related to persistent infection with **human papillomavirus (HPV)** and behavioral factors, not directly attributed to the estrogen component itself causing *carcinoma in situ*. - OCPs do not directly cause **cervical intraepithelial neoplasia (CIN)** or carcinoma in situ; the association is confounded by HPV infection duration and screening behaviors. *Breast carcinoma* - Epidemiological studies suggest a **slightly increased risk** of breast cancer in current and recent users of combined oral contraceptives (COCs), primarily due to the **estrogen component**. - This increased risk appears to **diminish over time** after discontinuation of OCCs, returning to baseline within 10 years. *Protection against endometrial carcinoma* - Combined oral contraceptives provide **significant protection** against endometrial hyperplasia and carcinoma through the **progestin component**, which opposes estrogen's proliferative effects on the endometrium. - However, in the context of **combined OCPs**, the estrogen component works synergistically with progestin; the balanced hormonal milieu provides this protective effect. - This protective effect is a well-established beneficial non-contraceptive effect of COCs, with up to **50% risk reduction** that persists for years after discontinuation. *Thromboembolism* - The **estrogen component** of oral contraceptives directly **increases the synthesis of clotting factors** (e.g., Factor VII, X, fibrinogen) and decreases anticoagulant proteins (e.g., antithrombin, protein S), leading to a procoagulant state. - This elevates the risk of **venous thromboembolism (VTE)**, including deep vein thrombosis and pulmonary embolism, especially in women with inherited thrombophilias or other risk factors.

Q: Which of the following is NOT a recognized method for termination of pregnancy in the first trimester?

Ethyl cyanoacrylate. ***Ethyl cyanoacrylate*** - **Ethyl cyanoacrylate** is primarily used as a **tissue adhesive** (surgical glue), not as a medical agent for terminating pregnancy. - It has no known or recognized role in medical or surgical abortion procedures. *Suction and evacuation* - **Suction and evacuation**, also known as **vacuum aspiration**, is a common and safe surgical method for first-trimester abortion. - It involves using a cannula connected to a suction device to remove the gestational sac. *Methotrexate + Misoprostol* - This combination is a recognized regimen for **medical abortion**, particularly in the early first trimester. - **Methotrexate** stops cell division, and **misoprostol** causes uterine contractions to expel the pregnancy. *Misoprostol + Mifepristone* - This is the most common and effective combination for **medical abortion** in the first trimester. - **Mifepristone** blocks progesterone, while **misoprostol** induces uterine contractions.

Q: Which of the following is not used for emergency contraception?

Danazol. ***Danazol*** - **Danazol** is an attenuated androgen used primarily for the treatment of **endometriosis** and **fibrocystic breast disease**. - It works by suppressing the pituitary-ovarian axis and does not have a role in **emergency contraception**. *Mifepristone* - **Mifepristone** (RU-486) is an **anti-progestin** that can be used for emergency contraception when given within 120 hours of unprotected intercourse. - It also has a primary use for **medical abortion** when administered in higher doses early in pregnancy. *IUCD* - An **intrauterine contraceptive device (IUCD)**, specifically the copper IUCD, is considered the most effective form of emergency contraception. - It can be inserted up to **5 days** after unprotected intercourse and offers immediate, long-term contraception. *Levonorgestrel* - **Levonorgestrel** is a synthetic progestin widely used as an oral emergency contraceptive (e.g., Plan B One-Step). - It works by inhibiting or delaying **ovulation** and thickening cervical mucus. It is most effective when taken within **72 hours** of unprotected intercourse.

Q: Best method of post-coital contraception is:

IUCD. ***IUCD*** - An **intrauterine contraceptive device (IUCD)** is the most effective method for **emergency contraception** when inserted within 5 days of unprotected intercourse. - It also provides highly effective **long-term contraception** once inserted. *High Estrogen pills* - While historically used, high-dose estrogen pills are **less effective** than other emergency contraceptive methods and are associated with a **higher incidence of side effects** like nausea and vomiting. - The use of high-estrogen pills alone for emergency contraception is **no longer recommended** as a primary option due to better alternatives. *Androgens* - **Androgens** are male hormones and have **no role** in contraception, whether emergency or sustained. - Administering androgens in females would lead to **virilization side effects** and offer no contraceptive benefit. *Levonorgestrel pills* - **Levonorgestrel pills (Plan B)** are a common and effective form of emergency contraception, but they are **less effective** than an IUCD, especially if administered closer to ovulation or later within the 5-day window. - Their efficacy **decreases with time** after unprotected intercourse, whereas an IUCD maintains high effectiveness for up to 5 days.

Q: What is the recommended interval for administering DMPA, an injectable contraceptive?

