Pathology
1 questionsWhich of the following is not an aneuploidy?
INI-CET 2025 - Pathology INI-CET Practice Questions and MCQs
Question 71: Which of the following is not an aneuploidy?
- A. Trisomy 13
- B. Bloom Syndrome (Correct Answer)
- C. Trisomy 21
- D. Klinefelter Syndrome
Explanation: ***Bloom Syndrome*** - **Bloom syndrome** is a **rare autosomal recessive disorder** caused by a mutation in the *BLM* gene, leading to excessive sister chromatid exchange and chromosomal breakage (a form of **chromosomal instability syndrome**). - It is a **syndrome of gene mutation** and **chromosomal instability**, not an abnormal number of chromosomes (aneuploidy). ***Trisomy 21*** - This refers to having three copies of chromosome 21 (47, XX or XY, +21), which is the definition of a common **aneuploidy** known as **Down Syndrome** [1]. - Aneuploidy is the condition of having an abnormal number of chromosomes in a haploid set [3]. ***Trisomy 13*** - This involves having three copies of chromosome 13 (47, XX or XY, +13), which is a lethal **aneuploidy** known as **Patau Syndrome** [2]. - It results from meiotic non-disjunction, leading to severe developmental defects [1]. ***Klinefelter Syndrome*** - The genotype is typically 47, XXY, meaning there is an extra X chromosome [2]. - This is a form of sex chromosome **aneuploidy**, characterized by small testes, infertility, and gynecomastia [4]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 170-171. [2] 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. 92-93. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 168-169. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 191-192.
Pediatrics
7 questionsWhich of the following is/are incorrect regarding breastfeeding technique? 1. Infant's chin should be touching the breast 2. Infant's lower lip should be inverted during latching to the breast 3. A greater part of areola above the breast should be covered than below 4. Infant's cheeks should appear full during effective sucking.
Which of the following is not true regarding Marasmus in a child?
A 9-month-old child is brought to OPD with developmental concerns. The child cannot sit without support, says "dada" and "mama", and has stranger anxiety. What is the appropriate management?
A neonate delivered at 36-week gestation develops respiratory distress soon after birth. CXR is as shown. Likely diagnosis?
A young boy presented with petechiae and his platelet count was 10,000/cu mm. Bone marrow aspirate revealed normal cellularity with megakaryocyte hyperplasia. Most appropriate initial therapy?
Which of the following is not true in Turner Syndrome?
Which of the following vaccines is contraindicated in a patient of Severe Combined Immunodeficiency (SCID)?
INI-CET 2025 - Pediatrics INI-CET Practice Questions and MCQs
Question 71: Which of the following is/are incorrect regarding breastfeeding technique? 1. Infant's chin should be touching the breast 2. Infant's lower lip should be inverted during latching to the breast 3. A greater part of areola above the breast should be covered than below 4. Infant's cheeks should appear full during effective sucking.
- A. 1 & 4
- B. 2 & 3 (Correct Answer)
- C. 2, 3 & 4
- D. 1, 2, 3 & 4
Explanation: **Correct Answer: 2 & 3** Statements 2 and 3 describe **incorrect breastfeeding techniques**: ***Statement 2 (Incorrect)*** - The infant's lower lip should be **everted (rolled outward)**, not inverted - Proper latching requires lips to be wide open, resembling a 'fish mouth' - An inverted lower lip indicates **poor latch** and inadequate breast tissue in the mouth ***Statement 3 (Incorrect)*** - A **greater part of the areola below** the nipple should be covered, not above - This ensures the nipple points toward the roof of the mouth - Asymmetric latch with more lower areola covered is essential for effective milk transfer *Statement 1 (Correct)* - Infant's chin touching the breast is a sign of **proper positioning** - Helps achieve a deep latch and facilitates swallowing - Slightly extends the neck for optimal sucking mechanics *Statement 4 (Correct)* - **Full cheeks** during sucking indicate effective milk transfer - Shows proper seal of lips around the breast - Dimpled or hollow cheeks suggest **ineffective suction** or poor latch *Why other options are incorrect:* - **1 & 4**: Both are correct breastfeeding techniques - **2, 3 & 4**: Incorrectly includes statement 4, which describes proper technique - **1, 2, 3 & 4**: Incorrectly includes statements 1 and 4, which are both correct
Question 72: Which of the following is not true regarding Marasmus in a child?
