Contraception and Family Planning Practice Questions

Q: Which method of sterilization is least suited for recanalisation?

Bipolar cauterization. **Explanation:** The success of tubal recanalization (reversal of sterilization) depends primarily on the **length of the healthy fallopian tube remaining** and the **degree of tissue destruction** caused during the initial procedure. **Why Bipolar Cauterization is the correct answer:** Bipolar cauterization involves passing an electric current through a segment of the fallopian tube. This causes extensive **thermal damage** and lateral heat spread, leading to significant necrosis and scarring of the tubal tissue. Typically, 2–3 cm of the tube is destroyed. Because the damage is widespread and the blood supply is often compromised, there is insufficient healthy tissue left for a successful end-to-end anastomosis, making it the least suited for recanalization. **Analysis of Incorrect Options:** * **Clips (e.g., Hulka-Clemens, Filshie):** These cause the **least amount of damage** (approx. 4 mm of the tube). They have the highest success rates for recanalization. * **Fallopian Rings (Silastic bands):** These cause intermediate damage (approx. 2 cm) by causing ischemic necrosis of a small loop. Recanalization success is better than cauterization but lower than clips. * **Pomeroy’s Technique:** This is a surgical method involving ligation and excision of a mid-segment loop. While it removes a segment of the tube, the remaining ends are usually healthy and not thermally damaged, allowing for relatively successful surgical reversal. **High-Yield Clinical Pearls for NEET-PG:** * **Best method for recanalization:** Clips (Minimal tissue destruction). * **Most common method used in India:** Minilap with Pomeroy’s technique. * **Most common method used globally (Laparoscopic):** Falope rings. * **Ideal length of tube for successful reversal:** At least 4 cm of healthy tube must remain. * **Site of reversal:** The **isthmus-isthmus** anastomosis yields the highest pregnancy rates.

Q: What is the Pearl Index?

Accidental pregnancies per 100 women-years of exposure. The **Pearl Index** is the most common method used in clinical trials and epidemiological studies to measure the **effectiveness of a contraceptive method**. ### **Explanation of the Correct Answer** The Pearl Index is defined as the number of unintended pregnancies per **100 woman-years** of exposure. It represents the failure rate of a contraceptive method. A lower Pearl Index indicates a more effective contraceptive method. The formula used is: $$\text{Pearl Index} = \frac{\text{Total number of accidental pregnancies} \times 1200}{\text{Total months of exposure}}$$ *(Note: 1200 is used to convert the denominator into 100 woman-years, as $100 \text{ women} \times 12 \text{ months} = 1200$).* ### **Analysis of Incorrect Options** * **Option A (1000 women-years):** This is a common distractor. Standard epidemiological reporting for contraception uses a base of 100 to express results as a percentage-like failure rate. * **Options C & D (10 or 1 women-years):** These values are too small to provide a statistically significant or standardized representation of contraceptive failure across a population. ### **NEET-PG High-Yield Pearls** * **Perfect Use vs. Typical Use:** The Pearl Index varies based on whether the method is used correctly every time (perfect) or how it is used in real-world conditions (typical). * **Lowest Pearl Index (Most Effective):** Implants (e.g., Nexplanon) have the lowest Pearl Index (~0.05), followed by Vasectomy and IUCDs. * **Highest Pearl Index (Least Effective):** Barrier methods (Condoms) and behavioral methods (Withdrawal/Rhythm method) have higher Pearl Indices. * **Alternative Measure:** The **Life Table Analysis** is considered superior to the Pearl Index because it calculates failure rates at specific intervals (e.g., at 6 months vs. 24 months), accounting for the fact that failure rates usually decrease over time as users become more proficient.

Q: Which of the following agents cannot be used for postcoital contraception?

Danazol. **Explanation:** The correct answer is **Danazol**. While historically explored as a potential emergency contraceptive, Danazol (an ethinyl testosterone derivative) has been proven **ineffective** for postcoital contraception and is no longer recommended or used for this purpose. Its primary roles in gynecology are the treatment of endometriosis and hereditary angioedema. **Analysis of Options:** * **Copper T (Option B):** This is the **most effective** method of emergency contraception (failure rate <0.1%). It can be inserted up to 5 days (120 hours) after unprotected intercourse and provides the added benefit of long-term reversible contraception. * **Mifepristone (Option C):** A selective progesterone receptor modulator (SPRM). In low doses (10 mg or 25 mg), it is highly effective for emergency contraception by delaying ovulation. It is often preferred over the Yuzpe regimen due to fewer side effects. * **High-dose Estrogen (Option D):** Historically used as the "morning-after pill" (e.g., Ethinyl estradiol 5mg for 5 days). While effective, it is rarely used today due to severe nausea and vomiting. It has been largely replaced by the **Yuzpe Regimen** (combined E+P) or Levonorgestrel-only pills. **NEET-PG High-Yield Pearls:** 1. **Gold Standard:** The most effective emergency contraceptive is the **Copper-T 380A**. 2. **Drug of Choice (DOC):** The current hormonal DOC is **Levonorgestrel (1.5 mg single dose)**, effective up to 72 hours. 3. **Ulipristal Acetate:** A newer SPRM effective up to **120 hours (5 days)**; it is more effective than LNG in obese women. 4. **Mechanism:** Most hormonal emergency contraceptives work primarily by **delaying or inhibiting ovulation**; they are not abortifacients.

Q: A patient was placed on depot medroxy progesterone acetate. She now complains of irregular spotting. Which of the following is NOT a treatment option?

