INI-CET 2023 Practice Questions

Q: Identify the lines shown in the following image:

Langer's lines. ***Langer's lines*** - The image displays lines that represent the **natural orientation of collagen fibers** within the human skin, which are known as Langer's lines (also called cleavage lines). - Making surgical incisions **parallel to these lines** can result in better wound healing and less scarring. - Named after **Karl Langer**, an Austrian anatomist who described these lines in 1861. *Hinderer's lines* - While **Hinderer** described relaxed skin tension lines (RSTLs) used in plastic surgery, these are **different from Langer's lines**. - The image shows Langer's lines specifically, which are based on **collagen fiber orientation**, not relaxed skin tension. *Dermatomes* - **Dermatomes** are areas of skin mainly supplied by a single **spinal nerve root**. - They represent **neurologic segments** and do not correspond to the collagen fiber orientation shown in the image. *Blaschko's lines* - **Blaschko's lines** are invisible lines of skin cell migration that become visible in certain **genetic or acquired dermatological conditions**. - They represent a **mosaic pattern** due to different cell populations and are distinctly different from the structural collagen lines shown.

Q: A South Indian male farmer presents to the ENT OPD with complaints of reddish mass coming out from the nose as shown in the image below and the histopathology examination is also given below. What is the likely diagnosis?

Rhinosporidiosis. **Rhinosporidiosis** - The image shows a **reddish, friable mass** in the nose, and the histopathology reveals **large sporangia** containing endospores, which are characteristic findings of *Rhinosporidium seeberi*, the causative agent of rhinosporidiosis. - The patient's demographic (South Indian male farmer) is also consistent, as rhinosporidiosis is **endemic in India and Sri Lanka** and is often associated with exposure to **stagnant water**. *Nasal polyp* - Nasal polyps are typically **pale, yellowish-grey, glistening, and translucent** masses, contrasting with the reddish appearance in the image. - Histologically, they show **edematous stroma** with inflammatory cells but lack the distinct sporangia seen in the provided image. *Inverted papilloma* - Inverted papillomas are characterized by **endophytic growth** of squamous or transitional epithelium into the underlying stroma. - Although they can be reddish, their histopathology shows **inverted papillary projections**, not fragmented sporangia. *Antrochoanal polyp* - An antrochoanal polyp typically originates from the **maxillary sinus** and extends into the choana and nasopharynx, which may not be overtly visible as a mass presenting anteriorly in the nostril without further examination. - Like other nasal polyps, its histological appearance would be **edematous inflammatory tissue** without the parasitic structures seen here.

Q: A man presents with alcoholic smell and congested conjunctiva but normal motor functions (walking normally). What is the most appropriate assessment of his condition?

Alcohol intoxication. ***Alcohol intoxication*** - The presence of **congested conjunctiva** is an **objective sign of alcohol intoxication** from forensic medicine perspective, indicating physiological effects of alcohol on the body. - **Intoxication exists on a spectrum** - motor impairment is not required for diagnosis; early signs like conjunctival congestion and alcoholic odor are sufficient evidence of intoxication. *Severe alcohol poisoning* - This represents **life-threatening alcohol toxicity** with signs like **stupor**, **respiratory depression**, **hypothermia**, and **severe motor impairment**. - The patient's **normal motor functions** and ability to walk clearly rule out severe poisoning, which would present with profound neurological depression. *No evidence of alcohol consumption* - **Alcoholic smell** and **congested conjunctiva** are direct physical evidence contradicting this assessment. - Ignoring these **objective forensic signs** would constitute inappropriate clinical evaluation of alcohol-related conditions. *Alcohol consumption without intoxication* - This would mean alcohol intake with **zero physiological signs** - no conjunctival congestion, no behavioral changes, no physical manifestations. - The presence of **congested conjunctiva** indicates alcohol has already begun affecting the individual's physiology, moving beyond mere "consumption" into the **intoxication spectrum** as defined in forensic medicine texts.

Q: Least chance of perinatal transmission?

Hepatitis A. ***Hepatitis A*** - Perinatal transmission of **hepatitis A virus (HAV)** is rare because it's primarily transmitted via the **fecal-oral route**. - While HAV can be present in blood during the viremic phase, the risk of maternal-fetal transmission is negligible due to the short duration of viremia and antibodies usually present in immune mothers. *HSV* - **Herpes simplex virus (HSV)** has a significant risk of perinatal transmission, especially during **vaginal delivery** if the mother has active genital lesions. - Neonatal herpes can lead to severe disseminated disease, central nervous system involvement, or skin, eye, and mouth disease. *Rubella* - **Rubella virus** can cause congenital rubella syndrome (CRS) if the mother is infected during pregnancy, leading to severe birth defects. - This highly teratogenic virus readily crosses the **placenta**, particularly in the first trimester. *CMV* - **Cytomegalovirus (CMV)** is the most common cause of congenital viral infection, with often asymptomatic mothers transmitting the virus to the fetus. - Perinatal transmission can occur *in utero*, during **delivery**, or through **breastfeeding**.

