Contraception and Family Planning Practice Questions

Q: The depicted instrument is used in which procedure?

Tubectomy (Female Sterilization). ***Tubectomy (Female Sterilization)*** - The depicted instrument is a **Falope ring applicator** or **Filshie clip applicator** specifically designed for **tubal occlusion** during female sterilization procedures. - It is widely used in **laparoscopic tubectomy** procedures as part of **family planning programs** in India, providing permanent contraception by blocking the fallopian tubes. *Punch Biopsy* - Punch biopsy instruments are **circular cutting tools** with sharp edges used to obtain **skin or tissue samples**. - They are much smaller, handheld devices that create **cylindrical tissue cores**, unlike the specialized tubal occlusion instrument shown. *Bone marrow biopsy set* - Bone marrow biopsy requires **Jamshidi needles** or **trephine needles** that are long, hollow instruments for accessing the **bone marrow cavity**. - These instruments are designed for **penetrating bone** and aspirating marrow, completely different from tubal sterilization equipment. *Trocar and cannula for laparoscopy* - **Trocars** are sharp, pointed instruments used to create **initial entry ports** in the abdomen for laparoscopic surgery. - They are **straight, spike-like instruments** with cannulas, not specialized applicators for tubal rings or clips as depicted.

Q: Which of the following is NOT a side effect of oral contraceptives?

Increased risk of ovarian cancer. **Explanation:** The correct answer is **D. Increased risk of ovarian cancer**. In fact, Combined Oral Contraceptive Pills (COCPs) are highly **protective** against ovarian cancer. **Why Option D is correct:** COCPs suppress ovulation by inhibiting the release of FSH and LH. According to the "Incessant Ovulation Theory," reducing the number of ovulatory cycles decreases repetitive trauma to the ovarian epithelium. Using COCPs for 5 years reduces the risk of ovarian cancer by approximately 50%, and this protective effect persists for up to 15–20 years after discontinuation. **Why other options are incorrect:** * **A. Irregular bleeding:** Breakthrough bleeding or spotting is the most common side effect, especially during the first few months of use (progestogen-induced endometrial instability). * **B. Headache:** Estrogen can trigger or worsen migraines. New-onset focal headaches or migraines with aura are contraindications due to the increased risk of stroke. * **C. Thrombosis:** The estrogen component (Ethinylestradiol) increases the synthesis of clotting factors (II, VII, IX, X) in the liver, significantly increasing the risk of Venous Thromboembolism (VTE). **High-Yield NEET-PG Pearls:** * **Protective Effects:** COCPs reduce the risk of **Ovarian, Endometrial, and Colorectal cancers**. * **Increased Risks:** COCPs slightly increase the risk of **Breast and Cervical cancers**, as well as Hepatic Adenomas. * **Non-contraceptive benefits:** Reduced incidence of Pelvic Inflammatory Disease (PID), ectopic pregnancy, and benign breast disease. * **Absolute Contraindication:** Smokers >35 years old (>15 cigarettes/day) due to high cardiovascular risk.

Q: Levonorgestrel-containing IUCD prevents pregnancy primarily due to which mechanism?

Making the endometrium unreceptive. **Explanation:** The **Levonorgestrel-releasing Intrauterine System (LNG-IUS)**, such as Mirena, primarily acts through local progestogenic effects. The high local concentration of levonorgestrel leads to profound **endometrial atrophy** and down-regulation of estrogen receptors, making the **endometrium unreceptive** to implantation. This is considered its most significant mechanism of action. **Analysis of Options:** * **A (Correct):** As mentioned, the primary mechanism is the induction of a thin, atrophic endometrium that prevents a fertilized egg from implanting. * **B (Incorrect):** While some systemic absorption occurs, ovulation is maintained in the majority of cycles (about 75-85%). It is not the primary contraceptive mechanism. * **C (Incorrect):** This is the primary mechanism for **Copper-containing IUCDs**, which cause a sterile inflammatory response and are spermicidal. LNG-IUS relies on hormonal changes rather than inflammation. * **D (Incorrect):** Progestogens make the cervical mucus **thick and viscid** (not thin), which creates a barrier to sperm penetration. While this is a secondary mechanism of LNG-IUS, endometrial changes remain the primary factor. **High-Yield Clinical Pearls for NEET-PG:** * **Life span:** LNG-IUS (Mirena) is FDA-approved for up to 8 years (previously 5). * **Non-contraceptive use:** It is the **Gold Standard** (First-line) medical management for **Heavy Menstrual Bleeding (HMB)** and Adenomyosis. * **Failure Rate:** It has one of the lowest failure rates (0.2%), comparable to surgical sterilization. * **Pearl:** Unlike Copper-T, LNG-IUS typically reduces menstrual blood flow and may lead to amenorrhea, which is often a desired therapeutic effect.

Q: A mother of 3 children had unprotected sexual intercourse last night. She wishes to avoid conception as her youngest child is only 7 months old. Which of the following is NOT used for emergency contraception?

