INI-CET 2022 Practice Questions

Q: Identify the cell marked in the image below

Mast cell. ***Mast cell*** - The cell indicated by the arrow displays characteristic features of a **mast cell**, including its large size, prominent central nucleus, and cytoplasm densely packed with numerous large, basophilic (darkly stained) granules. - These granules contain powerful inflammatory mediators like **histamine** and **heparin**, which are key in allergic reactions and inflammation. *Macrophage* - Macrophages are typically larger than mast cells with an **irregular shape**, a kidney-shaped nucleus, and often contain phagocytosed material in their cytoplasm, which is not clearly visible here. - While they are also immune cells, they lack the characteristic dense, uniform basophilic granulation seen in the indicated cell. *Plasma cell* - Plasma cells are characterized by an **eccentric nucleus** with **chromatin clumping** (cartwheel or clock-face appearance) and a prominent Golgi apparatus (perinuclear halo), none of which are evident in the marked cell. - Their cytoplasm is typically basophilic but lacks the distinct large granules. *Fibroblast* - Fibroblasts are typically **spindle-shaped** or stellate cells with elongated nuclei and a sparse cytoplasm, responsible for producing extracellular matrix. - They do not possess the abundant, dense cytoplasmic granules that are a hallmark of the cell shown.

Q: A young patient presents to the clinic with erythematous lesions over the exposed areas of the skin like hands, arms, chest, etc. she also complaints of arthralgia and breathlessness. Which among the following antibodies will be useful in diagnosing this condition?

Anti-dsDNA antibodies. Anti-dsDNA antibodies - The clinical presentation with erythematous lesions in sun-exposed areas (consistent with photosensitivity [1] or malar rash), arthralgia, and breathlessness (suggesting serositis [4] or pulmonary involvement) is highly suggestive of Systemic Lupus Erythematosus (SLE) [3]. - Anti-dsDNA antibodies are highly specific for SLE and are included in the diagnostic criteria [4]. Their levels often correlate with disease activity, especially in lupus nephritis. *Anti-centromere antibodies* - These antibodies are typically associated with CREST syndrome (a limited form of systemic sclerosis), characterized by Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasias. - This clinical picture does not align with the patient's symptoms, which point more towards an inflammatory multi-systemic disease. *Anti-RNP antibodies* - Anti-ribonucleoprotein (RNP) antibodies are characteristic of Mixed Connective Tissue Disease (MCTD) [2], which features overlapping symptoms of SLE, systemic sclerosis, and polymyositis [3]. - While some features like arthralgia might overlap, the classic erythematous lesions and breathlessness are more directly linked to SLE in this presentation, and anti-dsDNA is more specific for distinguishing SLE. *Anti-Scl 70 antibodies* - Also known as anti-topoisomerase I antibodies, these are highly specific for diffuse cutaneous systemic sclerosis. - This condition is characterized by widespread skin thickening, interstitial lung disease, and other visceral organ involvement, which is not fully supported by the patient's primary symptoms of prominent erythematous rashes and isolated arthralgia.

Q: A patient presented with violent, flinging movements. Where is the lesion causing the hemiballismus seen?

Subthalamic nucleus. ***Subthalamic nucleus*** - **Hemiballismus** is characterized by **violent, flinging movements** of one side of the body, most commonly affecting the proximal limbs [1]. - This involuntary movement disorder is typically caused by a lesion, often an **infarct** or **hemorrhage**, in the **contralateral subthalamic nucleus (STN)** [1]. *Putamen* - Lesions in the **putamen** are more commonly associated with other movement disorders such as **dystonia** or **chorea**. - The putamen is part of the **striatum** and plays a key role in the direct and indirect pathways of the basal ganglia. *Globus pallidus* - Damage to the **globus pallidus (GP)**, particularly the external segment (GPe), can lead to conditions like **dystonia** or contribute to Parkinsonian symptoms depending on the specific region affected [2]. - The globus pallidus is a central component of the **basal ganglia output** to the thalamus. *Caudate nucleus* - Lesions in the **caudate nucleus** are closely linked to **Huntington's disease**, which primarily manifests as **chorea** and cognitive decline [1]. - The caudate nucleus is primarily involved in **cognitive functions** and motor control planning.

Q: A child presents with multiple skin lesions over the inner thigh and genital areas. It initially started as macule and later developed to become nodules. Some nodules have central umbilication. The histology of the lesion is shown below

Henderson-Patterson bodies. ***Henderson-Patterson bodies*** - The clinical description of **umbilicated nodules** in the genital area of a child is characteristic of **molluscum contagiosum** [1], [2]. - **Henderson-Patterson bodies** are large eosinophilic, intracytoplasmic inclusions seen in cells infected with the **molluscum contagiosum virus** [2]. *Guarnieri bodies* - **Guarnieri bodies** are eosinophilic, intracytoplasmic inclusions found in cells infected with the **variola virus** (smallpox). - While they are also viral inclusions bodies, they are associated with a different viral disease that does not typically present as umbilicated nodules in this manner. *Cowdry type A inclusion bodies* - **Cowdry type A inclusion bodies** are intranuclear inclusions characteristic of **herpes simplex virus** (HSV) and **varicella-zoster virus** (VZV) infections. - Herpes lesions are typically **vesicular** and painful, not umbilicated nodules like molluscum contagiosum. *Negri bodies* - **Negri bodies** are pathognomonic eosinophilic inclusions found in the cytoplasm of nerve cells in individuals infected with the **rabies virus**. - Rabies presents with neurological symptoms after a bite from an infected animal, which is distinctly different from the described skin lesions. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 997-998. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1177-1180.

