Contraception and Family Planning Practice Questions

Q: Copper-T with threads is visible in a case of early pregnancy. What is the treatment of choice?

Remove CuT only. **Explanation:** The management of a pregnancy with an intrauterine contraceptive device (IUCD) in situ depends primarily on whether the **threads are visible** and the **gestational age**. **Why Option A is Correct:** When a woman becomes pregnant with a Copper-T (CuT) in situ and the strings are visible, the treatment of choice is **immediate removal of the CuT**. Leaving the device in place significantly increases the risk of **septic abortion** (by 50%), mid-trimester miscarriage, and preterm labor. Removing the device early reduces these risks, although there is a small (approx. 25-30%) risk of spontaneous abortion triggered by the removal itself. Since the patient is in "early pregnancy" and strings are visible, removal is the safest priority. **Why Other Options are Incorrect:** * **Option B:** Suction evacuation is only indicated if the patient **desires medical termination of pregnancy (MTP)**. The question implies management of the CuT to continue the pregnancy safely. * **Option C:** Reassurance alone is dangerous. Leaving the CuT increases the risk of maternal sepsis and chorioamnionitis. * **Option D:** Laparotomy is reserved for ectopic pregnancies or if the CuT has perforated the uterus and is located intra-abdominally (translocated IUCD), which is not indicated here. **High-Yield Clinical Pearls for NEET-PG:** * **Threads NOT visible:** Perform an ultrasound. If the IUCD is intrauterine, **do not** attempt removal as it may rupture the sac. * **Ectopic Risk:** While IUCDs prevent all pregnancies, if a failure occurs, the *proportion* of pregnancies that are ectopic is higher (approx. 1 in 20). * **Teratogenicity:** Copper-T is **not** known to be teratogenic to the fetus. * **Gold Standard:** If the patient wants to continue the pregnancy and strings are visible, **pull them out.**

Q: A woman with a history of deep vein thrombosis requires contraception. Which of the following methods is medically contraindicated for this patient?

Oral contraceptives. **Explanation:** The correct answer is **Oral Contraceptives (Combined Oral Contraceptive Pills - COCPs)**. **1. Why Oral Contraceptives are Contraindicated:** Combined oral contraceptives contain **estrogen**, which is known to increase the hepatic synthesis of clotting factors (II, VII, IX, and X) and decrease natural anticoagulants like Antithrombin III. This induces a pro-thrombotic state. According to the **WHO Medical Eligibility Criteria (MEC)**, a history of Deep Vein Thrombosis (DVT) or current DVT is classified as **MEC Category 4** (unacceptable health risk) for estrogen-containing methods, as they significantly increase the risk of recurrent thromboembolism. **2. Why Incorrect Options are Wrong:** * **Intrauterine Device (IUD):** Both the Copper-T and Levonorgestrel-releasing IUS are safe (MEC 1). They do not contain estrogen and do not affect the systemic coagulation cascade. * **Condoms:** These are barrier methods with no systemic hormonal effects, making them safe for patients with any medical comorbidity. * **Laparoscopic Tubal Ligation:** This is a permanent surgical method. While surgery itself carries a transient risk of DVT, the method does not involve long-term hormonal exposure and is not contraindicated once the patient is stable. **High-Yield Clinical Pearls for NEET-PG:** * **Progestogen-Only Pills (POPs):** These are generally safe (MEC 2) for women with a history of DVT and are the hormonal "method of choice" if estrogen must be avoided. * **MEC Category 4 for COCPs:** Includes history of DVT/PE, Migraine with aura, Smokers >35 years (>15 cigarettes/day), and Breast Cancer. * **DMPA (Injectable):** Use caution in active DVT (MEC 3), but history of DVT is MEC 2.

Q: All of the following are long-acting reversible contraceptives except?

