Contraception and Family Planning Practice Questions

Q: MVA syringe is used for?

First trimester MTP. ***First trimester MTP*** - A **manual vacuum aspiration (MVA) syringe** is specifically designed for performing vacuum aspiration procedures during the first trimester of pregnancy. - It creates a **negative pressure** to gently remove uterine contents, commonly used for **medical termination of pregnancy (MTP)** or management of miscarriage. *2nd trimester MTP* - For **second-trimester MTP**, procedures like **dilatation and evacuation (D&E)** or **induction with medication** are typically preferred over manual vacuum aspiration due to larger fetal size and increased uterine wall fragility. - The **MVA syringe** may not provide sufficient suction or capacity for safe and complete evacuation in the second trimester. *Vacuum delivery* - **Vacuum delivery** is a procedure used during childbirth to assist in vaginal delivery by applying suction to the fetal head. - This procedure uses a **vacuum extractor cup** and a specialized pump, not an MVA syringe. *All of the options* - The MVA syringe is only appropriate for **first-trimester MTP** and early miscarriage management, not for late-trimester procedures or vacuum-assisted delivery. - Therefore, choosing "All of the options" would be incorrect.

Q: Which of the following is NOT used as an emergency contraceptive?

Danazol. ***Danazol*** - **Danazol** is an **androgen derivative** primarily used to treat **endometriosis** and **fibrocystic breast disease**, not for emergency contraception. - Its mechanism involves suppressing **ovarian function** and creating an anovulatory state, which is not suitable for immediate post-coital intervention. *RU 486* - **RU 486 (Mifepristone)** is a **progesterone receptor modulator** that can be used as an emergency contraceptive, especially at higher doses. - It acts by **blocking progesterone receptors**, preventing implantation or inducing abortion if pregnancy has already occurred. *Copper T* - The **Copper T (intrauterine device - IUD)** is a highly effective method of emergency contraception if inserted within 5 days of unprotected intercourse. - It works by causing a **spermicidal effect** and preventing fertilization or implantation by inducing an inflammatory reaction in the uterus. *OCpill* - **OCPills (oral contraceptive pills)**, usually a combination of estrogen and progestin, can be used as emergency contraception when taken in higher doses. - This method, known as the **Yuzpe regimen**, involves taking two doses of combined oral contraceptives within 72 hours of unprotected intercourse to inhibit ovulation or fertilization.

Q: The depicted instrument (Fallopian ring applicator) is used in which procedure?

Tubectomy (Female Sterilisation). ***Tubectomy (Female Sterilisation)*** - The **Fallopian ring applicator** is a specialized instrument designed for applying **Silastic bands** (Fallopian rings) to the fallopian tubes. - This procedure, known as **laparoscopic tubal ligation** or **female sterilization**, involves occluding the fallopian tubes to prevent the union of sperm and egg. *Punch Biopsy* - A **punch biopsy** uses a circular blade to remove a core of tissue, primarily for **skin or mucosal lesions**. - The instruments involved are a **punch biopsy tool**, forceps, and scissors, which are distinctly different from an applicator. *Bone marrow biopsy set* - A **bone marrow biopsy set** typically includes a specialized needle (e.g., Jamshidi needle) for aspirations and biopsies from the **iliac crest**. - These instruments are designed for obtaining samples from bone and marrow, not for occluding tubular structures. *Trocar and cannula (used for general laparoscopy)* - A **trocar and cannula** system is used to create an access port into a body cavity for **laparoscopic surgery**. - While it facilitates the entry for instruments like the Fallopian ring applicator, it is a general entry tool and not the specific instrument depicted for the tubectomy itself.

Q: Which contraceptive method provides protection against ovarian cancer?

Oral contraceptive pills. ***Oral contraceptive pills*** - **Combined oral contraceptives** significantly decrease the risk of **ovarian cancer** due to the suppression of ovulation, which reduces the number of ovulatory cycles and subsequent epithelial microtrauma. - The protective effect increases with the **duration of use** and persists for many years after discontinuation. *Depo-Provera* - Depo-Provera (medroxyprogesterone acetate) is a **progestin-only injectable contraceptive** that primarily prevents ovulation. - While it offers highly effective contraception, its protective effect against ovarian cancer is **less established and not as robust** as that of combined oral contraceptives. *Intrauterine device* - **Intrauterine devices (IUDs)**, whether hormonal (levonorgestrel-releasing) or copper, primarily prevent pregnancy by altering the uterine environment or affecting sperm motility. - They do **not provide significant protection** against ovarian cancer, although hormonal IUDs have shown some possible association with reduced endometrial cancer risk. *Barrier methods* - **Barrier methods** like condoms or diaphragms physically block sperm from reaching the egg, preventing pregnancy. - They offer **no direct biological mechanism** to reduce the risk of ovarian cancer.

