Forensic Medicine
1 questionsAn 18 year old female was sexually assaulted by a 20 year old male. There was presence of stains on the clothes of the victim. Barberio's test was performed on the stains. Which of the following is detected by this test?
INI-CET 2021 - Forensic Medicine INI-CET Practice Questions and MCQs
Question 31: An 18 year old female was sexually assaulted by a 20 year old male. There was presence of stains on the clothes of the victim. Barberio's test was performed on the stains. Which of the following is detected by this test?
- A. Choline
- B. Acid phosphatase
- C. Spermine (Correct Answer)
- D. Fructose
Explanation: ***Spermine*** - The **Barberio's test** is a specific forensic test used to detect the presence of **spermine picrate crystals** when mixed with a picric acid solution. - The formation of yellow, needle-like crystals confirms the presence of **spermine**, a polyamine found in high concentrations in seminal fluid. *Choline* - While choline is present in semen, it is detected by the **Florence test**, which forms dark brown crystals. - The Barberio's test is not designed to detect choline. *Acid phosphatase* - **Acid phosphatase** is an enzyme found in high concentrations in seminal fluid and is detected by a different test, typically the **spot test with sodium alpha-naphthyl phosphate** and fast blue B dye. - This test is a presumptive test for semen but does not detect spermine. *Fructose* - **Fructose** is a sugar present in seminal fluid, providing energy for sperm. - Its detection involves specific biochemical tests, not the Barberio's test, which targets spermine.
Obstetrics and Gynecology
4 questionsA pregnant woman at 36 weeks gestation is found to have high blood pressure recording and a urine protein of 3+. Concomitant presence of which of the following symptoms would make you suspect imminent eclampsia? 1. Headache 2. Blurred vision 3. Persistent pedal oedema 4. Epigastric pain
Arrange the following in sequential order with regards to the steps of collection of samples for pap smear testing: Use posterior vaginal wall retractor Take the sample Make smear on a slide Fix the smear
Which of the following is a part of AMTSL?
Which of the following is not a cause of secondary amenorrhea?
INI-CET 2021 - Obstetrics and Gynecology INI-CET Practice Questions and MCQs
Question 31: A pregnant woman at 36 weeks gestation is found to have high blood pressure recording and a urine protein of 3+. Concomitant presence of which of the following symptoms would make you suspect imminent eclampsia? 1. Headache 2. Blurred vision 3. Persistent pedal oedema 4. Epigastric pain
- A. 1,2,3,4
- B. 2 and 4 only
- C. 1,2,3
- D. 1 and 2 only (Correct Answer)
Explanation: ***1 and 2 only*** - **Headache** (severe, persistent, frontal or occipital) and **blurred vision** (scotomas, photophobia, or visual field defects) are the classic **neurological symptoms** indicating cerebral irritation and vasospasm that directly precede eclamptic seizures. - These symptoms reflect **imminent CNS involvement** and are the strongest predictors of impending seizure, requiring urgent intervention (magnesium sulfate prophylaxis, delivery planning). - While other symptoms indicate severe pre-eclampsia, these neurological signs specifically herald **imminent eclampsia**. *2 and 4 only* - **Blurred vision** is indeed a key warning sign, and **epigastric pain** (right upper quadrant pain) is an important symptom of severe pre-eclampsia indicating hepatic capsule distension or subcapsular hematoma. - However, this option misses **headache**, which is one of the most critical neurological warning signs of imminent seizure. Epigastric pain indicates hepatic involvement (severe disease) but is not as directly predictive of immediate seizure onset as the combination of headache and visual disturbances. *1,2,3,4* - While headache, blurred vision, and epigastric pain are all features of severe pre-eclampsia, **persistent pedal edema** is extremely common in normal pregnancy and pre-eclampsia (present in >80% of cases) and is **not a specific indicator of imminent eclampsia**. - Generalized edema alone does not indicate imminent seizure risk and is too non-specific to be grouped with the acute neurological warning signs. *1,2,3* - **Headache** and **blurred vision** are the correct neurological indicators of imminent eclampsia. - However, **persistent pedal edema** is very common in pre-eclampsia and not specific for imminent eclamptic seizure risk. It does not have the same predictive value as severe headache or acute visual disturbances for identifying patients at immediate risk of convulsion.
