For many aspirants preparing for INI SS, one of the most useful ways to revise is by looking at paper recalls. They give a real sense of how concepts are tested and where the examiners focus.
In this session, Dr. Aditya Nimbkar walked through several questions that appeared in the December 2025 INI SS exam.
Lecture details:
1. Fertility-Sparing Management in Endometrial Carcinoma:-
One question described a 30-year-old nulliparous woman diagnosed with grade 1, stage IA endometrioid endometrial carcinoma who still wished to preserve fertility.
Normally, the standard treatment for Endometrial Carcinoma is hysterectomy, but in women who strongly desire future pregnancy, a fertility-preserving approach can sometimes be considered.
When is fertility-sparing treatment acceptable?
It is considered only in carefully selected cases:
- Type 1 endometrioid carcinoma
- Stage IA disease
- No lymphovascular space invasion (LVSI)
- No evidence of extra-uterine spread
Preferred Management
The treatment used in such cases is high-dose progestin therapy, most commonly:
- Medroxyprogesterone acetate
- Dose: 400–600 mg per day
Another option is placing a levonorgestrel-releasing intrauterine system (LNG-IUS) such as Mirena intrauterine system, sometimes combined with oral progestins initially.
Follow-up is Critical
These patients require strict monitoring, which includes:
- Endometrial sampling every 6 months
- Assessing regression or progression of disease
If the disease progresses, definitive surgery (hysterectomy) must be advised. Even if fertility treatment succeeds and pregnancy occurs, hysterectomy is usually recommended once childbearing is complete.
2. Lifetime Risk of Ovarian Cancer in BRCA Mutation:-
Another question asked about the lifetime risk of ovarian cancer associated with BRCA1 mutation.
To understand the significance, it helps to compare it with the background risk.
Ovarian Cancer Risk
- General population: 1–2%
- BRCA1 mutation: 35–45% lifetime risk
- BRCA2 mutation: 10–20% lifetime risk
Because of this high risk, women with confirmed BRCA mutations are often advised risk-reducing surgery.
Preventive Strategy
Recommended measures may include:
- Risk-reducing salpingo-oophorectomy
- Sometimes prophylactic mastectomy
- Surgery usually advised around 35–40 years, after completing family planning.
3. Family History of Breast and Ovarian Cancer: What Should Be Done?
Another scenario involved a 30-year-old woman using oral contraceptive pills for three years, with a strong family history:
- Mother diagnosed with Breast Cancer at 47 years
- Sister diagnosed with Ovarian Cancer at 36 years
The key question was: What is the most appropriate advice?
Correct Approach
The best step is genetic testing for BRCA mutation.
Before considering any preventive surgery, it is important to confirm whether a hereditary mutation is present.
Important Points About OCPs
Interestingly, oral contraceptive pills:
- Increase risk of breast cancer slightly
- But reduce the risk of ovarian cancer
- Also reduce the risk of endometrial cancer
This protective effect occurs because:
- Progesterone causes endometrial atrophy
- Ovulation suppression reduces ovarian epithelial injury and repair cycles
4. Bakri Balloon Maximum Capacity:-
A practical obstetrics question asked about the maximum capacity of the Bakri Balloon.
Answer is 600 mL
Why?
The Bakri balloon is used to treat postpartum hemorrhage, especially atonic PPH, in which the uterus does not contract following delivery.
Mechanism
The balloon is filled with fluid and placed inside the uterus. Hydrostatic pressure is produced as a result, which
- Stops bleeding sinuses.
- Creates a tamponade effect.
- Aids in stopping bleeding
The balloon is usually stored for a maximum of 24 hours. Surgical treatment, such as a hysterectomy, may be necessary if the bleeding persists or the uterus does not regain tone.
Alternative Technique
A commonly used low-cost alternative is the Shivkar’s Balloon Pack, which uses a condom attached to a Foley catheter and filled with saline to create the same tamponade effect.
5. Misoprostol Dose in Postpartum Hemorrhage:-
Another tricky question focused on the dose of Misoprostol used in postpartum hemorrhage treatment.
The key detail was the route of administration.
Therapeutic Oral Dose
- 600 micrograms orally
Students often mark 1000 micrograms, but that dose is usually associated with rectal administration.
The exam question specifically mentioned oral dosing, which makes 600 micrograms the correct answer according to World Health Organization guidelines.
Final Takeaway
Paper recalls like these give a clear idea of how concept-based clinical thinking is tested in exams like INI SS. Instead of rote memorization, the focus is often on understanding guidelines, risk assessment, and real-world management decisions.
If you want more such exam-focused discussions, concept breakdowns, and clinical insights, make sure to explore more sessions from Conceptual OBG and stay updated with expert explanations that simplify even the most complex topics.