Oral contraceptive pills. **Explanation:** The core concept of **Long-Acting Reversible Contraception (LARC)** refers to methods that provide highly effective pregnancy prevention for an extended period (typically 3 months to 10 years) without requiring daily or frequent action by the user. **Why Oral Contraceptive Pills (OCPs) are the correct answer:** OCPs are classified as **Short-Acting Reversible Contraceptives (SARC)**. Their efficacy is highly user-dependent, requiring strict daily adherence. If a user forgets a pill, the failure rate increases significantly. Because they do not provide long-term protection from a single administration, they do not fit the LARC criteria. **Analysis of Incorrect Options:** * **Intrauterine Devices (IUDs):** Both Copper-T (non-hormonal) and LNG-IUS (Mirena) are classic LARCs. They provide protection for 3 to 10 years after a single insertion. * **Implants:** Subdermal implants (e.g., Norplant, Nexplanon) are LARCs that provide continuous contraception for 3 to 5 years. * **Injectable Progestins:** While sometimes debated in strict definitions due to their 3-month duration, the WHO and standard textbooks (like Williams) often group **DMPA (Depot Medroxyprogesterone Acetate)** under long-acting methods because they remove the "daily" compliance burden. **NEET-PG High-Yield Pearls:** * **Most Effective:** LARCs (Implants and IUDs) have "typical use" failure rates nearly identical to "perfect use" failure rates (<1%), making them more effective than sterilization. * **Tier 1 Contraceptives:** Implants and IUDs. * **Tier 2 Contraceptives:** Injectables, OCPs, Patches, and Vaginal rings. * **Quick Start:** LARCs can be inserted at any time during the menstrual cycle if pregnancy is reasonably excluded. * **Lactational Amenorrhea Method (LAM):** Only effective for the first 6 months postpartum if the mother is exclusively breastfeeding and remains amenorrheic.

Q: For emergency contraception, when must an IUD be inserted?

Within 5 days of coitus. The Cu-T 380A Intrauterine Device (IUD) is the most effective method of emergency contraception (EC), with a failure rate of less than 0.1%. ### **Explanation of the Correct Answer** **Option B (Within 5 days of coitus)** is correct because the primary mechanism of the IUD as EC is to prevent implantation by causing a sterile inflammatory reaction in the endometrium that is toxic to the blastocyst. Since implantation typically occurs 6 to 12 days after fertilization, inserting the IUD within **120 hours (5 days)** of unprotected intercourse ensures the uterine environment is altered before the blastocyst can implant. ### **Analysis of Incorrect Options** * **Option A:** While "the sooner, the better" applies to hormonal EC (like Levonorgestrel), an IUD does not *have* to be inserted immediately to be effective; it remains highly effective up to the 5-day window. * **Option C:** Seven days exceeds the standard window for guaranteed efficacy, as implantation may have already commenced. (Note: Some guidelines suggest it can be inserted up to 5 days after the *earliest estimated day of ovulation*, but for NEET-PG, the standard "5 days after coitus" rule applies). * **Option D:** This is incorrect; the Cu-IUD is actually the "Gold Standard" for EC due to its superior efficacy compared to oral pills. ### **High-Yield Clinical Pearls for NEET-PG** * **Efficacy:** Cu-IUD is >99% effective, making it more effective than Ulipristal acetate or Levonorgestrel. * **Dual Benefit:** It provides immediate EC and continues to provide long-term contraception for up to 10 years. * **Contraindication:** It should not be used if the patient has a current Pelvic Inflammatory Disease (PID) or is already pregnant. * **Mechanism:** Primarily prevents implantation (post-fertilization) and is also spermicidal.

Q: Which of the following is NOT a non-contraceptive advantage of oral contraceptive pills?

