INI-CET 2021 Practice Questions

Q: Fibers from the marked structure terminate at which of the following?

Red nucleus. ***Red nucleus*** - The arrow points to the **superior cerebellar peduncle**, which contains efferent fibers from the **dentate nucleus** of the cerebellum. - A major projection of the superior cerebellar peduncle is to the **contralateral red nucleus**, forming part of the **dentato-rubro-thalamic pathway**. *Subthalamus* - The subthalamus is part of the **diencephalon** and is involved in motor control as part of the **basal ganglia circuit**. - It does not receive direct efferent projections from the cerebellum via the superior cerebellar peduncle. *Inferior olivary nucleus* - The inferior olivary nucleus is a major source of **climbing fibers** to the cerebellum, providing **afferent input** for motor learning and coordination. - It does not receive direct efferent output from the cerebellum's deep nuclei via the superior cerebellar peduncle. *Fastigial nucleus* - The fastigial nucleus is one of the **deep cerebellar nuclei**, located medially. - Its primary efferent projections are via the **inferior cerebellar peduncle** to the vestibular nuclei and reticular formation, not typically receiving fibers from the superior cerebellar peduncle.

Q: A 12-year-old presented with fever and difficulty swallowing. He had swelling in the marked region and was advised to undergo tonsillectomy. Post-surgery the gauze continued to soak with blood. Which of the following vessels must have been injured?

Paratonsillar vein. ***Paratonsillar vein*** - The **paratonsillar vein**, also known as the **external palatine vein**, is the major vein draining the palatine tonsil and usually the primary source of **post-tonsillectomy hemorrhage**. - Its superficial location and tendency to be large and thin-walled make it particularly vulnerable to injury during **tonsillectomy**, leading to persistent bleeding. *Ascending pharyngeal artery* - The ascending pharyngeal artery contributes to the blood supply of the tonsil, but it is a **deep-seated artery** that is less frequently injured during tonsillectomy compared to the paratonsillar vein. - While its injury could lead to significant bleeding, it's not the most common vascular source of hemorrhage in this context. *Tonsillar branch of facial artery* - The **tonsillar branch of the facial artery** is a significant arterial supply to the tonsil. However, arterial bleeding is typically more pulsatile and rapid, whereas persistent soaking of gauze suggests venous bleeding. - While injury to this artery can occur, the **paratonsillar vein** is a more common source of persistent oozing hemorrhage post-tonsillectomy. *Retromandibular vein* - The **retromandibular vein** is located posterior to the mandible and is not directly associated with the tonsillar bed. - Injury to this vein during a **tonsillectomy** is highly unlikely due to its anatomical position.

Q: A patient presented with meningitis, and the CSF sample was subjected to gram staining and microscopy and appears as shown in the microscopic image given below. Which of the following features / tests will be characteristic of the organism?

Catalase negative, optochin sensitive.. ***Catalase negative, optochin sensitive*** - The image shows **Gram-positive diplococci** (lancet-shaped, occurring in pairs), indicative of *Streptococcus pneumoniae*. - *S. pneumoniae* is known for being **catalase-negative** and **optochin-sensitive**, which are key diagnostic features that distinguish it from other α-hemolytic streptococci. - Additional characteristic: *S. pneumoniae* **ferments inulin** (bile soluble, quellung positive). *Ferments glucose and maltose but not inulin* - The phrase "does not ferment inulin" would suggest a streptococcus species OTHER than *S. pneumoniae*. - *S. pneumoniae* characteristically **DOES ferment inulin**, which is an important diagnostic feature. - This option is incorrect because it describes sugar fermentation that contradicts *S. pneumoniae* characteristics. *Oxidase and catalase negative, does not ferment inulin* - While *S. pneumoniae* is catalase-negative and oxidase-negative (oxidase test not routinely used for Gram-positive cocci), the statement "does not ferment inulin" is **incorrect** for *S. pneumoniae*. - *S. pneumoniae* **ferments inulin**, which is a key differentiating feature from other streptococci. - This combination of features does not match the organism shown in the microscopy. *Oxidase and catalase positive and does not ferment maltose or glucose* - This biochemical profile is typical for non-fermenting Gram-negative bacteria like *Pseudomonas aeruginosa*. - Such organisms would appear as **Gram-negative rods**, not the **Gram-positive diplococci** seen in the image. - This option is clearly incorrect based on the Gram stain morphology alone.

Q: A 32 year old laborer working at a construction site presented with fever and hemoptysis. The sputum sample collected for examination showed the following. The smear will be stained by which of the following sequences?

