Contraception and Family Planning Practice Questions

Q: What is the best hormonal contraceptive for a patient with sickle cell anemia?

Progestogen-Only Pill (POP). ### Explanation **Correct Answer: B. Progestogen-Only Pill (POP)** **Why it is correct:** In patients with Sickle Cell Anemia (SCA), the primary goal of contraception is to avoid triggers for vaso-occlusive crises (VOC). **Progestogens** (specifically POPs, DMPA, or implants) are the preferred hormonal choice because they have been shown to **reduce the frequency and intensity of painful crises**. The underlying mechanism involves the stabilization of the red blood cell membrane, which inhibits the sickling process. Additionally, progestogens reduce menstrual blood loss, helping to manage the chronic anemia often seen in these patients. **Why the other options are incorrect:** * **A. Oral Contraceptive Pill (OCP):** Combined OCPs contain estrogen. Estrogen is generally avoided or used with caution in SCA because it is pro-thrombotic. Since SCA is already a hypercoagulable state with a high risk of stroke and thromboembolism, adding estrogen increases the risk of vascular complications. * **C. Copper T (Cu-T):** While not hormonal, the Copper T often causes increased menstrual bleeding (menorrhagia) and dysmenorrhea. In a patient with baseline hemolytic anemia, any increase in blood loss can worsen their clinical status. * **D. None of the above:** Incorrect, as POPs are a recognized and recommended option. **High-Yield Clinical Pearls for NEET-PG:** * **DMPA (Depot Medroxyprogesterone Acetate)** is often cited in literature as the "gold standard" for SCA because it significantly reduces VOC, but among the options provided, POP is the best hormonal choice. * **WHO Eligibility Criteria (MEC):** Progestogen-only methods are **MEC Category 1** (no restriction) for Sickle Cell Disease. * **Levonorgestrel Intrauterine System (LNG-IUS)** is also an excellent choice as it reduces menstrual blood loss significantly. * **Avoid Estrogen:** Always remember that Estrogen + Sickle Cell = Increased Risk of Thrombosis.

Q: Which of the following is NOT included in emergency contraception?

DMPA. **Explanation:** Emergency contraception (EC) refers to methods used to prevent pregnancy after unprotected intercourse, typically within a specific window (up to 5 days). **Why DMPA is the correct answer:** **DMPA (Depot Medroxyprogesterone Acetate)** is a long-acting injectable contraceptive administered every 3 months. It is used for **routine, long-term contraception**, not emergency use. It works primarily by inhibiting ovulation over a sustained period and does not provide the rapid hormonal surge or local effect required to prevent implantation or ovulation immediately after a single act of intercourse. **Analysis of other options:** * **Oral Contraceptives (Yuzpe Regimen):** Combined oral contraceptive pills (Ethinylestradiol + Levonorgestrel) can be used in specific high doses as EC. Though less commonly used now due to side effects like nausea, it remains a recognized method. * **Copper T (Cu-IUCD):** This is the **most effective** method of emergency contraception. If inserted within 5 days (120 hours) of unprotected intercourse, it prevents pregnancy by causing a local inflammatory response toxic to sperm and ova and preventing implantation. * **Levonorgestrel (LNG) tablets:** Often called the "morning-after pill" (e.g., 1.5 mg single dose), this is the most common hormonal EC. It works by delaying or inhibiting ovulation. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard/Most Effective EC:** Copper T (Failure rate <0.1%). * **Drug of Choice (Hormonal):** Levonorgestrel 1.5mg (effective up to 72 hours, though can be used up to 120 hours). * **Ulipristal Acetate:** A selective progesterone receptor modulator (SPRM); it is more effective than LNG and is the hormonal EC of choice between 72–120 hours. * **Mifepristone:** Can also be used as an EC in low doses (10–25 mg).

Q: Which is the progesterone of choice for emergency contraception?

