INI-CET 2022 Practice Questions

Q: In all the following places, hand rub can be used according to standard hand hygiene protocol, except...

If the hands are visibly soiled. ***If the hands are visibly soiled*** - **Hand rub (alcohol-based hand rub)** is ineffective at removing gross contamination and organic matter from visibly soiled hands. - In such cases, **hand washing with soap and water** is mandatory to physically remove dirt, debris, and microorganisms. *While moving from a contaminated site to a clean site during patient care* - **Hand rub** is appropriate in this scenario to prevent the transfer of microorganisms from a potentially contaminated body site or object to another, cleaner area of the patient. - This is part of the "5 Moments for Hand Hygiene" to ensure **patient safety** and prevent **cross-contamination**. *During direct patient contact* - **Hand rub** can be used before and after direct patient contact if hands are not visibly soiled, as it provides rapid and effective decontamination. - This practice is crucial for minimizing the transmission of **healthcare-associated infections**. *Before donning gloves* - **Hand rub** should be performed before donning gloves, especially when performing procedures that involve contact with mucous membranes, non-intact skin, or sterile sites. - This ensures that hands are clean underneath the gloves, providing an additional layer of **infection prevention**.

Q: As per the National Tuberculosis Elimination Program (NTEP), HIV TB prevalence of what percentage would deem a district a high priority district?

>10 %. ***>10%*** - As per the **National Tuberculosis Elimination Program (NTEP)** guidelines, a district is categorized as a **high-priority district** for HIV-TB co-infection if the prevalence of HIV among TB patients is **greater than 10%**. - This threshold helps in identifying regions that require enhanced focus and resources for **integrated HIV and TB care** and prevention strategies. - This is the specific cut-off defined by NTEP for prioritizing districts for targeted interventions. *>15%* - While 15% would also indicate a high prevalence, the specific threshold set by NTEP for deeming a district high priority is **>10%**, not >15%. - Districts with prevalence between 10% and 15% would already be classified as high priority at the >10% threshold. *>20%* - A prevalence of >20% would certainly indicate a severe problem, but the **NTEP's definition** for a high-priority district is specifically **>10%**. - Using a higher threshold like 20% would delay interventions in districts that already face significant challenges with HIV-TB co-infection. *>12%* - The NTEP guidelines use a specific cut-off of **>10%** for defining high-priority districts for HIV-TB co-infection. - While 12% exceeds the 10% threshold, it is not the defining threshold mentioned in the official guidelines for this classification.

Q: The most common pattern of involvement in Pott's spine is

Paradiscal. ***Paradiscal*** - In **Pott's spine (tuberculous spondylitis)**, the infection typically starts in the anterior inferior aspect of the vertebral body and spreads to the adjacent disc space, making the **paradiscal** area the most common site of involvement. - This pattern is due to the rich **paradiscal vascular supply**, which facilitates the hematogenous spread of *Mycobacterium tuberculosis* to these regions. *Central* - **Central involvement** refers to the lesion being primarily located within the center of the vertebral body, which is less common in Pott's spine as the bacteria typically target the highly vascularized anterior and inferior margins. - While central lesions can occur, they are not the predominant pattern seen in initial stages of tuberculous spondylitis. *Posterior* - **Posterior involvement** usually refers to involvement of the posterior vertebral elements such as the neural arch, laminae, or spinous processes. - This type of involvement is **rare** in Pott's spine and is generally seen in very advanced or disseminated disease. *Anterior* - While the infection often begins in the anterior part of the vertebral body, the term **anterior** alone is less specific than "paradiscal" and doesn't fully capture the predominant involvement of the adjacent disc space. - The disease's characteristic spread across the disc space to an adjacent vertebra is a key feature of the paradiscal pattern, leading to **kyphosis** and vertebral collapse.

