Contraception and Family Planning Practice Questions

Q: Which of the following is a side effect of Progestin Only Pills (POPs)?

Ovarian cysts. ***Ovarian cysts*** - **Functional ovarian cysts** are a known side effect of Progestin Only Pills (**POPs**), as POPs can alter the normal ovulatory cycle but usually do not completely suppress follicular development. - While generally benign and self-resolving, they can cause pain and discomfort. *Venous thromboembolism* - **POPs** are not significantly associated with an increased risk of **venous thromboembolism** due to the absence of estrogen, unlike combined hormonal contraceptives. - This is a key advantage of POPs, making them suitable for individuals at risk for thromboembolic events. *Increased risk of diabetes mellitus* - There is generally **no significant increased risk** of **diabetes mellitus** associated with POPs. - While some hormonal contraceptives *may* have minor effects on glucose metabolism, this is not a prominent or clinically significant side effect of POPs. *Ectopic pregnancy* - POPs **do not increase the risk of ectopic pregnancy**. In fact, they **reduce the overall pregnancy rate**, including ectopic pregnancies, by preventing ovulation. - However, if a pregnancy does occur while on POPs, there is a *slightly higher proportion* of those pregnancies that may be ectopic compared to unaided conceptions, but the *absolute risk* remains low.

Q: Which of the following is NOT an absolute contraindication for the use of an Intrauterine Device (IUD)?

Anemia. ***Anemia*** - Anemia, even if severe, is generally *not an absolute contraindication* for IUD use, especially for a **hormonal IUD** which can actually *reduce menstrual blood loss*. - While **copper IUDs** can sometimes *increase menstrual bleeding*, the benefits of contraception often outweigh the risks in anemic patients, or iron supplementation can be initiated. *Pregnancy* - **Confirmed or suspected pregnancy** is an absolute contraindication for IUD insertion due to the risk of **miscarriage**, **infection**, and harm to the fetus. - An IUD should *never* be inserted into a pregnant uterus. *Acute pelvic inflammatory disease* - **Acute PID** is a severe infection of the upper genital tract and is an *absolute contraindication* to IUD insertion. - Insertion during active infection could **exacerbate the infection** and lead to serious complications such as infertility or sepsis. *Undiagnosed vaginal bleeding* - **Undiagnosed abnormal vaginal bleeding** requires investigation to rule out serious underlying conditions such as **endometrial cancer** or **trophoblastic disease** before IUD insertion. - Inserting an IUD could **mask symptoms** or delay diagnosis of a serious pathology.

Q: What is the standard dose of mifepristone in medical termination of pregnancy (MTP)?

200mg. ***200mg*** - The standard dose of **mifepristone** for medical termination of pregnancy (MTP) is **200mg orally**. - This dose is typically followed 24-48 hours later by a **prostaglandin analog** (e.g., misoprostol) to complete the termination process. *10mg* - This dose is significantly lower than the recommended therapeutic dose for medical abortion. - Such a low dose would likely be **ineffective** in achieving termination. *20 mg* - This dose is also much lower than the standard therapeutic recommendation. - It would not adequately block progesterone receptors to initiate the termination process effectively. *100mg* - While closer to the standard dose, 100mg is still considered **sub-therapeutic** for many individuals undergoing medical abortion. - A lower efficacy rate would be expected compared to the 200mg dose.

Q: What is the timing for the highest risk of Pelvic Inflammatory Disease (PID) after the insertion of an Intrauterine Device (IUD)?

Within 3 weeks. **Correct Answer: Within 3 weeks** - The highest risk of **Pelvic Inflammatory Disease (PID)** after IUD insertion is typically observed in the **first 20 days (approximately 3 weeks)** post-insertion. - This elevated risk is mainly due to the potential introduction of **bacteria** from the vagina or cervix into the uterus during the insertion process. - Studies show that the risk of PID is **6-fold higher** in the first 20 days compared to later periods. *Incorrect: Within 5 weeks* - While PID can occur after 3 weeks, the **highest incidence** is concentrated in the earlier period (first 3 weeks). - The risk significantly **decreases after the initial weeks**, suggesting that the critical window for bacterial ascent is shorter. *Incorrect: Within 7 weeks* - By 7 weeks, the risk of developing PID attributable to IUD insertion becomes **negligible** compared to the general population. - Most infections that manifest beyond the initial month are usually due to **newly acquired sexually transmitted infections (STIs)**, not the insertion itself. *Incorrect: Within 14 weeks* - At 14 weeks, any PID development is generally **not linked to the IUD insertion event** but rather to other risk factors like new sexual partners or untreated STIs. - The immediate trauma and potential bacterial contamination from the insertion procedure have **long ceased to be the primary cause** of infection.

Q: What is the recommended timing for the insertion of a Copper T intrauterine device?

