Anesthesiology
2 questionsWhich of the following statements given below is incorrect regarding CPR?
Patient of pneumonia on ventilator with wt. 50 kg. RR 14/min, bicarbonate - 18, pH 7.3, pCO2 48 mmHg, pO2 110 mmHg, PEEP 12 cm H2O, tidal volume 420 mL, SpO2 - 100% with FiO2 90%. What is next step in management?
INI-CET 2023 - Anesthesiology INI-CET Practice Questions and MCQs
Question 101: Which of the following statements given below is incorrect regarding CPR?
- A. Chest compression rate 100-120/min
- B. Depth of chest compression up to 5-6 cm
- C. Ventilation 22-25/ min (Correct Answer)
- D. Allow adequate chest recoil
Explanation: ***Ventilation 22-25/ min*** - A ventilation rate of 22-25 breaths/min is **too high** for CPR, which typically recommends 10-12 breaths/min, corresponding to 2 breaths after every 30 compressions. - Excessive ventilation can lead to **hyperventilation**, increasing intrathoracic pressure and reducing venous return, thus decreasing cardiac output. *Chest compression rate 100-120/min* - The recommended chest compression rate for adults in CPR is **100-120 compressions per minute**, ensuring adequate blood flow to vital organs. - Maintaining this rate is crucial for maximizing the effectiveness of chest compressions by providing sufficient circulation. *Depth of chest compression up to 5-6 cm* - The recommended depth for adult chest compressions is at least 5 cm (2 inches), but no more than **6 cm (2.4 inches)** to prevent injury. - This depth ensures that enough pressure is exerted to circulate blood effectively without causing excessive trauma. *Allow adequate chest recoil* - Complete chest recoil is essential to allow the heart to **fully refill with blood** between compressions. - Leaning on the chest between compressions prevents adequate recoil, which can reduce pulmonary and coronary perfusion and **decrease the effectiveness of CPR**.
Question 102: Patient of pneumonia on ventilator with wt. 50 kg. RR 14/min, bicarbonate - 18, pH 7.3, pCO2 48 mmHg, pO2 110 mmHg, PEEP 12 cm H2O, tidal volume 420 mL, SpO2 - 100% with FiO2 90%. What is next step in management?
- A. Increase PEEP
- B. Increase tidal volume
- C. Decrease fio2 (Correct Answer)
- D. Decrease RR
Explanation: **Decrease FiO2** - The patient has an **SpO2 of 100% with a FiO2 of 90%**, indicating **hyperoxia** induced by excessive oxygen delivery. - Decreasing FiO2 is the appropriate next step to prevent **oxygen toxicity** (e.g., absorption atelectasis, free radical damage) while maintaining adequate oxygenation. *Increase PEEP* - The patient's **PaO2 of 110 mmHg** is already well within the normal to high range, suggesting that oxygenation is adequate. - Increasing PEEP would be considered if the patient had **refractory hypoxemia**, not hyperoxia. *Increase tidal volume* - The current tidal volume of **420 mL for a 50 kg patient (8.4 mL/kg)** is already at the higher end of lung-protective ventilation (typically 6-8 mL/kg). - Increasing tidal volume further could lead to **ventilator-induced lung injury** (VILI) due to volutrauma, especially in a patient with pneumonia. *Decrease RR* - The patient has a **pCO2 of 48 mmHg** and a **pH of 7.3**, indicating **respiratory acidosis** (hypoventilation). - Decreasing the respiratory rate would further exacerbate the acidosis by reducing minute ventilation and increasing pCO2, which is inappropriate.
Internal Medicine
6 questionsA 40-year-old man presents with daytime sleepiness and impaired concentration and memory. On examination his BMI is 41 kg/m2, BP is 160/100 mm Hg. His awake ABG analysis is given: PaO2=66 mm Hg, PaCO2=50 mm Hg, HCO3=28 mEq/L. What is the most likely diagnosis?
A 35-year-old female presents with skin thickening and muscle weakness. Her peripheries became pale on exposure to cold. Her ANA is positive and creatine kinase is increased. Scl-70 is positive and perifascicular infiltration is noted in biopsy. What is the antibody associated with this condition?
What is the possible cause of irreversible dementia?
What is the correct order for cardiac auscultation on the left side, from superior to inferior? a. Pulmonary b. Tricuspid c. Mitral
Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen
A patient presented with complaints of pain in the flank region with hematuria. On investigation, X-ray shows multiple calcification (stones) in both kidneys. What is the probable diagnosis?
INI-CET 2023 - Internal Medicine INI-CET Practice Questions and MCQs
Question 101: A 40-year-old man presents with daytime sleepiness and impaired concentration and memory. On examination his BMI is 41 kg/m2, BP is 160/100 mm Hg. His awake ABG analysis is given: PaO2=66 mm Hg, PaCO2=50 mm Hg, HCO3=28 mEq/L. What is the most likely diagnosis?
