Contraception and Family Planning Practice Questions

Q: Use of oral contraceptive pills decreases which of the following?

Glucose tolerance. Combined Oral Contraceptive Pills (COCPs) exert systemic metabolic effects due to their estrogen and progestogen components. **Why Glucose Tolerance Decreases (Correct Answer):** COCPs, particularly the progestogen component, induce a state of **insulin resistance**. Progestogens decrease the number of insulin receptors and impair peripheral glucose uptake. Estrogen can also interfere with glucose metabolism by affecting cortisol levels. This results in a "diabetogenic" effect, leading to **decreased glucose tolerance**. While clinically insignificant in healthy women, it is a critical consideration for those with pre-diabetes or gestational diabetes history. **Analysis of Incorrect Options:** * **B. Binding Globulins:** Estrogen stimulates the liver to **increase** the synthesis of transport proteins. COCPs increase Sex Hormone-Binding Globulin (SHBG), Thyroid-Binding Globulin (TBG), and Cortisol-Binding Globulin (CBG). * **C. High-density lipoprotein (HDL):** Estrogen generally **increases** HDL (the "good" cholesterol) and decreases LDL. While some older progestogens could oppose this, modern low-dose formulations typically result in a net increase or neutral effect on HDL. * **D. Triglycerides:** Estrogen **increases** the hepatic synthesis of triglycerides. Therefore, COCPs are contraindicated in patients with severe hypertriglyceridemia due to the risk of pancreatitis. **High-Yield Clinical Pearls for NEET-PG:** * **Protective Effects:** COCPs **decrease** the risk of Ovarian cancer, Endometrial cancer, and Benign Breast Disease. * **Increased Risks:** COCPs **increase** the risk of Cervical cancer (with long-term use), Breast cancer (slight), and Hepatic Adenoma. * **Coagulation:** COCPs increase Factors VII, X, and Fibrinogen, leading to a hypercoagulable state (increased VTE risk). * **Blood Pressure:** They may cause a slight increase in BP due to the stimulation of the Renin-Angiotensin-Aldosterone System (RAAS).

Q: Prostaglandins can be used for medical termination of pregnancy by all routes except?

Intravenous. **Explanation:** The correct answer is **Intravenous (A)**. **Medical Rationale:** Prostaglandins (PGs) are potent stimulators of uterine smooth muscle. While they are highly effective for medical termination of pregnancy (MTP), the **intravenous route** is avoided because it leads to a rapid, systemic surge of the drug. This causes severe, intolerable side effects due to the contraction of smooth muscles in other organ systems, leading to intense nausea, vomiting, explosive diarrhea, bronchospasm, and significant hypertension or pyrexia. Consequently, the IV route has no clinical place in modern obstetric practice for MTP. **Analysis of Other Options:** * **Intramuscular (B):** 15-methyl PGF2α (Carboprost) is frequently administered intramuscularly. It is highly effective for mid-trimester abortions and the management of postpartum hemorrhage (PPH). * **Extra-amniotic (C):** PGF2α or PGE2 can be instilled into the space between the uterine wall and the fetal membranes via a catheter. This allows for a high local concentration with slower systemic absorption, reducing side effects. * **Intra-amniotic (D):** Injection of PGs (usually PGF2α) into the amniotic sac is a classic method for second-trimester induction. It ensures a sustained local effect on the myometrium. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** For first-trimester medical abortion, the combination of **Mifepristone (Oral)** and **Misoprostol (Vaginal/Sublingual/Buccal)** is the gold standard. * **Misoprostol (PGE1):** Unique because it is stable at room temperature and can be administered via oral, vaginal, sublingual, or rectal routes. * **Side Effect Profile:** The most common side effect of prostaglandins is GI upset (diarrhea), while the most specific contraindication for PGF2α (Carboprost) is **Asthma** (due to bronchoconstriction).

Q: What is the primary mechanism of action of the progestogen-only pill?