Levonorgestrel. **Explanation:** **Levonorgestrel (LNG)** is the progesterone of choice for emergency contraception (EC) due to its high efficacy and safety profile. The primary mechanism of action is the **prevention or delay of ovulation** by inhibiting the LH surge. It is most effective when taken as soon as possible after unprotected intercourse (ideally within 72 hours), though it may be used up to 120 hours. The standard regimen is a single dose of **1.5 mg** (or two doses of 0.75 mg taken 12 hours apart). **Analysis of Options:** * **Levonorgestrel (C):** It is a second-generation synthetic progestogen. It is preferred over the older Yuzpe regimen (Estrogen + Progesterone) because it causes significantly less nausea and vomiting. * **Norgesterone (A):** This is an older progestogen not typically used in modern emergency contraception protocols. * **Micronized Progesterone (B):** This is a natural form of progesterone used primarily for luteal phase support in infertility or for hormone replacement therapy; it lacks the potency required for emergency contraceptive action. * **DMPA (D):** Depot Medroxyprogesterone Acetate is an injectable contraceptive used for long-term protection (3 months), not for emergency use. **High-Yield Clinical Pearls for NEET-PG:** * **Window of Efficacy:** Most effective within 72 hours; efficacy decreases with increased Body Mass Index (BMI >26 kg/m²). * **Ulipristal Acetate:** A Selective Progesterone Receptor Modulator (SPRM) that is now considered more effective than LNG, especially between 72–120 hours. * **Gold Standard:** The **Copper-T (IUCD)** remains the most effective method of emergency contraception overall (failure rate <0.1%) and can be inserted up to 5 days after the earliest predicted day of ovulation. * **Failure:** If a patient conceives after LNG failure, there is no evidence of teratogenicity.

Q: Regarding the given mode of contraception, all statements are true EXCEPT?

It does not inhibit ovulation.. ***It does not inhibit ovulation*** - The **etonogestrel implant** (Nexplanon) **does inhibit ovulation** in approximately **97% of menstrual cycles**, making this statement false. - **Ovulation suppression** is the **primary mechanism** of contraceptive action for this subdermal implant. *It has the least failure rate* - The etonogestrel implant has a **failure rate of less than 1%**, making it one of the **most effective reversible contraceptives**. - It provides **continuous hormone release** without user compliance issues, contributing to its high effectiveness. *It contains etonogestrel* - The subdermal implant (Nexplanon) contains **68 mg of etonogestrel**, a **third-generation progestin**. - Etonogestrel is released continuously over **3 years**, providing consistent contraceptive efficacy. *It is effective for 3 years* - The **etonogestrel implant** provides contraceptive protection for **3 years** from insertion. - After 3 years, the implant must be **removed and replaced** if continued contraception is desired.

Q: Reversal of sterilization is best achieved by which method?

Falope ring application. The success of sterilization reversal (tubal re-anastomosis) is directly proportional to the amount of healthy fallopian tube preserved and the degree of tissue destruction. **Why Falope Ring is the Correct Answer:** The **Falope ring (Silastic band)** is a mechanical method of tubal occlusion. It works by looping a small segment of the fallopian tube and constricting it. This method causes **minimal tissue destruction** (usually only 1–2 cm of the tube). Because the remaining segments of the tube are healthy and long, surgical re-anastomosis has the highest success rate compared to other methods. **Analysis of Incorrect Options:** * **B. Cauterization:** This involves using bipolar or unipolar current to burn the tubes. It causes extensive thermal damage and lateral heat spread, destroying a large portion of the tube and making reversal difficult. * **C. Pomeroy Method:** This is the most common surgical method (ligation and excision). While it is relatively easy to reverse compared to cautery, it still involves the excision of a tubal segment, resulting in more tissue loss than a ring or clip. * **D. Irving Method:** This is a highly effective but aggressive surgical technique where the proximal end of the tube is buried in the myometrium. It is the most difficult to reverse due to the extensive surgical alteration of the anatomy. **NEET-PG High-Yield Pearls:** * **Best Reversibility:** Hulka-Clemens Clip > Falope Ring > Pomeroy Method. (Note: While clips are technically best, among the given options, the Falope ring is the superior choice). * **Most Common Method (India):** Modified Pomeroy’s technique. * **Failure Rate:** The Falope ring has a failure rate of approximately 0.2–0.5%. * **Prerequisite for Reversal:** A minimum of **4 cm** of healthy tubal length is ideally required for a successful pregnancy post-reversal.

