INI-CET 2023 Practice Questions

Q: Match the incubation periods of the following diseases: a. Syphilis b. SARS c. Hepatitis A d. Chickenpox Match with: 1. 10-21 days 2. 21 days (3 weeks) 3. 2-7 days 4. 15-50 days

a-2, b-3, c-4, d-1. ***a-2, b-3, c-4, d-1*** - This option correctly matches all incubation periods: **Syphilis (a) = 21 days (3 weeks)** - the average incubation for primary chancre appearance is 21 days (range 10-90 days). - **SARS (b) = 2-7 days** - the typical incubation period for SARS-CoV-1 is 2-10 days, with most cases manifesting within 2-7 days. - **Hepatitis A (c) = 15-50 days** - the standard incubation period averages 28-30 days (range 15-50 days). - **Chickenpox (d) = 10-21 days** - varicella has a well-established incubation of 10-21 days, typically 14-16 days. *a-3, b-4, c-2, d-1* - This incorrectly assigns **2-7 days to Syphilis**, which is far too short for the primary chancre to appear (actual: 21 days average). - **15-50 days for SARS** is excessively long; SARS manifests within 2-10 days. - **21 days for Hepatitis A** is at the lower end but not representative of the typical range (15-50 days). *a-2, b-3, c-1, d-4* - This incorrectly pairs **10-21 days with Hepatitis A**, which has a longer incubation (15-50 days). - **15-50 days for Chickenpox** is too long; varicella's incubation is 10-21 days. *a-4, b-3, c-1, d-2* - This incorrectly assigns **15-50 days to Syphilis** (actual: 21 days average) and **10-21 days to Hepatitis A** (actual: 15-50 days). - While these ranges have some overlap with actual values, they represent inversions of the correct assignments.

Q: Slapped cheek appearance is associated with which of the following?

Parvovirus B19 infection. ***Parvovirus B19 infection*** - **Parvovirus B19** infection, also known as Fifth Disease or **Erythema Infectiosum**, classically presents with a **slapped cheek rash** on the face. - This characteristic facial rash is usually followed by a **lacy, reticular rash** on the trunk and extremities. *Herpes zoster* - **Herpes zoster** (shingles) presents as a painful, vesicular rash that follows a **dermatomal distribution**. - It does not cause a **slapped cheek appearance**; its rash is typically unilateral and confined to a single dermatome. *Molluscum contagiosum* - **Molluscum contagiosum** is characterized by small, flesh-colored, **umbilicated papules** with a central dimple. - These lesions can occur anywhere on the body but do not produce a diffuse facial rash like the **slapped cheek appearance**. *Kaposi sarcoma* - **Kaposi sarcoma** is a vascular tumor that manifests as **purple, brown, or reddish skin lesions**, often seen in immunocompromised individuals. - It is not associated with a **widespread facial rash** or the characteristic distribution of a slapped cheek appearance.

Q: A patient has dyspareunia, and dysmenorrhea with adnexal tenderness. What is the first step of investigation?

Transvaginal USG. ***Transvaginal USG*** - This is the **first-line investigation** for evaluating pelvic pain, dyspareunia, dysmenorrhea, and adnexal tenderness due to its ability to provide **high-resolution images** of the uterus, ovaries, and surrounding structures to identify potential pathology like **endometriomas** or other adnexal masses. - It allows for detailed assessment of **ovarian cysts**, fibroids, and other pelvic abnormalities, which can explain the patient's symptoms. *Colposcopy* - This procedure is primarily used to closely examine the **cervix, vagina, and vulva** for abnormal cells, often following an abnormal Pap test. - It is not the initial step for investigating generalized pelvic pain, dyspareunia, or adnexal tenderness. *Diagnostic laparoscopy* - While a **diagnostic laparoscopy** can provide a definitive diagnosis for conditions like **endometriosis**, it is an **invasive surgical procedure** and typically reserved for cases where non-invasive imaging, such as transvaginal ultrasound, has not yielded a clear diagnosis or when conservative management has failed. - It is not considered the first-step investigation due to its **invasive nature** and associated risks. *Transabdominal pelvic ultrasound* - A **transabdominal pelvic ultrasound** provides a broader view of the pelvic organs but often has **lower resolution** and is less accurate for detailed assessment of the uterus, ovaries, and adnexa compared to transvaginal ultrasound, especially in obese patients. - It is often used if a transvaginal ultrasound is not feasible or for assessing larger pelvic masses, but the **transvaginal approach** is superior for detailed evaluation of the female reproductive organs.

