Contraception and Family Planning Practice Questions

Q: Which of the following statements about misoprostol is true?

It is used for first-trimester abortion.. **Explanation:** **Misoprostol** is a synthetic **Prostaglandin E1 (PGE1)** analog, widely used in obstetrics due to its potent uterotonic and cervical ripening properties. **Why Option B is correct:** Misoprostol is a cornerstone in medical termination of pregnancy (MTP). For **first-trimester abortion** (up to 9 weeks/63 days), it is used in combination with Mifepristone (Progesterone antagonist). Mifepristone sensitizes the myocardium and softens the cervix, while Misoprostol (administered 24–48 hours later) induces uterine contractions to expel the products of conception. **Analysis of Incorrect Options:** * **Option A:** Misoprostol is a **PGE1** analog. **Dinoprostone** is the PGE2 analog used for induction of labor. * **Option C & D:** While these statements are clinically "true" in practice (Misoprostol is used for PPH and can be given rectally), they are considered **secondary or off-label** compared to the primary, FDA-approved indication in the context of standard NEET-PG questioning. For PPH, Oxytocin remains the first-line drug of choice. Misoprostol is used as an adjunct (usually 800 mcg). * **Note on Route:** Misoprostol can be administered via oral, sublingual, vaginal, and rectal routes. Sublingual has the fastest onset, while vaginal has the highest bioavailability. **High-Yield Clinical Pearls for NEET-PG:** * **Dose for MTP:** 400 mcg (oral/vaginal) following 200 mg Mifepristone. * **Dose for PPH Prophylaxis:** 600 mcg orally (AMTSL). * **Dose for PPH Treatment:** 800 mcg sublingually/rectally. * **Side Effects:** Shivering and pyrexia (most common), transient diarrhea. * **Contraindication:** Previous LSCS (increased risk of uterine rupture when used for induction of labor in the 3rd trimester).

Q: What is the most common complication following intrauterine device insertion?

Bleeding. **Explanation:** The most common complication and the most frequent reason for the discontinuation of an Intrauterine Device (IUD), specifically the Copper-T, is **Bleeding (Option A)**. This typically manifests as menorrhagia (increased menstrual flow), metrorrhagia (intermenstrual spotting), or polymenorrhea. The underlying mechanism involves a local inflammatory response in the endometrium, leading to increased vascularity, capillary permeability, and local fibrinolytic activity. **Analysis of Incorrect Options:** * **B. Pain:** This is the second most common complication. It usually occurs as spasmodic dysmenorrhea due to uterine contractions attempting to expel the foreign body. While common, its incidence is lower than bleeding. * **C. Pelvic Infection:** While IUDs slightly increase the risk of Pelvic Inflammatory Disease (PID) within the first 20 days post-insertion (due to the introduction of vaginal flora into the uterus), it is not the most common complication. * **D. Uterine Perforation:** This is a rare but serious iatrogenic complication, occurring in approximately 1 per 1,000 insertions. It most commonly happens during the procedure itself. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of removal:** Bleeding and Pain. * **Most common side effect of LNG-IUS (Mirena):** Amenorrhea or oligomenorrhea (unlike Copper-T, which causes bleeding). * **Ideal time for insertion:** During menstruation or within 10 days of the cycle (to ensure the patient is not pregnant and the cervix is slightly dilated). * **Protective effect:** IUDs are known to be protective against endometrial cancer.

Q: The use of a levonorgestrel-releasing intrauterine contraceptive device is helpful in all of the following conditions except:

Premenstrual symptoms. **Explanation:** The **Levonorgestrel-releasing Intrauterine System (LNG-IUS)**, such as Mirena, works primarily by releasing 20 mcg of levonorgestrel daily directly into the uterine cavity. This causes profound endometrial atrophy and thickening of cervical mucus. **Why "Premenstrual Symptoms" is the correct answer:** Premenstrual Syndrome (PMS) is driven by cyclical hormonal fluctuations (estrogen and progesterone) during the luteal phase of the **ovarian cycle**. Since the LNG-IUS acts locally and does not consistently suppress ovulation, the systemic hormonal shifts responsible for PMS remain largely unaffected. Therefore, it is not a primary treatment for premenstrual symptoms. **Analysis of other options:** * **Menorrhagia:** The LNG-IUS is the "medical gold standard" for idiopathic menorrhagia. It causes thinning of the endometrial lining, leading to a 90% reduction in menstrual blood loss and often resulting in amenorrhea. * **Dysmenorrhea:** By reducing endometrial prostaglandins and decreasing menstrual flow, it significantly alleviates both primary and secondary dysmenorrhea (especially that associated with adenomyosis). * **Pelvic Inflammatory Disease (PID):** The progestogen thickens the cervical mucus, creating a biological barrier that prevents the ascent of pathogens into the upper genital tract, thereby exerting a protective effect against PID. **High-Yield Clinical Pearls for NEET-PG:** * **Life span:** 5 years (Mirena) or 7 years (recent updates). * **Non-contraceptive uses:** First-line for Adenomyosis, Endometrial Hyperplasia (without atypia), and as the progestogen component of Hormone Replacement Therapy (HRT). * **Most common side effect:** Irregular spotting/bleeding during the first 3–6 months. * **Pearl:** Unlike Copper-T, LNG-IUS *decreases* the risk of PID and ectopic pregnancy (though if pregnancy occurs, the *proportion* of ectopics is higher).

