Maternal and Child Health Practice Questions

Q: Norplant 1 is expected to be effective for how many years?

5 years. **Explanation:** **Norplant** is a long-acting reversible contraceptive (LARC) system consisting of subdermal implants that release **Levonorgestrel** (a progestogen). 1. **Why Option B is Correct:** * **Norplant-1** (the original system) consists of **6 silastic capsules**, each containing 36 mg of Levonorgestrel (total 216 mg). It is designed to provide highly effective contraception for **5 years** by maintaining a steady, low-dose release of the hormone. * **Mechanism of Action:** It primarily works by thickening cervical mucus (preventing sperm penetration) and suppressing ovulation in about 50% of cycles. 2. **Why Other Options are Incorrect:** * **Option A (2 years):** No standard subdermal implant is limited to only 2 years. Most are designed for 3 to 5 years. * **Option C (7 years):** While some Copper-T IUDs (like CuT 380A) are effective for 10 years, Norplant's hormonal reservoir is exhausted and its efficacy declines significantly after 5 years. * **Option D (9 years):** This exceeds the pharmacological lifespan of all currently available subdermal contraceptive implants. 3. **High-Yield Clinical Pearls for NEET-PG:** * **Norplant-2 (Jadelle):** Consists of **2 rods** (instead of 6 capsules) and is also effective for **5 years**. * **Implanon/Nexplanon:** A single-rod implant containing **Etonogestrel**, effective for **3 years**. * **Insertion Site:** Usually the non-dominant upper arm, subdermally, during the first 7 days of the menstrual cycle. * **Return to Fertility:** Rapid; hormone levels become undetectable within 5–7 days of removal. * **Most Common Side Effect:** Irregular menstrual bleeding (breakthrough bleeding or spotting).

Q: Which one of the following is the most common problem associated with the use of condoms?

Contact dermatitis. **Explanation:** The correct answer is **C. Contact dermatitis**. **Why it is correct:** The most significant medical complication associated with condom use is an allergic reaction to **latex**, the material from which most condoms are manufactured. This typically manifests as **Type IV hypersensitivity (Contact Dermatitis)**, characterized by localized itching, redness, and swelling. In severe cases, it can progress to Type I hypersensitivity (anaphylaxis). For individuals with this sensitivity, non-latex alternatives (polyurethane or polyisoprene) are recommended. **Analysis of Incorrect Options:** * **A. Increased monilial infection:** Condoms do not cause candidiasis (moniliasis). In fact, by maintaining the acidic pH of the vagina (preventing the alkaline semen from neutralizing it), they may actually offer a slight protective effect against certain vaginal imbalances. * **B. Premature ejaculation:** This is incorrect. Condoms are often used therapeutically to *manage* premature ejaculation because the latex barrier decreases glans sensitivity, thereby potentially prolonging the duration of intercourse. * **C. Retention of urine:** There is no physiological or anatomical mechanism by which external condom use would cause urinary retention in either partner. **NEET-PG High-Yield Pearls:** * **Failure Rate:** The typical use failure rate is approximately **18%**, while the perfect use failure rate is **2%**. * **Dual Protection:** Condoms are the only contraceptive method that provides "dual protection" against both unintended pregnancy and **STIs/HIV**. * **Mechanism:** They act as a mechanical barrier, preventing the deposition of sperm in the vagina. * **Oil-based lubricants:** These should never be used with latex condoms as they cause the latex to degrade and rupture; only water-based lubricants are compatible.

Q: Which year was the Medical Termination of Pregnancy (MTP) Act passed?

1971. **Explanation:** The **Medical Termination of Pregnancy (MTP) Act** was passed by the Indian Parliament in **1971** and came into force on April 1, 1972. It was enacted to provide a legal framework for the termination of certain pregnancies by registered medical practitioners, primarily to reduce the incidence of maternal mortality and morbidity caused by illegal abortions. **Analysis of Options:** * **1971 (Correct):** The year the MTP Act was enacted. It is a landmark legislation in reproductive health. Note that the Act was recently amended in **2021**, increasing the upper gestation limit to 24 weeks for specific categories of women. * **1981 (Incorrect):** This year is associated with the launch of the National Leprosy Eradication Programme (NLEP) and the first reported cases of HIV/AIDS globally. * **1957 (Incorrect):** This year is significant for the launch of the National Tuberculous Survey in India, but unrelated to abortion laws. * **1961 (Incorrect):** This year saw the enactment of the **Dowry Prohibition Act** and the Maternity Benefit Act in India. **High-Yield Clinical Pearls for NEET-PG:** * **Shantilal Shah Committee (1964):** Their recommendations led to the drafting of the MTP Act. * **MTP Amendment Act 2021:** * Termination up to **20 weeks** requires the opinion of **one** doctor. * Termination between **20-24 weeks** (for special categories) requires **two** doctors. * Beyond **24 weeks** (for fetal abnormalities), a State-level **Medical Board** must decide. * **Confidentiality:** The name and particulars of the woman must not be revealed except to a person authorized by law (Section 5A).