Reduced risk of hepatic adenoma. **Explanation:** Combined Oral Contraceptive Pills (COCPs) offer several health benefits beyond pregnancy prevention. However, **Hepatic Adenoma** is a known, albeit rare, **complication** of long-term COCP use, not a benefit. Estrogen in the pills can stimulate the growth of these benign liver tumors, which carry a risk of rupture and intraperitoneal hemorrhage. **Analysis of Options:** * **A. Reduced risk of Pelvic Inflammatory Disease (PID):** COCPs increase the viscosity of cervical mucus, creating a barrier that prevents the upward migration of pathogenic bacteria into the upper genital tract. * **C. Reduced risk of Benign Breast Disease:** COCPs are protective against fibroadenomas and fibrocystic breast disease (though they do not significantly reduce the risk of breast cancer). * **D. Reduced risk of Anemia:** By inhibiting ovulation and thinning the endometrial lining, COCPs reduce the volume and duration of menstrual bleeding (menorrhagia), thereby preventing iron-deficiency anemia. **High-Yield Clinical Pearls for NEET-PG:** * **Cancer Protection:** COCPs significantly reduce the risk of **Ovarian cancer** (by 50%) and **Endometrial cancer** (by 50%). This protection persists for 15–20 years after discontinuation. They also reduce the risk of **Colorectal cancer**. * **Cancer Risks:** COCPs are associated with a slight increase in the risk of **Cervical cancer** (especially with >5 years of use) and **Breast cancer**. * **Other Benefits:** Reduced risk of ectopic pregnancy, functional ovarian cysts, and improvement in acne and dysmenorrhea.

Q: Combined OCPs can be used in all conditions except which of the following?

Breast cancer. **Explanation:** The correct answer is **Breast cancer**. Combined Oral Contraceptive Pills (COCPs) are contraindicated in breast cancer because it is a **hormone-sensitive malignancy**. Estrogen and progesterone can stimulate the proliferation of breast cancer cells, potentially worsening the prognosis or causing recurrence. According to the WHO Medical Eligibility Criteria (MEC), current breast cancer is classified as **Category 4** (unacceptable health risk). **Analysis of Options:** * **Fibroadenoma:** This is a benign breast condition. COCPs are not contraindicated and, in some cases, may even reduce the risk of benign breast disease. * **Ectopic Pregnancy:** COCPs are highly effective at preventing pregnancy. By preventing ovulation, they significantly reduce the absolute risk of both intrauterine and ectopic pregnancies. A history of ectopic pregnancy is not a contraindication. * **Iron Deficiency Anemia:** COCPs are actually **beneficial** here. They reduce menstrual blood loss (menorrhagia) and induce withdrawal bleeds that are lighter and shorter, thereby helping to improve hemoglobin levels. **High-Yield Clinical Pearls for NEET-PG:** * **WHO MEC Category 4 (Absolute Contraindications):** Undiagnosed vaginal bleeding, smokers >35 years (>15 cigarettes/day), history of DVT/PE, ischemic heart disease, stroke, complicated valvular heart disease, and active liver disease (cirrhosis/tumors). * **Cancer Risks:** COCPs **increase** the risk of breast and cervical cancer but are **protective** against ovarian, endometrial, and colorectal cancers. * **Non-contraceptive benefits:** Reduced risk of PID, ectopic pregnancy, and functional ovarian cysts.

Q: An intrauterine pregnancy of approximately 10 weeks gestation is confirmed in a 30-year-old gravida 5, para 4 woman with an IUD in place. The patient expresses a strong desire for the pregnancy to be continued. On examination, the string of the IUD is noted to be protruding from the cervical os. What is the most appropriate course of action?

