Contraception and Family Planning Practice Questions

Q: Which of the following is a benefit of third-generation oral contraceptive pills?

Decreased risk of myocardial infarction. **Explanation:** Oral contraceptive pills (OCPs) have evolved through generations primarily by modifying the type of progestogen used. Third-generation OCPs contain progestogens like **Desogestrel, Gestodene, or Norgestimate**. **Why Option B is Correct:** Third-generation progestogens are more "selective" and possess **lower androgenic activity** compared to second-generation pills (like Levonorgestrel). This results in a more favorable lipid profile, specifically higher HDL (good cholesterol) and lower LDL levels. Consequently, they are associated with a **decreased risk of myocardial infarction (MI)** and stroke compared to older formulations. **Analysis of Incorrect Options:** * **A. Decreased risk of thromboembolism:** This is incorrect. Third-generation OCPs are associated with a **higher risk of Venous Thromboembolism (VTE)**—roughly double the risk of second-generation pills—due to their effect on hepatic synthesis of coagulation factors. * **C & D. Increased risk of breakthrough bleeding/More side effects:** These are incorrect. Because third-generation pills are more potent and less androgenic, they generally offer **better cycle control** (less breakthrough bleeding) and fewer androgenic side effects like acne, hirsutism, and weight gain. **High-Yield Clinical Pearls for NEET-PG:** * **1st Gen:** Norethynodrel (High dose, rarely used now). * **2nd Gen:** Levonorgestrel (Most common, lowest VTE risk, but more androgenic). * **3rd Gen:** Desogestrel, Gestodene (Lowest MI risk, but higher VTE risk). * **4th Gen:** Drospirenone (Anti-mineralocorticoid and anti-androgenic; excellent for PCOS and PMDD). * **Absolute Contraindication:** Smokers >35 years old (due to high MI/stroke risk).

Q: Which method of Medical Termination of Pregnancy is not used in the first trimester of pregnancy?

Intrauterine instillation of hypertonic saline. **Explanation:** The correct answer is **A. Intrauterine instillation of hypertonic saline.** Medical Termination of Pregnancy (MTP) methods are categorized based on the gestational age. The first trimester is defined as up to 12 weeks (though medical methods are often used up to 9–10 weeks). **Why Option A is correct:** Intrauterine instillation of hypertonic saline (or urea/prostaglandins) is a **second-trimester** method (usually 15–20 weeks). It involves injecting a 20% saline solution into the amniotic sac to induce fetal demise and uterine contractions. It is **never** used in the first trimester because the amniotic sac is too small to safely access via transabdominal amniocentesis, and the risk of systemic toxicity (hypernatremia) is high. **Why the other options are incorrect:** * **B. Suction and Evacuation:** This is the **gold standard surgical method** for first-trimester MTP (up to 12 weeks). It is quick, safe, and effective. * **C & D. Mifepristone and Misoprostol:** These are the primary drugs used in **Medical MTP**. According to current protocols, a combination of 200 mg Mifepristone (anti-progestogen) followed by 800 mcg Misoprostol (prostaglandin E1 analogue) is highly effective for terminating pregnancies up to 9–10 weeks. **High-Yield NEET-PG Pearls:** * **MTP Act (India) Update:** MTP can now be performed up to **24 weeks** for specific categories of women (e.g., survivors of sexual assault, minors, fetal anomalies). * **Best Surgical Method (<12 weeks):** Suction Evacuation. * **Best Surgical Method (12–15 weeks):** Dilatation and Evacuation (D&E). * **Most common complication of MTP:** Incomplete abortion. * **Hypertonic Saline Risk:** Can cause "Water Intoxication" or Consumption Coagulopathy (DIC).

Q: What is the recognized method for identifying a missed Intrauterine Device (IUD)?

