INI-CET 2022 Previous Year Questions Practice Questions

Q: Match the following molecules with their carriers in plasma: MOLECULES: 1. Thyroxine 2. Fatty acid 3. Hemoglobin 4. Heme CARRIERS: A. Hemopexin B. Prealbumin C. Albumin D. Haptoglobin

1-B, 2-C, 3-D, 4-A. ***1-B, 2-C, 3-D, 4-A*** - **Thyroxine** is primarily transported by **prealbumin (transthyretin)**, which has high affinity for thyroid hormones and prevents their rapid clearance. - **Fatty acids** bind to **albumin** at multiple binding sites, allowing efficient transport of these hydrophobic molecules in plasma. - **Hemoglobin** released from lysed red blood cells is bound by **haptoglobin** to prevent renal loss and iron wastage. - **Heme** groups are specifically transported by **hemopexin**, which has the highest binding affinity for heme among plasma proteins. *1-B, 2-C, 3-A, 4-D* - Incorrectly pairs **hemoglobin** with hemopexin; hemoglobin binds to **haptoglobin** to form stable complexes. - Incorrectly pairs **heme** with haptoglobin; free heme has highest affinity for **hemopexin**, not haptoglobin. *1-A, 2-B, 3-C, 4-D* - Incorrectly pairs **thyroxine** with hemopexin; thyroxine is primarily carried by **prealbumin** and thyroxine-binding globulin. - Incorrectly pairs **fatty acids** with prealbumin; fatty acids bind predominantly to **albumin** due to its multiple hydrophobic binding sites. *1-A, 2-D, 3-B, 4-C* - Incorrectly pairs **heme** with albumin; while albumin can bind heme weakly, **hemopexin** is the specific high-affinity carrier. - Incorrectly pairs **hemoglobin** with prealbumin; free hemoglobin forms specific complexes with **haptoglobin** for recycling. [Practice more INI-CET 2022 questions on OnCourse]

Q: What does the given ECG show?

P-pulmonale. ***P-pulmonale*** - The ECG shows tall, peaked **P waves** with an amplitude of more than **2.5 mm in lead II**, which is characteristic of P-pulmonale. - P-pulmonale indicates **right atrial enlargement or hypertrophy**, often due to conditions like severe lung disease (e.g., COPD) or pulmonary hypertension. *Improper calibration* - Improper calibration would typically affect the amplitude of all ECG complexes globally or specific leads consistently, which is not the primary finding here. - The calibration mark (first beat in lead I) appears normal, indicating standard calibration (10mm/mV). *Electrical alternans* - **Electrical alternans** is characterized by beat-to-beat variation in the QRS complex amplitude, which is not visible in this ECG. - It is commonly associated with **pericardial effusion with cardiac tamponade**. *Ventricular bigeminy* - **Ventricular bigeminy** is a pattern where every normal sinus beat is followed by a premature ventricular contraction (PVC). - This ECG shows a regular rhythm with consistent P-QRS-T morphology, without alternating normal and PVC beats. [Practice more INI-CET 2022 questions on OnCourse]

Q: A young man sustained a scorpion sting 2 hours ago. On examination, his blood pressure is $108 / 60 \mathrm{~mm} \mathrm{Hg} ; \mathrm{HR}, 72$ beats / minute and respiratory rate, 32 breaths/ minute. He also complains of breathlessness. How do you manage this patient?

Prazosin. ***Prazosin*** - The patient's presentation with scorpion sting complicated by **breathlessness** and a respiratory rate of 32 breaths/minute suggests a **neurotoxic reaction** leading to **pulmonary edema** or **myocardial dysfunction**. - **Prazosin**, an alpha-1 adrenergic blocker, is recommended in such cases to counteract the **sympathomimetic effects** of scorpion venom, particularly reducing pulmonary and systemic vascular resistance, thereby alleviating pulmonary edema and improving cardiac function. *Frusemide* - While frusemide is a diuretic used to treat pulmonary edema, its use in scorpion envenomation is controversial and generally not recommended as a primary treatment. - The underlying cause is sympathetic overactivity, and diuresis alone without addressing the root cause may not be sufficient and could exacerbate hypovolemia in some settings. *Ivabradine* - Ivabradine is a **heart rate-lowering agent** that acts by selectively inhibiting the funny current (If) in the sinoatrial node. - It is primarily used for the treatment of **stable chronic heart failure** with reduced ejection fraction and stable angina, not for acute scorpion envenomation. *Metoprolol* - Metoprolol, a beta-blocker, could potentially worsen bronchoconstriction in patients with underlying respiratory issues and is generally not recommended in the acute management of severe scorpion envenomation, especially if there are signs of respiratory distress or cardiogenic shock. - While scorpion venom can cause tachycardia, directly blocking beta-receptors without addressing alpha-adrenergic overactivity may not be beneficial and could lead to adverse effects. [Practice more INI-CET 2022 questions on OnCourse]

Q: A male patient with hemoptysis. On examination, hilar mass was present. The histopathological image is shown below. Immunohistochemistry revealed that the cells were positive for p40. What is the diagnosis?