Q: Which of the following is NOT a method used for laparoscopic sterilization?

Irving method. **Explanation:** The **Irving method** is the correct answer because it is an **open surgical technique** for tubal ligation, not a laparoscopic one. In this procedure, the fallopian tube is cut, and the proximal end is buried into the posterior wall of the uterus, while the distal end is buried in the broad ligament. Due to the extensive tissue mobilization and suturing required, it cannot be performed via a laparoscope. It is known for having the lowest failure rate among all sterilization techniques. **Analysis of other options:** * **Electrocoagulation (Option A):** This was one of the earliest laparoscopic methods. It uses unipolar or bipolar current to thermally destroy a segment of the fallopian tube. * **Falope Ring (Option B):** Also known as the Yoon ring, this is a silastic band applied laparoscopically using a special applicator. It creates a loop of the tube, causing ischemia and eventual fibrosis. * **Filshie Clip (Option D):** This is a titanium clip lined with silicone rubber. It is applied laparoscopically to crush a 3-5 mm segment of the tube. It is popular due to minimal tissue destruction and higher potential for reversibility compared to other methods. **High-Yield Clinical Pearls for NEET-PG:** * **Most common laparoscopic method:** Falope ring (widely used in mass sterilization camps). * **Method with lowest failure rate:** Irving method (Failure rate ~1 in 1,000). * **Method with highest failure rate:** Madlener method (no longer recommended). * **Pomeroy’s Method:** The most common "open" method used during postpartum sterilization (minilap) due to its simplicity and efficacy. * **Bipolar Cautery:** Preferred over unipolar cautery in laparoscopy to prevent accidental bowel burns.

Q: Which intrauterine contraceptive device (IUCD) is associated with the highest incidence of ectopic pregnancy?

Progestasert. **Explanation:** The correct answer is **Progestasert**. **1. Why Progestasert is the correct answer:** Progestasert is a first-generation hormone-releasing IUCD that releases progesterone. While all IUCDs significantly reduce the *absolute* risk of all pregnancies (including ectopic), if a pregnancy does occur with an IUCD in situ, the *relative* risk of it being ectopic is higher. Progestasert carries the highest risk among all IUCDs because progesterone **decreases fallopian tube motility** and slows down ciliary action. This delay in the transport of the fertilized ovum through the tube increases the likelihood of implantation within the tube rather than the uterus. **2. Why the other options are incorrect:** * **Lippes loop (Option B):** A non-medicated (inert) IUCD. While it has a higher failure rate than medicated IUCDs, it does not specifically alter tubal motility to the extent that hormonal devices do. * **Copper-T and Multiload (Options C & D):** These are medicated copper-releasing IUCDs. Copper acts primarily as a spermicide and causes a sterile inflammatory response in the endometrium. While they can be associated with ectopic pregnancy if they fail, the risk is significantly lower than with progesterone-only devices. **High-Yield Clinical Pearls for NEET-PG:** * **Highest Ectopic Risk:** Progestasert (Progesterone-releasing). * **Lowest Ectopic Risk:** LNG-20 (Mirena) actually has a lower absolute risk of ectopic pregnancy compared to women using no contraception, because it is highly effective at preventing conception altogether. * **Mechanism:** Progesterone = Decreased tubal motility; Copper = Spermicidal/Inflammatory. * **Most Common Site of Ectopic Pregnancy:** Ampulla of the Fallopian tube. * **Key Fact:** The most common cause of ectopic pregnancy overall is Pelvic Inflammatory Disease (PID), but among IUCD failures, Progestasert carries the highest relative risk.

Q: A couple had unprotected intercourse and they are worried about pregnancy. What is the progesterone of choice for emergency contraception?

