INI-CET 2018 Practice Questions

Q: What is the best management of the case shown?

Stop smoking and screen for cancer. ***Stop smoking and screen for cancer*** - The image shows **smoker's palate (nicotinic stomatitis)**, characterized by diffuse white thickening of the palatal mucosa with red dots representing inflamed salivary gland orifices. This condition is caused by **chronic heat exposure from smoking**. - While generally benign, smoker's palate indicates a high risk for other **oral cancers**, particularly those involving the lips, tongue, and floor of the mouth, necessitating smoking cessation and regular screening. *Dapsone plus steroids* - This combination is typically used for **autoimmune blistering diseases** like **dermatitis herpetiformis** or **pemphigoid**, which present with different clinical features. - Smoker's palate is not an autoimmune condition and would not respond to these treatments. *Vitamin supplements* - Vitamin supplements are not a treatment for smoker's palate, as it is a localized lesion caused by irritation from smoke. - While general nutritional support is good, it doesn't address the underlying cause or potential complications of this specific condition. *Antifungals for oral candidiasis* - **Oral candidiasis (thrush)** typically presents as removable white plaques on the oral mucosa, often associated with immunosuppression or antibiotic use. - The lesions in the image are firmly attached, non-removable, and show specific morphological changes (red dots), which are not characteristic of candidiasis.

Q: A patient presented with fever and joint pain for which she was put on NSAIDs. After 10 days she developed a skin lesion as shown in the image. Diagnosis is:

Fixed drug eruption. ***Fixed drug eruption*** - The appearance of a **well-demarcated, erythematous, and pigmented patch** on the skin, combined with a history of recent **NSAID use** and prior fever/arthralgia (suggesting possible prior exposure and sensitization to the drug), is highly characteristic of fixed drug eruption. - FDEs typically recur at the **same site(s)** upon re-exposure to the offending drug, and NSAIDs are known culprits. The lesion often heals with post-inflammatory **hyperpigmentation**. *Chikungunya* - While Chikungunya causes **fever and severe joint pain**, the rash associated with it is typically a more generalized, **maculopapular rash**, not a localized, well-demarcated lesion as seen in the image. - The onset of the skin lesion **10 days after starting NSAIDs** points more towards a drug reaction than a viral exanthem, especially with the appearance of a **pigmented patch**. *Dengue* - Dengue fever presents with **fever, joint pain, and often a rash**, but the rash is usually a generalized **macular or maculopapular eruption**, sometimes with petechiae, and is not typically a single, demarcated, post-inflammatory hyperpigmented lesion. - Similar to Chikungunya, the timing and morphology of the lesion are not typical for Dengue rash. *Melasma* - Melasma is a chronic skin condition causing **dark, discolored patches** on the face, primarily due to hormonal changes (e.g., pregnancy, birth control) or sun exposure. - It does not typically present acutely after drug ingestion with accompanying inflammation or an eruption-like morphology.

Q: The given image shows which of the following conditions? (AIIMS Nov 2018)

Inter-nuclear ophthalmoplegia. ***Inter-nuclear ophthalmoplegia*** - The image shows that the **right eye** is **unable to adduct past the midline** when attempting to look left (middle image), which is a classic sign of internuclear ophthalmoplegia (INO). - The **left eye** shows **abducting nystagmus**, a common associated finding in INO due to damage to the **medial longitudinal fasciculus (MLF)**. *Oculomotor nerve palsy* - An oculomotor nerve (CN III) palsy would typically present with a **down-and-out deviation** of the affected eye, **ptosis**, and a **dilated pupil**, which are not seen here. - The patient would also have difficulty moving the eye medially, superiorly, and inferiorly, whereas here the right eye can move down and up, but not fully medially. *Lateral rectus palsy* - A lateral rectus (CN VI) palsy would cause an inability to **abduct** the affected eye and an **esotropia** (eye turning inward) at primary gaze. - The image shows impaired adduction, not abduction, of the right eye, ruling out lateral rectus palsy. *Trochlear nerve palsy* - A trochlear nerve (CN IV) palsy results in weakness of the **superior oblique muscle**, leading to **vertical diplopia**, especially when looking down and in, and a characteristic **head tilt** to compensate. - This presentation does not match the image, which primarily demonstrates a horizontal gaze abnormality with adduction deficit.

