INI-CET 2022 Practice Questions

Q: Which of the following statements is true regarding the tape shown in the image?

It is used to assess severe acute malnutrition.. ***It is used to assess severe acute malnutrition.*** - The tape shown is a **Mid-Upper Arm Circumference (MUAC)** tape, which is a simple and effective tool for screening children aged 6-59 months for **severe acute malnutrition (SAM)**. - The color-coded sections (red, yellow, green) on the tape directly indicate nutritional status to facilitate rapid assessment and decision-making for intervention. *Reading of 13.5 to 14.5 cm is considered undernourished.* - A MUAC reading between **11.5 cm and 12.5 cm** often indicates **moderate acute malnutrition (MAM)**, falling in the yellow zone on many MUAC tapes. - A reading of **13.5 to 14.5 cm** would typically fall in the **green zone**, indicating a **healthy nutritional status** for children aged 6-59 months, not undernourished. *It is called Shelter's tape.* - The tape shown is known as a **MUAC tape** (Mid-Upper Arm Circumference tape), not Shelter's tape. - There is no widely recognized medical assessment tool called "Shelter's tape" for nutritional assessment. *It is useful mainly for frontline field workers.* - While it is indeed a valuable tool for **frontline field workers** due to its simplicity and ease of use in community settings, it is also utilized by **healthcare professionals** in clinics and hospitals for rapid screening and assessment of malnutrition. - Its utility extends beyond just field workers, making it an essential tool in various healthcare settings, especially in low-resource environments.

Q: Which of these is not a cardiac poison?

Atropa belladonna. ***Atropa belladonna*** - This plant primarily contains **atropine** and other **belladonna alkaloids**, which are **anticholinergic** and cause symptoms like dry mouth, dilated pupils, tachycardia, and hallucinations. - While it can cause *tachycardia*, its primary toxic effects are not directly on the cardiac muscle contractility or rhythmicity leading to a **"cardiac poison"** classification (e.g. arrhythmias or heart failure), but rather through autonomic nervous system modulation. *Aconite* - Aconite, derived from the **monkshood plant**, contains **aconitine**, a potent neurotoxin and cardiotoxin. - It causes severe **arrhythmias**, including ventricular fibrillation, which can be rapidly fatal by directly affecting **sodium channels** in myocardial cells. *Cerbera thevetia* - Commonly known as Yellow Oleander, it contains **cardiac glycosides** similar to digoxin. - These glycosides inhibit the **Na+/K+-ATPase pump** in cardiac myocytes, leading to increased intracellular calcium, enhanced contractility, and dose-dependent **arrhythmias** (bradycardia, heart blocks, ventricular arrhythmias). *Nicotiana tabacum* - Tobacco contains **nicotine**, which primarily acts on **nicotinic acetylcholine receptors**. - Acute poisoning can lead to initial stimulation followed by depression of the autonomic ganglia, causing a range of cardiac effects including **tachycardia**, **hypertension**, and **arrhythmias** due to sympathetic nervous system activation.

Q: The dead body of a child was recovered from a river with froth around his mouth, which reappeared even after wiping it off. Which postmortem finding is not seen in this case?

High concentration of arsenic from shaft of hair. ***High concentration of arsenic from the shaft of hair*** - The presence of arsenic in hair is indicative of chronic **arsenic poisoning**, which is unrelated to drowning. - The scenario describes a body recovered from a river with froth, suggesting **drowning**, not poisoning. *Voluminous and ballooned out lungs* - This is a classic postmortem finding in drowning due to the aspiration of water and air trapping, leading to **pulmonary emphysema acquosum**. - The lungs appear large and distended, often with impressions of the ribs on their surfaces. *Cadaveric spasm with mud in a closed fist* - **Cadaveric spasm** (instantaneous rigor) can occur in cases of violent death, intense physical exertion, or emotional stress just before death, often seen in drowning victims. - Finding foreign material like mud or weeds clutched tightly in the hand is a significant indicator that the victim was **alive and struggling** in the water during submersion. *Paltauf's hemorrhage in subpleura* - **Paltauf's hemorrhages** are small, pinpoint hemorrhages found under the pleural surface (subpleural) and are a characteristic sign of drowning. - They result from the rupture of capillaries due to the sudden increase in intrathoracic pressure during the struggle to breathe underwater.