Question 32: Arrange the following in sequential order with regards to the steps of collection of samples for pap smear testing: Use posterior vaginal wall retractor Take the sample Make smear on a slide Fix the smear
- A. 1,2,4,3
- B. 3,1,2,4
- C. 1,2,3,4 (Correct Answer)
- D. 2,1,3,4
Explanation: ***1,2,3,4*** - The correct sequence for collecting a Pap smear involves first **visualizing the cervix** using a posterior vaginal wall retractor, then **taking the sample** (e.g., using a broom or spatula and brush), followed by **making a smear on a slide** and finally **fixing the smear** to preserve the cells. - This sequential order ensures proper cell collection and preservation for accurate cytological examination. *1,2,4,3* - This option incorrectly places **fixing the smear** before **making the smear on the slide**. Cells must first be spread onto the slide before they can be fixed. - Fixing an un-smeared sample or attempting to smear after fixing would lead to an inadequate or damaged specimen. *3,1,2,4* - This sequence incorrectly starts with **making a smear on a slide** before any sample has been collected or the cervix visualized. - One cannot make a smear without first taking a sample and accessing the cervix via a retractor. *2,1,3,4* - This option incorrectly states that **taking the sample** occurs before **using a posterior vaginal wall retractor**. The retractor is essential for proper visualization and access to the cervix to obtain a quality sample. - Attempting to take a sample without proper visualization would lead to an inadequate or incorrect specimen collection.
Question 33: Which of the following is a part of AMTSL?
- A. Uterine massage
- B. Controlled cord traction (Correct Answer)
- C. Early cord clamping
- D. Uterotonics after delivery of placenta
Explanation: ***Controlled cord traction*** - **Controlled cord traction (CCT)** is a key component of Active Management of Third Stage of Labor (AMTSL) performed during placental delivery. - This technique involves applying gentle, sustained traction to the umbilical cord while simultaneously providing counter-traction to the fundus (Brandt-Andrews maneuver) to prevent **uterine inversion**. - CCT is performed after administering a uterotonic and is the primary active maneuver for delivering the placenta. *Uterine massage* - **Uterine massage** is also a component of AMTSL, but it is performed **after placental delivery** to ensure adequate uterine contraction and prevent postpartum hemorrhage. - The three components of AMTSL per WHO recommendations are: (1) Uterotonic administration, (2) Controlled cord traction, (3) Uterine massage after placental delivery. - While technically part of AMTSL, **controlled cord traction** is the more specific answer as it refers to the active maneuver during placental separation and delivery itself. *Early cord clamping* - **Early cord clamping** (within 60 seconds of birth) has been removed from AMTSL recommendations in favor of **delayed cord clamping** (1-3 minutes or when pulsation stops). - Current WHO guidelines recommend delayed cord clamping for all births while still performing AMTSL, as delayed clamping provides neonatal benefits without increasing maternal hemorrhage risk. *Uterotonics after delivery of placenta* - **Uterotonics** (oxytocin 10 IU IM/IV) are administered **within 1 minute of birth** of the baby, which is *before* placental delivery, not after. - This prophylactic administration is the cornerstone of AMTSL and reduces postpartum hemorrhage risk by approximately 60%. - Administering uterotonics *after* placental delivery does not constitute proper AMTSL timing.
Question 34: Which of the following is not a cause of secondary amenorrhea?
- A. Kallman syndrome (Correct Answer)
- B. Asherman's syndrome
- C. Sheehan's syndrome
- D. Turner's mosaic
Explanation: ***Kallman syndrome*** - This is a cause of **primary amenorrhea** because it involves congenital **GnRH deficiency**, preventing the onset of puberty and menstruation from the beginning. - Patients typically present with failure of pubertal development and **anosmia** (inability to smell). *Asherman's syndrome* - Characterized by **intrauterine adhesions** or scarring, often following uterine surgeries like D&C. - These adhesions can prevent the proper shedding of the endometrium, leading to **secondary amenorrhea** after previously established menses. *Sheehan's syndrome* - Occurs due to **ischemic necrosis of the pituitary gland** following severe postpartum hemorrhage, typically presenting with failure of lactation, fatigue, and **secondary amenorrhea**. - The pituitary damage leads to **deficiency of multiple pituitary hormones**, including FSH and LH. *Turner's mosaic* - While classic **Turner syndrome (45,XO)** is a common cause of primary amenorrhea and gonadal dysgenesis, **Turner's mosaic** (e.g., 45,XO/46,XX) can sometimes result in variable ovarian function. - In some mosaic cases, individuals may experience **menarche** and then develop premature ovarian failure, leading to **secondary amenorrhea**.