Increases cervical mucus viscosity. **Explanation:** The **Progestogen-Only Pill (POP)**, also known as the "mini-pill," primarily functions by altering the female reproductive tract environment rather than consistently suppressing the hypothalamic-pituitary-ovarian axis. **1. Why Option A is Correct:** The primary and most consistent mechanism of action of POPs is **increasing the viscosity and thickness of cervical mucus**. Under the influence of continuous low-dose progestogen, the mucus becomes scanty, thick, and cellular. This creates a "hostile" environment that acts as a physical barrier, preventing sperm penetration into the upper reproductive tract. **2. Why Other Options are Incorrect:** * **Option B (Inhibits ovulation):** While POPs can suppress ovulation in some cycles (approximately 40–60% of the time), it is **not** the primary or reliable mechanism. In contrast, the Combined Oral Contraceptive Pill (COCP) primarily works by inhibiting ovulation via FSH and LH suppression. * **Option C (Antispermicidal effects):** POPs do not contain spermicidal agents. They hinder sperm transport through mechanical (mucus) and functional (endometrial/tubal) changes rather than direct chemical destruction of sperm. **3. High-Yield Clinical Pearls for NEET-PG:** * **Secondary Mechanisms:** POPs also cause endometrial thinning (making it unfavorable for implantation) and alter fallopian tube motility. * **The "3-Hour Rule":** Traditional POPs have a very short half-life; if a dose is delayed by more than **3 hours**, contraceptive efficacy is significantly reduced. * **Ideal Candidates:** POPs are the contraceptive of choice for **lactating mothers** (as they do not affect milk quantity/quality) and women in whom estrogen is contraindicated (e.g., history of VTE, smokers >35 years, or migraine with aura). * **Side Effects:** The most common side effect is **irregular menstrual bleeding** or spotting.

Q: Which of the following is an absolute contraindication for combined oral contraceptive pills, EXCEPT?

Women aged greater than 35 years. This question tests your knowledge of the **WHO Medical Eligibility Criteria (MEC)** for contraceptive use. Combined Oral Contraceptive Pills (COCPs) contain estrogen, which increases the risk of thromboembolism and cardiovascular events. ### **Explanation of the Correct Answer** **Option B (Women aged >35 years)** is the correct answer because age alone is **not** an absolute contraindication. According to WHO MEC, age >35 in a non-smoker is categorized as **MEC 2** (Advantages generally outweigh risks). Therefore, a healthy, non-smoking 38-year-old woman can safely use COCPs. ### **Analysis of Incorrect Options (Absolute Contraindications)** * **A. Smoking women >35 years:** This is **MEC 4** (Absolute contraindication). The synergistic effect of age, smoking, and estrogen significantly spikes the risk of myocardial infarction and stroke. (Note: Smoking <15 cigarettes/day is MEC 3; ≥15 cigarettes/day is MEC 4). * **C. Lactation:** Estrogen suppresses prolactin and reduces milk quantity/quality. In the first **6 weeks postpartum**, it is **MEC 4** due to the high risk of VTE and lactation interference. * **D. Breast Cancer:** Current breast cancer is **MEC 4** because it is a hormone-sensitive tumor; estrogen may promote tumor growth. ### **High-Yield Clinical Pearls for NEET-PG** * **MEC 4 (Never Use):** Undiagnosed vaginal bleeding, history of DVT/PE, Migraine with aura, Ischemic heart disease, Liver cirrhosis/adenoma, and uncontrolled Hypertension (>160/100). * **MEC 3 (Exercise Caution):** Well-controlled hypertension, Migraine without aura (in women >35), and concurrent use of anticonvulsants (enzyme inducers). * **Drug of Choice:** For lactating mothers, the Progesterone Only Pill (POP) or Centchroman (Saheli) is preferred.

Q: Which of the following drugs is NOT used as a post-coital contraceptive?

Misoprostol. **Explanation:** The correct answer is **Misoprostol**. Post-coital (emergency) contraception aims to prevent pregnancy by delaying ovulation or interfering with fertilization/implantation *before* pregnancy is established. **Why Misoprostol is the correct answer:** Misoprostol is a synthetic Prostaglandin E1 (PGE1) analogue. It causes uterine contractions and cervical ripening. It is used for **medical abortion** (terminating an established pregnancy), induction of labor, and management of PPH. It is **not** used as an emergency contraceptive because it does not prevent conception; it acts as an abortifacient. **Analysis of other options:** * **Danazol:** Historically used as an emergency contraceptive (high-dose ethisterone derivative). While rarely used now due to side effects, it is pharmacologically categorized as a post-coital agent. * **Ethinyl Estradiol:** Used in the **Yuzpe Regimen** (combined oral contraceptive pills containing Ethinyl Estradiol + Levonorgestrel). * **Levonorgestrel (LNG):** The current "gold standard" for hormonal emergency contraception (e.g., i-Pill, 1.5mg single dose). It works primarily by inhibiting the LH surge and delaying ovulation. **High-Yield Clinical Pearls for NEET-PG:** * **Most effective emergency contraceptive:** Copper-T (IUD) inserted within 5 days (120 hours). * **Most effective oral agent:** Ulipristal acetate (Selective Progesterone Receptor Modulator). * **Time limit:** Most oral emergency contraceptives are effective up to 72 hours, though Ulipristal and Copper-T are effective up to 120 hours. * **Yuzpe Regimen:** 100 mcg Ethinyl Estradiol + 0.5 mg LNG, repeated after 12 hours.