Squamous cell carcinoma. ***Squamous cell carcinoma*** - **P40 positivity** is a highly specific marker for squamous cell differentiation, making this diagnosis most likely. - The presence of a **hilar mass** in a male, combined with hemoptysis, is characteristic of squamous cell carcinoma, which often arises centrally [1]. [2] *Large cell carcinoma* - This diagnosis is typically made when there is a **lack of differentiation** into squamous, glandular, or neuroendocrine features. - Large cell carcinoma would not show p40 positivity, as it **lacks overt squamous differentiation**. *Adenocarcinoma lung* - **Adenocarcinoma** is characterized by glandular differentiation and would typically be positive for markers like **TTF-1** and **CK7**, not p40. - While adenocarcinomas can present with hemoptysis, a **hilar mass** is more suggestive of squamous cell carcinoma [1]. *Small cell cancer lung* - **Small cell carcinoma** is a neuroendocrine tumor characterized by small cells with scant cytoplasm and high mitotic activity, and it would be positive for neuroendocrine markers like **chromogranin** and **synaptophysin**. - Small cell carcinoma would **not be positive for p40**, which indicates squamous differentiation. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 336-337. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 723-724. [Practice more INI-CET 2022 questions on OnCourse]

Question 1

Match the following molecules with their carriers in plasma:

MOLECULES:
1. Thyroxine
2. Fatty acid
3. Hemoglobin
4. Heme

CARRIERS:
A. Hemopexin
B. Prealbumin
C. Albumin
D. Haptoglobin

Accepted Answer

1-B, 2-C, 3-D, 4-A

Answer

1-B, 2-C, 3-A, 4-D

Answer

1-A, 2-B, 3-C, 4-D

Answer

1-A, 2-D, 3-B, 4-C

Question 2

What does the given ECG show?

Accepted Answer

P-pulmonale

Answer

Improper calibration

Answer

Electrical alternans

Answer

Ventricular bigeminy

Question 3

A young man sustained a scorpion sting 2 hours ago. On examination, his blood pressure is $108 / 60 \mathrm{~mm} \mathrm{Hg} ; \mathrm{HR}, 72$ beats / minute and respiratory rate, 32 breaths/ minute. He also complains of breathlessness. How do you manage this patient?

Accepted Answer

Prazosin

Answer

Frusemide

Answer

lvabradine

Answer

Metoprolol

Question 4

A male patient with hemoptysis. On examination, hilar mass was present. The histopathological image is shown below. Immunohistochemistry revealed that the cells were positive for p40. What is the diagnosis?

Accepted Answer

Squamous cell carcinoma

Answer

Adenocarcinoma lung

Answer

Small cell carcinoma

Answer

Large cell carcinoma

Question 5

A male patient with hemoptysis. On examination, hilar mass was present. The histopathological image is shown below. Immunohistochemistry revealed that the cells were positive for p40. What is the diagnosis?

Accepted Answer

Squamous cell carcinoma

Answer

Large cell carcinoma

Answer

Adenocarcinoma lung

Answer

Small cell cancer lung

Question 6

Match the following drugs in Column A with their contraindications in Column B.

Accepted Answer

A-4, B-1, C-3, D-2

Answer

A-1, B-3, C-2, D-4

Answer

A-3, B-2, C-4, D-1

Answer

A-2, B-4, C-1, D-3

Question 7

Which among the following is the false statement regarding statins?

Accepted Answer

They can be given with verapamil and other enzyme inhibitors

Answer

These drugs should not be stopped even in severe conditions like injury, surgery etc.

Answer

Although HMG-CoA reductase inhibitors substantially reduce the risk of cardiovascular events, there is mild increase in lipoprotein a (Lpa) levels.

Answer

With the long term use, there is slight increase in the incidence of type 2 diabetes mellitus.

Question 8

Choose the correctly matched pairs regarding the drugs used in schizophrenia:

1. D2 antagonism: Reduces positive symptoms
2. 5HT2A antagonism: Reduces negative symptoms
3. 5HT1A agonism: Weight loss
4. Muscarinic antagonism: Reduces extrapyramidal symptoms

Accepted Answer

1,2

Answer

1,4

Answer

1,2,4

Answer

1,2,3,4

Question 9

Which physiological adaptation does not happen at high altitudes?

Accepted Answer

Respiratory acidosis

Answer

Pulmonary vasoconstriction

Answer

Hypoxia

Answer

Polycythemia

Question 10

The countercurrent mechanism is present in which of the following parts of the body?
A. Eye
B. Testes
C. Kidney
D. Gut
E. Lungs

Accepted Answer

B and C are correct

Answer

A, B, C, D, E are correct

Answer

B, C, D, E are correct

Answer

A, B, C are correct

INI-CET 2022

Biochemistry

Internal Medicine

Pathology

Pharmacology

Physiology