Contraception and Family Planning Practice Questions

Q: What is the ideal contraceptive for a couple living in different cities who meet only occasionally?

Barrier method. **Explanation:** The choice of contraceptive method depends heavily on the frequency of intercourse and the lifestyle of the couple. For a couple living in different cities who meet only occasionally, the **Barrier method (Condoms)** is the ideal choice. **1. Why Barrier Method is Correct:** The primary medical concept here is **"Coitus-dependent contraception."** Since the couple meets infrequently, they do not require continuous systemic hormonal levels or semi-permanent devices. Barrier methods are used only during the act of intercourse, avoiding unnecessary side effects of long-term medications. Additionally, they provide protection against Sexually Transmitted Infections (STIs), which is a crucial consideration for couples living apart. **2. Why Other Options are Incorrect:** * **IUCD (Option B):** These are Long-Acting Reversible Contraceptives (LARC). While highly effective, they are generally preferred for couples seeking long-term spacing (3–10 years) who have frequent intercourse. * **OCP (Option C):** These require strict daily compliance. Taking a daily systemic hormone for a couple that meets only once every few months is considered unnecessary hormonal exposure. * **DMPA (Option D):** This is an injectable contraceptive given every 3 months. Like OCPs, it provides continuous systemic suppression of ovulation, which is not "need-based" for occasional contact. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Contraceptive for Newly Married:** OCPs (Centchroman/Chhaya is also a popular choice in India). * **Ideal Contraceptive for Lactating Mothers:** Progestogen-only pills (POPs) or Lactational Amenorrhea Method (LAM) for the first 6 months. * **Pearl Index:** Condoms have a higher failure rate (typical use) compared to IUCDs/OCPs, but they are the only method that prevents STIs. * **Emergency Contraception:** Should be advised as a backup for this couple in case of barrier failure (condom rupture).

Q: All of the following are contraceptive implants except?

Mesigyna. **Explanation:** The correct answer is **D. Mesigyna**. **1. Why Mesigyna is the correct answer:** Mesigyna is a **Combined Injectable Contraceptive (CIC)**, not an implant. It contains an estrogen (Estradiol valerate 5 mg) and a progestogen (Norethisterone enanthate 50 mg). It is administered intramuscularly once every month. In contrast, contraceptive implants are sub-dermal devices that provide long-term reversible contraception (LARC). **2. Analysis of incorrect options (Implants):** * **Norplant:** The first-generation implant system. It consists of **6 silastic capsules** containing Levonorgestrel (LNG), effective for 5 years. * **Jadelle:** A second-generation implant (often called Norplant-2). It consists of **2 rods** containing Levonorgestrel, effective for 5 years. It is easier to insert and remove than Norplant. * **Implanon:** A third-generation, **single-rod** implant containing Etonogestrel (68 mg). It is effective for 3 years. (Note: Nexplanon is the newer, radiopaque version of Implanon). **3. NEET-PG High-Yield Pearls:** * **Mechanism of Action (Implants):** Primarily work by suppressing ovulation and thickening cervical mucus. * **Most Common Side Effect:** The most frequent reason for discontinuation of implants is **irregular menstrual bleeding** (amenorrhea or spotting). * **Failure Rate:** Implants have the lowest failure rate among all contraceptive methods (Pearl Index ~0.05), making them more effective than permanent sterilization. * **Anticonvulsants:** Enzyme-inducing drugs (e.g., Phenytoin, Carbamazepine) can decrease the efficacy of hormonal implants.

Q: What is the rate of release of levonorgestrel into the uterus from Mirena, a progestin-releasing intrauterine device?