Q: Identify the pattern of abrasion shown in the image below.

Ligature mark. ***Ligature mark*** - The image clearly displays a **linear impression** on the neck, consistent with a **ligature mark**, which is an abrasion caused by a constricting object. - This type of abrasion is often seen in cases of **strangulation or hanging**, where a cord or similar item tightens around the neck. *Pressure abrasion* - Pressure abrasions are typically caused by **blunt forceful contact** with a surface, resulting in a scraped or grazed appearance, which differs from the distinct linear mark shown. - They are usually broad and irregular, not forming a clear, thin line as seen in the image. *Graze abrasion* - Graze abrasions, also known as scrapes, involve the **superficial removal of the epidermis** due to friction against a rough surface. - They tend to be spread out and irregular, lacking the deep, circumscribed linear pattern characteristic of a ligature mark. *Imprint abrasion* - Imprint abrasions reflect the **exact pattern of the impacting object** (e.g., tire track, weapon pattern), which is not evident in the image. - While a ligature itself can leave an imprint, the term "imprint abrasion" is usually reserved for more complex patterns than a simple linear groove.

Q: The following cost-effective investigations are routinely recommended in the screening of antenatal mothers, EXCEPT:

Echocardiography for cardiac disease. ***Echocardiography for cardiac disease*** - **Echocardiography** is not a *routinely recommended* screening investigation for all antenatal mothers due to its cost and the relatively low prevalence of significant congenital heart disease requiring universal screening. - It is typically performed only if there are **specific risk factors** or suspicious findings suggesting cardiac pathology. *Blood sugar levels for GDM* - Screening for **gestational diabetes mellitus (GDM)** with blood sugar levels (e.g., glucose challenge test) is routinely recommended due to the potential maternal and fetal complications if untreated. - GDM is a common condition that can be effectively managed with early diagnosis, making screening a **cost-effective** preventive measure. *VDRL for syphilis* - Screening for **syphilis** using tests like VDRL (Venereal Disease Research Laboratory) is a standard and *routinely recommended* antenatal investigation. - Early detection and treatment of syphilis in pregnant women prevent serious adverse outcomes such as **congenital syphilis**, which can cause severe fetal morbidity and mortality. *Urine analysis for bacteriuria* - **Urine analysis** for **asymptomatic bacteriuria** is routinely recommended during pregnancy because untreated bacteriuria can lead to pyelonephritis, preterm labor, and low birth weight. - It is a simple, **cost-effective** test with significant benefits for maternal and fetal health.

Q: An 11-year-old boy was brought to the outpatient clinic with intention tremor and poor scholastic performance. His sister has similar complaints. On examination, hepatomegaly is seen. The eye finding is shown in the image. What is the probable diagnosis?

Wilson's disease. ***Wilson's disease*** - The combination of **intention tremor**, **poor scholastic performance** (indicating neurological involvement), **hepatomegaly**, and the **eye finding** (Kayser-Fleischer ring seen in the image) points strongly to Wilson's disease. The sister having similar complaints suggests an **autosomal recessive** inheritance pattern, consistent with Wilson's disease. - The image shows **Kayser-Fleischer ring**, a golden-brown ring at the corneal limbus due to **copper deposition in Descemet's membrane**, which is pathognomonic for Wilson's disease with neurological involvement. - Wilson's disease is caused by mutations in the **ATP7B gene**, leading to impaired copper excretion and accumulation in the liver, brain, and cornea. *Glutaric aciduria* - This is a rare **autosomal recessive metabolic disorder** that primarily affects the brain, leading to **dystonia** and **developmental delay**. - While it can cause neurological symptoms, it typically does not present with **hepatomegaly** or **Kayser-Fleischer rings** as prominent features. *Hepatitis A* - **Hepatitis A** is an acute viral infection of the liver, causing symptoms like fever, fatigue, nausea, vomiting, and **jaundice**. - However, it typically does not cause **intention tremor**, **poor scholastic performance**, or have a familial pattern suggesting an inherited neurological disorder. It also does not cause Kayser-Fleischer rings. *Huntington's chorea* - **Huntington's chorea** is an **autosomal dominant neurodegenerative disorder** characterized by **chorea**, psychiatric symptoms, and cognitive decline, typically manifesting in adulthood. - It does not present with **hepatomegaly** or **Kayser-Fleischer rings** at this age and is not associated with the constellation of liver and neurological symptoms described.

