INI-CET 2017 Practice Questions

Q: Which of the following bones is the first one to ossify?

C. ***C*** - The **capitate bone** is the first carpal bone to ossify, typically appearing around **1-3 months** of postnatal life. - As the largest carpal bone, its early ossification serves as an important radiological marker for assessing **skeletal maturity** in pediatric patients. *A* - The **scaphoid bone** ossifies much later, around **5-6 years** of age, making it one of the last carpal bones to develop. - Due to its **retrograde blood supply**, the scaphoid is particularly susceptible to **avascular necrosis** following fractures. *B* - The **trapezoid bone** typically begins ossification between **4-6 years** of age, significantly later than the capitate. - Located between the **trapezium and capitate**, it forms part of the distal carpal row and contributes to **index finger stability**. *D* - The **lunate bone** usually starts ossifying around **2-4 years** of age, making it the second carpal bone to ossify after the capitate. - The lunate is clinically significant as it's commonly affected by **Kienböck's disease** (avascular necrosis) and **perilunate dislocations**.

Q: A patient presents with ulcer on the side of the nose, as shown, which bleeds on itching. What is the diagnosis? (AIIMS Nov 2017)

Basal cell carcinoma. ***Basal cell carcinoma*** - The image shows a **pearly appearance** with a **central ulceration** and **rolled borders**, which are classic clinical features of **nodular basal cell carcinoma**. - **Bleeding upon minor trauma or itching** (friability) is also a common characteristic of basal cell carcinoma, especially the ulcerated form. *Squamous cell carcinoma* - Squamous cell carcinoma typically presents as a **crusted, firm, red nodule** or a **patch with scales and ulceration**, often in sun-exposed areas. - While it can ulcerate and bleed, it usually lacks the distinct **pearly appearance and rolled borders** seen in basal cell carcinoma. *Marjolin ulcer* - A Marjolin ulcer is a **malignant degeneration of a chronic ulcer**, burn scar, or chronic inflammatory lesion, most commonly an aggressive squamous cell carcinoma. - It would present in the context of a **pre-existing long-standing lesion** or scar, which is not indicated here, and generally has a more irregular, indurated appearance. *Nevus* - A nevus (mole) is a benign growth of pigment-producing cells which typically presents as a **well-demarcated pigmented lesion**. - While some nevi can be raised or irregular, they generally do **not ulcerate spontaneously or bleed easily** on scratching unless traumatized, nor do they typically have the pearly, rolled borders of a basal cell carcinoma.

Q: An intra-operative photograph of cortical mastoidectomy is shown. Identify the lateral semi-circular canal. (AIIMS Nov 2017)

D. ***Correct Option D*** - The diagram shows a simplified view of the temporal bone anatomy post-mastoidectomy, and 'D' clearly points to the position of the **lateral semicircular canal**. - During cortical mastoidectomy, the **lateral semicircular canal** is typically identified in the superior and posterior wall of the mastoid cavity, just above the aditus and facial nerve. - This is a critical landmark during mastoid surgery as injury to it can cause vertigo and hearing loss. *Incorrect Options A, B, and C* - These labels point to other anatomical structures visible in the mastoid cavity during cortical mastoidectomy, such as the tegmen tympani, facial nerve, sigmoid sinus, or other osseous landmarks. - Proper identification of the lateral semicircular canal is essential to avoid iatrogenic injury during surgery.

Q: Which of the following is the diagnosis of the audiogram shown below?

Noise induced hearing loss. ***Noise induced hearing loss*** - The audiogram shows a classic **'noise notch'**, characterized by a dip in hearing at **3000-6000 Hz**, with recovery at 8000 Hz, reflecting damage to hair cells in the cochlea from excessive noise exposure. - Both air conduction (solid line) and bone conduction (dashed line) thresholds are depressed in the same pattern, indicating a **sensorineural hearing loss**. *Otosclerosis* - Otosclerosis typically causes a **conductive hearing loss**, meaning air conduction thresholds would be significantly worse than bone conduction thresholds, showing an **air-bone gap**. - It often results in a characteristic **Carhart notch** (a dip at 2000 Hz) in bone conduction, but this audiogram shows sensorineural loss without a significant air-bone gap. *Ototoxicity* - Ototoxicity usually results in a **high-frequency sensorineural hearing loss**, often affecting frequencies above 4000 Hz first, and typically shows a more gradual, sloping loss rather than a sharp notch. - While it is sensorineural, the specific 'notch' pattern seen here is more characteristic of noise exposure. *Meniere's disease* - Meniere's disease classically presents with a **low-frequency sensorineural hearing loss** that can fluctuate, accompanied by **tinnitus, vertigo, and aural fullness**. - The audiogram does not show a low-frequency loss, nor does it typically present with a noise notch.

