Contraception and Family Planning Practice Questions

Q: When prescribing oral contraceptive pills, which of the following should a female health worker evaluate, EXCEPT?

Having two live issues. The primary objective when screening a patient for Combined Oral Contraceptive Pills (COCPs) is to identify **medical contraindications** that could lead to life-threatening complications, rather than assessing their parity or family size. ### Why "Having two live issues" is the Correct Answer The number of children a woman has (parity) is a social or demographic factor, not a medical contraindication. While family planning counseling may change based on the number of children, it does not affect the **safety profile** of the pill. A woman can safely take COCPs regardless of whether she has zero, two, or five children, provided she has no medical risks. ### Evaluation of Incorrect Options (Medical Contraindications) * **Calf Tenderness:** This is a clinical sign of **Deep Vein Thrombosis (DVT)**. Estrogen in COCPs increases the synthesis of clotting factors, significantly raising the risk of thromboembolism. Any history or sign of venous thrombosis is an absolute contraindication. * **Convulsions:** Patients with a history of epilepsy require careful evaluation because many **anti-epileptic drugs (AEDs)** like Phenytoin or Carbamazepine are hepatic enzyme inducers. They increase the metabolism of OCPs, leading to contraceptive failure. * **History of Chronic Headache:** Specifically, **Migraine with aura** is a major contraindication due to a significantly increased risk of ischemic stroke when combined with estrogen-containing pills. ### High-Yield Clinical Pearls for NEET-PG * **WHO Eligibility Criteria Category 4 (Absolute Contraindications):** Smokers >35 years (>15 cigarettes/day), history of DVT/PE, Migraine with aura, Breast cancer, and undiagnosed abnormal uterine bleeding. * **Non-contraceptive benefits:** COCPs reduce the risk of Ovarian and Endometrial cancers (protective effect lasts for years after discontinuation). * **Drug Interaction:** Rifampicin is the most potent enzyme inducer that decreases OCP efficacy.

Q: Cu 380A should be replaced once in how many years?

10 years. **Explanation:** The **Copper T 380A (Cu 380A)** is a second-generation Intrauterine Contraceptive Device (IUCD) and is currently the most widely used copper IUD worldwide. The "380" refers to the surface area of copper (380 $mm^2$) wrapped around the polyethylene frame. **Why 10 years is correct:** The Cu 380A is FDA-approved and recommended by the Government of India (under the National Family Planning Program) for a duration of **10 years**. The high surface area of copper ensures a slow, steady release of copper ions, which are spermicidal and prevent fertilization. While some studies suggest it may remain effective for up to 12 years, for exam purposes and clinical guidelines, the replacement interval is strictly 10 years. **Why other options are incorrect:** * **4 and 6 years:** These durations do not correspond to any standard copper IUD. Older models like the Lippes Loop were permanent until menopause, but modern copper devices have specific lifespans. * **8 years:** While longer than some devices, it is not the standardized duration for the 380A model. Note that the **Cu T 375** (Multiload) is replaced every **5 years**. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily **pre-fertilization** (spermicidal); it causes a sterile inflammatory response in the endometrium. * **Ideal Candidate:** Monogamous parous women (low risk of PID). * **Ideal Time of Insertion:** Within 10 days of the menstrual cycle (to ensure the patient is not pregnant). * **Post-partum Insertion:** Can be inserted within 48 hours (PPIUCD) or after 6 weeks (involution complete). * **Emergency Contraception:** Cu 380A is the **most effective** method of emergency contraception if inserted within 5 days of unprotected intercourse.

Q: Combined oral contraceptive pills decrease the risk of the following conditions except?

