Contraception and Family Planning Practice Questions

Q: In which of the following situations is it preferable NOT to insert an IUCD?

Immediately following a mid-trimester abortion. ### Explanation The correct answer is **D. Immediately following a mid-trimester abortion.** **1. Why Option D is Correct:** The risk of **expulsion** and **perforation** is significantly higher when an Intrauterine Contraceptive Device (IUCD) is inserted immediately after a mid-trimester (second trimester) abortion. During this period, the uterus is large, soft, and thin-walled. Furthermore, the cervix is dilated, making it easier for the device to be expelled as the uterus undergoes involution. Standard practice recommends waiting for **6 weeks** (post-involution) before insertion in such cases. **2. Analysis of Incorrect Options:** * **A. Postmenstrual:** This is the **ideal time** for insertion. The cervix is slightly open, the endometrium is thin (minimizing trauma/bleeding), and it confirms the patient is not pregnant. * **B. Emergency postcoital:** A Copper-T is the most effective method of emergency contraception if inserted within **5 days (120 hours)** of unprotected intercourse. * **C. Six weeks after delivery:** This is known as **Interval Insertion**. By 6 weeks, the uterus has returned to its normal size (involution complete), making it a safe and standard time for insertion. **3. High-Yield Clinical Pearls for NEET-PG:** * **PPIUCD (Postpartum IUCD):** Can be inserted within **48 hours** of delivery. If not done within 48 hours, wait for 6 weeks (due to high expulsion risk between 48 hours and 6 weeks). * **Post-Abortion:** IUCD can be inserted immediately after a **first-trimester** abortion (MTP/spontaneous), but should be delayed after a second-trimester abortion. * **Most Common Side Effect:** Bleeding (Menorrhagia). * **Most Common Reason for Removal:** Bleeding/Pain. * **Absolute Contraindication:** Undiagnosed vaginal bleeding, current PID, or suspected pregnancy.

Q: Which contraceptive method helps in preventing carcinoma of the cervix?

Barrier contraceptives. **Explanation:** **1. Why Barrier Contraceptives are Correct:** Carcinoma of the cervix is primarily caused by persistent infection with high-risk strains of **Human Papillomavirus (HPV)**, most commonly types 16 and 18. Since HPV is a sexually transmitted infection (STI), **barrier methods** (specifically male and female condoms) act as a physical shield. They prevent direct skin-to-skin and mucosal contact, thereby significantly reducing the transmission of HPV. By preventing the primary causative agent, barrier methods serve as a protective factor against cervical dysplasia and subsequent malignancy. **2. Analysis of Incorrect Options:** * **Intracervical/Intrauterine Devices (IUCDs):** While some studies suggest IUCDs might trigger a local immune response that helps clear HPV, they do not prevent the initial infection. Furthermore, they do not provide a physical barrier against STIs. * **Oral Contraceptive Pills (OCPs):** Long-term use of OCPs (typically >5 years) is actually associated with a **slight increase in the risk** of cervical cancer. This is attributed to hormonal influences on the transformation zone and the fact that OCP users are less likely to use barrier protection (confounding factor). **3. High-Yield Clinical Pearls for NEET-PG:** * **Protective Effect of OCPs:** OCPs are highly protective against **Ovarian** and **Endometrial** cancers (the "Rule of O": OCPs protect against Ovarian/Endometrial). * **IUCDs and Cancer:** IUCDs are associated with a decreased risk of **Endometrial cancer**. * **Primary Prevention of Cervical Cancer:** The most effective primary prevention is the **HPV Vaccine** (e.g., Gardasil-9), ideally administered before the onset of sexual activity. * **Secondary Prevention:** Regular screening via **Pap Smear** and **HPV DNA testing**.

Q: Which of the following statements about the calendar method of contraception is false?