Danazol. **Explanation:** The correct answer is **Danazol**. While Danazol is a synthetic androgen used in the treatment of endometriosis and hereditary angioedema, it has **no role** in emergency contraception (EC). Historically, high doses were studied, but it was found to be ineffective compared to modern methods and is not recommended by any current clinical guidelines. **Analysis of Options:** * **Intrauterine Device (IUD):** The Copper-T (Cu-T) is the **most effective** method of emergency contraception. It can be inserted up to 5 days (120 hours) after unprotected intercourse and provides the added benefit of long-term contraception. * **Ethinyl Estradiol and Levonorgestrel:** This combination is known as the **Yuzpe Regimen**. It involves taking two doses (100 mcg EE + 0.5 mg LNG each) 12 hours apart. While effective, it is now less preferred due to a high incidence of nausea and vomiting compared to LNG-only pills. * **Mifepristone:** A selective progesterone receptor modulator (SPRM). In low doses (10 mg or 25 mg), it is highly effective as an emergency contraceptive by delaying ovulation. (Note: High doses are used for medical abortion). **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard (Most Effective):** Copper IUD (Failure rate <0.1%). * **Drug of Choice (Hormonal):** Levonorgestrel (LNG) 1.5 mg single dose (effective up to 72 hours). * **Ulipristal Acetate:** Currently considered the most effective *oral* EC, effective up to 120 hours (5 days). * **Mechanism:** Most hormonal ECs work primarily by **delaying or inhibiting ovulation**; they do not disrupt an established pregnancy (not abortifacients).

Q: Assertion: Spermicides containing non-oxynol-9 provide effective protection against STDs. Reason: Non-oxynol 9 has apoptotic effects on HIV, gonococci and chlamydia.

Both assertion and reason are false. **Explanation:** The correct answer is **D (Both assertion and reason are false)**. **1. Why the Assertion and Reason are False:** While Non-oxynol-9 (N-9) is a potent surfactant that disrupts the cell membranes of spermatozoa, it does **not** provide protection against STDs. In fact, clinical trials have shown that N-9 can increase the risk of HIV transmission. The reason is also false because N-9 does not have "apoptotic effects." Instead, it acts via **detergent-like disruption** of cell membranes. This non-specific action causes micro-abrasions and inflammation in the vaginal and rectal epithelium. These lesions act as portals of entry for pathogens like HIV, *Neisseria gonorrhoeae*, and *Chlamydia trachomatis*, thereby increasing rather than decreasing the risk of infection. **2. Analysis of Incorrect Options:** * **Option A & B:** Incorrect because the assertion is false. N-9 is strictly a contraceptive and is contraindicated for individuals at high risk of STDs/HIV. * **Option C:** Incorrect because the reason is scientifically inaccurate. The mechanism is membrane disruption (cytotoxicity), not programmed cell death (apoptosis). **3. High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Spermicides (N-9) inhibit sperm motility and oxygen uptake by disrupting the lipoprotein membrane. * **Failure Rate:** The typical use failure rate is high (~28%), making it one of the least effective standalone methods. * **WHO Recommendation:** The WHO explicitly states that N-9 should not be used for STD/HIV prevention and should not be used as a lubricant during anal intercourse. * **Ideal Usage:** It is most effective when used in combination with barrier methods like diaphragms or condoms.

Q: Which of the following is NOT true about centchroman?

Failure rate is 10 per 100 women-years. **Explanation:** Centchroman (Ormeloxifene) is a unique **Selective Estrogen Receptor Modulator (SERM)** developed by CDRI, Lucknow. It is marketed under the trade names **Saheli** or **Chhaya** and is part of India’s National Family Planning Programme. **Why Option D is the correct answer (The False Statement):** The failure rate of Centchroman is significantly lower than 10 per 100 women-years. With typical use, the Pearl Index is approximately **1.83 to 2.84 per 100 women-years**. A failure rate of 10 would be unacceptably high for a modern contraceptive method. **Analysis of Incorrect Options:** * **A. Anti-estrogenic:** Centchroman acts as an estrogen antagonist in the uterus (preventing implantation) and breast, while having weak estrogenic effects elsewhere. Its primary contraceptive mechanism is altering the endometrium to make it unreceptive to a fertilized ovum. * **B. Not a teratogen:** Unlike many hormonal contraceptives, Centchroman is non-steroidal and has no reported teratogenic effects. If a woman conceives while taking it, there is no risk of fetal malformation. * **C. Long-acting pill:** It has a long half-life (approx. 170 hours), allowing for infrequent dosing. The standard regimen is **twice weekly for the first 3 months**, followed by **once weekly** thereafter. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** Ideal for lactating mothers as it does not affect the quantity or quality of breast milk. * **Non-Contraceptive Benefits:** Used in the management of Abnormal Uterine Bleeding (AUB) and mastalgia. * **Side Effects:** The most common side effect is **delayed periods** (prolonged cycles), which occurs in about 8-10% of users. * **Contraindications:** Polycystic Ovarian Syndrome (PCOS), cervical dysplasia, and recent history of jaundice or liver disease.

