INI-CET 2022 Practice Questions

Q: India is a country with different cultures and diverse languages. Which steps should a physician take to address the patient for better outcomes? 1. Insist on good communication 2. Insist on communication only via an interpreter 3. Treat them regardless of their cultural perceptions 4. The physician should consider the patient's religion and cultural perception Select the correct combination:

1,4. ***1,4*** - **Good communication** is paramount in healthcare, especially in a diverse country like India, to ensure **patient understanding**, **adherence** to treatment plans, and overall patient satisfaction. - Considering a patient's **religion and cultural perceptions** allows the physician to tailor treatment and communication in a sensitive and **respectful manner**, fostering trust and better **health outcomes**. *1,2* - While good communication (1) is vital, **insisting solely on an interpreter** (2) may not always be feasible or necessary, particularly if the physician and patient share a common language or if the patient prefers direct communication. This can also disrupt the flow of rapport building. - **Over-reliance on interpreters** can sometimes lead to misinterpretations or loss of non-verbal cues if the interpreter is not trained in medical interpretation. *2,3* - **Insisting only on an interpreter** (2) can be restrictive and may compromise direct patient-physician rapport, as discussed above. - **Treating patients regardless of their cultural perceptions** (3) is an ethnocentric approach that can lead to mistrust, non-adherence, and ultimately **poor health outcomes** as it disregards the patient's beliefs and values regarding health and illness. *3,4* - **Treating patients regardless of their cultural perceptions** (3) can result in a lack of understanding and non-adherence if the treatment conflicts with the patient's deeply held beliefs. - While considering religion and cultural perception (4) is crucial, this option includes an incorrect approach (3) that can undermine patient care.

Q: Recommended HPV vaccination schedule for 9 to 14-year-olds according to WHO SAGE guidelines is:

1 or 2 doses. ***1 or 2 doses*** - The **WHO Strategic Advisory Group of Experts (SAGE)** on Immunization recommends a simplified **one- or two-dose schedule** for girls and boys aged 9–14 years. - This recommendation, updated in April 2022, is based on evidence demonstrating comparable efficacy of **single-dose HPV vaccination** to multi-dose regimens in this age group, while improving accessibility and uptake. - **Key advantage**: Reduced doses improve vaccination completion rates and reduce programmatic costs without compromising protection. *3 doses* - A **three-dose schedule** (0, 1-2, 6 months) was the original recommendation but is **no longer recommended** for the 9–14 age group. - Three doses are now reserved for **immunocompromised individuals** or those starting vaccination at older ages in some guidelines. - Maintaining a three-dose schedule would increase costs and reduce completion rates unnecessarily. *3 or 4 doses* - **Four doses** have never been part of any WHO HPV vaccination recommendation. - This option represents an excessive and unsupported schedule that would create unnecessary barriers to vaccination coverage. *4 doses* - **Four doses** are not recommended by WHO SAGE for any age group or clinical scenario. - This would represent over-vaccination without evidence of additional benefit and would significantly impair program implementation.

Q: Which of the following is a true statement about screening tests for genetic diseases?

It defines risk of transmission of disease to the child. ***Correct: It defines risk of transmission of disease to the child*** - Genetic screening aims to identify individuals or couples at risk of passing on **heritable genetic conditions** to their offspring. - This information helps in **family planning** and provides prenatal diagnostic options if the risk is high. - This is the **primary purpose** of genetic screening programs. *Incorrect: Screening test has better accuracy than diagnostic test* - **Screening tests** are designed to be broad and detect potential risks, often with lower specificity and sensitivity than diagnostic tests. - **Diagnostic tests** are typically more accurate and definitive, confirming the presence or absence of a disease after a positive screening result. *Incorrect: It is always invasive* - Many genetic screening tests, such as **non-invasive prenatal screening (NIPS)** from maternal blood or carrier screening via saliva, are non-invasive or minimally invasive. - While some diagnostic tests like **amniocentesis** or **chorionic villus sampling** are invasive, screening itself is not universally so. *Incorrect: Screening requires genetic mapping* - **Genetic mapping** refers to determining the relative positions of genes on a chromosome, which is a research tool for understanding genome organization. - Genetic screening primarily involves testing for specific mutations or chromosomal abnormalities, not creating a comprehensive genetic map of an individual.

Q: All the following are true about acute cholecystitis, except

Preferential visualization of gall bladder in HIDA scan. ***Preferential visualization of gall bladder in HIDA scan*** - In acute cholecystitis, the **cystic duct** becomes obstructed, preventing bile flow into the gallbladder. - A **HIDA scan** (hepatobiliary iminodiacetic acid scan) would show **non-visualization of the gallbladder** due to this obstruction, not preferential visualization. *Gall bladder thickness >3 mm on USG* - An **ultrasound (USG)** finding of gallbladder wall thickening **greater than 3 mm** is a common indicator of inflammation in acute cholecystitis. - This thickening is due to **edema** and inflammation of the gallbladder wall. *Murphy's sign positive* - A **positive Murphy's sign** involves tenderness and an inspiratory arrest upon palpation of the right upper quadrant, specifically over the gallbladder. - This clinical sign is a **classic indicator** of acute cholecystitis. *Leukocytosis* - **Leukocytosis**, an elevated white blood cell count, is a common systemic inflammatory response seen in acute cholecystitis. - It reflects the body's reaction to the **inflammation and possible infection** within the gallbladder.

Q: Which of the following is not a relative contraindication for breast conservative surgery?