- A. Protein loss is responsible for edema in this patient (Correct Answer)
- B. Weight-for-age is less than 60 % of expected
- C. Seen due to carbohydrate (caloric) deficiency
- D. Child appears emaciated with loss of subcutaneous fat
Explanation: ***Protein loss is responsible for edema in this patient*** - This statement is **false** because **marasmus** is primarily a **caloric-energy** deficiency, leading to severe wasting and **no edema**. - Edema is the characteristic feature of **Kwashiorkor**, which is primarily due to protein deficiency/loss, leading to decreased oncotic pressure. *Seen due to carbohydrate (caloric) deficiency* - Marasmus results from a severe deficiency of **calories** (energy), often due to inadequate intake of **carbohydrates** and fats. - This leads to the body breaking down its own stores, including muscle and fat, for energy. *Child appears emaciated with loss of subcutaneous fat* - The child with marasmus appears severely wasted, or **emaciated** (looks like 'an old man/woman' or 'skin and bones'). - There is visible loss of **subcutaneous fat** (pinching a fold of skin feels loose, without the layer of fat underneath). *Weight-for-age is less than 60% of expected* - Marasmus is a severe form of Protein Energy Malnutrition (PEM), traditionally documented when the **weight-for-age** is less than **60%** of the expected weight (compared to the standard reference). - The **Gomez classification** uses <60% weight-for-age to define **grade III** (severe) malnutrition, which corresponds to marasmus.
Question 73: A 9-month-old child is brought to OPD with developmental concerns. The child cannot sit without support, says "dada" and "mama", and has stranger anxiety. What is the appropriate management?
- A. Reassure the parents that it's normal development
- B. Order an immediate MRI
- C. Refer to neurologist for developmental assessment (Correct Answer)
- D. Advise parents to start exercises
Explanation: ***Refer to neurologist for developmental assessment*** - The milestone of **sitting without support** is generally expected by **8-9 months**. Failure to achieve this at 9 months, especially when it should have been emerging, is a **red flag for motor delay**. - Although language (saying 'dada'/'mama' non-specifically) and social milestones (stranger anxiety) are adequate, the gross motor delay warrants a **specialized developmental assessment** to rule out conditions like hypotonia, cerebral palsy, or neuromuscular disorders. - Early identification and intervention are crucial for optimal developmental outcomes. *Incorrect: Order an immediate MRI* - **Neuroimaging (like MRI)** is an expensive and invasive diagnostic step, usually reserved for cases where an underlying structural brain abnormality is strongly suspected *after* a thorough clinical and developmental assessment. - Initial management for suspected developmental delay involves detailed assessment by a specialist (pediatrician/neurologist) and screening tests, not immediate imaging. *Incorrect: Reassure the parents that it's normal development* - This reassurance is inappropriate because the child is demonstrating a **lag in gross motor milestones** (cannot sit without support at 9 months). - Some children may sit slightly later, but given this is at the upper limit of normal, further assessment is warranted rather than simple reassurance. - Failure to address a developmental delay early can lead to missed opportunities for timely **early intervention services**. *Incorrect: Advise parents to start exercises* - While physical therapy (exercises) will likely be part of the recommended intervention, simply advising exercises without a formal **developmental diagnosis** or proper assessment by a **physiotherapist/specialist** is insufficient and potentially incomplete management. - The priority is to **identify the cause** of the delay (e.g., hypotonia, cerebral palsy, muscular dystrophy) through specialist evaluation before initiating targeted therapy.
Question 74: A neonate delivered at 36-week gestation develops respiratory distress soon after birth. CXR is as shown. Likely diagnosis?
- A. Meconium Aspiration Syndrome
- B. Respiratory Distress Syndrome (Correct Answer)
- C. Transient Tachypnea of Newborn
- D. Neonatal Pneumonia
Explanation: ***Respiratory Distress Syndrome*** - The chest X-ray shows classic features of RDS, including a diffuse **reticulogranular pattern** (ground-glass appearance) and prominent **air bronchograms**, indicative of widespread alveolar atelectasis. - This condition is primarily caused by **surfactant deficiency** in preterm infants (like this 36-week neonate), leading to increased surface tension, alveolar collapse, and respiratory distress shortly after birth. ***Transient Tachypnea of Newborn*** - This is caused by delayed clearance of **fetal lung fluid** and is more common in term infants delivered by Caesarean section. - The chest X-ray typically shows **perihilar streaking**, fluid in the interlobar fissures, and hyperinflation, which are not the primary findings in the provided image. ***Neonatal Pneumonia*** - While it can present with respiratory distress, neonatal pneumonia typically shows **asymmetrical patchy infiltrates**, consolidation, or pleural effusions on chest X-ray. - The diffuse, symmetrical ground-glass appearance seen here is less characteristic of an infectious process like pneumonia, which is often more localized. ***Meconium Aspiration Syndrome*** - This condition occurs in term or post-term infants following aspiration of **meconium-stained amniotic fluid**, which is not mentioned in the history. - The characteristic X-ray findings are coarse, patchy opacities, **hyperinflation**, and potential air-leak syndromes (e.g., pneumothorax), which differ from the image.