Q: A pregnant patient who is using a Copper T intrauterine device wishes to terminate the pregnancy. What is the treatment of choice?

Menstrual regulation and sterilization. **Explanation:** The correct answer is **Menstrual regulation and sterilization**. This question addresses the management of a contraceptive failure in a patient who no longer desires the pregnancy. **1. Why Option D is Correct:** When a patient becomes pregnant with a Copper T (Cu-T) in situ and expresses a desire to terminate the pregnancy, the standard management is to perform a termination of pregnancy (TOP). In early pregnancy, this is often referred to as **Menstrual Regulation (MR)**. Since the pregnancy occurred despite using an effective long-acting reversible contraceptive (LARC), it indicates a contraceptive failure. If the patient has completed her family, **sterilization** is offered as a permanent method to prevent future unintended pregnancies. **2. Why the other options are incorrect:** * **Option A & B:** These are incorrect because the patient specifically wishes to **terminate** the pregnancy. While removing the Cu-T is mandatory if a patient chooses to *continue* a pregnancy (to reduce the risk of septic abortion and preterm labor), it does not apply here. * **Option C:** Performing an abortion with the Cu-T in situ is technically difficult and increases the risk of uterine trauma or incomplete evacuation. The device must be removed during the procedure. **High-Yield Clinical Pearls for NEET-PG:** * **Ectopic Risk:** If a patient conceives with a Cu-T in situ, the absolute risk of pregnancy is low, but the *relative* risk of the pregnancy being **ectopic** is significantly increased (approx. 3–4%). Always rule out ectopic pregnancy via ultrasound. * **Management if continuing pregnancy:** If the patient wants to keep the baby, the Cu-T should be removed if the strings are visible. This reduces the risk of spontaneous abortion from 50% to about 25%. * **Mechanism of Cu-T:** It primarily acts as a spermicide by causing a sterile inflammatory response in the endometrium.

Q: Which of the following is NOT a benefit of oral contraceptive pills (OCPs)?

Protection from breast cancer. **Explanation:** The correct answer is **C (Protection from breast cancer)**. Combined Oral Contraceptive Pills (COCPs) do not provide protection against breast cancer; in fact, epidemiological data suggests a slight, transient increase in the relative risk of breast cancer among current and recent users. This risk returns to baseline approximately 10 years after discontinuation. **Why other options are incorrect:** * **Option A:** OCPs are a first-line treatment for **menstrual abnormalities** like menorrhagia and dysmenorrhea. They induce a predictable withdrawal bleed and thin the endometrial lining, reducing blood loss. * **Option B:** Their primary function is **protection against unwanted pregnancy** by inhibiting ovulation through the suppression of FSH and LH. * **Option D:** OCPs provide significant **protection from endometrial cancer** (risk reduced by ~50%) and **ovarian cancer** (risk reduced by ~40%). This protective effect persists for 15–20 years after stopping the pill. **High-Yield Clinical Pearls for NEET-PG:** * **Cancer Protection:** OCPs reduce the risk of three major cancers: **Endometrial, Ovarian, and Colorectal cancer.** * **Cancer Risk:** OCPs are associated with a slight increase in the risk of **Breast cancer** and **Cervical cancer** (especially with >5 years of use). * **Non-Contraceptive Benefits:** Reduced incidence of Benign Prostatic Hyperplasia (BPH) is NOT a benefit, but reduced **Benign Breast Disease** (like fibroadenoma) and **Functional Ovarian Cysts** are. * **Mechanism:** OCPs prevent pregnancy primarily by **preventing ovulation**, thickening cervical mucus, and making the endometrium unfavorable for implantation.