Q: A 2-year-old child is brought with complaints of watering of eyes, photophobia and intermittently keeping eyes closed while watching TV. What may be the diagnosis? (AIIMS Nov 2018)

Congenital Glaucoma. ***Congenital Glaucoma*** - The triad of **watering of eyes (epiphora)**, **photophobia**, and **blepharospasm** (keeping eyes closed) is highly characteristic of **congenital glaucoma** in infants and young children. - The image also shows significantly enlarged and hazy corneas (buphthalmos), which are classic signs of increased intraocular pressure and corneal edema in congenital glaucoma. *Retinoblastoma* - While retinoblastoma affects children, its primary presentation is typically **leukocoria** (a white pupillary reflex) or strabismus. - It does not commonly present with watering of eyes, photophobia, or blepharospasm as prominent symptoms. *Congenital endothelial dystrophy* - Congenital endothelial dystrophy primarily causes **corneal edema** and haziness due to abnormal corneal endothelium. - While it can cause some photophobia and tearing, it generally does not present with the severe blepharospasm seen in glaucoma, and the corneal enlargement (buphthalmos) is not a feature. *Megalocornea* - Megalocornea is a condition characterized by an **enlarged cornea** but with normal intraocular pressure and clear corneas. - It is usually asymptomatic or associated with mild ametropia, and does not cause watering of eyes, photophobia, or corneal haziness.

Q: The following spectacle is used in? (AIIMS Nov 2018)

Bifocal glasses for presbyopia. ***Bifocal glasses for presbyopia*** - The image clearly shows spectacle lenses with a visible **horizontal line separating two distinct optical powers**, which is characteristic of **bifocal lenses**. - **Presbyopia** is the condition where the eye's lens loses its ability to focus on near objects, requiring a different optical correction for near vision separate from distance vision, precisely what bifocals provide. *Progressive glasses for presbyopia* - **Progressive lenses** offer a gradual change in optical power from distance to near vision without a visible dividing line, unlike the spectacles shown. - They provide a continuous range of focus, but the absence of a visible segment in progressive lenses differentiates them from bifocals. *Bifocals for paediatric pseudo-phakia* - While pediatric pseudophakia (presence of an intraocular lens in a child) might require bifocals, the question asks for the primary use of the *pictured* bifocals, which commonly address **age-related presbyopia**. - Additionally, pseudophakia itself doesn't inherently imply a need for bifocals unless there's an accommodative issue, which is more typically associated with adult presbyopia. *Bifocals for adult aphakia* - **Aphakia** is the absence of the natural lens in the eye, which requires strong corrective lenses. While bifocals can be used in aphakia to provide both distance and near correction, the pictured bifocals are a standard design most commonly associated with correcting **presbyopia** in the general population. - Aphakic corrections generally involve much higher power lenses, which might appear thicker or have different characteristics than the standard bifocal shown.

Q: What technique has been depicted in the image shown below?

Sentinel lymph node biopsy. ***Sentinel lymph node biopsy*** - The image shows a **skin incision in the axilla**, which is the typical site for accessing **axillary lymph nodes for biopsy**. - A surgical instrument is poised to enter the incision, consistent with the procedure for **identifying and removing the sentinel lymph node**. *Brachytherapy* - This involves placing **radioactive sources** inside or next to the area requiring treatment, usually for cancer. - The image does not depict any radioactive sources or the specialized equipment used for brachytherapy. *USG* - **Ultrasonography (USG)** uses sound waves to create images of internal body structures. - The image shows a surgical incision and instrument, not an ultrasound transducer or screen. *Lateral pectoral nerve block* - A **nerve block** involves injecting an anesthetic close to a nerve to relieve pain or numb an area. - While it involves an injection, the image shows an incision in the axillary region, which is typically for surgical access, not solely for nerve block administration.

Q: What does the image show? (AIIMS Nov 2018)

Pneumatic compression stockings. ***Pneumatic compression stockings*** - The image clearly shows sleeves wrapped around the patient's legs, connected by **tubes to a device** that inflates and deflates these sleeves, characteristic of **intermittent pneumatic compression (IPC)**. - IPC devices are used to prevent **deep vein thrombosis (DVT)** by promoting venous blood flow through cyclical compression. *Anti-shock garment* - An anti-shock garment (e.g., **military anti-shock trousers (MAST)**) is a full-body or lower-body suit that applies circumferential pressure to the lower extremities and abdomen to auto-transfuse blood to the core organs in cases of **hypovolemic shock**. - The device in the image covers only the legs and appears to be designed for intermittent, not sustained, compression. *Alginate dressings* - **Alginate dressings** are topical wound care products derived from seaweed, used to absorb exudate from wounds. - They are used directly on wounds and do not involve mechanical devices or full limb coverage like that shown. *Compression stockings (Unna boot)* - While an Unna boot is a type of **sustained compression bandage** (paste bandage) for leg ulcers, it provides continuous, static compression and is typically left in place for days. - The device in the image is clearly an **active, intermittent mechanical system** with a pump, not a static bandage.

