INI-CET 2021 Practice Questions

Q: Identify the pelvic diaphragm in the picture given below:

1. ***1*** - Label 1 points to the **levator ani muscle**, which is the primary component of the **pelvic diaphragm**. - The pelvic diaphragm consists of the levator ani and coccygeus muscles, forming the floor of the pelvic cavity. *2* - Label 2 points to the **external anal sphincter**, a voluntary muscle that surrounds the anal canal. - This muscle is superficial to the pelvic diaphragm and is responsible for maintaining fecal continence. *3* - Label 3 points to the **internal anal sphincter**, an involuntary smooth muscle layer intrinsic to the anal canal. - It maintains resting anal tone and is deep to the external anal sphincter. *4* - Label 4 points to the **ischiorectal fossa**, a fat-filled space located on either side of the anal canal. - This space contains vessels and nerves, but it is not part of the muscular pelvic diaphragm.

Q: Third part of vertebral artery is related to which of the following ?

Posterior arch of atlas (C1). ***Posterior arch of atlas (C1)*** - The **third part** of the vertebral artery emerges from the **transverse foramen of C1** and courses laterally and posteriorly around the **posterior arch of the atlas**. - This segment then pierces the **posterior atlanto-occipital membrane** and dura to enter the skull. *Transverse foramina of C2-C6 vertebrae* - This describes the typical course of the **second part** of the vertebral artery, which ascends through the transverse foramina of the cervical vertebrae from **C6 to C2**. - The third part's specific relation is to C1, not the lower cervical vertebrae. *Foramen magnum and intracranial course* - This refers to the **fourth part** of the vertebral artery, which enters the skull through the **foramen magnum** and then runs superiorly to join the other vertebral artery to form the basilar artery. - The third part is extra-cranial, occurring before entry into the skull. *Transverse foramen of C6 vertebra* - The **first part** of the vertebral artery courses superiorly from its origin, typically entering the transverse foramen of the **C6 vertebra**. - The third part is located much higher, at the level of the C1 vertebra.

Q: Identify the type of marked chromosome in the given karyotype.

Acrocentric. ***Acrocentric*** - Acrocentric chromosomes have a **centromere positioned very close to the end**, resulting in one very short arm (p arm) and one long arm (q arm). - Chromosome 13, as indicated by the arrow in the karyotype, clearly exhibits this morphology with a distinctly short p arm. *Metacentric* - **Metacentric chromosomes** have the centromere located approximately in the **middle of the chromosome**, resulting in two arms of roughly equal length. - Examples of metacentric chromosomes in a human karyotype include chromosomes 1, 3, 16, 19, and 20. *Telocentric* - **Telocentric chromosomes** have the **centromere at the very end of the chromosome**, meaning there is essentially only one arm. - This type of chromosome structure is not found in normal human karyotypes. *Submetacentric* - **Submetacentric chromosomes** have the centromere off-center, leading to one arm being **moderately shorter** than the other. - Chromosomes 2, 4-12, 17, 18, and X are generally classified as submetacentric in human karyotypes.

Q: Which of the following methods cannot be used to precipitate proteins?

Moving pH away from isoelectric pH. ***Moving pH away from isoelectric pH*** - Proteins are **least soluble** at their **isoelectric point (pI)**, where their net charge is zero, causing them to aggregate and precipitate. - Moving the pH **away from the isoelectric point** increases the net charge on the protein, enhancing its solubility and preventing precipitation. *Add alcohol and acetone* - **Organic solvents** like alcohol and acetone reduce the dielectric constant of water, weakening the **hydrophobic interactions** that maintain protein solubility. - This leads to increased protein-protein interactions and **precipitation** as the protein unfolds or aggregates. *Using heavy metal ions* - **Heavy metal ions** (e.g., lead, mercury) are positively charged and bind strongly to the negatively charged groups on proteins, such as **carboxylates** and **sulfhydryl groups**. - This binding can disrupt protein structure, lead to aggregation, and cause **precipitation**. *Adding trichloroacetic acid* - **Trichloroacetic acid (TCA)** is a strong acid that significantly lowers the pH of the solution, causing proteins to become **protonated**. - This change in charge and the disruption of **salt bridges** and hydrogen bonds lead to protein denaturation and **precipitation**.

Q: Which of the following statements are true? 1. Due to increasing mammography there occurs over diagnosis of breast carcinoma 2. Colon cancer screening is done by digital rectal examination 3. Oral cancer screening is done by visual inspection 4. Cervix cancer screening is done by a pap smear

