INI-CET 2021 Practice Questions

Q: A skull was recovered from a forest. According to inquest papers, a girl had gone missing 15 days back. The skull was sent to the forensic research lab. Which of the following would identify it as a female skull? 1. Large frontal and parietal eminence 2. Heavy cheek bones 3. Smooth glabella 4. Square orbits 5. Narrow mastoid

1,3 and 5. ***1,3 and 5*** - **Large frontal and parietal eminences** are characteristic features of a **female skull**, indicating a more rounded appearance. - A **smooth glabella** (the area between the eyebrows) is typical for females, as males tend to have a more prominent brow ridge. A **narrow mastoid** process is also characteristic in females. *2,3 and 4* - **Heavy cheekbones** and **square orbits** are features more commonly associated with a **male skull**. - While a **smooth glabella** is a female characteristic, its combination with male features makes this option incorrect. *1 and 4 only* - **Large frontal eminences** are indicative of a female skull, but **square orbits** are a feature of a **male skull**. - This combination presents conflicting information regarding gender identification. *3,4 and 5* - A **smooth glabella** and **narrow mastoid** are features of a **female skull**. - However, **square orbits** are typically found in **male skulls**, rendering this option incorrect.

Q: The dead body of a 20 year old man found in the sea was brought in for postmortem examination. Which of the following findings would you see in seawater drowning? 1. Hemoconcentration 2. Pulmonary edema 3. Hyponatremia 4. Hypernatremia 5. Hemolysis

1 and 4. ***1 and 4*** - In **seawater drowning**, the hypertonic seawater (3-4% salt) creates an osmotic gradient that pulls plasma fluid from the blood into the alveoli, leading to **hemoconcentration**. - The absorption of hypertonic seawater into the bloodstream results in **hypernatremia** and hyperchloremia. - These are the characteristic electrolyte and hematologic findings specific to seawater drowning. *2, 4 and 5* - While **hypernatremia** is correct, this option incorrectly includes **pulmonary edema** (which is non-specific to drowning type) and **hemolysis** (which is characteristic of freshwater drowning, not seawater). - **Hemolysis** occurs in freshwater drowning when hypotonic water enters the bloodstream, causing red blood cells to swell and lyse. *2, 3 and 5* - This option is incorrect as it includes findings characteristic of **freshwater drowning**: **hyponatremia** and **hemolysis**. - In freshwater drowning, hypotonic water absorption causes hemodilution (not hemoconcentration), leading to hyponatremia and hemolysis. - **Pulmonary edema** is present in both types but does not differentiate between them. *1 and 3* - While **hemoconcentration** is correct for seawater drowning, **hyponatremia** is incorrect. - Hyponatremia is a feature of freshwater drowning due to dilution of serum sodium by absorbed hypotonic water.

Q: The friend and victim had alcohol and got into an argument over a common girlfriend, following which the friend kills the victim by sitting on his chest and covering his nose and mouth. This is an example of?

Smothering. ***Smothering*** - This scenario describes **manual obstruction** of the mouth and nose, preventing air entry without external neck compression. - The act of sitting on the chest further restricts respiratory movements, contributing to **asphyxia**. *Gagging* - Gagging refers to the obstruction of the **oral cavity** due to material placed inside the mouth, typically to prevent speaking or crying out. - While it can contribute to asphyxia, the primary mechanism described here involves external covering of both nose and mouth. *Choking* - Choking involves the **internal obstruction** of the airway, usually by a foreign body lodged in the pharynx or larynx. - This scenario explicitly details external occlusion of the respiratory orifices, not internal blockage. *Throttling* - Throttling is a form of **manual strangulation** that involves direct compression of the neck by hands or forearm. - The description of covering the nose and mouth rather than compressing the neck rules out throttling.

Q: Which of the following can be prevented by transfusing irradiated RBCs?

