INI CET Obstetrics & Gynecology Syllabus

Obstetrics & Gynecology syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Obstetrics & Gynecology in INI CET, not a summary of it.

1. 1

   Anatomy and Physiology

   2 topics

   • Anatomy of the female reproductive system
     • External genitalia
     • Internal genitalia (uterus, fallopian tubes, ovaries)
     • Pelvic floor muscles
   • Physiology of the menstrual cycle
     • Hormonal regulation (FSH, LH, estrogen, progesterone)
     • Follicular development
     • Ovulation
     • Endometrial changes
2. 2

   Normal Pregnancy

   3 topics

   • Antenatal care
     • Initial assessment
     • Risk assessment
     • Screening tests (ultrasound, biochemical markers)
     • Prenatal counseling
   • Physiological changes in pregnancy
     • Cardiovascular changes
     • Respiratory changes
     • Gastrointestinal changes
     • Renal changes
     • Endocrine changes
   • Fetal development and monitoring
     • Fetal growth and development
     • Fetal movements
     • Fetal heart rate monitoring (cardiotocography, Doppler ultrasound)
3. 3

   Obstetric Disorders

   4 topics

   • Hypertensive disorders of pregnancy
     • Gestational hypertension
     • Preeclampsia
     • Eclampsia
     • HELLP syndrome
   • Gestational diabetes mellitus
     • Diagnosis
     • Monitoring
     • Management (dietary modification, insulin therapy)
   • Preterm labor
     • Risk factors
     • Diagnosis
     • Prevention (progesterone supplementation)
     • Management (tocolysis, antenatal corticosteroids)
   • Multiple pregnancy
     • Diagnosis
     • Complications (preterm birth, twin-to-twin transfusion syndrome)
     • Management
4. 4

   Labor and Delivery

   4 topics

   • Normal labor
     • Stages of labor (first stage, second stage, third stage)
     • Mechanisms of labor
     • Assessment of progress
   • Intrapartum monitoring
     • Fetal heart rate monitoring (cardiotocography)
     • Assessment of fetal well-being
     • Partogram
   • Management of labor
     • Induction of labor
     • Augmentation of labor
     • Pain relief methods (analgesia, anesthesia)
     • Instrumental delivery (forceps, vacuum extraction)
   • Cesarean section
     • Indications
     • Preoperative preparation
     • Surgical techniques
     • Postoperative care
5. 5

   Postpartum Care

   3 topics

   • Physiological changes in the postpartum period
     • Uterine involution
     • Lochia
     • Breastfeeding
     • Maternal bonding
   • Postpartum complications
     • Postpartum hemorrhage
     • Puerperal sepsis
     • Postpartum blues
     • Postpartum depression
   • Contraception
     • Counseling on contraceptive methods (oral contraceptives, intrauterine devices, implants, sterilization)
     • Initiation of contraception in the postpartum period
6. 6

   Gynecological Disorders

   4 topics

   • Menstrual disorders
     • Dysmenorrhea
     • Menorrhagia
     • Oligomenorrhea
     • Amenorrhea
   • Benign gynecological conditions
     • Fibroids (leiomyomas)
     • Ovarian cysts
     • Endometriosis
     • Pelvic inflammatory disease (PID)
   • Gynecological cancers
     • Cervical cancer
     • Endometrial cancer
     • Ovarian cancer
     • Vulvar cancer
   • Reproductive endocrinology
     • Polycystic ovary syndrome (PCOS)
     • Premature ovarian insufficiency (POI)
     • Hyperprolactinemia
7. 7

   Reproductive Endocrinology and Infertility

   4 topics

   • Evaluation of Infertility
     • History taking
     • Physical examination
     • Investigations (hormonal assays, imaging studies)
     • Male factor evaluation
   • Assisted Reproductive Technologies (ART)
     • Intrauterine insemination (IUI)
     • In vitro fertilization (IVF)
     • Intracytoplasmic sperm injection (ICSI)
     • Gamete donation
   • Endocrine Disorders Causing Infertility
     • Hypothalamic-pituitary dysfunction
     • Thyroid disorders
     • Hyperprolactinemia
   • Ovulation Induction
     • Clomiphene citrate
     • Gonadotropins
     • Aromatase inhibitors for ovulation induction in women with anovulatory infertility
8. 8

