Competency-Based Question Bank: Reproductive Health

Section A: Competency-Based Multiple Choice Questions (Application & Analysis)

1. Analyze the Contraceptive Choice: A 30-year-old woman who has completed her family and desires a permanent method of contraception visits a clinic. She has a history of heavy menstrual bleeding. Which method would be contraindicated (not recommended)? a) Tubectomy b) Vasectomy for her husband c) LNG-20 IUD (Mirena) d) Copper-T IUD Answer: d) Copper-T IUD Explanation: Copper-releasing IUDs can increase menstrual flow and cramping in some women. For a patient already suffering from heavy bleeding (menorrhagia), this would worsen her condition. LNG-20 would actually be beneficial as it reduces bleeding.

2. Assertion (A): The "Saheli" pill is considered a significant advancement in contraception. Reason (R): It is a non-steroidal preparation with fewer side effects and a once-a-week dosage. a) Both A and R are true and R is the correct explanation of A. b) Both A and R are true but R is not the correct explanation of A. c) A is true but R is false. d) A is false but R is true. Answer: a) Both A and R are true and R is the correct explanation of A. Explanation: Developed by CDRI, Lucknow, Saheli uses centchroman (non-steroidal), which has very high contraceptive value with minimal side effects compared to traditional steroidal pills.

3. Evaluate the Scenario: A couple has been trying to conceive for 2 years. Tests reveal the male partner has a very low sperm count (oligospermia), and the female partner is healthy. Which ART method is the most direct solution? a) GIFT (Gamete Intrafallopian Transfer) b) IUI (Intra-Uterine Insemination) c) ZIFT (Zygote Intrafallopian Transfer) d) Surgical sterilization Answer: b) IUI (Intra-Uterine Insemination) Explanation: In IUI, semen is collected, concentrated, and injected directly into the uterus. This bypasses the need for a high sperm count to travel through the vagina and cervix.

4. Legal/Ethical Application: A doctor performs an amniocentesis solely to determine the sex of the fetus. Under which Indian Act is this action punishable? a) The Medical Termination of Pregnancy (MTP) Act b) The PCPNDT Act c) The POCSO Act d) The Consumer Protection Act Answer: b) The PCPNDT Act Explanation: The Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994, strictly prohibits the use of any technique for sex determination to prevent female foeticide.

5. Analyze the Graph: If a population pyramid shows a very broad base and a sharp tapering top, what does this indicate? a) Low birth rate, High life expectancy. b) High birth rate, High death rate (Rapid growth). c) Zero population growth. d) Declining population. Answer: b) High birth rate, High death rate (Rapid growth). Explanation: A broad base means many children (high natality). A sharp taper means few reach old age (high mortality). This is typical of an "Expanding" population.

6. Critical Thinking: Why is "Lactational Amenorrhea" not considered a reliable contraceptive method after 6 months postpartum? a) The baby starts weaning and suckling frequency decreases, lowering Prolactin. b) The uterus has fully recovered. c) Oxytocin levels drop significantly. d) The mother's nutritional status improves. Answer: a) The baby starts weaning and suckling frequency decreases... Explanation: Intense suckling triggers high Prolactin, which suppresses GnRH and ovulation. As the frequency drops (due to weaning/complementary foods), Prolactin drops, and the menstrual cycle resumes.

7. Identify the mismatch: Which STI is correctly matched? a) Genital Herpes - Virus - Curable b) Syphilis - Bacteria - Curable c) AIDS - Retrovirus - Curable d) Trichomoniasis - Protozoa - Incurable Answer: b) Syphilis - Bacteria - Curable Explanation: Bacterial STIs like Syphilis and Gonorrhea are curable with antibiotics. Viral STIs (AIDS, Herpes, Hepatitis B) are generally incurable. Trichomoniasis is a curable protozoan infection.

8. Assertion (A): IUDs like Copper-T are ideal contraceptives for females who want to delay pregnancy. Reason (R): They suppress sperm motility and the fertilizing capacity of sperm. a) Both A and R are true and R is the correct explanation of A. b) Both A and R are true but R is not the correct explanation of A. c) A is true but R is false. d) A is false but R is true. Answer: a) Both A and R are true and R is the correct explanation of A. Explanation: Copper ions released into the uterine fluid are toxic to sperm, reducing their motility and ability to fertilize the egg.

9. Predict the Consequence: If the government stops free distribution of contraceptives, what is the most likely demographic impact? a) Increase in MMR. b) A sharp rise in the birth rate (Natality). c) Increase in sex ratio. d) Decrease in IMR. Answer: b) A sharp rise in the birth rate (Natality). Explanation: Accessibility is key to population control. Lack of contraceptives leads to more unintended pregnancies and a higher birth rate.

10. Application: A female cannot produce ova but has a suitable environment for development. Which ART method should be used? a) ZIFT b) GIFT (using donor egg) c) IUI d) AI Answer: b) GIFT (using donor egg). Explanation: GIFT (Gamete Intrafallopian Transfer) involves placing an egg (from a donor) and sperm into her fallopian tube so fertilization can happen naturally in her body.

11. Reasoning: Why are "Natural Methods" like the Rhythm method highly prone to failure? a) Sperm can survive only 2 hours. b) Ovulation can be delayed or irregular due to stress/lifestyle. c) They require medical supervision. d) They have side effects. Answer: b) Ovulation can be delayed or irregular... Explanation: Natural methods depend on predicting the "Safe Period". Since biological cycles vary, miscalculating the day of ovulation leads to pregnancy.

