Contraception and Family Planning Practice Questions

Q: All except one is recommended for use in emergency contraception?

Selective oestrogen receptor modulators. **Explanation:** Emergency contraception (EC) is intended to prevent pregnancy after unprotected intercourse or contraceptive failure. The correct answer is **Selective Estrogen Receptor Modulators (SERMs)**, as they are not used for emergency contraception; rather, they are primarily used in the treatment of breast cancer (Tamoxifen) or infertility (Clomiphene). **Why the other options are used:** * **Combined Oral Contraceptives (Option A):** Known as the **Yuzpe Regimen**, this involves two doses of ethinyl estradiol (100 mcg) and levonorgestrel (0.5 mg) taken 12 hours apart. It is less commonly used now due to high rates of nausea and vomiting. * **Progestin-only Regimens (Option B):** The **Levonorgestrel (LNG) 1.5 mg** single dose (or two 0.75 mg doses) is the most widely used hormonal EC. It works primarily by delaying ovulation. * **Antiprogestins (Option D):** **Ulipristal acetate (30 mg)** is a selective progesterone receptor modulator (SPRM) and is currently considered the most effective hormonal EC, effective up to 120 hours (5 days) after intercourse. **Mifepristone** (low dose) is also an effective antiprogestin used for EC. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** The **Copper-T 380A IUD** is the most effective method of emergency contraception (failure rate <0.1%) and can be inserted up to 5 days after intercourse. * **Time Window:** Hormonal methods are most effective within 72 hours, though Ulipristal is effective up to 120 hours. * **Mechanism:** EC prevents or delays ovulation; it is **not** an abortifacient and will not disrupt an established pregnancy. * **Drug of Choice:** Levonorgestrel is the DOC for lactating mothers and is available over-the-counter.

Q: The drug being given is:

Ethacrydine lactate (0.1%). ***Ethacrydine lactate (0.1%)*** - **Ethacrydine lactate** (Rivanol) is easily identifiable by its characteristic **yellow color** when used as an intra-amniotic injection. - It is a commonly used **abortifacient** for **mid-trimester pregnancy termination** via intra-amniotic instillation. *20% mannitol* - **Mannitol** is a **colorless solution** used as an osmotic diuretic, not for pregnancy termination. - It lacks the distinctive **yellow coloration** that would make it identifiable in this clinical context. *50% Urea* - **Urea** solutions are **colorless** and were historically used for intra-amniotic abortion but are less commonly used now. - Does not have the **characteristic yellow appearance** that helps identify the drug being administered. *Misoprostol* - **Misoprostol** is a **prostaglandin E1 analog** available as **oral or vaginal tablets**, not as an injectable solution. - It is **white/off-white in color** and would not present as a colored liquid for injection.

Q: Which of the following is NOT a side effect of progesterone-only pills?

Decreased lactation. **Explanation:** The correct answer is **C. Decreased lactation**. Progesterone-only pills (POPs), often called the "minipill," are the hormonal contraceptive of choice for breastfeeding mothers. Unlike combined oral contraceptive pills (COCs), which contain estrogen that suppresses prolactin and significantly reduces the quantity and quality of breast milk, **progesterone does not inhibit lactation**. In fact, some studies suggest POPs may slightly increase milk volume or have a neutral effect, making them safe to initiate in the immediate postpartum period. **Analysis of Incorrect Options:** * **A. Irregular bleeding:** This is the most common side effect of POPs. Because they do not contain estrogen to stabilize the endometrium, users often experience breakthrough bleeding or spotting. * **B. Amenorrhea:** Over time, the progestogen causes endometrial atrophy, leading to a cessation of menses in a significant percentage of users. * **C. Weight gain:** While less pronounced than with injectable contraceptives (like DMPA), mild weight gain is a documented side effect of progestogens due to their anabolic effects and potential for increased appetite. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** POPs primarily work by thickening cervical mucus (preventing sperm penetration) and causing endometrial atrophy. They do not consistently suppress ovulation (only in ~50% of cycles). * **The "3-Hour Rule":** Traditional POPs must be taken at the same time every day. A delay of more than 3 hours is considered a "missed pill," requiring backup contraception for 48 hours. * **Ideal Candidate:** Lactating women, women over 35 who smoke, and those with contraindications to estrogen (e.g., history of VTE, migraine with aura, or uncontrolled hypertension).

