Contraception and Family Planning Practice Questions

Q: Which of the following drugs cannot be used for Medical Termination of Pregnancy (MTP) in a patient with bronchial asthma?

Prostaglandin. ### Explanation **Correct Option: A. Prostaglandin** Prostaglandins, specifically **Prostaglandin F2-alpha (PGF2α)** and its analogues (like Carboprost), are potent **bronchoconstrictors**. In patients with bronchial asthma, these drugs can trigger severe bronchospasm and life-threatening asthma attacks. While Misoprostol (PGE1) is more commonly used for MTP and has a weaker effect on the bronchi, the entire class of prostaglandins is generally avoided or used with extreme caution in asthmatics if safer alternatives exist. **Analysis of Incorrect Options:** * **B. Oxytocin:** This is a posterior pituitary hormone used for induction of labor and preventing PPH. It acts specifically on uterine smooth muscle and has no significant effect on bronchial smooth muscle, making it safe for asthmatics. * **C. Mifepristone:** This is an anti-progestational steroid. It works by blocking progesterone receptors to cause decidual breakdown and cervical softening. It does not interact with the respiratory system and is the first-line drug for medical MTP. * **D. Ethacrydine:** This is an abortifacient used for second-trimester MTP via extra-amniotic instillation. It acts as a local irritant to induce contractions and does not cause bronchoconstriction. **Clinical Pearls for NEET-PG:** * **Carboprost (PGF2α):** Specifically contraindicated in **Asthma**. * **Methylergometrine (Methergine):** Specifically contraindicated in **Hypertension** and Preeclampsia (causes vasoconstriction). * **Misoprostol (PGE1):** The most common prostaglandin used in MTP; it is safer than PGF2α but still used cautiously in severe asthmatics. * **MTP Act Update:** Medical MTP is highly effective up to **9 weeks (63 days)** of gestation using a combination of Mifepristone (200mg) and Misoprostol (800mcg).

Q: What are the contraindications for the use of an intrauterine contraceptive device (IUCD)?

Undiagnosed vaginal bleeding and PID. **Explanation:** The selection of an Intrauterine Contraceptive Device (IUCD) requires careful screening for contraindications to prevent complications like infection or delayed diagnosis of malignancy. **Why Option D is Correct:** According to the WHO Medical Eligibility Criteria (MEC), **Pelvic Inflammatory Disease (PID)** and **Undiagnosed Vaginal Bleeding** are Category 4 contraindications (unacceptable health risk). 1. **PID:** Inserting an IUCD during an active infection can exacerbate the condition and lead to pelvic sepsis or tubal damage. 2. **Undiagnosed Vaginal Bleeding:** This is a contraindication because the bleeding could be a symptom of an underlying malignancy (like endometrial or cervical cancer) or pregnancy. An IUCD must not be inserted until the cause is diagnosed and serious pathology is ruled out. **Analysis of Incorrect Options:** * **Options A & B:** While they mention undiagnosed bleeding and PID, Option D is the most complete representation of the standard contraindications listed in the question context. * **Option C:** **Obesity** is not a contraindication for IUCD use. In fact, LARC (Long-Acting Reversible Contraception) like the IUCD or LNG-IUS is often preferred for obese patients as it avoids the metabolic risks associated with combined oral contraceptives. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications (MEC 4):** Pregnancy, active PID, undiagnosed vaginal bleeding, distorted uterine cavity (large fibroids), and current copper allergy (for Cu-T). * **Wilson’s Disease:** A specific contraindication for Copper-T, but not for the Levonorgestrel-releasing system (Mirena). * **Timing:** The best time for insertion is during menstruation or within 10 days of the cycle to ensure the patient is not pregnant and the cervix is slightly dilated. * **Ideal Candidate:** A parous woman in a stable monogamous relationship (low risk of STIs/PID).

Q: Which of the following statements about Nova T is true?