Ectopic pregnancy is a reported complication.. **Explanation:** The **Calendar (Rhythm) Method** is a natural family planning technique based on predicting ovulation by tracking the menstrual cycle. **Why Option D is the correct (false) statement:** Ectopic pregnancy is **not** a complication of the calendar method. Ectopic pregnancy occurs when a fertilized egg implants outside the uterus. While the calendar method has a high failure rate (typical use failure rate ~24%), a failure simply results in a **normal intrauterine pregnancy**. In contrast, methods like the Progestin-only pill (POP), Levonorgestrel-IUD, or tubal ligation—which prevent intrauterine implantation more effectively than they prevent ovulation or tubal transport—are associated with a higher *relative* risk of ectopic pregnancy if they fail. **Analysis of other options:** * **Option A:** True. Abstinence is only required during the "fertile window" (calculated as the shortest cycle minus 18 days to the longest cycle minus 11 days). * **Option B:** True. It is a behavioral method requiring no devices, hormones, or clinical procedures, thus incurring no financial cost. * **Option C:** True. These are complementary "Fertility Awareness-Based Methods" (FABM). Basal Body Temperature (BBT) identifies the post-ovulatory rise, and the Billings method tracks changes in cervical mucus (spinnbarkeit). **High-Yield Clinical Pearls for NEET-PG:** * **Pearl 1:** The calendar method is unreliable for women with irregular cycles. * **Pearl 2:** The **Standard Days Method** is a simplified version of the calendar method suitable for women with cycles between 26–32 days (abstinence on days 8–19). * **Pearl 3:** Natural methods do not protect against STIs/HIV. * **Pearl 4:** **Lactational Amenorrhea Method (LAM)** is only effective for up to 6 months postpartum, provided the mother is exclusively breastfeeding and remains amenorrheic.

Q: Oral contraceptive pills (OCPs) decrease the risk of which of the following cancers?

Endometrial cancer. **Explanation:** Combined Oral Contraceptive Pills (OCPs) exert a significant protective effect against certain gynecological malignancies, most notably **endometrial cancer**. **Why Endometrial Cancer is the Correct Answer:** The primary mechanism is the **progestogenic effect**, which antagonizes the action of estrogen on the endometrium. Progesterone prevents endometrial hyperplasia by limiting the proliferative phase and inducing secretory changes. Long-term OCP use reduces the risk of endometrial cancer by approximately 50%, and this protective effect persists for up to 15–20 years after discontinuation. **Analysis of Incorrect Options:** * **Cervical Cancer:** OCPs are actually associated with a **slight increase** in the risk of cervical cancer, particularly with use exceeding 5 years. This may be due to biological changes in the transformation zone or behavioral factors (decreased barrier contraceptive use). * **Vaginal Cancer:** There is no established protective link between OCP use and vaginal cancer. * **Liver Carcinoma:** OCPs are associated with a rare but specific risk of **Hepatic Adenoma** (benign). While the link to Hepatocellular Carcinoma (HCC) is debated, OCPs certainly do not decrease its risk. **High-Yield Clinical Pearls for NEET-PG:** * **The "Rule of Two":** OCPs decrease the risk of **two** main cancers: **Endometrial** and **Ovarian** (specifically epithelial ovarian cancer). * **Ovarian Cancer Protection:** OCPs reduce risk by suppressing ovulation ("incessant ovulation" theory). * **Colorectal Cancer:** Emerging evidence suggests OCPs also decrease the risk of colorectal cancer. * **Breast Cancer:** OCPs are associated with a very slight, transient increase in breast cancer risk, which returns to baseline 10 years after stopping.

Q: A 28-year-old woman at 13 weeks of gestation presents with ultrasound findings of anencephaly and requests medical termination of pregnancy (MTP). Which of the following is NOT a preferred method of MTP in this condition?

