INI-CET 2024 Practice Questions

Q: Which nutrient deficiency directly impairs hydroxylation during collagen synthesis?

D. Vitamin C. ***Vitamin C*** - **Vitamin C** (ascorbic acid) is a crucial **cofactor** for the enzymes **prolyl hydroxylase** and **lysyl hydroxylase**, which are essential for **collagen cross-linking and stability**. - Its deficiency leads to **scurvy**, characterized by weakened connective tissue, impaired wound healing, and fragile blood vessels due to **defective collagen synthesis**. *Vitamin D* - **Vitamin D** is primarily involved in **calcium and phosphate homeostasis**, which are vital for bone mineralization. - Its deficiency can lead to **rickets** in children and **osteomalacia** in adults, conditions of weakened bones, but not directly to collagen defects. *Copper* - **Copper** is a cofactor for **lysyl oxidase**, an enzyme that cross-links collagen and elastin, contributing to the tensile strength of connective tissues. - While copper deficiency can affect collagen structure, **Vitamin C deficiency** has a more direct and severe impact on the initial synthesis and hydroxylation steps of collagen, making it the primary answer for collagen defects. *Vitamin E* - **Vitamin E** is a fat-soluble antioxidant that protects cell membranes from **oxidative damage**. - Its deficiency is associated with neurological symptoms and hemolytic anemia but does not directly cause defects in **collagen synthesis or structure**.

Q: What are the criteria for administering Anti-D immunoglobulin postpartum in an Rh-negative female?

DCT negative, Baby Rh +ve. ***DCT negative, Baby Rh +ve*** * The mother is **Rh-negative** and needs Anti-D immunoglobulin if her baby is **Rh-positive** to prevent sensitization. * A **negative Direct Coombs Test (DCT)** indicates that the mother has not yet developed antibodies against the baby's Rh-positive red blood cells, making Anti-D administration effective for prevention. * *DCT positive, Baby Rh +ve* * If the **DCT is positive**, it means the mother has already formed **antibodies** against the baby's Rh-positive red blood cells (sensitization has occurred). * In this scenario, administering Anti-D immunoglobulin would be **ineffective** as the immune response has already begun. * *DCT negative, Baby Rh -ve* * If the baby is **Rh-negative**, there is no risk of Rh sensitization for an Rh-negative mother. * Therefore, **Anti-D immunoglobulin is not necessary** in this situation. * *DCT positive, Baby Rh -ve* * A **positive DCT** in an Rh-negative mother implies sensitization has occurred, but it would not be due to an Rh-negative baby. * Administering Anti-D immunoglobulin would be **ineffective** and unnecessary if the baby is Rh-negative.

Q: A G2 P1 female with 6 weeks amenorrhea presents with bleeding PV, hypotension, and altered sensorium. She has pain in the abdomen and on per vaginal examination cervical movement tenderness is present. On USG, there is free fluid present in the right paracolic gutter. What is the most probable diagnosis?

Ruptured ectopic. ***Ruptured ectopic*** - The combination of **amenorrhea**, **vaginal bleeding**, **abdominal pain**, and signs of **hypovolemic shock** (hypotension, altered sensorium) is highly suggestive of a ruptured ectopic pregnancy. - The presence of **cervical motion tenderness** and **free fluid in the paracolic gutter** on ultrasound strongly indicates intra-abdominal hemorrhage. *Abruptio placenta* - This condition typically occurs in the **second or third trimester** of pregnancy, not at 6 weeks gestation. - While it causes vaginal bleeding and abdominal pain, the presentation of **profound shock** in early pregnancy with free fluid suggests an ectopic rupture rather than placental abruption. *Placenta previa* - **Painless vaginal bleeding** in the second or third trimester is characteristic of placenta previa. - It would not explain the severe abdominal pain, cervical motion tenderness, or signs of hypovolemic shock in a 6-week pregnancy. *Missed abortion* - A missed abortion involves the **death of the embryo/fetus** with retention of products of conception, often with minimal or no symptoms. - It would not typically present with **hypotension**, **altered sensorium**, **severe abdominal pain**, or **free fluid in the abdomen**.