Ophthalmology
1 questionsA 30-year-old female presents with redness and pain in the eye. Examination revealed 38 mm of Hg on IOP, aqueous flare, and corneal precipitates. Which of the following drugs must be avoided for her?
INI-CET 2021 - Ophthalmology INI-CET Practice Questions and MCQs
Question 31: A 30-year-old female presents with redness and pain in the eye. Examination revealed 38 mm of Hg on IOP, aqueous flare, and corneal precipitates. Which of the following drugs must be avoided for her?
- A. Carbonic anhydrase inhibitors
- B. Prostaglandin analogs (Correct Answer)
- C. Mannitol
- D. Beta-blockers
Explanation: ***Prostaglandin analogs*** - **Prostaglandin analogs** are **contraindicated in anterior uveitis** because they can significantly worsen inflammation. - They increase the risk of **cystoid macular edema (CME)** in patients with intraocular inflammation. - Can exacerbate existing **uveitis** and compromise treatment outcomes. - While they effectively lower IOP in non-inflammatory conditions, their pro-inflammatory effects make them unsuitable when aqueous flare and KPs are present. *Carbonic anhydrase inhibitors* - These drugs work by decreasing **aqueous humor production** and are safe and effective for reducing **IOP** in **uveitis**. - They do not exacerbate inflammation and are commonly used in the management of **uveitic glaucoma**. - Available in topical (dorzolamide, brinzolamide) and systemic (acetazolamide) formulations. *Mannitol* - **Mannitol** is an osmotic diuretic used for acute, severe elevations in **IOP**. - It rapidly reduces **IOP** by drawing fluid out of the vitreous and is safe to use in uveitis with elevated pressure. - Its use is typically for short-term, urgent IOP control. *Beta-blockers* - **Beta-blockers** (timolol, betaxolol) reduce **IOP** by decreasing **aqueous humor production**. - They are safe and commonly used to manage **elevated IOP** in uveitic patients. - They do not exacerbate inflammation and are first-line agents for IOP control.
Pathology
3 questionsWhich is the cell of origin of Chronic Lymphocytic Leukaemia / Small Lymphocytic Lymphoma?
Arrange the following cellular events of inflammation in the correct sequence: 1. Rolling 2. Cytokine-mediated integrin activation 3. Adhesion 4. Migration
A 5 year old child who presented with proptosis of one of the eyes was found to have a desmin positive tumour. What is the probable diagnosis?
INI-CET 2021 - Pathology INI-CET Practice Questions and MCQs
Question 31: Which is the cell of origin of Chronic Lymphocytic Leukaemia / Small Lymphocytic Lymphoma?
- A. Mature B cells
- B. Progenitor T cells
- C. Mature T cells
- D. Naïve B cells (Correct Answer)
Explanation: ***Naïve B cells*** - Chronic Lymphocytic Leukaemia (CLL) and Small Lymphocytic Lymphoma (SLL) originate from **CD5-positive B lymphocytes** arrested in a mature but **naïve differentiation stage** [1]. - These cells express both **B-cell markers (CD19, CD20, CD23)** and a T-cell marker (CD5), which is characteristic of the clone [4]. *Mature B cells* - While CLL/SLL are derived from B cells, they are specifically from **naïve, not fully mature, B cells**. - **Other B-cell lymphomas** like follicular lymphoma or mantle cell lymphoma originate from distinct stages of mature B-cell differentiation [2]. *Progenitor T cells* - **Progenitor T cells** are the cells of origin for **T-cell acute lymphoblastic leukaemia (T-ALL)**, not CLL/SLL [3]. - T-ALL involves immature T lymphocytes and presents with different clinical and immunophenotypic features [3]. *Mature T cells* - **Mature T cells** can give rise to various **peripheral T-cell lymphomas**, like peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) or cutaneous T-cell lymphoma (Mycosis Fungoides). - These are distinct from CLL/SLL, which is a B-cell neoplasm [4]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 596-598. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 610-612. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 598-599. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 598.