20 mcg/day. **Explanation:** **Mirena** is a Levonorgestrel-releasing Intrauterine System (LNG-IUS) that contains a total of 52 mg of Levonorgestrel. The correct answer is **20 mcg/day** because this is the initial steady-state release rate of the hormone into the uterine cavity. This local release causes endometrial thickening, cervical mucus changes, and inhibition of sperm motility, providing highly effective contraception for up to 5–8 years. **Analysis of Options:** * **A (20 mcg/day):** This is the standard initial release rate for Mirena. Over time, this rate gradually declines (reaching approximately 10 mcg/day after 5 years), but 20 mcg/day is the definitive value tested in exams. * **B (30 mcg/day):** This value does not correspond to any standard LNG-IUS. Progestin-only pills (Minipills) like Levonorgestrel 0.03 mg contain 30 mcg, but the IUD release rate is lower. * **C & D (50 & 70 mcg/day):** These values are significantly higher than the physiological dose required for local intrauterine action and would lead to increased systemic side effects. Progestasert (an older, now obsolete IUD) released Progesterone at 65 mcg/day. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Primarily local action (endometrial atrophy); it is **not** primarily anovulatory. * **Non-contraceptive use:** It is the "Gold Standard" medical management for **Heavy Menstrual Bleeding (HMB)** and is used in Endometrial Hyperplasia. * **Other LNG-IUS:** * **Kylena:** Releases ~17.5 mcg/day (smaller frame). * **Jaydess/Skyla:** Releases ~14 mcg/day (3-year duration). * **Failure Rate:** 0.2%, comparable to tubal ligation.

Q: Which of the following is NOT a contraindication for medical abortion?

Age more than 35 years. ### Explanation Medical abortion (using Mifepristone and Misoprostol) is a safe procedure, but its success and safety depend on identifying specific contraindications. **1. Why "Age more than 35 years" is the correct answer:** Age alone is **not** a contraindication for medical abortion. While advanced maternal age may increase risks in surgical procedures or pregnancy complications, medical abortion remains safe for women over 35, provided they do not have co-morbidities like heavy smoking (which increases cardiovascular risk) or uncontrolled hypertension. **2. Why the other options are contraindications:** * **Hemoglobin < 8 gm% (Severe Anemia):** Medical abortion involves significant vaginal bleeding (often heavier than a normal period). In patients with severe anemia, this blood loss can lead to hypovolemic shock or the need for emergency transfusion. * **Undiagnosed Adnexal Mass:** This is a major contraindication because it raises the suspicion of an **Ectopic Pregnancy**. Medical abortion drugs will not terminate a tubal pregnancy, and a rupture could be life-threatening. * **Uncontrolled Seizure Disorder:** Patients with uncontrolled epilepsy are generally excluded because the stress of the procedure, potential drug interactions, or the physiological changes during cramping and bleeding could trigger seizures. **3. High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications:** Confirmed/suspected ectopic pregnancy, chronic adrenal failure, long-term corticosteroid therapy, inherited coagulopathy, or allergy to Mifepristone/Misoprostol. * **IUD Presence:** An IUD is a contraindication *unless* it is removed before the medical abortion begins. * **MTP Act (India) Update:** Medical abortion is legal up to **9 weeks (63 days)** of gestation under the MTP Act. * **Standard Regimen:** 200 mg Mifepristone (Oral) followed by 400 mcg Misoprostol (Oral/Vaginal/Sublingual) after 24–48 hours.

Q: MTP can be done up to what gestational age?

20 weeks. **Explanation:** The Medical Termination of Pregnancy (MTP) Act was originally enacted in 1971. According to the **original MTP Act (1971)**, the legal limit for termination of pregnancy was **20 weeks**. This remains the standard answer for many traditional MCQ formats unless the question specifically references the 2021 Amendment. **Why the correct answer is 20 weeks:** Under the 1971 Act, a pregnancy could be terminated up to 12 weeks with the opinion of one Registered Medical Practitioner (RMP), and between 12 to 20 weeks with the opinion of two RMPs. The 20-week limit was historically set based on the viability of the fetus and the safety of the mother. **Analysis of Incorrect Options:** * **A (12 weeks):** This is the threshold where the opinion of only one RMP is required, but it is not the upper legal limit. * **B (16 weeks):** There is no specific legal significance to 16 weeks under the MTP Act. * **D (10 weeks):** This is incorrect; medical methods (pills) are often used up to 7–9 weeks, but the legal limit for MTP is much higher. **High-Yield Clinical Pearls for NEET-PG:** * **MTP Amendment Act 2021:** This is a crucial update. The limit has been increased to **24 weeks** for specific categories of women (survivors of sexual assault, minors, change of marital status, etc.). * **No Upper Limit:** Under the 2021 Amendment, there is no upper gestational limit if the termination is necessary due to **substantial fetal abnormalities** diagnosed by a Medical Board. * **Confidentiality:** The name and particulars of the woman whose pregnancy is terminated shall not be revealed except to a person authorized by law. * **Consent:** Only the woman's consent is required if she is an adult; if she is a minor or mentally ill, consent from a guardian is mandatory.