Ultrasound (USG). **Explanation:** The management of a "missed IUD" (when strings are not visible on per-vaginal examination) follows a specific diagnostic hierarchy. **1. Why Ultrasound (USG) is the Correct Answer:** USG is the **first-line investigation** of choice for a missed IUD. It is highly sensitive, non-invasive, and does not involve ionizing radiation. The primary clinical goal is to determine if the IUD is **intrauterine** (malpositioned or rotated) or **extrauterine** (perforated into the peritoneal cavity). If the USG shows an empty uterine cavity, the IUD is considered "lost," and further imaging is required. **2. Analysis of Incorrect Options:** * **X-ray (Abdomen/Pelvis):** This is the **second-line** investigation. It is performed only if the USG fails to locate the IUD within the uterus. An X-ray helps identify an extrauterine IUD (perforation) but cannot definitively confirm if an IUD is inside the uterine cavity versus behind it. * **Barium Meal:** This is used to visualize the upper gastrointestinal tract (esophagus, stomach, duodenum). It has no role in pelvic imaging or IUD localization. * **CT Scan:** While highly accurate, it is not the "recognized" initial method due to high cost and significant radiation exposure. It is reserved for complex cases of organ perforation. **Clinical Pearls for NEET-PG:** * **Step 1:** Check for strings. If absent, perform **USG**. * **Step 2:** If USG is empty, perform **X-ray Erect Abdomen & Pelvis** (to rule out expulsion vs. perforation). * **X-ray Marker:** If an IUD is seen on X-ray, a lateral view or a uterine sound insertion during X-ray can help localize its relation to the uterus. * **Pregnancy:** Always rule out pregnancy in cases of a missed IUD, as the device may have been expelled or the pregnancy may have displaced the strings.

Q: Suction evacuation as MTP is best done up to how many weeks of gestation?

12 weeks. **Explanation:** **Suction Evacuation (Vacuum Aspiration)** is the gold standard surgical method for Medical Termination of Pregnancy (MTP) in the **first trimester**. * **Why 12 weeks is correct:** Up to 12 weeks of gestation, the products of conception are small enough to be safely aspirated through a Karman’s cannula or a rigid suction tip. Beyond 12 weeks, the fetal bones begin to ossify and the placenta becomes more vascular, significantly increasing the risk of incomplete evacuation, uterine perforation, and heavy hemorrhage if suction alone is used. * **Why other options are incorrect:** * **9 weeks:** While suction evacuation is safe at 9 weeks, it is not the *upper limit*. Medical methods (Mifepristone + Misoprostol) are often preferred up to 7–9 weeks, but suction remains effective until 12 weeks. * **18 and 24 weeks:** These fall into the second trimester. For these gestations, **Dilatation and Evacuation (D&E)** or medical induction (using Prostaglandins) are the methods of choice, as suction alone is insufficient to remove the larger fetal parts. **High-Yield Clinical Pearls for NEET-PG:** 1. **MVA vs. EVA:** Manual Vacuum Aspiration (MVA) is typically used up to **10 weeks** (using a 60ml syringe), while Electric Vacuum Aspiration (EVA) is preferred between **10–12 weeks** due to consistent pressure. 2. **Pressure:** The ideal pressure for EVA is **600 mmHg**. 3. **Cannula Size:** The size of the Karman’s cannula (in mm) should generally correspond to the weeks of gestation (e.g., 8mm for 8 weeks). 4. **MTP Act (India):** Recent amendments allow MTP up to **24 weeks** for specific categories of women, but the *surgical technique* of suction evacuation remains limited to the first trimester.

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

Spermicide. **Explanation:** The correct answer is **C. Spermicide**. Barrier methods of contraception work by physically or chemically preventing sperm from entering the uterine cavity and reaching the oocyte. Spermicides (such as Nonoxynol-9) act as a **chemical barrier** by disrupting the sperm cell membrane, thereby immobilizing or killing them before they can pass through the cervix. Other common barrier methods include condoms (male and female), diaphragms, and cervical caps. **Analysis of Incorrect Options:** * **A. Oral contraceptive pill:** This is a **hormonal method**. It primarily works by inhibiting ovulation through the suppression of FSH and LH, and secondarily by thickening cervical mucus. * **B. Intrauterine device (IUD):** This is an **intrauterine contraceptive device**. While it prevents fertilization, its mechanism is primarily mediated through a sterile inflammatory response in the endometrium (Copper-T) or hormonal changes (LNG-IUD), rather than acting as a mechanical barrier. * **D. Tubectomy:** This is a **permanent/surgical method** of sterilization. It involves the surgical ligation or occlusion of the fallopian tubes to prevent the union of sperm and ovum. **NEET-PG High-Yield Pearls:** * **Nonoxynol-9** is the most common spermicide used globally. * **Dual Protection:** Condoms are the only barrier method that provides significant protection against both pregnancy and **STIs/HIV**. * **Failure Rates:** Barrier methods generally have higher "typical use" failure rates compared to LARC (Long-Acting Reversible Contraception) like IUDs. * **Ideal Use:** Spermicides are most effective when used in combination with mechanical barriers like a diaphragm.

