OG20.1-3,OG21.1-2,OG22.1-2 | Medical Termination and Contraception — Graded Quiz

Correct. Under the MTP Amendment Act 2021, MTP between 20 and 24 weeks requires two RMPs' opinions and applies to specified categories including substantial foetal anomaly. Anencephaly at 22 weeks clearly falls within this category. The State Medical Board process applies only beyond 24 weeks.

MTP 2021 tiers: ≤20 weeks/one RMP; 20–24 weeks specified categories/two RMPs; >24 weeks substantial foetal abnormality/State Medical Board. Foetal anomaly at 22 weeks = two RMPs, not State Medical Board.

Not correct. The 2021 Act is structured: ≤20 weeks = one RMP; 20–24 weeks for specified categories (including foetal anomaly) = two RMPs; >24 weeks for substantial foetal abnormality = State Medical Board. Anencephaly at 22 weeks = 20–24 week tier = two RMPs required.

Correct. For second-trimester MTP (13–24 weeks), the preferred medical method is mifepristone 200 mg orally followed 24–48 hours later by repeated doses of misoprostol (vaginal/sublingual) to achieve uterine evacuation via medical induction. Sharp D&C carries high perforation risk at this gestation and is obsolete. Carboprost alone without mifepristone priming is less effective.

Second-trimester MTP (13–24 weeks): mifepristone 200 mg + misoprostol (repeated doses) is the gold standard medical method. Surgical options at this stage include dilatation and evacuation (D&E, NOT sharp D&C). Requires higher-level facility with surgical backup.

Not correct. MVA is suitable only up to approximately 12 weeks. Sharp D&C is obsolete and carries high perforation risk at 15 weeks. Carboprost alone is not the standard first-line method. The gold standard for second-trimester medical termination is mifepristone priming followed by misoprostol.

Correct. Fever, uterine tenderness, and persistent beta-hCG at 3 days post-MTP indicate retained products of conception with superimposed endometritis (post-abortal sepsis). This requires antibiotics and uterine evacuation (suction evacuation), not expectant management.

Post-abortal sepsis: fever + uterine tenderness + persistent beta-hCG = retained POC + endometritis. Management: systemic antibiotics + suction evacuation. Do not confuse with normal post-procedure cramping/bleeding which is expected and afebrile.

Not correct. Fever at 38.6°C with uterine tenderness 3 days post-MTP is not a normal response. Continuing pregnancy would not present with fever. Haematometra presents with cyclical pain and an enlarged non-tender uterus without septic features. The combination of retained POC + fever = post-abortal sepsis.

Correct. A competent adult woman consents for herself under the MTP Act — no family member's permission is required or legally valid. The patient's non-verbal cues suggest possible coercion. The first step is to create a private environment (ask the accompanying person to leave) and assess whether the patient is acting voluntarily and has decisional capacity.

MTP consent principle: competent adult woman signs alone — no husband, partner, or family co-signature required. Presence of a dominant family member and patient non-verbal cues = possible coercion. Always create a private consultation space before beginning consent.

Not correct. Under the MTP Act 2021, a competent adult woman is the sole decision-maker for her MTP. The mother-in-law has no legal authority to consent. Dual consent is not required. Deferring without addressing the coercion concern also fails the patient. The correct step is a private consultation.

Correct. Form F is the mandatory record for every ultrasound examination. Recording foetal sex in any field of Form F constitutes determination and potential communication of foetal sex, which is prohibited under the PCPNDT Act. The column for foetal sex must remain blank; any entry indicating sex is a punishable offence.

PCPNDT Form F: mandatory for every ultrasound. Foetal sex column MUST be blank — any entry indicating sex is a criminal offence. Routine biometric and anatomical measurements are required and lawful. The Appropriate Authority conducts Form F inspections as the primary audit mechanism.

Not correct. Form F requires documentation of biometric measurements and foetal anatomy (including cardiac views) as legitimate medical records. However, the PCPNDT Act mandates that the foetal sex column remain blank at all times — any entry recording the foetal sex constitutes an offence under the Act.

Correct. The copper IUCD (CuT 380A) is the ideal choice: it is non-hormonal (suitable when hormonal methods are relatively contraindicated or undesired), highly effective (>99%), long-acting (up to 10 years), and reversible. Hypertension does not contraindicate IUCD. COC is MEC 3 for controlled hypertension.

Copper CuT 380A: non-hormonal, >99% effective, up to 10 years, reversible, WHO MEC 1 for hypertension. Ideal for women in whom oestrogen or progestogen is contraindicated or undesired. COC = MEC 3 for hypertension; IUCD = MEC 1.

Not correct. COC is relatively contraindicated (WHO MEC 3) in women with hypertension. DMPA is hormonal, causes menstrual irregularity, and has a delayed return to fertility — less suitable as a first choice for a woman who may want reversal. Copper IUCD is the optimal non-hormonal long-acting reversible contraceptive.

Correct. Vasectomy involves ligation or occlusion of the vas deferens under local anaesthesia as a day-care procedure. It is simpler (no general anaesthesia, no peritoneal entry), safer, and has a failure rate of approximately 0.1% — lower than COC (0.3–3% typical use). Note: contraceptive cover is NOT immediate; semen analysis must confirm azoospermia (typically at 12 weeks/20 ejaculations).