Levonorgestrel. **Explanation:** **Levonorgestrel (LNG)** is the gold standard progesterone for emergency contraception (EC). The primary mechanism of action is the **inhibition or delay of ovulation** by suppressing the Luteinizing Hormone (LH) surge. It is most effective when taken as soon as possible, ideally within 72 hours of unprotected intercourse, though it may be used up to 120 hours. **Why Levonorgestrel is correct:** * It is the most widely studied and recommended progestogen-only EC pill (POEC). * The standard dose is a single **1.5 mg tablet** (or two 0.75 mg doses 12 hours apart). * It has a superior safety profile and higher efficacy compared to older methods like the Yuzpe regimen. **Analysis of Incorrect Options:** * **A. Norethisterone:** Primarily used for menstrual cycle regulation, dysfunctional uterine bleeding, and endometriosis. It is not used for emergency contraception. * **B. Medroxyprogesterone acetate (DMPA):** Used as an injectable contraceptive (Depo-Provera) for long-term protection (3 months), not for post-coital emergency use. * **D. Desogestrel:** A third-generation progestogen used in daily Combined Oral Contraceptive Pills (COCPs) or Progestogen-Only Pills (POPs), but not as a dedicated emergency contraceptive. **High-Yield Clinical Pearls for NEET-PG:** * **Window of Efficacy:** LNG is effective up to 72–120 hours, but **Ulipristal acetate** (a selective progesterone receptor modulator) is more effective between 72–120 hours. * **Most Effective EC:** The **Copper-T (IUCD)** is the most effective method of emergency contraception if inserted within 5 days. * **Failure Rate:** LNG-EC has a failure rate of approximately 1–3%. It does not work if implantation has already occurred and is not an abortifacient. * **Vomiting:** If the patient vomits within 2 hours of taking the LNG pill, the dose must be repeated.

Q: Which of the following is NOT a mechanism of action of oral contraceptive pills?

Blocking the fimbrial ostia. **Explanation:** The mechanism of action of Combined Oral Contraceptive Pills (COCPs) is multi-factorial, primarily targeting the Hypothalamic-Pituitary-Ovarian (HPO) axis and the female reproductive tract environment. **Why Option D is Correct:** **Blocking the fimbrial ostia** is a mechanical/anatomical barrier. This occurs during surgical procedures like **Tubal Ligation** (e.g., Pomeroy’s technique) or due to pathological conditions like Salpingitis/PID. OCPs are pharmacological agents and do not physically obstruct the fallopian tubes. **Why the other options are incorrect (Mechanisms of OCPs):** * **Option B (Primary Mechanism):** The estrogen and progestogen components provide negative feedback to the hypothalamus and anterior pituitary. This suppresses **GnRH, FSH, and LH**, preventing the mid-cycle LH surge. Without the LH surge, ovulation does not occur, resulting in an **anovulatory cycle**. * **Option A:** Progestogen increases the viscosity and thickness of the **cervical mucus**, making it "hostile" and impenetrable to sperm. * **Option C:** OCPs cause the endometrium to become thin, atrophic, and out of sync with the menstrual cycle (decidualization), which **prevents the implantation** of a blastocyst should fertilization occur. **High-Yield Clinical Pearls for NEET-PG:** * **Most potent component for ovulation inhibition:** Progestogen (suppresses LH). * **Role of Estrogen:** Primarily inhibits FSH (preventing follicle selection) and provides cycle control (prevents breakthrough bleeding). * **Failure Rate:** The Pearl Index for perfect use of COCPs is **0.1 per 100 woman-years**. * **Non-contraceptive benefits:** Reduced risk of Ovarian and Endometrial cancers (protective effect persists for years after discontinuation).

Q: All of the following drugs have been used for medical abortion except?

Atosiban. **Explanation:** The correct answer is **Atosiban** because it is a **tocolytic agent**, not an abortifacient. Its primary clinical use is to delay imminent preterm birth by inhibiting uterine contractions. **Why Atosiban is the correct answer:** Atosiban is a competitive **Oxytocin receptor antagonist**. By blocking these receptors in the myometrium, it decreases the frequency of contractions and uterine tone. In the context of pregnancy management, it is used to "stop" labor (tocolysis), which is the functional opposite of medical abortion. **Why the other options are incorrect:** * **Mifepristone (RU-486):** An anti-progestational agent. It blocks progesterone receptors, leading to decidual necrosis, cervical softening, and increased uterine sensitivity to prostaglandins. It is the first step in the standard medical abortion regimen. * **Misoprostol:** A Prostaglandin E1 (PGE1) analogue. It causes cervical ripening and potent uterine contractions to expel the products of conception. It is typically administered 24–48 hours after Mifepristone. * **Methotrexate:** A folate antagonist that inhibits dihydrofolate reductase. It targets rapidly dividing cells (trophoblastic tissue) and is used medically for early unruptured ectopic pregnancies and occasionally in combination with misoprostol for early induced abortion. **High-Yield Clinical Pearls for NEET-PG:** * **Standard Regimen (WHO/GOI):** Mifepristone 200 mg orally followed by Misoprostol 800 mcg (vaginal/buccal/sublingual) for up to 9 weeks (63 days) of gestation. * **MTP Act 2021 Update:** Medical abortion is legal up to 24 weeks under specific conditions, but the "pills-only" method is most effective in the first trimester. * **Atosiban Side Effects:** Generally well-tolerated; most common are nausea, headache, and tachycardia (less than beta-mimetics).

