INI-CET 2024 Practice Questions

Q: Which of the following minerals is needed for fertility?

Zinc. ***Zinc*** - Zinc is crucial for **reproductive health** in both men and women, impacting **testosterone synthesis**, **spermatogenesis**, egg quality, and **hormone regulation**. - Essential for **gonadal development** and function in both sexes. - Deficiency leads to **hypogonadism**, reduced fertility, impaired sperm production, and increased risk of **miscarriage**. - Most commonly deficient mineral affecting fertility globally. *Selenium* - Selenium is also **essential for male fertility**, being a critical component of **glutathione peroxidase** in sperm mitochondria. - Required for **sperm motility**, morphology, and structural integrity of the sperm midpiece. - Deficiency can cause male infertility due to impaired sperm function. - However, zinc deficiency is more prevalent and has broader effects across both male and female reproductive systems. *Iron* - Iron is vital for **red blood cell formation** and preventing **anemia**. - Severe iron deficiency anemia can **impair ovulation** and indirectly affect fertility in women. - Not directly involved in reproductive processes at the cellular level like zinc. *Copper* - Essential for various enzymatic functions but not primarily associated with fertility. - **Excessive copper** can negatively impact fertility and cause hormonal imbalances. - Deficiency is rare and not a primary cause of infertility.

Q: Which of the following interventions is least appropriate for an 8-year-old boy with bilateral sensorineural hearing loss?

Adenoidectomy with grommet insertion. ***Adenoidectomy with grommet insertion*** - This procedure addresses **conductive hearing loss** (e.g., due to **otitis media with effusion**), while the boy has **sensorineural hearing loss (SNHL)**. - **Grommet insertion** (tympanostomy tubes) is used to improve middle ear ventilation and drain fluid, which is irrelevant for SNHL. *Hearing aid* - A **hearing aid** amplifies sound and is a common and appropriate intervention for **sensorineural hearing loss**, especially for mild to severe cases. - It can significantly improve a child's ability to hear and develop speech. *Cochlear implant* - A **cochlear implant** is appropriate for children with **severe to profound sensorineural hearing loss** who do not benefit sufficiently from hearing aids. - It directly stimulates the auditory nerve, bypassing damaged parts of the inner ear. *Preferential sitting in the classroom* - This is a simple and effective **accommodative strategy** to improve a child's listening environment and is appropriate for any degree of hearing loss. - It helps the child to better hear the teacher and participate in classroom discussions.

Q: A 20-year-old chronic alcoholic presents with severe hematemesis. USG shows distension of portal vein and the liver appears hyperechoic. Pantoprazole has been initiated. What is the next step in management?

Perform an endoscopy to identify and treat varices. **Perform an endoscopy to identify and treat varices** - Severe **hematemesis** in a chronic alcoholic with signs of **portal hypertension** (distended portal vein, hyperechoic liver) strongly suggests bleeding esophageal varices [1]. - **Endoscopy** is crucial for both diagnosing the source of bleeding and providing immediate therapeutic intervention, such as **variceal band ligation** or **sclerotherapy** [1]. *Administer IV fluids and electrolytes to stabilize hemodynamics* - While **hemodynamic stabilization with IV fluids** is an immediate and critical step in managing severe GI bleeding, it is not the *next step in definitive management* after pantoprazole initiation, which aims to address the *cause* of the bleeding. - This is an initial supportive measure, but addressing the source of hemorrhage is paramount once stabilization begins [1]. *Order a liver biopsy to assess for fibrosis* - A **liver biopsy** is primarily used for diagnosing the underlying cause and severity of liver disease, such as **cirrhosis** and **fibrosis**. - It is not an urgent procedure in the context of acute, severe hematemesis and would delay critical interventions to stop the bleeding. *Initiate a course of broad-spectrum antibiotics* - **Antibiotics** are indeed utilized in patients with cirrhosis and upper GI bleeding to prevent **spontaneous bacterial peritonitis** and other infections, often administered *after* hemodynamic stabilization and initial endoscopic management. - However, stopping the active bleeding is the immediate priority before initiating prophylactic antibiotics.

Q: A patient presents with the following arterial blood gas (ABG) and electrolyte values: pH: 7.34, Na: 135 mEq/L, Cl: 93 mEq/L, HCO3: 20 mEq/L, Random Blood Sugar (RBS): 420 mg/dl. What is the most likely acid-base disturbance?