Graft versus host disease. Graft versus host disease - **Irradiation** of red blood cell (RBC) products inactivates proliferating donor **T-lymphocytes**, which are responsible for mediating transfusion-associated **graft-versus-host disease (TA-GVHD)**. - TA-GVHD is a severe and often fatal complication where donor immune cells attack recipient tissues. *HLA Alloimmunization* - **HLA alloimmunization** is prevented by **leukoreduction**, which removes donor leukocytes expressing HLA antigens, not by irradiation. - Irradiation targets the proliferative capacity of T-lymphocytes, but does not remove the cells themselves or prevent the presentation of HLA antigens. *Transfusion Related Acute Lung Injury (TRALI)* - **TRALI** is primarily associated with **donor antibodies** (anti-HLA or anti-HNA) in plasma that react with recipient neutrophils, leading to lung injury. - It is prevented by selecting plasma donors who have not been pregnant or by using male-only plasma, not by irradiating RBCs. *Immunomodulation* - **Transfusion-related immunomodulation (TRIM)** is a broad effect associated with multiple blood components, including cytokines and biological response modifiers in the transfused products. - While leukoreduction may reduce some aspects of TRIM, irradiation is not specifically used to prevent or reduce this phenomenon.

Q: What is the minimum percentage for normal sperm morphology according to WHO criteria in seminal fluid analysis?

4 %. ***4 %*** - According to the **World Health Organization (WHO) 2010 criteria** (maintained in WHO 2021, 6th edition), a minimum of **4% normal forms** is considered the lower reference limit for **sperm morphology**. - This seemingly low percentage reflects the **strict criteria (Tygerberg's strict criteria)** used for assessing sperm shape and structure, which evaluates the head, midpiece, and tail dimensions. - Values ≥4% are considered within normal range for **male fertility potential**. *8 %* - An 8% normal morphology would be considered **above the lower reference limit** according to current WHO guidelines. - While quantitatively better and indicating good sperm quality, it is not the *minimum* threshold required for classification as normal. *6 %* - A **6% normal morphology** is above the 4% minimum threshold set by WHO for normal sperm morphology. - This value is not the designated **lower reference limit** for identifying normal morphology as per the standard recommendations. *10 %* - A 10% normal morphology indicates **very good sperm morphology**, well above the lower reference limit. - However, the question asks for the **minimum percentage** for normal classification, and 10% is not that lower threshold.

Q: Which of the following instruments are used in the caesarean section? 1. Bard-Parker blade 2. Doyen's retractor 3. Cusco's speculum 4. Allis forceps 5. Shirodkar's uterine clamp 6. Green Armytage forceps

1,2,4,6. ***Correct: 1,2,4,6*** - **Bard-Parker blade** (scalpel) is used for making the abdominal and uterine incisions in caesarean section. - **Doyen's retractor** is a common abdominal wall retractor used in C-sections to provide good exposure of the uterus. - **Allis forceps** are used to grasp and hold tissues, often the rectus sheath or uterine edges, for traction or approximation during the procedure. - **Green Armytage forceps** are specialized obstetric forceps primarily used to clamp the uterine edges after incision to control bleeding. *Incorrect: 1,2,3,6* - This option incorrectly includes **Cusco's speculum**, which is a vaginal speculum used for gynecological examinations and procedures like colposcopy or Pap smears, not for a caesarean section. - While Bard-Parker blade, Doyen's retractor, and Green Armytage forceps are correct, the inclusion of Cusco's speculum makes this option incorrect. *Incorrect: 1,2,5,6* - This option incorrectly includes **Shirodkar's uterine clamp**. Shirodkar's procedure refers to a type of cervical cerclage, and there isn't a widely recognized "Shirodkar's uterine clamp" used in standard caesarean sections. - Bard-Parker blade, Doyen's retractor, and Green Armytage forceps are correct, but the presence of Shirodkar's uterine clamp makes the option incorrect in the context of a typical C-section. *Incorrect: 1,2,3,5* - This option incorrectly includes both **Cusco's speculum** and **Shirodkar's uterine clamp**. - As explained, Cusco's speculum is for vaginal examination, and Shirodkar's clamp is not a standard instrument for caesarean sections.

Q: What is the normal cervical length?

