A 16-year-old girl is brought by her mother to a district hospital with a 22-week pregnancy resulting from sexual assault, and her mother gives written consent for termination. Under the MTP Act as amended in 2021, whose opinion is required before the pregnancy is terminated?

Two registered medical practitioners

One registered medical practitioner

The district magistrate or a court

A 26-year-old second gravida chose an IUCD at her ANC visits. She has just had a normal vaginal delivery in the labour room of a Community Health Centre, the placenta is complete and there is no fever or prolonged rupture of membranes. She lives far away and says she is unlikely to come back for a postnatal visit. When is the IUCD best inserted?

Within 10 minutes of delivery of the placenta

After her first menstrual period returns

Between the third and seventh day after delivery

Twelve weeks after the delivery

A 26-year-old woman from rural Bihar has 4 years of primary infertility and scanty periods. Her HSG shows both tubes rigid and beaded with several constrictions, and dye does not spill from either end. Chest X-ray is normal, her husband's semen is normal and she has no fever. Which investigation is the most appropriate next step?

Endometrial biopsy for NAAT and culture

Sputum smear microscopy for acid-fast bacilli

Contraception, infertility and MTP Act

33 NEET-PG practice questions on Contraception, infertility and MTP Act, part of Obstetrics & Gynaecology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 16-year-old girl is brought by her mother to a district hospital with a 22-week pregnancy resulting from sexual assault, and her mother gives written consent for termination. Under the MTP Act as amended in 2021, whose opinion is required before the pregnancy is terminated?
1. AOne registered medical practitioner
2. BThe state-level Medical Board
3. CTwo registered medical practitioners
4. DThe district magistrate or a court
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Answer: C · Two registered medical practitioners
The MTP (Amendment) Act 2021 allows termination up to 20 weeks on the opinion of one registered medical practitioner, and from 20 to 24 weeks on the opinion of two, for special categories that include survivors of sexual assault and minors. Beyond 24 weeks termination is allowed only for substantial fetal abnormalities diagnosed by a Medical Board. Because she is under 18, the written consent of her guardian is needed. The doctor must also report a sexual offence against a child to the police under the POCSO Act, while the MTP Act keeps her identity confidential except from a person authorised by law.
- A: One practitioner is enough only up to 20 weeks.
- B: The Medical Board decides only beyond 24 weeks for fetal abnormalities.
- D: No court or magistrate permission is needed within 24 weeks.
Question 2 · Medium
A 26-year-old second gravida chose an IUCD at her ANC visits. She has just had a normal vaginal delivery in the labour room of a Community Health Centre, the placenta is complete and there is no fever or prolonged rupture of membranes. She lives far away and says she is unlikely to come back for a postnatal visit. When is the IUCD best inserted?
1. AWithin 10 minutes of delivery of the placenta
2. BAfter her first menstrual period returns
3. CBetween the third and seventh day after delivery
4. DTwelve weeks after the delivery
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Answer: A · Within 10 minutes of delivery of the placenta
A post-placental IUCD, inserted by hand or with a long placental forceps within 10 minutes of placental delivery, gives her long-term contraception before she leaves the facility. Insertion is also acceptable up to 48 hours after delivery, but between 48 hours and 6 weeks it is avoided because the involuting uterus raises the risk of perforation and expulsion. Expulsion is somewhat more common than with interval insertion, so she should check the threads and attend if they are missing. Chorioamnionitis, prolonged rupture of membranes and unresolved PPH are contraindications.
- B: Waiting for menses delays protection and risks an unplanned pregnancy in a woman unlikely to return.
- C: Insertion between 48 hours and 6 weeks after delivery is avoided because of perforation and expulsion.
- D: Waiting 12 weeks leaves her unprotected and she is unlikely to return.
Question 3 · Medium