High Anion Gap Metabolic Acidosis (HAGMA). ### High Anion Gap Metabolic Acidosis (HAGMA) - The **pH (7.34)** indicates **acidemia**, and the **low bicarbonate (20 mEq/L)** suggests a metabolic acidosis [1], [2]. - Calculation of the anion gap: Na - (Cl + HCO3) = 135 - (93 + 20) = 22 mEq/L. An anion gap > 12 mEq/L is considered high, confirming **High Anion Gap Metabolic Acidosis (HAGMA)** [4]. The **RBS of 420 mg/dl** also points towards a likely cause such as **diabetic ketoacidosis** [3]. *Normal Anion Gap Metabolic Acidosis (NAGMA)* - This would be present if the calculated anion gap were within the normal range (typically 8-12 mEq/L). - Causes of NAGMA (e.g., hyperchloremic acidosis) are typically associated with increased chloride levels to compensate for the bicarbonate loss, which is not the primary finding here [4]. *Respiratory Acidosis* - This condition is characterized by a **low pH** and an **elevated PaCO2**, which is not provided but implied by the **low bicarbonate** not fitting a respiratory picture [2]. - While the pH is low, the primary disturbance given the other values (especially the low bicarbonate) is metabolic, not respiratory. *Metabolic Alkalosis* - Metabolic alkalosis is characterized by an **elevated pH** and an **elevated bicarbonate level**, which contradicts the presented values of low pH and low bicarbonate [2]. - This condition would involve a net gain of bicarbonate or a loss of acids, which is the opposite of the findings in this patient.

Q: What is the best investigation for identifying malaria species?

Thin smear with Giemsa. ***Thin smear with Giemsa*** - A **thin smear** allows for the visualization of **parasite morphology** within red blood cells, which is crucial for distinguishing between species of *Plasmodium*. - **Giemsa stain** provides optimal contrast for identifying characteristic features such as **merozoites**, **trophozoites**, **schizonts**, and **gametocytes** of different malaria species. *Thick smear* - A **thick smear** is primarily used for **detecting the presence of malaria parasites** and for quantifying parasite density due to its higher sensitivity. - However, because red blood cells are lysed, it **does not preserve parasite morphology** well, making species identification difficult. *QBC* - **Quantitative Buffy Coat (QBC) analysis** is a rapid method for detecting malaria parasites based on their fluorescence under UV light. - While sensitive for detection, it generally **does not allow for precise species identification** due to the lack of clear morphological detail. *Thin smear with acridine orange* - A **thin smear stained with acridine orange** is used for rapid detection of parasites by fluorescence microscopy. - Similar to QBC, it is **less effective for detailed morphological examination** and specific species identification compared to Giemsa-stained thin smears.

Q: In a child presenting unilateral watering and photophobia which of the following is the least likely disorder?

Congenital NLDO. **Congenital NLDO** - **Congenital nasolacrimal duct obstruction (NLDO)** typically presents with **unilateral watering** (epiphora) due to blockage of tear drainage. - While it causes watering, **photophobia** is not a characteristic symptom of isolated NLDO, making it less likely given the combined presentation. *Congenital entropion* - **Congenital entropion** involves the inward turning of the eyelid margin, causing eyelashes to rub against the cornea. - This irritation can lead to **unilateral watering** and **photophobia** due to corneal abrasion and discomfort. *Congenital glaucoma* - **Congenital glaucoma** is characterized by elevated intraocular pressure, which can cause corneal edema and stretching. - These changes commonly result in **unilateral watering** (epiphora) and marked **photophobia**, often accompanied by **buphthalmos** (enlarged eye). *Congenital dacryocystitis* - **Congenital dacryocystitis** is an infection of the lacrimal sac, often secondary to NLDO. - It presents with **unilateral watering**, discharge, and inflammation of the lacrimal sac, and the associated irritation can induce **photophobia**.

Q: Which is an intranuclear immunohistochemistry marker for neuroendocrine tumors?

INSM. ***INSM*** - **INSM1 (Insulinoma-associated protein 1)** is a highly sensitive and specific **transcription factor** expressed in neuroendocrine cells. - It exhibits **intranuclear staining** in immunohistochemistry, making it a reliable marker for neuroendocrine differentiation in tumors. *NCAM1/CD56* - **NCAM1/CD56** is a **cell surface adhesion molecule** - It shows **membranous or cytoplasmic staining** in immunohistochemistry, not intranuclear. *Chromogranin* - **Chromogranin A** is a **storage protein** found in dense core granules of neuroendocrine cells. [1] - It demonstrates **cytoplasmic staining** in immunohistochemistry and is a general neuroendocrine marker. [1] *Synaptophysin* - **Synaptophysin** is a **transmembrane glycoprotein** associated with synaptic vesicles. - It exhibits **cytoplasmic or membranous staining** in immunohistochemistry and is also a general neuroendocrine marker. [2] **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 419-420. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 780-781.

Q: Which one of the following is a criterion of Kawasaki disease?