Q: Use of combined oral contraceptive pills is contraindicated in women with any of the following conditions except?

Tuberculosis. **Explanation:** The correct answer is **Tuberculosis**. Combined Oral Contraceptive Pills (COCPs) contain both estrogen and progestogen. Their contraindications are primarily based on the **WHO Medical Eligibility Criteria (MEC)**, focusing on cardiovascular risks and hormonal sensitivities. 1. **Why Tuberculosis is the correct answer:** Tuberculosis itself is not a contraindication to COCP use. However, it is a "high-yield" distractor because **Rifampicin** (a first-line anti-TB drug) is a potent hepatic enzyme inducer. It increases the metabolism of estrogen, potentially leading to contraceptive failure. While the *medication* requires caution (MEC Category 3), the *disease* itself does not prohibit use. 2. **Why other options are incorrect:** * **Lactation:** Estrogen suppresses prolactin's action on breast tissue, reducing milk quantity and quality. It is contraindicated in the first 6 months of breastfeeding (MEC 4 if 20 years (MEC 4) due to the increased risk of arterial thrombosis. **High-Yield Clinical Pearls for NEET-PG:** * **MEC Category 4 (Absolute Contraindication):** Smoker >35 years (≥15 cigarettes/day), Migraine with aura, Undiagnosed abnormal uterine bleeding, Breast cancer, and History of Stroke/IHD. * **Drug Interaction:** For patients on Rifampicin, the preferred method is an IUD or Injectable MPA, as these are not affected by liver enzyme induction. * **Benefit:** COCPs are protective against Ovarian and Endometrial cancers.

Q: The first dose of oral contraceptive pills for emergency contraception should be taken within how many hours?

72 hours. **Explanation:** The primary mechanism of hormonal emergency contraception (EC) is to delay or inhibit ovulation. For maximum efficacy, the first dose must be administered as soon as possible after unprotected intercourse, ideally within **72 hours (3 days)**. This timeframe corresponds to the window before the LH surge triggers ovulation and before fertilization/implantation can occur. **Analysis of Options:** * **72 hours (Correct):** Standard guidelines (WHO and MoHFW) recommend the use of Levonorgestrel (LNG) 1.5 mg or the Yuzpe regimen within 72 hours. While some efficacy remains up to 120 hours, the failure rate increases significantly after the 72-hour mark. * **24 & 48 hours (Incorrect):** While taking the pill within these windows is highly effective (the sooner, the better), they do not represent the maximum clinical "cutoff" window typically tested in exams. * **96 hours (Incorrect):** This exceeds the standard recommended window for traditional LNG-based emergency pills. **High-Yield Clinical Pearls for NEET-PG:** 1. **Drug of Choice:** Levonorgestrel (1.5 mg single dose) is the preferred hormonal EC due to better tolerability and higher efficacy than the Yuzpe regimen (Ethinylestradiol + Levonorgestrel). 2. **Ulipristal Acetate:** A selective progesterone receptor modulator (SPRM) that is effective up to **120 hours (5 days)** and is more effective than LNG in obese women. 3. **Most Effective EC:** The **Copper-T (Cu-T 380A)** IUD is the most effective emergency contraceptive and can be inserted up to **5 days** after unprotected intercourse. 4. **Centchroman (Chhaya):** A non-steroidal SERM used for routine contraception (twice weekly for 3 months, then weekly), but **not** used for emergency contraception.

Q: Which of the following is NOT a mechanism by which an Intrauterine Contraceptive Device (IUCD) acts?

