INI-CET 2021 - Obstetrics and Gynecology Practice Questions

Q: A primigravida is in labor. Her per-vaginal examination revealed a posterior cervix with 5 cm cervical length, 1 cm dilatation, soft consistency, and head at -1 station. Calculate the Bishop score.

5. ***5*** - The Bishop score calculation: **cervical position** (posterior = 0), **cervical effacement** (5 cm length = 0), **dilation** (1 cm = 1), **consistency** (soft = 2), and **station** (-1 = 1). - According to standard **Dutta textbook** references, this totals to 5 points (0 + 0 + 1 + 2 + 1), with soft consistency correctly scoring 2 points. *3* - This score incorrectly assigns only **1 point for soft consistency** instead of the standard 2 points. - The miscalculation underestimates the **cervical readiness** for labor induction. *0* - A score of 0 would require all parameters to be at their **minimum values** (firm consistency, closed cervix, high station). - The given parameters show **1 cm dilation**, **soft consistency**, and **-1 station**, each contributing positive points. *8* - A high score of 8 indicates a **very favorable cervix** with significant effacement, anterior position, and greater dilation. - The current findings show **minimal effacement** (5 cm length), **posterior position**, and only **1 cm dilation**, inconsistent with such a high score.

Q: Identify the instrument given below.

Cusco's speculum. ***Cusco's speculum*** - This is a **bivalved, self-retaining speculum** with two articulated blades that open and close using a **thumbscrew/locking mechanism** at the handle. - Commonly used for **per speculum examination** to visualize the **cervix and vaginal walls** during gynecological procedures. *Sims' speculum* - A **single-bladed (univalve) speculum** that requires an **assistant to hold** during examination, unlike the self-retaining instrument shown. - Used to retract the **posterior vaginal wall** but lacks the dual-blade design visible in the image. *Graves' speculum* - Similar bivalved design to Cusco's but features **longer and wider blades** for better visualization in larger patients. - More commonly used in the **United States**, with a bulkier appearance than the instrument pictured. *Auvard's speculum* - A **weighted, self-retaining single-blade speculum** used as a **posterior vaginal retractor**. - Completely different design from the bivalved instrument shown, with only **one blade** and no locking mechanism.

Q: Double bleb sign seen in early pregnancy is due to?

Yolk sac and amniotic sac. ***Yolk sac and amniotic sac*** - The **double bleb sign** on ultrasound refers to the separate visualization of the **yolk sac** and the **amniotic sac** within the gestational sac. - This sign is a crucial indicator of a **viable intrauterine pregnancy** in the early stages, typically between 5.5 and 6.5 weeks of gestation. *Amnion and chorion* - The **amnion** and **chorion** are membranes that form later in pregnancy and eventually fuse. - While they are distinct structures, their visualization does not constitute the "double bleb sign," which specifically refers to the distinct spaces of the yolk sac and amniotic sac. *Chorion and decidua* - The **chorion** is the outer fetal membrane, and the **decidua** is the modified endometrium during pregnancy. - While both are important structures in early pregnancy, they are not the structures visualized in the double bleb sign. *Twin pregnancy* - A **twin pregnancy** would involve two separate gestational sacs or, in the case of monochorionic-diamniotic twins, two amniotic sacs within one chorion, each containing a fetus. - The double bleb sign is a feature of a **single intrauterine pregnancy** and is not indicative of twins.

Q: The following set of instruments are used for which procedure?

Pap smear. ***Pap smear*** - The image displays a complete set of instruments used for a **Pap smear**, including **glass slides** for sample collection, a **cervical brush**, a **spatula** (cytobrush and Ayre spatula), and a **speculum** to visualize the cervix. - These tools are specifically designed for collecting cervical cells to screen for **cervical cancer** and **precancerous changes**. *Biopsy* - A biopsy typically involves specialized instruments like **punch biopsy tools**, **forceps**, or needles to extract tissue samples, which are not depicted here. - While glass slides might be used for processing biopsy samples, the primary collection tools are absent. *Dilatation and curettage* - This procedure requires instruments such as **dilators** to open the cervix and **curetters** to scrape the uterine lining, which are not shown in the image. - The instruments shown are for surface cell collection, not for uterine cavity procedures. *Hysteroscopy* - Hysteroscopy uses a **hysteroscope**—a thin, lighted tube with a camera—to visualize the inside of the uterus. - The instruments in the image are for external examination and cervical cell collection, not for direct visualization of the uterine cavity.

Q: Which of the following is not a long-acting reversible contraceptive method?

Combined oral contraceptives. ***Combined oral contraceptives*** - While effective, **combined oral contraceptives** require daily adherence and are not typically classified as long-acting due to their need for frequent, consistent administration. - Their mechanism involves **exogenous hormones** that suppress ovulation and thicken cervical mucus, but their contraceptive effect relies on continuous daily intake. *Implanon* - **Implanon** (etonogestrel implant) is a **subdermal contraceptive implant** that provides effective contraception for up to three years. - It works by slowly releasing progestin, making it a **long-acting reversible contraceptive (LARC)**. *Copper T* - The **Copper T intrauterine device (IUD)** is a non-hormonal LARC that can prevent pregnancy for **up to 10 years**. - It acts by creating an inflammatory reaction in the uterus that is toxic to sperm and eggs, preventing fertilization. *Depo-Provera injection* - The **Depo-Provera injection** (medroxyprogesterone acetate) is a progestin-only contraceptive given every **3 months**. - While it offers extended protection, it is **not universally classified as a LARC** by major guidelines (WHO, ACOG, CDC), which typically reserve this designation for IUDs and implants that do not require regular clinic visits.

Question 1

A primigravida is in labor. Her per-vaginal examination revealed a posterior cervix with 5 cm cervical length, 1 cm dilatation, soft consistency, and head at -1 station. Calculate the Bishop score.

Accepted Answer

5

Answer

0

Answer

8

Answer

3

Question 2

Identify the instrument given below.

Accepted Answer

Cusco's speculum

Answer

Sims' speculum

Answer

Graves' speculum

Answer

Auvard's speculum

Question 3

Double bleb sign seen in early pregnancy is due to?

Accepted Answer

Yolk sac and amniotic sac

Answer

Amnion and chorion

Answer

Twin pregnancy

Answer

Chorion and decidua

Question 4

The following set of instruments are used for which procedure?

Accepted Answer

Pap smear

Answer

Biopsy

Answer

Dilatation and curettage

Answer

Hysteroscopy

Question 5

Which of the following is not a long-acting reversible contraceptive method?

Accepted Answer

Combined oral contraceptives

Answer

Implanon

Answer

Copper T

Answer

Depo-Provera injection

Question 6

A teenage girl presented with irregular cycles and increased facial hair. Her ovaries showed increased volume. Which of the following are used in the first line treatment?

1. Laparoscopic ovarian drilling
2. Anti-androgens
3. Lifestyle modifications
4. Combined oral contraceptive pills

Accepted Answer

2,3,4

Answer

1,2,3

Answer

1,2,4

Answer

1,3,4

INI-CET 2021 — Obstetrics and Gynecology