Q: Combination of appearance in CTEV

Equinus, inversion, forefoot adduction, cavus. ***Equinus, inversion, forefoot adduction, cavus*** - The classic presentation of **clubfoot** (CTEV) involves a characteristic combination of deformities: **equinus** (fixed plantarflexion of the ankle), **inversion** (tilting of the heel inward), **forefoot adduction** (inward turning of the front of the foot), and **cavus** (an abnormally high arch). - These four components are essential for the diagnosis and classification of CTEV. *Equinus, eversion, forefoot adduction, cavus* - This option incorrectly lists **eversion** instead of inversion. Eversion involves the outward tilting of the heel and is not a feature of CTEV. - While equinus, forefoot adduction, and cavus are typical, the presence of eversion rules out classic CTEV. *Equinus, inversion, forefoot adduction, planus* - This option incorrectly lists **planus** (pes planus or flatfoot) instead of cavus. Cavus (high arch) is a defining characteristic of CTEV, not a flatfoot. - While equinus, inversion, and forefoot adduction are correct, the presence of planus makes this option incorrect. *Equinus, eversion, forefoot abduction, cavus* - This option incorrectly lists both **eversion** and **forefoot abduction**. Eversion is the outward tilting of the heel, and forefoot abduction is the outward turning of the front of the foot. - Both eversion and forefoot abduction are opposite to the deformities seen in classical CTEV.

Q: A 49 year old female presents with a breast lump. Which of the following findings is in accordance with basal-like breast cancer?

ER-, PR-, HER2-. ***ER-, PR-, HER2-*** - **Basal-like breast cancer** is characterized by its **triple-negative** status, meaning it does not express estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER2) [1]. - This specific immunophenotype is crucial for diagnosis and influences treatment strategies, as these cancers do not respond to therapies targeting these receptors [1]. *ER+, PR-, HER2-* - This profile describes a **hormone-sensitive** cancer (ER positive) but without PR or HER2 expression. - While it responds to endocrine therapies, it is distinct from basal-like cancer due to its ER positivity. *ER-, PR-, HER2+* - This profile indicates a cancer that is **HER2-positive**, meaning it overexpresses HER2, and can be targeted with anti-HER2 therapies like trastuzumab. - This is a separate molecular subtype of breast cancer often referred to as HER2-enriched, which is distinct from basal-like [2]. *ER+, PR+, HER2-* - This is the most common subtype, known as **luminal A** or **luminal B** depending on grade and Ki-67 expression, characterized by sensitivity to endocrine therapy [2]. - This hormone receptor-positive and HER2-negative profile is very different from the triple-negative basal-like breast cancer. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1064-1066. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1060.

Q: Which of these is the most life-threatening injury that can be identified by assessing the breathing component of the patient?

Tension pneumothorax. ***Tension pneumothorax*** - A tension pneumothorax is a **life-threatening condition** identified during the breathing assessment, as it severely impairs ventilation and causes **hemodynamic instability** by compressing major vessels. - Key signs include absent breath sounds on the affected side, **tracheal deviation**, and **hypotension** due to mediastinal shift. *Blunt cardiac injury* - While serious, blunt cardiac injury is typically identified during the **circulation assessment**, with signs like arrhythmias, hypotension, or cardiac tamponade. - Its direct impact on breathing is less immediate compared to a tension pneumothorax. *Cervical spine injury* - A cervical spine injury can affect breathing if it involves the **phrenic nerve** (C3-C5), leading to respiratory paralysis, but this is assessed during the **disability component** or secondary survey for neurological deficits. - It does not directly cause an acute, life-threatening compromise of lung function discernible primarily through a breathing assessment like a tension pneumothorax. *Laryngotracheal injury* - A laryngotracheal injury primarily affects the **airway component** (A in ABCDE), leading to immediate obstruction or stridor. - While critical, it is distinct from problems with the lungs' ability to expand or perform gas exchange, which are assessed under breathing.

Q: A 32-year-old female patient with Graves' disease with eye signs and enlarged thyroid planned for a total thyroidectomy. What can be given in the preoperative period to reduce intraoperative bleeding in the patient?

