Contraception and Family Planning Practice Questions

Q: The contraceptive shown below acts by:

Preventing implantation. ***Preventing implantation*** - The image shows **Saheli (Centchroman/Ormeloxifene)**, a non-steroidal oral contraceptive that works primarily as a **Selective Estrogen Receptor Modulator (SERM)**. - Its **primary mechanism** is to render the **endometrium unsuitable for implantation** by causing endometrial changes that prevent the blastocyst from attaching to the uterine wall. - This is the main contraceptive effect that makes Saheli effective at preventing pregnancy. *Preventing fertilization* - While Centchroman may have some **secondary effects** on cervical mucus and tubal motility that could affect sperm transport, this is not its primary mechanism of action. - Fertilization can still occur with Saheli use; the contraceptive effect primarily occurs at the implantation stage. - Unlike barrier methods or spermicides, Saheli does not primarily work by preventing sperm-egg union. *Preventing ovulation* - Saheli is specifically known for being a **non-hormonal contraceptive that does NOT suppress ovulation**. - This distinguishes it from combined oral contraceptive pills (COCs) that work by preventing ovulation. - Ovulation occurs normally in women taking Saheli, which is one of its advantages as it maintains more natural hormonal cycles. *Preventing zygote cell multiplication* - This would imply a direct toxic effect on the dividing embryo, which is not the mechanism of Centchroman. - The drug works by altering the endometrial receptivity rather than directly affecting the zygote's cellular division process. - Its action is on the **uterine environment** rather than on embryonic cell multiplication.

Q: A patient has received the following birth control method. It is called:

Contraceptive implant. ***Contraceptive implant*** - The image shows a **small, flexible rod inserted under the skin of the upper arm**, which is characteristic of a contraceptive implant. - This device continuously releases a progestin hormone to **prevent pregnancy** for up to three years or more.

Q: The contraception method shown below is made of:

Molybdenum-cobalt steel alloy. ***Molybdenum-cobalt steel alloy*** - The image displays the Essure device, which used a **molybdenum-cobalt steel alloy** for its inner core, providing structural integrity. - The outer fibers of the device were made of **polyethylene terephthalate**, inducing a localized inflammatory response to cause tubal occlusion, but the question specifically asks about the core material. *Quinacrine pellet* - Quinacrine is a drug used in **nonsurgical sterilization** but is delivered as a pellet, not as a coiled device as depicted. - This method involves placing quinacrine pellets directly into the uterus to induce scarring and block the fallopian tubes, which is a different mechanism and appearance. *Quinacrine pellet with LNG* - While quinacrine is mentioned above for non-surgical sterilization, a combination with **levonorgestrel (LNG)** in a single pellet form for this specific purpose is not a standard or widely recognized contraceptive method that matches the device shown. - LNG is a progestin commonly found in hormonal IUDs and implants, but not typically associated with the quinacrine pellet method for tubal occlusion. *Nickel-titanium steel alloy* - While **nickel-titanium alloys** (like nitinol) are used in various medical devices due to their shape memory and superelastic properties, the **Essure device** specifically used a molybdenum-cobalt steel alloy for its core. - Other medical implants might use nickel-titanium, but it is not the primary material for the device shown in the image.

Q: Identify the laparoscopic tubal sterilization shown below.

Filshie clip. ***Filshie clip*** - The image clearly displays a **clip** being applied to the fallopian tube, which is characteristic of the **Filshie clip** method of tubal sterilization. - Filshie clips are widely used due to their **high efficacy** and ability to be applied with minimal tissue damage. *Falope ring* - A Falope ring, also known as a Yoon ring, involves placing a **silastic band** to create a loop of the fallopian tube. The image does not show a looped tube with a ring. - This method typically causes a segment of the tube to become **necrotic** and atrophy, severing continuity. *Hulka clip* - The Hulka clip is a spring-loaded clip that is typically **smaller and more rounded** at the ends compared to the clip shown in the image. - It also involves occlusion of the fallopian tube but has a distinct appearance from the Filshie clip. *Pomeroy's technique* - Pomeroy's technique is a method of tubal ligation where a loop of the fallopian tube is **ligated and then excised**, which is a surgical procedure rather than the application of a device. - This method results in a **severed and separated** fallopian tube, unlike the clip shown in the image.

Q: What is the method of contraception shown below?