12. Assertion (A): MTP is considered safe only during the first trimester. Reason (R): In the second trimester, the fetus becomes intimately associated with maternal tissues. a) Both A and R are true and R is the correct explanation of A. b) Both A and R are true but R is not the correct explanation of A. c) A is true but R is false. d) A is false but R is true. Answer: a) Both A and R are true and R is the correct explanation of A. Explanation: Surgical complexity and risk of maternal hemorrhage/infection increase significantly after 12 weeks of gestation.

13. Diagnosis: A patient has itching and fluid discharge. If left untreated, what is a potential complication? a) Improved fertility. b) Ectopic pregnancy or PID. c) Increased immunity. d) Weight gain. Answer: b) Ectopic pregnancy or PID. Explanation: Reproductive Tract Infections (RTIs) can lead to Pelvic Inflammatory Disease, which causes scarring of the fallopian tubes, leading to infertility or ectopic pregnancy.

14. Mechanism Analysis: How does the "Emergency Contraceptive" pill work? a) By inducing abortion. b) By preventing or delaying ovulation. c) By killing sperm. d) By blocking tubes. Answer: b) By preventing or delaying ovulation. Explanation: High doses of progestogens prevent the LH surge, stopping ovulation if it hasn't happened yet, or make the uterus hostile to implantation.

15. Ethical Evaluation: What is the primary ethical concern in commercial surrogacy? a) Health of the child. b) Exploitation of poor women for financial gain. c) Success rate. d) Donor identity. Answer: b) Exploitation of poor women for financial gain. Explanation: The "commodification" of the female body and the potential for wealthy individuals to exploit vulnerable women is a major human rights and ethical concern.

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Section B: Case-Study & Source-Based Questions

Case Study 1: The IVF Dilemma

Mrs. Sharma has blocked fallopian tubes. Mr. Sharma has a normal sperm count.

16. Select: Why is GIFT not a viable option? Answer: GIFT requires at least one healthy, open fallopian tube because the egg and sperm are placed inside the tube to fertilize naturally. Since hers are blocked, fertilization cannot occur there.

17. Sequence: Steps for IVF? Answer: 1. Ovarian Stimulation (Hormones) -> 2. Egg Retrieval (Surgery) -> 3. In vitro Fertilization (Lab) -> 4. Embryo Transfer.

18. Analyze: If embryo is at 8-cell stage, where is it placed? Answer: ZIFT (Zygote Intrafallopian Transfer). It is placed in the Fallopian Tube. (If >8 cells, it is IUT into the Uterus).

Case Study 2: graying population

Country X has an inverted population pyramid.

19. Evaluate: Long-term consequence? Answer: A shrinking workforce and an increased economic burden on the young to support a large elderly population.

20. Propose: Policy? Answer: Incentives for larger families, such as subsidized childcare, tax breaks for parents, and extended parental leave.

Case Study 3: The Silent Epidemic

Chlamydia and Gonorrhea are rising on a campus.

21. Identify: Why "silent"? Answer: They are often asymptomatic (especially in females). People don't feel sick, so they don't get tested and continue to spread the infection to partners.

22. Consequence: Untreated consequence? Answer: Pelvic Inflammatory Disease (PID), which can lead to permanent scarring of the fallopian tubes and Infertility.

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Section C: Creating, Designing & Critical Thinking

23. Designing a Campaign: Female Foeticide. Answer:

• Slogan: "Daughters are the Future, not a Burden."
• Target: Expectant parents and family elders.
• Legal Strategy: Mandatory registration of all ultrasound machines and tracking of scans.
• Social Strategy: "Sukanya Samriddhi" scheme – a savings bond for the girl child provided by the state.

24. Ethical Debate: Sex education in schools. Answer:

• Arguments FOR: 1. Reduces STIs/unintended pregnancies. 2. Empowers children to recognize and report abuse. 3. Dispels myths/misinformation from the internet.
• Counter-Arguments: 1. May offend religious beliefs. 2. Fear of encouraging early sexual activity (needs evidence-based curriculum). 3. Teachers may be uncomfortable (requires professional training).

25. Visualizing Data: Literacy vs Fertility. Answer:

• Relationship: Inverse. As female literacy increases, the TFR (Total Fertility Rate) decreases.
• Explanation: Educated women tend to marry later, have better knowledge of contraception, and prioritize their careers and the health of fewer children.

26. Formulating a Solution: IUD fear. Answer:

• Counseling Script: "It is perfectly normal to have some light spotting for the first 2-3 months. This is just your body adjusting to the copper. It is NOT an injury and will stop soon. The IUD is 99% effective and you don't have to remember a pill every day!"

27. Designing a Model: Vasectomy vs Condom. Answer:

• Vasectomy Model: Two straws (Vas deferens). Cut them and tie the ends with thread. Show that the straw is now blocked.
• Condom Model: A balloon over a finger.
• Lesson: Use two balloons. Balloon 1 (Testis) produces beads (sperm). Balloon 2 (Seminal vesicle) produces water (semen). In Vasectomy, the "bead" tube is tied, so only "water" comes out. Semen is produced, but it is "seedless."