A 30-year-old woman at 6 weeks of amenorrhoea requests medical abortion at a district hospital. Before prescribing mifepristone and misoprostol, the doctor checks for conditions that would rule out the medical method: 1. A pregnancy of unknown location on ultrasound with suspected ectopic pregnancy. 2. Chronic adrenal failure. 3. Inherited porphyria. 4. Breastfeeding a 5-month-old baby. Which conditions rule out medical abortion?
1. A1, 2 and 3 only
2. B2, 3 and 4 only
3. C1 and 3 only
4. D1, 2 and 4 only
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Answer: A · 1, 2 and 3 only
Medical abortion does not treat an ectopic pregnancy and can delay its diagnosis, so a suspected ectopic must be excluded first. Mifepristone also blocks glucocorticoid receptors, so it is contraindicated in chronic adrenal failure, and both drugs are avoided in inherited porphyria. Breastfeeding is not a contraindication; only small amounts of misoprostol reach the milk. An IUCD in place must be removed before the regimen is started.
- B: Includes breastfeeding, which is not a contraindication, and leaves out ectopic pregnancy.
- C: Leaves out chronic adrenal failure, a contraindication because mifepristone is antiglucocorticoid.
- D: Includes breastfeeding and leaves out inherited porphyria.
Question 4 · Hard
A 26-year-old woman from rural Bihar has 4 years of primary infertility and scanty periods. Her HSG shows both tubes rigid and beaded with several constrictions, and dye does not spill from either end. Chest X-ray is normal, her husband's semen is normal and she has no fever. Which investigation is the most appropriate next step?
1. ATuberculin skin test
2. BSerum CA-125 estimation
3. CEndometrial biopsy for NAAT and culture
4. DSputum smear microscopy for acid-fast bacilli
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Answer: C · Endometrial biopsy for NAAT and culture
Rigid, beaded tubes with multiple constrictions and blocked ends, with scanty periods, in a woman from an endemic area suggest female genital tuberculosis, a common cause of tubal infertility in India. The diagnosis is confirmed microbiologically on an endometrial sample, traditionally taken just before menstruation, sent for a nucleic acid amplification test such as CBNAAT, culture and histology. A positive result is treated with standard antitubercular therapy under NTEP. Tubal damage is often permanent, so many women later need IVF.
- A: A positive tuberculin test shows infection, not active genital disease, in an endemic area.
- B: CA-125 is non-specific and is raised in many pelvic conditions.
- D: Sputum testing is unhelpful when the chest X-ray is normal and the disease is genital.
Question 5 · Medium
A 25-year-old woman attends a PHC 4 months after delivery. She is breastfeeding day and night, her periods have not returned and she asks whether breastfeeding alone will prevent pregnancy. The medical officer reviews three conditions: 1. The baby is less than 6 months old. 2. Her menstrual periods have not returned. 3. She is fully or nearly fully breastfeeding. Which conditions must all be present for the lactational amenorrhoea method to be relied on?
1. A1, 2 and 3
2. B1 and 2 only
3. C1 and 3 only
4. D2 and 3 only
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Answer: A · 1, 2 and 3
The lactational amenorrhoea method is about 98% effective only while all three conditions hold: the baby is under 6 months, the mother has no menstrual bleeding, and she is fully or nearly fully breastfeeding, day and night. Frequent suckling disrupts the pulsatile release of GnRH, so follicles do not mature and ovulation is suppressed. As soon as any one condition fails, ovulation can return before the first period, and she needs another method. Progestogen-only methods and a copper IUCD can be started without affecting milk.
- B: Leaves out full breastfeeding; supplementary feeds let ovulation return.
- C: Leaves out amenorrhoea; once periods return she may already be ovulating.
- D: Leaves out the age of the baby; protection is not reliable beyond 6 months.
Question 6 · Medium
A 22-year-old mother who is exclusively breastfeeding attends a PHC 6 weeks after delivery and chooses the injectable contraceptive Antara (DMPA). The medical officer plans her counselling: 1. It is given as 150 mg intramuscularly every 3 months. 2. Fertility returns within 2 to 4 weeks of missing an injection. 3. Long-term use lowers bone mineral density, which largely recovers after stopping. 4. It can be started now while she is breastfeeding. Which statements are correct?
1. A1 and 3 only
2. B1, 2 and 4 only
3. C1, 2, 3 and 4
4. D1, 3 and 4 only
Answer and explanation in LearnFree account
Question 7 · Easy