Potassium iodide. ***Potassium iodide*** - **Potassium iodide** (e.g., Lugol's solution) is given preoperatively to patients with Graves' disease undergoing thyroidectomy because it **decreases the vascularity** of the thyroid gland, thereby reducing intraoperative bleeding. - It also helps to **block the release of thyroid hormones** from the thyroid gland, stabilizing the patient's thyroid function. *Propylthiouracil* - **Propylthiouracil (PTU)** is an **antithyroid drug** that prevents the synthesis of thyroid hormones by inhibiting the organification of iodine and the coupling of iodotyrosines. - Although it helps to achieve a **euthyroid state** before surgery, it does not directly reduce the vascularity of the thyroid gland to decrease intraoperative bleeding. *Betamethasone* - **Betamethasone** is a corticosteroid used for its **anti-inflammatory** and immunosuppressive effects. - It is not typically used preoperatively in Graves' disease to reduce thyroid vascularity or bleeding; its primary role might be in managing severe **ophthalmopathy** or thyroid storm, not surgical bleeding. *Propranolol* - **Propranolol** is a **beta-blocker** used to control the adrenergic symptoms of hyperthyroidism, such as **tachycardia**, palpitations, and tremors. - While it helps to achieve a more stable cardiac state for surgery, it does not directly impact the **vascularity** of the thyroid gland or reduce surgical bleeding.

Q: What is the correct sequence of management in a patient who presents to the casualty with an RTA? 1. Cervical spine stabilization 2. Intubation 3. IV cannulation 4. CECT

1,2,3,4. ***1,2,3,4*** - This sequence follows the **ATLS (Advanced Trauma Life Support)** protocol, prioritizing immediate life threats in order. - **Cervical spine stabilization** is the **first action upon patient contact** to prevent secondary neurological injury in any trauma patient. - **Airway management (intubation)** is then performed **with maintained in-line c-spine stabilization** - these occur nearly simultaneously but c-spine protection is instituted first. - **IV cannulation (circulation)** follows to establish vascular access for resuscitation and medications. - **CECT (imaging)** is performed last, once the patient is stabilized after addressing immediate life threats. - This follows the **ATLS Primary Survey: Airway (with c-spine protection) → Breathing → Circulation → Disability → Exposure**. *2,1,4,3* - This incorrectly places intubation **before** cervical spine stabilization is initiated. - In ATLS, **c-spine protection must be applied immediately upon patient contact** before any airway manipulation. - Delaying IV cannulation until after CECT is inappropriate as circulatory access is critical for early resuscitation. *1,3,2,4* - While this correctly starts with cervical spine stabilization, it incorrectly places **IV cannulation before intubation**. - In the ATLS primary survey, **Airway comes before Circulation** - securing the airway takes priority over establishing IV access. - This sequence could delay critical airway management in a patient with respiratory compromise. *2,1,3,4* - This sequence places **intubation before cervical spine stabilization**, which violates ATLS principles. - **C-spine stabilization must be the first action** upon approaching any trauma patient to prevent secondary spinal cord injury. - While intubation with in-line stabilization is possible, the c-spine protection must be instituted first, not after beginning airway manipulation.

Q: A patient presents with pneumothorax on chest x-ray. Which of the following is NOT a boundary of the triangle of safety for intercostal chest drain (ICD) insertion?

Mid - clavicular line. ***Mid-clavicular line*** - The **mid-clavicular line** is **NOT** a boundary of the triangle of safety; it is a vertical reference line located centrally on the thorax. - The triangle of safety is located in the **mid-axillary region**, not at the mid-clavicular line. - The mid-clavicular line is used for other procedures but is **anterior to the safe zone** for ICD insertion. *Base of axilla* - The **base of the axilla** forms the **superior boundary** of the triangle of safety. - This boundary is typically at the level of the **5th intercostal space** (nipple level in males). - It helps guide ICD insertion away from the **brachial plexus** and axillary vessels. *Lateral border of latissimus dorsi* - The **lateral border of the latissimus dorsi muscle** forms the **posterior boundary** of the triangle of safety. - This landmark ensures the insertion is anterior to major back muscles and avoids injury to the long thoracic nerve. *Lateral edge of pectoralis major* - The **lateral edge of the pectoralis major muscle** forms the **anterior boundary** of the triangle of safety. - This ensures the ICD is inserted lateral to the pectoral muscle, avoiding breast tissue and superficial vessels.

