Anatomy
1 questionsIdentify which of the following structure is a sebaceous gland:
INI-CET 2022 - Anatomy INI-CET Practice Questions and MCQs
Question 91: Identify which of the following structure is a sebaceous gland:
- A. 2 (Correct Answer)
- B. 3
- C. 4
- D. 1
Explanation: ***Correct: (2) Sebaceous gland*** - The structure labeled (2) is a **sebaceous gland**, characterized by its **multicellular alveolar structure** typically associated with a hair follicle - Sebaceous glands are **holocrine glands** where the entire cell disintegrates to release sebum (oily secretion) - These glands are found throughout the body except on palms and soles, and produce **sebum for lubrication** of hair and skin - Histologically identified by **grape-like clusters of cells** with foamy cytoplasm due to lipid content *Incorrect: (3) Inner root sheath* - The structure labeled (3) represents the **inner root sheath** of the hair follicle - This is a **structural component**, not a glandular structure - Functions to provide support and guidance to the developing hair shaft - Composed of three layers: Henle's layer, Huxley's layer, and the cuticle *Incorrect: (4) Hair matrix* - The structure labeled (4) indicates the **hair matrix**, located at the base of the hair follicle - This is a **proliferative zone** with actively dividing cells responsible for hair growth - Not a glandular structure, but rather the germinative region where hair cells differentiate - Contains melanocytes that provide pigment to the growing hair *Incorrect: (1) Hair shaft* - The structure labeled (1) is the **hair shaft**, the visible keratinized portion of the hair - This is the **final product** of the hair follicle, composed of dead, keratinized cells - Not a glandular structure, but rather a modified epidermal structure - Extends from the hair follicle through the skin surface
Dermatology
2 questionsA woman presents with lesions on the inner thighs and peri-anal region. They are nodular, 4-6 mm in size and appear pale. The histopathological image shows multiple intracytoplasmic inclusion bodies consistent with Henderson-Patterson bodies. The diagnosis is:
A 7-year-old child presents to the dermatology clinic with multiple small, painless, flesh-colored papules on the trunk and arms that have been present for 3 months. The lesions are 2-4 mm in diameter, dome-shaped with a smooth surface, and several have a characteristic central umbilication. The child is otherwise healthy and immunocompetent. The lesions are not pruritic and there is no associated lymphadenopathy. On closer examination, a white, cheesy material can be expressed from the central depression of some lesions. What is the most likely diagnosis?
INI-CET 2022 - Dermatology INI-CET Practice Questions and MCQs
Question 91: A woman presents with lesions on the inner thighs and peri-anal region. They are nodular, 4-6 mm in size and appear pale. The histopathological image shows multiple intracytoplasmic inclusion bodies consistent with Henderson-Patterson bodies. The diagnosis is:
- A. Trichodysplasia spinulosa
- B. Molluscum contagiosum (Correct Answer)
- C. Condyloma acuminata
- D. Donovanosis
Explanation: ***Molluscum contagiosum*** - The clinical presentation of **nodular, pale lesions** in the inner thighs and peri-anal region, combined with histopathology showing **Henderson-Patterson bodies** (large eosinophilic intracytoplasmic inclusions), is pathognomonic for molluscum contagiosum. - Henderson-Patterson bodies represent viral factories within infected keratinocytes, a key diagnostic feature of this **poxvirus** infection. *Trichodysplasia spinulosa* - This condition is characterized by **follicular papules** with prominent keratin spines, typically occurring on the face, and is associated with the **Trichodysplasia spinulosa-associated polyomavirus**. - It does not present with Henderson-Patterson bodies or the typical nodular lesions seen in molluscum contagiosum. *Condyloma acuminata* - These are **genital warts** caused by the **human papillomavirus (HPV)**, presenting as verrucous or cauliflower-like growths. - Histologically, they show **koilocytic atypia** (vacuolated cells with nuclear abnormalities), not Henderson-Patterson bodies. *Donovanosis* - Also known as **granuloma inguinale**, this is a chronic, progressive, ulcerative granulomatous disease caused by **Klebsiella granulomatis**. - Histopathology reveals **Donovan bodies** (intracellular bacteria within macrophages), which are distinct from Henderson-Patterson bodies and the clinical presentation of nodular lesions.