Q: Oral contraceptive pills are contraindicated in:

Hepatadenoma. **Explanation:** The correct answer is **Hepatadenoma (Hepatic Adenoma)**. Combined Oral Contraceptive Pills (COCPs) are absolute contraindications in patients with benign or malignant liver tumors because the estrogen component can stimulate the growth of these tumors and increase the risk of rupture and life-threatening intraperitoneal hemorrhage. **Why the other options are incorrect:** * **Premenstrual Tension (PMT):** COCPs are often used as a **treatment** for PMT/PMS. By suppressing ovulation and stabilizing hormonal fluctuations throughout the cycle, they help alleviate physical and emotional symptoms. * **Endometriosis:** COCPs are a **first-line medical management** strategy. They induce a state of "pseudopregnancy," causing atrophy of the ectopic endometrial tissue and reducing dysmenorrhea. * **Pelvic Inflammatory Disease (PID):** COCPs are actually considered **protective** against PID. They increase the viscosity of cervical mucus, making it difficult for ascending pathogens (like *N. gonorrhoeae*) to enter the upper reproductive tract. **High-Yield NEET-PG Pearls:** * **WHO Eligibility Criteria Category 4 (Absolute Contraindications):** * Smokers >35 years (≥15 cigarettes/day). * History of Thromboembolism (DVT/PE) or Stroke. * Current Breast Cancer. * Decompensated Cirrhosis, Hepatoma, or Viral Hepatitis (Active). * Migraine with Aura (increased risk of ischemic stroke). * Uncontrolled Hypertension (>160/100 mmHg). * **Key Benefit:** COCPs significantly reduce the risk of **Ovarian and Endometrial cancers** (protective effect lasts years after discontinuation).

Q: All of the following are recognized effects of combined oral contraceptives except?

Increased risk of colon cancer. **Explanation:** Combined Oral Contraceptive Pills (COCPs) exert a wide range of systemic effects, both beneficial and adverse. The correct answer is **D** because COCPs are actually associated with a **decreased risk of colorectal cancer** (approximately 15-20% reduction), rather than an increased risk. **Analysis of Options:** * **Option D (Correct):** Epidemiological studies consistently show that COCP use is a protective factor against colon cancer. Therefore, stating it increases the risk is factually incorrect. * **Option A (Incorrect):** Breakthrough bleeding (spotting) is the most common side effect of COCPs, especially during the first few months of use or with low-dose estrogen formulations. * **Option B (Incorrect):** COCPs provide significant protection against endometrial cancer (by suppressing endometrial proliferation) and ovarian cancer. This protection persists for years after discontinuation. * **Option C (Incorrect):** Estrogen increases the synthesis of clotting factors and can cause endothelial changes. This leads to a slightly increased risk of venous thromboembolism (VTE), myocardial infarction, and ischemic stroke, particularly in women who smoke or have hypertension. **NEET-PG High-Yield Pearls:** 1. **Cancer Protection:** COCPs decrease the risk of three cancers: **Ovarian, Endometrial, and Colorectal.** 2. **Cancer Risk:** COCPs are associated with a slight increase in the risk of **Cervical and Breast cancer.** 3. **Non-Contraceptive Benefits:** Reduced incidence of Pelvic Inflammatory Disease (PID), ectopic pregnancy, benign breast disease, and improvement in dysmenorrhea/menorrhagia. 4. **Absolute Contraindications:** Smokers >35 years (>15 cigarettes/day), history of thromboembolism, migraine with aura, and undiagnosed abnormal uterine bleeding.

Q: Which vaccine is contraindicated in pregnancy?

MMR. **Explanation:** The core principle in obstetric immunization is that **Live Attenuated Vaccines** are generally **contraindicated** during pregnancy. This is due to the theoretical risk of the live virus crossing the placenta and causing fetal infection or teratogenic effects. **Why MMR is the Correct Answer:** The **MMR (Measles, Mumps, and Rubella)** vaccine contains live attenuated viruses. The Rubella component is of particular concern as it can theoretically cause **Congenital Rubella Syndrome (CRS)**. Therefore, MMR should be administered either before conception (with a recommendation to avoid pregnancy for 28 days/1 month post-vaccination) or in the immediate postpartum period. **Analysis of Incorrect Options:** * **Diphtheria:** This is a **toxoid** vaccine. It is safe and routinely administered during pregnancy (usually as Tdap) to provide passive immunity to the newborn against neonatal tetanus and pertussis. * **Hepatitis-B:** This is a **subunit (recombinant)** vaccine. It is safe and indicated for pregnant women at high risk of infection. * **Killed Polio Vaccine (IPV):** Inactivated (killed) vaccines do not pose a risk of replication or fetal infection. While IPV is not routinely given unless there is a high risk of exposure, it is not contraindicated like the live oral version (OPV). **High-Yield Clinical Pearls for NEET-PG:** 1. **Safe Vaccines:** All Inactivated/Killed vaccines (Flu shot, Rabies, IPV), Toxoids (Tetanus, Diphtheria), and Recombinant vaccines (Hep-B, HPV—though HPV is usually deferred). 2. **Contraindicated Vaccines:** "Live" vaccines—**MMR, Varicella, BCG, Yellow Fever, and Oral Polio (OPV).** 3. **Exception:** Yellow Fever vaccine may be given if the risk of disease outweighs the risk of vaccination (e.g., unavoidable travel to endemic zones). 4. **Best Time for Tdap:** Between **27 and 36 weeks** of gestation to maximize transplacental antibody transfer.