Q: A 10 week old child comes for vaccination, with previous history of inconsolable cry & fever after getting vaccinated at 6 weeks. What should be done next?

Give DT. ***Correct Option: Give DT*** - **Inconsolable crying** (typically defined as crying ≥3 hours) following pertussis-containing vaccine is classified as a **precaution** for subsequent doses per IAP, CDC, and WHO guidelines - When a **precaution** exists, the pertussis component should be **withheld** from future doses - **DT vaccine** (diphtheria-tetanus without pertussis) ensures continued protection against diphtheria and tetanus while avoiding repeat exposure to the pertussis antigen that likely caused the reaction - This represents appropriate **risk-benefit assessment** in immunization practice *Incorrect: Give DPT vaccination* - Continuing DPT after inconsolable crying ignores established AEFI (Adverse Events Following Immunization) guidelines - While fever alone is not a contraindication, **inconsolable crying is a recognized precaution** that warrants modification of the vaccination schedule - Repeating the same vaccine risks recurrence of the adverse event *Incorrect: Defer for 1 month* - Simply deferring without changing the vaccine type doesn't address the underlying issue - The child would still receive the pertussis component later, risking another adverse reaction - Unnecessary delay in protection against diphtheria and tetanus when DT is available *Incorrect: Administer antibiotics* - **Post-vaccination fever and crying** are inflammatory responses to vaccine antigens, not bacterial infections - Antibiotics have no role in managing vaccine-related reactions - This approach doesn't address the need for continued immunization protection

Q: The bitter taste of toxic substances prevents us from their consumption, which of the following elicits the bitterness?

Alkaloids. ***Alkaloids*** - **Alkaloids** are a large group of naturally occurring chemical compounds that are mostly produced by plants, often having marked physiological actions on humans and other animals. - Many alkaloids, such as **quinine** and **strychnine**, have a characteristic **bitter taste**, which serves as a natural defense mechanism for plants against herbivores. *Aldehyde* - **Aldehydes** are organic compounds characterized by a carbonyl group to which a hydrogen atom and an R-group are attached. - While some aldehydes may have strong or pungent odors, they do not typically elicit a **bitter taste** in the same way alkaloids do; some might be sweet or fruity. *Hydrogen ions* - **Hydrogen ions (H+)** are responsible for **acidity** and are detected as a **sour taste**. - The sensation of sourness is directly related to the concentration of hydrogen ions in a substance, not bitterness. *Amino acids* - **Amino acids** are the building blocks of proteins and can elicit various tastes depending on their specific structure. - Some amino acids are **sweet** (e.g., alanine, glycine), some are **umami** (e.g., glutamate), and some are **bitter** only in certain contexts or at high concentrations, but they are not the primary group defining a broad bitter taste like alkaloids.

Q: Windkessel effect is not shown by which of the following vessel?

Radial. ***Radial*** - The **radial artery** is a muscular artery, and these vessels primarily regulate blood flow and pressure through vasoconstriction and vasodilation, rather than storing elastic energy. - While all arteries have some elasticity, the **Windkessel effect** is most prominent in large elastic arteries, which are structurally different from muscular arteries like the radial artery. *Renal* - The **renal artery** is a highly compliant, distensible artery that assists in dampening pulsatile flow and ensuring continuous, stable perfusion to the kidneys. - As a major artery off the aorta, it contributes to the **Windkessel effect** by accommodating changes in pressure during the cardiac cycle. *Aorta* - The **aorta** is the primary vessel demonstrating the **Windkessel effect** due to its high elasticity and large diameter. - During systole, it stretches and stores a significant volume of blood, releasing it during diastole to maintain a continuous flow. *Abdominal* - The **abdominal aorta** is a large elastic artery that, like the thoracic aorta, is crucial for expressing the **Windkessel effect**. - Its elastic recoil during diastole helps to sustain blood flow to the lower body and abdominal organs.

Q: Cystic fibrosis leads to defect in which of the following channels?