Q: After delivering a baby boy, a 25 -year-old mother developed acute PPH and hypovolemic shock, and major blood transfusion occurred. All of the following are complications of blood transfusion except?

Hypokalemia. ***Hypokalemia*** - **Hypokalemia is NOT a typical complication of massive blood transfusion**. In fact, massive transfusion is characteristically associated with **hyperkalemia**, not hypokalemia. - **Stored blood** contains high levels of extracellular potassium due to **red blood cell lysis** during storage (potassium levels can reach 30-50 mEq/L in units stored >21 days). - Rapid transfusion of multiple units delivers a significant **potassium load**, making **hyperkalemia** the expected electrolyte abnormality. - While hypokalemia could theoretically occur later due to **alkalosis from citrate metabolism** or during the **rewarming/correction phase**, this is **indirect, uncommon, and not a recognized acute complication** of the transfusion itself. - Therefore, hypokalemia is the exception among the listed options. *Hypothermia* - **Direct and common complication** when cold blood products (stored at 1-6°C) are rapidly infused without adequate warming. - Can cause **coagulopathy**, cardiac arrhythmias, decreased drug metabolism, and leftward shift of oxygen-hemoglobin dissociation curve. - Prevention requires use of **blood warmers** during massive transfusion. *Hypocalcemia* - **Very common complication** of massive transfusion due to **citrate toxicity**. - **Citrate** (anticoagulant in stored blood) chelates ionized calcium in the recipient's circulation. - Normally metabolized by the liver, but rapid transfusion overwhelms hepatic metabolism, leading to **symptomatic hypocalcemia**. - Can cause **cardiac dysfunction, hypotension, and prolonged QT interval**. *Hypomagnesemia* - Can occur with massive transfusion as **magnesium is also chelated by citrate**, similar to calcium. - Less commonly recognized than hypocalcemia but documented in massive transfusion protocols. - Can contribute to **cardiac arrhythmias and neuromuscular irritability**.

Q: Which test is not required for Turner mosaic syndrome?

ANA. ***ANA*** - **Antinuclear antibody (ANA)** testing is primarily used for diagnosing autoimmune diseases like **systemic lupus erythematosus** and is not routinely required for the management of Turner mosaic syndrome. - While autoimmune conditions can rarely co-occur, ANA is not a standard screening or diagnostic test for the common complications of Turner syndrome. *Audiometry* - **Audiometry** is recommended for Turner syndrome patients due to an increased risk of **hearing loss**, particularly **sensorineural hearing loss**. - Regular monitoring helps detect and manage hearing impairments early, which can affect development and quality of life. *Oral glucose tolerance test* - Patients with Turner syndrome have an increased risk of developing **glucose intolerance** and **type 2 diabetes mellitus**. - An **oral glucose tolerance test (OGTT)** is important for screening and early detection of these metabolic abnormalities. *Echo* - **Echocardiography** is crucial for evaluating potential **cardiovascular abnormalities**, which are common in Turner syndrome. - These can include **bicuspid aortic valve**, **coarctation of the aorta**, and other structural heart defects.

Q: A female was given morphine sulphate during labour for pain but she developed respiratory distress. Which of the following will be the correct antidote?