Q: Mifepristone and misoprostol are allowed for medical termination of pregnancy (MTP) until which gestational week?

9 weeks. **Explanation:** The medical termination of pregnancy (MTP) using a combination of **Mifepristone** (a progesterone antagonist) and **Misoprostol** (a prostaglandin E1 analogue) is approved for use up to **9 weeks (63 days)** of gestation. 1. **Why 9 weeks is correct:** According to the updated guidelines and the MTP Amendment Act, the medical regimen is highly effective (95-98%) up to 63 days. Mifepristone sensitizes the myometrium to prostaglandins and causes decidual necrosis, while Misoprostol induces uterine contractions and cervical ripening to expel the products of conception. 2. **Why other options are incorrect:** * **6 and 7 weeks:** While medical abortion is safe at these stages, it is not the upper limit. Earlier protocols (pre-2000s) sometimes cited 7 weeks, but current standards extend to 9 weeks. * **12 weeks:** Beyond 9 weeks, the efficacy of the standard medical regimen decreases, and the risk of incomplete abortion and heavy bleeding increases. For pregnancies between 9 and 12 weeks, surgical methods (like Suction & Evacuation) are generally preferred, although medical induction can be done in a hospital setting with different dosing schedules. **Clinical Pearls for NEET-PG:** * **The Regimen:** 200 mg Mifepristone (Oral) followed by 400 mcg Misoprostol (Oral/Vaginal/Sublingual) after 24–48 hours. * **MTP Act 2021 Update:** Pregnancy can be terminated up to **24 weeks** in specific categories of women (e.g., rape survivors, minors), but this usually requires surgical intervention or different medical protocols beyond the first trimester. * **Contraindications:** Suspected ectopic pregnancy, chronic adrenal failure, and long-term corticosteroid therapy. * **Golden Rule:** Always confirm the gestational age via ultrasound before initiating MTP to rule out ectopic pregnancy.

Question 1

Maximum risk of ectopic pregnancy is after reversal or failure of which of these female sterilization procedures?

Accepted Answer

Laparoscopic electrocoagulation

Answer

Laparoscopic clips

Answer

Laparoscopic rings

Answer

Pomeroys ligation

Question 2

All of the following conditions are contraindications for the use of a progestin-releasing intrauterine device, EXCEPT:

Accepted Answer

Women with menorrhagia

Answer

Carcinoma of the breast

Answer

Acute liver disease or tumor

Answer

Hypersensitivity to any component of this product

Question 3

All except one is recommended for use in emergency contraception?

Accepted Answer

Selective oestrogen receptor modulators

Answer

Combined oral contraceptives

Answer

Progestin only regimens

Answer

Antiprogestins

Question 4

The drug being given is:

Accepted Answer

Ethacrydine lactate (0.1%)

Answer

20% mannitol

Answer

50% Urea

Answer

Misoprostol

Question 5

Which of the following is NOT a side effect of progesterone-only pills?

Accepted Answer

Decreased lactation

Answer

Irregular bleeding

Answer

Amenorrhea

Answer

Weight gain

Question 6

Which of the following is NOT a contraindication or consideration for contraception methods in patients with liver disease?

Accepted Answer

Progestin-only contraception is the preferred method for patients with liver disease.

Answer

Combined oral contraceptive pills (OCPs) should not be initiated in women with active hepatitis.

Answer

Combined OCPs can be continued in women experiencing an acute flare-up of liver disease while already taking them.

Answer

Discontinuing OCPs can resolve symptoms of cholestasis.

Question 7

Oral contraceptive pills are contraindicated in:

Accepted Answer

Hepatadenoma

Answer

Premenstrual tension

Answer

Endometriosis

Answer

Pelvic inflammatory disease

Question 8

All of the following are recognized effects of combined oral contraceptives except?

Accepted Answer

Increased risk of colon cancer

Answer

Breakthrough bleeding

Answer

Decreased risk of endometrial cancer

Answer

Increased risk of ischemic stroke

Question 9

Which vaccine is contraindicated in pregnancy?

Accepted Answer

MMR

Answer

Diphtheria

Answer

Hepatitis-B

Answer

Killed polio vaccine

Question 10

Mifepristone and misoprostol are allowed for medical termination of pregnancy (MTP) until which gestational week?

Accepted Answer

9 weeks

Answer

6 weeks

Answer

7 weeks

Answer

12 weeks

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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