   Urogynecology and Pelvic Floor Disorders

   3 topics

   • Urinary incontinence
     • Stress urinary incontinence
     • Urge urinary incontinence
     • Mixed urinary incontinence
     • Overflow incontinence
   • Pelvic organ prolapse
     • Anterior compartment prolapse (cystocele)
     • Posterior compartment prolapse (rectocele)
     • Uterine prolapse
   • Pelvic floor dysfunction
     • Pelvic floor muscle exercises (Kegel exercises)
     • Biofeedback therapy
     • Surgical management of pelvic organ prolapse
9. 9

   Sexual and Reproductive Health

   4 topics

   • Sexual health and contraception
     • Sexual history taking
     • Counseling on sexual health
     • Contraceptive counseling
   • Sexually transmitted infections (STIs)
     • Chlamydia
     • Gonorrhea
     • Syphilis
     • Genital herpes
     • Human papillomavirus (HPV)
     • HIV/AIDS
   • Menopause
     • Symptoms of menopause
     • Hormone replacement therapy (HRT)
     • Management of menopausal symptoms (hot flashes, vaginal dryness)
   • Sexual dysfunction
     • Female sexual dysfunction (hypoactive sexual desire disorder, dyspareunia, vaginismus)
     • Male sexual dysfunction (erectile dysfunction, premature ejaculation)
10. 10

    Gynecological Oncology

    4 topics

    • Cervical cancer
      • Screening (Pap smear, HPV testing)
      • Diagnosis
      • Staging
      • Management
    • Endometrial cancer
      • Clinical features
      • Diagnosis (endometrial biopsy)
      • Staging
      • Management
    • Ovarian cancer
      • Clinical features
      • Diagnosis (CA-125, imaging studies)
      • Staging
      • Management
    • Gestational trophoblastic disease
      • Hydatidiform mole
      • Invasive mole
      • Choriocarcinoma
      • Placental site trophoblastic tumor

Obstetrics & Gynecology flashcards for INI CET

24 of 52 cards from the Obstetrics & Gynecology deck — real questions with worked answers.

1. What are the layers of the uterus and the arterial supply of the female reproductive tract?

   The uterus has 3 layers: endometrium (inner mucosa, cyclically shed), myometrium (thick smooth muscle), and perimetrium (serosa). Blood supply: uterine artery (branch of internal iliac/anterior division) anastomoses with the ovarian artery (branch of abdominal aorta). The ureter passes BELOW the uterine artery ('water under the bridge') ~1.5 cm lateral to the cervix at the level of the internal os — a key surgical landmark.

2. Describe the hormonal events of the menstrual (ovarian) cycle phases.

   Follicular phase: FSH stimulates follicle growth; rising estradiol. Ovulation: estradiol peak triggers an LH surge (positive feedback), releasing the oocyte ~36 h after surge onset / ~10-12 h after LH peak. Luteal phase: corpus luteum secretes progesterone (and estrogen), maintained ~14 days; if no pregnancy, it regresses, progesterone falls, menstruation follows. The luteal phase is fixed (~14 days); cycle length varies due to follicular phase.

3. What endometrial changes correspond to each phase of the menstrual cycle?

   Proliferative phase (estrogen-driven): endometrial regeneration and gland proliferation. Secretory phase (progesterone-driven): coiled glands, secretory vacuoles, stromal edema, predecidual change preparing for implantation. Menstrual phase: ischemia and shedding of the functional layer following corpus luteum demise and falling progesterone.

4. What is the recommended schedule and key components of antenatal care?

   WHO 2016 recommends a minimum of 8 antenatal contacts. Components: booking visit with history/exam, blood pressure and urine (proteinuria) at each visit, blood group/Rh and antibody screen, hemoglobin, blood glucose/OGTT screening, infection screening (HIV, syphilis, hepatitis B), dating/anomaly ultrasound, fundal height measurement, tetanus immunization, iron-folic acid supplementation, and fetal heart auscultation.