A 30-year-old woman comes to the gynae OPD 18 hours after a condom burst during intercourse. She is on day 13 of a regular 28-day cycle, does not want a pregnancy now and prefers tablets. Which regimen is the most appropriate?
1. ALevonorgestrel 1.5 mg as a single dose
2. BMisoprostol 800 µg as a single dose
3. CNorethisterone 5 mg as a single dose
4. DMedroxyprogesterone 10 mg as a single dose
Answer and explanation in LearnFree account
Question 8 · Easy
A 29-year-old woman with primary infertility and regular 28-day cycles is booked for hysterosalpingography at a district hospital to test tubal patency. On which days of her cycle should the test be done?
1. ADay 1 to 3
2. BDay 7 to 10
3. CDay 21 to 24
4. DDay 14 to 16
Answer and explanation in LearnFree account
Question 9 · Medium
A 28-year-old married woman with a 10-week pregnancy after a contraceptive failure requests termination at a government hospital. Her husband comes with her and refuses to sign, saying he wants the child. She is mentally sound. Whose consent is required for the termination?
1. AConsent of her parents
2. BHer husband's written consent
3. CHer own written consent alone
4. DWritten consent of both spouses
Answer and explanation in LearnFree account
Question 10 · Medium
A 37-year-old woman who smokes 20 cigarettes a day attends the gynae OPD for contraception. She is normotensive, has no migraine and has two children. She asks for the pill her sister uses, an ethinylestradiol and levonorgestrel combination. Which method is the most appropriate for her?
1. ACombined vaginal ring
2. BMonthly combined injectable
3. CCopper IUCD
4. DCombined oral pill
Answer and explanation in LearnFree account
Question 11 · Medium
A 24-year-old woman on the combined oral pill is diagnosed with pulmonary tuberculosis at a PHC and started on isoniazid, rifampicin, pyrazinamide and ethambutol. She wants to avoid pregnancy during treatment. What contraceptive advice is most appropriate?
1. ASwitch to the etonogestrel implant
2. BSwitch to a copper IUCD
3. CContinue the same pill unchanged
4. DSwitch to the progestogen-only pill
Answer and explanation in LearnFree account
Question 12 · Medium
A 29-year-old woman with secondary infertility has irregular periods and milky nipple discharge. She takes no drugs. Serum prolactin is 96 ng/mL (reference below 25 ng/mL), TSH is normal and MRI shows a 7 mm pituitary microadenoma with normal visual fields. Which treatment is the most appropriate?
1. ATranssphenoidal surgery
2. BLevothyroxine
3. CCabergoline
4. DClomiphene citrate
Answer and explanation in LearnFree account
Question 13 · Medium
A 40-year-old para 2 with hypertension controlled on amlodipine (BP 138/88 mm Hg) has heavy regular periods. Her haemoglobin is 9.6 g/dL, ultrasound shows a normal-sized uterus with no fibroid or polyp, and an endometrial biopsy is normal. She also wants reliable contraception. What is the most appropriate treatment?
1. ALaparoscopic tubal ligation
2. BCombined oral contraceptive pill
3. CCu IUCD 380A
4. DLevonorgestrel intrauterine system
Answer and explanation in LearnFree account
Question 14 · Easy
A 25-year-old woman with one child attends a Primary Health Centre for spacing. After counselling she chooses the Cu IUCD 380A, which is inserted without problems. She asks how long the device will protect her. Under the national family planning programme, for how long is this device approved?
1. A7 years
2. B3 years
3. C10 years
4. D5 years
Answer and explanation in LearnFree account
Question 15 · Medium
A 30-year-old woman had a dilatation and curettage for retained products 10 days after her second delivery. Since then her periods have become scanty and then stopped, and she has not conceived for 2 years. Pregnancy test is negative, FSH, prolactin and TSH are normal, and there is no withdrawal bleeding after oestrogen followed by progestogen. What is the investigation of choice?
1. APelvic MRI
2. BEndometrial biopsy
3. CHysterosalpingography
4. DHysteroscopy
Answer and explanation in LearnFree account
Question 16 · Medium
A 36-year-old woman with 3 years of primary infertility is being assessed before IVF at an infertility clinic. The doctor wants one blood test of ovarian reserve that can be drawn on any day of the cycle and best predicts her response to stimulation. Which test is the most appropriate?
1. ADay 21 serum progesterone
2. BDay 3 serum oestradiol
3. CSerum anti-Müllerian hormone
4. DDay 3 serum FSH
Answer and explanation in LearnFree account
Question 17 · Hard