Silver core. **Explanation:** **Nova T** is a second-generation copper-releasing intrauterine device (IUCD). The correct answer is **D (Silver core)** because the copper wire of Nova T contains a **silver core**. This design is specifically engineered to prevent the fragmentation of the copper wire, thereby increasing the device's durability and ensuring a steady release of copper ions over time. **Analysis of Options:** * **A. Effective for 10 years:** This is incorrect. Nova T is typically effective for **5 years**. The Cu-T 380A is the device famously known for its 10-year lifespan. * **B. More copper content:** This is incorrect. Nova T has a surface area of **200 $mm^2$** of copper. In contrast, the Cu-T 380A has significantly more copper (380 $mm^2$). * **C. More chances of perforation:** This is incorrect. The risk of uterine perforation (approx. 1 in 1000 insertions) is generally consistent across standard IUCDs and depends more on the provider's technique and the timing of insertion (e.g., postpartum) rather than the specific design of Nova T. **High-Yield Clinical Pearls for NEET-PG:** * **The Silver Advantage:** The silver core prevents "pitting" or corrosion of the copper wire, which was a common issue in older models. * **Surface Area Comparison:** * **Nova T / Cu-T 200:** 200 $mm^2$ (5 years) * **Cu-T 380A:** 380 $mm^2$ (10 years - Gold Standard) * **Multiload 375:** 375 $mm^2$ (5 years) * **Ideal Candidate:** IUCDs are best suited for parous women in stable monogamous relationships. * **Most Common Side Effect:** Bleeding (Menorrhagia) is the most common reason for removal, followed by pain.

Q: What is the most suitable method for Medical Termination of Pregnancy (MTP) during the third month of gestation?

Suction and evacuation. **Explanation:** The "third month" of gestation corresponds to **9–12 weeks** of pregnancy. According to standard obstetric guidelines and the MTP Act, **Suction and Evacuation (S&E)** is the gold standard and most suitable method for termination in the first trimester (up to 12 weeks). * **Why Suction and Evacuation is correct:** It is a safe, rapid, and highly effective surgical procedure. It involves dilating the cervix and using a vacuum source (electric or manual) to remove the products of conception. It has a lower risk of uterine perforation and hemorrhage compared to traditional curettage. **Analysis of Incorrect Options:** * **A. Dilatation and Curettage (D&C):** This is an older technique involving sharp metal curettes. It is no longer preferred because it carries a higher risk of uterine trauma, Asherman syndrome, and increased blood loss compared to suction. * **B. Extra-amniotic Ethacridine:** This is a method used for **second-trimester** abortions (usually 15–20 weeks). It is not indicated for the first trimester as surgical evacuation is much simpler and safer at 12 weeks. * **C. Hysterectomy:** This is a major surgery involving the removal of the uterus. It is never a primary method for MTP unless there is a concurrent life-threatening pathology (e.g., intractable hemorrhage or uterine malignancy). **High-Yield NEET-PG Pearls:** * **Up to 7 weeks (49 days):** Medical MTP (Mifepristone + Misoprostol) is the preferred choice. * **Up to 12 weeks:** Suction and Evacuation is the surgical method of choice. * **13–24 weeks:** Medical induction (Prostaglandins/Misoprostol) or Dilatation and Evacuation (D&E) are used. * **MTP Act Update:** Pregnancy can now be terminated up to **24 weeks** for specific categories of women (e.g., survivors of sexual assault, minors, fetal abnormalities) with the opinion of two doctors.

Q: What is the lifespan of an LNG-IUD?

5 years. **Explanation:** The **Levonorgestrel-releasing Intrauterine Device (LNG-IUD)**, commonly known by the brand name **Mirena**, is a highly effective long-acting reversible contraceptive (LARC). It contains a reservoir of 52 mg of levonorgestrel which is released at an initial rate of 20 µg/day. 1. **Why 5 years is correct:** The reservoir is designed to maintain therapeutic hormone levels for a period of **5 years**. While recent studies suggest some models may remain effective for up to 7–8 years, the standard FDA-approved and textbook duration for the 52 mg LNG-IUD (Mirena) remains 5 years. It works primarily by thickening cervical mucus and causing endometrial atrophy. 2. **Why other options are incorrect:** * **2 years:** No standard IUD has a lifespan this short; however, some injectable contraceptives or older implants had shorter durations. * **10 years:** This is the standard lifespan for the **Copper T 380A** (non-hormonal IUD). * **12 years:** While some studies suggest Copper T 380A can last this long, it is not the standard recommendation for LNG systems. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Candidate:** LNG-IUD is the **treatment of choice for Menorrhagia** (DUB) as it reduces menstrual blood loss by up to 90%. * **Non-contraceptive benefits:** Used in the management of endometriosis, adenomyosis, and endometrial hyperplasia. * **Pearl:** Unlike Copper-T, the LNG-IUD often leads to **amenorrhea** or oligomenorrhea, which should be explained to the patient beforehand. * **Other variants:** *Kyleena* (19.5 mg LNG) is also approved for 5 years, while *Skyla* (13.5 mg LNG) is approved for 3 years.

