INI-CET 2026 - Obstetrics and Gynecology PYQs Practice Questions

Q: A 34-year-old female, G2P1, with a history of pre-eclampsia in her previous pregnancy, comes for her first ANC visit at 12 weeks. What is the most appropriate intervention for prevention of pre- eclampsia in her current pregnancy?

Low-dose aspirin. ### ***Low-dose aspirin*** - Per ACOG and USPSTF guidelines, **low-dose aspirin** (81 mg/day) is recommended for the prevention of pre-eclampsia in high-risk women starting between 12 and 28 weeks of gestation (ideally before 16 weeks). - A history of **pre-eclampsia** in a previous pregnancy is a high-risk factor that mandates prophylactic treatment to reduce morbidity. *Low-dose aspirin with Low Molecular Weight Heparin (LMWH)* - There is no clinical indication for the routine addition of **LMWH** to aspirin for pre-eclampsia prevention unless the patient has a diagnosed **thrombophilia** or **antiphospholipid syndrome**. - Adding anticoagulation unnecessarily increases the risk of bleeding complications without clear benefit in reducing pre-eclampsia related outcomes. *Low calcium intake* - Current evidence-based guidelines recommend **calcium supplementation** for high-risk populations, specifically in areas with low dietary calcium intake, rather than restricting it. - Studies show that **calcium supplementation** (1–2 g/day) helps reduce the risk of pre-eclampsia, whereas "low" intake is not a therapeutic intervention. *Low salt intake* - Routine **sodium restriction** is not recommended for pregnancy as it does not prevent pre-eclampsia or gestational hypertension. - Maintaining a normal, balanced diet is advised; significant salt restriction may lead to inadequate fetal nutrition without maternal benefit. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A 21-year-old girl presents with primary amenorrhea. Examination shows absent uterus, present breast development, and sparse pubic and axillary hair. What is the genetic etiology?

MRKH. ***Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome*** - Characterized by **Müllerian agenesis** (absent uterus and upper two-thirds of the vagina), which explains the primary amenorrhea despite normal ovarian function. - Patients have a **46,XX** karyotype, normal breast development due to functional ovaries, and normal secondary sexual characteristics, though pubic hair may be lighter depending on individual variance. *Androgen insensitivity syndrome (AIS)* - Presents with **46,XY karyotype** and **testis** (often undescended) rather than ovaries, and markedly absent pubic and axillary hair due to lack of androgen effect. - While breast development is present, it is due to aromatization of testicular testosterone to estrogen; this is distinguished from MRKH by the presence of testes and absent uterus. *Turner's syndrome* - Presents with **streak gonads** and hypergonadotropic hypogonadism, meaning patients typically have **absent breast development** without hormone replacement therapy. - Associated with a **45,X karyotype**, short stature, and other phenotypic features like webbed neck, rather than normal development with absent uterus. *Congenital adrenal hyperplasia (CAH)* - Typically presents with **ambiguous genitalia** in infancy due to virilization, though late-onset forms may present later. - Patients usually have a uterus, and findings typically involve excessive androgen production (acne, hirsutism, menstrual irregularities) rather than absent Müllerian structures. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Match the following conditions with their hormonal profiles: Condition Hormonal Profile 1. PCOS A. Normal FSH, Normal LH, Normal Estradiol B. Decreased FSH, Decreased LH, Decreased 2. Primary Ovarian Failure Estradiol C. Increased LH, Normal to Low FSH (High 3. Asherman Syndrome LH:FSH ratio) 4. Sheehan Syndrome D. Markedly Increased FSH, Low Estradiol

1-C, 2-D, 3-A, 4-B. ***1-C, 2-D, 3-A, 4-B*** - **PCOS (1-C)** is classically associated with an **increased LH:FSH ratio** (often >2:1 or >3:1) due to dysfunctional feedback mechanisms, while **Primary Ovarian Failure (2-D)** presents with **hypergonadotropic hypogonadism** characterized by **markedly elevated FSH** due to lack of negative feedback from the ovaries. - **Asherman Syndrome (3-A)** is an anatomical cause of amenorrhea due to intrauterine adhesions, meaning the **hypothalamic-pituitary-ovarian axis** remains intact, resulting in **normal hormonal levels**; conversely, **Sheehan Syndrome (4-B)** is caused by pituitary necrosis after postpartum hemorrhage, leading to **hypogonadotropic hypogonadism** (decreased FSH, LH, and Estradiol). *1-A, 2-B, 3-C, 4-D* - This sequence incorrectly maps **Asherman Syndrome** to PCOS and **Sheehan Syndrome** to ovarian failure. - Asherman Syndrome does not typically present with the hormonal dysregulation seen in PCOS or specific pituitary failure. *1-D, 2-C, 3-B, 4-A* - This sequence incorrectly associates **PCOS** with the high FSH of ovarian failure and **Primary Ovarian Failure** with the LH:FSH ratio pattern of PCOS. - These endocrine profiles are fundamentally reversed compared to their physiological mechanisms. *1-C, 2-A, 3-D, 4-B* - This sequence incorrectly identifies **Asherman Syndrome** as having the high FSH profile associated with ovarian failure. - Furthermore, it mistakenly suggests **Primary Ovarian Failure** has a normal hormonal profile, when it is actually defined by elevated gonadotropins. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A woman presents with frothy green vaginal discharge, intense pruritus, and a negative Whiff test. What is seen on microscopy?

