Obstetrics and Gynaecology — Contraception and Family Planning, NMC MBBS licence examination syllabus (Nepal Medical Council).
NMC-style practice questions written for this site. They are not past questions, and no past paper has been reproduced.
1. Why are implants and intrauterine devices more effective in practice than the combined pill?
Answer: Because they require no action from the user once in place. The pill must be remembered daily, so its typical-use effectiveness falls well below its perfect-use effectiveness, whereas for long-acting methods the two are almost identical.
2. Which component of a combined contraceptive carries the thromboembolic risk, and what follows from that?
Answer: The oestrogen. It follows that progestogen-only methods do not carry that risk, so a woman who cannot use oestrogen still has effective options — including the long-acting methods, which are more effective than the pill anyway.
3. A 38-year-old smoker requests the combined pill. How should this be handled?
Answer: Smoking over the age of 35 combined with oestrogen carries an increased cardiovascular and thromboembolic risk, so combined methods should be avoided. Explain why, and offer progestogen-only or long-acting alternatives rather than simply declining — the alternatives are more effective in typical use.
4. A woman describes headaches preceded by flashing lights in her vision. Why does this change her contraceptive options?
Answer: That is migraine with aura, which contraindicates oestrogen-containing methods. Migraine without aura does not carry the same restriction, so it is essential to ask specifically about preceding visual or neurological symptoms rather than about headaches in general.
5. A woman six weeks after delivery, breastfeeding and with no period yet, wants to avoid another pregnancy. What do you advise?
Answer: That fertility returns before the first period, so the absence of menstruation is not reassurance, and that breastfeeding alone is not reliable. A progestogen-only method is appropriate; oestrogen is avoided in the early postpartum weeks because clotting risk is highest then.
6. A woman worries that emergency contraception will cause an abortion. What is the accurate explanation?
Answer: It works principally by delaying or preventing ovulation, so it acts before fertilisation and does not end an established pregnancy. This matters practically as well as factually — the misunderstanding deters women from seeking it, and delay reduces its effectiveness.
7. A woman returns having stopped her contraceptive implant after two months because of irregular bleeding. What was the avoidable failure?
Answer: She was not warned in advance. Bleeding changes are the commonest reason methods are abandoned, and women told to expect them usually continue while those taken by surprise usually do not. Counselling before starting, not reassurance afterwards, is what prevents this.
8. Condoms are among the least effective methods for preventing pregnancy. Why might they still be the right recommendation?
Answer: Because they are the only method that also prevents sexually transmitted infection. Where that risk exists, condoms are recommended alongside a more effective contraceptive method rather than instead of one — the two goals require two different things.
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