Rash. ***Rash*** - A **polymorphous rash**, which can be macular, papular, or scarlatiniform, is one of the **five principal diagnostic criteria** for **Kawasaki disease**. - This rash typically appears early in the course of the illness and can affect any part of the body, often involving the trunk and extremities. *Edema* - **Edema of the hands and feet**, especially when accompanied by **erythema** (redness), is actually one of the **principal diagnostic criteria** for Kawasaki disease under "extremity changes." - This finding typically occurs in the acute phase, followed by **desquamation** (peeling) in the convalescent phase, particularly in the periungual region. - Note: While edema is a valid criterion, **rash** is considered the most characteristic and commonly used criterion among the options listed. *Purulent conjunctivitis* - **Kawasaki disease** characteristically presents with **bilateral non-purulent (non-exudative) conjunctival injection** - red eyes without discharge or exudate. - **Purulent conjunctivitis** (conjunctivitis with pus/discharge) indicates a bacterial infection and actually argues **against** the diagnosis of Kawasaki disease. - This is the only option that is definitively **not** a criterion. *Strawberry tongue* - **Strawberry tongue** (red, swollen tongue with prominent papillae) is part of the **oral changes criterion** in Kawasaki disease, which includes red cracked lips, strawberry tongue, and erythema of the oropharyngeal mucosa. - While also seen in scarlet fever and toxic shock syndrome, strawberry tongue is a **recognized feature** of Kawasaki disease. - Note: This is technically a valid criterion, though less specific than the polymorphous rash.

Q: Which of the following is not done in the primary survey of trauma?

NCCT head. ***NCCT head*** - A **Non-Contrast CT (NCCT) head** is typically performed during the **secondary survey** once the patient is hemodynamically stable and life-threatening conditions have been addressed. - The primary survey focuses on immediate **life-saving interventions** for airway, breathing, circulation, disability, and exposure. *Intubation* - **Intubation** is a critical intervention during the primary survey, specifically under the **'A' (Airway)** component, to establish and secure a patent airway in a compromised patient. - Failure to establish an airway can rapidly lead to **hypoxia** and death. *ICD drainage* - **Intercostal drain (ICD) drainage** is an urgent intervention in the primary survey, falling under **'B' (Breathing)**, to manage conditions like **tension pneumothorax** or massive hemothorax. - These conditions can severely compromise ventilation and circulation, requiring immediate relief. *CXR* - A **Chest X-ray (CXR)** is a rapid and essential diagnostic tool in the primary survey, also under **'B' (Breathing)**, to identify life-threatening thoracic injuries such as pneumothorax, hemothorax, or mediastinal shift. - It provides quick information crucial for immediate management decisions.

Question 1

Which of the following minerals is needed for fertility?

Accepted Answer

Zinc

Answer

Copper

Answer

Iron

Answer

Selenium

Question 2

Which of the following interventions is least appropriate for an 8-year-old boy with bilateral sensorineural hearing loss?

Accepted Answer

Adenoidectomy with grommet insertion

Answer

Hearing aid

Answer

Cochlear implant

Answer

Preferential sitting in the classroom

Question 3

A 20-year-old chronic alcoholic presents with severe hematemesis. USG shows distension of portal vein and the liver appears hyperechoic. Pantoprazole has been initiated. What is the next step in management?

Accepted Answer

Perform an endoscopy to identify and treat varices

Answer

Administer IV fluids and electrolytes to stabilize hemodynamics

Answer

Order a liver biopsy to assess for fibrosis

Answer

Initiate a course of broad-spectrum antibiotics

Question 4

Which of the following statements about atrial fibrillation is correct?

Accepted Answer

Discrepancy in pulse rate and heart rate are reliable for diagnosis

Answer

Rarely seen in heart with normal morphology

Answer

Cardioversion is used for all cases of atrial fibrillation

Answer

Only digoxin used for rate control

Question 5

A patient presents with the following arterial blood gas (ABG) and electrolyte values: pH: 7.34, Na: 135 mEq/L, Cl: 93 mEq/L, HCO3: 20 mEq/L, Random Blood Sugar (RBS): 420 mg/dl. What is the most likely acid-base disturbance?

Accepted Answer

High Anion Gap Metabolic Acidosis (HAGMA)

Answer

Normal Anion Gap Metabolic Acidosis (NAGMA)

Answer

Respiratory Acidosis

Answer

Metabolic Alkalosis

Question 6

What is the best investigation for identifying malaria species?

Accepted Answer

Thin smear with Giemsa

Answer

Thick smear

Answer

QBC

Answer

Thin smear with acridine orange

Question 7

In a child presenting unilateral watering and photophobia which of the following is the least likely disorder?

Accepted Answer

Congenital NLDO

Answer

Congenital entropion

Answer

Congenital glaucoma

Answer

Congenital dacryocystitis

Question 8

Which is an intranuclear immunohistochemistry marker for neuroendocrine tumors?

Accepted Answer

INSM

Answer

NCAM1/CD56

Answer

Chromogranin

Answer

Synaptophysin

Question 9

Which one of the following is a criterion of Kawasaki disease?

Accepted Answer

Rash

Answer

Edema

Answer

Purulent conjunctivitis

Answer

Strawberry tongue

Question 10

Which of the following is not done in the primary survey of trauma?

Accepted Answer

NCCT head

Answer

Intubation

Answer

ICD drainage

Answer

CXR

INI-CET 2024

Biochemistry

ENT

Internal Medicine

Microbiology

Ophthalmology

Pathology

Pediatrics

Surgery