Bipolar electrocoagulation. ***Bipolar electrocoagulation*** - The image shows a **bipolar forceps** grasping and coagulating a fallopian tube. The characteristic **blackened, constricted appearance** of the tube segment is indicative of tissue coagulation. - This method uses **high-frequency electrical current** passed between two electrodes (the jaws of the forceps) to cause **thermal damage** and occlude the fallopian tube. *Pomeroy's technique* - This technique involves **ligating a loop** of the fallopian tube with absorbable suture and then **excising the looped segment**. - The image does not show a ligated and excised segment, nor the presence of sutures. *Parkland technique* - The Parkland technique involves **ligating two segments** of the fallopian tube at a distance from each other and then **resecting the intervening segment**. - This method results in a gap between the ligated ends, which is not depicted in the image. *Falope ring* - The Falope ring method involves applying a **small silicone band** or ring to a **knuckled loop** of the fallopian tube, causing necrosis and occlusion. - The image clearly displays grasping forceps and electrocoagulation, **not the application of a ring**.

Q: A 25 -year-old lady is undergoing the following procedure for an unplanned conception. The maximum pressure generated during the procedure is: (DNB Pattern 2018)

400-600 mm Hg. ***400-600 mm Hg*** - This range of negative pressure is typically generated during **manual vacuum aspiration (MVA)**, which is depicted in the image. MVA is a common method for early pregnancy termination. - The MVA syringe creates a vacuum for aspiration of uterine contents, and this pressure range is effective for safe and complete evacuation. *100-200 mm Hg* - This pressure range is generally **too low** for effective and complete uterine aspiration in an MVA procedure. - Insufficient vacuum may lead to incomplete abortion, requiring further intervention. *200-400 mm Hg* - While higher than 100-200 mm Hg, this range might still be **suboptimal** for ensuring complete removal of uterine contents during MVA. - The generally accepted effective pressure is higher to maximize success rates and minimize complications. *600-800 mm Hg* - This pressure range is typically **higher than necessary** for MVA and could potentially increase the risk of uterine injury or perforation. - Excessive vacuum pressure is not associated with improved outcomes and may be more dangerous.

Q: The following instrument is used for performing aspiration of uterine cavity within days of a missed period in a woman with previously normal cycle: (DNB Pattern 2018)

14 days. ***14 days*** - Manual vacuum aspiration (MVA) is an effective and safe method for **early uterine cavity aspiration** following a missed period. - It is typically performed when the gestational age is very early, often within **1-2 weeks** (around 14 days) of a missed period, ensuring the uterine contents are minimal. *28 days* - While MVA can be performed at 28 days (4 weeks) after a missed period, it represents a slightly later stage where the pregnancy is more established. - The procedure is safest and most effective in the earliest stages of pregnancy; 14 days post-missed period represents an **earlier and often preferred window**. *42 days* - At 42 days (6 weeks) after a missed period, the gestational sac and fetal pole are more developed. - While still possible, MVA at this stage may involve a **larger volume of aspirated tissue** and potentially a slightly higher risk compared to very early aspiration. *72 days* - 72 days (around 10 weeks) after a missed period indicates a **more advanced pregnancy**. - At this stage, other methods like **dilation and curettage (D&C)** might be preferred over MVA due to the increased size of the gestational contents.

Q: The sterilization method shown here is known as: (DNB Pattern 2018)

Tubal occlusion by hysteroscopic sterilization. ***Tubal occlusion by hysteroscopic sterilization*** - The image depicts a device inserted into the **fallopian tube** via a hysteroscopic approach to cause permanent **occlusion**. - This method involves placing small coils that induce a benign inflammatory reaction, leading to **fibrosis** and blockage of the tubes, preventing spermatozoa from reaching the ovum. *Tubal ligation* - This method involves **surgically cutting, tying, blocking, or sealing** the fallopian tubes, typically performed via laparoscopy or minilaparotomy. - The image does not show a surgical incision or a ligated/cut segment of the fallopian tube. *Vasectomy* - **Vasectomy** is a male sterilization procedure involving the cutting or sealing of the **vas deferens** to prevent sperm from entering the seminal fluid. - The image clearly shows a portion of the female reproductive system, specifically the uterus and fallopian tube. *Intrauterine device (IUD) insertion* - An **IUD** is a small, T-shaped device inserted into the **uterus** to prevent pregnancy, either by releasing copper or hormones. - The device in the image is placed inside the fallopian tube, not within the main uterine cavity, and its morphology does not resemble a typical IUD.

Q: The most popular technique of tubal ligation is :

Pomeroy Technique. ***Pomeroy Technique*** - The **Pomeroy technique** is the most widely performed method of tubal ligation due to its simplicity, ease of execution, and high efficacy. - It involves lifting a loop of the fallopian tube, ligating its base, and then excising the looped segment, leading to clear separation of the tubal ends. *Madlener Operation* - The Madlener operation involves crushing and ligating a loop of the **fallopian tube** without excising any segment. - This method has a higher failure rate compared to the Pomeroy technique due to the possibility of recanalization. *Uchida method* - The **Uchida method** is a more complex technique that involves injecting a solution into the subserosal layer of the fallopian tube to separate the mucosa and muscularis, followed by excision of a segment and burying the proximal end. - It is known for its high effectiveness but is less commonly performed due to its technical complexity. *Cornual resection* - **Cornual resection** involves removing a portion of the fallopian tube where it enters the uterine wall (the cornua). - This procedure is technically more challenging and is associated with a higher risk of complications, including hemorrhage, making it less popular as a primary method for sterilization.