Q: The following image shows:

Respiratory papillomatosis. ***Respiratory papillomatosis*** - The image displays multiple **wart-like growths** on the vocal cords, characteristic of **respiratory papillomatosis**, which is caused by the **human papillomavirus (HPV)**. - These lesions often have an **irregular, cauliflower-like appearance** and can recur even after removal, making it a challenging condition to manage. *Vocal nodule* - Vocal nodules are typically **bilateral, symmetrical lesions** located at the junction of the anterior and middle thirds of the vocal cords. - They are usually **smooth, small, and whitish**, resulting from chronic vocal abuse, unlike the irregular and multiple growths seen in the image. *Vocal polyp* - Vocal polyps are typically **unilateral lesions** that can appear as sessile or pedunculated masses on a vocal cord. - They are often **larger than nodules** and may have a reddish or gelatinous appearance, but they usually occur singly, not as multiple diffuse growths like those pictured. *TB of vocal cords* - Tuberculosis of the vocal cords often presents with **ulcerative lesions**, granulomas, or diffuse inflammation, and may be accompanied by other signs of pulmonary TB. - The lesions caused by TB are generally **not papillomatous** or wart-like in nature, differentiating them from the appearance in the image.

Q: Identify the line shown in the given image:

Donaldson line. ***Donaldson line*** - The image illustrates the posterior aspect of the petrous temporal bone, showing the relationship between the **facial nerve**, **posterior semicircular canal**, and the **endolymphatic sac**. - The dashed line directly passes superomedial to the **endolymphatic sac** and inferolateral to the **posterior semicircular canal**, which is characteristic of Donaldson's line, used as a surgical landmark. *Ohngren's line* - Ohngren's line is a radiological landmark used in the context of **maxillary sinus tumors**. - It runs from the **medial canthus of the eye** to the **angle of the mandible**, dividing the maxillary sinus. *Weber Ferguson line* - The Weber-Ferguson incision is a **facial incision** used for access to the **maxillary sinuses and midface**. - It is a surgical approach, not an anatomical line delineating internal structures. *Frankfurt line* - The Frankfurt horizontal plane, or Frankfurt line, is an **anthropometric landmark** used in craniometry and orthodontics. - It is defined by the superior border of the **external auditory meatus** and the inferior orbital rim.

Q: What type of fracture is shown in X-ray of left shoulder?

Ideberg classification grade 4. ***Ideberg classification grade 4*** - The X-ray shows a **scapular fracture**, specifically involving the glenoid. Ideberg classification is used for **glenoid fractures**. - An Ideberg grade 4 fracture involves a **transverse fracture below the scapular notch**, separating the load-bearing part of the glenoid from the rest of the scapula, which appears consistent with the image. *Neer classification grade 4* - The **Neer classification** system is used for **proximal humerus fractures**, not scapular fractures. - A grade 4 Neer fracture involves **four part displacement** of the humeral head, greater tuberosity, lesser tuberosity, and humeral shaft. *Garden classification grade 3* - The **Garden classification** system is specifically used for **femoral neck fractures**, which are fractures of the hip. - A Garden grade 3 fracture represents a **complete, displaced fracture of the femoral neck**, distinct from the shoulder injury shown. *Schatzker classification grade 5* - The **Schatzker classification** system is used for **tibial plateau fractures**, which are fractures of the knee joint. - A Schatzker grade 5 fracture involves a **bicondylar fracture** of the tibial plateau, which is severe and impacts the knee, not the shoulder.

Q: A 4-year-old boy fell on outstretched hand. X- Ray is shown below. Which blood vessel is most commonly affected?

Radial artery. ***Radial artery*** - The X-ray image shows a **supracondylar fracture of the humerus**, which is a common injury in children who fall on an outstretched hand. - While the **brachial artery** runs anterior to the humeral condyles and is the most commonly injured *major* vessel in supracondylar fractures, the **radial artery** is distal to this area and can be affected by subsequent complications like compartment syndrome or direct trauma from displaced fragments, and is a frequently assessed pulse in these injuries to monitor peripheral perfusion. *Ulnar artery* - The ulnar artery is less commonly affected in supracondylar humeral fractures compared to the brachial or radial arteries. - Its anatomical course protects it somewhat from direct trauma in typical fracture displacement patterns. *Brachial artery* - The **brachial artery** is indeed the most commonly injured *major* vessel in supracondylar fractures due to its close proximity to the distal humerus and its anterior course. - However, the question asks for the most commonly affected blood vessel *following* such an injury, and while direct injury to the brachial artery is a concern, assessment of the **radial artery** pulse is critical for evaluating distal perfusion and identifying potential complications like **compartment syndrome**, which affects blood flow through distal arteries like the radial artery. *Cubital vein* - Veins, including the cubital veins, are generally more pliable and less prone to severe injury or occlusion by bone fragments compared to arteries. - While venous compromise can occur, it is less common and less clinically significant in immediate assessment of these fractures compared to arterial injury.

Q: An elderly patient slipped in the bathroom and sustained injury over the hip joint. X- Ray is shown below. Her attitude of leg will be?

