Contraception and Family Planning Practice Questions

Q: Which of the following female sterilization techniques involves excision of a tubal segment from the cornual end?

Kroener method. ***Kroener method*** - The Kroener method involves **excision of the fimbrial (distal) end of the fallopian tube** (fimbriectomy), making it a reliable sterilization technique. - This technique results in immediate and effective sterilization by removing the portion of the tube that captures the ovum from the ovary. - **Note**: The question asks about the cornual end, but Kroener method specifically removes the fimbrial end, not the cornual end. *Irving method* - The Irving method involves **ligation and transection of the fallopian tube at the isthmic portion**, with the proximal cut end being buried within the posterior uterine wall or broad ligament. - This technique is designed to prevent **recanalization** by separating the ends of the tube and burying the cornual/proximal segment. - This method works closer to the cornual end than Kroener method. *Uchida method* - The Uchida method involves **injecting a sclerosing solution** into the tubal lumen after serosal incision and removing a portion of the tube, leaving the muscularis and mucosa intact within the broad ligament. - This method aims to prevent subsequent **fistula formation** by burying the proximal tubal stump. *Madlener technique* - The Madlener technique involves **crushing a loop of the fallopian tube** (usually at the mid-portion) and ligating it with a non-absorbable suture, without excising any part of the tube. - This method has a higher failure rate due to the potential for **recanalization** and involves less tissue destruction compared to excisional methods.

Q: What is the LNG content of Mirena?

52 mg. ***52 mg*** - Mirena is a **levonorgestrel-releasing intrauterine system (IUS)** that contains 52 mg of **levonorgestrel (LNG)**. - This specific dosage ensures effective contraception for up to 8 years by continuously releasing a small amount of LNG. *20 mg* - This dosage refers to **Kyleena**, another levonorgestrel IUS that contains 19.5 mg (approximately 20 mg) of LNG. - Kyleena is effective for up to 5 years and is a smaller-sized IUS option. *13.5 mg* - This dosage is associated with the IUS **Skyla**, which contains 13.5 mg of levonorgestrel for a shorter duration of use (up to 3 years). - Different IUS devices are designed with varying **LNG content** to suit different clinical needs and durations. *39 mg* - This is not a standard **LNG content** for currently available IUS devices. - The main levonorgestrel IUS options contain 52 mg (Mirena, Liletta), 19.5 mg (Kyleena), or 13.5 mg (Skyla).

Q: What is the minimum number of Medical Termination of Pregnancies (MTPs) that a Registered Medical Practitioner (RMP) must assist in to perform MTP in the first trimester?

25. ***25*** - Under the **Medical Termination of Pregnancy Rules, 2003**, a Registered Medical Practitioner (RMP) must assist in at least **25 MTPs performed by a registered medical practitioner** who has experience in performing MTPs. - This requirement is part of the criteria for an RMP to be approved to perform MTPs independently, ensuring they gain sufficient practical experience. *5* - This number is **insufficient** according to the MTP Rules, 2003, for an RMP to be considered adequately trained to perform MTPs independently in the first trimester. - The stipulated experience aims for a higher volume of supervised procedures to ensure competence. *15* - This number also falls short of the **minimum experience criteria** set by the MTP Rules, 2003, for an RMP to perform MTPs independently. - The regulations emphasize a more extensive practical exposure to ensure proficiency and safety in performing the procedure. *50* - While assisting in 50 MTPs would certainly provide adequate experience, it is **not the minimum requirement** specified by the MTP Rules, 2003. - The law specifies a lower but still substantial number as the threshold for certification.

Q: In which of the following conditions is IUCD insertion contraindicated?

Acute PID. ***Acute PID*** - **Acute Pelvic Inflammatory Disease (PID)** is a strong contraindication for IUCD insertion as it can worsen the infection and lead to severe complications. - Inserting an IUCD in the presence of acute infection can facilitate the spread of bacteria into the sterile upper genital tract. *Previous LSCS (Lower Segment Cesarean Section)* - A previous **Lower Segment Cesarean Section (LSCS)** is generally **not an absolute contraindication** for IUCD insertion. - The uterus has healed, and the risk of perforation or expulsion is not significantly higher than in women without a prior LSCS. *Lactating mother (breastfeeding)* - Being a **lactating mother** is **not a contraindication** for IUCD insertion; in fact, IUCDs are often a preferred contraceptive method for breastfeeding women. - Hormonal IUCDs release only small amounts of progestin, which has minimal impact on milk supply, and copper IUCDs are non-hormonal. *Chronic pelvic pain (without infection)* - While chronic pelvic pain may require investigation, if **no active infection** or other contraindication is identified, it is generally **not an absolute contraindication** to IUCD insertion. - However, the patient should be counselled that an IUCD might potentially exacerbate or change the pattern of her chronic pain, and alternative options should be discussed.

