INI-CET 2021 Practice Questions

Q: SAFE strategy for trachoma includes all except?

Evaluation of control program. ***Evaluation of control program*** - **Evaluation** is a monitoring and assessment process used to measure the effectiveness of the SAFE strategy, but it is **not one of the four intervention components** of the strategy itself. - The SAFE strategy consists of: **S**urgery, **A**ntibiotics, **F**acial cleanliness, and **E**nvironmental improvement. *Surgery for trichiasis* - **Trichiasis** (in-turned eyelashes) is a blinding complication of trachoma requiring **surgical correction** to prevent corneal damage. - This is the "S" component of SAFE. *Antibiotics* - **Mass drug administration** with **azithromycin** (single oral dose) is used to reduce the community reservoir of *Chlamydia trachomatis*. - This is the "A" component of SAFE. *Facial cleanliness* - Promoting **facial hygiene**, especially in children, prevents transmission of *Chlamydia trachomatis* through contact and fly vectors. - This is the "F" component of SAFE. *Environmental improvement (Not listed as an option but part of SAFE)* - Improving **water supply**, **sanitation**, and **waste management** reduces breeding sites for flies and improves hygiene. - This is the "E" component of SAFE.

Q: A person working in a dye factory presented with nausea, vomiting, dark bloody stools, conjunctivitis, and a burning sensation in the throat and stomach. Which poisoning do you suspect in this case?

Potassium permanganate. ***Potassium permanganate*** - The presence of **nausea, vomiting, dark bloody stools, conjunctivitis, and a burning sensation in the throat and stomach** is highly indicative of **potassium permanganate poisoning**, which is a caustic agent. - Exposure in a **dye factory** setting further supports this, as potassium permanganate is used as an **oxidizing agent** and **dyeing agent** in various industries. *Lead* - Lead poisoning typically presents with **neurological symptoms** (e.g., foot drop, wrist drop, encephalopathy), **gastrointestinal complaints** (e.g., colic, constipation), and **hematological abnormalities** (e.g., anemia with basophilic stippling). - The acute caustic effects like **burning sensation in the throat and bloody stools** are not characteristic of lead poisoning. *Arsenic* - Acute arsenic poisoning often involves **severe gastroenteritis** ("rice-water stools"), **garlic odor on breath**, **peripheral neuropathy**, and **cardiac arrhythmias**. - While it can cause gastrointestinal distress, the specific caustic burn and conjunctivitis alongside the industrial exposure profile point away from arsenic. *Thallium* - Thallium poisoning is characterized by **rapid hair loss (alopecia)**, **severe peripheral neuropathy**, and **gastrointestinal symptoms** (e.g., abdominal pain, vomiting, diarrhea). - The constellation of symptoms described, particularly the caustic burn and dark bloody stools, does not align with the typical presentation of thallium toxicity.

Q: On conducting the autopsy on a victim of hanging, the ligature mark is seen at the lower 1/3rd of the neck. The victim is seen to have a protruded tongue. He was found with his head hanging to his left side with saliva dribbling from the left angle of his mouth. The right pupil appears constricted and there is ptosis (drooping) of the right eyelid. Compression of which of the following structures is the most probable reason for the unilateral ptosis in this case?

Cervical sympathetic chain. ***Cervical sympathetic chain*** - The combination of **unilateral ptosis**, **miosis** (constricted pupil), and sometimes **anhidrosis** (lack of sweating) is characteristic of **Horner's syndrome**, which results from damage to the **cervical sympathetic chain**. - Hanging can cause compression or injury to this chain, leading to the observed **Horner's syndrome** on the ipsilateral side of the injury. *Left vagus nerve* - Compression of the **vagus nerve** is associated with cardiac arrhythmias, bradycardia, or gastric disturbances, not directly with ptosis. - The symptoms observed are specific to sympathetic dysfunction, not parasympathetic vagal stimulation. *Right internal jugular vein* - Compression of the **internal jugular vein** would cause venous congestion and edema in the head and neck, not neurological signs like ptosis or miosis. - While it can be injured in hanging, it does not directly explain the specific neurological findings. *Right internal carotid artery* - Compression of the **internal carotid artery** could lead to cerebral ischemia or stroke symptoms, such as weakness or sensory deficits, but not typically isolated ptosis and miosis. - The observed symptoms point to a specific sympathetic pathway disruption rather than arterial occlusion.

Q: Which of the following symptoms are seen in endometriosis? 1. Infertility 2. Dysmenorrhea 3. Vaginal discharge 4. Vaginal bleeding

1,2. ***Correct: 1,2 (Infertility and Dysmenorrhea)*** - **Infertility** is present in 30-50% of women with endometriosis, making it one of the most common presentations. Caused by inflammation, adhesions, altered pelvic anatomy, and inflammatory mediators that impair reproductive function. - **Dysmenorrhea (painful menstruation)** is the hallmark symptom of endometriosis. The pain is typically severe, progressive, and occurs due to cyclic bleeding from ectopic endometrial tissue, causing inflammation and irritation of surrounding structures. - These are the two most characteristic and consistent symptoms of endometriosis. *Incorrect: 2,3* - While dysmenorrhea is correct, **vaginal discharge is NOT a characteristic symptom of endometriosis**. Vaginal discharge is typically associated with infections (vaginitis, cervicitis) or other gynecological conditions, not endometriosis. *Incorrect: 1,2,4* - While infertility and dysmenorrhea are correct, including "vaginal bleeding" makes this option less accurate. Although some women with endometriosis may experience menorrhagia or irregular bleeding (particularly with adenomyosis or ovarian endometriomas), **abnormal vaginal bleeding is not a primary or pathognomonic symptom** of endometriosis. *Incorrect: 3,4* - **Vaginal discharge** is not associated with endometriosis. - **Vaginal bleeding** as a standalone symptom is not a primary feature of endometriosis, though menstrual abnormalities can occasionally occur. **Note:** Other classic symptoms of endometriosis include dyspareunia (painful intercourse), dyschezia (painful defecation), and chronic pelvic pain.

