INI-CET 2023 Practice Questions

Q: Identify the lines shown in the following image:

Langer's lines. ***Langer's lines*** - The image displays lines that represent the **natural orientation of collagen fibers** within the human skin, which are known as Langer's lines (also called cleavage lines). - Making surgical incisions **parallel to these lines** can result in better wound healing and less scarring. - Named after **Karl Langer**, an Austrian anatomist who described these lines in 1861. *Hinderer's lines* - While **Hinderer** described relaxed skin tension lines (RSTLs) used in plastic surgery, these are **different from Langer's lines**. - The image shows Langer's lines specifically, which are based on **collagen fiber orientation**, not relaxed skin tension. *Dermatomes* - **Dermatomes** are areas of skin mainly supplied by a single **spinal nerve root**. - They represent **neurologic segments** and do not correspond to the collagen fiber orientation shown in the image. *Blaschko's lines* - **Blaschko's lines** are invisible lines of skin cell migration that become visible in certain **genetic or acquired dermatological conditions**. - They represent a **mosaic pattern** due to different cell populations and are distinctly different from the structural collagen lines shown.

Q: A South Indian male farmer presents to the ENT OPD with complaints of reddish mass coming out from the nose as shown in the image below and the histopathology examination is also given below. What is the likely diagnosis?

Rhinosporidiosis. **Rhinosporidiosis** - The image shows a **reddish, friable mass** in the nose, and the histopathology reveals **large sporangia** containing endospores, which are characteristic findings of *Rhinosporidium seeberi*, the causative agent of rhinosporidiosis. - The patient's demographic (South Indian male farmer) is also consistent, as rhinosporidiosis is **endemic in India and Sri Lanka** and is often associated with exposure to **stagnant water**. *Nasal polyp* - Nasal polyps are typically **pale, yellowish-grey, glistening, and translucent** masses, contrasting with the reddish appearance in the image. - Histologically, they show **edematous stroma** with inflammatory cells but lack the distinct sporangia seen in the provided image. *Inverted papilloma* - Inverted papillomas are characterized by **endophytic growth** of squamous or transitional epithelium into the underlying stroma. - Although they can be reddish, their histopathology shows **inverted papillary projections**, not fragmented sporangia. *Antrochoanal polyp* - An antrochoanal polyp typically originates from the **maxillary sinus** and extends into the choana and nasopharynx, which may not be overtly visible as a mass presenting anteriorly in the nostril without further examination. - Like other nasal polyps, its histological appearance would be **edematous inflammatory tissue** without the parasitic structures seen here.

Q: Windkessel effect is not shown by which of the following vessel?

Radial. ***Radial*** - The **radial artery** is a muscular artery, and these vessels primarily regulate blood flow and pressure through vasoconstriction and vasodilation, rather than storing elastic energy. - While all arteries have some elasticity, the **Windkessel effect** is most prominent in large elastic arteries, which are structurally different from muscular arteries like the radial artery. *Renal* - The **renal artery** is a highly compliant, distensible artery that assists in dampening pulsatile flow and ensuring continuous, stable perfusion to the kidneys. - As a major artery off the aorta, it contributes to the **Windkessel effect** by accommodating changes in pressure during the cardiac cycle. *Aorta* - The **aorta** is the primary vessel demonstrating the **Windkessel effect** due to its high elasticity and large diameter. - During systole, it stretches and stores a significant volume of blood, releasing it during diastole to maintain a continuous flow. *Abdominal* - The **abdominal aorta** is a large elastic artery that, like the thoracic aorta, is crucial for expressing the **Windkessel effect**. - Its elastic recoil during diastole helps to sustain blood flow to the lower body and abdominal organs.

Q: Cystic fibrosis leads to defect in which of the following channels?

Cl-. ***Cl-*** - Cystic fibrosis is caused by a mutation in the **CFTR gene**, which encodes for the **Cystic Fibrosis Transmembrane Conductance Regulator protein**. - This protein functions primarily as a **chloride channel**, and its dysfunction leads to impaired chloride transport across epithelial cell membranes. *K+* - While potassium channels are crucial for many physiological processes, their primary dysfunction is **not directly linked to the pathogenesis of cystic fibrosis**. - Defects in potassium channels are associated with conditions like **long QT syndrome** or certain forms of epilepsy. *Ca2+* - **Calcium channels play a role in various cellular signaling pathways**, but their direct defect is not the underlying cause of cystic fibrosis. - Conditions like **Lambert-Eaton myasthenic syndrome** involve antibodies affecting presynaptic calcium channels. *Na+* - **Sodium channels are involved in maintaining membrane potential and fluid balance**, and while they interact with CFTR, their primary defect is not the cause of cystic fibrosis. - Dysregulation of sodium transport can occur secondary to CFTR dysfunction, leading to **dehydrated mucus**, but the initial defect is in chloride.