- A. Obstructive sleep apnea (Correct Answer)
- B. Narcolepsy
- C. Obesity hypoventilation syndrome
- D. Central sleep apnea
Explanation: ***Obstructive Sleep Apnea (Correct Answer)*** - Classic triad: **morbid obesity (BMI 41 kg/m²)**, **excessive daytime somnolence**, and **systemic hypertension (160/100 mmHg)** — hallmarks of OSA - **ABG findings** (PaO2=66 mmHg, PaCO2=50 mmHg, HCO3=28 mEq/L) indicate **chronic nocturnal hypoxemia and hypercapnia** with compensatory **metabolic alkalosis** from repeated apneic episodes - **Cognitive impairment** (impaired concentration and memory) results from **sleep fragmentation** and intermittent nocturnal hypoxia - Obesity promotes **pharyngeal fat deposition** → upper airway narrowing and collapse during sleep → recurrent obstructive events *Narcolepsy* - Causes excessive daytime sleepiness but is **not associated with obesity, hypertension, or ABG abnormalities** - Hallmarks include **cataplexy**, sleep paralysis, and hypnagogic/hypnopompic hallucinations — none present here - Caused by **orexin (hypocretin) deficiency**; associated with **HLA-DQB1*06:02**; ABG is normal *Obesity Hypoventilation Syndrome (OHS / Pickwickian Syndrome)* - Defined as **awake PaCO2 >45 mmHg + BMI >30 kg/m²** with exclusion of other causes of hypoventilation - OHS frequently coexists as an **overlap with and consequence of severe OSA** rather than being the primary diagnosis - In this setting, **OSA is the most prevalent and primary diagnosis**; OHS is specifically considered when awake hypoventilation persists despite adequate OSA treatment *Central Sleep Apnea* - Results from **failure of central respiratory drive** (brainstem), not upper airway obstruction - Associated with **congestive heart failure, opioid use, high-altitude exposure, or neurological disease** — none present here - Not characteristically associated with morbid obesity; clinical and ABG picture here favors an **obstructive** rather than central pattern
Question 102: A 35-year-old female presents with skin thickening and muscle weakness. Her peripheries became pale on exposure to cold. Her ANA is positive and creatine kinase is increased. Scl-70 is positive and perifascicular infiltration is noted in biopsy. What is the antibody associated with this condition?
- A. Anti Jo1 antibody
- B. Anti centromere antibody
- C. Antinuclear antibody
- D. Anti PM scl antibody (Correct Answer)
Explanation: ***Anti PM scl antibody*** - The constellation of **skin thickening** [2], **muscle weakness** [1], **Raynaud's phenomenon** (pale peripheries on cold exposure) [3], **elevated creatine kinase**, and **perifascicular infiltration** on muscle biopsy indicates an overlap syndrome between **systemic sclerosis** and **polymyositis/dermatomyositis** [3]. - **Anti-PM/Scl antibodies** are highly specific markers for this **overlap syndrome**, explaining the mixed features of scleroderma and myositis. *Anti Jo1 antibody* - This antibody is primarily associated with **polymyositis** or **dermatomyositis**, especially with the **anti-synthetase syndrome**, which includes features like **interstitial lung disease**, **Raynaud's**, and **arthritis** [1]. - While muscle weakness is present, the prominent skin thickening and positive Scl-70 point away from isolated myositis. *Anti centromere antibody* - This antibody is characteristic of **limited cutaneous systemic sclerosis (CREST syndrome)**, which involves **calcinosis**, **Raynaud's phenomenon**, esophageal dysmotility, sclerodactyly, and telangiectasias. - While Raynaud's is present, the widespread skin thickening, muscle weakness, and perifascicular infiltration are not typical of limited cutaneous systemic sclerosis. *Antinuclear antibody* - A **positive antinuclear antibody (ANA)** is a general screening test for **autoimmune diseases** and is present in a wide range of conditions, including systemic sclerosis, lupus, and myositis [4]. - While ANA is positive in this patient, it is not specific enough to diagnose the exact overlap syndrome with its unique clinical and laboratory findings.
Question 103: What is the possible cause of irreversible dementia?