Small tumor size (<3cm). ***Small tumor size (<3cm)*** ✓ - A small tumor size is **NOT a contraindication** for breast-conserving surgery; it is actually a **favorable condition** and an indication for breast conservation. - Small tumors allow for complete tumor removal with good cosmetic outcomes and adequate margins. - This is the **correct answer** as it is the only option that is NOT a relative contraindication. *Multicentric disease* - **Multicentric disease** refers to the presence of multiple tumor foci in **different quadrants** of the breast, making complete surgical removal challenging with breast-conserving surgery. - This is a **relative contraindication** as it increases the risk of **positive margins** and local recurrence, making mastectomy often a more appropriate option. *Previous radiation to breast* - Prior radiation therapy to the breast is a **contraindication** (often considered absolute) for subsequent breast radiation, which is an essential component of breast-conserving therapy. - Re-irradiation carries a high risk of severe **skin and tissue toxicity**, making further breast conservation unfeasible. *Large tumor size* - A large tumor size is a **relative contraindication** as it can make it difficult to achieve **clear surgical margins** while maintaining an acceptable cosmetic result. - However, **neoadjuvant chemotherapy** may downstage large tumors to make them suitable for breast-conserving surgery. - Without tumor reduction, it often requires **mastectomy**.

Q: Which of the following is not a perineal approach for the condition shown in the image?

Ripstein's procedure. ***Ripstein's procedure*** - The Ripstein procedure is an **abdominal approach** used for performing a rectopexy to treat rectal prolapse, which is clearly visible in the image. - It involves **fixing the rectum to the sacrum** through an abdominal incision using a synthetic mesh sling. - This is the **only non-perineal approach** among the options listed. *Delorme's procedure* - This is a **perineal approach** for rectal prolapse. - Involves **mucosal stripping** and plication of the rectal muscle wall through the anus. - Suitable for patients unfit for abdominal surgery or with short segment prolapse. *Altemeier's procedure* - This is a **perineal rectosigmoidectomy** (perineal approach). - Involves **resection of the prolapsed rectum and sigmoid colon** through the perineum. - Often combined with levatoroplasty for better results. *Thiersch's procedure* - This is a **perineal encirclement procedure**. - Involves placing a **wire, suture, or synthetic material** around the anus to narrow the anal opening. - Simple perineal approach but has high recurrence rates; rarely used as definitive treatment.

Question 1

India is a country with different cultures and diverse languages. Which steps should a physician take to address the patient for better outcomes?

1. Insist on good communication
2. Insist on communication only via an interpreter
3. Treat them regardless of their cultural perceptions
4. The physician should consider the patient's religion and cultural perception

Select the correct combination:

Accepted Answer

1,4

Answer

1,2

Answer

2,3

Answer

3,4

Question 2

Recommended HPV vaccination schedule for 9 to 14-year-olds according to WHO SAGE guidelines is:

Accepted Answer

1 or 2 doses

Answer

3 doses

Answer

3 or 4 doses

Answer

4 doses

Question 3

Which of the following is a true statement about screening tests for genetic diseases?

Accepted Answer

It defines risk of transmission of disease to the child

Answer

Screening test has better accuracy than diagnostic test

Answer

It is always invasive

Answer

Screening requires genetic mapping

Question 4

Which of the following is the true statement regarding measures to prevent typhoid transmission in the community?

Accepted Answer

Hygiene practice and clean sanitation control are more important than the typhoid vaccine.

Answer

Typhoid vaccine administration is the best method of preventing transmission.

Answer

Person-to-person transmission is the primary mode of spread.

Answer

Drug resistance in typhoid is not as big a problem as in TB.

Question 5

A multivariate analysis was conducted to examine the relationship between risk of developing blindness and age. The results are shown in the table below. Which of the following is true?

Accepted Answer

>80 y age group has the strongest association with blindness risk

Answer

60-69 y age group shows statistically significant association with blindness

Answer

<50 y age group serves as the reference category

Answer

50-59 y age group has the highest odds ratio for blindness risk

Question 6

A 37-year-old unmarried nulliparous woman, having regular intercourse, is on oral contraceptive pills. Her mother was diagnosed with carcinoma breast at 60 years of age, and her elder sister was diagnosed with carcinoma ovary at 40 years of age. What is the next line of management?

Accepted Answer

Genetic counseling and screening for BRCA

Answer

Prophylactic surgery

Answer

Stop taking oral contraceptive pills

Answer

Routine mammography

Question 7

All the following are true about acute cholecystitis, except

Accepted Answer

Preferential visualization of gall bladder in HIDA scan

Answer

Gall bladder thickness >3 mm on USG

Answer

Murphy's sign positive

Answer

Leukocytosis

Question 8

Which of the following is not a relative contraindication for breast conservative surgery?

Accepted Answer

Small tumor size (<3cm)

Answer

Multicentric disease

Answer

Previous radiation to breast

Answer

Large tumor size

Question 9

Which of the following is not a perineal approach for the condition shown in the image?

Accepted Answer

Ripstein's procedure

Answer

Delorme's procedure

Answer

Altemeier's procedure

Answer

Thiersch's procedure

Question 10

A 50-year-old alcoholic patient presents with a history of waxing and waning jaundice for the past 2 months. His CT examination reveals dilatation of the common bile duct and pancreatic duct. What is the most probable diagnosis in the patient?

Accepted Answer

Periampullary carcinoma

Answer

Common bile duct stone

Answer

Head of the pancreas carcinoma

Answer

Cholangiocarcinoma

INI-CET 2022

Community Medicine

Obstetrics and Gynecology

Surgery