Q: Which of the following is NOT a benefit of LNG-IUD?

Treatment of stage 2 endometrial cancer. **Explanation:** The **Levonorgestrel-releasing Intrauterine Device (LNG-IUD)**, commonly known by the brand name Mirena, releases 20 µg of levonorgestrel daily. Its primary mechanism is local progestogenic action on the endometrium. **Why Option D is Correct:** LNG-IUD is **not** a treatment for Stage 2 endometrial cancer. Stage 2 endometrial cancer involves invasion of the cervical stroma and requires definitive surgical management (Total Abdominal Hysterectomy with Bilateral Salpingo-oophorectomy) and potentially radiotherapy. While LNG-IUD can be used for **Endometrial Hyperplasia** or very early-stage (Stage 1A), well-differentiated adenocarcinoma in patients who are unfit for surgery or wish to preserve fertility, it has no role in Stage 2 disease. **Analysis of Incorrect Options:** * **A. Management of menorrhagia:** LNG-IUD is the **medical gold standard** for treating Idiopathic Menorrhagia. It causes profound endometrial atrophy, reducing menstrual blood loss by up to 90%. * **B. Contraceptive effect:** It is a highly effective Long-Acting Reversible Contraceptive (LARC) with a Pearl Index of approximately 0.2. It works by thickening cervical mucus and causing endometrial thinning. * **C. Hormone replacement therapy (HRT):** In postmenopausal women, LNG-IUD provides the "progestogen component" to protect the endometrium from hyperplasia when the patient is taking systemic estrogen therapy. **High-Yield Clinical Pearls for NEET-PG:** * **Life span:** Approved for 5 years (Mirena) to 8 years (recent updates). * **Non-contraceptive benefits:** Reduces dysmenorrhea, treats endometriosis/adenomyosis, and prevents endometrial hyperplasia during Tamoxifen therapy. * **Most common side effect:** Initial irregular spotting/breakthrough bleeding for the first 3–6 months, followed by amenorrhea in many users.

Q: Oral contraceptive pills protect against all of the following EXCEPT:

Hepatic adenoma. **Explanation:** The correct answer is **Hepatic adenoma**. This is because Combined Oral Contraceptive Pills (COCPs) are a well-documented **risk factor** for the development of hepatic adenomas, rather than a protective factor. The estrogen component in the pills can stimulate the growth of these benign liver tumors; therefore, COCPs are contraindicated in women with a history of hepatic adenoma. **Analysis of other options:** * **Fibroadenoma of the breast:** COCPs have a protective effect against **benign breast diseases**, including fibroadenomas and fibrocystic disease. (Note: Their effect on breast *cancer* remains controversial/slightly increased risk). * **Carcinoma of the ovary:** COCPs significantly reduce the risk of epithelial ovarian cancer (by ~50%). This protection increases with the duration of use and persists for up to 15–20 years after discontinuation. * **Uterine malignancy (Endometrial Cancer):** COCPs reduce the risk of endometrial cancer by approximately 50% due to the progestogen component, which prevents estrogen-induced endometrial hyperplasia. **High-Yield NEET-PG Pearls:** 1. **Protective Effects of COCPs:** Reduced risk of Ovarian cancer, Endometrial cancer, Colorectal cancer, PID, Ectopic pregnancy, and Iron deficiency anemia. 2. **Increased Risks with COCPs:** Hepatic adenoma, Venous Thromboembolism (VTE), Hypertension, and Cervical cancer (with long-term use). 3. **Mnemonic for Cancer Protection:** COCPs protect against the "Inside" cancers (Ovary, Endometrium, Colon) but may increase risk for "Outside/Surface" cancers (Cervix, Breast).