Place a progestin-only implant.. **Explanation:** The primary side effect of Depot Medroxyprogesterone Acetate (DMPA) is **breakthrough bleeding or irregular spotting**, caused by the thinning of the endometrial lining (endometrial atrophy) and increased fragility of the capillaries due to the lack of estrogen. **Why Option D is the Correct Answer:** Placing a **progestin-only implant** (like Nexplanon) is **not** a treatment for DMPA-induced spotting. In fact, it would likely exacerbate the problem. The underlying cause of spotting in DMPA users is a "progestin-only" environment leading to an unstable, atrophic endometrium. Adding more progestin does not stabilize the lining; instead, it further suppresses endogenous estrogen, worsening the irregular bleeding. **Why the other options are incorrect (Management of Spotting):** * **Option A (COCPs):** Combined Oral Contraceptive Pills provide ethinyl estradiol, which helps stabilize the endometrium and promote organized growth, effectively stopping the spotting. * **Option B (Mefenamic Acid):** NSAIDs are a first-line non-hormonal treatment. They work by inhibiting prostaglandin synthesis, which reduces local inflammation and decreases menstrual blood flow. * **Option C (Premarin):** Premarin (conjugated equine estrogen) provides exogenous estrogen to "rescue" the atrophic endometrium, promoting healing and stabilization of the lining. **High-Yield Clinical Pearls for NEET-PG:** * **DMPA Schedule:** 150 mg intramuscularly every 3 months (12 weeks). * **Amenorrhea:** After 1 year of DMPA use, approximately 50-70% of women develop amenorrhea, which is a normal and expected effect. * **Bone Mineral Density (BMD):** Long-term DMPA use is associated with a reversible decrease in BMD (FDA Black Box Warning). * **Weight Gain:** DMPA is the only contraceptive significantly associated with weight gain.

Q: Nonoxynol-9 is a/an:

Barrier contraceptive. **Explanation:** **Nonoxynol-9** is a non-ionic surfactant that acts as a **chemical barrier contraceptive (spermicide)**. It works by disrupting the cell membrane of the spermatozoa, leading to loss of motility and eventual death of the sperm before they can enter the cervical canal. It is commonly available in the form of foams, jellies, creams, and films, or as a coating on condoms and diaphragms. **Analysis of Options:** * **Option A (Hormonal):** Incorrect. Nonoxynol-9 contains no hormones (like Estrogen or Progesterone) and does not interfere with the Hypothalamic-Pituitary-Ovarian axis or ovulation. * **Option B (Intrauterine):** Incorrect. While some medicated IUDs exist (Copper or Levonorgestrel), Nonoxynol-9 is a topical agent applied vaginally, not an intrauterine device. * **Option D (Post-coital):** Incorrect. Spermicides must be applied **before** intercourse to be effective. Post-coital (emergency) contraception typically involves high-dose progestins (Levonorgestrel) or SPRMs (Ulipristal). **Clinical Pearls for NEET-PG:** * **Failure Rate:** When used alone, spermicides have a high failure rate (Typical use: ~28%). They are most effective when used in combination with mechanical barriers like a diaphragm. * **STI Risk:** Contrary to older beliefs, Nonoxynol-9 **does not protect against HIV/STIs**. In fact, frequent use can cause vaginal and rectal irritation/ulceration, which may actually **increase** the risk of HIV transmission. * **Mechanism:** It reduces the surface tension of the sperm midpiece and tail, causing irreversible immobilization.

Question 1

Which method of sterilization is least suited for recanalisation?

Accepted Answer

Bipolar cauterization

Answer

Clips

Answer

Fallopian rings

Answer

Pomeroys technique

Question 2

What is the Pearl Index?

Accepted Answer

Accidental pregnancies per 100 women-years of exposure

Answer

Accidental pregnancies per 1000 women-years of exposure

Answer

Accidental pregnancies per 10 women-years of exposure

Answer

Accidental pregnancies per women-years of exposure

Question 3

Which of the following is NOT a characteristic of an ideal candidate for copper-T insertion?

Accepted Answer

Has a history of ectopic pregnancy

Answer

Has borne at least one child

Answer

Is willing to check the IUD tail

Answer

Has normal menstrual periods

Question 4

Which of the following agents cannot be used for postcoital contraception?

Accepted Answer

Danazol

Answer

Copper T

Answer

Mifepristone

Answer

High dose estrogen

Question 5

Which of the following contraceptive methods has the least risk of ectopic pregnancy?

Accepted Answer

Condoms

Answer

Tubectomy

Answer

Oral contraceptive pills

Answer

Intrauterine device (Copper T)

Question 6

A patient was placed on depot medroxy progesterone acetate. She now complains of irregular spotting. Which of the following is NOT a treatment option?

Accepted Answer

Place a progestin-only implant.

Answer

Add combined oral contraceptive pills for 4 weeks.

Answer

Give mefenamic acid for 1 week.

Answer

Give premarin for 4 weeks.

Question 7

A 28-year-old female, with a one-year-old daughter, diagnosed with diabetes a few months ago which is controlled with diet and exercise, presents seeking contraception. Which of the following is the best contraceptive method of choice for this patient?

Accepted Answer

Condoms used by the husband

Answer

Intrauterine contraceptive device (IUCD)

Answer

Oral contraceptive pills (OCP)

Answer

Vaginal sponge

Question 8

Nonoxynol-9 is a/an:

Accepted Answer

Barrier contraceptive

Answer

Hormonal contraceptive

Answer

Intrauterine contraceptive

Answer

Post-coital contraceptive

Question 9

What is the most common infection associated with IUCD use?

Accepted Answer

Chlamydia

Answer

Staphylococcus epidermidis

Answer

Staphylococcus aureus

Answer

Group D Streptococcus

Question 10

If a patient misses oral contraceptive pills for 10 consecutive days, what is the most appropriate management?

Accepted Answer

Continue the pills and use an additional form of contraception

Answer

Stop the pills and resume after 7 days

Answer

Continue the pills as usual

Answer

Take an additional pill

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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