A 31-year-old woman with primary infertility has regular cycles of 35 days. To confirm ovulation, a serum progesterone was taken on day 21 of her cycle and was 1.2 ng/mL. Her husband's semen analysis is normal and her HSG shows patent tubes. What is the most appropriate next step?
1. ADiagnose a luteal phase defect
2. BRepeat serum progesterone on day 28
3. CRepeat serum progesterone on day 21
4. DStart letrozole for anovulation
Answer and explanation in LearnFree account
Question 18 · Easy
A 34-year-old man with three children undergoes no-scalpel vasectomy at a district hospital sterilisation camp. Before discharge he asks whether he and his wife can stop using condoms from the next day. What is the correct advice?
1. AUse condoms only for the next 20 days after surgery
2. BHis wife should take pills for one year
3. CNo other method is needed after one week
4. DUse condoms until semen shows no sperm at 3 months
Answer and explanation in LearnFree account
Question 19 · Hard
A 30-year-old man with 3 years of primary infertility has a semen volume of 0.8 mL, pH 6.6, no sperm in the centrifuged sample and fructose absent. Both testes are of normal size, the vasa deferentia cannot be felt in the scrotum and his FSH is normal. ICSI with surgically retrieved sperm is planned. Which genetic test should be offered before treatment?
1. ACFTR mutation testing of both partners
2. BY chromosome AZF microdeletion test
3. CKaryotype of the man for 47,XXY
4. DKaryotype of the woman for Turner mosaicism
Answer and explanation in LearnFree account
Question 20 · Hard
A 22-year-old woman with epilepsy controlled on carbamazepine also has migraine with aura. She comes to the gynae OPD for contraception, wants no pregnancy for 5 years, and says she cannot remember daily tablets. Which method is the most appropriate for her?
1. AEtonogestrel subdermal implant
2. BCopper IUCD
3. CProgestogen-only pill
4. DCombined pill containing 50 µg oestrogen
Answer and explanation in LearnFree account
Question 21 · Medium
Which of the following changes were brought in by the Medical Termination of Pregnancy (Amendment) Act 2021? 1. The upper limit was raised from 20 to 24 weeks for special categories of women. 2. The contraceptive-failure ground was extended from married women to any woman or her partner. 3. A married woman now needs her husband's consent for termination. 4. Medical Boards in each state decide on termination beyond 24 weeks for substantial fetal abnormalities.
1. A1 and 2 only
2. B2, 3 and 4 only
3. C1, 2, 3 and 4
4. D1, 2 and 4 only
Answer and explanation in LearnFree account
Question 22 · Easy
A 25-year-old woman with a 6-week intrauterine pregnancy chooses medical termination at a district hospital. She is first given an oral tablet of mifepristone, to be followed by misoprostol. How does mifepristone act?
1. AProgesterone receptor antagonist
2. BProstaglandin E1 analogue
3. COxytocin receptor agonist
4. DSelective oestrogen receptor modulator
Answer and explanation in LearnFree account
Question 23 · Medium
A 34-year-old man is evaluated at an infertility clinic. After 3 days of abstinence his semen shows: volume 2.6 mL, sperm concentration 5 million/mL, progressive motility 14% and normal forms 2% (WHO 2021 lower reference limits: volume 1.4 mL, concentration 16 million/mL, progressive motility 30%, normal forms 4%). How is this report best described?
1. AOligoasthenoteratozoospermia
2. BOligoasthenozoospermia
3. CAsthenoteratozoospermia
4. DOligoteratozoospermia
Answer and explanation in LearnFree account
Question 24 · Hard
A 31-year-old woman with 3 years of primary infertility had pelvic inflammatory disease in the past. HSG showed both tubes dilated and blocked at their fimbrial ends, and transvaginal ultrasound shows bilateral fluid-filled hydrosalpinges. Her AMH is normal and her husband's semen is normal. IVF is planned at the infertility clinic. What should be done before the embryo transfer?
1. AIntrauterine insemination for 3 cycles
2. BTubal reconstructive surgery and wait
3. CLaparoscopic salpingectomy of both tubes
4. DProceed to IVF with no tubal surgery
Answer and explanation in LearnFree account
Question 25 · Medium
A 23-year-old newly married woman at a gynae OPD wants to delay her first pregnancy for 3 years. She works night shifts, often forgets tablets and asks which method fails least often in real-life use. Which method has the lowest typical-use failure rate in the first year?
1. AInjectable DMPA
2. BEtonogestrel subdermal implant
3. CCopper IUCD
4. DCombined oral pill
Answer and explanation in LearnFree account