Breast cancer. **Explanation:** Combined Oral Contraceptive Pills (COCPs) exert a protective effect against several gynecological conditions, but their relationship with breast cancer is complex and generally considered a risk factor rather than a protective one. **Why Breast Cancer is the correct answer:** Epidemiological studies (such as the Collaborative Group on Hormonal Factors in Breast Cancer) indicate that current and recent users of COCPs have a **slight relative increase in the risk** of being diagnosed with breast cancer. This risk is duration-dependent but typically returns to baseline 10 years after stopping the pill. Therefore, COCPs do not decrease the risk of breast cancer. **Why the other options are incorrect:** * **Endometrial Cancer:** COCPs provide a significant protective effect (approx. 50% reduction) by providing progestogen, which opposes the proliferative effect of estrogen on the endometrium. This protection persists for 15–20 years after discontinuation. * **Ovarian Cancer:** By suppressing ovulation, COCPs reduce "incessant ovulation" and epithelial trauma. This reduces the risk of epithelial ovarian cancer by about 40–50%. * **Ectopic Pregnancy:** Since COCPs are highly effective at preventing conception/ovulation, the absolute risk of any pregnancy, including ectopic pregnancy, is significantly reduced compared to women not using contraception. **High-Yield Clinical Pearls for NEET-PG:** * **Protective Effects of COCPs:** Decreased risk of Endometrial, Ovarian, and Colorectal cancers; reduced incidence of PID, Benign Breast Disease (e.g., fibroadenoma), and Iron Deficiency Anemia. * **Increased Risks with COCPs:** Increased risk of Cervical cancer (especially with HPV), Hepatic adenoma, and Venous Thromboembolism (VTE). * **Mechanism:** COCPs primarily work by inhibiting LH surge, thereby preventing ovulation.

Q: Which of the following is contained in a "Today" sponge?

Nonoxynol. **Explanation:** The **"Today" sponge** is a vaginal contraceptive device that acts as a mechanical barrier, a chemical spermicide, and an absorbent for semen. **1. Why Nonoxynol is correct:** The active ingredient in the Today sponge is **Nonoxynol-9 (1 gram)**. It is a non-ionic surfactant that works by disrupting the cell membrane of the spermatozoa, effectively immobilizing or killing them before they can enter the cervix. The sponge is made of polyurethane and must be moistened with water before insertion to activate the spermicide. **2. Analysis of Incorrect Options:** * **Deflon:** This is not a contraceptive agent. It is likely a distractor or a confusion with *Delfen* (a brand of contraceptive foam that also contains Nonoxynol-9). * **Femshield:** This is an older brand name for the **Female Condom** (now commonly known as FC2). It is a polyurethane or nitrile sheath, not a sponge. * **Desogestrel:** This is a **third-generation progestin** used in oral contraceptive pills (e.g., Cerazette) and some emergency contraceptive pills. It is a hormonal method, not a chemical spermicide. **3. High-Yield Clinical Pearls for NEET-PG:** * **Duration of Action:** The sponge provides protection for up to **24 hours**, regardless of the frequency of intercourse during that period. * **Post-coital use:** It must be left in place for at least **6 hours** after the last act of intercourse but should not be left in for more than 30 hours total. * **Risk:** Use of the sponge is associated with an increased risk of **Toxic Shock Syndrome (TSS)** if left in too long and does not protect against STIs (it may actually increase HIV transmission risk due to vaginal irritation). * **Pearl:** Nonoxynol-9 is also the most common spermicide used in contraceptive creams, jellies, and foams.

Q: Which of the following is NOT an adverse effect of oral contraceptive pills?

Dysmenorrhea. **Explanation:** The correct answer is **D. Dysmenorrhea**. Combined Oral Contraceptive Pills (COCPs) are actually a primary medical treatment for dysmenorrhea, rather than a cause. **Why Dysmenorrhea is the correct choice:** COCPs work by inhibiting ovulation. This leads to a reduction in the production of endometrial prostaglandins (specifically PGF2α), which are the primary mediators of uterine contractions and pain during menstruation. By creating a thinner endometrial lining and preventing the "prostaglandin surge" associated with ovulatory cycles, COCPs significantly **relieve** dysmenorrhea. **Analysis of Incorrect Options:** * **A. Weight Gain:** Though often perceived as a minor side effect, estrogen can cause fluid retention and progestogens can increase appetite, leading to perceived or actual weight gain in some users. * **B. Hypertension:** Estrogen increases the hepatic production of angiotensinogen. This can activate the Renin-Angiotensin-Aldosterone System (RAAS), leading to a mild increase in blood pressure in susceptible individuals. * **C. Thromboembolism:** This is the most serious side effect. Estrogen increases the synthesis of clotting factors (II, VII, IX, X) and decreases anticoagulants like Protein S and Antithrombin III, significantly raising the risk of Venous Thromboembolism (VTE). **High-Yield NEET-PG Pearls:** * **Protective Effects:** COCPs reduce the risk of **Ovarian cancer** (by 50%), **Endometrial cancer** (by 50%), and **Benign breast disease**. * **Risk Factors:** The risk of MI and Stroke is significantly higher in COCP users who are **smokers** and aged **>35 years**. * **Drug Interactions:** Enzyme inducers like **Rifampicin** and **Antiepileptics** (Phenytoin, Carbamazepine) decrease the efficacy of COCPs, leading to breakthrough bleeding or pregnancy.