- A. Vitamin B12 deficiency
- B. NPH
- C. Hypothyroid
- D. Lewy body (Correct Answer)
Explanation: ***Lewy body*** - **Lewy body dementia** is a progressive, irreversible neurodegenerative disorder characterized by the abnormal accumulation of **alpha-synuclein proteins** within neurons [1]. - It presents with fluctuating cognition, recurrent visual hallucinations, and spontaneous **parkinsonism**, eventually leading to severe and irreversible cognitive decline [1]. *Vitamin B12 deficiency* - **Vitamin B12 deficiency** can cause cognitive impairment and dementia-like symptoms, but these are often **reversible** with appropriate B12 supplementation [2]. - Symptoms include **anemia**, peripheral neuropathy, and psychiatric changes, which can improve with treatment. *NPH* - **Normal Pressure Hydrocephalus (NPH)** presents with a classic triad of gait disturbance, urinary incontinence, and dementia [2]. - While it causes dementia, it is often **reversible** with surgical placement of a **ventriculoperitoneal shunt** to drain excess CSF [2]. *Hypothyroid* - **Hypothyroidism** can lead to cognitive slowing, memory impairment, and confusion, resembling dementia. - These symptoms are typically **reversible** and improve significantly with **thyroid hormone replacement therapy**.
Question 104: What is the correct order for cardiac auscultation on the left side, from superior to inferior? a. Pulmonary b. Tricuspid c. Mitral
- A. c>b>a (Mitral > Tricuspid > Pulmonary)
- B. a>b>c (Pulmonary > Tricuspid > Mitral) (Correct Answer)
- C. b>a>c (Tricuspid > Pulmonary > Mitral)
- D. c>a>b (Mitral > Pulmonary > Tricuspid)
Explanation: **a>b>c (Pulmonary > Tricuspid > Mitral)** - This order accurately reflects the anatomical positions of the **auscultation points** on the left side of the chest, moving from the superior aspect (second intercostal space) down to the inferior aspect (fifth intercostal space). - The **pulmonary area** is auscultated at the second left intercostal space, the **tricuspid area** at the fourth or fifth left intercostal space near the sternum, and the **mitral (apical) area** at the fifth left intercostal space at the midclavicular line [1]. *c>b>a (Mitral > Tricuspid > Pulmonary)* - This order is incorrect as it places the **mitral area** (inferior) superior to the **tricuspid** and **pulmonary areas**, which contradicts the anatomical arrangement for auscultation. - Auscultating in this sequence would involve moving from an inferior left position upwards, which is not the standard superior-to-inferior left-sided auscultation approach. *b>a>c (Tricuspid > Pulmonary > Mitral)* - This order is incorrect because it places the **tricuspid area** superior to the **pulmonary area**, which is factually wrong. - The **pulmonary area** is at the second left intercostal space, making it superior to the tricuspid area (fourth or fifth left intercostal space) [1]. *c>a>b (Mitral > Pulmonary > Tricuspid)* - This order is incorrect as it incorrectly positions the **mitral area** as the most superior point on the left side, which is anatomically inaccurate for auscultation. - The **pulmonary area** is located more superiorly than both the tricuspid and mitral areas in the standard auscultation sequence [1].
Question 105: Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen
- A. A-3, B-4, C-2, D-1
- B. A-1, B-4, C-3, D-2 (Correct Answer)
- C. A-4, B-2, C-3, D-1
- D. A-2, B-4, C-3, D-1
Explanation: **A-1, B-4, C-3, D-2** - **Caplan syndrome** was first described in **coal workers** with **rheumatoid arthritis** and progressive massive fibrosis. - **Asbestosis** is often associated with **pleural effusion**, which can be benign or malignant. - **Mesothelioma** typically involves the **lower lobes** of the lungs, specifically the pleura, and is strongly linked to asbestos exposure. - **Sarcoidosis** is characterized by **non-caseating granulomas**, which have a predilection for the **upper lobes** of the lungs. *A-3, B-4, C-2, D-1* - This option incorrectly states that Caplan syndrome involves the lower lobe; **Caplan syndrome** is defined by the presence of large nodules in the lungs of coal workers with rheumatoid arthritis, and their specific lobar distribution is not a defining characteristic. - This option incorrectly states that Mesothelioma has an upper lobe predominance; **Mesothelioma** is a pleural malignancy and typically involves the **lower lobes**, extending along the pleura. *A-4, B-2, C-3, D-1* - This option incorrectly associates Caplan syndrome with pleural effusion; **Caplan syndrome** manifests as rheumatoid nodules in the lungs, not primarily pleural effusion. - This option incorrectly states that Asbestosis has an upper lobe predominance; **Asbestosis** predominantly affects the **lower lobes** of the lungs, causing interstitial fibrosis. *A-2, B-4, C-3, D-1* - This option incorrectly states that Caplan syndrome has an upper lobe predominance; the defining feature of **Caplan syndrome** is the combination of rheumatoid arthritis and pneumoconiosis, not specific lobar involvement. - This option correctly identifies pleural effusion with asbestosis and lower lobe involvement with mesothelioma, but **Caplan syndrome** is not characterized by upper lobe predominance.
Question 106: A patient presented with complaints of pain in the flank region with hematuria. On investigation, X-ray shows multiple calcification (stones) in both kidneys. What is the probable diagnosis?