1,3,4. ***Correct: 1,3,4*** - **Statement 1 is TRUE**: Overdiagnosis is a well-documented consequence of increased mammography screening. It detects slow-growing tumors that might never have caused clinical symptoms or harm during a woman's lifetime, leading to unnecessary treatment and associated morbidities. - **Statement 3 is TRUE**: Oral cancer screening primarily involves thorough visual inspection by a healthcare professional to identify suspicious lesions, ulcers, or color changes in the oral cavity. - **Statement 4 is TRUE**: Cervical cancer screening is effectively done by Pap smear, which detects precancerous and cancerous cells. - **Statement 2 is FALSE**: Digital rectal examination is NOT the primary screening method for colon cancer. Standard screening methods include colonoscopy, fecal occult blood testing (FOBT), and fecal immunochemical test (FIT). *Incorrect: 1,2,3,4* - While statements 1, 3, and 4 are true, statement 2 is incorrect. Digital rectal examination is not a primary or definitive screening method for colon cancer—it only examines the rectum and misses most of the colon. *Incorrect: 4 only* - While cervical cancer screening by Pap smear is true, this option is incomplete as it misses other true statements (1 and 3) regarding mammography overdiagnosis and oral cancer screening. *Incorrect: 2,3,4* - This option incorrectly includes statement 2. Colon cancer screening is NOT done by digital rectal examination. Proper screening methods include colonoscopy, FOBT, FIT, and flexible sigmoidoscopy.

Q: A 45-year-old male patient presented with a history of bilateral lower limb weakness, which progressed to his upper limbs in a year. On examination, he had weakness in both lower limbs and wasting in the left upper limb. Babinski sign was positive and the deep tendon reflexes were hyperactive. He has no sensory loss or any autonomic dysfunction. What is the likely diagnosis?

ALS. ***ALS*** - This patient exhibits a classic combination of **upper motor neuron (UMN)** signs (hyperactive deep tendon reflexes, positive Babinski sign) and **lower motor neuron (LMN)** signs (weakness, wasting), along with progressive limb weakness [1], [2]. These findings are characteristic of **amyotrophic lateral sclerosis (ALS)**, especially with the sparing of sensory and autonomic function [1]. - ALS is fundamentally a **motor neuron disease** that affects both UMNs and LMNs, leading to progressive muscle weakness without significant sensory deficits [1]. *GBS* - **Guillain-Barré Syndrome (GBS)** typically presents with **acute, ascending paralysis** and **areflexia** or hyporeflexia, which contradicts the hyperactive reflexes and progressive, chronic nature observed in the patient. - While GBS causes motor weakness, it is primarily a demyelinating neuropathy affecting the peripheral nervous system and usually spares upper motor neuron signs. *MS* - **Multiple sclerosis (MS)** is characterized by **demyelinating lesions** in the central nervous system, leading to a wide variety of neurological deficits, often with sensory disturbances, visual problems, and bladder dysfunction. - While MS can cause motor weakness and hyperreflexia, it usually presents with a relapsing-remitting course and significant sensory symptoms, which are absent in this patient. *Tropical spastic paraparesis* - **Tropical spastic paraparesis** primarily causes **progressive spasticity and weakness** in the lower limbs, indicative of central nervous system involvement, often linked to **HTLV-1 infection**. - While it features upper motor neuron signs, it typically does not involve the prominent muscle wasting and lower motor neuron signs observed in this patient.

Q: Identify the pathology from the given flow-volume loop:

Fixed central airway obstruction. ***Fixed central airway obstruction*** - This flow-volume loop shows **flattening of both the inspiratory and expiratory limbs**, creating a characteristic "box" or "square" shape. - This pattern indicates that airflow is limited equally during both inspiration and expiration, regardless of lung volume changes, which is characteristic of a **fixed central airway obstruction**. - Examples include **tracheal stenosis, tracheal tumors, or fixed goiters** compressing the trachea. *Variable extrathoracic obstruction* - Characterized by flattening of the **inspiratory limb only**, as negative intrathoracic pressure during inspiration exacerbates the obstruction. - The expiratory limb typically remains normal as positive intrathoracic pressure tends to open the airway. - Examples include **vocal cord paralysis or extrathoracic tracheal tumors**. *Variable intrathoracic obstruction* - Characterized by flattening of the **expiratory limb only**, as positive intrathoracic pressure during forced expiration collapses the airway. - The inspiratory limb usually remains normal as negative pressure helps maintain airway patency. - Examples include **intrathoracic tracheal tumors or tracheomalacia**. *Fixed distal airway obstruction* - Fixed obstructions producing the characteristic "box" pattern are typically **central (proximal) lesions in large airways**, not distal. - Distal airway obstructions (like **COPD or asthma**) produce a different flow-volume loop pattern characterized by **decreased peak expiratory flow** and "scooping" or "concave" appearance of the expiratory limb, not the flat bilateral pattern seen here.

