Contraception: smoking over 35: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Contraception: smoking over 35

Sample item

A 37-year-old who smokes 20 cigarettes daily requests the combined oral contraceptive pill. What is the advice?

AAdvise it only after 2 years of smokingBPrescribe a higher oestrogen doseCAvoid it, as it is category 4 for smokers aged 35 or more who smoke 15 or more cigarettes a dayDIt is safe for all smokers

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Avoid it, as it is category 4 for smokers aged 35 or more who smoke 15 or more cigarettes a day

Smoking plus oestrogen increases arterial thrombotic and cardiovascular risk, which rises with age. For women of 35 or more, combined methods are category 3 for fewer than 15 cigarettes and category 4 for 15 or more per day. Alternative methods and smoking cessation support should be offered.

Option by option

A. Advise it only after 2 years of smoking
There is no time-based exception.
B. Prescribe a higher oestrogen dose
A higher dose of oestrogen increases the risk.
C. Avoid it, as it is category 4 for smokers aged 35 or more who smoke 15 or more cigarettes a day (correct)
Correct. Heavy smoking over 35 makes combined pills unacceptable.
D. It is safe for all smokers
The risk is significant after 35 years.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this OBG question

What is the answer to this OBG question?

The best answer is C, Avoid it, as it is category 4 for smokers aged 35 or more who smoke 15 or more cigarettes a day. Smoking plus oestrogen increases arterial thrombotic and cardiovascular risk, which rises with age.

Why is "Advise it only after 2 years of smoking" not the answer?

There is no time-based exception.

Why is "Prescribe a higher oestrogen dose" not the answer?

A higher dose of oestrogen increases the risk.

Why is "It is safe for all smokers" not the answer?

The risk is significant after 35 years.

What concept does this question test?

It tests Contraception: smoking over 35 in OBG. For women of 35 or more, combined methods are category 3 for fewer than 15 cigarettes and category 4 for 15 or more per day. Alternative methods and smoking cessation support should be offered.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Contraception: smoking over 35?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.