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Contraception, infertility and MTP Act

A 16-year-old girl is brought by her mother to a district hospital with a 22-week pregnancy resulting from sexual assault, and her mother gives written consent for termination. Under the MTP Act as amended in 2021, whose opinion is required before the pregnancy is terminated?

A 30-year-old woman comes to the gynae OPD 18 hours after a condom burst during intercourse. She is on day 13 of a regular 28-day cycle, does not want a pregnancy now and prefers tablets. Which regimen is the most appropriate?

A 29-year-old woman with primary infertility and regular 28-day cycles is booked for hysterosalpingography at a district hospital to test tubal patency. On which days of her cycle should the test be done?

A 28-year-old married woman with a 10-week pregnancy after a contraceptive failure requests termination at a government hospital. Her husband comes with her and refuses to sign, saying he wants the child. She is mentally sound. Whose consent is required for the termination?

A 37-year-old woman who smokes 20 cigarettes a day attends the gynae OPD for contraception. She is normotensive, has no migraine and has two children. She asks for the pill her sister uses, an ethinylestradiol and levonorgestrel combination. Which method is the most appropriate for her?

A 24-year-old woman on the combined oral pill is diagnosed with pulmonary tuberculosis at a PHC and started on isoniazid, rifampicin, pyrazinamide and ethambutol. She wants to avoid pregnancy during treatment. What contraceptive advice is most appropriate?

A 29-year-old woman with secondary infertility has irregular periods and milky nipple discharge. She takes no drugs. Serum prolactin is 96 ng/mL (reference below 25 ng/mL), TSH is normal and MRI shows a 7 mm pituitary microadenoma with normal visual fields. Which treatment is the most appropriate?

A 25-year-old woman with one child attends a Primary Health Centre for spacing. After counselling she chooses the Cu IUCD 380A, which is inserted without problems. She asks how long the device will protect her. Under the national family planning programme, for how long is this device approved?

A 36-year-old woman with 3 years of primary infertility is being assessed before IVF at an infertility clinic. The doctor wants one blood test of ovarian reserve that can be drawn on any day of the cycle and best predicts her response to stimulation. Which test is the most appropriate?

A 31-year-old woman with primary infertility has regular cycles of 35 days. To confirm ovulation, a serum progesterone was taken on day 21 of her cycle and was 1.2 ng/mL. Her husband's semen analysis is normal and her HSG shows patent tubes. What is the most appropriate next step?

A 34-year-old man with three children undergoes no-scalpel vasectomy at a district hospital sterilisation camp. Before discharge he asks whether he and his wife can stop using condoms from the next day. What is the correct advice?

A 22-year-old woman with epilepsy controlled on carbamazepine also has migraine with aura. She comes to the gynae OPD for contraception, wants no pregnancy for 5 years, and says she cannot remember daily tablets. Which method is the most appropriate for her?

A 25-year-old woman with a 6-week intrauterine pregnancy chooses medical termination at a district hospital. She is first given an oral tablet of mifepristone, to be followed by misoprostol. How does mifepristone act?

A 23-year-old newly married woman at a gynae OPD wants to delay her first pregnancy for 3 years. She works night shifts, often forgets tablets and asks which method fails least often in real-life use. Which method has the lowest typical-use failure rate in the first year?