INI-CET High Yield Questions for OBGYN

Mastering the INI-CET demands a strategic approach to preparation, with an emphasis on high-yield topics proving to be a successful tactic. This blog zeroes in on exactly that – a curated list of high-yield questions in OBS-GYN that are highly likely to appear on the INI-CET. By acquainting yourself with these questions and their detailed explanations, you'll deepen your understanding of obstetrics and gynecology concepts, enhancing your confidence and readiness for exam day.

1. A 23-year-old primigravida presents in labor for delivery. She is a known case of rheumatic heart disease. After delivery of the placenta, the patient starts to bleed heavily. All of the following drugs may be used for management, except?

A.Misoprostol

B. Methylergometrine

C. Oxytocin

D. Carboprost

Correct Option: B

• Methylergometrine is an ergot alkaloid that stimulates uterine contractions and is used to manage postpartum hemorrhage.
• However, it causes vasoconstriction which can greatly increase BP.

Incorrect Options:

Option A: Misoprostol

• Misoprostol is contraindicated in hemodynamic instability, ectopic pregnancy, and Inflammatory Bowel Diseases.

Option C: Oxytocin

• Oxytocin is contraindicated in the following conditions:
  • Uterine tachysystole
  • Hypersensitivity
  • When delivery can not be performed vaginally

Option D: Carboprost

• It is contraindicated in asthma

2. Which of the following is associated with increased risk for the complication, shown below?

1. Premature rupture of membranes
2. Postpartum hemorrhage
3. Fetal exsanguination before labour
4. Fetal neural tube defects.

Correct Option C:

• The image of the placenta shows vessels from the umbilical cord traveling within the membrane unsupported (velamentous cord), while the USG image also suggests vessels from the cord near the fetal presenting part in the lower segment.

• Such findings are suggestive of velamentous cord with vasa previa.

Vasa previa

• Presence of velamentous cord at the level of Internal Os.
• Rupture of the membranes involving the overlying vessels lead to vaginal bleeding.
• As it is entirely fetal blood, this may result in fetal exsanguination and even death in more than 50% of cases.
• Diagnosis is best made by doppler

Incorrect Options:

Option A:

• There is no increased risk of PROM.

Option B:

• Vasa previa may be associated with increased risk of PPH given its association with placenta previa, but this is less likely a complication than fetal exsanguination.

Option D:

• There is no increased risk of fetal malformations with vasa previa.

3. A 22-year-old primigravida presents to the antenatal clinic in the second month of pregnancy with complaints of cough, hemoptysis, night sweats, and fever. She is diagnosed with pulmonary tuberculosis after relevant investigations. Which of the following anti-tubercular drug combination s may be given to this patient?

1. Any of the 1st line drugs except streptomycin
2. Any of the 1st line drugs except ethambutol
3. Only 2nd line agents can be used in pregnancy
4. ATT should be started only in the second trimester

Correct Option:

Option A: Any of the 1st line drugs except streptomycin

• Streptomycin is the only first-line anti-TB drug documented to have harmful effects on the human fetus (congenital deafness) and should not be used.
• Streptomycin is contraindicated in pregnancy.

Incorrect Options:

Option B: Any of the 1st line drugs except ethambutol

• Among the 1^st line anti-TB drugs, streptomycin is the only one contraindicated in pregnancy. Ethambutol can be used in pregnancy.

Option C: Only 2nd line agents can be used in pregnancy

• First-line anti-TB drugs can be used in pregnancy, except streptomycin. They are more effective than 2^nd line drugs.

Option D: ATT should be started only in the second trimester

• ATT should be started as soon as TB is confirmed. It can be started in the 1^st trimester.

4. A 26-year-old pregnant woman, G3P2 at the gestation of 12 weeks has come to the hospital. She has a history of conisation one year back, and currently, she is on follow-up with no recurrence of cervical abnormalities on the Pap smear. She also has a history of preterm births at 30 and 32 weeks during her last 2 pregnancies. Which of the following would be the next step in managing this patient?

1. Termination of pregnancy
2. Cervical cerclage
3. Complete bed rest
4. Ecosprin + LMWH

Correct Option B: Cervical cerclage

• Conization, also known as a cone biopsy, is a surgical procedure in which a cone-shaped wedge of tissue is removed from the cervix or other part of the body for examination and treatment of abnormal cells or lesions.
• Given the history of conization and previous preterm births, cervical cerclage may be considered. Cervical cerclage is a surgical procedure where a stitch is placed around the cervix to provide support and prevent cervical insufficiency. This can be a preventive measure to reduce the risk of preterm birth.