Q: Identify the given bone marrow biopsy instrument

Jamshidi needle. ***Jamshidi needle*** - The image displays a **Jamshidi needle**, characterized by its **tapered, beveled tip** designed to facilitate entry into the bone and procure an intact core of bone marrow. - This needle is widely considered the **gold standard** for bone marrow biopsy due to its effectiveness in obtaining high-quality trephine samples. *Salah needle* - A Salah needle is primarily used for **bone marrow aspiration**, not typically for a trephine biopsy, and it has a different design meant for aspirating liquid marrow. - It features a **shorter, sturdier design** with a sharp bevel, optimized for safely extracting marrow fluid. *Tru-cut needle* - The Tru-cut needle is primarily designed for obtaining **soft tissue biopsies** (e.g., liver, kidney, prostate) and is not typically used for bone marrow biopsies. - Its mechanism involves an inner cutting stylet and an outer cutting cannula, which is unsuitable for penetrating dense bone and retrieving a bone core. *Vim Silverman needle* - The Vim Silverman needle is also designed for **soft tissue biopsies**, similar to the Tru-cut, and not specifically for bone marrow. - It utilizes a split needle design to capture tissue, which is not appropriate for obtaining a solid bone marrow core.

Q: Which among the following drugs is the new FDA approved immune checkpoint inhibitor for endometrial carcinoma?

Pembrolizumab. **Pembrolizumab** * **Pembrolizumab** (Keytruda), a **PD-1 inhibitor**, received accelerated FDA approval for patients with **advanced endometrial carcinoma** that is mismatch repair deficient (dMMR) or microsatellite instability-high (MSI-H), and has progressed following prior systemic therapy or is not a candidate for curative surgery or radiation. * This approval was based on data from the KEYNOTE-158 study, demonstrating **durable responses** in these specific subsets of endometrial cancer, highlighting its role in precision oncology. *Ipilimumab* * **Ipilimumab** (Yervoy) is a **CTLA-4 inhibitor** primarily approved for the treatment of **melanoma** and renal cell carcinoma, often in combination with nivolumab. * While it is an immune checkpoint inhibitor, its primary indications and specific FDA approvals do not include **endometrial carcinoma**. *Trastuzumab* * **Trastuzumab** (Herceptin) is a **monoclonal antibody** that targets the **HER2 protein**, commonly used in the treatment of **HER2-positive breast cancer** and certain types of gastric cancer. * It is not an immune checkpoint inhibitor and its mechanism of action is distinct from blocking immune checkpoints like PD-1 or CTLA-4. *Nivolumab* * **Nivolumab** (Opdivo) is a **PD-1 inhibitor** with broad FDA approvals for various cancers, including melanoma, non-small cell lung cancer, renal cell carcinoma, classical Hodgkin lymphoma, and others. * While a potent immune checkpoint inhibitor, **pembrolizumab** received the specific accelerated approval for advanced endometrial carcinoma in the context described, making it the most direct answer for the "new FDA approved" status in this specific indication.

Q: Identify the correct match, regarding the drug and its adverse effect.

Verapamil - constipation. ***Verapamil - Constipation*** - **Verapamil**, a **non-dihydropyridine calcium channel blocker**, frequently causes constipation due to its effect on smooth muscle in the gastrointestinal tract, leading to **decreased intestinal motility**. - This adverse effect is common and often dose-dependent, making it a significant consideration in patient management. *Aliskiren - hypokalemia* - **Aliskiren**, a **direct renin inhibitor**, can cause **hyperkalemia** by reducing angiotensin II levels, which normally stimulate aldosterone secretion. - It does not typically cause hypokalemia; rather, potassium-sparing effects are often observed. *Hydralazine - heart failure* - **Hydralazine** is a **vasodilator** used to treat hypertension and **heart failure** with reduced ejection fraction by reducing afterload. - It does not cause heart failure; instead, it is often prescribed to improve cardiac function in patients with heart failure. *Atenolol - hemolytic anemia* - **Atenolol** is a **beta-blocker** primarily used for hypertension, angina, and arrhythmias. - **Hemolytic anemia** is a rare adverse effect associated with certain drugs, but it is not a known or common side effect of atenolol.