Question 75: A young boy presented with petechiae and his platelet count was 10,000/cu mm. Bone marrow aspirate revealed normal cellularity with megakaryocyte hyperplasia. Most appropriate initial therapy?
- A. Bone Marrow Transplant
- B. Methotrexate
- C. Aspirin
- D. IVIG (Correct Answer)
Explanation: ***IVIG*** - The presentation (young patient, **petechiae**, extremely low platelet count of 10,000/cu mm, and **megakaryocyte hyperplasia** in bone marrow) is classic for **Immune Thrombocytopenia (ITP)**. - Given the severe thrombocytopenia (platelets <20,000/cu mm) and active bleeding risk (petechiae), the initial treatment of choice is typically **IVIG (Intravenous Immunoglobulin)** or corticosteroids to rapidly increase the platelet count. *Aspirin* - **Aspirin** is an antiplatelet agent that **inhibits platelet aggregation**; it is strictly contraindicated in severe thrombocytopenia like ITP as it would increase the risk of hemorrhage. - It is used for pain relief or secondary prevention of cardiovascular events, not for treating low platelet counts. *Bone Marrow Transplant* - **Bone marrow transplant** is a radical and highly risky procedure reserved for refractory, life-threatening hematological malignancies or severe aplastic anemia, or failed therapy for ITP. - It is never the appropriate **initial therapy** for acute ITP, which is predominantly an autoimmune disorder of peripheral platelet destruction. *Methotrexate* - **Methotrexate** is an immunosuppressive drug used typically in chronic inflammatory conditions (like rheumatoid arthritis) or malignancies. - It is considered a second or third-line treatment option, or part of a more aggressive immunosuppression regimen, for ITP that has failed initial therapy (steroids/IVIG), not the immediate first choice.
Question 76: Which of the following is not true in Turner Syndrome?
- A. Short 4th metacarpals
- B. Webbed neck
- C. Widely spaced hypoplastic nipples
- D. Prominent occiput (Correct Answer)
Explanation: ***Prominent occiput*** - This physical feature is **NOT** associated with Turner Syndrome and is therefore the correct answer. - A prominent occiput is a classic distinguishing feature of **Trisomy 18 (Edwards Syndrome)**, not Turner syndrome. - Turner syndrome patients typically have normal occiput configuration, helping differentiate it from other chromosomal aneuploidies. *Incorrect - Short 4th metacarpals* - This is actually a **classic feature** of Turner Syndrome, known as the **metacarpal sign**. - Short 4th and 5th metacarpals are well-documented skeletal abnormalities in Turner syndrome. - On X-ray, extending a line along the 4th and 5th metacarpal heads normally passes distal to the 3rd metacarpal head, but in Turner syndrome it passes through or proximal to it. *Incorrect - Webbed neck* - This is a highly characteristic feature of Turner Syndrome, clinically known as **pterygium colli**. - Results from regression of fetal cystic hygromas (lymphatic malformations). - Strongly associated with the **45,X karyotype** and is a significant phenotypic marker. *Incorrect - Widely spaced hypoplastic nipples* - This describes the **shield chest** appearance, a key physical characteristic of Turner syndrome. - Part of the constellation of congenital developmental anomalies including broad chest with increased internipple distance. - Directly linked to the underlying chromosomal abnormality and developmental changes.
Question 77: Which of the following vaccines is contraindicated in a patient of Severe Combined Immunodeficiency (SCID)?