Q: All of the following statements regarding benefits of combined oral contraceptive pills are TRUE, EXCEPT:

It decreases the risk of cervical cancer. **Explanation:** The correct answer is **B**, as Combined Oral Contraceptive Pills (COCPs) do **not** decrease the risk of cervical cancer; in fact, long-term use (typically >5 years) is associated with a slightly **increased risk** of cervical cancer. This is likely due to increased susceptibility to HPV infection or behavioral factors. **Analysis of Options:** * **Option A (Ectopic Pregnancy):** COCPs prevent ovulation. Since there is no ovum to fertilize, the absolute risk of both intrauterine and ectopic pregnancies is significantly reduced. * **Option C (Dysmenorrhea/Endometriosis):** COCPs suppress the menstrual cycle and induce a state of endometrial atrophy. This reduces prostaglandin production and prevents the cyclic growth of ectopic endometrial tissue, thereby alleviating pain. * **Option D (Acute Salpingitis):** COCPs decrease the risk of Pelvic Inflammatory Disease (PID). They thicken the cervical mucus, creating a barrier against ascending infections, and reduce menstrual flow, which limits the medium for bacterial growth. **High-Yield Clinical Pearls for NEET-PG:** * **Protective Effects (The "Big Three"):** COCPs significantly reduce the risk of **Ovarian cancer** (by 50%), **Endometrial cancer** (by 50%), and **Colorectal cancer**. * **Ovarian Cancer:** Protection is due to "ordered ovarian rest" (suppression of incessant ovulation). * **Endometrial Cancer:** Protection is due to the progestogen component preventing estrogen-induced hyperplasia. * **Increased Risks:** COCPs are associated with an increased risk of **Cervical cancer**, **Breast cancer**, and **Hepatic adenomas**. * **Non-Contraceptive Benefits:** They reduce the risk of functional ovarian cysts, benign breast disease, and iron-deficiency anemia.

Q: Which of the following is NOT a recommended treatment for a woman with an IUD in situ and a positive cervical cytology for Actinomyces infection?

Hysterectomy. **Explanation:** The presence of *Actinomyces-like organisms* (ALO) on a routine cervical Pap smear in an asymptomatic IUD user is a common clinical scenario. *Actinomyces israelii* is a Gram-positive, anaerobic bacterium that is a normal commensal of the female genital tract but can proliferate in the presence of a foreign body like an IUD. **Why Hysterectomy is the Correct Answer:** Hysterectomy is a radical surgical procedure and is **never** indicated for the mere presence of *Actinomyces* on cytology. Management is conservative unless the patient is symptomatic. Performing a hysterectomy for an incidental finding on a Pap smear would be a gross over-treatment and is medically contraindicated. **Analysis of Other Options:** * **Option A (No intervention needed):** This is the **current standard of care** for asymptomatic women. If the patient has no symptoms (no pelvic pain, discharge, or fever), the IUD can be left in situ, and the patient is simply monitored. * **Option D (Removal of IUD):** This is a valid management option if the patient is concerned or symptomatic. However, it is not mandatory if she is asymptomatic. * **Option C (Extended course of antibiotics):** While not routinely recommended for asymptomatic colonization, a course of Penicillin (the drug of choice) may be prescribed if the IUD is removed or if there are mild symptoms of Pelvic Inflammatory Disease (PID). **NEET-PG High-Yield Pearls:** 1. **Asymptomatic + Actinomyces on Pap smear:** Do nothing (No treatment, no IUD removal). 2. **Symptomatic (Pelvic pain/PID) + Actinomyces:** Remove IUD and start high-dose **Penicillin G** (or Doxycycline if allergic). 3. **Pelvic Actinomycosis:** Classically presents with "woody" pelvic induration and "sulfur granules" in the discharge. 4. The risk of *Actinomyces* colonization increases with the **duration** of IUD use (especially >5 years).

Question 1

A woman using oral contraceptive pills misses 3 pills during the third week of her cycle. What is the recommended course of action?

Accepted Answer

Finish only the remaining hormonal pills in the current pack and start a new pack the next day.

Answer

Continue taking the pills from the current pack.

Answer

Take all missed pills along with the next scheduled pill and continue the pack.

Answer

Start a new pack of oral contraceptive pills immediately.

Question 2

Which of the following drugs cannot be used for Medical Termination of Pregnancy (MTP) in a patient with bronchial asthma?

Accepted Answer

Prostaglandin

Answer

Oxytocin

Answer

Mifepristone

Answer

Ethacrydine

Question 3

What are the contraindications for the use of an intrauterine contraceptive device (IUCD)?

Accepted Answer

Undiagnosed vaginal bleeding and PID

Answer

Undiagnosed vaginal bleeding

Answer

Undiagnosed vaginal bleeding and obesity

Question 4

Which of the following statements about Nova T is true?

Accepted Answer

Silver core

Answer

Effective for 10 years

Answer

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

On this page

Practice by Chapter

Want unlimited practice?