- A. Polycystic kidney disease
- B. Parathyroid Adenoma
- C. Renal calculi (Correct Answer)
- D. CKD
Explanation: ***Renal calculi*** - The presence of **flank pain**, **hematuria**, and **multiple calcifications (stones) in both kidneys** on X-ray directly points to a diagnosis of renal calculi (kidney stones) [1]. - These stones can cause pain due to obstruction and irritation, leading to blood in the urine [1]. *Polycystic kidney disease* - This condition is characterized by the development of numerous **cysts in the kidneys**, which are fluid-filled sacs, not calcifications or stones [2]. - While it can cause flank pain and hematuria, the imaging finding of **multiple calcifications** is inconsistent with typical PCKD presentation [2]. *Parathyroid Adenoma* - A parathyroid adenoma leads to **hyperparathyroidism**, which can cause **hypercalcemia** and subsequently increase the risk of **calcium kidney stones** [1]. - However, the diagnosis directly relates to the presence of stones as seen on X-ray, not the underlying cause of stone formation, and the question does not provide enough information to confirm hyperparathyroidism. *CKD* - **Chronic kidney disease (CKD)** is a progressive loss of kidney function over time, representing a *spectrum* of kidney damage. - While kidney stones can lead to CKD, and CKD can present with various symptoms, the direct finding of **multiple calcifications (stones)** on imaging is a specific indicator of renal calculi rather than CKD itself as the primary diagnosis.
Microbiology
1 questionsWith the lack of CD40 in B cells, which immunological abnormality is seen?
INI-CET 2023 - Microbiology INI-CET Practice Questions and MCQs
Question 101: With the lack of CD40 in B cells, which immunological abnormality is seen?
- A. Total lack of NK cells
- B. Lack of CD8 mediated cytotoxicity
- C. Inability of neutrophil against infections
- D. Decreased IgG and increase in IgM (Correct Answer)
Explanation: ***Decreased IgG and increase in IgM*** - The interaction between **CD40 on B cells** and **CD40L (CD154) on T helper cells** is crucial for **B cell activation**, proliferation, and **class switch recombination** (CSR). - Without this interaction, B cells cannot undergo CSR, leading to a failure to produce **IgG, IgA, or IgE**, while **IgM levels remain high** because IgM production is the initial default. *Total lack of NK cells* - **Natural Killer (NK) cells** are part of the innate immune system and their development is largely independent of CD40-CD40L signaling. - The absence of CD40 on B cells primarily affects adaptive humoral immunity, not NK cell numbers or function. *Lack of CD8 mediated cytotoxicity* - **CD8+ T cells** mediate cytotoxicity against infected or cancerous cells and their activation is primarily dependent on antigen presentation by **MHC class I molecules** and costimulation, not directly on B cell CD40. - While B cells can act as APCs, their CD40 interaction is more critical for T helper cell help for humoral responses. *Inability of neutrophil against infections* - **Neutrophils** are phagocytic cells important in innate immunity, and their function is largely independent of CD40 on B cells. - Neutrophil activity relies on pathogen recognition, phagocytosis, and degranulation, which are not directly regulated by the B cell CD40-CD40L pathway.
Pathology
1 questionsAll of the following are tests done for Turner mosaic screening except?
INI-CET 2023 - Pathology INI-CET Practice Questions and MCQs
Question 101: All of the following are tests done for Turner mosaic screening except?
- A. Karyotype
- B. FISH
- C. Serum FSH (Correct Answer)
- D. Buccal smear
Explanation: ***Serum FSH*** - **Serum Follicle-Stimulating Hormone (FSH)** levels are used to assess ovarian function and can be elevated in conditions like Turner syndrome due to **gonadal dysgenesis**, but it is a **functional test**, not a screening tool for mosaicism. - While elevated FSH is a clinical feature of Turner syndrome, it does not directly screen for the chromosomal mosaicism itself. *Karyotype* - **Karyotyping** is the **gold standard** for diagnosing Turner syndrome and its mosaics by visualizing the entire set of chromosomes [1]. - It can identify various forms of mosaicism involving the X chromosome, where some cells have 45,XO and others have 46,XX or other variations [1]. *FISH* - **Fluorescence in situ hybridization (FISH)** is a molecular cytogenetic technique used to detect specific chromosomal abnormalities, including those associated with Turner mosaicism. - It uses DNA probes that bind to specific regions of the X chromosome, allowing for the rapid detection of **aneuploidy** or deletions that might indicate mosaicism [2]. *Buccal smear* - A **buccal smear**, historically used for **Barr body** analysis, can provide an initial screening for X chromosome abnormalities. - The presence of Barr bodies (inactive X chromosomes) can help differentiate between 45,XO (no Barr body) and mosaic variants like 45,XO/46,XX (variable number of Barr bodies). **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. 54-55. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 186-187.