- A. IPV
- B. DPT
- C. Hepatitis B
- D. MMR (Correct Answer)
Explanation: ***MMR*** - **MMR (Measles, Mumps, Rubella)** is a **live attenuated vaccine**. Live vaccines are absolutely contraindicated in individuals with **Severe Combined Immunodeficiency (SCID)** due to the inability to mount an effective immune response, leading to uncontrolled replication of the vaccinal organism and potentially fatal infection. - SCID causes profound defects in both **T-cell and B-cell immunity**, making the patient susceptible to infections from live vaccines. ***DPT*** - **DPT (Diphtheria, Pertussis, Tetanus)** is an **inactivated (killed) vaccine**; it is safe and typically recommended for SCID patients as it cannot cause the disease. - Only **live vaccines** are contraindicated in SCID, whereas **inactivated or recombinant vaccines** are generally safe. ***Hepatitis B*** - **Hepatitis B vaccine** is a **recombinant vaccine** (inactivated component) and is not contraindicated in patients with SCID. - While the immune response may be suboptimal, the vaccine itself poses no risk of causing the disease. ***IPV*** - **IPV (Inactivated Poliovirus Vaccine)** is a **killed vaccine**. It is safe for SCID patients and must be used instead of the **OPV (Oral Poliovirus Vaccine)**, which is a live vaccine. - Killed vaccines contain non-replicating antigens and thus cannot cause disease, even in highly immunocompromised individuals.
Surgery
2 questionsWhich of the following statements regarding Vacuum-Assisted Closure (VAC) therapy is correct? 1. It promotes granulation tissue formation 2. It reduces interstitial and periwound edema 3. It drains excessive exudate 4. It increases local blood flow
What is a true statement about Z plasty?
INI-CET 2025 - Surgery INI-CET Practice Questions and MCQs
Question 71: Which of the following statements regarding Vacuum-Assisted Closure (VAC) therapy is correct? 1. It promotes granulation tissue formation 2. It reduces interstitial and periwound edema 3. It drains excessive exudate 4. It increases local blood flow
- A. All correct (Correct Answer)
- B. 1 and 3 correct
- C. 2 and 4 correct
- D. 1, 2, 3 correct
Explanation: ***All correct*** - Vacuum-Assisted Closure (VAC) therapy, or Negative Pressure Wound Therapy (**NPWT**), provides several mechanical and biological benefits that collectively promote complex wound healing and preparing the wound bed for definitive closure. - The therapeutic effects of NPWT include promoting **granulation tissue formation**, reducing **interstitial and periwound edema**, draining excessive **exudate** (which lowers bacterial load), and significantly increasing **local blood flow** (perfusion) in the wound bed. ***1 and 3 correct*** - This option is incomplete because the reduction of **edema** (statement 2) and the increase in **local blood flow** (statement 4) are well-established, crucial mechanisms of NPWT. - Excluding statements 2 and 4 falsely limits the physiological effects of VAC, which relies on managing tissue pressure and perfusion for optimal results. ***2 and 4 correct*** - This option is incomplete because the primary visible clinical goals of NPWT, namely the promotion of **granulation tissue** (statement 1) and the active removal of **exudate/infectious material** (statement 3), are ignored. - NPWT's ability to stimulate cellular activity for **granulation** is one of its most critical roles in preparing the wound for closure. ***1, 2, 3 correct*** - While statements 1, 2, and 3 are correct, this option excludes the crucial benefit of statement 4: increasing **local blood flow**. - Increased blood flow ensures adequate delivery of **oxygen and nutrients** to support cellular repair and proliferation, which is fundamental to successful vacuum-assisted wound healing.
Question 72: What is a true statement about Z plasty?
- A. To increase length (Correct Answer)
- B. It is a type of split-thickness skin graft
- C. Zigzag suturing
- D. Flap turning
Explanation: ***To increase length*** - The primary purpose of **Z-plasty** is to lengthen a contracted scar or structure, typically achieving a 50% to 75% increase in length. - It also helps to change the direction of a scar, making it align better with **Langer's lines** (lines of tension), thus improving cosmetic outcomes. - The **central limb** of the Z increases in length when the two triangular flaps are transposed. *It is a type of split-thickness skin graft* - Z-plasty is **not a graft** but rather a **local tissue rearrangement technique** using transposition flaps. - A **split-thickness skin graft (STSG)** is a separate reconstructive technique used to cover large wounds or burns and is harvested superficially. - Z-plasty utilizes adjacent tissue without the need for harvesting skin from another site. *Zigzag suturing* - This term is sometimes inaccurately used to describe the final appearance of a Z-plasty closure, but the fundamental goal of Z-plasty is **length increase and scar reorientation**, not creating a zigzag pattern. - A **W-plasty**, which creates a pattern of small triangles in a zigzag fashion, is used primarily to break up long linear scars and prevent scar contracture, not for significant lengthening. *Flap turning* - Although Z-plasty involves transposing two triangular flaps, the purpose is not merely flap turning but specifically **increasing length and changing the direction** of the tissue. - The flaps are designed at specific angles (usually 30°, 45°, or 60°) to optimize the redistribution of tissue and relieve **tissue tension**.