Question 92: A 7-year-old child presents to the dermatology clinic with multiple small, painless, flesh-colored papules on the trunk and arms that have been present for 3 months. The lesions are 2-4 mm in diameter, dome-shaped with a smooth surface, and several have a characteristic central umbilication. The child is otherwise healthy and immunocompetent. The lesions are not pruritic and there is no associated lymphadenopathy. On closer examination, a white, cheesy material can be expressed from the central depression of some lesions. What is the most likely diagnosis?
- A. Trichodysplasia spinulosa
- B. Condyloma acuminata
- C. Donovanosis
- D. Molluscum contagiosum (Correct Answer)
Explanation: ***Molluscum contagiosum*** - The classic presentation of **flesh-colored, dome-shaped papules** with **central umbilication** is pathognomonic for molluscum contagiosum. - The presence of a **white, cheesy material** that can be expressed from the central depression is characteristic of the viral core. *Trichodysplasia spinulosa* - This condition presents with **follicular papules** and **spiny projections**, primarily on the face, and is typically seen in **immunocompromised** individuals. - The description of **flesh-colored, dome-shaped papules** with **umbilication** does not fit the typical presentation of trichodysplasia spinulosa. *Condyloma acuminata* - These are **genital warts** caused by HPV, typically presenting as **verrucous** or **cauliflower-like lesions** on the anogenital region. - The description of **small, painless, flesh-colored papules** with **central umbilication** on the trunk and arms is inconsistent with condyloma acuminata. *Donovanosis* - Donovanosis, or **granuloma inguinale**, is a rare bacterial infection causing **ulcerative lesions** in the genital and perianal areas. - This diagnosis is highly unlikely given the child's age, rash location (trunk and arms), and the specific morphology of the lesions.
Pathology
3 questionsMatch the following cell types/patterns (Column A) with their associated malignancies (Column B): Column A (Cell types/patterns): a) Faggot cell b) Popcorn cell c) Starry sky pattern d) Cerebriform nuclei Column B (Associated malignancies): 1) Acute promyelocytic leukemia 2) Lymphocyte-predominant Hodgkin's lymphoma 3) Burkitt lymphoma 4) Sezary syndrome
A 35 year old woman presents with fatigue. Investigations revealed the following: Hb, 5 g/dL; MCH, 24; low MCV; leukocytes, 11,000/ uL, and platelets, 5 lakhs. The peripheral smear is shown below. What is the diagnosis? Normal values: - Mean cell volume (MCV); 90 ± 8 fL - Mean cell Hb(MCH); 30 ± 3 pg
Iron in tissues is stained by:
INI-CET 2022 - Pathology INI-CET Practice Questions and MCQs
Question 91: Match the following cell types/patterns (Column A) with their associated malignancies (Column B): Column A (Cell types/patterns): a) Faggot cell b) Popcorn cell c) Starry sky pattern d) Cerebriform nuclei Column B (Associated malignancies): 1) Acute promyelocytic leukemia 2) Lymphocyte-predominant Hodgkin's lymphoma 3) Burkitt lymphoma 4) Sezary syndrome
- A. 1-a, 2-d, 3-c, 4-b
- B. 1-b, 2-c, 3-a, 4-d
- C. 1-a, 2-b, 3-c, 4-d (Correct Answer)
- D. 1-b, 2-a, 3-d, 4-c
Explanation: ***1-a, 2-b, 3-c, 4-d*** - **Acute promyelocytic leukemia (APL)** is characterized by **faggot cells**, which are abnormal promyelocytes containing multiple **Auer rods**. - **Lymphocyte-predominant Hodgkin's lymphoma** is associated with **popcorn cells** (also known as L&H cells), which are large, multilobated Reed-Steinberg variant cells [3]. - **Burkitt lymphoma** shows the characteristic **starry sky pattern**, resulting from uniformly sized tumor cells interspersed with numerous tingible body macrophages [1]. - **Sézary syndrome** is characterized by **cerebriform nuclei** in Sézary cells, which are a hallmark of this leukemic variant of cutaneous T-cell lymphoma [2]. *1-a, 2-d, 3-c, 4-b* - This option incorrectly associates **cerebriform nuclei** with lymphocyte-predominant Hodgkin's lymphoma; this lymphoma is characterized by **popcorn cells**. - It also mismatches **Sézary syndrome** with popcorn cells; Sézary syndrome is defined by **cerebriform nuclei** [2]. *1-b, 2-c, 3-a, 4-c* - This option incorrectly links **popcorn cells** with acute promyelocytic leukemia; APL is characterized by **faggot cells** with Auer rods. - It also misassociates **Burkitt lymphoma** with faggot cells; Burkitt lymphoma shows the distinctive **starry sky pattern** [1]. *1-b, 2-a, 3-d, 4-c* - This option incorrectly matches **popcorn cells** with acute promyelocytic leukemia; APL contains **faggot cells** with multiple Auer rods. - It also wrongly associates **faggot cells** with lymphocyte-predominant Hodgkin's lymphoma; this condition features **popcorn cells** (L&H cells) [3]. **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. 606. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 564-565. [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. 613-614, 616.