Cl-. ***Cl-*** - Cystic fibrosis is caused by a mutation in the **CFTR gene**, which encodes for the **Cystic Fibrosis Transmembrane Conductance Regulator protein**. - This protein functions primarily as a **chloride channel**, and its dysfunction leads to impaired chloride transport across epithelial cell membranes. *K+* - While potassium channels are crucial for many physiological processes, their primary dysfunction is **not directly linked to the pathogenesis of cystic fibrosis**. - Defects in potassium channels are associated with conditions like **long QT syndrome** or certain forms of epilepsy. *Ca2+* - **Calcium channels play a role in various cellular signaling pathways**, but their direct defect is not the underlying cause of cystic fibrosis. - Conditions like **Lambert-Eaton myasthenic syndrome** involve antibodies affecting presynaptic calcium channels. *Na+* - **Sodium channels are involved in maintaining membrane potential and fluid balance**, and while they interact with CFTR, their primary defect is not the cause of cystic fibrosis. - Dysregulation of sodium transport can occur secondary to CFTR dysfunction, leading to **dehydrated mucus**, but the initial defect is in chloride.

Q: Banana sign is seen in which of the following conditions?

Spina bifida. ***Spina bifida*** - The **"banana sign"** is a distinctive ultrasound finding associated with **Chiari II malformation**, which is frequently seen in cases of **spina bifida**. - It refers to the characteristic **flattening and anterior bowing of the cerebellar hemispheres**, compressing them against the skull and giving them a banana-like appearance. *NCC* - **Neurocysticercosis (NCC)** is caused by tapeworm larvae in the central nervous system and is characterized by **cysts** or calcifications on imaging, not a "banana sign." - Imaging findings in NCC typically include **cystic lesions**, **edema**, and calcifications, unrelated to cerebellar shape. *Omphalocele* - **Omphalocele** is an abdominal wall defect where abdominal organs protrude through the navel, covered by a membrane. - The ultrasound findings for omphalocele involve visualization of abdominal contents outside the abdominal cavity, which is distinct from intracranial findings like the "banana sign." *Anencephaly* - **Anencephaly** is a severe birth defect where a baby is born without parts of the brain and skull, typically presenting with an **absent cranial vault** and cerebral hemispheres. - While a severe neural tube defect, anencephaly features agenesis of the brain and skull, rather than the cerebellar distortion seen as a "banana sign."

Question 1

Identify the lines shown in the following image:

Accepted Answer

Langer's lines

Answer

Hinderer's lines

Answer

Dermatomes

Answer

Blaschko's lines

Question 2

A South Indian male farmer presents to the ENT OPD with complaints of reddish mass coming out from the nose as shown in the image below and the histopathology examination is also given below. What is the likely diagnosis?

Accepted Answer

Rhinosporidiosis

Answer

Nasal polyp

Answer

Inverted papilloma

Answer

Antrochoanal polyp

Question 3

A man presents with alcoholic smell and congested conjunctiva but normal motor functions (walking normally). What is the most appropriate assessment of his condition?

Accepted Answer

Alcohol intoxication

Answer

Severe alcohol poisoning

Answer

No evidence of alcohol consumption

Answer

Alcohol consumption without intoxication

Question 4

Least chance of perinatal transmission?

Accepted Answer

Hepatitis A

Answer

HSV

Answer

Rubella

Answer

CMV

Question 5

A 10 week old child comes for vaccination, with previous history of inconsolable cry & fever after getting vaccinated at 6 weeks. What should be done next?

Accepted Answer

Give DT

Answer

Defer for 1 month

Answer

Administer antibiotics

Answer

Give DPT vaccination

Question 6

The bitter taste of toxic substances prevents us from their consumption, which of the following elicits the bitterness?

Accepted Answer

Alkaloids

Answer

Aldehyde

Answer

Hydrogen ions

Answer

Amino acids

Question 7

Windkessel effect is not shown by which of the following vessel?

Accepted Answer

Radial

Answer

Renal

Answer

Aorta

Answer

Abdominal aorta

Question 8

Cystic fibrosis leads to defect in which of the following channels?

Accepted Answer

Cl-

Answer

K+

Answer

Ca2+

Answer

Na+

Question 9

Find the correct Auditory pathway sequence.

Accepted Answer

Eight nerve → cochlear nuclei → superior olivary nucleus → lateral lemniscus → inferior colliculus → medial geniculate body → auditory cortex

Answer

Superior olivary nucleus → lateral lemniscus → inferior colliculus → medial geniculate body → auditory cortex → Eight nerve → Cochlear nuclei

Answer

Cochlear nuclei → superior olivary nucleus → lateral lemniscus → inferior colliculus → medial geniculate body → auditory cortex → Eight nerve

Answer

Superior olivary nucleus → inferior colliculus → medial geniculate body → auditory cortex → Eight nerve → Cochlear nuclei → lateral lemniscus

Question 10

Banana sign is seen in which of the following conditions?

Accepted Answer

Spina bifida

Answer

NCC

Answer

Omphalocele

Answer

Anencephaly

INI-CET 2023

Anatomy

ENT

Forensic Medicine

Obstetrics and Gynecology

Pediatrics

Physiology

Radiology