Q: Which of the following is the principle disadvantage of depot progestin?

Irregular menstrual bleeding and prolonged anovulation. **Explanation:** Depot Medroxyprogesterone Acetate (DMPA), commonly known as the "Antara" program injection in India, is a long-acting injectable contraceptive. **Why Option D is Correct:** The most significant clinical disadvantage and the leading cause of discontinuation for DMPA is **menstrual irregularity**. Initially, users experience unpredictable spotting or breakthrough bleeding. With prolonged use, the endometrium becomes atrophic, leading to **amenorrhea** (seen in 50-70% of users at one year). Furthermore, DMPA causes **prolonged anovulation**; there is a significant delay in the return of fertility, averaging **7 to 9 months** after the last injection, as the drug takes time to clear from the systemic circulation. **Analysis of Incorrect Options:** * **A. Weight gain:** While a common side effect (average 1.5–2 kg in the first year), it is often manageable and less likely to cause immediate discontinuation compared to unpredictable bleeding. * **B. Breast tenderness:** This is a minor progestogenic side effect that usually subsides after the first few months. * **C. Depression:** Though reported by some users, large-scale studies have not conclusively proven a direct causal link between DMPA and clinical depression. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily inhibits ovulation by suppressing the LH surge. It also increases cervical mucus viscosity. * **Dosage:** 150 mg intramuscularly (IM) every 3 months (12 weeks). * **Black Box Warning:** Long-term use is associated with a reversible decrease in **Bone Mineral Density (BMD)**. It is generally advised not to use it for more than 2 years if other options are available. * **Non-contraceptive benefit:** Reduces the risk of endometrial cancer and iron-deficiency anemia (due to amenorrhea).

Question 1

Which of the following statements about misoprostol is true?

Accepted Answer

It is used for first-trimester abortion.

Answer

It is a PGE2 analog.

Answer

It is used in the management of postpartum hemorrhage (PPH).

Answer

It is administered rectally.

Question 2

What is the most common complication following intrauterine device insertion?

Accepted Answer

Bleeding

Answer

Pain

Answer

Pelvic infection

Answer

Uterine perforation

Question 3

The use of a levonorgestrel-releasing intrauterine contraceptive device is helpful in all of the following conditions except:

Accepted Answer

Premenstrual symptoms

Answer

Menorrhagia

Answer

Dysmenorrhea

Answer

Pelvic inflammatory disease

Question 4

Which of the following is NOT a method used for laparoscopic sterilization?

Accepted Answer

Irving method

Answer

Electrocoagulation

Answer

Falope ring

Answer

Filchie clip

Question 5

Which intrauterine contraceptive device (IUCD) is associated with the highest incidence of ectopic pregnancy?

Accepted Answer

Progestasert

Answer

Lippes loop

Answer

Copper-T

Answer

Multiload device

Question 6

A couple had unprotected intercourse and they are worried about pregnancy. What is the progesterone of choice for emergency contraception?

Accepted Answer

Levonorgestrel

Answer

Norethisterone

Answer

Medroxyprogesterone acetate

Answer

Desogestrel

Question 7

Which of the following is NOT a mechanism of action of oral contraceptive pills?

Accepted Answer

Blocking the fimbrial ostia

Answer

Inhibiting sperm penetration into the cervical mucus

Answer

Inducing an anovulatory cycle

Answer

Preventing blastocyst implantation

Question 8

All of the following drugs have been used for medical abortion except?

Accepted Answer

Atosiban

Answer

Mifepristone

Answer

Misoprostol

Answer

Methotrexate

Question 9

In a non-breastfeeding woman, what is the use of combined oral contraceptive pills during the first three weeks following delivery?

Accepted Answer

Relative contraindication

Answer

Absolute contraindication

Answer

Indicated

Answer

Not required

Question 10

Which of the following is the principle disadvantage of depot progestin?

Accepted Answer

Irregular menstrual bleeding and prolonged anovulation

Answer

Weight gain

Answer

Breast tenderness

Answer

Depression

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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