Q: What is the most common neonatal disorder screened for?

Neonatal hypothyroidism. **Explanation:** **Congenital Hypothyroidism (CH)** is the most common preventable cause of intellectual disability worldwide and is the most frequent disorder screened for in neonatal screening programs globally. 1. **Why it is the correct answer:** CH has a high incidence (approximately 1 in 2,500 to 4,000 live births). Early detection is critical because clinical signs are often absent at birth due to the protective effect of maternal thyroid hormones. If left untreated, it leads to irreversible neurological damage and cretinism. Screening via **TSH levels** (usually between 48–72 hours of life) allows for early Levothyroxine replacement, ensuring normal neurodevelopment. 2. **Why the other options are incorrect:** * **Neonatal Hyperthyroidism:** This is rare and usually transient, occurring in infants born to mothers with Graves' disease due to the transplacental passage of TSH-receptor antibodies. It is not a routine screening target. * **Hemoglobinopathies:** While conditions like Sickle Cell Anemia and Thalassemia are common in specific ethnic groups or high-prevalence regions (and are part of the NBS in some Indian states), they are not as universally the "most common" screened disorder compared to CH. * **Congenital Dislocation of the Hip (DDH):** While screened via physical examination (Barlow and Ortolani maneuvers), it is a structural deformity rather than a metabolic/endocrine disorder typically associated with "neonatal screening" laboratory panels. **High-Yield Pearls for NEET-PG:** * **Ideal time for screening:** 48–72 hours after birth (to avoid the physiological neonatal TSH surge). * **Most common cause of CH:** Thyroid dysgenesis (85%). * **Other common NBS targets:** Phenylketonuria (PKU), Galactosemia, Congenital Adrenal Hyperplasia (CAH), and G6PD deficiency. * **Goitre:** Not usually present in thyroid dysgenesis; if present, suspect dyshormonogenesis.

Q: What is the ideal contraceptive for a couple who live separately in two cities and meet only occasionally?

Barrier methods. **Explanation:** The selection of a contraceptive method depends on the frequency of sexual intercourse, the need for protection against STIs, and the patient's lifestyle. **Why Barrier Methods are Correct:** For couples who live apart and meet only occasionally (infrequent intercourse), **Barrier methods** (specifically condoms) are the "ideal" choice. This is because they are used **"on-demand"** only when required. Unlike hormonal or long-acting methods, they do not require daily compliance or continuous systemic medication for a couple that is not regularly active. Additionally, they provide the added benefit of protection against Sexually Transmitted Infections (STIs). **Why Other Options are Incorrect:** * **Oral Contraceptive Pills (OCPs):** These require strict daily compliance to be effective. For a couple meeting only once or twice a month, taking a daily systemic hormone is considered unnecessary "over-medication." * **IUCD (Copper T):** This is a Long-Acting Reversible Contraceptive (LARC). While highly effective, it is generally preferred for couples living together who desire long-term spacing (3–10 years) rather than those with infrequent contact. * **Injectable DMPA (Antara Program):** This requires an injection every 3 months. Similar to OCPs, it provides continuous systemic hormonal exposure which is not justified for occasional use. **High-Yield NEET-PG Pearls:** * **Ideal for newly married couples:** OCPs (to establish a regular cycle and high efficacy). * **Ideal for spacing after the first child:** IUCD (Copper T 380A). * **Ideal for lactating mothers:** Progestogen-only pills (POPs) or Centchroman (Chhaya). * **Failure rate (Pearl Index) of Condoms:** 2–14 per 100 woman-years (highly dependent on correct usage).

Q: Which is the most effective contraceptive method available?

Third-generation intrauterine contraceptive device (IUCD). The effectiveness of a contraceptive method is primarily measured by its **Pearl Index** (number of unintended pregnancies per 100 woman-years of use). ### **Why Option C is Correct** The **Third-generation Intrauterine Contraceptive Device (IUCD)**, specifically the **Levonorgestrel-releasing Intrauterine System (LNG-IUS/Mirena)**, is considered the most effective reversible contraceptive. Its efficacy is comparable to surgical sterilization. Unlike pills or injectables, it eliminates "user failure" (forgetting a dose), providing a "fit and forget" long-acting reversible contraception (LARC) with a failure rate as low as **0.2%**. ### **Analysis of Other Options** * **A. Combined Oral Contraceptive Pill (COCP):** While highly effective with "perfect use," the "typical use" failure rate is higher (around 7-9%) due to missed pills. * **B. Progestin Injectable (DMPA):** Administered every 3 months. While effective, it has a higher failure rate than IUCDs due to delays in subsequent injections. * **D. Centchroman (Chhaya):** A non-steroidal, selective estrogen receptor modulator (SERM). While safe and part of India’s National Family Planning Program, its efficacy is lower than hormonal IUCDs and COCPs. ### **High-Yield Clinical Pearls for NEET-PG** * **Most effective overall:** Implant (Nexplanon) > LNG-IUS > Vasectomy. * **Pearl Index of LNG-IUS:** 0.2 (Most effective among the given options). * **First-generation IUCD:** Non-medicated (e.g., Lippes Loop). * **Second-generation IUCD:** Copper-releasing (e.g., Cu-T 380A - effective for 10 years). * **Third-generation IUCD:** Hormone-releasing (e.g., LNG-IUS - effective for 5 years). * **Ideal Contraceptive for a lactating mother:** Progestogen-only pills (POPs) or IUCD (does not affect milk quantity/quality).