Q: Which of the following is next investigation to be done in managing this condition? (AIIMS May 2018)

Gastrografin follow through. ***Gastrografin follow through*** - The provided image (presumably an abdominal X-ray of a neonate or infant) shows significant **gastric and duodenal distension** with a **'double-bubble' sign**, indicative of a high intestinal obstruction like **duodenal atresia** or **annular pancreas**. - **Gastrografin follow-through** is the next appropriate investigation to delineate the exact level and cause of obstruction, as it's a water-soluble contrast that is safer in suspected perforation than barium. *USG abdomen* - While an abdominal ultrasound can identify some causes of obstruction, it is **less effective** than a contrast study in precisely delineating the **level and type of bowel obstruction**. - It might show dilated bowel loops but won't provide the detailed anatomical information needed for surgical planning as well as a contrast study. *Exploratory Laparotomy* - **Exploratory laparotomy** is a surgical procedure and not an investigative step to be performed *next* after an initial plain film, especially when the diagnosis can be refined with less invasive imaging. - It would be done *after* further diagnostics confirm the need for surgical intervention and help plan the surgical approach. *Double contrast barium* - **Double contrast barium** is generally **contraindicated** in cases of suspected intestinal obstruction, especially in neonates, due to the risk of **perforation** and subsequent **barium peritonitis**, which can be severe. - Gastrografin is preferred as it is water-soluble and reabsorbable, making it safer if perforation is present. *Barium meal* - Similar to double contrast barium, a **barium meal** is **contraindicated** in neonatal intestinal obstruction due to the risk of **barium peritonitis** if perforation occurs. - Water-soluble contrast agents like Gastrografin are safer and preferred in pediatric emergency settings with suspected bowel obstruction.

Q: All of the following are usually associated findings in the given condition except? (AIIMS May 2018)

Absent kidney. ***Absent kidney*** - **Absent kidney (renal agenesis)** is not a typical associated finding in biliary atresia. - Biliary atresia primarily involves malformations of the **bile ducts** and is not directly linked to renal agenesis. - This is the correct answer to this "EXCEPT" question. *Hepatic artery anomalies* - **Hepatic artery anomalies**, such as aberrant or hypoplastic hepatic arteries, are frequently associated with biliary atresia. - These vascular malformations can contribute to the pathogenesis or progression of the disease. *Malrotation of gut* - **Intestinal malrotation** is a common abdominal anomaly found in conjunction with biliary atresia. - The altered embryological development affecting the biliary system can simultaneously impact gut rotation. *Polysplenia* - **Polysplenia**, a condition with multiple small spleens, is part of the heterotaxy syndrome often linked with biliary atresia. - This association reflects a broader developmental defect affecting left-right body axis determination. *Cardiac anomalies* - **Cardiac anomalies** are recognized associations with biliary atresia, particularly in the syndromic form. - These can include various congenital heart defects as part of the broader malformation syndrome.

Question 1

What is the best management of the case shown?

Accepted Answer

Stop smoking and screen for cancer

Answer

Dapsone plus steroids

Answer

Vitamin supplements

Answer

Antifungals for oral candidiasis

Question 2

A patient presented with fever and joint pain for which she was put on NSAIDs. After 10 days she developed a skin lesion as shown in the image. Diagnosis is:

Accepted Answer

Fixed drug eruption

Answer

Chikungunya

Answer

Dengue

Answer

Melasma

Question 3

The given image shows which of the following conditions? (AIIMS Nov 2018)

Accepted Answer

Inter-nuclear ophthalmoplegia

Answer

Oculomotor nerve palsy

Answer

Lateral rectus palsy

Answer

Trochlear nerve palsy

Question 4

A 2-year-old child is brought with complaints of watering of eyes, photophobia and intermittently keeping eyes closed while watching TV. What may be the diagnosis? (AIIMS Nov 2018)

Accepted Answer

Congenital Glaucoma

Answer

Retinoblastoma

Answer

Congenital endothelial dystrophy

Answer

Megalocornea

Question 5

The following spectacle is used in? (AIIMS Nov 2018)

Accepted Answer

Bifocal glasses for presbyopia

Answer

Progressive glasses for presbyopia

Answer

Bifocals for paediatric pseudo-phakia

Answer

Bifocals for adult aphakia

Question 6

What technique has been depicted in the image shown below?

Accepted Answer

Sentinel lymph node biopsy

Answer

Brachytherapy

Answer

USG

Answer

Lateral pectoral nerve block

Question 7

What does the image show? (AIIMS Nov 2018)

Accepted Answer

Pneumatic compression stockings

Answer

Anti-shock garment

Answer

Alginate dressings

Answer

Compression stockings (Unna boot)

Question 8

Which of the following is next investigation to be done in managing this condition? (AIIMS May 2018)

Accepted Answer

Gastrografin follow through

Answer

USG abdomen

Answer

Exploratory Laparotomy

Answer

Double contrast barium

Answer

Barium meal

Question 9

All of the following are usually associated findings in the given condition except? (AIIMS May 2018)

Accepted Answer

Absent kidney

Answer

Hepatic artery anomalies

Answer

Malrotation of gut

Answer

Polysplenia

Answer

Cardiac anomalies

Question 10

A 3-month-old child presents with umbilical discharge. The appearance is shown below. Which of the following is the next step in management of this patient? (AIIMS May 2018)

Accepted Answer

USG abdomen

Answer

MRI abdomen

Answer

CECT

Answer

Exploratory laparotomy

Answer

MCUG

INI-CET 2018

Dermatology

Ophthalmology

Surgery