Q: Oral contraceptive pills predispose to which of the following conditions?

Cerebral stroke. **Explanation:** The correct answer is **Cerebral stroke**. Combined Oral Contraceptive Pills (COCPs) contain estrogen, which has a significant impact on the coagulation profile. Estrogen increases the hepatic synthesis of clotting factors (II, VII, IX, X, and fibrinogen) and decreases natural anticoagulants like Antithrombin III and Protein S. This creates a **hypercoagulable state**, increasing the risk of thromboembolic events, including deep vein thrombosis (DVT), pulmonary embolism, and arterial events like myocardial infarction and **ischemic cerebral stroke**. The risk is significantly potentiated in women who smoke, are over 35 years old, or have underlying hypertension. **Analysis of Incorrect Options:** * **Asthma:** There is no established causal link between COCP use and the development or exacerbation of asthma. * **Peripheral neuropathy:** COCPs are not neurotoxic. In fact, some studies suggest B-vitamin supplementation may be needed for long-term users, but they do not predispose to neuropathy. * **Ovarian carcinoma:** This is a **protective effect**. COCPs significantly *reduce* the risk of ovarian and endometrial cancers by suppressing ovulation and thinning the endometrial lining. **High-Yield Clinical Pearls for NEET-PG:** * **Cancer Risks:** COCPs **increase** the risk of Cervical cancer and Breast cancer (slight), but **decrease** the risk of Ovarian, Endometrial, and Colorectal cancers. * **Benign Tumors:** COCPs are a known risk factor for **Hepatic Adenoma**. * **Absolute Contraindications:** Undiagnosed vaginal bleeding, history of thromboembolism, estrogen-dependent tumors, and smokers >35 years (>15 cigarettes/day).

Q: Which of the following natural family planning methods is most effective?

Symptothermal method. **Explanation:** The **Symptothermal method** is the most effective natural family planning (NFP) method because it is a **multi-index approach**. It combines multiple physiological markers of ovulation—specifically Basal Body Temperature (BBT), cervical mucus changes, and sometimes cervical position or calendar calculations—to identify the fertile window. By cross-referencing these indicators, the margin of error inherent in using a single parameter is significantly reduced, leading to a lower failure rate (Perfect use Pearl Index: ~0.4%). **Analysis of Incorrect Options:** * **Basal Body Temperature (BBT) method:** This relies on the 0.4–0.8°F rise in temperature caused by **progesterone** after ovulation. Its main drawback is that it only identifies the *end* of the fertile phase (post-ovulatory) and can be affected by fever, stress, or lack of sleep. * **Cervical Mucus Method:** This involves monitoring the changes in vaginal secretions. Under estrogen influence, mucus becomes thin, watery, and stretchy (**Spinnbarkeit phenomenon**). * **Billings Method:** This is a specific standardized version of the cervical mucus method. While effective, any single-index method (like A, B, or C) is statistically less reliable than the combined approach of the Symptothermal method. **High-Yield NEET-PG Pearls:** * **Pearl Index:** Defined as the number of unintended pregnancies per 100 woman-years of exposure. A lower index indicates higher efficacy. * **Lactational Amenorrhea Method (LAM):** Only effective for up to 6 months postpartum, provided the mother is exclusively breastfeeding and remains amenorrheic. * **Spinnbarkeit Test:** Refers to the elasticity of cervical mucus; maximum elasticity (10-12 cm) occurs just before ovulation. * **Standard Days Method:** Uses a "CycleBeads" string; it is only suitable for women with cycles between 26 and 32 days.