Q: Acid-base imbalance is suspected in a patient. Which of the following parameters would you use for initial determination of acid-base status?

pH, PaCO2, and Bicarbonate. ***pH, PaCO2, and Bicarbonate*** - The **pH** provides immediate assessment of overall acid-base status (acidemia if 7.45) - The **PaCO2** reflects the respiratory component - elevated in respiratory acidosis or compensated metabolic alkalosis; decreased in respiratory alkalosis or compensated metabolic acidosis - The **HCO3- (bicarbonate)** reflects the metabolic component - essential for determining whether the primary disorder is metabolic or respiratory - This triad forms the **standard approach** to arterial blood gas (ABG) interpretation taught in all major medical textbooks - Together, these three parameters allow complete initial classification of acid-base disorders using the Henderson-Hasselbalch relationship *pH and PaCO2* - While pH and PaCO2 are critical measurements, **without bicarbonate**, you cannot differentiate between metabolic and respiratory disorders or assess metabolic compensation - For example, a low pH with normal PaCO2 could indicate metabolic acidosis, but you need HCO3- to confirm this diagnosis - Incomplete for initial acid-base determination *pH, PaCO2, and Base excess* - Base excess is a **calculated parameter** used to quantify the metabolic component of acid-base disturbances - While useful, it is considered a **secondary parameter** for more detailed metabolic analysis rather than essential for initial determination - Standard ABG interpretation uses bicarbonate, not base excess, as the primary metabolic parameter *pH, PaCO2, Bicarbonate, and Base excess* - While this includes all relevant parameters, **base excess is redundant** for initial determination - Base excess adds quantitative information about metabolic component but is not required for the initial classification of acid-base status - The essential triad for initial assessment is pH, PaCO2, and HCO3-

Q: Which of the following is not an off-label use of risperidone?

Bipolar disorder. ***Bipolar disorder*** - **Risperidone** is FDA-approved for the treatment of **bipolar I disorder**, both as monotherapy and adjunctive therapy for acute manic or mixed episodes. - This means its use for bipolar disorder is an **on-label indication**, not an off-label use. *PTSD* - The use of risperidone for **post-traumatic stress disorder (PTSD)** is considered an **off-label use**, as it is not specifically approved by the FDA for this condition. - While atypical antipsychotics may be used in some cases for severe PTSD symptoms, especially those involving psychosis or severe agitation, it is not a primary or approved treatment. *OCD* - The use of risperidone as an adjunct in **obsessive-compulsive disorder (OCD)**, particularly in treatment-resistant cases, is an **off-label use**. - While some studies support its use for augmenting SSRIs in OCD, it is not an FDA-approved indication. *Dementia* - Using risperidone for behavioral symptoms associated with **dementia** (e.g., aggression, agitation) is generally considered an **off-label use**. - Although it may be prescribed for these symptoms, there are significant concerns regarding increased mortality risk in elderly patients with dementia-related psychosis, leading to specific warnings and limited official indications.

Question 1

Identify the pelvic diaphragm in the picture given below:

Accepted Answer

1

Answer

2

Answer

3

Answer

4

Question 2

Third part of vertebral artery is related to which of the following ?

Accepted Answer

Posterior arch of atlas (C1)

Answer

Foramen magnum and intracranial course

Answer

Transverse foramen of C6 vertebra

Answer

Transverse foramina of C2-C6 vertebrae

Question 3

Identify the type of marked chromosome in the given karyotype.

Accepted Answer

Acrocentric

Answer

Metacentric

Answer

Telocentric

Answer

Submetacentric

Question 4

Which of the following methods cannot be used to precipitate proteins?

Accepted Answer

Moving pH away from isoelectric pH

Answer

Add alcohol and acetone

Answer

Using heavy metal ions

Answer

Adding trichloroacetic acid

Question 5

Which of the following statements are true?

1. Due to increasing mammography there occurs over diagnosis of breast carcinoma
2. Colon cancer screening is done by digital rectal examination
3. Oral cancer screening is done by visual inspection
4. Cervix cancer screening is done by a pap smear

Accepted Answer

1,3,4

Answer

1,2,3,4

Answer

4 only

Answer

2,3,4

Question 6

A 45-year-old male patient presented with a history of bilateral lower limb weakness, which progressed to his upper limbs in a year. On examination, he had weakness in both lower limbs and wasting in the left upper limb. Babinski sign was positive and the deep tendon reflexes were hyperactive. He has no sensory loss or any autonomic dysfunction. What is the likely diagnosis?

Accepted Answer

ALS

Answer

GBS

Answer

MS

Answer

Tropical spastic paraparesis

Question 7

What would happen to the half-life and plasma concentration of a drug which follows first-order kinetics, if the dose is doubled?

Accepted Answer

Half - life remains the same and plasma concentration doubles

Answer

Half - life and plasma concentration remains the same

Answer

Half - life doubles and plasma concentration remains the same

Answer

Half - life and plasma concentration doubles

Question 8

Identify the pathology from the given flow-volume loop:

Accepted Answer

Fixed central airway obstruction

Answer

Variable extra thoracic obstruction

Answer

Variable intrathoracic obstruction

Answer

Fixed distal airway obstruction

Question 9

Acid-base imbalance is suspected in a patient. Which of the following parameters would you use for initial determination of acid-base status?

Accepted Answer

pH, PaCO2, and Bicarbonate

Answer

pH, PaCO2, and Base excess

Answer

pH and PaCO2

Answer

pH, PaCO2, Bicarbonate, and Base excess

Question 10

Which of the following is not an off-label use of risperidone?

Accepted Answer

Bipolar disorder

Answer

PTSD

Answer

OCD

Answer

Dementia

INI-CET 2021

Anatomy

Biochemistry

Community Medicine

Internal Medicine

Pharmacology

Physiology

Psychiatry