Q: An 8-month-old child was found to have features of vitamin A deficiency. What is the dose of oral vitamin A required?

1,00,000 IU. ***1,00,000 IU*** - For children aged **6-11 months** with clinical vitamin A deficiency, the recommended dose of oral vitamin A is **1,00,000 IU** (100,000 IU). - An 8-month-old child falls in this age category and requires this specific dose. - This dose is given as part of a **three-dose regimen**: on day 1 (immediately), day 2, and after 2-4 weeks as per **WHO guidelines**. *50,000 IU* - This dose is recommended for **infants less than 6 months** of age with vitamin A deficiency. - Using this dose for an 8-month-old would be **underdosing**, providing inadequate treatment for the deficiency. *75,000 IU* - This is **not a standard dose** for vitamin A supplementation in any age group for deficiency treatment. - Standard WHO guidelines specify 50,000 IU for infants <6 months, 100,000 IU for 6-11 months, and 200,000 IU for children 12-59 months. *2,00,000 IU* - This higher dose is used for children aged **12-59 months** (1-5 years) with vitamin A deficiency. - Administering 200,000 IU to an 8-month-old would be an **overdose**, potentially leading to **acute vitamin A toxicity** with symptoms like bulging fontanelle, vomiting, and irritability.

Q: Which of the following statements about the ABCDE approach in pediatric Advanced Life Support (PALS) is incorrect?

Dehydration is a component of the ABCDE approach.. ***Dehydration is a component of the ABCDE approach.*** - The **ABCDE approach** in PALS focuses on **Airway, Breathing, Circulation, Disability, and Exposure**, which are immediate life threats. - While dehydration is a crucial clinical concern in children, it's a **diagnostic consideration** and management target, not a primary component of the initial rapid assessment categories (A, B, C, D, E) themselves. - Dehydration may affect circulation (C) but is not itself a separate component of the ABCDE framework. *Airway management is essential in PALS.* - **Airway** is the first step in the ABCDE approach, focusing on ensuring a **patent and protected airway** to allow for effective ventilation. - **Airway management** is critical in pediatric resuscitation to prevent respiratory arrest and optimize oxygen delivery. *Breathing assessment is part of the ABCDE approach.* - **Breathing** is the second step, involving the assessment of **respiratory rate, effort, breath sounds, and oxygen saturation**. - Effective breathing is vital for adequate **oxygenation and ventilation**, and addressing breathing problems is a key part of PALS. *Circulation is a critical component of the ABCDE approach.* - **Circulation** is the third step, involving the assessment of **heart rate, blood pressure, capillary refill time, and peripheral perfusion**. - **Circulatory assessment** helps identify shock or cardiac arrest, which require immediate intervention. - The complete ABCDE also includes **Disability** (neurological status assessment using AVPU or GCS) and **Exposure** (full examination while preventing hypothermia).

Q: Fluid of choice for shock in a child with severe acute malnutrition + hypoglycemia

Ringer lactate + 5% dextrose. ***Ringer lactate + 5% dextrose*** - This combination provides both **electrolytes** (from Ringer lactate) to help correct **shock** and **glucose** (from 5% dextrose) to address **hypoglycemia** in a child with severe acute malnutrition (SAM). - Patients with SAM are at a high risk of **hypoglycemia** during shock, making glucose supplementation crucial. *Normal saline* - While suitable for initial fluid resuscitation in shock, it does **not contain glucose** and would not address the concomitant hypoglycemia. - Excessive use of normal saline can also lead to **hyperchloremic metabolic acidosis**, which is undesirable in already compromised patients. *Ringer lactate* - Ringer lactate provides **electrolytes** and is a good crystalloid for shock resuscitation, but it **lacks glucose** to correct hypoglycemia. - In SAM patients, where energy stores are depleted, simply providing Ringer lactate might not be sufficient to prevent or treat hypoglycemia. *10% dextrose* - 10% dextrose would effectively treat **hypoglycemia** but is not an appropriate fluid for fluid resuscitation in **shock**. - It would not adequately expand the intravascular volume or provide the necessary electrolytes for managing shock alone.