5. What are the cardiovascular and hematological physiological changes in normal pregnancy?

   Cardiac output rises 30-50% (increased stroke volume and heart rate); plasma volume increases ~50% and red cell mass ~20-30%, producing dilutional 'physiological anemia.' Systemic vascular resistance falls, so BP decreases in the 2nd trimester and returns toward baseline at term. Pregnancy is a hypercoagulable state (increased fibrinogen and clotting factors).

6. What are the respiratory and renal physiological changes in pregnancy?

   Respiratory: tidal volume and minute ventilation increase ~40% causing a compensated respiratory alkalosis (low PaCO2, ~30 mmHg); functional residual capacity falls. Renal: GFR and renal plasma flow rise ~50%, lowering serum creatinine and urea; mild glycosuria and physiological hydronephrosis (right > left) are common.

7. Calculate the expected date of delivery using Naegele's rule.

   EDD = first day of the last menstrual period (LMP) + 1 year − 3 months + 7 days (equivalently LMP + 9 months + 7 days). It assumes a regular 28-day cycle; adjust for cycle length. Example: LMP 1 January → EDD 8 October.

8. How is fetal wellbeing assessed antenatally, and what does the biophysical profile include?

   Methods: fetal movement counting, cardiotocography (non-stress test), and ultrasound (growth, amniotic fluid, Doppler). The biophysical profile (BPP) scores 5 parameters (2 points each, max 10): fetal breathing movements, gross body movements, fetal tone, amniotic fluid volume, and a reactive NST. Score 8-10 reassuring; ≤4 concerning for hypoxia.

9. What umbilical artery Doppler findings indicate fetal compromise?

   Normal flow shows forward diastolic flow with a low resistance index. With placental insufficiency, resistance rises causing reduced, then absent, then reversed end-diastolic flow (AEDF/REDF). Absent or reversed end-diastolic flow signals severe compromise and high perinatal mortality, often prompting delivery depending on gestation.

10. Classify the hypertensive disorders of pregnancy.

    1) Chronic hypertension (present before 20 weeks or pre-pregnancy). 2) Gestational hypertension (new hypertension after 20 weeks without proteinuria/organ involvement). 3) Pre-eclampsia (new hypertension after 20 weeks WITH proteinuria or end-organ dysfunction). 4) Eclampsia (pre-eclampsia plus seizures). 5) Chronic hypertension with superimposed pre-eclampsia.

11. What are the diagnostic criteria and severe features of pre-eclampsia?

    Diagnosis: BP ≥140/90 mmHg on two occasions after 20 weeks PLUS proteinuria (≥300 mg/24 h or protein:creatinine ratio ≥0.3) OR end-organ dysfunction (thrombocytopenia, renal/liver impairment, pulmonary edema, neurological/visual symptoms). Severe features include BP ≥160/110, platelets <100,000, doubled creatinine, transaminases ≥2× normal, pulmonary edema, or cerebral/visual symptoms.

12. What is the drug of choice for seizure prophylaxis/treatment in eclampsia, and how is toxicity managed?

    Magnesium sulfate is first-line for preventing and treating eclamptic seizures (superior to phenytoin/diazepam). Monitor deep tendon reflexes, respiratory rate, urine output, and serum levels. Early toxicity: loss of patellar reflexes; later: respiratory depression and cardiac arrest. Antidote: IV calcium gluconate.

13. What is HELLP syndrome?

    A severe variant of pre-eclampsia defined by Hemolysis (microangiopathic, schistocytes, raised LDH/bilirubin), Elevated Liver enzymes, and Low Platelets. It may occur with only mild hypertension. Definitive treatment is delivery; complications include hepatic hematoma/rupture and DIC.

14. What are the screening criteria and diagnostic thresholds for gestational diabetes mellitus (GDM)?

    Screen at 24-28 weeks (earlier if high risk). Using the 75 g OGTT (IADPSG/WHO), GDM is diagnosed if any value is met or exceeded: fasting ≥92 mg/dL, 1-hour ≥180 mg/dL, or 2-hour ≥153 mg/dL. India's DIPSI test uses a single 2-hour value ≥140 mg/dL after a 75 g non-fasting load.