Vasectomy: ligation/occlusion of vas deferens, local anaesthesia, day-care, failure rate ~0.1%. No effect on testosterone or libido. NOT immediately effective — use backup contraception until azoospermia confirmed (semen analysis at 12 weeks). Simpler and safer than female tubal ligation.

Not correct. Vasectomy does not affect testosterone production or libido — testosterone enters the bloodstream directly from testicular Leydig cells, bypassing the vas. Vasectomy failure rate (~0.1%) is lower than COC in typical use (~7%). Crucially, protection is NOT immediate — a backup method is required until azoospermia is confirmed.

Correct. Absent IUCD threads plus acute lower abdominal pain plus shoulder-tip pain (diaphragmatic irritation from blood or peritoneal fluid) plus rebound tenderness strongly indicates uterine perforation with migration of the IUCD into the peritoneal cavity. A pregnancy test helps exclude ectopic but the clinical picture here is perforation. Laparoscopic removal is required.

IUCD complication recognition: absent threads + acute pain + shoulder-tip pain + peritonism = uterine perforation with peritoneal migration. Investigation: pelvic X-ray / ultrasound to locate device; management: laparoscopic retrieval. Distinguish from PID (fever + bilateral adnexal tenderness) and expulsion (device visible or found by patient).

Not correct. PID presents with fever, bilateral adnexal tenderness and purulent discharge — not shoulder-tip pain or rebound. Expulsion presents with the device being found or visible in the vagina. The combination of absent threads + shoulder-tip pain + peritonism = uterine perforation, not PID or expulsion.

Correct. The clinical triad — thin homogeneous grey-white discharge, fishy amine odour (enhanced post-coitus and with KOH), pH >4.5, and clue cells on wet mount — fulfils Amsel criteria for bacterial vaginosis. Treatment is metronidazole 400–500 mg twice daily for 7 days (or 2 g single dose). Partner treatment is NOT routinely required for BV (unlike trichomoniasis).

BV Amsel criteria (3 of 4): homogeneous thin grey-white discharge; pH >4.5; positive whiff test (KOH); clue cells on wet mount. Treatment: metronidazole 400–500 mg BD × 7 days. No routine partner treatment needed. Most common mistake: treating BV with antifungals.

Not correct. Candida presents with thick white cottage-cheese discharge and intense pruritus with a normal pH (≤4.5). Trichomoniasis presents with frothy yellow-green discharge with flagellated organisms on wet mount and requires partner treatment. The thin grey-white discharge, fishy amine odour, pH >4.5, and clue cells (not flagellated organisms) = BV.

Correct. Recurrent vulvovaginal candidiasis (RVVC) is defined as ≥4 episodes per year. Even in apparently immunocompetent women, RVVC warrants screening for predisposing factors: undiagnosed diabetes mellitus, HIV infection, corticosteroid use, or other immunosuppression. Following investigation, maintenance antifungal therapy (fluconazole 150 mg weekly for 6 months) is appropriate.

Recurrent VVC: ≥4 episodes/year. Investigate for DM, HIV, immunosuppression even if clinically not apparent. Management: treat current episode (fluconazole 150 mg orally or clotrimazole topically) + maintenance therapy (fluconazole 150 mg weekly × 6 months) + address predisposing factors.

Not correct. RVVC (≥4 episodes/year) is not normal and warrants investigation for predisposing conditions. Colposcopy is not indicated for RVVC. Maintenance fluconazole is appropriate after investigations confirm no treatable underlying cause — not as the first step without screening.

Correct. Under the PCPNDT Act, first-offence penalties include imprisonment up to 3 years and a fine up to Rs 10,000 (enhanced for subsequent offences to 5 years and Rs 50,000). The Appropriate Authority can suspend/cancel registration. Crucially, both the person performing the act AND the person aiding/requesting (including the woman seeking sex determination, in some interpretations) can be prosecuted.

PCPNDT penalties: first offence = up to 3 years imprisonment + Rs 10,000 fine; subsequent = up to 5 years + Rs 50,000. Both performer and requester may be prosecuted. Registration cancelled. The Appropriate Authority (district/state) is the enforcement body.

Not correct. The PCPNDT Act does not provide for a 'warning on first offence' approach for deliberate sex determination. Penalties are: first offence — imprisonment up to 3 years + fine up to Rs 10,000; subsequent offences — up to 5 years + Rs 50,000. Both the practitioner and the principal (who requested) may face prosecution.

Correct. Complicated diabetes (with nephropathy, retinopathy, neuropathy, or cardiovascular disease) is WHO MEC Category 2 for the LNG-IUS — meaning the benefits generally outweigh the risks, and it can be used with caution. The LNG-IUS is an excellent choice as it reduces menstrual blood loss and the levonorgestrel acts locally with minimal systemic absorption.

LNG-IUS in complicated diabetes = WHO MEC 2 (benefits outweigh risks; use with caution). COC in complicated diabetes = MEC 3 or 4. The local progestogen delivery of LNG-IUS results in minimal systemic absorption, making it safer than systemic hormonal methods in metabolic/vascular disease.

Not correct. For the LNG-IUS, complicated diabetes (with end-organ complications) is WHO MEC Category 2 — benefits generally outweigh risks. Note: COC in complicated diabetes is MEC 3/4, but the LNG-IUS has minimal systemic progestogen and is categorised differently. WHO MEC 4 for IUCD applies to conditions like active PID or pregnancy.