Question 92: A 35 year old woman presents with fatigue. Investigations revealed the following: Hb, 5 g/dL; MCH, 24; low MCV; leukocytes, 11,000/ uL, and platelets, 5 lakhs. The peripheral smear is shown below. What is the diagnosis? Normal values: - Mean cell volume (MCV); 90 ± 8 fL - Mean cell Hb(MCH); 30 ± 3 pg
- A. Essential thrombocytosis
- B. Iron - deficiency anemia (Correct Answer)
- C. Thalassemia major
- D. Megaloblastic anemia
Explanation: ***Iron-deficiency anemia*** - The patient presents with **severe anemia (Hb 5 g/dL)**, **low MCH (24 pg)**, and **low MCV**, which are classic indicators of **microcytic, hypochromic anemia** [3]. The peripheral smear shows **hypochromic microcytic red cells** with abundant central pallor and **anisopoikilocytosis**, consistent with iron-deficiency anemia [1]. - While the **platelet count is elevated (5 lakhs)**, it can occur in iron deficiency as reactive thrombocytosis [1]. Leukocytosis in the absence of infection may be a mild reactive process secondary to severe anemia. *Essential thrombocytosis* - This is a **myeloproliferative neoplasm** characterized by significantly elevated platelet counts (often > 450,000/uL), but typically does not present with severe anemia, low MCH, or low MCV. - The primary issue in this patient is severe anemia with microcytic hypochromic features, not isolated thrombocytosis. *Thalassemia major* - While thalassemia major also presents with **microcytic, hypochromic anemia** and can have a very low MCV, it usually manifests in early childhood and is associated with significant **hemolysis**, **splenomegaly**, and characteristic red blood cell morphology such as **target cells** and **nucleated red blood cells** [2]. - The extremely low Hb and microcytic indices alone are not enough to distinguish it from severe iron deficiency without further specific markers like iron studies or hemoglobin electrophoresis. *Megaloblastic anemia* - Megaloblastic anemia is characterized by **macrocytic anemia** (high MCV), which is the opposite of the low MCV presented in this case. - It typically results from **vitamin B12** or **folate deficiency** and the peripheral smear would show **macro-ovalocytes** and **hypersegmented neutrophils**, which are not seen here. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, p. 648. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 638-639.
Question 93: Iron in tissues is stained by:
- A. Masson's trichrome
- B. PAS
- C. Congo red
- D. Prussian blue (Correct Answer)
Explanation: ***Prussian blue*** - The **Prussian blue reaction**, also known as **Perls' stain**, specifically detects **ferric iron (Fe³⁺)** in tissues [3]. - It forms a **bright blue precipitate** (ferric ferrocyanide) when ferric iron reacts with potassium ferrocyanide in an acidic solution. *Masson's trichrome* - This stain is primarily used to differentiate **collagen fibers** from muscle fibers, which appear blue/green and red, respectively [1]. - It does not specifically stain or identify iron deposits in tissues. *PAS* - The **Periodic acid-Schiff (PAS) stain** is used to identify **carbohydrates** such as glycogen, mucosubstances, and fungal cell walls, which appear magenta. - It is not used for the detection of iron. *Congo red* - **Congo red** is a specialized stain used for identifying **amyloid deposits**, which appear pink-red and show apple-green birefringence under polarized light [2]. - It is not used for staining iron in tissues. **References:** [1] 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. 25-26. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 268-269. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 394-395.