Within 10 days of start of menstrual cycle. ***Within 10 days of start of menstrual cycle*** - Inserting the **Copper T IUD** during this phase ensures the woman is not pregnant, as ovulation typically occurs later in the cycle. - The **cervix is slightly dilated** during menstruation, making insertion easier and less uncomfortable. - This is the **recommended timing** as per standard guidelines for IUD insertion. *3 days after periods are over* - While this timing might seem appropriate, it doesn't align with the optimal window for ensuring **non-pregnancy** and ease of insertion. - The **cervix may have already closed** significantly, making insertion potentially more difficult than during menstruation. *During active pelvic infection* - Insertion of an IUD during an **active pelvic infection** is **absolutely contraindicated** due to the risk of exacerbating the infection and leading to more serious complications like **pelvic inflammatory disease (PID)**. - The presence of infection increases the likelihood of bacteria being carried into the **uterine cavity**, potentially causing severe consequences. *Just after menstruation* - While close to the ideal window, this timing is less specific than "within 10 days" and may miss the optimal cervical conditions. - The benefits of a slightly dilated cervix during the early menstrual phase would be maximized with the more precise timing of within 10 days of cycle start.

Q: Which of the following is a method of natural family planning that involves tracking basal body temperature?

Basal body temperature (BBT) method. ***Basal body temperature (BBT) method*** - The **basal body temperature** (BBT) method relies on a slight increase in a woman's resting body temperature, typically by 0.5 to 1.0°F, occurring after **ovulation**. - This temperature shift signals that ovulation has occurred, allowing couples to identify the **fertile window** and avoid intercourse during that time. - This method involves tracking daily basal body temperature to predict ovulation. *Coitus interruptus (withdrawal method)* - This method involves the male withdrawing his penis from the vagina just before **ejaculation**. - It does not involve tracking **basal body temperature** and has a higher failure rate compared to many other contraceptive methods due to potential pre-ejaculatory fluid containing sperm. *Safe period (calendar method)* - The calendar method, also known as the **rhythm method** or **Ogino-Knaus method**, estimates the fertile window based on the typical length of a woman's menstrual cycles. - This method relies on calculating the approximate times of ovulation and avoiding intercourse during those days; it does not involve daily **temperature tracking**. *Abstinence (not having sexual intercourse)* - **Abstinence** involves completely refraining from sexual intercourse and is the only 100% effective method of preventing pregnancy and sexually transmitted infections (STIs). - This method does not involve any form of physical tracking, such as **basal body temperature**, as there is no risk of conception.

Q: Copper T is ideally inserted at-

Just after menstruation. ***Just after menstruation*** - The **endometrium is thin** immediately after menstruation, making insertion easier and reducing the risk of pain and perforation. - Inserting it after menstruation also helps to ensure the woman is **not pregnant** at the time of insertion, as the uterus has shed its lining. *Just before menstruation* - The endometrium is typically **thicker and more vascular** just before menstruation, increasing the risk of bleeding and pain during insertion. - There is a higher possibility of **early pregnancy**, which would contraindicate IUD insertion. *On the 26th day* - The 26th day of the menstrual cycle is usually in the **luteal phase**, when the endometrium is highly vascularized and receptive, which could increase discomfort and bleeding during insertion. - This timing also carries a **higher risk of pregnancy**, making IUD insertion potentially hazardous if not confirmed otherwise. *On the 14th day* - The 14th day typically corresponds to the **ovulation period**, making it a high-risk time for conception if protection has not been used. - The uterus is also more sensitive during ovulation, potentially leading to increased discomfort or complications during insertion.

Q: In which scenario is the I-pill (emergency contraceptive) most appropriately used?

In case of contraceptive failure or unprotected sex. ***In case of contraceptive failure or unprotected sex*** - This is the **most comprehensive and appropriate answer** as it covers **both major indications** for emergency contraception. - The **I-pill (levonorgestrel)** is indicated when there has been unprotected intercourse OR when a contraceptive method has failed (e.g., condom breakage, missed pills, dislodged IUD). - It should be taken as soon as possible, ideally within **72 hours** of the event, though it can be used up to 120 hours with reduced efficacy. - This option correctly encompasses the full scope of emergency contraception use. *After unprotected sexual intercourse* - While this is a **valid indication**, it only covers one scenario and is not as comprehensive as the correct answer. - This option misses situations of contraceptive failure where intercourse was technically "protected" but the method failed. *When a contraceptive method fails* - This is also a **valid indication** but only covers contraceptive accidents (condom breakage, missed pills). - It excludes situations where no contraceptive was used at all. - Like the previous option, it is incomplete compared to the correct answer. *As a regular contraceptive method* - The I-pill is **not intended for routine contraception** due to higher hormone doses and lower efficacy compared to regular methods. - It has a higher side effect profile with frequent use and does not protect against sexually transmitted infections. - Emergency contraception should only be used occasionally in emergency situations.

Q: What is the maximum gestational age (from LMP) for performing medical termination of early pregnancy using mifepristone and misoprostol?