Q: What is the most commonly performed type of tubal ligation in current practice?

Pomeroy's method. ### Explanation **Pomeroy’s method** is the most commonly performed technique for tubal ligation worldwide, particularly in the postpartum period. Its popularity stems from its **simplicity, safety, and high efficacy**. The procedure involves grasping a loop of the fallopian tube (usually the isthmic portion), ligating the base with an absorbable suture (like plain catgut), and excising the loop. As the suture absorbs, the two ends of the tube fibrose and pull apart, creating a gap that prevents fertilization. **Analysis of Incorrect Options:** * **Irving’s operation:** This is the most effective method (lowest failure rate) but is technically difficult and requires extensive dissection. It involves burying the proximal end of the tube into the myometrium and the distal end into the broad ligament. * **Yoon ring application:** This is a mechanical method commonly used during **laparoscopic** tubal occlusion. While frequent in interval sterilization, it is not the "most common" overall compared to the Pomeroy technique used in both open and laparoscopic settings. * **Madlener procedure:** This involves crushing and ligating a loop of the tube without excision. It is rarely performed today because it has a high failure rate and carries an increased risk of tubal recanalization and ectopic pregnancy. **High-Yield Clinical Pearls for NEET-PG:** * **Most common method:** Pomeroy’s. * **Most effective method:** Irving’s (Failure rate ~0.1%). * **Failure rate of Pomeroy’s:** Approximately 0.1–0.5%. * **Ideal time for Postpartum Sterilization:** 24–48 hours after delivery. * **Site of ligation:** Usually the **isthmus** (the narrowest part). * **Modified Pomeroy:** Uses non-absorbable sutures (less common due to risk of fistula).

Question 1

Which of the following is NOT a contraindication for progestasert?

Accepted Answer

Previous history of abortion

Answer

Pelvic inflammatory disease

Answer

Uterine fibroids

Answer

Previous history of ectopic pregnancy

Question 2

What is the best hormonal contraceptive for a patient with sickle cell anemia?

Accepted Answer

Progestogen-Only Pill (POP)

Answer

Oral Contraceptive Pill (OCP)

Answer

Copper T Intrauterine Device (Cu-T)

Answer

None of the above

Question 3

Which of the following is NOT included in emergency contraception?

Accepted Answer

DMPA

Answer

Oral contraceptive

Answer

Copper T

Answer

Levonorgestrel tablets

Question 4

What is the most effective mode of contraception for a woman with heart disease?

Accepted Answer

Intrauterine Contraceptive Devices (IUCD)

Answer

Oral pills

Answer

Norplant

Answer

Condom

Question 5

Which is the progesterone of choice for emergency contraception?

Accepted Answer

Levonorgestrel

Answer

Norgesterone

Answer

Micronized progesterone

Answer

DMPA

Question 6

Regarding the given mode of contraception, all statements are true EXCEPT?

Accepted Answer

It does not inhibit ovulation.

Answer

It has the least failure rate.

Answer

It contains etonogestrel.

Answer

It is effective for 3 years.

Question 7

Reversal of sterilization is best achieved by which method?

Accepted Answer

Falope ring application

Answer

Cauterization

Answer

Pomeroy method

Answer

Irving method

Question 8

Oral contraceptive pills predispose to which of the following conditions?

Accepted Answer

Cerebral stroke

Answer

Asthma

Answer

Peripheral neuropathy

Answer

Ovarian carcinoma

Question 9

Which of the following natural family planning methods is most effective?

Accepted Answer

Symptothermal method

Answer

Basal body temperature method

Answer

Cervical mucus method

Answer

Billings method

Question 10

What is the most commonly performed type of tubal ligation in current practice?

Accepted Answer

Pomeroy's method

Answer

Irving's operation

Answer

Yoon ring application

Answer

Madlener procedure

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

On this page

Practice by Chapter

Want unlimited practice?