Pharmacology
2 questionsWhich of the following statements is correct regarding the given graph?
Match the following antiarrhythmic drugs with their mechanism of action: | Mechanism of action | Drug | | :-- | :-- | | 1. Na+ channel blocker | A. Quinidine | | 2. K+ channel blocker | B. Digoxin | | 3. Na+K+ ATPase inhibitor | C. Esmolol | | 4. Beta-blocker | D. Ibutilide |
INI-CET 2022 - Pharmacology INI-CET Practice Questions and MCQs
Question 91: Which of the following statements is correct regarding the given graph?
- A. Drug 1 represents agonist and drug 2 represents inverse agonist
- B. Drug 3 represents agonist and drug 4 represents inverse agonist
- C. Drug 2 represents partial agonist and drug 3 represents inverse agonist
- D. Drug 1 represents agonist and drug 4 represents inverse agonist (Correct Answer)
Explanation: ***Drug 1 represents agonist and drug 4 represent inverse agonist*** - **Drug 1** demonstrates maximal efficacy, producing a **supraphysiologic response** above the baseline (100%), characteristic of an **agonist**. - **Drug 4** produces a response **below the baseline** (100%), indicating inhibition of constitutive receptor activity, which is the definition of an **inverse agonist**. *Drug 1 represents agonist and drug 2 represents inverse agonist* - While **Drug 1** is correctly identified as an **agonist** due to its maximal effect above baseline, **Drug 2** is a **partial agonist**, as it produces a submaximal effect above baseline but does not reach the full agonist's efficacy. - **Drug 2** does not reduce the baseline response, so it cannot be an inverse agonist. *Drug 3 represents agonist and drug 4 represents inverse agonist* - **Drug 3** maintains the **baseline response** (at 100%) regardless of concentration, indicating it is a **neutral antagonist** or has no effect, not an agonist. - **Drug 4** is correctly identified as an **inverse agonist** because it reduces the baseline receptor activity. *Drug 2 represents partial agonist and drug 3 represents inverse agonist* - **Drug 2** is correctly identified as a **partial agonist** as it produces an effect above baseline but less than a full agonist. - **Drug 3** is incorrect; it shows no change from baseline (100%), reflecting a **neutral antagonist** or inactive substance, not an inverse agonist which would decrease the baseline response.
Question 92: Match the following antiarrhythmic drugs with their mechanism of action: | Mechanism of action | Drug | | :-- | :-- | | 1. Na+ channel blocker | A. Quinidine | | 2. K+ channel blocker | B. Digoxin | | 3. Na+K+ ATPase inhibitor | C. Esmolol | | 4. Beta-blocker | D. Ibutilide |
- A. 1-D, 2-B, 3-A, 4-C
- B. 1-A, 2-D, 3-B, 4-C (Correct Answer)
- C. 1-A, 2-C, 3-D, 4-B
- D. 1-D, 2-C, 3-A, 4-B
Explanation: ***1-A, 2-D, 3-B, 4-C*** - **Quinidine** is a Class IA antiarrhythmic drug that primarily blocks **sodium channels**, prolonging the action potential duration and refractoriness. - **Ibutilide** is a Class III antiarrhythmic drug that blocks **potassium channels**, leading to delayed repolarization and increased effective refractory period. - **Digoxin** inhibits the **Na+/K+ ATPase pump**, increasing intracellular calcium and affecting AV nodal conduction. - **Esmolol** is a **beta-blocker** (Class II antiarrhythmic) that reduces heart rate and contractility by blocking β1-adrenergic receptors. *1-A, 2-C, 3-D, 4-B* - This option incorrectly matches **Esmolol** (a beta-blocker) with **K+ channel blocker** and **Ibutilide** (K+ channel blocker) with **Na+K+ ATPase inhibitor**. - It also incorrectly matches **Digoxin** (Na+K+ ATPase inhibitor) with **beta-blocker**. *1-D, 2-C, 3-A, 4-B* - This option incorrectly matches **Ibutilide** (K+ channel blocker) with **Na+ channel blocker** and incorrectly matches **Quinidine** (Na+ channel blocker) with **Na+K+ ATPase inhibitor**. - It also incorrectly matches **Digoxin** (Na+K+ ATPase inhibitor) with **beta-blocker**. *1-D, 2-B, 3-A, 4-C* - This option incorrectly matches **Ibutilide** (K+ channel blocker) with **Na+ channel blocker** and **Digoxin** (Na+K+ ATPase inhibitor) with **K+ channel blocker**. - It also incorrectly matches **Quinidine** (Na+ channel blocker) with **Na+K+ ATPase inhibitor**.