Carbol fuchsin - acid - alcohol- methylene blue. ***Carbol fuchsin - acid - alcohol- methylene blue*** - The image displays thin, red, rod-shaped bacteria against a blue background, characteristic of **acid-fast bacilli** stained using the **Ziehl-Neelsen (ZN) method**. This staining sequence identifies *Mycobacterium tuberculosis*. - The ZN stain involves **carbol fuchsin** as the primary stain, followed by **acid-alcohol** as a decolorizer, and then **methylene blue** as a counterstain. *Methylene blue- malachite green-acetic acid - water* - This sequence is not a standard microbiological staining procedure for identifying common pathogens or acid-fast bacteria. - It does not contain the necessary components to achieve **acid-fast staining**, which is crucial for identifying mycobacteria. *Gentian violet - iodine - alcohol saffranin* - This sequence describes the reagents used in a **Gram stain**, which differentiates bacteria based on their cell wall composition. - Gram staining would show either purple (Gram-positive) or pink (Gram-negative) bacteria, not the red acid-fast bacilli seen in the image. *Methanol - methylene blue-acid - water* - While methylene blue is a counterstain in ZN, this sequence is incomplete and incorrect for standard acid-fast staining or other common bacterial stains. - It lacks **carbol fuchsin** as the primary stain, which is essential for acid-fast bacteria to retain the stain after destaining.

Q: Identify the organism from the life cycle shown in the image given below

Cryptosporidium. ***Cryptosporidium*** - This life cycle demonstrates **oocysts** being shed in feces and sporulating in the environment, which is characteristic of *Cryptosporidium*. - The infection of **intestinal cells** and the development of **trophozoites**, **schizonts**, and **gametes** within the same host also align with the *Cryptosporidium* life cycle. - *Cryptosporidium* oocysts are **immediately infective** upon shedding and contain **four sporozoites** without sporocysts. *Cystoisospora* - While *Cystoisospora* also produces **oocysts**, their oocysts contain **two sporocysts**, each with four sporozoites, whereas *Cryptosporidium* oocysts are immediately infective and contain **four sporozoites** upon shedding. - *Cystoisospora* typically involves a **monoxenous** life cycle (one host), but the distinct oocyst structure differentiates it from *Cryptosporidium*. *Plasmodium knowlesi* - *Plasmodium knowlesi* is a parasite responsible for **malaria** and its life cycle involves an **insect vector** (mosquito) and a **vertebrate host** (human or monkey). - The diagram shows a fecal-oral transmission route with **oocysts** and tissue cysts, which is not consistent with the **blood-borne transmission** and liver/blood stage development of *Plasmodium*. *Toxoplasma gondii* - *Toxoplasma gondii* has a complex life cycle with **definitive host** (cats) and **intermediate hosts** (humans, animals), producing **oocysts** in cat feces. - However, *Toxoplasma* oocysts contain **two sporocysts** with **four sporozoites each**, and the parasite forms **tissue cysts** in intermediate hosts, which differs from the *Cryptosporidium* life cycle shown with direct intestinal infection and immediate oocyst infectivity.

Q: A mother notices a swelling in the abdomen of her 3-year-old child while bathing him. He had a history of hematuria two weeks back, which resolved spontaneously. On examination, a right-sided reniform ballotable mass was found. What is the most appropriate initial investigative approach?

Ultrasound, CT scan with contrast, and CBC. ***Ultrasound, CT scan with contrast, and CBC*** - This combination allows for comprehensive **assessment of the kidney mass**, its extent, and helps differentiate it from other abdominal masses, while a CBC checks for paraneoplastic anemia or polycythemia. - **Ultrasound** is typically the initial imaging modality due to its non-invasiveness and ability to characterize the mass as solid or cystic, followed by a **CT scan with contrast** for detailed anatomical information and staging. *Ultrasound, CT scan with contrast, CBC, and Bone marrow biopsy* - While ultrasound, CT scan with contrast, and CBC are appropriate, a **bone marrow biopsy** is usually reserved for suspected metastasis or specific types of tumors like neuroblastoma, not as an initial step for a primary renal mass presentation in a 3-year-old child. - The initial focus is on characterizing the renal mass and systemic workup, and bone marrow biopsy would be considered later if there's evidence or high suspicion of metastatic disease to the bone marrow. *Ultrasound and CT scan with contrast* - While these imaging studies are crucial for diagnosing and staging the renal mass, neglecting a **complete blood count (CBC)** would be an oversight. - A CBC can reveal important information such as anemia (common with renal tumors), thrombocytosis, or other hematological abnormalities that might influence treatment decisions or indicate prognosis. *CT scan with contrast and Bone marrow biopsy* - Relying solely on a **CT scan with contrast** as the initial imaging can be less efficient than starting with ultrasound, especially in children, and lacks the preliminary information provided by a CBC. - A **bone marrow biopsy** is not typically part of the initial workup for a suspected Wilms' tumor unless there is specific concern for bone marrow involvement or to rule out a neuroblastoma.