Remove the IUD immediately. **Explanation:** The management of a pregnancy with an Intrauterine Device (IUD) in situ depends on the visibility of the strings and the gestational age. **1. Why Option C is Correct:** When a woman becomes pregnant with an IUD and the **strings are visible**, the most appropriate action is to **remove the IUD immediately** (ideally before 12 weeks). Leaving the IUD in place significantly increases the risk of: * **Spontaneous Abortion:** Risk increases by up to 50%. * **Septic Abortion:** A life-threatening infection. * **Preterm Labor and Delivery:** Risk increases fourfold. Removal of the IUD reduces these risks, although the risk of miscarriage remains slightly higher than in a normal pregnancy. **2. Why Incorrect Options are Wrong:** * **Options A & B:** Leaving the IUD in place (with or without antibiotics) exposes the patient to a high risk of chorioamnionitis and septic abortion. Prophylactic antibiotics do not mitigate the mechanical and infectious risks posed by the foreign body. * **Option D:** Pregnancy termination is not mandatory. If the patient desires to continue the pregnancy, removal of the IUD is the standard of care. The risk of congenital malformations is not increased by the presence of an IUD. **High-Yield Clinical Pearls for NEET-PG:** * **Strings NOT visible:** If strings are not seen, perform an ultrasound. If the IUD is intrauterine, it should be **left alone** to avoid disrupting the pregnancy. * **Ectopic Risk:** While IUDs are highly effective, if a pregnancy *does* occur, the **probability** of it being an ectopic pregnancy is higher (approx. 1 in 20) compared to the general population. * **Teratogenicity:** There is no evidence that IUDs cause birth defects. * **Actinomyces:** If *Actinomyces* is found on a PAP smear in an asymptomatic IUD user, the IUD does **not** need to be removed.

Q: At the Primary Health Centre (PHC) level, a woman who complains of spotting following Intrauterine Contraceptive Device (IUCD) insertion should be advised:

Iron supplements and observation. **Explanation:** The most common side effect of Intrauterine Contraceptive Devices (IUCDs) like Cu-T 380A is **increased menstrual blood loss and intermenstrual spotting**. This typically occurs during the first 3–6 months following insertion as the endometrium adjusts to the foreign body. **Why Iron Supplements and Observation?** At the PHC level, the primary goal is to manage side effects without discontinuing a highly effective method of contraception. Since chronic spotting or heavy bleeding can lead to a depletion of iron stores and subsequent anemia, the standard protocol is to provide **Iron and Folic Acid (IFA) supplements**. Reassurance and observation are key, as spotting usually subsides spontaneously after a few cycles. **Analysis of Incorrect Options:** * **Analgesics (A):** While NSAIDs (like Mefenamic acid) are effective for managing IUCD-induced *cramping* or heavy bleeding by reducing prostaglandin levels, they are not the primary management for isolated spotting at the PHC level. * **Antibiotics (B):** Spotting is a mechanical/hormonal side effect, not an infectious one. Antibiotics are only indicated if there are signs of Pelvic Inflammatory Disease (PID). * **Removal of IUCD (D):** This is a last resort. Removal is only indicated if the bleeding is persistent, severe, or if the patient is unwilling to continue despite counseling. **NEET-PG High-Yield Pearls:** * **Most common side effect of IUCD:** Bleeding (spotting or menorrhagia). * **Most common reason for removal:** Bleeding and pain. * **Ideal time for insertion:** Within 10 days of the start of the menstrual cycle (to ensure the patient is not pregnant). * **Mechanism of Cu-T:** Primarily spermicidal; causes a sterile inflammatory response in the endometrium.

Q: Which contraceptive method is contraindicated in an HIV-positive patient?