Q: Which contraceptive method has the least failure rate?

MIRENA. ***MIRENA*** - MIRENA, a **levonorgestrel-releasing intrauterine system (LNG-IUS)**, has the **lowest failure rate among all contraceptive methods**, with a Pearl Index of **0.1-0.2%**. - Its superior efficacy is due to both its **hormonal action** (thickening cervical mucus, thinning endometrial lining, suppressing ovulation in some cycles) and its **long-acting reversible contraceptive (LARC)** nature, which **eliminates user error**. - Unlike DMPA, MIRENA maintains consistently low failure rates in both perfect and typical use scenarios. *CuT* - The **copper-T intrauterine device (IUD)** is highly effective with a failure rate of about **0.6-0.8%**, but slightly higher than MIRENA. - Its mechanism is primarily non-hormonal, causing a **sterile inflammatory reaction** in the uterus that is spermicidal and prevents implantation. *DMPA* - **Depot Medroxyprogesterone Acetate (DMPA)**, an injectable contraceptive, has a perfect use failure rate of about **0.2-0.3%**, comparable to MIRENA in ideal conditions. - However, its **typical use failure rate is significantly higher (around 6%)** due to adherence challenges with scheduled 3-monthly injections, making it less effective in real-world practice. - It works by **inhibiting ovulation**, thickening cervical mucus, and thinning the endometrial lining. *O.C. PILLS* - **Oral contraceptive pills** have a perfect use failure rate of about **0.3%**, but their typical use failure rate is much higher (around 7-9%) due to **missed doses** or inconsistent use. - They primarily act by **suppressing ovulation** through a combination of estrogen and progestin.

Q: Which of the following is not an absolute contraindication for OC pills?

Old STD. ***Old STD*** - A *past* history of a sexually transmitted disease (STD) that has been successfully treated and is no longer active is generally **not an absolute contraindication** for initiating oral contraceptive pills (OCPs). - The primary concern with STDs and OCPs relates to potential *co-infection with HIV* or active infections that could cause complications, but an old, resolved STD on its own does not prohibit OCP use. *Suspicious vaginal bleeding* - **Undiagnosed abnormal vaginal bleeding** is an absolute contraindication (WHO Category 4) for starting OCPs because it could be a symptom of a serious underlying condition, such as **endometrial hyperplasia or cancer**, which needs to be excluded before hormonal therapy is initiated. - Introducing OCPs without investigation could **mask the underlying pathology** and delay diagnosis and appropriate treatment. *Cervical cancer* - **Known or suspected cervical cancer** is an absolute contraindication (WHO Category 4) for OCP use. - OCPs are avoided in these cases to prevent potential progression and to allow for proper evaluation and treatment of the malignancy. *Active viral hepatitis* - **Acute or flare of viral hepatitis** is an absolute contraindication (WHO Category 4) for OCP use. - The liver metabolizes steroid hormones, and introducing OCPs during active hepatitis could worsen liver function and delay recovery. - OCPs can be considered once liver function normalizes and acute phase resolves.

Q: Copper IUCD as a contraceptive measure can be used maximum till what time after unprotected intercourse?

5 days. ***5 days*** - A **copper IUCD** (intrauterine contraceptive device) can be effectively inserted for **emergency contraception** up to **5 days** after unprotected sexual intercourse. - This method is highly effective because it prevents **implantation** by creating a spermicidal and hostile uterine environment. *2 days* - While some emergency contraceptive pills might be effective within a shorter window, **2 days** is too early to be the maximum time for **copper IUCD** insertion according to guidelines for emergency contraception. - The efficacy window for the copper IUCD extends beyond this period, offering a longer post-coital option. *3 days* - **3 days** is a common window for some emergency contraceptive pills like those containing levonorgestrel, but the **copper IUCD** offers a longer timeframe for effective use. - The mechanism of action of the copper IUCD is different, allowing it to be effective for a longer duration after intercourse. *4 days* - Although closer to the correct answer, **4 days** is still not the maximum recommended time for **copper IUCD** insertion for emergency contraception. - Clinical guidelines and evidence support its use for an additional day beyond this point for optimal effectiveness.

Q: What is the most common infection associated with long-term IUCD use?

