INI-CET 2023 Practice Questions

Q: Blackfoot disease is seen in which of the following?

Arsenic. ***Arsenic*** - Chronic arsenic exposure can lead to **Blackfoot disease**, a severe peripheral vascular disease causing **gangrene** and limb loss, particularly affecting the lower extremities. - This condition is characterized by **dark pigmentation** and ischemic changes in the affected limbs due to vascular compromise. *Mercury* - Mercury poisoning (e.g., **Minamata disease**) primarily affects the **nervous system** and kidneys, causing symptoms like tremor, neuropsychiatric disturbances, and renal dysfunction. - It does not typically cause **Blackfoot disease** or similar peripheral ischemic conditions. *Copper* - Copper toxicity can lead to **liver damage** (e.g., in Wilson's disease), neurological symptoms, and gastrointestinal issues. - Excessive copper does not cause **Blackfoot disease**. *Cadmium* - Cadmium toxicity primarily targets the **kidneys** (leading to renal tubular dysfunction), bones (**osteomalacia** as seen in Itai-itai disease), and lungs. - It is not associated with **Blackfoot disease**.

Q: Black foot disease with peripheral neuropathy is seen in which metal poisoning?

Arsenic. ***Arsenic*** - Chronic arsenic exposure is associated with **Blackfoot disease**, a severe form of peripheral vascular disease leading to gangrene. - **Peripheral neuropathy** is another common manifestation of chronic arsenic poisoning, characterized by tingling, numbness, and weakness. *Mercury* - Mercury poisoning (Minamata disease) primarily causes **neurological symptoms** like tremors, ataxia, and cognitive impairment, but not specifically Blackfoot disease. - It does not typically lead to severe peripheral vascular disease and gangrene. *Lead* - Lead poisoning (plumbism) is known for causing **neuropathy** (especially motor neuropathy, "wrist drop") and **abdominal pain**, but not Blackfoot disease. - It also affects hematological (anemia) and renal systems. *Cadmium* - Cadmium poisoning (Itai-itai disease) primarily affects the **bones** (osteomalacia, osteoporosis) and **kidneys**. - While it can cause renal damage, it does not typically lead to Blackfoot disease or prominent peripheral neuropathy.

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 an **alcoholic smell** and **congested conjunctiva** (bloodshot eyes) are classic signs of recent alcohol consumption. - Despite normal motor function, these signs are sufficient to indicate that the individual is under the influence of alcohol, hence experiencing **intoxication**. *Severe alcohol poisoning* - This condition involves much more severe symptoms, such as **impaired consciousness**, **respiratory depression**, **hypothermia**, and often an inability to walk or function normally. - The man's normal motor functions rule out immediate concerns of severe poisoning, as he is clearly not in a life-threatening state often associated with severe poisoning. *No evidence of alcohol consumption* - The presence of an **alcoholic smell** and **congested conjunctiva** directly contradict this option, as they are clear indicators of recent alcohol intake. - Disregarding these physical signs would be an inappropriate assessment of the situation. *Alcohol consumption without intoxication* - While one can consume alcohol without becoming intoxicated, the presence of **congested conjunctiva** is a physical sign indicating a physiological response to alcohol that typically accompanies intoxication, even if motor impairment is not yet obvious. - **Intoxication** refers to the state where alcohol has begun to affect the individual's mental and physical faculties, which is supported by the observed symptoms.

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: Order of drawing blood in vacutainers should be in the following sequence to prevent contamination?

Blue, Red, Violet, Grey. ***Blue, Red, Violet, Grey*** - This sequence follows the **CLSI (Clinical and Laboratory Standards Institute) order of draw** guidelines, which are critical for preventing **cross-contamination** between additives of different vacutainers. - The order starts with tubes for **coagulation studies** (blue top with sodium citrate), followed by serum tubes (red top), EDTA tubes (violet top for hematology), and finally glycolytic inhibitor tubes (grey top for glucose). - This prevents tissue thromboplastin contamination and anticoagulant carryover that could affect laboratory test results. *Grey, Blue, Red, Violet* - This order is incorrect as it places the **grey top tube** (containing fluoride/oxalate) first, which could contaminate subsequent tubes with its additives and affect tests. - The **blue top tube** for coagulation studies should come early in the sequence to minimize tissue thromboplastin contamination. *Blue, Violet, Red, Grey* - This sequence is incorrect because the **violet top tube** (EDTA) is placed before the **red top tube** (serum). - **EDTA contamination** can chelate calcium and other cations, interfering with chemistry tests performed on serum in the red top tube. *Red, Blue, Violet, Grey* - This order is incorrect as the **red top tube** is placed first, followed by the **blue top tube** (citrate). - The blue top tube should precede tubes with clot activators to **prevent tissue thromboplastin** from contaminating coagulation samples, which would lead to falsely shortened clotting times.