Q: A 25-year-old woman at 7 weeks of gestation requests a termination of pregnancy. Which combination of medications is used for a medical abortion?

Mifepristone and misoprostol. ***Mifepristone and misoprostol*** - This is the **WHO-recommended standard regimen** for medical abortion up to 10 weeks of gestation. - **Mifepristone (200 mg)** is an **anti-progestin** that blocks progesterone receptors, causing decidual breakdown, cervical softening, and increased uterine sensitivity to prostaglandins. - **Misoprostol (800 mcg)** is a **prostaglandin E1 analog** administered 24-48 hours later, causing strong uterine contractions and cervical ripening to expel the pregnancy. - This combination has **95-98% efficacy** in early pregnancy termination. *Methotrexate and misoprostol* - Methotrexate is an **antimetabolite** that can be used for medical abortion, but it has **slower onset** (5-7 days) and **more side effects** compared to mifepristone. - This regimen is now rarely used for elective abortion due to lower efficacy and longer time to completion. - More commonly reserved for ectopic pregnancy management. *Methotrexate and mifepristone* - These two agents are **not combined** for medical abortion. - Both are abortifacient agents but work through different mechanisms and are not used together. - Standard protocols use an anti-progestin (mifepristone) followed by a prostaglandin (misoprostol). *Mifepristone and oxytocin* - **Oxytocin** is not part of the medical abortion regimen in the first trimester. - Oxytocin is used for **labor induction in second/third trimester** and **postpartum hemorrhage prevention**. - Prostaglandins (misoprostol) are preferred over oxytocin for first-trimester medical abortion due to additional cervical ripening effects.

Q: In women with PCOS and high cardiovascular risk, which contraceptive method is generally considered safer?

Progestin-only pills. ***Progestin-only pills*** - **Progestin-only pills (POPs)** are generally safer for women with PCOS and high cardiovascular risk because they avoid the estrogenic component, which can increase the risk of **thromboembolic events** and worsen **dyslipidemia** or **hypertension**. - They also bypass the potential for estrogen-related exacerbation of **insulin resistance**, a common comorbidity in PCOS. *Combined OCPs* - **Combined oral contraceptive pills (COCs)** contain both estrogen and progestin, and the estrogen component can increase the risk of **venous thromboembolism (VTE)**, stroke, and myocardial infarction, especially in women with pre-existing cardiovascular risk factors. - Estrogen can also negatively impact **lipid profiles** and **blood pressure**, making them less suitable for high-risk individuals. *Both are equally safe* - This statement is incorrect as the **estrogen component** in combined oral contraceptive pills (COCs) introduces additional cardiovascular risks not present with progestin-only methods. - The differing hormonal compositions directly lead to varying safety profiles, particularly concerning **thromboembolic events** and **lipid metabolism**. *Neither is safe* - This statement is incorrect as **progestin-only contraceptives** are considered a safe and effective option for managing PCOS symptoms and providing contraception, even in the presence of elevated cardiovascular risk. - Their safety profile is better than combined hormonal methods for this specific patient population due to the absence of **estrogen-related risks**.

Q: Which of the following is not considered an absolute contraindication for the use of an Intra Uterine Contraceptive Device (IUD)?

Uterine malformation. ***Uterine malformation*** - While a uterine malformation can make IUD insertion more difficult or reduce its effectiveness, it is often considered a **relative contraindication**, depending on the specific anomaly and the patient's desire for contraception. - In certain cases, an IUD might still be a viable option, but it requires careful consideration and specialized insertion techniques. *Pregnancy* - The presence of an existing pregnancy is an **absolute contraindication** for IUD insertion, as it can lead to complications such as miscarriage or ectopic pregnancy. - An IUD is a contraceptive device, and inserting it when a woman is already pregnant directly contradicts its purpose and poses significant risks. *Undiagnosed vaginal bleeding* - This is an **absolute contraindication** because it could be a symptom of a serious underlying condition, such as cervical cancer, endometrial cancer, or ectopic pregnancy. - Inserting an IUD before diagnosing the cause of the bleeding could delay treatment of a potentially life-threatening condition and exacerbate the bleeding. *Pelvic inflammatory disease* - Current or recent (within the last 3 months) **pelvic inflammatory disease (PID)** is an **absolute contraindication** due to the increased risk of worsening infection. - IUD insertion can introduce bacteria from the vagina into the uterus, potentially exacerbating an existing infection or causing a new one.

Q: Identify the contraceptive device shown in the image.

