INICET Obstetrics & Gynecology Previous Year Questions (2018–2026)

The correct answer is 2 cm.

A rectocele is herniation of the anterior rectal wall through a weak rectovaginal septum into the posterior vaginal wall. On defecography, the depth of the bulge beyond the expected anterior rectal line is measured, and a rectocele larger than 2 cm is considered abnormal/diagnostic. By grade: grade I is up to 2 cm (often an incidental finding in parous women), grade II is 2 to 4 cm, and grade III is more than 4 cm. A rectocele that is large (often >3 cm) and retains contrast/stool after evacuation is the one most likely to be clinically significant and to cause obstructed defecation. So the diagnostic cutoff asked here is 2 cm.

Incorrect Options:

• 0.5 cm: well within normal; tiny bulges are common and not a rectocele.
• 1 cm: grade I (up to 2 cm) is frequently seen in normal parous women and is not considered diagnostic/abnormal.
• 3 cm: this is already abnormal and typically clinically significant, but the threshold that DEFINES an abnormal rectocele is 2 cm, not 3 cm.

High-Yield Facts:

• Defecography: rectocele >2 cm = abnormal/diagnostic.
• Grades: I (<2 cm), II (2-4 cm), III (>4 cm).
• A rectocele is herniation through the rectovaginal septum.
• Clinically significant rectoceles (often >3 cm) retain stool and cause obstructed defecation.

Figure: Rectocele - the anterior rectal wall herniates through the rectovaginal septum into the posterior vaginal wall; a bulge >2 cm on defecography is diagnostic.

The correct answer is 1, 2, 3 and 4.

Probable signs of pregnancy are objective findings the examiner can elicit but that are not absolutely confirmatory. Hegar's sign (softening and compressibility of the lower uterine segment, ~6 weeks), Braxton Hicks contractions (painless irregular uterine contractions), and Goodell's sign (softening of the cervix) are all classic probable signs - and they are grouped here with the listed Sehrt's sign. Since Hegar's, Braxton Hicks, and Goodell's are unquestionably probable signs, the only option that includes all three is "1, 2, 3 and 4." Other probable signs include Chadwick's, Piskacek's, Osiander's signs, ballottement, and a positive pregnancy test.

Why the other options are wrong:

• 1 and 2: omits Goodell's sign, which is a definite probable sign.
• 1 and 4: omits Braxton Hicks contractions, also a probable sign.
• 1, 3 and 4: drops Braxton Hicks (a probable sign), so it is incomplete.

High-Yield Facts:

• Hegar's sign = soft, compressible lower uterine segment.
• Goodell's sign = softening of the cervix.
• Chadwick's sign = bluish discoloration of cervix/vagina.
• Positive signs (fetal heart sounds, fetal movements felt by examiner, USG fetus) are confirmatory, unlike probable signs.

The correct answer is 1-c, 2-a, 3-d, 4-b.

Premature ovarian insufficiency is primary ovarian (gonadal) failure: the ovary stops responding, so estradiol falls and feedback is lost, giving markedly raised FSH and LH with low estradiol (hypergonadotropic hypogonadism) - matching (c). Sheehan syndrome is postpartum pituitary necrosis, so gonadotropin output drops, giving low FSH, LH, and estradiol (hypogonadotropic hypogonadism) - (a). Asherman syndrome is an outflow/ uterine problem (intrauterine adhesions) with an intact HPO axis, so FSH, LH, and estradiol are normal - (d). PCOS shows a high LH with normal FSH (raised LH:FSH ratio) and normal-to-high estrogen - (b). Hence 1-c, 2-a, 3-d, 4-b.

Why the other options are wrong:

• 1-a, 2-c, 3-b, 4-d: swaps POI and Sheehan - POI has HIGH (not low) gonadotropins.
• 1-c, 2-d, 3-a, 4-b: gives Sheehan normal hormones and Asherman low gonadotropins, which is reversed.
• 1-b, 2-a, 3-d, 4-c: assigns PCOS the POI profile (high FSH, low estradiol) - wrong.

High-Yield Facts:

• POI: high FSH/LH, low estradiol (hypergonadotropic hypogonadism).
• Sheehan: low FSH/LH/estradiol (hypogonadotropic - pituitary failure).
• Asherman: normal hormones (uterine outflow problem).
• PCOS: raised LH:FSH ratio (high LH, normal FSH).

Figure: The hypothalamic-pituitary-ovarian axis - pituitary failure (Sheehan) lowers gonadotropins, while ovarian failure (POI) removes feedback and raises FSH/LH.