Menstrual regulation. **Explanation:** The correct answer is **A. Menstrual regulation**. **1. Why Menstrual Regulation is NOT preferred:** Menstrual regulation (MR) is a procedure used for the termination of pregnancy very early in the first trimester, typically within **6 weeks of the last menstrual period (LMP)** or up to 14 days of a missed period. It involves manual vacuum aspiration of the uterine contents. Since the patient in this scenario is at **13 weeks of gestation** (early second trimester), MR is technically inappropriate and unsafe due to the size of the fetus and the advanced gestational age. **2. Analysis of Other Options (Second Trimester MTP Methods):** * **B. Intra-amniotic instillation (Urea/PGF2α):** This is a recognized method for second-trimester termination. Hypertonic solutions or prostaglandins are injected into the amniotic sac to induce uterine contractions and fetal expulsion. * **C. Extraovular instillation (Ethacridine lactate):** Also known as the "Emcredil" method, a Foley catheter is used to instill the solution into the space between the uterine wall and the fetal membranes. It is a classic method for mid-trimester MTP. * **D. Parenteral administration of PGF2α:** Systemic administration (IM or IV) of prostaglandins (like Carboprost) is a highly effective pharmacological method to induce labor in the second trimester. **Clinical Pearls for NEET-PG:** * **MTP Act (India):** Termination is legal up to **24 weeks** for specific categories (including fetal anomalies like anencephaly). * **First Trimester (up to 12 weeks):** Preferred methods are Medical (Mifepristone + Misoprostol) or Surgical (Suction Evacuation). * **Second Trimester (13–24 weeks):** Preferred methods include Dilatation and Evacuation (D&E) or Medical Induction (Prostaglandins/Oxytocin). * **Anencephaly:** This is a lethal neural tube defect; once diagnosed, MTP is indicated regardless of gestational age (within legal limits).

Q: Which contraceptive is contraindicated during lactation?

Combined Oral Contraceptive Pill (OCP). **Explanation:** The primary reason **Combined Oral Contraceptive Pills (COCPs)** are contraindicated during lactation (specifically within the first 6 months) is the **Estrogen** component. Estrogen suppresses the production of prolactin, leading to a significant reduction in both the quantity and quality of breast milk. Furthermore, there is a theoretical risk of estrogen being excreted in milk, potentially affecting the infant. According to WHO Medical Eligibility Criteria (MEC), COCPs are categorized as **MEC 4** (unacceptable health risk) if used <3 weeks postpartum and **MEC 3** between 3 weeks to 6 months if breastfeeding. **Analysis of Incorrect Options:** * **B. Intrauterine Device (IUD):** Both Cu-T and LNG-IUS are safe during lactation. They do not interfere with milk production. While the risk of perforation is slightly higher in lactating women due to a soft uterus, they remain a first-line postpartum contraceptive (PPIUCD). * **C. Progesterone-only pill (POP):** Also known as the "Minipill," this is the **contraceptive of choice** for lactating mothers. Progesterone does not suppress lactation; in some studies, it has been shown to slightly increase milk volume. **NEET-PG High-Yield Pearls:** * **Ideal time to start POPs:** 6 weeks postpartum (though can be started earlier as per recent guidelines). * **Lactational Amenorrhea Method (LAM):** Effective only if the mother is exclusively breastfeeding, is amenorrheic, and the baby is <6 months old. * **DMPA (Injectable):** Safe during lactation; usually administered after 6 weeks postpartum to ensure lactation is well-established. * **Centchroman (Saheli):** A non-steroidal SERM; it is safe during lactation and does not affect milk yield.

Q: A single tablet of levonorgestrel 0.75 mg has been taken for effective post-coital contraception. When should the second tablet be taken?

