INI CET Obstetrics And Gynecology Flashcards

24 sample cards from the Obstetrics And Gynecology deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. What is the FIGO PALM-COEIN classification for abnormal uterine bleeding?

   Structural causes (PALM): Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia. Non-structural causes (COEIN): Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified.

2. What are the Rotterdam criteria for diagnosing PCOS?

   At least 2 of 3: (1) oligo/anovulation, (2) clinical or biochemical hyperandrogenism, and (3) polycystic ovaries on ultrasound (>=12 follicles 2-9 mm per ovary or ovarian volume >10 mL), after excluding other causes.

3. Define primary and secondary amenorrhea.

   Primary amenorrhea: no menarche by age 15 with normal secondary sexual characteristics, or by age 13 with no secondary sexual development. Secondary amenorrhea: absence of menses for 3 consecutive cycles or 6 months in a previously menstruating woman.

4. What hormonal changes define menopause and what is its average age?

   Menopause is permanent cessation of menstruation (12 months of amenorrhea), confirmed by raised FSH (>40 IU/L) and low estradiol. Average age is ~45-51 years (~51 worldwide, ~47 in India).

5. Describe the hormonal control of the menstrual cycle phases.

   Follicular phase: FSH stimulates follicle growth and rising estrogen. LH surge (triggered by peak estrogen) causes ovulation ~day 14. Luteal phase: corpus luteum secretes progesterone; if no pregnancy it regresses, hormones fall, and menstruation occurs.

6. What are the Amsel criteria for diagnosing bacterial vaginosis?

   At least 3 of 4: (1) thin homogeneous grey-white discharge, (2) vaginal pH >4.5, (3) positive whiff/amine test (fishy odor with KOH), and (4) clue cells on microscopy (>20% of epithelial cells).

7. Differentiate the discharge of candidiasis, trichomoniasis, and bacterial vaginosis.

   Candidiasis: thick, white, curdy/cheesy, intense itch, pH normal (<4.5). Trichomoniasis: profuse, frothy, yellow-green, 'strawberry cervix', pH >4.5. Bacterial vaginosis: thin grey, fishy odor, pH >4.5, minimal inflammation.

8. What is the syndromic diagnosis and treatment principle of pelvic inflammatory disease (PID)?

   PID is suspected with lower abdominal/pelvic pain plus cervical motion, uterine, or adnexal tenderness in a sexually active woman. Treatment covers N. gonorrhoeae, Chlamydia, and anaerobes (e.g., ceftriaxone + doxycycline + metronidazole).

9. What is the most common benign tumor of the uterus and its commonest type?

   Leiomyoma (uterine fibroid) is the most common benign uterine tumor. The intramural type is the most common, followed by subserosal and submucosal.

10. Define endometriosis and its classic clinical triad.

    Endometriosis is the presence of functioning endometrial tissue (glands and stroma) outside the uterine cavity. Classic triad: dysmenorrhea, dyspareunia, and dyschezia; it commonly causes infertility and chocolate cysts of the ovary.

11. What organism causes chancroid and how does its ulcer differ from a syphilitic chancre?

    Chancroid is caused by Haemophilus ducreyi - a painful, soft, ragged genital ulcer with tender suppurative inguinal nodes (bubo). A syphilitic (primary) chancre from Treponema pallidum is painless, indurated, and clean-based.

12. What is the most common cause of cervical cancer and the key HPV subtypes involved?

    Persistent infection with high-risk human papillomavirus (HPV) - especially types 16 and 18, which cause ~70% of cervical cancers. Types 6 and 11 cause genital warts.

13. What are the recommendations for cervical cancer screening (Pap smear / HPV testing)?

    Begin at age 21 (or 25-30 per some guidelines): cytology every 3 years from 21-29; from 30-65, cytology every 3 years OR HPV testing/co-testing every 5 years. India: HPV DNA or VIA-based screening is recommended for population programs.

14. What is the most common gynecological malignancy in developed countries and its commonest histological type?

    Endometrial (uterine) carcinoma is the most common gynecological cancer in developed countries. Endometrioid adenocarcinoma (Type I, estrogen-dependent) is the commonest histological type.

15. Why is ovarian cancer often diagnosed late, and what is its most common histological type?

    Ovarian cancer presents late due to vague, non-specific symptoms and absence of effective screening ('silent killer'). The most common type is epithelial serous cystadenocarcinoma; CA-125 is the tumor marker used for monitoring.

16. What tumor marker is associated with choriocarcinoma / gestational trophoblastic disease, and what characterizes a complete hydatidiform mole?

    Beta-hCG is the marker. A complete mole has a 46,XX (paternal) karyotype, no fetal tissue, diffuse swelling of villi ('snowstorm' on USG), and markedly elevated beta-hCG; it carries higher malignant potential than a partial mole.

17. What is the Pearl Index and what does a lower value indicate?

    The Pearl Index is the number of contraceptive failures (pregnancies) per 100 woman-years of exposure. A lower value indicates a more effective method.

18. What is the mechanism of action of combined oral contraceptive pills (COCs)?

    Primarily suppression of ovulation by inhibiting the LH surge and FSH (via estrogen + progestin); secondary effects include thickening of cervical mucus and creating an unfavorable (atrophic) endometrium.

19. What are the options and time windows for emergency contraception?

    Levonorgestrel 1.5 mg within 72 hours, ulipristal acetate within 120 hours, or insertion of a copper IUD within 5 days of unprotected intercourse (the copper IUD is the most effective method).

20. What is the mechanism of action and effective duration of the copper-bearing intrauterine device (Cu-IUD)?

    Copper acts as a spermicide and impairs sperm motility/viability and fertilization, plus inducing a sterile inflammatory (foreign-body) endometrial reaction. Cu T 380A is effective for up to 10 years.

21. Up to what gestational age is medical termination of pregnancy permitted in India after the MTP (Amendment) Act 2021?

    Up to 20 weeks on the opinion of one registered medical practitioner; 20-24 weeks (with two practitioners' opinions) for specified categories of women; and no upper limit if there is substantial fetal abnormality diagnosed by a Medical Board.

22. What does the PCPNDT Act, 1994 prohibit?

    The Pre-Conception and Pre-Natal Diagnostic Techniques Act prohibits prenatal sex determination and sex selection to prevent female feticide; it regulates the use of diagnostic techniques and makes disclosure of fetal sex a punishable offense.

23. What is the WHO definition of the perinatal period and perinatal mortality rate?

    The perinatal period extends from 22 (or 28) completed weeks of gestation to 7 completed days after birth. Perinatal mortality rate = (stillbirths + early neonatal deaths) per 1000 total births.

24. What are the components of the APGAR score and when is it assessed?

    Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration - each scored 0-2 (max 10), assessed at 1 and 5 minutes after birth to evaluate neonatal status.

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