Three months. ***Three months*** - **Depot medroxyprogesterone acetate (DMPA)** is a long-acting reversible injectable contraceptive containing 150 mg of medroxyprogesterone acetate. - The standard administration schedule is **every 12 weeks (3 months)**, with a grace period allowing administration up to 13-15 weeks to maintain contraceptive effectiveness. - DMPA works by **suppressing ovulation** through sustained progestogen levels, and the 3-month interval is based on its pharmacokinetics to maintain therapeutic levels. *Three weeks* - A three-week interval is typical for **combined oral contraceptive pill packs** (21 active pills followed by 7-day break), not for DMPA. - Administering DMPA at this frequency would lead to **excessive progestogen exposure** and unnecessary side effects, as the injection maintains contraceptive levels for 12-13 weeks. *Two months* - While a two-month interval provides longer protection than oral contraceptives, it is **not the standard recommended interval** for DMPA. - This interval would result in **premature readministration** before the previous dose's effect wanes, leading to unnecessary injections and potential side effects. *Two years* - A two-year interval is far too long for DMPA, which has a **duration of action of approximately 12-14 weeks** per injection. - Such an interval would result in **complete loss of contraceptive protection** within 3-4 months, with return of ovulation and risk of unintended pregnancy.

Q: What is the preferred method of contraception for a female with a family history of ovarian cancer?

Combined oral contraceptive pills (OCP). ***Combined oral contraceptive pills (OCP)*** - **OCPs** have been shown to significantly **reduce the risk of ovarian cancer by 30-50%**, with the protective effect increasing with duration of use. - This protection is attributed to **suppression of ovulation**, reducing repetitive ovulation-related epithelial damage and inflammation that contributes to ovarian cancer development. - The benefit **persists for years after discontinuation** and is particularly important for individuals with a family history of ovarian cancer, as it addresses a key modifiable risk factor. - **First-line recommendation** for contraception in women with family history of ovarian cancer. *Progestin-only pills (POP)* - While **POPs** are effective contraceptives and generally safe, they do **not offer the same well-established protective effect against ovarian cancer** as combined hormonal contraceptives. - Their primary mechanism is through thickening cervical mucus and suppressing ovulation, without the estrogen component. - Evidence for ovarian cancer protection is limited compared to combined OCPs. *Copper intrauterine device (Cu IUCD)* - The **Cu IUCD** provides highly effective contraception by creating a local inflammatory response in the uterus that is spermicidal. - It is a **non-hormonal method** and therefore does not impact the risk of ovarian cancer. - Excellent contraceptive option for other indications, but not specifically protective against ovarian cancer. *Condoms* - **Condoms** primarily prevent pregnancy by blocking sperm from reaching the egg and are effective in preventing sexually transmitted infections. - They are a **barrier method** and provide no hormonal protection against ovarian cancer. - Useful for STI prevention but not relevant to ovarian cancer risk reduction.

Question 1

Which of the following is an absolute contraindication for intrauterine contraceptive devices (IUCDs)?

Accepted Answer

Puerperal sepsis

Answer

Current sexually transmitted disease (STD)

Answer

Uterine anomaly

Answer

No absolute contraindications exist

Question 2

Which of the following is an example of a barrier method of contraception?

Accepted Answer

Condom

Answer

Hormonal contraceptive

Answer

IUD

Answer

Sterilization

Question 3

With the use of DMPA contraceptive, the side effects are all of the following except:

Accepted Answer

Change in quantity and quality of breast milk

Answer

Weight gain

Answer

Irregular bleeding

Answer

Decreased bone mineral density

Question 4

What does the term 'CuT 200' refer to in the context of contraceptive devices?

Accepted Answer

200 square millimeters of copper surface area on the device

Answer

200 millimeters of copper over the loop

Answer

The copper concentration remains unchanged for 200 days

Answer

200 square centimeters of copper surface area on the device

Question 5

Estrogen in the oral contraceptive pill causes all the following except:

Accepted Answer

Carcinoma in situ cervix

Answer

Breast carcinoma

Answer

Protection against endometrial carcinoma

Answer

Thromboembolism

Question 6

Which of the following is NOT a recognized method for termination of pregnancy in the first trimester?

Accepted Answer

Ethyl cyanoacrylate

Answer

Suction and evacuation

Answer

Methotrexate + Misoprostol

Answer

Misoprostol + Mifepristone

Question 7

Which of the following is not used for emergency contraception?

Accepted Answer

Danazol

Answer

IUCD

Answer

Levonorgestrel

Answer

Mifepristone

Question 8

Best method of post-coital contraception is:

Accepted Answer

IUCD

Answer

Androgens

Answer

High Estrogen pills

Answer

Levonorgestrel pills

Question 9

What is the recommended interval for administering DMPA, an injectable contraceptive?

Accepted Answer

Three months

Answer

Three weeks

Answer

Two months

Answer

Two years

Question 10

What is the preferred method of contraception for a female with a family history of ovarian cancer?

Accepted Answer

Combined oral contraceptive pills (OCP)

Answer

Progestin-only pills (POP)

Answer

Copper intrauterine device (Cu IUCD)

Answer

Condoms

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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