Inhibition of ovulation. **Explanation:** The primary mechanism of action for Intrauterine Contraceptive Devices (IUCDs) is to create a local environment that is hostile to sperm and prevents fertilization. **Why "Inhibition of Ovulation" is the correct answer:** IUCDs (both Copper and Hormonal) are **non-anovulatory** methods of contraception. They act locally within the uterus and do not suppress the Hypothalamic-Pituitary-Ovarian (HPO) axis. Therefore, patients using an IUCD continue to have regular ovulatory cycles. **Analysis of incorrect options:** * **Chronic endometrial inflammation:** Copper IUCDs (e.g., Cu-T 380A) act as a foreign body, inducing a sterile inflammatory response in the endometrium. This leads to the release of cytokines and macrophages which are spermicidal and prevent implantation. * **Increased motility of the fallopian tubes:** IUCDs alter the tubal and uterine motility, which interferes with the transport of the gametes (sperm and ovum), ensuring they do not meet at the right time for fertilization. * **Inducing endometrial atrophy:** This is the hallmark of **Hormonal IUCDs (LNG-IUD/Mirena)**. The continuous release of levonorgestrel leads to profound endometrial atrophy and thickening of cervical mucus, preventing sperm penetration. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect of Cu-T:** Menorrhagia (Bleeding). * **Most common reason for removal of Cu-T:** Pain followed by bleeding. * **Ideal time for insertion:** Within 10 days of the menstrual cycle (to ensure the patient is not pregnant). * **LNG-IUD (Mirena):** Is the **Drug of Choice (DOC)** for Menorrhagia (DUB) and provides protection against Endometrial Hyperplasia. * **Mechanism of Cu-T:** Primarily **spermicidal** (Copper ions inhibit sperm motility and viability).

Question 1

Which of the following is a benefit of third-generation oral contraceptive pills?

Accepted Answer

Decreased risk of myocardial infarction

Answer

Decreased risk of thromboembolism

Answer

Increased risk of breakthrough bleeding

Answer

More side effects

Question 2

Which method of Medical Termination of Pregnancy is not used in the first trimester of pregnancy?

Accepted Answer

Intrauterine instillation of hypertonic saline

Answer

Suction and evacuation

Answer

Mifepristone

Answer

Misoprostol

Question 3

What is the recognized method for identifying a missed Intrauterine Device (IUD)?

Accepted Answer

Ultrasound (USG)

Answer

X-ray

Answer

Barium meal

Answer

CT Scan

Question 4

Suction evacuation as MTP is best done up to how many weeks of gestation?

Accepted Answer

12 weeks

Answer

9 weeks

Answer

18 weeks

Answer

24 weeks

Question 5

Which of the following is a barrier method of contraception?

Accepted Answer

Spermicide

Answer

Oral contraceptive pill

Answer

Intrauterine device

Answer

Tubectomy

Question 6

A woman on combined oral contraceptive pills forgot to take them for two successive doses. What is the next best course of action?

Accepted Answer

Take the missed pills as soon as remembered, continue the remaining pills at the usual time, and use backup contraception for the next seven days.

Answer

Continue the next pill on the following day as scheduled.

Answer

Take three pills on the next day, then resume one pill daily.

Answer

Take two pills each day for the remainder of the cycle.

Question 7

Use of combined oral contraceptive pills is contraindicated in women with any of the following conditions except?

Accepted Answer

Tuberculosis

Answer

Lactation

Answer

Diabetes

Answer

Thromboembolism

Question 8

Which of the following is NOT true about spermicidal agents?

Accepted Answer

'Immediate douching' is a must after intercourse to avoid irritant action.

Answer

Contain non-ionic surfactants causing osmotic changes resulting in the killing of sperms.

Answer

They act as a physical barrier to sperm transport.

Answer

Do not have STD/HIV protection action.

Question 9

The first dose of oral contraceptive pills for emergency contraception should be taken within how many hours?

Accepted Answer

72 hours

Answer

24 hours

Answer

48 hours

Answer

96 hours

Question 10

Which of the following is NOT a mechanism by which an Intrauterine Contraceptive Device (IUCD) acts?

Accepted Answer

Inhibition of ovulation

Answer

Chronic endometrial inflammation

Answer

Increased motility of the fallopian tubes

Answer

Inducing endometrial atrophy

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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