Q: Oral contraceptive pills (OCPs) are a risk factor for the development of all EXCEPT:

Ectopic pregnancy. **Explanation:** The correct answer is **C. Ectopic pregnancy**. Combined Oral Contraceptive Pills (OCPs) primarily work by suppressing ovulation through the inhibition of the hypothalamic-pituitary-ovarian axis. Since ovulation is prevented, the risk of any pregnancy—including ectopic pregnancy—is significantly **decreased** compared to the general population. While progesterone-only pills (POPs) or Levonorgestrel-IUDs may have a higher *proportion* of pregnancies being ectopic if failure occurs, OCPs are overall protective against ectopic pregnancy. **Analysis of Incorrect Options:** * **Deep Vein Thrombosis (DVT) & Pulmonary Embolism (Options A & B):** The estrogen component (Ethinyl Estradiol) in OCPs increases the hepatic synthesis of clotting factors (II, VII, IX, X) and decreases anticoagulants like Protein S and Antithrombin III. This creates a hypercoagulable state, significantly increasing the risk of venous thromboembolism (VTE). * **Breast Cancer (Option D):** Long-term use of OCPs is associated with a slight, transient increase in the relative risk of breast cancer. However, this risk typically returns to baseline 10 years after discontinuing the pill. **High-Yield Facts for NEET-PG:** * **Protective Effects of OCPs:** OCPs significantly reduce the risk of **Ovarian cancer** (by 50%), **Endometrial cancer** (by 50%), and **Colorectal cancer**. They also reduce the incidence of Benign Breast Disease and Pelvic Inflammatory Disease (PID). * **Increased Risks:** OCPs increase the risk of **Cervical cancer** (especially with >5 years of use) and **Hepatic adenomas**. * **Absolute Contraindications:** History of VTE, smokers >35 years old (>15 cigarettes/day), undiagnosed vaginal bleeding, and estrogen-dependent tumors.

Question 1

Use of oral contraceptive pills decreases which of the following?

Accepted Answer

Glucose tolerance

Answer

Binding globulins

Answer

High-density lipoprotein (HDL) cholesterol

Answer

Triglycerides

Question 2

Prostaglandins can be used for medical termination of pregnancy by all routes except?

Accepted Answer

Intravenous

Answer

Intramuscular

Answer

Extra-amniotic

Answer

Intra-amniotic

Question 3

What is the primary mechanism of action of the progestogen-only pill?

Accepted Answer

Increases cervical mucus viscosity

Answer

Inhibits ovulation

Answer

Has antispermicidal effects

Answer

None of the above

Question 4

A patient with poorly compensated cardiac disease, who has delivered 2 days ago, should be advised to:

Accepted Answer

Suggest her husband undergo vasectomy

Answer

Undergo sterilization (tubectomy) after 1 week

Answer

Undergo sterilization after 6 weeks

Answer

Take oral contraceptive pills after 6 months

Question 5

Which of the following is an absolute contraindication for combined oral contraceptive pills, EXCEPT?

Accepted Answer

Women aged greater than 35 years

Answer

Smoking women over 35 years of age

Answer

Lactation

Answer

Breast cancer

Question 6

Which of the following drugs is NOT used as a post-coital contraceptive?

Accepted Answer

Misoprostol

Answer

Danazol

Answer

Ethinyl estradiol

Answer

Levonorgestrel

Question 7

A primipara with a history of myocardial infarction (MI) presents on the 40th day postpartum requesting contraception. What is the contraceptive of choice?

Accepted Answer

Condom with spermicidal jelly

Answer

Combined oral contraceptive pill

Answer

Intrauterine contraceptive device

Answer

Laparoscopic sterilization

Question 8

A pregnant patient who is using a Copper T intrauterine device wishes to terminate the pregnancy. What is the treatment of choice?

Accepted Answer

Menstrual regulation and sterilization

Answer

Continue the pregnancy

Answer

Remove the Copper T and continue the pregnancy

Answer

Perform abortion with the Copper T in situ

Question 9

Which of the following is NOT a benefit of oral contraceptive pills (OCPs)?

Accepted Answer

Protection from breast cancer

Answer

Improve menstrual abnormalities

Answer

Protection against unwanted pregnancy

Answer

Protection from endometrial cancer

Question 10

Oral contraceptive pills (OCPs) are a risk factor for the development of all EXCEPT:

Accepted Answer

Ectopic pregnancy

Answer

Deep vein thrombosis (DVT)

Answer

Pulmonary embolism

Answer

Breast cancer

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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