Intrauterine contraceptive device (IUCD). ### Explanation The correct answer is **A. Intrauterine contraceptive device (IUCD)**. **Why IUCD is the correct answer:** In the context of HIV and contraception, the primary concern is the risk of **Pelvic Inflammatory Disease (PID)** and the potential for increased menstrual bleeding. While the WHO Medical Eligibility Criteria (MEC) generally allows IUCD use in stable HIV patients (Category 2), it is strictly **contraindicated (MEC Category 4)** for **initiation** in patients with **AIDS who are not on antiretroviral therapy (ART)** or those who are clinically unwell. The risk of secondary infections and the potential for increased viral shedding in vaginal secretions due to IUCD-induced menorrhagia make it the least preferred option among the choices provided in a standard examination context. **Analysis of Incorrect Options:** * **B. Combined Oral Contraceptive Pills (COCPs):** These are safe (MEC Category 1) but require caution due to drug interactions. Certain Protease Inhibitors can decrease the efficacy of COCPs by inducing liver enzymes. * **C. Minipill (Progestogen-only pill):** These are safe and do not carry the thromboembolic risks associated with estrogen, making them a viable option for HIV patients. * **D. Barrier Methods:** Condoms are the **method of choice** for HIV-positive patients. They provide "dual protection" by preventing both pregnancy and the transmission of HIV/STIs to partners. **High-Yield Clinical Pearls for NEET-PG:** * **Dual Protection:** Always counsel HIV patients to use a barrier method (condoms) in addition to another highly effective contraceptive. * **WHO MEC Category 4 for IUCD:** Includes current PID, purulent cervicitis, and initiation in patients with advanced HIV/AIDS (CD4 <200 cells/mm³). * **Drug Interaction:** Ritonavir (a Protease Inhibitor) is a potent enzyme inducer that significantly reduces the levels of ethinyl estradiol in COCPs.

Question 1

Copper-T with threads is visible in a case of early pregnancy. What is the treatment of choice?

Accepted Answer

Remove CuT only

Answer

Suction evacuation with Copper-T removal

Answer

Reassurance and continue pregnancy

Answer

Laparotomy

Question 2

A woman with a history of deep vein thrombosis requires contraception. Which of the following methods is medically contraindicated for this patient?

Accepted Answer

Oral contraceptives

Answer

Intrauterine device (IUD)

Answer

Condoms

Answer

Laparoscopic tubal ligation

Question 3

All of the following are long-acting reversible contraceptives except?

Accepted Answer

Oral contraceptive pills

Answer

Injectable progestins

Answer

Implants

Answer

Intrauterine devices

Question 4

All of the following are contraindications for the use of progesterone-only pills except?

Accepted Answer

Diabetes mellitus

Answer

Pregnancy

Answer

Patient suffering from breast cancer

Answer

Peripheral vascular disease

Question 5

For emergency contraception, when must an IUD be inserted?

Accepted Answer

Within 5 days of coitus

Answer

Immediately

Answer

Within 7 days of coitus

Answer

An IUD is not used as emergency contraception

Question 6

Which of the following is NOT a non-contraceptive advantage of oral contraceptive pills?

Accepted Answer

Reduced risk of hepatic adenoma

Answer

Reduced risk of pelvic inflammatory disease

Answer

Reduced risk of benign breast disease

Answer

Reduced risk of anemia

Question 7

Combined OCPs can be used in all conditions except which of the following?

Accepted Answer

Breast cancer

Answer

Fibroadenoma

Answer

Ectopic pregnancy

Answer

Iron deficiency anemia

Question 8

An intrauterine pregnancy of approximately 10 weeks gestation is confirmed in a 30-year-old gravida 5, para 4 woman with an IUD in place. The patient expresses a strong desire for the pregnancy to be continued. On examination, the string of the IUD is noted to be protruding from the cervical os. What is the most appropriate course of action?

Accepted Answer

Remove the IUD immediately

Answer

Leave the IUD in place without any other treatment

Answer

Leave the IUD in place and continue prophylactic antibiotics throughout pregnancy

Answer

Terminate the pregnancy because of the high risk of infection

Question 9

At the Primary Health Centre (PHC) level, a woman who complains of spotting following Intrauterine Contraceptive Device (IUCD) insertion should be advised:

Accepted Answer

Iron supplements and observation

Answer

Analgesics and observation

Answer

Antibiotics and observation

Answer

Removal of IUCD

Question 10

Which contraceptive method is contraindicated in an HIV-positive patient?

Accepted Answer

Intrauterine contraceptive device (IUCD)

Answer

Combined oral contraceptive pills (COC pills)

Answer

Minipill

Answer

Barrier methods

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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