Question 32: Arrange the following cellular events of inflammation in the correct sequence: 1. Rolling 2. Cytokine-mediated integrin activation 3. Adhesion 4. Migration
- A. 1,2,3,4 (Correct Answer)
- B. 3,4,1,2
- C. 2,1,4,3
- D. 4,1,2,3
Explanation: ***1,2,3,4*** - The correct sequence of cellular events for leukocyte recruitment during inflammation begins with **rolling** [1], followed by **cytokine-mediated integrin activation** [2], then firm **adhesion** to the endothelium [1], and finally **migration** (diapedesis) into the tissues [3]. - This step-by-step process ensures effective targeting of leukocytes to the site of injury or infection [1]. *3,4,1,2* - This sequence is incorrect as **adhesion** cannot occur before **rolling**, and **migration** is the final step after adhesion, not an early one. - **Cytokine-mediated integrin activation** must precede firm adhesion [1]. *2,1,4,3* - This order is incorrect because **rolling** (1) is the initial interaction that allows leukocytes to slow down on the endothelium [2], and it occurs before **cytokine-mediated integrin activation** (2) which strengthens the binding. - **Migration** (4) is also misplaced as it should be the last step after firm adhesion (3). *4,1,2,3* - This sequence is incorrect as **migration** (4) is the last step in the process, not the first. - **Rolling** (1) initiates the process by transiently interacting with endothelial cells, followed by activation and adhesion. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 87. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Migration in the tissues toward a chemotactic stimulus, pp. 86-87. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 87-89.
Question 33: A 5 year old child who presented with proptosis of one of the eyes was found to have a desmin positive tumour. What is the probable diagnosis?
- A. Neuroblastoma
- B. Retinoblastoma
- C. Rhabdomyosarcoma (Correct Answer)
- D. Ewing's sarcoma
Explanation: ***Rhabdomyosarcoma*** - **Desmin positivity** is a characteristic immunohistochemical feature of **rhabdomyosarcoma**, as desmin is an intermediate filament found in muscle cells [1]. - In a 5-year-old child presenting with **proptosis**, rhabdomyosarcoma of the orbit is a highly probable diagnosis, as it is the most common primary malignant orbital tumor in childhood [3]. *Neuroblastoma* - Neuroblastoma is typically a tumor of neural crest origin, with classic immunohistochemical markers being **neuron-specific enolase (NSE)** and **chromogranin**, not desmin [2]. - While it can manifest with orbital metastases leading to proptosis, the desmin positivity rules it out as the primary diagnosis [3]. *Retinoblastoma* - Retinoblastoma is a malignant tumor of the retina, presenting with **leukocoria** (white pupillary reflex) and occasionally proptosis in advanced stages [4]. - It arises from neuroectodermal cells, and its characteristic markers include **synaptophysin** and **neuron-specific enolase (NSE)**, not desmin [4]. *Ewing's sarcoma* - Ewing's sarcoma is a primary malignant small round blue cell tumor of bone and soft tissue, typically marked by expression of **CD99** and a characteristic **t(11;22) translocation**. - While it can occur in the orbit, it is not desmin positive, making rhabdomyosarcoma a more likely diagnosis given the immunohistochemical findings. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1224-1225. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 211-212. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1323-1324. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 737-738.
Pharmacology
1 questionsWhich of the following is not used to treat PCOD?
INI-CET 2021 - Pharmacology INI-CET Practice Questions and MCQs
Question 31: Which of the following is not used to treat PCOD?
- A. Tamoxifen (Correct Answer)
- B. OCP
- C. Metformin
- D. Clomiphene citrate
Explanation: ***Tamoxifen*** - **Tamoxifen** is a selective estrogen receptor modulator (SERM) primarily used in the treatment of **estrogen receptor-positive breast cancer**. - While other SERMs like clomiphene citrate are used in PCOD for ovulation induction, tamoxifen is not a standard treatment for **PCOD** itself. *OCP* - **Oral contraceptive pills (OCPs)** are a common first-line treatment for managing various symptoms of PCOD, such as **menstrual irregularities** and **hirsutism**. - They work by suppressing ovarian androgen production and providing regular withdrawal bleeds. *Metformin* - **Metformin** is an insulin-sensitizing agent often used in PCOD, especially in women with **insulin resistance** or impaired glucose tolerance. - It helps improve **menstrual regularity** and can facilitate ovulation in some patients by reducing insulin levels. *Clomiphene citrate* - **Clomiphene citrate** is a selective estrogen receptor modulator (SERM) commonly used as an **ovulation induction agent** in women with PCOD who are trying to conceive. - It works by blocking estrogen receptors in the hypothalamus, leading to increased release of **gonadotropins** (FSH and LH).