Q: A 20-year-old girl experienced rape around the 13th day of her regular menstrual cycle. What is the best emergency contraception that can be offered?

Levonorgestrel tablets. **Explanation:** The correct answer is **Levonorgestrel (LNG) tablets**. In cases of sexual assault, emergency contraception (EC) should be provided as soon as possible to prevent unintended pregnancy. **Why Levonorgestrel is the best choice here:** While the Copper-T (Cu-T) is technically the most effective EC, **Levonorgestrel (1.5 mg single dose)** is considered the first-line medical management in rape victims due to several practical and clinical reasons. It is highly effective when taken within 72 hours (up to 120 hours), easy to administer, and does not require a pelvic examination or sterile procedure, which may be traumatic for a rape survivor. It works primarily by delaying ovulation. **Analysis of Incorrect Options:** * **A & D (COCPs and Ethinylestradiol):** The Yuzpe regimen (combined pills) is less effective and associated with significantly higher rates of nausea and vomiting compared to LNG. Pure Ethinylestradiol is not a standard EC protocol. * **B (Cu-T insertion):** Although Cu-T is the most effective EC (failure rate <0.1%), it is generally avoided as the *first* choice in rape cases due to the high risk of **Pelvic Inflammatory Disease (PID)**. Rape victims are at high risk for undiagnosed Sexually Transmitted Infections (STIs) like Chlamydia and Gonorrhea; inserting an IUD through an infected cervix can lead to ascending infection. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard EC:** Copper-T (most effective, can be used up to 5 days). * **Drug of Choice (DOC) for EC:** Levonorgestrel 1.5mg (Single dose). * **Ulipristal Acetate (30mg):** More effective than LNG, especially between 72–120 hours, but LNG remains the standard in many government protocols. * **Mifepristone:** Can be used as EC in low doses (10–25 mg). * **Rape Protocol:** Always prioritize psychological support and STI prophylaxis (Ceftriaxone, Azithromycin, and Tinidazole) alongside EC.

Q: Which of the following statements about DMPA (Depot Medroxyprogesterone Acetate) is FALSE?

It typically causes weight loss.. **Explanation:** **Why Option C is the correct (False) statement:** Depot Medroxyprogesterone Acetate (DMPA) is clinically associated with **weight gain**, not weight loss. This is one of its most common side effects and a frequent reason for discontinuation. The weight gain is attributed to both an increase in appetite (anabolic effect of progestogen) and an increase in body fat deposition. Studies show an average gain of 1.5–2.5 kg in the first year of use. **Analysis of other options:** * **Option A (True):** DMPA is a highly effective contraceptive. With perfect use, the failure rate is approximately **0.3 per 100 woman-years**, making it comparable to sterilization and LARC methods. * **Option B (True):** The standard dose for the intramuscular (IM) formulation is **150 mg every 12 weeks (3 months)**. It is usually administered in the gluteal or deltoid muscle. * **Option D (True):** High-dose progestogens like DMPA can decrease insulin sensitivity and lead to **mild glucose intolerance**. While usually not clinically significant in healthy women, it requires caution in patients with pre-existing diabetes. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily inhibits ovulation by suppressing the LH surge. It also thickens cervical mucus. * **Amenorrhea:** About 50% of users develop amenorrhea after one year of use (a "benefit" for women with menorrhagia). * **Bone Mineral Density (BMD):** Long-term use is associated with a reversible decrease in BMD. The FDA provides a "Black Box Warning" for use exceeding 2 years. * **Return to Fertility:** There is a **delayed return to fertility**, taking an average of 7–10 months after the last injection. * **Anticonvulsant Effect:** DMPA is the contraceptive of choice for women with epilepsy as it raises the seizure threshold.