Shortened, abducted and externally rotated. ***Shortened, abducted and externally rotated*** - The X-ray image reveals an **intertrochanteric fracture** of the right hip, characterized by a fracture line between the greater and lesser trochanters. - Due to the pull of strong muscles acting on the fractured fragments (e.g., iliopsoas, gluteal muscles), the limb typically assumes a position of **shortening, abduction, and external rotation**. *Shortened and abducted* - While **shortening** and **abduction** are present in intertrochanteric fractures, this answer is incomplete as it misses the crucial component of **external rotation**. - The powerful **external rotators** and the **gravity** acting on the unstable distal fragment contribute significantly to the external rotation. *Lengthened and internally rotated* - This attitude is characteristic of a **posterior hip dislocation**, where the femoral head is driven posteriorly and superiorly, typically leading to limb lengthening and internal rotation. - This is opposite to the typical presentation of an intertrochanteric fracture as seen in the X-ray. *Flexed and adducted and internally rotated* - A flexed, adducted, and internally rotated position is also seen in **posterior hip dislocations**, which is not consistent with the X-ray findings of an intertrochanteric hip fracture. - Hip fractures usually result in some degree of **external rotation** due to the muscle forces.

Q: In a patient of head injury, the following sign is noted on his handkerchief. Which is the next test to confirm the diagnosis? (AIIMS Nov 2017)

Beta trace protein. ***Beta trace protein*** - The image shows a "double ring" or "halo" sign, where blood spreads in a central area and is surrounded by a clear ring of fluid, indicating the presence of **cerebrospinal fluid (CSF) mixed with blood**. - **Beta trace protein (BTP)**, also known as protoprostaglandin D synthase, is a specific and sensitive marker for the detection of CSF leakage, differentiating it from other body fluids. *Beta 2 micro-globulin* - **Beta 2 micro-globulin** is a protein found on the surface of most nucleated cells and is elevated in various conditions like renal failure, inflammatory diseases, and lymphomas. - While it can be present in CSF, it is not a specific marker for CSF leakage and can be influenced by other factors. *Beta amyloid* - **Beta amyloid** is a protein primarily associated with Alzheimer's disease, forming plaques in the brain. - Its detection is used in the diagnosis and research of neurodegenerative disorders, not acute CSF leaks after head injury. *Beta glucuronidase* - **Beta glucuronidase** is a lysosomal enzyme found in various tissues and bodily fluids. - It is associated with conditions like bacterial vaginosis or urinary tract infections, and it is not a recognized marker for CSF leakage.

Question 1

Which of the following bones is the first one to ossify?

Accepted Answer

C

Answer

A

Answer

B

Answer

D

Question 2

A patient presents with ulcer on the side of the nose, as shown, which bleeds on itching. What is the diagnosis? (AIIMS Nov 2017)

Accepted Answer

Basal cell carcinoma

Answer

Squamous cell carcinoma

Answer

Marjolin ulcer

Answer

Nevus

Question 3

An intra-operative photograph of cortical mastoidectomy is shown. Identify the lateral semi-circular canal. (AIIMS Nov 2017)

Accepted Answer

D

Answer

A

Answer

B

Answer

C

Question 4

Which of the following is the diagnosis of the audiogram shown below?

Accepted Answer

Noise induced hearing loss

Answer

Otosclerosis

Answer

Ototoxicity

Answer

Meniere's disease

Question 5

The following image shows:

Accepted Answer

Respiratory papillomatosis

Answer

Vocal nodule

Answer

Vocal polyp

Answer

TB of vocal cords

Question 6

Identify the line shown in the given image:

Accepted Answer

Donaldson line

Answer

Ohngren's line

Answer

Weber Ferguson line

Answer

Frankfurt line

Question 7

What type of fracture is shown in X-ray of left shoulder?

Accepted Answer

Ideberg classification grade 4

Answer

Neer classification grade 4

Answer

Garden classification grade 3

Answer

Schatzker classification grade 5

Question 8

A 4-year-old boy fell on outstretched hand. X- Ray is shown below. Which blood vessel is most commonly affected?

Accepted Answer

Radial artery

Answer

Ulnar artery

Answer

Brachial artery

Answer

Cubital vein

Question 9

An elderly patient slipped in the bathroom and sustained injury over the hip joint. X- Ray is shown below. Her attitude of leg will be?

Accepted Answer

Shortened, abducted and externally rotated

Answer

Shortened and abducted

Answer

Lengthened and internally rotated

Answer

Flexed and adducted and internally rotated

Question 10

In a patient of head injury, the following sign is noted on his handkerchief. Which is the next test to confirm the diagnosis? (AIIMS Nov 2017)

Accepted Answer

Beta trace protein

Answer

Beta 2 micro-globulin

Answer

Beta amyloid

Answer

Beta glucuronidase

INI-CET 2017

Anatomy

Dermatology

ENT

Orthopaedics

Surgery