Q: In a young female of reproductive age, what is an absolute contraindication for prescribing oral contraceptive pills?

Impaired liver function. **Explanation:** The correct answer is **D. Impaired liver function**. Combined Oral Contraceptive Pills (COCPs) contain steroid hormones (estrogen and progesterone) that are primarily metabolized by the liver. In patients with active liver disease, viral hepatitis, or cirrhosis, the liver cannot effectively clear these hormones, leading to toxic accumulation and potential worsening of hepatic dysfunction. Furthermore, estrogens increase the risk of developing hepatic adenomas. **Analysis of Options:** * **A. Diabetes:** This is a **relative contraindication**. COCPs can be used in diabetic patients unless there are associated vascular complications (nephropathy, retinopathy, or neuropathy) or the disease duration is >20 years. * **B. Hypertension:** This is generally a **relative contraindication**. However, it becomes an absolute contraindication only if the blood pressure is severely elevated (Systolic ≥160 mmHg or Diastolic ≥100 mmHg) or if there is associated vascular disease. * **C. Obesity:** Obesity is a **relative contraindication**. While it increases the baseline risk of venous thromboembolism (VTE), it does not strictly prohibit COCP use unless other major risk factors are present. **High-Yield NEET-PG Pearls:** * **Absolute Contraindications (WHO Category 4):** Breast cancer (current), smoking >15 cigarettes/day in women >35 years, history of DVT/PE, ischemic heart disease, migraine with aura, and active liver disease. * **Drug Interactions:** Enzyme inducers like Rifampicin, Phenytoin, and Carbamazepine decrease the efficacy of COCPs, leading to breakthrough bleeding or contraceptive failure. * **Non-contraceptive benefits:** COCPs reduce the risk of ovarian and endometrial cancers (protective effect persists for years after discontinuation).

Question 1

What is the ideal contraceptive for a couple living in different cities who meet only occasionally?

Accepted Answer

Barrier method

Answer

Intrauterine contraceptive device (IUCD)

Answer

Oral contraceptive pill (OCP)

Answer

DMPA (Depot medroxyprogesterone acetate)

Question 2

All of the following are contraceptive implants except?

Accepted Answer

Mesigyna

Answer

Norplant

Answer

Implanon

Answer

Jadelle

Question 3

What is the rate of release of levonorgestrel into the uterus from Mirena, a progestin-releasing intrauterine device?

Accepted Answer

20 mcg/day

Answer

30 mcg/day

Answer

50 mcg/day

Answer

70 mcg/day

Question 4

Which of the following statements is true regarding RU-486?

Accepted Answer

It is used for inducing abortion in the early weeks of pregnancy.

Answer

It can be used in conjunction with a contraceptive pill.

Answer

It acts on the cytoplasmic receptor.

Answer

It is used for preventing ectopic implantation.

Question 5

Which of the following is NOT a contraindication for medical abortion?

Accepted Answer

Age more than 35 years

Answer

Hemoglobin less than 8 gm%

Answer

Undiagnosed adnexal mass

Answer

Uncontrolled seizure disorder

Question 6

MTP can be done up to what gestational age?

Accepted Answer

20 weeks

Answer

12 weeks

Answer

16 weeks

Answer

10 weeks

Question 7

Which of the following is NOT a benefit of LNG-IUD?

Accepted Answer

Treatment of stage 2 endometrial cancer

Answer

Management of menorrhagia

Answer

Contraceptive effect

Answer

Hormone replacement therapy after menopause

Question 8

Which contraceptive method is associated with an increased risk of actinomycosis?

Accepted Answer

Intrauterine Contraceptive Device (IUCD)

Answer

Oral Contraceptive Pills (OCPs)

Answer

Condom

Answer

Vaginal contraceptive methods

Question 9

Oral contraceptive pills protect against all of the following EXCEPT:

Accepted Answer

Hepatic adenoma

Answer

Fibroadenoma of the breast

Answer

Carcinoma of the ovary

Answer

Uterine malignancy

Question 10

In a young female of reproductive age, what is an absolute contraindication for prescribing oral contraceptive pills?

Accepted Answer

Impaired liver function

Answer

Diabetes

Answer

Hypertension

Answer

Obesity

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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