Incorrect Options:

Option A: Termination of pregnancy

• History of conisation and history of 2 preterm births is indicative that the patient has cervical insufficiency due to a short cervix. Women with a history of conization have a shorter cervical length.
• Termination of pregnancy is not indicated here, as strengthening the cervix can benefit the patient.

Option C: Complete bed rest

• Complete bed rest is advised; however, cervical cerclage is more definitive, which should be followed by rest.

Option D: Ecosprin + LMWH

• Ecosprin with LMWH is indicated in recurrent abortions due to antiphospholipid antibody syndrome.

5. A 28-year-old nulliparous woman is undergoing evaluation for infertility. She is being monitored for ovulation with serial ultrasounds and LH levels. Ovulation is expected after how many hours of the ‘Peak’ of the ‘Upstroke’ in this diagram here:

1. 0-6 hours
2. 10-12 hours
3. 12-24 hours
4. 24-36 hours

Correct Option:

Option B: 10-12 hours

• From the onset of the LH surge, it takes 24-36 hours and from the peak, it takes 10-12 hours to ovulate.
• The midcycle LH surge is responsible for a dramatic increase in local concentrations of prostaglandins and proteolytic enzymes in the follicle. These substances progressively weaken the follicular wall and ultimately allow a perforation to form.

Incorrect Options:

Option A: 0-6 hours

Option C: 12-24 hours

Option D: 24-36 hours

Also Read: INI-CET Previous Year Question Papers

6. A 28-year-old female with menorrhagia and primary infertility has a Hb of 8gm%. Hysteroscopic view of the uterus shows. What is the diagnosis?

1. Pedunculated subserosal fibroid
2. Submucosal Fibroid
3. Carcinoma Endometrium
4. Gestational sac

Correct Option:

Option B: Submucosal Fibroid

• In the image, a round, firm regular-edge mass is located in the uterine cavity attached to the stalk, so it is a submucosal fibroid.
• Submucosal fibroids are associated with heavy menstrual bleeding, intermenstrual bleeding, infertility, and pain.

Incorrect Options:

Option A: Pedunculated subserosal fibroid

• A pedunculated subserosal fibroid typically extends outward from the outer surface of the uterus (serosa) and is not expected to be visualized within the uterine cavity on hysteroscopy. This option is less likely given the hysteroscopic view.

Option C: Carcinoma Endometrium

• Carcinoma of the endometrium is a malignant condition affecting the lining of the uterus. It is not typically visualized as a mass within the uterine cavity on hysteroscopy. The primary presentation of endometrial carcinoma includes abnormal uterine bleeding.

Option D: Gestational sac

• A gestational sac is not expected to be visualized on hysteroscopy in a non-pregnant state. Additionally, the symptoms of menorrhagia and primary infertility are not typically associated with a gestational sac.

7. A 23-year-old female patient presents to the clinic with complaints of pain and occasional bleeding after sexual intercourse The clinicians decide to do a per-vaginal examination. She uses the instrument shown below to perform the procedure. What is the name of the instrument shown below?

1. Ayre's spatula
2. Cusco's speculum
3. Sim's double-bladed speculum
4. Doyen's retractor

Correct Option:

Option B: Cusco's Speculum Or Duck-Billed Speculum

• It is a stainless steel instrument with 2 concave Blades attached by a hinge.
• It is self-retaining.
• It is used to inspect the vagina for doing a Pap smear or a biopsy

Incorrect Options:

Option A: Ayre spatula

• The Ayre spatula is used for collecting Pap smears. It is a hardwood spatula with a flat surface and U-shaped holes on the other. The large end is for vaginal samples, while the thin end is for collecting cervical samples.It is spun 360 degrees in the vagina to collect cells for a Pap smear test.
• After exposing the external os with a speculum, the Ayre spatula is inserted into the cervix.
• Cytology specimens are acquired by firmly moving the spatula over the ectocervix and rapidly transferring the cells to a slide or jar.

Option C: Sim's double-bladed speculum

• Sims' vaginal speculum is a surgical device with two blades to examine the vagina and cervix.
• Sims' speculum is placed into the vagina to retract the posterior vaginal wall. It exposes the vaginal walls better than Cusco's speculum and is preferable for gynecological procedures.The instrument can be moved around the vaginal wall to improve vision.
• The groove in the center of Sims' speculum allows secretions and blood to flow freely to the outside, keeping the region dry.