Question 1

Which of the following statements is true regarding the tape shown in the image?

Accepted Answer

It is used to assess severe acute malnutrition.

Answer

Reading of 13.5 to 14.5 cm is considered undernourished.

Answer

It is called Shelter's tape.

Answer

It is useful mainly for frontline field workers.

Question 2

Which of these is not a cardiac poison?

Accepted Answer

Atropa belladonna

Answer

Aconite

Answer

Cerbera thevetia

Answer

Nicotiana tabacum

Question 3

The dead body of a child was recovered from a river with froth around his mouth, which reappeared even after wiping it off. Which postmortem finding is not seen in this case?

Accepted Answer

High concentration of arsenic from shaft of hair

Answer

Voluminous and ballooned out lungs

Answer

Cadaveric spasm with mud in closed fist

Answer

Paltauf's hemorrhage in sub pleura

Question 4

Identify the pattern of abrasion shown in the image below.

Accepted Answer

Ligature mark

Answer

Pressure abrasion

Answer

Graze abrasion

Answer

Imprint abrasion

Question 5

Which of the following is not true about lupus nephritis in pregnancy?

Accepted Answer

Ecosprin, methotrexate, cyclophosphamide, corticosteroids, azathioprine are safe in pregnancy

Answer

Pregnancy to be planned once the disease has been quiescent for at least 6 months and there is no evidence of renal dysfunction

Answer

High dose corticosteroids for lupus flare in pregnancy is safe

Answer

Immunosuppression can be continued during pregnancy

Question 6

Which of the following is false regarding management of diabetes in pregnancy?

Accepted Answer

Elective C-section has no role in reducing incidence of brachial plexus injury

Answer

In active labor, if RBS <70 mg/dL, D5 is started at 100-150 ml/hr till the RBS is >70 mg/dL

Answer

In a patient being planned for induction of labor, night dose of intermediate insulin is given as planned, and the morning dose is withheld

Answer

Capillary blood glucose monitoring levels are kept at fasting- 95 mg/dL; 1 hr postprandial- 140 mg/dL; 2 hrs postprandial- 120 mg/dL

Question 7

The following cost-effective investigations are routinely recommended in the screening of antenatal mothers, EXCEPT:

Accepted Answer

Echocardiography for cardiac disease

Answer

Blood sugar levels for GDM

Answer

VDRL for syphilis

Answer

Urine analysis for bacteriuria

Question 8

An 11-year-old boy was brought to the outpatient clinic with intention tremor and poor scholastic performance. His sister has similar complaints. On examination, hepatomegaly is seen. The eye finding is shown in the image. What is the probable diagnosis?

Accepted Answer

Wilson's disease

Answer

Glutaric aciduria

Answer

Hepatitis A

Answer

Huntington's chorea

Question 9

A child presents with complaints of fever, rash, body ache, and throat ache. He had a history of thorn prick injury a week back. What antibiotics would you give empirically to this child?

Accepted Answer

Amoxicillin+ clavulanate

Answer

Ceftriaxone

Answer

Vancomycin

Answer

Meropenem

Question 10

An unconscious child is brought to the casualty. What is the correct sequence of the management?

Accepted Answer

Airway, Breathing, Circulation

Answer

Circulation, Airway, Breathing

Answer

Breathing, Circulation, Airway

Answer

Circulation, Breathing, Airway

INI-CET 2022

Community Medicine

Forensic Medicine

Obstetrics and Gynecology

Pediatrics