Female condom. ***Female condom*** - This contraceptive device is designed for use by women and consists of a **sheath inserted into the vagina**, typically made of nitrile or polyurethane, which lines the vagina and part of the vulva. - It features two rings: an **inner ring** that sits high in the vagina near the cervix, and an **outer ring** that remains outside, covering the labia, as depicted in the image. - Provides protection against both pregnancy and sexually transmitted infections. *Male condom* - A male condom is a **sheath placed over an erect penis**, designed to prevent sperm from entering the vagina. - Its appearance and method of use are distinctly different, lacking the two-ring structure seen in the image. *Diaphragm* - A diaphragm is a **dome-shaped silicone cup** that is inserted into the vagina to cover the cervix. - It requires fitting by a healthcare provider and is used with spermicide. - Unlike the female condom, it does not have an external ring and does not provide STI protection. *Cervical cap* - A cervical cap is a **small, thimble-shaped silicone device** that fits tightly over the cervix. - It is smaller than a diaphragm and also requires professional fitting and spermicide use. - It does not have the characteristic dual-ring sheath structure visible in the image.

Q: What is the use of the instrument shown in the image?

Laparoscopic sterilization. ***Laparoscopic sterilization*** - The image likely depicts a **laparoscope** or a device used for **tubal ligation**, which is a common method of **sterilization**. - **Laparoscopic sterilization** involves blocking or sealing the fallopian tubes to prevent the passage of eggs. *Induction of abortion* - Induction of abortion typically uses **medical methods (medications)** or **surgical procedures** like D&C, which do not involve the device shown. - The instrument shown is designed for **access and intervention** within the abdominal cavity, not for uterine evacuation. *Creating pneumoperitoneum in laparoscopic surgery* - **Pneumoperitoneum** is created using a **Veress needle** and a **CO2 insufflator** to distend the abdominal cavity, providing space for surgery. - The instrument shown is not a Veress needle or an insufflator; it appears to be an instrument used *after* pneumoperitoneum is established. *Surgical removal of an ectopic pregnancy* - While an ectopic pregnancy can be removed laparoscopically, the instrument shown is a general laparoscopic tool. - The primary purpose of this specific instrument (likely a **grasping forceps** or **dissector**) is not solely for ectopic pregnancy removal, but for various laparoscopic manipulations including sterilization.

Question 1

MVA syringe is used for?

Accepted Answer

First trimester MTP

Answer

2nd trimester MTP

Answer

Vacuum delivery

Answer

All of the options

Question 2

Which of the following is NOT used as an emergency contraceptive?

Accepted Answer

Danazol

Answer

RU 486

Answer

Copper T

Answer

OCpill

Question 3

Which of the following cannot be used as Post-coital contraceptive?

Accepted Answer

A drug primarily used for endometriosis and fibrocystic breast disease (e.g., Danazol)

Answer

A device that prevents fertilization and implantation (e.g., CuT 200)

Answer

A hormonal method that disrupts ovulation (e.g., high-dose estrogens)

Answer

A progesterone receptor blocker used within 72 hours (e.g., RU 486)

Question 4

The depicted instrument (Fallopian ring applicator) is used in which procedure?

Accepted Answer

Tubectomy (Female Sterilisation)

Answer

Punch Biopsy

Answer

Bone marrow biopsy set

Answer

Trocar and cannula (used for general laparoscopy)

Question 5

Which contraceptive method provides protection against ovarian cancer?

Accepted Answer

Oral contraceptive pills

Answer

Depo-Provera

Answer

Intrauterine device

Answer

Barrier methods

Question 6

A 25-year-old woman at 7 weeks of gestation requests a termination of pregnancy. Which combination of medications is used for a medical abortion?

Accepted Answer

Mifepristone and misoprostol

Answer

Methotrexate and misoprostol

Answer

Methotrexate and mifepristone

Answer

Mifepristone and oxytocin

Question 7

In women with PCOS and high cardiovascular risk, which contraceptive method is generally considered safer?

Accepted Answer

Progestin-only pills

Answer

Combined OCPs

Answer

Both are equally safe

Answer

Neither is safe

Question 8

Which of the following is not considered an absolute contraindication for the use of an Intra Uterine Contraceptive Device (IUD)?

Accepted Answer

Uterine malformation

Answer

Undiagnosed vaginal bleeding

Answer

Pregnancy

Answer

Pelvic inflammatory disease

Question 9

Identify the contraceptive device shown in the image.

Accepted Answer

Female condom

Answer

Male condom

Answer

Diaphragm

Answer

Cervical cap

Question 10

What is the use of the instrument shown in the image?

Accepted Answer

Laparoscopic sterilization

Answer

Induction of abortion

Answer

Creating pneumoperitoneum in laparoscopic surgery

Answer

Surgical removal of an ectopic pregnancy

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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