Q: An HIV positive woman on ART was prescribed ergotamine for a migraine attack 4 days back. She presented with complaints that she is unable to feel her legs from the mid - thigh to her toes, for the past two days. The angiography image is given below. What is the likely diagnosis?

Ergotism. ***Ergotism*** - The patient's inability to feel her legs from mid-thigh to toes, following ergotamine use, combined with the angiography showing **vasoconstriction** and absent distal flow, strongly suggests ergotism. - **Ergotamine** is a potent vasoconstrictor and its adverse effects are exacerbated by drug interactions with certain antiretroviral therapies (ART) used in HIV treatment, leading to severe **ischemia**. *Atherosclerosis* - While atherosclerosis can cause peripheral arterial disease, it usually presents with more gradual onset of symptoms and **claudication** rather than acute, severe sensory loss as described. - The angiography in atherosclerosis typically shows **localized plaques** and stenoses, which are not the primary finding here of widespread peripheral vasoconstriction. *Polyradicular Neuropathy* - Polyradicular neuropathy involves nerve damage causing sensory and motor deficits but does not directly cause the **vascular changes** seen on angiography. - The clinical presentation of sudden, severe sensory loss in the context of recent ergotamine use and the angiographic findings point away from a primary neurological disorder as the sole cause. *Vasculitis* - While vasculitis can occur in HIV patients and cause limb ischemia, the **temporal relationship** with ergotamine use (symptoms starting 2 days after medication) strongly suggests a drug-related cause. - Vasculitis typically presents with more systemic features and would not have such an acute onset directly following ergotamine administration.

Q: A woman with right-sided loss of sensations of both the upper and lower limb complains of shooting pain from her fingers to the right shoulder and a burning sensation when touching cold water. Motor functions are normal. Which of the following structures is likely to be involved?

Lateral spinothalamic tract. ***Lateral spinothalamic tract*** - The symptoms described, such as **loss of sensations**, **shooting pain** (neuropathic pain), and **burning sensation** with cold water (dysesthesia/allodynia), are characteristic of damage to the **spinothalamic tract**, which carries **pain and temperature** sensations. - Involvement of the **right-sided upper and lower limb** indicates a lesion affecting sensory pathways on the ipsilateral side of the body before decussation, or more commonly a contralateral lesion above the level of decussation for the specific tract. Given the symptoms affecting pain and temperature, the lateral spinothalamic tract is the primary candidate. *Anterior spinothalamic tract* - This tract primarily transmits **crude touch** and **pressure** sensations. - While loss of sensation is present, the prominent **shooting pain** and **burning sensation with cold water** are not typically associated with isolated anterior spinothalamic tract lesions. *Spinocerebellar tract* - This tract is responsible for transmitting **proprioceptive information** to the cerebellum for motor coordination. - Damage to the spinocerebellar tracts would manifest as **ataxia** and **incoordination**, not pain or loss of touch/temperature sensation, and motor functions are stated as normal in the patient. *Posterior column* - The posterior column (dorsal column-medial lemniscus pathway) transmits **fine touch**, **vibration**, and **proprioception**. - While a loss of sensation is present, the specific complaints of **shooting pain** and **burning sensation to cold water** are not characteristic of posterior column damage, which would typically present with deficits in discriminative touch, vibratory sense, and position sense.

Q: A patient admitted after a road traffic accident is put on mechanical ventilation. He opens his eyes on verbal command and moves all four limbs spontaneously. Calculate his GCS.

Eyes-3, Verbal -NT, Motor-6. ***Eyes-3, Verbal -NT, Motor-6*** - **Eyes opening to verbal command** scores 3 points on the GCS [1]. - The patient is on **mechanical ventilation**, meaning their verbal response cannot be assessed, leading to a "Non-Testable" (NT) score for verbal [1]. **Spontaneous movement of all four limbs** indicates full motor function, scoring 6 points [2]. *Eyes -3, Verbal-1, Motor -6* - While **eyes opening to verbal command** (3 points) and **spontaneous motor movement** (6 points) are correct, a verbal score of 1 implies **no verbal response** if the patient were able to speak, which is not applicable here due to mechanical ventilation. *Eyes-2, Verbal -1, Motor -5* - **Eyes opening to pain** scores 2, but the patient responded to verbal command. A verbal score of 1 is for no response, and a motor score of 5 indicates localizing to pain, not spontaneous movement. *Eyes-2, Verbal -NT, Motor -5* - **Eyes opening to pain** scores 2, but the patient responded to verbal command (3 points). While **Verbal-NT** is correct due to mechanical ventilation, a motor score of 5 (localizes to pain) is incorrect, as the patient moved limbs spontaneously (6 points).