Q: Depot progestins are administered by which route?

Both subcutaneous and intramuscular route. **Explanation:** Depot progestins, primarily **Depot Medroxyprogesterone Acetate (DMPA)**, are long-acting reversible contraceptives (LARCs) designed for slow release into the systemic circulation. Traditionally, DMPA was administered exclusively via the **intramuscular (IM)** route (150 mg every 3 months) [1]. However, a newer formulation, **DMPA-SC 104**, is specifically designed for **subcutaneous (SC)** administration (104 mg every 3 months). Therefore, both routes are clinically utilized [1]. * **Why Option D is Correct:** DMPA is available in two preparations: 1. **DMPA-IM:** Injected into the gluteal or deltoid muscle. 2. **DMPA-SC:** Injected into the anterior thigh or abdomen. The SC version allows for easier self-administration and carries a lower dose while maintaining efficacy for 13 weeks. * **Why Option B is Incorrect:** Progestins are never given intravenously for contraception. The "depot" effect relies on the formation of a drug reservoir in muscle or fat for slow absorption; an IV bolus would cause immediate metabolism and lack the required duration of action. * **Why Options A & C are Incorrect:** While both are used, selecting only one would be incomplete. In the context of modern medical practice and NEET-PG patterns, the inclusion of the SC route is a high-yield update. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily inhibits ovulation by suppressing the LH surge; it also thickens cervical mucus. * **The "Antara" Program:** Under India’s National Family Planning Program, DMPA is provided free of cost under the brand name **Antara**. * **Side Effects:** Menstrual irregularities (most common), weight gain, and a reversible decrease in **Bone Mineral Density (BMD)** [2]. * **Return to Fertility:** There is a characteristic delay in the return to fertility (average 7–10 months) after the last injection.

Question 1

Tubectomy in a heart patient who has recently delivered is best done after which period?

Accepted Answer

1 week

Answer

48 hours

Answer

2 weeks

Answer

Immediately

Question 2

The depicted instrument is used in which procedure?

Accepted Answer

Tubectomy (Female Sterilization)

Answer

Punch Biopsy

Answer

Bone marrow biopsy set

Answer

Trocar and cannula for laparoscopy

Question 3

Which of the following is NOT a side effect of oral contraceptives?

Accepted Answer

Increased risk of ovarian cancer

Answer

Irregular bleeding

Answer

Headache

Answer

Thrombosis

Question 4

Levonorgestrel-containing IUCD prevents pregnancy primarily due to which mechanism?

Accepted Answer

Making the endometrium unreceptive

Answer

Suppressing ovulation

Answer

Initiating inflammatory changes within the endometrium

Answer

Making cervical mucus thin

Question 5

Which of the following is NOT a mechanism of action for an Intrauterine Contraceptive Device (IUCD)?

Accepted Answer

Constriction of the fallopian tubes

Answer

Thickening of cervical mucus

Answer

Inducing a local foreign body reaction

Answer

Making the endometrium unfavorable for implantation

Question 6

A mother of 3 children had unprotected sexual intercourse last night. She wishes to avoid conception as her youngest child is only 7 months old. Which of the following is NOT used for emergency contraception?

Accepted Answer

Danazol

Answer

Intrauterine device (IUD)

Answer

Ethinyl estradiol and levonorgestrel

Answer

Mifepristone

Question 7

Assertion: Spermicides containing non-oxynol-9 provide effective protection against STDs.
Reason: Non-oxynol 9 has apoptotic effects on HIV, gonococci and chlamydia.

Accepted Answer

Both assertion and reason are false

Answer

Both assertion and reason are true independently

Answer

Assertion is true, reason is false

Answer

Assertion is false, reason is true

Question 8

Which of the following is NOT true about centchroman?

Accepted Answer

Failure rate is 10 per 100 women-years

Answer

Anti-estrogenic

Answer

Not a teratogen

Answer

Long-acting pill

Question 9

A 32-year-old multipara with an intrauterine contraceptive device (Cu-T) in place presents for a regular checkup. Her urine pregnancy test is positive, and a 10-week intrauterine gestation is confirmed on ultrasonography. She wishes to continue the pregnancy. Which of the following management strategies is recommended in this patient?

Accepted Answer

Remove the IUD and plan expectant pregnancy management.

Answer

Remove the IUD and evacuate the uterine contents.

Answer

Leave the IUD in place and plan expectant pregnancy management.

Answer

Leave the IUD in place and administer broad-spectrum antibiotics for the next 4 weeks.

Question 10

Depot progestins are administered by which route?

Accepted Answer

Both subcutaneous and intramuscular route

Answer

Subcutaneous route

Answer

Intravenous route

Answer

Intramuscular route

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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