Q: According to ICD-10, what is the minimum body length used to define perinatal mortality?

35 cm. ### Explanation **Concept & Correct Answer:** According to the **World Health Organization (ICD-10)**, perinatal mortality includes late fetal deaths (stillbirths) and early neonatal deaths. To ensure international comparability, the ICD-10 defines the criteria for including a fetus or neonate in these statistics based on specific thresholds. The correct answer is **35 cm (Option C)**. This is the standard minimum **crown-heel length** used to define a perinatal death when the birth weight or gestational age is unknown. Under ICD-10 criteria for international reporting, a perinatal death is defined by: 1. **Birth weight:** 1000 grams or more. 2. **Gestational age:** 28 completed weeks (196 days) or more. 3. **Body length:** 35 cm or more (crown-heel). **Analysis of Incorrect Options:** * **Option A (28 cm):** This does not correspond to any standard ICD-10 threshold for perinatal mortality. It is often confused with the "28 weeks" gestational age criteria. * **Option B (30 cm):** While 30 cm is sometimes associated with a 24-week fetus (the limit of viability in some developed nations), it is not the ICD-10 standard for perinatal statistics. * **Option D (38 cm):** This length typically corresponds to a more mature fetus (around 30-32 weeks) and exceeds the minimum threshold required for definition. **High-Yield Clinical Pearls for NEET-PG:** * **Perinatal Period:** Starts at **28 weeks** of gestation and ends **7 days** after birth. * **Formula:** (Late fetal deaths + Early neonatal deaths / Total births) × 1000. * **National vs. International:** While ICD-10 uses 1000g/28 weeks for international comparison, many countries (including India under the Sample Registration System) track perinatal mortality starting from **500g or 22 weeks** for internal health monitoring. * **Early Neonatal Death:** Death of a live-born baby within the first 7 completed days of life (0-6 days).

Question 1

Norplant 1 is expected to be effective for how many years?

Accepted Answer

5 years

Answer

2 years

Answer

7 years

Answer

9 years

Question 2

Which of the following statements about the Rhythm method of contraception is false?

Accepted Answer

Anencephaly is a reported complication of the calendar method.

Answer

It is associated with no costs.

Answer

The safe period can also be observed using the temperature rhythm or mucous method.

Answer

Abstinence is needed for about 7-10 days.

Question 3

Maternal near miss refers to:

Accepted Answer

A woman presenting with a life-threatening condition but has survived

Answer

Teenager becoming pregnant

Answer

Contraceptive failure in a teenager

Answer

A woman presenting with a life-threatening condition who has died

Question 4

Which one of the following is the most common problem associated with the use of condoms?

Accepted Answer

Contact dermatitis

Answer

Increased monilial infection of the vagina

Answer

Premature ejaculation

Answer

Retention of urine

Question 5

Which of the following is an intrauterine contraceptive device?

Accepted Answer

Multiload 375

Answer

CuT 200

Answer

CuT 380A

Answer

LNG-IUS

Question 6

Which year was the Medical Termination of Pregnancy (MTP) Act passed?

Accepted Answer

1971

Answer

1981

Answer

1957

Answer

1961

Question 7

What is the most common neonatal disorder screened for?

Accepted Answer

Neonatal hypothyroidism

Answer

Neonatal hyperthyroidism

Answer

Hemoglobinopathies

Answer

Congenital dislocation of the hip

Question 8

What is the ideal contraceptive for a couple who live separately in two cities and meet only occasionally?

Accepted Answer

Barrier methods

Answer

Oral contraceptive pills (OCPs)

Answer

Intrauterine contraceptive device (IUCD)

Answer

Injectable depot medroxyprogesterone acetate (DMPA)

Question 9

Which is the most effective contraceptive method available?

Accepted Answer

Third-generation intrauterine contraceptive device (IUCD)

Answer

Combined oral contraceptive pill

Answer

Progestin injectable

Answer

Centchroman

Question 10

According to ICD-10, what is the minimum body length used to define perinatal mortality?

Accepted Answer

35 cm

Answer

28 cm

Answer

30 cm

Answer

38 cm

Maternal and Child Health — MCQs

Maternal and Child Health — MCQs

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