15. What are the maternal and fetal complications of gestational diabetes?

    Fetal/neonatal: macrosomia, shoulder dystocia, neonatal hypoglycemia, hyperbilirubinemia, polycythemia, respiratory distress, and higher congenital anomaly risk (mainly with pre-existing diabetes). Maternal: pre-eclampsia, polyhydramnios, increased operative/cesarean delivery, and a markedly increased lifetime risk of type 2 diabetes.

16. Define preterm labor and outline its management (tocolysis, steroids, magnesium).

    Preterm labor = regular contractions with cervical change before 37 completed weeks. Management: antenatal corticosteroids (betamethasone/dexamethasone) 24-34 weeks for fetal lung maturity; tocolytics (nifedipine, atosiban) to delay delivery ~48 h to allow steroids and transfer; magnesium sulfate for fetal neuroprotection (<32 weeks); and group B Streptococcus prophylaxis when indicated.

17. What is the difference between dizygotic and monozygotic twins, and how does chorionicity relate to timing of splitting?

    Dizygotic (fraternal) twins arise from two ova/two sperm — always dichorionic diamniotic. Monozygotic (identical) twins arise from one zygote; chorionicity depends on splitting time: days 0-3 → dichorionic diamniotic; days 4-8 → monochorionic diamniotic; days 8-13 → monochorionic monoamniotic; after day 13 → conjoined twins.

18. What is twin-twin transfusion syndrome (TTTS) and which pregnancies are at risk?

    TTTS occurs in monochorionic (shared placenta) twins due to unbalanced inter-twin vascular anastomoses. The donor becomes hypovolemic, anemic, oliguric with oligohydramnios ('stuck twin'); the recipient becomes hypervolemic, polycythemic, polyuric with polyhydramnios and possible cardiac failure/hydrops. Treatment is fetoscopic laser ablation of placental anastomoses.

19. What are the cardinal movements of normal labor?

    In order: Engagement, Descent, Flexion, Internal rotation, Extension (delivery of the head), External rotation (restitution), and Expulsion (delivery of shoulders and body). These describe how the fetal head adapts to the maternal pelvis during vaginal delivery.

20. Define the stages of labor and their key endpoints.

    First stage: onset of regular contractions to full cervical dilatation (10 cm); divided into latent (slow, <6 cm) and active (≥6 cm, faster) phases. Second stage: full dilatation to delivery of the baby. Third stage: delivery of the baby to delivery of the placenta. (A fourth stage = first 1-2 h postpartum for monitoring.)

21. What are the components of a Bishop score and what does it predict?

    The Bishop score assesses cervical favorability for induction using 5 parameters: cervical dilatation, effacement, consistency, position, and fetal station. A higher score (typically ≥6-8) predicts a favorable cervix and successful induction; a low score suggests the need for cervical ripening agents.

22. What are the categories of cardiotocography (CTG) and the features assessed?

    CTG assesses baseline rate (normal 110-160 bpm), variability (normal 5-25 bpm), accelerations (reassuring), and decelerations (early, variable, late). Late decelerations suggest uteroplacental insufficiency; variable decelerations suggest cord compression. Traces are classified as normal/reassuring, suspicious, or pathological, guiding further fetal assessment (e.g., fetal scalp pH).

23. How is the partograph used to monitor the progress of labor?

    The partograph is a graphical record of labor plotting cervical dilatation against time, with alert and action lines. Crossing the alert line warns of slow progress; crossing the action line prompts intervention. It also records contractions, fetal heart rate, descent, maternal vitals, and liquor, helping detect prolonged/obstructed labor early.

24. What are the indications for cesarean section and the difference in classification by urgency?

    Indications: failure to progress/obstructed labor, fetal distress (non-reassuring CTG), malpresentation (breech/transverse), placenta previa or major hemorrhage, cord prolapse, failed instrumental delivery, and previous classical cesarean. Urgency categories: Category 1 (immediate threat to life of mother/fetus), Category 2 (compromise, not immediately life-threatening), Category 3 (early delivery, no compromise), Category 4 (elective).

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