Q: Arrange the following parts of sarcomere from periphery to center. 1. Z line 2. M line 3. A band 4. H zone

1,3,4,2. ***1,3,4,2*** - The **Z line** is found at the **periphery** of the sarcomere, defining its boundaries and anchoring the **actin filaments**. - Moving inwards, the **A band** is next, representing the entire length of the **myosin filament**, which may also overlap with actin. - The **H zone** is located within the A band, comprising only **myosin filaments** without actin overlap. - Finally, the **M line** is at the **center** of the sarcomere, bisecting the H zone and anchoring the myosin filaments. *2,3,4,1* - This sequence is incorrect because the **M line** is at the **center** and the **Z line** is at the **periphery**, which is the reverse of the expected order for from periphery to center. - Such an arrangement would place the innermost structure first and outermost last, not reflecting the correct spatial organisation. *4,2,3,1* - This order is incorrect as the **H zone** and **M line** are more central, while the **Z line** is peripheral. - Placing structures like the H zone and M line at the beginning does not align with arrangement from periphery to center. *3,1,4,2* - This option is incorrect because the **A band** includes both actin and myosin filaments, while the **Z line** is at the periphery of the sarcomere. - The given order does not represent a progression from the periphery to the center of the sarcomere.

Q: Blood pressure changes in radial artery were measured. Which of the following is the reason for initial rise in BP while performing Valsalva maneuver?

Increase in aortic pressure. ***Increase in aortic pressure*** - During the initial phase (Phase I) of the Valsalva maneuver, the sudden **increase in intrathoracic pressure** is transmitted directly to the aorta and other large arteries. - This transient increase in external pressure on the great vessels directly causes a brief **rise in aortic blood pressure** before other compensatory mechanisms take effect. *Increase in Left ventricular volume* - The Valsalva maneuver actually **decreases left ventricular volume** over time due to reduced venous return. - An increase in left ventricular volume would typically lead to a sustained increase in cardiac output and blood pressure, which is not what is observed initially during the Valsalva maneuver. *Increase in Left ventricular pressure* - While increased intrathoracic pressure can transiently affect left ventricular pressure, the initial blood pressure rise is primarily due to direct compression of the **aorta and systemic arteries**, not an intrinsic increase in myocardial contractility or ventricular filling pressure. - Ultimately, the Valsalva maneuver generally leads to a decrease in **left ventricular preload** and subsequent decrease in stroke volume during the prolonged straining phase. *Decrease in aortic pressure* - The graph clearly shows an **initial spike in mean aortic pressure** (Phase I) at the onset of the Valsalva maneuver. - A decrease in aortic pressure is characteristic of the later part of the straining phase (Phase II) due to **reduced cardiac output**.

Q: CO poisoning causes which type of hypoxia?

Anemic hypoxia. ***Anemic hypoxia*** - **Carbon monoxide (CO)** binds to **hemoglobin** with an affinity much higher than oxygen, forming **carboxyhemoglobin**. - This effectively reduces the **oxygen-carrying capacity of the blood**, mimicking a severe anemia, despite normal arterial PO2. *Hypoxic hypoxia* - Occurs when there is **insufficient oxygen delivery to the blood** due to low arterial PO2, as seen in high altitudes or respiratory diseases. - In CO poisoning, **arterial PO2 is typically normal**, distinguishing it from hypoxic hypoxia. *Stagnant hypoxia* - Results from **inadequate blood flow** to tissues, leading to reduced oxygen delivery, as observed in heart failure or shock. - CO poisoning primarily affects oxygen transport by hemoglobin, not the **rate of blood flow**. *Histotoxic hypoxia* - Characterized by the **inability of tissues to utilize oxygen** effectively, even when oxygen delivery is adequate, as seen in cyanide poisoning inhibiting cytochrome oxidase. - In CO poisoning, tissues can utilize oxygen; the problem is the **reduced availability of oxygen** from hemoglobin.

Q: A 14-year-old female patient presents to the ENT OPD and complains that she can hear sounds clearly but has difficulty processing and understanding what is being said. Her Pure tone audiometry and ABR are normal. What is the likely diagnosis in this patient?