3 cm. ***3 cm*** - The **normal cervical length** in a non-pregnant woman typically measures **3-4 cm**, with **3 cm** being the commonly cited average. - During pregnancy, cervical length is monitored via transvaginal ultrasound, and a length ≥3 cm is considered reassuring for pregnancy maintenance. - This measurement is crucial for assessing the risk of preterm labor and cervical incompetence. *10 cm* - A cervical length of **10 cm is anatomically impossible** and not consistent with normal female reproductive anatomy. - The entire uterus (fundus to external os) measures approximately 7-8 cm in a non-pregnant state, making 10 cm for cervix alone unrealistic. *5 cm* - While **5 cm is within the upper range** of normal cervical length, it is longer than the typical average. - Cervical length can vary between 3-5 cm in healthy women, but **3-4 cm is most commonly cited** as the standard reference. *7 cm* - A cervical length of **7 cm is longer than normal** and would be considered abnormally elongated. - This measurement approximates the entire uterine length (fundus to external os), not just the cervix.

Q: What is the most common route of the spread of retinoblastoma?

Hematogenous. ***Correct: Hematogenous*** - **Hematogenous spread** is the most common route of metastatic dissemination in retinoblastoma, occurring when tumor cells invade choroidal blood vessels. - This leads to distant metastases in **bone marrow, bones, liver, and brain** through bloodstream circulation. - Studies of metastatic retinoblastoma show hematogenous spread accounts for the majority of extraocular dissemination patterns. *Incorrect: Optic nerve invasion* - While optic nerve invasion is the **most clinically significant** prognostic factor and provides direct CNS access, it is not the most common route statistically. - Occurs in approximately 20-30% of enucleated eyes and is a critical indicator for adjuvant therapy. - When present, it dramatically worsens prognosis due to leptomeningeal spread potential. *Incorrect: Lymphatic spread* - The globe lacks true lymphatic drainage, making lymphatic spread extremely rare. - Lymphatic involvement only occurs if tumor extends beyond the eye into orbital tissues with lymphatic channels. - Not a primary route of retinoblastoma dissemination. *Incorrect: Direct invasion* - Direct orbital invasion occurs with advanced intraocular tumors breaking through the sclera. - This is a local extension rather than a route of distant metastatic spread. - While serious, it represents local progression rather than the most common dissemination pathway.

Q: Which of the following is true? 1. BRCA1 is an oncogene 2. HER2neu is amplified only in a fraction of breast cancer 3. EGFR (+) is seen in non-small cell lung cancer 4. N-MYC is a tumor suppressor gene

2,3. ***Correct Option: 2,3*** - **Statement 2 is TRUE**: HER2neu amplification occurs in only a fraction (~15-20%) of breast cancers, making it a specific subset requiring targeted therapy with trastuzumab (Herceptin) [1]. - **Statement 3 is TRUE**: EGFR (epidermal growth factor receptor) mutations or overexpression are commonly seen in non-small cell lung cancer (NSCLC) and serve as important therapeutic targets for tyrosine kinase inhibitors. *Incorrect Option: 1,3* - Statement 1 is **FALSE**: BRCA1 is a **tumor suppressor gene**, not an oncogene. It functions in DNA double-strand break repair, and loss-of-function mutations increase the risk of breast and ovarian cancers. - Statement 3 is TRUE, but the inclusion of the false statement about BRCA1 makes this option incorrect. *Incorrect Option: 1,2* - Statement 1 is **FALSE**: BRCA1 is a **tumor suppressor gene**, not an oncogene. - Statement 2 is TRUE [1], but the false classification of BRCA1 invalidates this option. *Incorrect Option: All of the options* - Statement 1 is **FALSE**: BRCA1 is a tumor suppressor gene, not an oncogene. - Statement 4 is **FALSE**: N-MYC is an **oncogene** that is amplified in neuroblastoma and other cancers, not a tumor suppressor gene. - Since two of the four statements are incorrect, "All of the options" cannot be true. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1059-1060.

Q: A patient with lytic lesions on the skull is suspected of a diagnosis of Langerhans cell histiocytosis. Which of the following is a characteristic finding on electron microscopy?