Q: Rapid cycling is characterized by all of the following except?

Occurs commonly in men. ***A. Occurs commonly in men*** - **Rapid cycling** is more common in **women** (approximately 70-90% of rapid cyclers are female) and is associated with comorbid conditions like **hypothyroidism**. - This is the **EXCEPT** answer because rapid cycling does NOT commonly occur in men—it predominantly affects women. *B. Commonly associated with concomitant hypothyroidism* - **Hypothyroidism** is a frequently noted comorbidity in individuals with **rapid-cycling bipolar disorder** (seen in 20-30% of cases). - Thyroid dysfunction can affect mood regulation and contribute to the instability characteristic of rapid cycling. - This IS a true characteristic of rapid cycling. *C. Antidepressants increase likelihood* - **Antidepressants** can sometimes **induce or worsen rapid cycling** in individuals with bipolar disorder, especially when used without a mood stabilizer. - This is why great care is taken when prescribing antidepressants in bipolar disorder to monitor for mood shifts. - This IS a true characteristic of rapid cycling. *D. At least 4 distinct episodes per year* - This is the **DSM-5 diagnostic criterion** for rapid cycling, meaning an individual experiences four or more mood episodes (depressive, manic, mixed, or hypomanic) within a 12-month period. - These episodes must be distinct and separated by either a full remission or a switch to an episode of opposite polarity. - This IS a true characteristic of rapid cycling.

Q: Which of the following is the core component of Beck's cognitive theory of depression?

C. Dysfunctional belief. ***Dysfunctional belief*** - **Dysfunctional beliefs**, or **core beliefs**, are the central component of Beck's cognitive theory, acting as underlying assumptions that shape an individual's interpretation of events. - These deep-seated beliefs are often rigid, extreme, and influence the development of maladaptive thoughts and behaviors in depression. *Cognitive distortions* - **Cognitive distortions** are systematic errors in thinking that arise from dysfunctional beliefs but are not the fundamental cause themselves. - They are the *patterned ways* in which individuals misconstrue reality, such as **catastrophizing** or **all-or-nothing thinking**. *Automated thoughts* - **Automatic thoughts** are spontaneous, fleeting thoughts that occur in response to specific situations. - While they are a key symptom and target of therapy in Beck's model, they stem from underlying dysfunctional beliefs and cognitive distortions, rather than being the core component. *Introjection* - **Introjection** is a psychoanalytic concept referring to the unconscious absorption of attitudes, ideas, and behaviors from external sources into one's own personality. - This concept is primarily associated with **psychodynamic theories** and is not part of Beck's cognitive model of depression.

Q: Which of the following statements about CT imaging is the MOST accurate?

Water has a Hounsfield unit (HU) of zero.. ***Water has a Hounsfield unit (HU) of zero.*** - The **Hounsfield unit (HU)** scale is a quantitative scale used to describe radiodensity in CT scans, where **water is defined as 0 HU**. - This establishes a crucial reference point for measuring the attenuation of other tissues, which can range from approximately **-1000 HU for air** to **+1000 HU or more for dense bone**. *CT head dose remains constant regardless of the protocol used.* - The **radiation dose** in CT scans is highly variable and depends significantly on the **protocol used**, including factors like mA, kVp, pitch, and scan length. - **Dose optimization techniques** and protocol adjustments are routinely employed to minimize patient exposure while maintaining diagnostic image quality. *CT cannot detect gallstones under any circumstances.* - While **ultrasound (US)** is the primary modality for detecting gallstones, CT can visualize them, especially if they are **calcified** or of mixed composition. - **Non-calcified gallstones** may be more challenging to detect on CT, but they are not impossible to see, particularly with current generation scanners and appropriate windowing. *CT uses unfiltered x-ray beams.* - CT scanners use **filtered x-ray beams** to provide higher quality images and reduce patient dose. - **Filtration (e.g., aluminum or copper)** removes low-energy x-rays, which would otherwise be absorbed by the patient without contributing to image formation.

Q: Case of trauma in a patient with an unknown blood group. Patient is unstable and requires urgent blood transfusion. Which type of blood should be transfused?

