INI-CET 2015 Previous Year Questions Practice Questions

Q: In a patient, Mitral valve vegetations are seen along the lines of closure along with fusion of commissures. What is the likely diagnosis?

Rheumatic endocarditis. ***Rheumatic endocarditis*** - **Rheumatic fever** is a common cause of **mitral valve disease**, leading to **vegetations along the lines of closure** [2] and characteristic **fusion of commissures** [1]. - This chronic inflammation results in **fibrosis** and **calcification**, causing **mitral stenosis** [3] or regurgitation. *Libman-Sacks endocarditis* - Characterized by **sterile vegetations** typically found on **both sides of the valve leaflets** (atrial and ventricular surfaces) [2], often associated with **Systemic Lupus Erythematosus (SLE)**. - It does not typically cause **commissural fusion** or significant valvular stenosis. *Marantic endocarditis* - Also known as **nonbacterial thrombotic endocarditis (NBTE)**, it involves **sterile vegetations** composed of fibrin and platelets, usually found on the **lines of closure** [2]. - It is associated with **debilitating illnesses** like cancer or sepsis, but **does not cause commissural fusion**. *Bacterial endocarditis* - Involves **large, destructive vegetations** that can be found on any part of the valve [2], often associated with **valve destruction**, **abscess formation**, and **septic emboli**. - While it causes vegetations, it typically **does not lead to commissural fusion** as a primary feature; fusion is more characteristic of chronic rheumatic heart disease. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 566-567. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 568. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 293-294. [Practice more INI-CET 2015 questions on OnCourse]

Q: Agarose gel electrophoresis from DNA of a population of cells as seen under ultraviolet light is shown below. What is the correct explanation for the finding seen in the band labeled as "C"?

Apoptotic cells. ***Apoptotic cells*** - Band C shows a characteristic **DNA ladder pattern** with discrete bands representing fragmentation into nucleosome-sized units (multiples of ~180-200 base pairs), which is pathognomonic of **apoptosis**. [1] - During apoptosis, **endonucleases** cleave DNA at internucleosomal linker regions, creating uniform fragments that migrate as distinct bands on agarose gel electrophoresis. *Predominantly necrotic cells* - **Necrotic cell DNA** undergoes random, non-specific degradation by cellular enzymes, resulting in a continuous **smear pattern** rather than discrete bands. - The **smear appearance** reflects DNA fragments of varying sizes distributed throughout the gel, unlike the organized pattern seen in band C. *Mixed population of normal and apoptotic cells* - A mixed population would show both **intact high molecular weight DNA** (remaining near the gel origin) and the **apoptotic ladder pattern** superimposed. - Band C displays a pure ladder pattern without evidence of intact DNA, indicating a homogeneous apoptotic population. *A population of viable cells* - **Viable cells** maintain intact genomic DNA that remains as a single **high molecular weight band** near the top of the gel. - The **fragmented ladder pattern** in band C is incompatible with viable cell DNA, which should show minimal degradation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 63-64. [Practice more INI-CET 2015 questions on OnCourse]

Q: The following is the FITC for IgG stained kidney specimen. What is this suggestive of?

SLE. ***SLE*** - **Lupus nephritis** (a kidney manifestation of SLE) often shows a "full house" immunofluorescence pattern, including **IgG deposition**, along with IgA, IgM, C3, and C1q [1]. - The presence of **IgG staining** in a kidney biopsy is a common finding in various forms of lupus nephritis, such as diffuse proliferative glomerulonephritis [1,5]. *Buerger's disease* - This is a **vasculitis** primarily affecting small and medium-sized arteries and veins, typically in the limbs. - It does **not primarily involve the kidneys** with IgG deposition and is not diagnosed via kidney biopsy immunofluorescence. *Goodpasture syndrome* - Characterized by **linear deposition of IgG** along the glomerular basement membrane (GBM) on immunofluorescence. - While it involves IgG, the question implies a more general IgG staining, and Goodpasture's has a very specific **linear pattern**, which is distinct from the granular or mesangial patterns often seen in SLE [2]. *Membranous glomerulonephritis* - This condition is characterized by **granular subepithelial deposits of IgG and C3** along the glomerular basement membrane [1]. - While it involves IgG, the question's image (if implied) would likely show a more diffuse, granular pattern, and SLE can also present with IgG, but often with other immune complex components, making SLE a broader and often more complex picture [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 532-533. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 911. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 230-232. [Practice more INI-CET 2015 questions on OnCourse]

Question 1

In the ECG shown below, which drug will not be given?

Accepted Answer

Adenosine

Answer

Verapamil

Answer

Diltiazem

Answer

Flecainide

Answer

Amiodarone

Question 2

In a patient, Mitral valve vegetations are seen along the lines of closure along with fusion of commissures. What is the likely diagnosis?

Accepted Answer

Rheumatic endocarditis

Answer

Libman-Sacks endocarditis

Answer

Marantic endocarditis

Answer

Bacterial endocarditis

Question 3

A 55-year-old male patient presented with a 4 month history of cough and hemoptysis. Bronchoscopy revealed an intrabronchial polyp. Biopsy from the polyp showed small cells with salt and pepper chromatin, with microscopic necrosis and 5 mitotic figures per 10 high power fields as shown below. Chromogranin staining was positive. What is the diagnosis and grade of the lesion?

Accepted Answer

Atypical carcinoid grade 2

Answer

Carcinoid grade 1

Answer

Small cell carcinoma grade IV

Answer

Large cell neuroendocrine carcinoma grade IV

Question 4

Agarose gel electrophoresis from DNA of a population of cells as seen under ultraviolet light is shown below. What is the correct explanation for the finding seen in the band labeled as "C"?

Accepted Answer

Apoptotic cells

Answer

Predominantly necrotic cells

Answer

Mixed population of normal and apoptotic cells

Answer

A population of viable cells

Question 5

The following is the FITC for IgG stained kidney specimen. What is this suggestive of?

Accepted Answer

SLE

Answer

Post-streptococcal glomerulonephritis

Answer

Goodpasture syndrome

Answer

Membranous glomerulonephritis

Answer

IgA nephropathy

Question 6

The following microscopic appearance is that of a schwannoma which most commonly involves the cerebellopontine angle. What does the area marked with the arrow represent?

Accepted Answer

Antony B pattern

Answer

Antony A pattern

Answer

Antony C pattern-Verocay cells

Answer

Antony D pattern-Verocay cells

Answer

Verocay bodies

Question 7

Methacholine acts primarily at which receptor?

Accepted Answer

M3

Answer

M1

Answer

M2

Answer

M4

Question 8

Identify the ECG given in the figure below.

Accepted Answer

Normal sinus rhythm

Answer

Paroxysmal supraventricular tachycardia

Answer

Atrial fibrillation

Answer

Ventricular fibrillation

Question 9

A patient presents with neck pain and rigidity which gets relieved after bathing in hot water and exercise. Cervical X-ray is shown below. What is your diagnosis?

Accepted Answer

Spondylitis

Answer

Spondylolisthesis

Answer

Spondylosis

Answer

Spondyloptosis

Question 10

In the condition shown below, rib notching is present in which of the following ribs? (AIIMS Nov 2015)

Accepted Answer

3rd to 9th ribs

Answer

1st to 9th ribs

Answer

11th and 12th ribs

Answer

All ribs

INI-CET 2015

Internal Medicine

Pathology

Pharmacology

Radiology