Central Auditory Processing Disorder (CAPD). ***Central Auditory Processing Disorder (CAPD)*** - **CAPD** is characterized by difficulty processing and understanding auditory information despite normal peripheral hearing, as indicated by normal pure tone audiometry and ABR. - The patient's inability to comprehend spoken words despite hearing them clearly is a hallmark symptom of **CAPD**. *Auditory cortex lesion* - While an **auditory cortex lesion** could impair sound processing, it would likely result in more profound and specific deficits in sound localization, discrimination, or recognition, rather than just difficulty understanding speech with otherwise normal hearing tests. - **Unilateral lesions** might cause mild or transient auditory issues, but bilateral lesions typically lead to **cortical deafness**, which contradicts the patient's ability to "hear sounds clearly." *Malingering* - **Malingering** involves deliberately fabricating or exaggerating symptoms for secondary gain, which is unlikely given the consistent presentation of difficulty understanding speech despite normal, objective hearing tests like ABR. - There are no indications in the case of **inconsistent test results** or other behaviors suggestive of feigned symptoms. *Sensorineural hearing loss* - **Sensorineural hearing loss** involves damage to the inner ear or auditory nerve, which would result in abnormal pure tone audiometry results and/or abnormal ABR findings. - The patient's **normal pure tone audiometry and ABR** rule out sensorineural hearing loss as the primary cause of her symptoms.

Question 1

Identify the lines shown in the following image:

Accepted Answer

Langer's lines

Answer

Hinderer's lines

Answer

Dermatomes

Answer

Blaschko's lines

Question 2

A South Indian male farmer presents to the ENT OPD with complaints of reddish mass coming out from the nose as shown in the image below and the histopathology examination is also given below. What is the likely diagnosis?

Accepted Answer

Rhinosporidiosis

Answer

Nasal polyp

Answer

Inverted papilloma

Answer

Antrochoanal polyp

Question 3

Windkessel effect is not shown by which of the following vessel?

Accepted Answer

Radial

Answer

Renal

Answer

Aorta

Answer

Abdominal aorta

Question 4

Cystic fibrosis leads to defect in which of the following channels?

Accepted Answer

Cl-

Answer

K+

Answer

Ca2+

Answer

Na+

Question 5

Find the correct Auditory pathway sequence.

Accepted Answer

Eight nerve → cochlear nuclei → superior olivary nucleus → lateral lemniscus → inferior colliculus → medial geniculate body → auditory cortex

Answer

Superior olivary nucleus → lateral lemniscus → inferior colliculus → medial geniculate body → auditory cortex → Eight nerve → Cochlear nuclei

Answer

Cochlear nuclei → superior olivary nucleus → lateral lemniscus → inferior colliculus → medial geniculate body → auditory cortex → Eight nerve

Answer

Superior olivary nucleus → inferior colliculus → medial geniculate body → auditory cortex → Eight nerve → Cochlear nuclei → lateral lemniscus

Question 6

Arrange the following parts of sarcomere from periphery to center.

1. Z line
2. M line
3. A band
4. H zone

Accepted Answer

1,3,4,2

Answer

2,3,4,1

Answer

4,2,3,1

Answer

3,1,4,2

Question 7

Blood pressure changes in radial artery were measured. Which of the following is the reason for initial rise in BP while performing Valsalva maneuver?

Accepted Answer

Increase in aortic pressure

Answer

Increase in Left ventricular volume

Answer

Increase in Left ventricular pressure

Answer

Decrease in aortic pressure

Question 8

Assertion: RMP depends on proteins and phosphate ions.
Reason: Diffusion potential can be calculated using nernst equation.
Choose the best statement regarding the assertion and reason.

Accepted Answer

Both true, Reason is not the explanation of assertion

Answer

Assertion false, Reason true

Answer

Both true, Reason is the explanation of assertion

Answer

Assertion true, Reason false

Question 9

CO poisoning causes which type of hypoxia?

Accepted Answer

Anemic hypoxia

Answer

Hypoxic hypoxia

Answer

Stagnant hypoxia

Answer

Histotoxic hypoxia

Question 10

A 14-year-old female patient presents to the ENT OPD and complains that she can hear sounds clearly but has difficulty processing and understanding what is being said. Her Pure tone audiometry and ABR are normal. What is the likely diagnosis in this patient?

Accepted Answer

Central Auditory Processing Disorder (CAPD)

Answer

Auditory cortex lesion

Answer

Malingering

Answer

Sensorineural hearing loss

INI-CET 2023

Anatomy

ENT

Physiology

Psychiatry