Radiology
2 questionsA child presents with cyanosis. His chest radiograph is shown below. What is the diagnosis?
Identify the condition based on the non-contrast CT scan of a patient given below.
INI-CET 2022 - Radiology INI-CET Practice Questions and MCQs
Question 91: A child presents with cyanosis. His chest radiograph is shown below. What is the diagnosis?
- A. Transposition of great arteries (TGA)
- B. Ebstein's anomaly
- C. Tetralogy of Fallot (TOF) (Correct Answer)
- D. Total anomalous pulmonary venous return (TAPVC)
Explanation: ***Tetralogy of Fallot (TOF)*** - The chest radiograph shows a **boot-shaped heart (coeur en sabot)** due to **right ventricular hypertrophy** and a **concave pulmonary artery segment** (absent main pulmonary artery segment), which is characteristic of TOF. - The patient also presents with **cyanosis**, a common symptom of TOF due to right-to-left shunting. *Transposition of great arteries (TGA)* - TGA typically presents with a **"egg-on-a-string" appearance** on chest radiograph, indicating a narrow superior mediastinum and increased pulmonary vascular markings, which is not seen here. - While patients with TGA are cyanotic, the cardiac silhouette on this radiograph is inconsistent with the classic TGA findings. *Ebstein's anomaly* - Ebstein's anomaly is characterized by **apical displacement of the tricuspid valve**, leading to a large right atrium and massive **cardiomegaly** on chest X-ray, often described as a "box-shaped" heart, which is not evident in the provided image. - While it causes cyanosis, the heart size in the image is not markedly enlarged enough to suggest Ebstein's anomaly. *Total anomalous pulmonary venous return (TAPVC)* - TAPVC typically presents with a **"snowman" or "figure-of-8" appearance** on chest X-ray due to a dilated superior vena cava and left brachiocephalic vein, or a small heart with increased pulmonary vascularity, neither of which is present in the image. - Although TAPVC causes cyanosis, the specific radiographic features like the "boot-shaped" heart rule out this diagnosis.
Question 92: Identify the condition based on the non-contrast CT scan of a patient given below.
- A. Hepatocellular carcinoma
- B. Hydatid cyst (Correct Answer)
- C. Liver abscess
- D. Focal nodular hyperplasia
Explanation: ***Hydatid cyst*** - The image distinctly shows a **large, well-defined cyst with internal septations**, consistent with the daughter cysts and collapsed membranes within a hydatid cyst (the "**water lily sign**"). - The thick, often calcified wall surrounding the lesion is a characteristic feature often seen in **Echinococcus granulosa** infection. *Hepatocellular carcinoma* - **Hepatocellular carcinoma (HCC)** typically appears as a **solid, enhancing mass** (especially on contrast-enhanced CT) and does not usually present with clearly defined internal septations or "water lily" sign on non-contrast imaging. - While HCC can show necrosis, it does not form the characteristic cystic structure seen here. *Liver abscess* - A **liver abscess** would typically appear as a ill-defined, fluid-filled lesion that may have a rim of enhancement on contrast CT, but it generally lacks the **distinct internal septations** or daughter cysts characteristic of a hydatid cyst. - Abscesses are often associated with signs of infection like fever and elevated inflammatory markers. *Fibronodular hyperplasia* - **Focal nodular hyperplasia (FNH)** is a benign liver lesion characterized by a central scar and is typically **isodense or slightly hypodense** to the liver parenchyma on non-contrast CT. - It does not present as a cystic lesion with internal daughter cysts or calcified walls.