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: A 52-year-old female patient presents with HER-2 positive breast cancer that has become resistant to trastuzumab treatment. The oncologist is considering the next line of treatment for the patient. Which of the following options would be the most appropriate choice?

Lapatinib. ***Lapatinib*** - Lapatinib is an oral **dual tyrosine kinase inhibitor** that targets both **HER2** and **EGFR** receptors, specifically approved for **trastuzumab-resistant HER2-positive breast cancer**. - Unlike trastuzumab (a monoclonal antibody that binds the extracellular domain), lapatinib inhibits the **intracellular tyrosine kinase domain** of HER2, providing an **alternative mechanism** to overcome resistance. - Often used in combination with capecitabine for patients who have progressed on trastuzumab-containing regimens. - **Clinical evidence**: The EGF100151 trial demonstrated efficacy in trastuzumab-refractory disease. *Vemurafenib* - Vemurafenib is a **BRAF V600E/K inhibitor** used primarily for **metastatic melanoma** with BRAF mutations. - It has **no activity against HER2** and is not indicated for breast cancer. - Would not provide benefit in this clinical scenario. *Erlotinib* - Erlotinib is a selective **EGFR tyrosine kinase inhibitor** used for **EGFR-mutant non-small cell lung cancer** and **pancreatic cancer** (with gemcitabine). - While it inhibits EGFR (which lapatinib also targets), erlotinib has **insufficient HER2 inhibition** to be effective in HER2-driven breast cancer. - Not approved or effective for trastuzumab-resistant HER2-positive breast cancer. *Sorafenib* - Sorafenib is a **multi-kinase inhibitor** targeting **RAF kinases, VEGFR-2/3, and PDGFR-β**, approved for **hepatocellular carcinoma, renal cell carcinoma, and thyroid cancer**. - It does **not specifically target HER2** signaling and has no established role in HER2-positive breast cancer. - Would not address the mechanism of disease in this patient.

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: 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

Blackfoot disease is seen in which of the following?

Accepted Answer

Arsenic

Answer

Mercury

Answer

Copper

Answer

Cadmium

Question 2

Black foot disease with peripheral neuropathy is seen in which metal poisoning?

Accepted Answer

Arsenic

Answer

Mercury

Answer

Lead

Answer

Cadmium

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

Match the following columns
A. Caplan syndrome
B. Mesothelioma
C. Silicosis
D. Asbestosis

1. Pleural effusion without shift
2. Crazy Paving
3. Lower lobe involved
4. Described in coal workers

Accepted Answer

A4-B1-C3-D2

Answer

A4-B1-C3-D3

Answer

A2-B1-C4-D3

Answer

A4-B3-C1-D2

Question 6

Order of drawing blood in vacutainers should be in the following sequence to prevent contamination?

Accepted Answer

Blue, Red, Violet, Grey

Answer

Grey, Blue, Red, Violet

Answer

Blue, Violet, Red, Grey

Answer

Red, Blue, Violet, Grey

Question 7

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 8

A 52-year-old female patient presents with HER-2 positive breast cancer that has become resistant to trastuzumab treatment. The oncologist is considering the next line of treatment for the patient. Which of the following options would be the most appropriate choice?

Accepted Answer

Lapatinib

Answer

Vemurafenib

Answer

Erlotinib

Answer

Sorafenib

Question 9

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 10

Banana sign is seen in which of the following conditions?

Accepted Answer

Spina bifida

Answer

NCC

Answer

Omphalocele

Answer

Anencephaly

INI-CET 2023

Community Medicine

Forensic Medicine

Obstetrics and Gynecology

Pathology

Pediatrics

Pharmacology

Physiology

Radiology