Motile flagellate organisms. ***Motile flagellate organisms*** - The clinical presentation of **frothy green vaginal discharge** and **intense pruritus** is classic for **Trichomoniasis**, caused by *Trichomonas vaginalis*. - Microscopy typically reveals **motile, flagellated protozoa** (pear-shaped) that are slightly larger than white blood cells, confirming the diagnosis. *Clue cells* - **Clue cells** (epithelial cells covered in bacteria) are the hallmark diagnostic finding for **Bacterial Vaginosis**. - Bacterial vaginosis typically presents with a **thin, grey-white discharge** and a **positive Whiff test**, which contrasts with this patient's negative test. *Yeasts with pseudo hyphae* - These are visualized in cases of **Vulvovaginal Candidiasis** (yeast infection) and indicate fungal colonization. - Candidiasis generally presents with a **thick, white, curd-like discharge** and intense external dysuria rather than frothy green fluid. *Candida* - *Candida albicans* is a fungal organism that typically requires pH testing or specific microscopic visualization (like potassium hydroxide prep) to confirm. - It is not the causative agent for green, frothy discharge, which is specifically characteristic of the protozoal infection **Trichomoniasis**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Which of the following is classified as a probable sign of pregnancy? A. Hegar's sign B. Goodell's sign C. Braxton Hicks contractions D. Seitz sign

A, B and C only. ***A, B and C only*** - **Hegar’s sign** (softening of the uterine isthmus), **Goodell’s sign** (softening of the cervix), and **Braxton Hicks contractions** are all well-established **probable signs of pregnancy** identified during physical examination. - These signs rely on objective physical findings related to the physiological changes of pregnancy, though they are not considered diagnostic confirmation like a positive ultrasound or fetal heart tones. *A and B only* - While **Hegar’s sign** and **Goodell’s sign** are indeed probable signs, this option incorrectly excludes **Braxton Hicks contractions**, which are also categorized as probable. - Excluding valid clinical indicators makes this answer choice incomplete for identifying the classic group of probable pregnancy signs. *B, C and D only* - This option incorrectly includes **Seitz sign**, which is not a standard recognized clinical sign of pregnancy, and excludes **Hegar’s sign**. - **Hegar’s sign** is a classic physical finding occurring in the first trimester, making its omission scientifically incorrect. *A, B, C and D* - This option incorrectly includes **Seitz sign**; there is no medically recognized diagnostic sign of pregnancy by that name. - The classification of **probable signs** strictly includes physiological physical changes, among which only A, B, and C qualify. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

A 34-year-old female, G2P1, with a history of pre-eclampsia in her previous pregnancy, comes for
her first ANC visit at 12 weeks. What is the most appropriate intervention for prevention of pre-
eclampsia in her current pregnancy?

Accepted Answer

Low-dose aspirin

Answer

Low-dose aspirin with Low Molecular Weight Heparin (LMWH)

Answer

Low calcium intake

Answer

Low salt intake

Question 2

A 21-year-old girl presents with primary amenorrhea. Examination shows absent uterus, present
breast development, and sparse pubic and axillary hair. What is the genetic etiology?

Accepted Answer

MRKH

Answer

Androgen insensitivity

Answer

Turner's syndrome

Answer

CAH

Question 3

Match the following conditions with their hormonal profiles:

Condition Hormonal Profile

1. PCOS A. Normal FSH, Normal LH, Normal Estradiol

B. Decreased FSH, Decreased LH, Decreased
2. Primary Ovarian Failure
Estradiol

C. Increased LH, Normal to Low FSH (High
3. Asherman Syndrome
LH:FSH ratio)

4. Sheehan Syndrome D. Markedly Increased FSH, Low Estradiol

Accepted Answer

1-C, 2-D, 3-A, 4-B

Answer

1-A, 2-B, 3-C, 4-D

Answer

1-D, 2-C, 3-B, 4-A

Answer

1-C, 2-A, 3-D, 4-B

Question 4

A woman presents with frothy green vaginal discharge, intense pruritus, and a negative Whiff
test. What is seen on microscopy?

Accepted Answer

Motile flagellate organisms

Answer

Clue cells

Answer

Yeasts with pseudo hyphae

Answer

Candida

Question 5

Which of the following is classified as a probable sign of pregnancy?
A. Hegar's sign
B. Goodell's sign
C. Braxton Hicks contractions
D. Seitz sign

Accepted Answer

A, B and C only

Answer

A and B only

Answer

B, C and D only

Answer

A, B, C and D

Question 6

Which of the following statements regarding the HPV vaccine is correct?

Accepted Answer

Primary target age is 9-14 years

Answer

One dose can be given instead of two

Answer

Live HPV vaccine is 100% protective for all HPV variants

Answer

90% of 15-year-old girls to be vaccinated

Question 7

A primigravida delivers the fetal head but the shoulders fail to deliver despite routine traction.
What is the first step in management?

Accepted Answer

McRoberts maneuver with suprapubic pressure

Answer

Wood's corkscrew maneuver

Answer

Rubin maneuver

Answer

Zavanelli maneuver

Question 8

A patient is unable to pass urine four hours after an instrumental vaginal delivery. Examination
reveals a bluish cystic swelling in the vaginal wall. What is the most likely diagnosis?

Accepted Answer

Vaginal hematoma

Answer

Perineal tear

Answer

Bartholin's cyst

Answer

Cystocoele

Question 9

What is the primary cause of mild breathlessness experienced during normal pregnancy?

Accepted Answer

Progesterone-induced stimulation of the respiratory centre

Answer

Decreased tidal volume

Answer

Reduced oxygen intake

Answer

Increased arterial PCO2 levels

INI-CET 2026 — Obstetrics and Gynecology