Contraception and Family Planning Practice Questions

Q: Which of the following is NOT an abdominal laparoscopic technique for tubal ligation?

Essure. **Explanation:** The question asks to identify the technique that is **not** an abdominal laparoscopic method for tubal ligation. **1. Why Essure is the correct answer:** Essure is a **hysteroscopic** (transcervical) sterilization technique, not an abdominal or laparoscopic one. It involves the insertion of micro-inserts (made of nickel-titanium and polyethylene fibers) into the fallopian tubes via the vagina and cervix. These inserts trigger a chronic inflammatory response, leading to fibrosis and complete tubal occlusion over 3 months. *Note: Essure was discontinued globally due to safety concerns, but remains a high-yield topic for identifying non-surgical routes.* **2. Analysis of incorrect options (Abdominal/Laparoscopic methods):** * **Pomeroy (Option A):** The most common method. A loop of the tube is ligated with absorbable suture and the knuckle is excised. * **Parkland (Option B):** Involves ligating the tube at two points and excising the intervening segment, ensuring the ends are separated to prevent recanalization. * **Irving (Option C):** The most effective method (lowest failure rate). The proximal end of the severed tube is buried into the posterior wall of the uterus. **Clinical Pearls for NEET-PG:** * **Most common method worldwide:** Pomeroy’s technique. * **Method with the lowest failure rate:** Irving’s technique. * **Madlener’s technique:** Ligation without excision (highest failure rate due to fistula formation). * **Uchida technique:** Involves subserosal injection and resection; very effective but complex. * **Timing:** Postpartum sterilization is ideally performed 24–48 hours after delivery.

Q: Non-contraceptive benefits of oral contraceptive pills may be seen in all of the following conditions except?

Breast cancer. **Explanation:** Combined Oral Contraceptive Pills (COCPs) offer several non-contraceptive benefits due to their ability to suppress ovulation and regulate the hormonal milieu. However, their relationship with breast cancer is a notable exception. **Why Breast Cancer is the Correct Answer:** COCPs do **not** provide a protective effect against breast cancer. In fact, most epidemiological studies suggest a **slight increase in the relative risk** of breast cancer among current and recent users. This risk is generally considered to return to baseline 10 years after discontinuing the pill. Therefore, it is not a "benefit." **Analysis of Other Options:** * **Endometrial Cancer:** COCPs provide a significant protective effect (approx. 50% reduction in risk) by preventing estrogen-driven endometrial hyperplasia through the progestogen component. This protection persists for years after stopping the pill. * **Rheumatoid Arthritis:** High-yield evidence suggests that COCPs may reduce the risk of developing severe rheumatoid arthritis and can ameliorate the progression of the disease. * **Endometriosis:** COCPs are a first-line medical management for endometriosis. They induce decidualization and subsequent atrophy of endometrial tissue, thereby reducing dysmenorrhea and pelvic pain. **High-Yield Clinical Pearls for NEET-PG:** * **Cancer Protection:** COCPs significantly reduce the risk of **Ovarian cancer** (by 40-80%) and **Endometrial cancer**. They also reduce the risk of **Colorectal cancer**. * **Increased Risk:** COCPs are associated with an increased risk of **Cervical cancer** (especially with >5 years of use) and **Hepatocellular adenoma**. * **Benign Conditions:** They reduce the incidence of Benign Breast Disease (e.g., fibroadenoma), Pelvic Inflammatory Disease (PID), and Iron Deficiency Anemia (due to reduced menstrual flow).

Q: What is the recommended dose of mifepristone for medical abortion?

600 mg. **Explanation:** The correct answer is **600 mg** because this is the dosage currently recommended under the **MTP (Medical Termination of Pregnancy) Act of India** for medical abortion up to 63 days (9 weeks) of gestation. **Medical Rationale:** Mifepristone is an anti-progestational agent that binds to progesterone receptors with high affinity, leading to decidual breakdown, cervical softening, and increased uterine sensitivity to prostaglandins. While clinical trials (and WHO guidelines) suggest that 200 mg is equally effective, the **statutory dose** prescribed by the Drug Controller General of India (DCGI) and the MTP Act remains **600 mg orally**, followed 48 hours later by 400 mcg of Misoprostol (either orally or vaginally). **Analysis of Options:** * **Option A (600 mg):** The standard legal and academic answer for NEET-PG based on Indian national guidelines. * **Option B (200 mg):** Though globally recommended by the WHO as the "evidence-based" dose to reduce cost and side effects, it is not the standard answer for Indian competitive exams unless "WHO guidelines" are specifically mentioned. * **Option C & D (400 mg / 100 mg):** These are sub-therapeutic or incorrect doses for the purpose of medical abortion. 400 mcg is, however, the standard dose for the second drug, Misoprostol. **High-Yield Clinical Pearls for NEET-PG:** * **MTP Act Limit:** Medical abortion is permitted up to **9 weeks (63 days)** of gestation. * **Mechanism:** Mifepristone (Antiprogestin) + Misoprostol (PGE1 analogue). * **Emergency Contraception:** A single dose of **10 mg** mifepristone can be used as an emergency contraceptive. * **Other uses:** Mifepristone is also used in the management of Cushing’s syndrome and uterine fibroids.

Q: Thromboembolism is primarily associated with which component of oral contraceptive pills (OCPs)?