O-. ***O-*** - **O-negative blood** is considered the **universal donor** because it lacks A, B, and Rh (D) antigens, making it safe for transfusion to patients of any blood type in an emergency. - In a critically unstable patient with an unknown blood group requiring urgent transfusion, using **O-negative blood minimizes the risk of a severe acute hemolytic transfusion reaction**. *AB+* - **AB-positive blood** is the **universal recipient** blood type, meaning individuals with AB+ blood can receive blood from any donor. - However, transfusing AB+ blood to a patient with an unknown blood type could lead to a **severe hemolytic reaction** if the patient is not AB+. *O+* - While **O-positive blood** is common and can be given to individuals who are Rh-positive, it contains the **Rh antigen**. - Transfusing O-positive blood to an Rh-negative patient (whose Rh status is unknown in this emergency) could cause **alloimmunization** and a hemolytic reaction. *A+* - **A-positive blood** contains A antigens and Rh antigens. - Giving A-positive blood to a patient with an unknown blood type is risky, as it would cause a **hemolytic reaction** if the patient is B, AB, or O, or if they are Rh-negative.

Question 1

Which nutrient deficiency directly impairs hydroxylation during collagen synthesis?

Accepted Answer

D. Vitamin C

Answer

A. Vitamin D

Answer

B. Copper

Answer

C. Vitamin E

Question 2

What are the criteria for administering Anti-D immunoglobulin postpartum in an Rh-negative female?

Accepted Answer

DCT negative, Baby Rh +ve

Answer

DCT positive, Baby Rh +ve

Answer

DCT negative, Baby Rh -ve

Answer

DCT positive, Baby Rh -ve

Question 3

A G2 P1 female with 6 weeks amenorrhea presents with bleeding PV, hypotension, and altered sensorium. She has pain in the abdomen and on per vaginal examination cervical movement tenderness is present. On USG, there is free fluid present in the right paracolic gutter. What is the most probable diagnosis?

Accepted Answer

Ruptured ectopic

Answer

Abruptio placenta

Answer

Placenta previa

Answer

Missed abortion

Question 4

An 8-month-old child was found to have features of vitamin A deficiency. What is the dose of oral vitamin A required?

Accepted Answer

1,00,000 IU

Answer

50,000 IU

Answer

75,000 IU

Answer

2,00,000 IU

Question 5

Which of the following statements about the ABCDE approach in pediatric Advanced Life Support (PALS) is incorrect?

Accepted Answer

Dehydration is a component of the ABCDE approach.

Answer

Airway management is essential in PALS.

Answer

Breathing assessment is part of the ABCDE approach.

Answer

Circulation is a critical component of the ABCDE approach.

Question 6

Fluid of choice for shock in a child with severe acute malnutrition + hypoglycemia

Accepted Answer

Ringer lactate + 5% dextrose

Answer

Normal saline

Answer

Ringer lactate

Answer

10% dextrose

Question 7

Rapid cycling is characterized by all of the following except?

Accepted Answer

Occurs commonly in men

Answer

Commonly associated with concomitant hypothyroidism

Answer

Antidepressants increase likelihood

Answer

At least 4 distinct episodes per year

Question 8

Which of the following is the core component of Beck's cognitive theory of depression?

Accepted Answer

C. Dysfunctional belief

Answer

A. Cognitive distortions

Answer

B. Automatic thoughts

Answer

D. Introjection

Question 9

Which of the following statements about CT imaging is the MOST accurate?

Accepted Answer

Water has a Hounsfield unit (HU) of zero.

Answer

CT head dose remains constant regardless of the protocol used.

Answer

CT cannot detect gallstones under any circumstances.

Answer

CT uses unfiltered x-ray beams.

Question 10

Case of trauma in a patient with an unknown blood group. Patient is unstable and requires urgent blood transfusion. Which type of blood should be transfused?

Accepted Answer

O-

Answer

AB+

Answer

O+

Answer

A+

INI-CET 2024

Biochemistry

Obstetrics and Gynecology

Pediatrics

Psychiatry

Radiology

Surgery