Q: Maximum success rate in reversal of sterilization is achieved in cases which follow which technique?

Laparoscopic ring application. **Explanation:** The success of tubal sterilization reversal (tubal re-anastomosis) is primarily determined by the **length of the healthy fallopian tube remaining** and the **extent of tissue destruction** caused during the initial procedure. **Why Laparoscopic Ring Application is Correct:** Laparoscopic sterilization using a **Falope ring (Silastic band)** is a mechanical method that causes minimal tissue damage. It typically destroys only a very small segment (about 1–2 cm) of the fallopian tube. Because a significant length of the tube remains healthy and the blood supply is well-preserved, surgical re-anastomosis has the highest success rate (up to 70–80%) compared to other methods. **Analysis of Incorrect Options:** * **Pomeroy’s Technique:** This is the most common method used during postpartum sterilization. It involves ligating a loop of the tube and excising it. While effective, it destroys a larger segment of the tube (3–4 cm) than a ring, leading to lower reversal success rates. * **Parkland’s Technique:** Similar to Pomeroy’s, this involves mid-segment resection. It ensures the ends are separated to prevent recanalization, but the resulting gap makes surgical reversal more difficult. * **Uchida’s Technique:** This is a complex method involving subserosal stripping and resection. It is highly effective at preventing pregnancy but is the most destructive to the tubal anatomy, making it the most difficult to reverse. **High-Yield Facts for NEET-PG:** * **Best Site for Reversal:** Isthmus-to-isthmus anastomosis yields the highest success. * **Worst Prognosis for Reversal:** Electro-cautery (especially unipolar) causes extensive thermal damage and has the lowest reversal success. * **Pearl:** For a successful reversal, the total remaining length of the fallopian tube should ideally be **>4 cm**. * **Failure Rate:** The failure rate of the Falope ring is approximately 1.7 per 1000 procedures.

Q: All of the following are mechanisms of action of oral contraceptive pills, except:

Interference with placental functioning. **Explanation:** The primary mechanism of action of Combined Oral Contraceptive Pills (COCPs) is to prevent pregnancy by acting on the hypothalamic-pituitary-ovarian axis. **Why Option D is the correct answer:** Oral contraceptive pills are used to **prevent** conception. Placental functioning only begins after successful implantation and the development of the trophoblast. Since COCPs act primarily to prevent fertilization and implantation, they do not have a physiological role in interfering with an established placenta. Therefore, interference with placental functioning is not a mechanism of OCPs. **Analysis of other options:** * **Inhibition of Ovulation (Option A):** This is the **most important** mechanism. The estrogen component suppresses FSH (preventing follicular development), while the progestogen component suppresses the LH surge, thereby preventing ovulation. * **Prevention of Fertilization (Option B):** Progestogens make the cervical mucus thick, viscid, and scanty. This creates a "hostile" environment that inhibits sperm penetration and transport, preventing the sperm from reaching the ovum. * **Interference with Implantation (Option C):** OCPs cause the endometrium to become thin and atrophic (decidualization), making it unreceptive for a blastocyst to implant. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Action:** Suppression of LH surge (Progestogen effect). * **Pearl:** Progestogen-only pills (POPs) primarily act by thickening cervical mucus; they do not consistently inhibit ovulation like COCPs. * **Non-contraceptive benefits:** Reduced risk of ovarian and endometrial cancers, and improvement in dysmenorrhea and menorrhagia. * **Contraindication:** OCPs are strictly contraindicated in smokers >35 years and women with a history of Thromboembolism.

Q: Fetal cardiac activity is detected with transvaginal ultrasound as early as which gestational age?