Q: Which of the following cancers are correctly matched with the criteria for the minimum number of lymph nodes required for pathological staging? A. CA stomach -10 B. CA colon -12 C. CA gall bladder -6 D. CA breast -15

B,C. ***B,C (Correct Answer)*** - **Colorectal cancer (B)** requires a minimum of **12 lymph nodes** for adequate pathological staging - **correctly matched** ✅ - **Gallbladder cancer (C)** requires at least **6 lymph nodes** for proper staging - **correctly matched** ✅ - These are the only two correctly matched pairs in the question - Adequate lymph node retrieval is essential to prevent **understaging** and ensure accurate prognostic assessment *A,B,C (Incorrect)* - While B and C are correct, **gastric cancer (A)** requires a minimum of **15 lymph nodes**, not 10 - The inclusion of A makes this combination incorrect *A,B,C,D (Incorrect)* - **Gastric cancer (A)** requires **15 lymph nodes**, not 10 - **incorrectly matched** - **Breast cancer (D)** requires a minimum of **10 lymph nodes**, not 15 - **incorrectly matched** - Only B and C are correctly matched *A,C,D (Incorrect)* - **Gastric cancer (A)** requires **15 lymph nodes**, not 10 - **incorrectly matched** - **Breast cancer (D)** requires **10 lymph nodes**, not 15 - **incorrectly matched** - C is correct, but A and D are both incorrectly matched

Question 1

In all the following places, hand rub can be used according to standard hand hygiene protocol, except...

Accepted Answer

If the hands are visibly soiled

Answer

While moving from a contaminated site to a clean site during patient care

Answer

During direct patient contact

Answer

Before donning gloves

Question 2

As per the National Tuberculosis Elimination Program (NTEP), HIV TB prevalence of what percentage would deem a district a high priority district?

Accepted Answer

>10 %

Answer

>15 %

Answer

>20 %

Answer

>12 %

Question 3

The most common pattern of involvement in Pott's spine is

Accepted Answer

Paradiscal

Answer

Central

Answer

Posterior

Answer

Question 4

Combination of appearance in CTEV

Accepted Answer

Equinus, inversion, forefoot adduction, cavus

Answer

Equinus, eversion, forefoot adduction, cavus

Answer

Equinus, inversion, forefoot adduction, planus

Answer

Equinus, eversion, forefoot abduction, cavus

Question 5

A 49 year old female presents with a breast lump. Which of the following findings is in accordance with basal-like breast cancer?

Accepted Answer

ER-, PR-, HER2-

Answer

ER+, PR-, HER2-

Answer

ER-, PR-, HER2+

Answer

ER+, PR+, HER2-

Question 6

Which of these is the most life-threatening injury that can be identified by assessing the breathing component of the patient?

Accepted Answer

Tension pneumothorax

Answer

Blunt cardiac injury

Answer

Cervical spine injury

Answer

Laryngotracheal injury

Question 7

A 32-year-old female patient with Graves' disease with eye signs and enlarged thyroid planned for a total thyroidectomy. What can be given in the preoperative period to reduce intraoperative bleeding in the patient?

Accepted Answer

Potassium iodide

Answer

Propylthiouracil

Answer

Betamethasone

Answer

Propranolol

Question 8

What is the correct sequence of management in a patient who presents to the casualty with an RTA?

1. Cervical spine stabilization
2. Intubation
3. IV cannulation
4. CECT

Accepted Answer

1,2,3,4

Answer

2,1,4,3

Answer

1,3,2,4

Answer

2,1,3,4

Question 9

A patient presents with pneumothorax on chest x-ray. Which of the following is NOT a boundary of the triangle of safety for intercostal chest drain (ICD) insertion?

Accepted Answer

Mid - clavicular line

Answer

Base of axilla

Answer

Lateral border of latissimus dorsi

Answer

Lateral edge of pectoralis major

Question 10

Which of the following cancers are correctly matched with the criteria for the minimum number of lymph nodes required for pathological staging?
A. CA stomach -10
B. CA colon -12
C. CA gall bladder -6
D. CA breast -15

Accepted Answer

B,C

Answer

A,B,C

Answer

A,B,C,D

Answer

A,C,D

INI-CET 2022

Community Medicine

Orthopaedics

Pathology

Surgery