Option D: Doyen’s retractor

• The Doyen's retractor is a handheld retractor mostly used in abdominal surgeries such as abdominal hysterectomies, caesarean section births, and ectopic pregnancy treatments. This handheld equipment also has a hooked handle, which may help the surgeon maintain a stronger grasp.

8. A 25-year-old female underwent induced ovulation. On USG, the ovary showed 8 developing follicles. The serum estradiol level was 800 pg/ml. What is the next step in the management of this patient?

1. Retrieve follicles
2. Give cabergoline
3. Cancel cycle
4. Withhold human chorionic gonadotropin (HCG)

Correct Option:

Option D: Withhold human chorionic gonadotropin (HCG)

• One follicle makes around 150-200 pg of estradiol. Once the follicles are ready in size, around 17-20 mm on USG, then the trigger of HCG is given for final oocyte maturity follicular rupture.
• For 8 follicles, the estradiol should be around the 1200-1600 range. So we can do two things:
• Either cancel the cycle, but with 8 follicles, it's not a wise step since more than 3 are adequate to attempt an oocyte aspiration.
• Or withhold the HCG, a prudent step here, to wait for another couple of days for the estradiol to hopefully rise and then give the trigger of HCG.

Incorrect Options:

Option A: Retrieve follicles

• In this case, 8 follicles have already been formed, which is adequate for ovulation. So, withholding the HCG is the best option.

Option B: Give cabergoline

• Cabergoline is used to treat of hyperprolactinemia.

Option C: Cancel cycle

• With 8 follicles, it’s not wise to cancel the cycle since more than 3 are adequate to attempt an oocyte aspiration.

9. A 31-year-old female, P1L1, underwent a routine pap smear, which was reported as CIN III (High-Grade Squamous Intraepithelial Lesion/ HSIL). The colposcopy showed an area of abnormal cells around her cervix. What will be the next step in management?

1. Trachelectomy
2. Hysterectomy
3. Conization
4. Colposcopy biopsy

Correct Option:

Option D: Colposcopy biopsy

• A colposcopy is recommended if cervical screening finds cell HPV-induced cell changes.
• These dysplastic cells can turn into cervical cancer cells.
• Colposcopy is a procedure that examines the cervix for abnormal tissue and takes a biopsy if needed.
• If CIN III is found, the next step is a colposcopy-directed biopsy for tissue diagnosis and to plan further management

Incorrect Options:

Option A: Trachelectomy

• Surgical removal of the cervix, is called trachelectomy.
• Trachelectomy is done in younger women with early cervix cancer (with a tumor no larger than 2-3 centimeters).
• Trachelectomy need not be done in premalignant lesions in a young female unless a biopsy proves invasive carcinoma.

Option B: Hysterectomy

• A hysterectomy is not done for CIN III unless a biopsy proves cancer

Option C: Conization

• Conization of the cervix is defined as the excision of a cone-shaped or cylindrical wedge from the cervix uteri that includes the transformation zone and all or a portion of the endocervical canal.
• Conization is not done in a young patient with an incomplete family as it causes
  • Short cervix→ cervical incompetence → abortions
  • Stenosis→ Infertility

10. A 62-year-old woman has postmenopausal bleeding after 13 years of menopause. She has hypertension and type 2 diabetes mellitus. An endometrial biopsy is performed showing grade I endometrial adenocarcinoma. Which of the following is the most appropriate next step in management?

A.Chemotherapy

B. Cone biopsy

C. HRT

D. Hysterectomy

Correct Option:

Option D:

• Hysterectomy, or surgical removal of the uterus, is a common and often curative treatment for endometrial adenocarcinoma. In cases of grade I endometrial adenocarcinoma, particularly when diagnosed early, hysterectomy may be the primary treatment. This surgical intervention aims to remove the cancerous tissue and prevent its spread.

Incorrect Options:

Option A:

• Chemotherapy is generally not the first-line treatment for early-stage, low-grade endometrial adenocarcinoma. It is more commonly considered for advanced or recurrent cases. The standard initial treatment for grade I endometrial adenocarcinoma is often surgery (hysterectomy).

Option B:

• Cone biopsy is used for diagnosis of cervical cancer in cases of cervical growth, or for treatment of stage 1A1 cancer without lymphovascular space invasion. This has no role in the management of endometrial cancer.

Option C:

• Hormone Replacement Therapy (HRT) is not appropriate in the management of endometrial adenocarcinoma. This is because estrogen replacement, a component of HRT, can stimulate the growth of endometrial cancer cells. In the context of endometrial adenocarcinoma, estrogen exposure is generally minimized rather than replaced.

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