Actinomycosis. ***Actinomycosis*** - *Actinomyces* species are **opportunistic anaerobic bacteria** that are part of the normal flora of the female genital tract. - Long-term presence of an **intrauterine contraceptive device (IUCD)** can create a favorable environment for their overgrowth, leading to pelvic **actinomycosis**. *Mucormycosis* - This is a rare but severe invasive fungal infection typically seen in **immunocompromised individuals**, especially those with uncontrolled diabetes or neutropenia. - It is not specifically associated with IUCD use. *Aspergillosis* - This is another fungal infection, commonly affecting the respiratory tract, and also generally seen in **immunocompromised patients**. - There is no direct link between IUCD use and an increased risk of aspergillosis. *Candidiasis* - While *Candida* infections are common in the female genital tract (vaginal yeast infections), they are not specifically associated with IUCD use as a long-term complication in the way **Actinomycosis** is. - IUCDs do not significantly increase the risk of recurrent or severe candidiasis.

Q: In the calendar method of contraception, assuming a shortest menstrual cycle of 28 days, what is the first day of the fertile period?

10th day of the shortest menstrual cycle. ***10th day of the shortest menstrual cycle*** - The **calendar method** (rhythm method) estimates the fertile window by subtracting 18 days from the shortest cycle length to find the first fertile day. - For a 28-day shortest cycle, 28 - 18 = **10th day**. *18th day of the shortest menstrual cycle* - Subtracting 11 days from the shortest cycle length determines the **last fertile day**, not the first. - This option incorrectly identifies the calculation for the beginning of the fertile window. *10th day of the longest menstrual cycle* - The first day of the fertile period is calculated based on the **shortest menstrual cycle**, not the longest. - Using the longest cycle length for this calculation would incorrectly postpone the estimated start of the fertile window. *18th day of the longest menstrual cycle* - This calculation (subtracting 11 days from the longest cycle) is used to determine the **last fertile day**. For example, for a 30-day longest cycle, 30 - 11 = 19, making the 19th day the last fertile day. - This option refers to the **longest cycle** and approximates the end of the fertile window, neither of which is relevant for the first fertile day of the shortest cycle.

Question 1

Which of the following female sterilization techniques involves excision of a tubal segment from the cornual end?

Accepted Answer

Kroener method

Answer

Uchida method

Answer

Irving method

Answer

Madlener technique

Question 2

What is the LNG content of Mirena?

Accepted Answer

52 mg

Answer

20 mg

Answer

13.5 mg

Answer

39 mg

Question 3

What is the minimum number of Medical Termination of Pregnancies (MTPs) that a Registered Medical Practitioner (RMP) must assist in to perform MTP in the first trimester?

Accepted Answer

25

Answer

5

Answer

15

Answer

50

Question 4

In which of the following conditions is IUCD insertion contraindicated?

Accepted Answer

Acute PID

Answer

Previous LSCS (Lower Segment Cesarean Section)

Answer

Lactating mother (breastfeeding)

Answer

Chronic pelvic pain (without infection)

Question 5

Which contraceptive method has the least failure rate?

Accepted Answer

MIRENA

Answer

CuT

Answer

DMPA

Answer

O.C. PILLS

Question 6

Which of the following statements about intra-uterine devices (IUDs) is incorrect?

Accepted Answer

Multiload Cu-375 is a third generation intra-uterine device (IUD)

Answer

Copper devices are effective as post-coital contraceptives

Answer

Pregnancy rates of Lippes Loop and T Cu-200 are similar

Answer

LNG-20 (Mirena) has an effective life of 5 years

Question 7

Which of the following is not an absolute contraindication for OC pills?

Accepted Answer

Old STD

Answer

Suspicious vaginal bleeding

Answer

Cervical cancer

Answer

Active viral hepatitis

Question 8

Copper IUCD as a contraceptive measure can be used maximum till what time after unprotected intercourse?

Accepted Answer

5 days

Answer

2 days

Answer

3 days

Answer

4 days

Question 9

What is the most common infection associated with long-term IUCD use?

Accepted Answer

Actinomycosis

Answer

Mucormycosis

Answer

Aspergillosis

Answer

Candidiasis

Question 10

In the calendar method of contraception, assuming a shortest menstrual cycle of 28 days, what is the first day of the fertile period?

Accepted Answer

10th day of the shortest menstrual cycle

Answer

18th day of the shortest menstrual cycle

Answer

10th day of the longest menstrual cycle

Answer

18th day of the longest menstrual cycle

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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