Q: Which of the following statements regarding female sterilization is correct? 1. It can be done 24 - 48 hours following delivery. 2. Ideal time for interval ligation is luteal phase preceding menstruation. 3. It can be combined with medical termination of pregnancy. 4. It is a preventive measure against serous ovarian cancer. Select the correct answer using the code given below:

1, 3 and 4. ***1, 3 and 4*** - Female sterilization can indeed be performed **24-48 hours postpartum** because the fundus is still high, making the fallopian tubes easily accessible. - Female sterilization can be safely **combined with medical termination of pregnancy**, offering a convenient option for women who desire permanent contraception after an abortion. - **Tubal ligation has been shown to reduce the risk of ovarian cancer** by approximately 30%, likely by preventing carcinogens from ascending through the tubes or by altering ovarian blood supply and hormone levels. - **Opportunistic salpingectomy** (removal of fallopian tubes during sterilization) provides even greater protection against high-grade serous ovarian cancer, as many such cancers originate in the fimbrial end of the fallopian tube. *1, 2 and 3* - While statements 1 and 3 are correct, **statement 2 is incorrect**. The ideal time for interval tubal ligation is the **follicular phase (early proliferative phase)**, typically within the **first 7 days of the menstrual cycle**, NOT the luteal phase preceding menstruation. - Performing sterilization in the early follicular phase minimizes the risk of an **undiagnosed early pregnancy**, as this is shortly after menstruation when pregnancy is least likely. *1, 2 and 4* - While statements 1 and 4 are correct, **statement 2 is incorrect**. The luteal phase is NOT the ideal time for interval sterilization because this is when pregnancy risk is highest. - The **follicular phase** is preferred to ensure the woman is not pregnant at the time of the procedure. *2, 3 and 4* - While statements 3 and 4 are correct, **statement 2 is incorrect**. Standard practice recommends interval tubal ligation during the **follicular phase (days 1-7 of cycle)**, not the luteal phase. - The luteal phase carries a risk of operating on an early, undiagnosed pregnancy.

Question 1

The contraceptive shown below acts by:

Accepted Answer

Preventing implantation

Answer

Preventing ovulation

Answer

Preventing fertilization

Answer

Preventing zygote cell multiplication

Question 2

A patient has received the following birth control method. It is called:

Accepted Answer

Contraceptive implant

Answer

Intrauterine device (IUD)

Answer

Contraceptive patch

Answer

Vaginal ring

Question 3

The contraception method shown below is made of:

Accepted Answer

Molybdenum-cobalt steel alloy

Answer

Quinacrine pellet

Answer

Quinacrine pellet with LNG

Answer

Nickel-titanium steel alloy

Question 4

Identify the laparoscopic tubal sterilization shown below.

Accepted Answer

Filshie clip

Answer

Falope ring

Answer

Hulka clip

Answer

Pomeroy's technique

Question 5

What is the method of contraception shown below?

Accepted Answer

Bipolar electrocoagulation

Answer

Pomeroy's technique

Answer

Parkland technique

Answer

Falope ring

Question 6

A 25 -year-old lady is undergoing the following procedure for an unplanned conception. The maximum pressure generated during the procedure is: (DNB Pattern 2018)

Accepted Answer

400-600 mm Hg

Answer

100-200 mm Hg

Answer

200-400 mm Hg

Answer

600-800 mm Hg

Question 7

The following instrument is used for performing aspiration of uterine cavity within days of a missed period in a woman with previously normal cycle: (DNB Pattern 2018)

Accepted Answer

14 days

Answer

28 days

Answer

42 days

Answer

72 days

Question 8

The sterilization method shown here is known as: (DNB Pattern 2018)

Accepted Answer

Tubal occlusion by hysteroscopic sterilization

Answer

Tubal ligation

Answer

Vasectomy

Answer

Intrauterine device (IUD) insertion

Question 9

The most popular technique of tubal ligation is :

Accepted Answer

Pomeroy Technique

Answer

Madlener Operation

Answer

Uchida method

Answer

Cornual resection

Question 10

Which of the following statements regarding female sterilization is correct?

1. It can be done 24 - 48 hours following delivery.
2. Ideal time for interval ligation is luteal phase preceding menstruation.
3. It can be combined with medical termination of pregnancy.
4. It is a preventive measure against serous ovarian cancer.

Select the correct answer using the code given below:

Accepted Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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