Naloxone. ***Naloxone*** - **Naloxone** is a pure opioid antagonist that rapidly reverses the effects of **opioid overdose** [1, 3], including **respiratory depression** [2], by competitively binding to opioid receptors [1]. - Its short half-life may necessitate repeated doses, especially with longer-acting opioids like morphine, to prevent recurrence of respiratory depression [1]. *Epinephrine* - **Epinephrine** is an adrenergic agonist used to treat **anaphylaxis** and severe allergic reactions, as it causes **vasoconstriction** and **bronchodilation**. - It is not an antidote for opioid-induced respiratory depression, which primarily results from central nervous system effects rather than allergic reactions. *Pralidoxime* - **Pralidoxime** is a **cholinesterase reactivator** used to treat poisoning by **organophosphates**, which inhibit acetylcholinesterase, leading to cholinergic crisis. - It works by restoring the function of the enzyme, thereby breaking down excess acetylcholine, and is not indicated for opioid overdose. *Atropine* - **Atropine** is an **anticholinergic agent** that blocks muscarinic acetylcholine receptors, used to treat **bradycardia** and **organophosphate poisoning**. - It would not reverse opioid-induced respiratory depression, as it primarily affects the parasympathetic nervous system and does not antagonize opioid receptor effects.

Q: Absence or mutation of SRY gene results in ?

Gonadal dysgenesis. ***Gonadal dysgenesis*** - The **SRY gene** (Sex-determining region Y gene) is critical for initiating **male sexual differentiation**; its presence leads to testicular development. - Absence or mutation of the SRY gene prevents proper testicular development, leading to **gonadal dysgenesis**, where the gonads are either absent or rudimentary, often resulting in a **female phenotype** despite a XY genotype. *Hydrocele testis* - This condition involves an accumulation of fluid around the testis, which is typically due to a **patent tunica vaginalis** or fluid imbalance. - It does not directly result from a genetic mutation in the SRY gene affecting initial **gonadal development**. *Undescended testis* - This condition (cryptorchidism) refers to the failure of one or both testes to descend into the scrotum. - While it can have genetic components, it is not a direct consequence of an SRY gene absence or mutation, which primarily affects the **formation of the gonad itself**. *None of the options* - This option is incorrect because **gonadal dysgenesis** is a direct and well-established consequence of SRY gene absence or mutation. - The SRY gene's primary role is to trigger the development of the testis, and its dysfunction leads to profound abnormalities in **gonadal formation**.

Q: What condition is associated with the sign seen in the given USG?

Spina bifida. ***Spina bifida*** - The ultrasound image displays the **"lemon sign"** (frontal bone indentation), which is a classic indicator of **spina bifida** on antenatal ultrasound. - The lemon sign is caused by **scalloping of the frontal bones** due to caudal displacement of brain tissue (Arnold-Chiari malformation type II) secondary to an open spinal defect. - This sign is most commonly seen in the **second trimester** and is associated with neural tube defects. *Anencephaly* - **Anencephaly** presents with absence of the cranial vault and cerebral hemispheres on ultrasound. - The characteristic finding is the **"frog-eye appearance"** with protruding orbits, not frontal bone scalloping. - This is incompatible with life and has a distinctly different ultrasound appearance. *Dandy-Walker malformation* - **Dandy-Walker malformation** shows an enlarged posterior fossa with cystic dilatation of the fourth ventricle and hypoplasia of the cerebellar vermis. - It may present with the **"banana sign"** (cerebellar compression), but not the lemon sign. - This is a posterior fossa abnormality, not associated with frontal bone changes. *Encephalocele* - **Encephalocele** presents as a herniation of brain tissue and meninges through a cranial defect, typically occipital. - Ultrasound shows a **cystic mass protruding from the skull**, not frontal bone indentation. - While it's a neural tube defect, it has a different ultrasound appearance than the lemon sign.

Q: What is the likely diagnosis of the image given below?