7 weeks. ***7 weeks (49 days)*** - Medical termination of pregnancy using **mifepristone and misoprostol** is most effective up to **49 days (7 weeks) of gestation** from the first day of the last menstrual period (LMP). - This is the **FDA-approved and WHO-recommended timeframe** for medical abortion with optimal efficacy (95-98% success rate). - The **MTP Act in India** allows medical methods up to **63 days (9 weeks)**, but 49 days represents the timeframe with highest efficacy and lowest complication rates. - Beyond this period, success rates decline and surgical methods may be more appropriate. *21 days* - This is only **3 weeks of gestation**, far too early and restrictive for medical abortion guidelines. - Most women wouldn't have confirmed pregnancy by this time. - This is not aligned with any standard medical abortion protocol. *4 weeks* - At **4 weeks gestation**, pregnancy has just been missed (around time of expected period). - This is too restrictive and not the maximum allowable timeframe for medical abortion. - Medical abortion can safely be performed well beyond this point. *14 days* - This is only **2 weeks of gestation** (around the time of ovulation in a typical cycle). - Pregnancy cannot even be reliably detected at this point. - This timeframe has no relevance to medical abortion guidelines.

Q: The mechanism of action of emergency contraception includes the following except:

Degeneration of corpus luteum. ***Degeneration of corpus luteum*** - Emergency contraception primarily works by interfering with ovulation and fertilization. It does **not directly cause degeneration of the corpus luteum**. - The **corpus luteum** forms after ovulation, and its degradation is a natural process (luteolysis) if pregnancy does not occur. Emergency contraception acts earlier in the reproductive process and does not target the corpus luteum. - This is the **correct answer** as it is NOT a mechanism of emergency contraception. *By preventing or delaying ovulation* - This is the **primary mechanism** of action for most forms of emergency contraception, particularly those containing **levonorgestrel (LNG)** and **ulipristal acetate (UPA)**. - By delaying the release of an egg from the ovary, it prevents the possibility of fertilization. - This is the most established and clinically significant mechanism. *Inhibition of fertilization* - Emergency contraception may affect fertilization by altering **cervical mucus** thickness, making it less penetrable to sperm. - Some evidence suggests effects on **sperm motility** or function, though this mechanism is less well-established than ovulation inhibition. - This represents a possible secondary mechanism. *Prevention of implantation of fertilized egg* - **Current evidence does NOT support this as a mechanism** for levonorgestrel or ulipristal acetate emergency contraception. - Studies by **WHO, ACOG, FIGO, and ICMR** have shown that LNG-EC is ineffective once fertilization has occurred. - The **copper IUD** used for emergency contraception may have some anti-implantation effects due to its inflammatory action on the endometrium. - However, for hormonal EC (the most common form), prevention of implantation is **not an established mechanism** based on current medical evidence.

Question 1

Which of the following is a side effect of Progestin Only Pills (POPs)?

Accepted Answer

Ovarian cysts

Answer

Venous thromboembolism

Answer

Increased risk of diabetes mellitus

Answer

Ectopic pregnancy

Question 2

Which of the following is NOT an absolute contraindication for the use of an Intrauterine Device (IUD)?

Accepted Answer

Anemia

Answer

Pregnancy

Answer

Acute pelvic inflammatory disease

Answer

Undiagnosed vaginal bleeding

Question 3

What is the standard dose of mifepristone in medical termination of pregnancy (MTP)?

Accepted Answer

200mg

Answer

10mg

Answer

20mg

Answer

100mg

Question 4

What is the timing for the highest risk of Pelvic Inflammatory Disease (PID) after the insertion of an Intrauterine Device (IUD)?

Accepted Answer

Within 3 weeks

Answer

Within 5 weeks

Answer

Within 7 weeks

Answer

Within 14 weeks

Question 5

What is the recommended timing for the insertion of a Copper T intrauterine device?

Accepted Answer

Within 10 days of start of menstrual cycle

Answer

3 days after periods are over

Answer

Just after menstruation

Answer

During active pelvic infection

Question 6

Which of the following is a method of natural family planning that involves tracking basal body temperature?

Accepted Answer

Basal body temperature (BBT) method

Answer

Coitus interruptus (withdrawal method)

Answer

Safe period (calendar method)

Answer

Abstinence (not having sexual intercourse)

Question 7

Copper T is ideally inserted at-

Accepted Answer

Just after menstruation

Answer

Just before menstruation

Answer

On the 26th day

Answer

On the 14th day

Question 8

In which scenario is the I-pill (emergency contraceptive) most appropriately used?

Accepted Answer

In case of contraceptive failure or unprotected sex

Answer

When a contraceptive method fails

Answer

After unprotected sexual intercourse

Answer

As a regular contraceptive method

Question 9

What is the maximum gestational age (from LMP) for performing medical termination of early pregnancy using mifepristone and misoprostol?

Accepted Answer

7 weeks

Answer

21 days

Answer

4 weeks

Answer

14 days

Question 10

The mechanism of action of emergency contraception includes the following except:

Accepted Answer

Degeneration of corpus luteum

Answer

Prevention of implantation of fertilized egg.

Answer

Inhibition of fertilization

Answer

By preventing or delaying ovulation

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

On this page

Practice by Chapter

Want unlimited practice?