Question 1

Fibers from the marked structure terminate at which of the following?

Accepted Answer

Red nucleus

Answer

Subthalamus

Answer

Inferior olivary nucleus

Answer

Fastigial nucleus

Question 2

A 12-year-old presented with fever and difficulty swallowing. He had swelling in the marked region and was advised to undergo tonsillectomy. Post-surgery the gauze continued to soak with blood. Which of the following vessels must have been injured?

Accepted Answer

Paratonsillar vein

Answer

Ascending pharyngeal artery

Answer

Tonsillar branch of facial artery

Answer

Retromandibular vein

Question 3

A patient presented with meningitis, and the CSF sample shows Gram-negative diplococci on Gram staining and microscopy. Which of the following features/tests will be characteristic of the organism?

Accepted Answer

Oxidase positive, catalase positive, ferments glucose and maltose

Answer

Catalase negative, optochin sensitive, alpha-hemolytic

Answer

Oxidase negative, catalase positive, coagulase positive

Answer

Catalase positive, urease positive, does not ferment glucose

Question 4

A patient presented with meningitis, and the CSF sample was subjected to gram staining and microscopy and appears as shown in the microscopic image given below. Which of the following features / tests will be characteristic of the organism?

Accepted Answer

Catalase negative, optochin sensitive.

Answer

Ferments glucose and maltose but not inulin

Answer

Oxidase and catalase negative, does not ferment inulin

Answer

Oxidase and catalase positive and does not ferment maltose or glucose

Question 5

A 32 year old laborer working at a construction site presented with fever and hemoptysis. The sputum sample collected for examination showed the following. The smear will be stained by which of the following sequences?

Accepted Answer

Carbol fuchsin - acid - alcohol- methylene blue

Answer

Methylene blue- malachite green-acetic acid - water

Answer

Gentian violet - iodine - alcohol saffranin

Answer

Methanol - methylene blue-acid - water

Question 6

Identify the organism from the life cycle shown in the image given below

Accepted Answer

Cryptosporidium

Answer

Cystoisospora

Answer

Plasmodium knowlesi

Answer

Toxoplasma gondii

Question 7

A mother notices a swelling in the abdomen of her 3-year-old child while bathing him. He had a history of hematuria two weeks back, which resolved spontaneously. On examination, a right-sided reniform ballotable mass was found. What is the most appropriate initial investigative approach?

Accepted Answer

Ultrasound, CT scan with contrast, and CBC

Answer

Ultrasound, CT scan with contrast, CBC, and Bone marrow biopsy

Answer

Ultrasound and CT scan with contrast

Answer

CT scan with contrast and Bone marrow biopsy

Question 8

An HIV positive woman on ART was prescribed ergotamine for a migraine attack 4 days back. She presented with complaints that she is unable to feel her legs from the mid - thigh to her toes, for the past two days. The angiography image is given below. What is the likely diagnosis?

Accepted Answer

Ergotism

Answer

Polyradicular neuropathy

Answer

Atherosclerosis

Answer

Vasculitis

Question 9

A woman with right-sided loss of sensations of both the upper and lower limb complains of shooting pain from her fingers to the right shoulder and a burning sensation when touching cold water. Motor functions are normal. Which of the following structures is likely to be involved?

Accepted Answer

Lateral spinothalamic tract

Answer

Anterior spinothalamic tract

Answer

Spinocerebellar tract

Answer

Posterior column

Question 10

A patient admitted after a road traffic accident is put on mechanical ventilation. He opens his eyes on verbal command and moves all four limbs spontaneously. Calculate his GCS.

Accepted Answer

Eyes-3, Verbal -NT, Motor-6

Answer

Eyes -3, Verbal-1, Motor -6

Answer

Eyes-2, Verbal -1, Motor -5

Answer

Eyes-2, Verbal -NT, Motor -5

INI-CET 2021

Anatomy

ENT

Microbiology

Pediatrics

Pharmacology

Physiology

Surgery