24 hours after the first tablet. **Explanation:** The correct answer is **B. 24 hours after the first tablet.** **Understanding the Concept:** Levonorgestrel (LNG) is a progestogen-only emergency contraceptive pill (ECP). The standard regimen for emergency contraception using 0.75 mg tablets involves a total dose of 1.5 mg. According to the **World Health Organization (WHO)** and standard clinical guidelines, if the 0.75 mg formulation is used, the two doses should be taken **24 hours apart**. While earlier protocols suggested a 12-hour interval, current evidence and updated guidelines (including those often cited in NEET-PG) emphasize the 24-hour interval for optimal efficacy and convenience. Alternatively, both tablets (1.5 mg total) can be taken as a single stat dose. **Analysis of Options:** * **Option A (12 hours):** This was the traditional Yuzpe regimen timing, but it is no longer the preferred interval for LNG-only pills as per updated guidelines. * **Options C & D (36 and 48 hours):** These intervals are too long. Delaying the second dose significantly reduces the efficacy of the hormonal surge required to inhibit or delay ovulation. **High-Yield Clinical Pearls for NEET-PG:** * **Window of Efficacy:** LNG-ECP should ideally be taken within 72 hours of unprotected intercourse, though it has some efficacy up to 120 hours. * **Mechanism of Action:** Primarily acts by **inhibiting or delaying ovulation**. It does not disrupt an established pregnancy (not an abortifacient). * **Single Dose Trend:** The most common current practice is a single dose of **1.5 mg LNG** (e.g., i-Pill or 72-H) as it improves compliance without increasing side effects. * **Most Effective EC:** The **Copper-T 380A** is the most effective emergency contraceptive if inserted within 5 days. * **Drug of Choice:** **Ulipristal acetate (30 mg)** is now considered more effective than LNG, especially between 72–120 hours.

Question 1

In which of the following situations is it preferable NOT to insert an IUCD?

Accepted Answer

Immediately following a mid-trimester abortion

Answer

Postmenstrual

Answer

Emergency postcoital

Answer

Six weeks after delivery

Question 2

Which contraceptive method helps in preventing carcinoma of the cervix?

Accepted Answer

Barrier contraceptives

Answer

Intracervical devices

Answer

Intrauterine contraceptive devices

Answer

Oral contraceptive pills

Question 3

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

Accepted Answer

Ectopic pregnancy is a reported complication.

Answer

Abstinence is needed for only a few days in a month.

Answer

It is associated with no cost.

Answer

The fertile period can also be estimated using the basal body temperature, rhythm, or cervical mucus methods.

Question 4

Oral contraceptive pills (OCPs) decrease the risk of which of the following cancers?

Accepted Answer

Endometrial cancer

Answer

Cervical cancer

Answer

Vaginal cancer

Answer

Liver carcinoma

Question 5

A 28-year-old woman at 13 weeks of gestation presents with ultrasound findings of anencephaly and requests medical termination of pregnancy (MTP). Which of the following is NOT a preferred method of MTP in this condition?

Accepted Answer

Menstrual regulation

Answer

Intra-amniotic instillation of urea and PGF2α

Answer

Extraovular instillation of ethacridine lactate

Answer

Parenteral administration of PGF2α

Question 6

Which contraceptive is contraindicated during lactation?

Accepted Answer

Combined Oral Contraceptive Pill (OCP)

Answer

Intrauterine Device (IUD)

Answer

Progesterone-only pill

Answer

None of the above

Question 7

A single tablet of levonorgestrel 0.75 mg has been taken for effective post-coital contraception. When should the second tablet be taken?

Accepted Answer

24 hours after the first tablet

Answer

12 hours after the first tablet

Answer

36 hours after the first tablet

Answer

48 hours after the first tablet

Question 8

Incidence of ectopic pregnancy is highest with which of the following contraceptive methods?

Accepted Answer

Progestogen-only contraceptives

Answer

Oral contraceptive pills

Answer

Copper T Intrauterine Contraceptive Device (IUCD)

Answer

Multiload Intrauterine Contraceptive Device (IUCD)

Question 9

Which of the following is the best explanation for the mechanism of action of the intrauterine device (IUD)?

Accepted Answer

A sterile inflammatory response of the endometrium prevents implantation.

Answer

Hyperperistalsis of the fallopian tubes accelerates oocyte transport and prevents fertilization.

Answer

A subacute or chronic bacterial endometritis interferes with implantation.

Answer

Premature endometrial sloughing associated with menorrhagia causes early abortion.

Question 10

The 'banana sign' and 'lemon sign' are associated with which fetal anomaly?

Accepted Answer

Neural tube defect

Answer

Hydrops fetalis

Answer

Multiple gestation (twins)

Answer

Intrauterine demise (IUD)

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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