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: Identify the surgical step shown in the image given below

Lens aspiration. ***Lens aspiration*** - The image shows a **phacoemulsification handpiece** (the instrument with the shining tip and central bore tube) actively fragmenting and aspirating the lens material, indicated by the cloudy material being removed. - This step is part of cataract surgery where the cataractous lens material is removed from the eye. *Capsulorrhexis* - This involves creating a **continuous curvilinear tear** in the anterior lens capsule, typically done at the beginning of cataract surgery. - The image does not show a tearing or incising action on the capsule; instead, it depicts material removal. *Hydrodissection* - This step involves injecting a **fluid wave** between the lens capsule and the lens cortex to separate them, facilitating nuclear rotation and removal. - The image depicts the removal of lens material, not the injection of fluid to separate layers. *Intraocular lens implantation* - This step involves inserting the **artificial lens** into the capsular bag after the cataractous lens has been removed. - The visual cues in the image indicate material removal and emulsification, not the insertion of a new lens.

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.

Q: A person was brought to the emergency department with facial swelling, itching, and hypotension following a bee sting. The mentioned clinical features are due to the increase in which immunoglobulin?

IgE. IgE - The symptoms of **facial swelling, itching, and hypotension** following a bee sting are characteristic of an immediate hypersensitivity reaction, specifically **anaphylaxis**, which is predominantly mediated by **IgE antibodies** [1]. - **IgE** binds to mast cells and basophils, and upon re-exposure to the allergen (bee venom), triggers the release of potent inflammatory mediators like **histamine**, causing vasodilation, increased vascular permeability, and smooth muscle contraction [1], . *IgG* - **IgG** antibodies are primarily involved in secondary immune responses, conferring long-term immunity, and neutralizing toxins and viruses [1]. - While IgG can be involved in some hypersensitivity reactions (Type II and Type III), it is not the primary immunoglobulin responsible for the acute, systemic symptoms of **anaphylaxis** from a bee sting [1]. *IgA* - **IgA** is the main immunoglobulin found in mucosal secretions, such as those in the gastrointestinal, respiratory, and genitourinary tracts, providing mucosal immunity. - It does not play a significant role in immediate hypersensitivity reactions or the systemic symptoms described in this scenario. *IgM* - **IgM** is the first antibody produced during a primary immune response and is important for activating the complement system and agglutinating antigens [1]. - It is not directly implicated in the pathogenesis of **Type I hypersensitivity reactions** like the anaphylactic response to a bee sting. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 208-213.

Question 1

SAFE strategy for trachoma includes all except?

Accepted Answer

Evaluation of control program

Answer

Antibiotics

Answer

Surgery for trichiasis

Answer

Facial cleanliness

Question 2

A person working in a dye factory presented with nausea, vomiting, dark bloody stools, conjunctivitis, and a burning sensation in the throat and stomach. Which poisoning do you suspect in this case?

Accepted Answer

Potassium permanganate

Answer

Lead

Answer

Arsenic

Answer

Thallium

Question 3

On conducting the autopsy on a victim of hanging, the ligature mark is seen at the lower 1/3rd of the neck. The victim is seen to have a protruded tongue. He was found with his head hanging to his left side with saliva dribbling from the left angle of his mouth. The right pupil appears constricted and there is ptosis (drooping) of the right eyelid. Compression of which of the following structures is the most probable reason for the unilateral ptosis in this case?

Accepted Answer

Cervical sympathetic chain

Answer

Left vagus nerve

Answer

Right internal jugular vein

Answer

Right internal carotid artery

Question 4

Which of the following symptoms are seen in endometriosis?

1. Infertility
2. Dysmenorrhea
3. Vaginal discharge
4. Vaginal bleeding

Accepted Answer

1,2

Answer

2,3

Answer

1,2,4

Answer

3,4

Question 5

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 6

Identify the surgical step shown in the image given below

Accepted Answer

Lens aspiration

Answer

Capsulorrhexis

Answer

Hydrodissection

Answer

Intraocular lens implantation

Question 7

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

Question 8

A person was brought to the emergency department with facial swelling, itching, and hypotension following a bee sting. The mentioned clinical features are due to the increase in which immunoglobulin?

Accepted Answer

IgE

Answer

IgG

Answer

IgA

Answer

IgM

Question 9

A 42 year-old female patient presents with cough, low-grade fever, and hemoptysis.
Investigations reveal a cavitary lesion on her right lung apex, which on biopsy reveals caseous necrosis. The underlying pathophysiology is:

Accepted Answer

Type 4 hypersensitivity reaction

Answer

Sudden cut off of blood supply

Answer

Enzyme degradation

Answer

Fibrinoid deposition

Question 10

Which of the following is a true statement about congenital CMV infection?

Accepted Answer

If mother is IgG positive for CMV prior to conception, the child is less likely to develop severe infection

Answer

About 20-30% of the infections are symptomatic

Answer

Triad of SNHL, periventricular calcification and enamel hypoplasia

Answer

Most children asymptomatic at birth can develop conductive hearing loss later in life

INI-CET 2021

Community Medicine

Forensic Medicine

Obstetrics and Gynecology

Ophthalmology

Pathology

Pediatrics