6 weeks. **Explanation:** The detection of fetal cardiac activity is a critical milestone in early pregnancy assessment. On **Transvaginal Sonography (TVS)**, the fetal heart pole and cardiac flicker can typically be visualized when the Crown-Rump Length (CRL) is 2–5 mm, which corresponds to approximately **6 weeks of gestation**. * **Why 6 weeks is correct:** Embryonic heart development begins early, but it reaches a size and rate detectable by high-frequency TVS probes by the 6th week. In a normal intrauterine pregnancy, cardiac activity must be seen once the CRL reaches 7 mm; failure to do so is a diagnostic criterion for pregnancy failure. * **Why 8 weeks is incorrect:** While cardiac activity is clearly visible and the heart is fully formed by 8 weeks, it can be detected much earlier via TVS. 8 weeks is more characteristic of detection via older, less sensitive transabdominal probes. * **Why 10 & 12 weeks are incorrect:** These represent later stages of the first trimester. By 10–12 weeks, fetal heart tones can typically be heard using a **Handheld Doppler**, but ultrasound detection occurs much earlier. **High-Yield Clinical Pearls for NEET-PG:** 1. **TVS vs. TAS:** TVS can detect pregnancy milestones about **1 week earlier** than Transabdominal Sonography (TAS). 2. **Sequence of TVS findings:** * **Gestational Sac:** 4.5 – 5 weeks (Mean Sac Diameter >25mm without embryo = Blighted ovum). * **Yolk Sac:** 5 – 5.5 weeks (First sign of an intrauterine pregnancy). * **Cardiac Activity:** 6 – 6.5 weeks. 3. **Discriminatory Zone:** The β-hCG level at which a gestational sac should be visible on TVS is **1500–2000 mIU/ml**.

Question 1

When prescribing oral contraceptive pills, which of the following should a female health worker evaluate, EXCEPT?

Accepted Answer

Having two live issues

Answer

Calf tenderness

Answer

Convulsions

Answer

History of chronic headache

Question 2

Cu 380A should be replaced once in how many years?

Accepted Answer

10 years

Answer

4 years

Answer

6 years

Answer

8 years

Question 3

Combined oral contraceptive pills decrease the risk of the following conditions except?

Accepted Answer

Breast cancer

Answer

Endometrial cancer

Answer

Ovarian cancer

Answer

Ectopic pregnancy

Question 4

Which of the following is contained in a "Today" sponge?

Accepted Answer

Nonoxynol

Answer

Deflon

Answer

Femshield

Answer

Desogestrel

Question 5

Which of the following is NOT an adverse effect of oral contraceptive pills?

Accepted Answer

Dysmenorrhea

Answer

Weight gain

Answer

Hypertension

Answer

Thromboembolism

Question 6

A 20-year-old girl experienced rape around the 13th day of her regular menstrual cycle. What is the best emergency contraception that can be offered?

Accepted Answer

Levonorgestrel tablets

Answer

Combined oral contraceptive pills

Answer

Intrauterine contraceptive device (Cu-T) insertion

Answer

Ethinylestradiol tablets

Question 7

Which of the following statements about DMPA (Depot Medroxyprogesterone Acetate) is FALSE?

Accepted Answer

It typically causes weight loss.

Answer

The failure rate is approximately 0.3 per 100 woman-years.

Answer

It is administered as 150 mg every 3 months.

Answer

Glucose intolerance can occur with its use.

Question 8

Maximum success rate in reversal of sterilization is achieved in cases which follow which technique?

Accepted Answer

Laparoscopic ring application

Answer

Pomeroy's technique

Answer

Parkland's technique

Answer

Uchida's technique

Question 9

All of the following are mechanisms of action of oral contraceptive pills, except:

Accepted Answer

Interference with placental functioning

Answer

Inhibition of ovulation

Answer

Prevention of fertilization

Answer

Interference with implantation of fertilized ovum

Question 10

Fetal cardiac activity is detected with transvaginal ultrasound as early as which gestational age?

Accepted Answer

6 weeks

Answer

8 weeks

Answer

10 weeks

Answer

12 weeks

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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