Birbeck granules. ***Birbeck granules*** - **Birbeck granules** are rod-shaped organelles with a striated core and a dilated end, resembling a "tennis racket," which are pathognomonic for **Langerhans cells** and, by extension, **Langerhans cell histiocytosis** [1]. - Their presence on **electron microscopy** is a definitive diagnostic feature for LCH [1]. *Eosinophils* - While **eosinophils** are often seen infiltrating lesions in **Langerhans cell histiocytosis**, they are not the diagnostic cellular component or ultrastructural finding on electron microscopy [1]. - **Eosinophils** are granulocytes involved in allergic reactions and parasitic infections; their appearance on EM is distinct from Birbeck granules. *Histiocytes* - **Histiocytes** (macrophages) are present in various inflammatory and neoplastic conditions and are the cell lineage from which **Langerhans cells** are derived, but their general presence on **electron microscopy** is not specific enough for diagnosing **LCH** [1]. - Without the characteristic **Birbeck granules**, a generic histiocyte would not distinguish LCH from other histiocytic disorders [1]. *Giant cells* - **Giant cells**, such as **multinucleated giant cells** or **osteoclasts**, can be found in association with bone lesions including **lytic lesions**, but they are not specific to **Langerhans cell histiocytosis** and do not possess Birbeck granules. - Their presence points to bone destruction or inflammation but not the underlying cellular pathology of LCH. **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, p. 630.

Question 1

A skull was recovered from a forest. According to inquest papers, a girl had gone missing 15 days back. The skull was sent to the forensic research lab. Which of the following would identify it as a female skull?

1. Large frontal and parietal eminence
2. Heavy cheek bones
3. Smooth glabella
4. Square orbits
5. Narrow mastoid

Accepted Answer

1,3 and 5

Answer

2,3 and 4

Answer

1 and 4 only

Answer

3,4 and 5

Question 2

The dead body of a 20 year old man found in the sea was brought in for postmortem examination. Which of the following findings would you see in seawater drowning?

1. Hemoconcentration
2. Pulmonary edema
3. Hyponatremia
4. Hypernatremia
5. Hemolysis

Accepted Answer

1 and 4

Answer

2,4 and 5

Answer

2,3 and 5

Answer

1 and 3

Question 3

The friend and victim had alcohol and got into an argument over a common girlfriend, following which the friend kills the victim by sitting on his chest and covering his nose and mouth. This is an example of?

Accepted Answer

Smothering

Answer

Gagging

Answer

Choking

Answer

Throttling

Question 4

Which of the following can be prevented by transfusing irradiated RBCs?

Accepted Answer

Graft versus host disease

Answer

HLA Alloimmunization

Answer

Transfusion Related Acute Lung Injury (TRALI)

Answer

Immunomodulation

Question 5

What is the minimum percentage for normal sperm morphology according to WHO criteria in seminal fluid analysis?

Accepted Answer

4 %

Answer

8 %

Answer

6 %

Answer

10 %

Question 6

Which of the following instruments are used in the caesarean section?

1. Bard-Parker blade
2. Doyen's retractor
3. Cusco's speculum
4. Allis forceps
5. Shirodkar's uterine clamp
6. Green Armytage forceps

Accepted Answer

1,2,4,6

Answer

1,2,3,6

Answer

1,2,5,6

Answer

1,2,3,5

Question 7

What is the normal cervical length?

Accepted Answer

3 cm

Answer

10 cm

Answer

5 cm

Answer

7 cm

Question 8

What is the most common route of the spread of retinoblastoma?

Accepted Answer

Hematogenous

Answer

Optic nerve invasion

Answer

Direct invasion

Answer

Lymphatic spread

Question 9

Which of the following is true?

1. BRCA1 is an oncogene
2. HER2neu is amplified only in a fraction of breast cancer
3. EGFR (+) is seen in non-small cell lung cancer
4. N-MYC is a tumor suppressor gene

Accepted Answer

2,3

Answer

1,3

Answer

1,2

Answer

All of the options

Question 10

A patient with lytic lesions on the skull is suspected of a diagnosis of Langerhans cell histiocytosis. Which of the following is a characteristic finding on electron microscopy?

Accepted Answer

Birbeck granules

Answer

Eosinophils

Answer

Histiocytes

Answer

Giant cells

INI-CET 2021

Forensic Medicine

Internal Medicine

Obstetrics and Gynecology

Ophthalmology

Pathology