Contraception and Family Planning Practice Questions

Q: All are long-acting reversible contraceptives except:

OCP. ***OCP (Oral Contraceptive Pills)*** - **Oral Contraceptive Pills (OCPs)** are taken daily and require consistent user adherence for effectiveness. - OCPs are classified as **short-acting reversible contraceptives**, not long-acting reversible contraceptives (LARCs). - LARCs are defined as contraceptive methods that require administration less than once per cycle and provide effective contraception for ≥2-3 years. *Implanon* - **Implanon** is a single-rod subdermal contraceptive implant that releases etonogestrel and provides contraception for up to **3 years**. - It is a highly effective LARC with a failure rate <1% and is easily reversible upon removal. *IUCD (Intrauterine Contraceptive Device)* - IUCDs include copper IUDs (effective for 5-10 years) and hormonal IUDs like Mirena (effective for 3-5 years). - They are highly effective LARCs with minimal user compliance required once inserted and are immediately reversible upon removal. *Jadelle* - **Jadelle** is a two-rod subdermal contraceptive implant that releases levonorgestrel and provides contraception for up to **5 years**. - Like other implants, it offers long-term protection, high efficacy (>99%), and is easily reversible.

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

Infection. ***Infection*** - An **active pelvic infection** (e.g., cervicitis, endometritis, pelvic inflammatory disease) is an absolute contraindication to IUCD insertion, as it can worsen the infection and lead to serious reproductive complications. - IUCD insertion in the presence of infection increases the risk of **sepsis** and damage to the fallopian tubes or uterus. *Anemia* - **Anemia** itself is not a contraindication for IUCD insertion, though specific types of IUCDs might be preferred. - For example, **copper IUCDs** can sometimes increase menstrual bleeding, which could worsen pre-existing anemia, but this is a relative consideration, not an absolute contraindication, and can be managed. *Hypertension* - **Hypertension** is not a contraindication for the use of IUCDs, as they do not significantly affect blood pressure. - This is a particular advantage of IUCDs for women who cannot use **estrogen-containing contraceptives** due to blood pressure concerns. *Option: "None of the options"* - This option is incorrect because **active infection** is a clear contraindication for IUCD insertion, as explained above. - There are specific medical conditions that absolutely preclude the safe placement of an IUCD.

Q: The most common complication of intrauterine contraceptive devices is:

Bleeding. ***Bleeding*** - **Irregular bleeding** and **heavier menstrual periods (menorrhagia)** are the most common reasons for IUD discontinuation. - This is particularly true for **non-hormonal copper IUDs**, which can increase menstrual blood loss and dysmenorrhea. *Ectopic pregnancy* - While IUDs significantly reduce the overall risk of pregnancy, if a pregnancy does occur with an IUD in place, there is a **higher relative risk** that it will be **ectopic**. - However, the **absolute number** of ectopic pregnancies is low due to the high effectiveness of IUDs in preventing pregnancy altogether. *Backache* - Backache is **not a common complication** directly attributed to IUD use. - It could be a general discomfort but isn't specifically caused by the device itself or its mechanism of action. *Cervical stenosis* - **Cervical stenosis** is a narrowing of the cervical canal, which is **not typically caused by IUD insertion or presence**. - More commonly, it results from **surgical procedures** on the cervix, infection, or radiation.

Q: Most preferable contraceptive method for a female suffering from rheumatic heart disease who has completed her family is:

Surgical sterilization (Tubal ligation). ***Surgical sterilization (Tubal ligation)*** - This option offers **permanent contraception**, which is ideal for a woman with **rheumatic heart disease** who has completed her family, minimizing future pregnancy risks. - It avoids the systemic or local side effects of other contraceptive methods, which is crucial for patients with pre-existing health conditions. *Long-term intrauterine device (IUCD)* - While effective, IUCDs carry a small risk of **infection** and potential for increased menstrual bleeding or pain, which might be undesirable in patients with cardiac conditions. - The insertion procedure itself can sometimes be associated with discomfort or risks of perforation. *Non-hormonal barrier methods* - These methods, such as condoms or diaphragms, have a **higher failure rate** compared to other options, making them less reliable for a woman who must avoid pregnancy due to health reasons. - Their effectiveness depends heavily on consistent and correct use, which can be challenging. *Hormonal contraceptive implant* - Hormonal methods, including implants, can sometimes have **systemic side effects**, such as changes in mood, weight, or bleeding patterns, which might impact a patient with chronic health conditions. - While generally safe, some hormonal contraceptives might have contraindications or require careful monitoring in patients with specific cardiac issues.

Q: What is the dose of mifepristone in medical abortion?

200 mg. ***200 mg*** - The standard dose of **mifepristone** for **medical abortion** in various protocols, including those up to 10 weeks of gestation, is **200 mg orally**. - This dose effectively blocks **progesterone receptors**, leading to endometrial breakdown and sensitization of the uterus to prostaglandins. - **WHO-recommended dose** with optimal efficacy and safety profile. *400 mg* - **400 mg is not a standard or recommended dose** for medical abortion in any established protocol. - The evidence-based regimens use either **200 mg** (current standard) or 600 mg (older protocol), but not 400 mg. - No clinical advantage has been demonstrated for this intermediate dose. *100 mg* - A dose of **100 mg of mifepristone is considered suboptimal** and less effective for inducing medical abortion compared to the standard 200 mg dose. - It may not sufficiently block progesterone receptors, potentially leading to **incomplete abortion** or treatment failure. - Not recommended in any standard medical abortion protocol. *600 mg* - Although **600 mg was an older protocol** for medical abortion, it has largely been replaced by the **200 mg dose**. - Research has demonstrated that **200 mg is equally effective** while resulting in a better side effect profile and lower cost. - The dose reduction from 600 mg to 200 mg represents evidence-based protocol optimization.

Question 1

All are long-acting reversible contraceptives except:

Accepted Answer

OCP

Answer

Implanon

Answer

IUCD

Answer

Jadelle

Question 2

In which of the following conditions is IUCD contraindicated?

Accepted Answer

Infection

Answer

Anemia

Answer

None of the options

Answer

Hypertension

Question 3

The most common complication of intrauterine contraceptive devices is:

Accepted Answer

Bleeding

Answer

Ectopic pregnancy

Answer

Backache

Answer

Cervical stenosis

Question 4

Most preferable contraceptive method for a female suffering from rheumatic heart disease who has completed her family is:

Accepted Answer

Surgical sterilization (Tubal ligation)

Answer

Non-hormonal barrier methods

Answer

Long-term intrauterine device (IUCD)

Answer

Hormonal contraceptive implant

Question 5

A 28-year-old nonsmoking woman presents to discuss birth control methods. She requests a contraceptive option that is not associated with weight gain. She and her husband agree that they desire no children for the next few years. Her periods are regular, but heavy and painful, with severe lower abdominal cramping and back pain, requiring pad changes every 4 hours. This pattern of bleeding has been present since she was 15 years old. For a week before her period begins, she experiences uncharacteristic tearfulness, irritability, and depression, which are affecting her personal relationships. Her physical examination reveals blood pressure 110/75, BMI 22, and moderate acne on her face and neck. What recommendation would best address her mood, skin, and contraceptive needs?

Accepted Answer

Combination oral contraceptive pill with drospirenone and ethinyl estradiol

Answer

Progesterone intrauterine device (IUD)

Answer

Depo-Provera (medroxyprogesterone acetate) shots every 3 months

Answer

Tubal ligation (permanent sterilization)

Question 6

What is the dose of mifepristone in medical abortion?

Accepted Answer

200 mg

Answer

400 mg

Answer

100 mg

Answer

600 mg

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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