Estrogen. **Explanation:** The correct answer is **Estrogen**. **1. Why Estrogen is Correct:** The association between Combined Oral Contraceptive Pills (COCPs) and venous thromboembolism (VTE) is primarily attributed to the **Estrogen** component (usually Ethinyl Estradiol). Estrogen exerts a pro-thrombotic effect by altering the hepatic synthesis of clotting factors. Specifically, it: * **Increases** levels of clotting factors II, VII, IX, and X. * **Decreases** levels of natural anticoagulants like Antithrombin III and Protein S. * **Increases** platelet aggregation. This shift in the balance toward a hypercoagulable state significantly increases the risk of deep vein thrombosis (DVT) and pulmonary embolism. **2. Why Other Options are Incorrect:** * **Progesterone:** While some third-generation progestins (e.g., Desogestrel) may slightly modulate the risk when combined with estrogen, the primary causative agent for the hypercoagulable state is estrogen. Progesterone-only pills (POPs) are generally considered safe for patients with a history of VTE. * **Iron:** Iron is often added to the 7-day placebo phase of OCP packs (e.g., Mala-N) to prevent iron-deficiency anemia; it has no effect on the coagulation cascade. * **FSH:** FSH is a gonadotropin produced by the pituitary, not a component of OCPs. OCPs actually work by *suppressing* FSH and LH. **3. NEET-PG High-Yield Pearls:** * **Dose-Dependency:** The risk of VTE is dose-dependent; modern "low-dose" pills ( 35 years, and migraine with aura are absolute contraindications for Estrogen-containing OCPs (WHO Eligibility Criteria Category 4). * **Surgery:** OCPs should ideally be stopped **4 weeks prior** to major elective surgery to reduce postoperative VTE risk.

Q: Which of the following is NOT a contraindication for insertion of an IUCD?

Cervical discharge. **Explanation:** The correct answer is **Cervical discharge**. In clinical practice, the presence of physiological cervical discharge is not a contraindication for IUCD insertion. However, if the discharge is purulent and associated with an active infection (like cervicitis or PID), insertion should be delayed. According to WHO Medical Eligibility Criteria (MEC), a history of non-purulent discharge does not preclude IUCD use. **Analysis of Options:** * **PID (Pelvic Inflammatory Disease):** This is a **Category 4 contraindication** (absolute). Inserting an IUCD during active PID can exacerbate the infection and lead to complications like tubo-ovarian abscess or infertility. * **Presence of fibroids:** While not all fibroids are contraindications, those that **distort the uterine cavity** (e.g., submucosal fibroids) are a contraindication because they prevent proper placement, increase the risk of expulsion, and may cause heavy bleeding. * **Suspected pregnancy:** This is an absolute contraindication. Insertion during pregnancy can lead to septic abortion or miscarriage. **High-Yield Clinical Pearls for NEET-PG:** * **WHO MEC Category 4 (Absolute Contraindications):** Unexplained vaginal bleeding, current PID, current STI (cervicitis), gestational trophoblastic disease, and copper allergy (for Cu-T). * **Ideal time for insertion:** Within 10 days of the onset of menstruation (to ensure the patient is not pregnant and the cervical os is slightly dilated). * **Post-placental insertion:** Within 48 hours of delivery (though risk of expulsion is higher). * **Most common side effect:** Bleeding (menorrhagia) is the most common reason for removal. Pain is the second most common.

Question 1

What is the technique used for Cu-T insertion?

Accepted Answer

Pushing

Answer

Surgery under local anesthesia

Answer

Surgery under general anesthesia

Answer

Laparotomy

Question 2

Which of the following is NOT an abdominal laparoscopic technique for tubal ligation?

Accepted Answer

Essure

Answer

Pomeroy

Answer

Parkland

Answer

Irving

Question 3

Non-contraceptive benefits of oral contraceptive pills may be seen in all of the following conditions except?

Accepted Answer

Breast cancer

Answer

Endometrial cancer

Answer

Rheumatoid arthritis

Answer

Endometriosis

Question 4

All of the following are complications of IUCD except:

Accepted Answer

Genital malignancy

Answer

Bleeding

Answer

Actinomycosis

Answer

Vaginal discharge

Question 5

In combined oral contraceptive pills, the contraceptive effect of the estrogenic component is primarily related to which of the following?

Accepted Answer

Suppression of follicle-stimulating hormone (FSH) secretion

Answer

Conversion of ethinyl estradiol to mestranol

Answer

Suppression of cervical mucus secretion

Answer

Suppression of growth hormone-releasing hormone secretion

Question 6

What is the recommended dose of mifepristone for medical abortion?

Accepted Answer

600 mg

Answer

200 mg

Answer

400 mg

Answer

100 mg

Question 7

Thromboembolism is primarily associated with which component of oral contraceptive pills (OCPs)?

Accepted Answer

Estrogen

Answer

Progesterone

Answer

Iron

Answer

Follicle Stimulating Hormone (FSH)

Question 8

Regarding the removal of a cervical cap, what is true?

Accepted Answer

The cervical cap must be left in place for at least 8 hours after intercourse.

Answer

The cervical cap should be left in place for the entire cycle length.

Answer

The cervical cap can be removed immediately, followed by vaginal douching.

Answer

The cervical cap should be left until the next menstruation starts.

Question 9

Which of the following is NOT a characteristic feature of an ideal IUCD candidate?

Accepted Answer

Has borne at least two children

Answer

Has no history of pelvic disease

Answer

Has normal menstrual periods

Answer

Is willing to check the IUCD tail

Question 10

Which of the following is NOT a contraindication for insertion of an IUCD?

Accepted Answer

Cervical discharge

Answer

PID

Answer

Presence of fibroids

Answer

Suspected pregnancy

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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