Ranula. ***Ranula*** - The image exhibits a characteristic **translucent, bluish, dome-shaped swelling** on the floor of the mouth, which is highly suggestive of a ranula. - A ranula is a type of **mucocele specifically involving the sublingual gland** or minor salivary glands in the floor of the mouth, often due to obstruction or trauma to the salivary duct. *Dermoid cyst* - While dermoid cysts can appear on the floor of the mouth, they typically present as a **firmer, doughy consistency** and are often **yellowish or skin-colored**, due to their epithelial and adnexal contents. - They are usually located in the midline and are **congenital lesions**, which differ in appearance from the fluid-filled, translucent nature of a ranula. *Mucocele* - A mucocele is a general term for a mucus retention cyst, but they typically present as **smaller, painless, bluish, benign lesions** found on the **lips** (especially the lower lip) or buccal mucosa, resulting from trauma to minor salivary glands. - The size and specific location (floor of the mouth associated with sublingual gland) in the image point more specifically to a ranula rather than a general mucocele. *Ludwig angina* - Ludwig angina is a **severe, rapidly spreading cellulitis of the submandibular and sublingual spaces**, usually stemming from an odontogenic infection. - It presents with **firm, brawny swelling of the submandibular region** and floor of the mouth, often accompanied by fever, dysphagia, and airway compromise, which are not depicted in the image.

Question 1

Match the incubation periods of the following diseases:
a. Syphilis
b. SARS
c. Hepatitis A
d. Chickenpox

Match with:
1. 10-21 days
2. 21 days (3 weeks)
3. 2-7 days
4. 15-50 days

Accepted Answer

a-2, b-3, c-4, d-1

Answer

a-3, b-4, c-2, d-1

Answer

a-2, b-3, c-1, d-4

Answer

a-4, b-3, c-1, d-2

Question 2

Slapped cheek appearance is associated with which of the following?

Accepted Answer

Parvovirus B19 infection

Answer

Herpes zoster

Answer

Molluscum contagiosum

Answer

Kaposi sarcoma

Question 3

Patient presented with following features:

- ipsilateral loss of pain and temperature sensation in the face
- Contralateral loss of pain and temperature sensation in the body
- Horner's syndrome
- Dysphagia and hoarseness
- Ataxia and vertigo

Which artery is involved in syndrome based on above clinical features?

Accepted Answer

Posterior inferior cerebellar artery

Answer

Basilar artery.

Answer

Superior cerebellar artery

Answer

Anterior inferior cerebellar artery

Question 4

A patient has dyspareunia, and dysmenorrhea with adnexal tenderness. What is the first step of investigation?

Accepted Answer

Transvaginal USG

Answer

Colposcopy

Answer

Diagnostic laparoscopy

Answer

Transabdominal pelvic ultrasound

Question 5

After delivering a baby boy, a 25 -year-old mother developed acute PPH and hypovolemic shock, and major blood transfusion occurred. All of the following are complications of blood transfusion except?

Accepted Answer

Hypokalemia

Answer

Hypothermia

Answer

Hypocalcemia

Answer

Hypomagnesemia

Question 6

Which test is not required for Turner mosaic syndrome?

Accepted Answer

ANA

Answer

Audiometry

Answer

Oral glucose tolerance test

Answer

Echo

Question 7

A female was given morphine sulphate during labour for pain but she developed respiratory distress. Which of the following will be the correct antidote?

Accepted Answer

Naloxone

Answer

Epinephrine

Answer

Pralidoxime

Answer

Atropine

Question 8

Absence or mutation of SRY gene results in ?

Accepted Answer

Gonadal dysgenesis

Answer

Hydrocele testis

Answer

Undescended testis

Answer

None of the options

Question 9

What condition is associated with the sign seen in the given USG?

Accepted Answer

Spina bifida

Answer

Anencephaly

Answer

Dandy-Walker malformation

Answer

Encephalocele

Question 10

What is the likely diagnosis of the image given below?

Accepted Answer

Ranula

Answer

Dermoid cyst

Answer

Mucocele

Answer

Ludwig angina

INI-CET 2023

Community Medicine

Dermatology

Internal Medicine

Obstetrics and Gynecology

Pediatrics

Pharmacology

Physiology

Radiology

Surgery