Q: During polysomnography, which stage of sleep is represented by the marked areas when observing the following wave patterns? EOG (Electrooculography) EEG (Electroencephalography) EMG (Electromyography)

NREM I sleep. ***NREM I sleep*** - This stage is characterized by a transition from wakefulness to sleep, identifiable by the appearance of **slow eye movements** in the EOG and a reduction in EEG frequency with the presence of **theta waves**. - The EMG shows a decrease in muscle tone but without the complete atonia seen in REM sleep. *REM sleep* - **Rapid eye movements** are characteristic in the EOG, and the EEG shows **low-amplitude, mixed-frequency waves** similar to wakefulness. - The EMG would display profound muscle atonia, which is not evident in the provided tracing. *NREM II sleep* - This stage is marked by the presence of **sleep spindles** and **K-complexes** in the EEG, which are absent in the marked area. - Eye movements are generally absent, and muscle activity continues to be low. *NREM III sleep* - This is the deepest stage of sleep, characterized by **high-amplitude, slow-delta waves** (20-50% of the epoch) in the EEG. - Eye movements are typically absent, and muscle tone is very low but not completely absent.

Q: Which of the following is false about bipolar disorder?

Unipolar mania is more common than bipolar disorder. ***Unipolar mania is more common than bipolar disorder*** - This statement is **false** because **unipolar mania is extremely rare**, while **bipolar disorder (which includes both manic and depressive episodes)** is significantly more common. - **Unipolar mania** refers to recurrent manic episodes without any depressive episodes, a presentation that is seldom observed clinically. *Genetic factors play important role* - This statement is **true**, as **bipolar disorder has a strong genetic component**, with **heritability estimated between 60-80%**. - **First-degree relatives** of individuals with bipolar disorder are at a significantly higher risk of developing the condition. *Rapid cycling is more common in females* - This statement is **true**; **rapid cycling (4 or more mood episodes per year)** occurs more frequently in females with bipolar disorder. - **Women with bipolar disorder** are also more likely to experience **mixed features** and **more depressive episodes** compared to males. *Age of onset is earlier than unipolar depression* - This statement is **true** because the **typical age of onset for bipolar disorder is in early adulthood (late teens to early 20s)**, whereas **unipolar depression often has a later average onset**, though both can occur at any age. - An earlier age of onset in bipolar disorder is linked to poorer prognosis and more severe illness course.

Q: Match the following: 1. Kleptomania 2. Pyromania 3. Mutilomania 4. Dipsomania A. Intense desire to drink alcoholic drinks B. Intense desire to mutilate C. Intense desire to steal items of trivial value D. Intense desire to burn things

1-C, 2-D, 3-B, 4-A. **1-C, 2-D, 3-B, 4-A** - **Kleptomania** is characterized by an **irresistible urge to steal objects** that are often of little value and not needed for personal use or monetary gain. - **Pyromania** involves a **preoccupation with fire** and an overwhelming urge to set fires and witness their effects. - **Mutilomania** is a rare impulse control disorder that involves an **intense desire to self-mutilate**. - **Dipsomania** describes an **uncontrollable craving for alcohol**, leading to recurrent bouts of excessive drinking. *1-C, 2-B, 3-D, 4-A* - This option incorrectly matches Pyromania with an intense desire to mutilate and Mutilomania with an intense desire to burn things. - **Pyromania** is specifically about fire, and **Mutilomania** is about self-harm. *1-D, 2-B, 3-A, 4-C* - This option incorrectly matches Kleptomania with the desire to burn things, Pyromania with the desire to mutilate, and Dipsomania with the desire to steal. - The core definitions of these terms are not aligned in this pairing. *1-D, 2-C, 3-B, 4-A* - This option incorrectly matches Kleptomania with the desire to burn things and Pyromania with the desire to steal. - The defining characteristics of these impulse control disorders are mismatched here.

Question 1

Identify the cell marked in the image below

Accepted Answer

Mast cell

Answer

Macrophage

Answer

Plasma cell

Answer

Fibroblast

Question 2

A young patient presents to the clinic with erythematous lesions over the exposed areas of the skin like hands, arms, chest, etc. she also complaints of arthralgia and breathlessness. Which among the following antibodies will be useful in diagnosing this condition?

Accepted Answer

Anti-dsDNA antibodies

Answer

Anti-centromere antibodies

Answer

Anti-RNP antibodies

Answer

Anti-Scl 70 antibodies

Question 3

A patient presented with violent, flinging movements. Where is the lesion causing the hemiballismus seen?

Accepted Answer

Subthalamic nucleus

Answer

Putamen

Answer

Globus pallidus

Answer

Caudate nucleus

Question 4

A child presents with multiple skin lesions over the inner thigh and genital areas. It initially started as macule and later developed to become nodules. Some nodules have central umbilication. The histology of the lesion is shown below

Accepted Answer

Henderson-Patterson bodies

Answer

Guarnieri bodies

Answer

Cowdry type A inclusion bodies

Answer

Negri bodies

Question 5

Identify the given bone marrow biopsy instrument

Accepted Answer

Jamshidi needle

Answer

Salah needle

Answer

Tru-cut needle

Answer

Vim Silverman needle

Question 6

Which among the following drugs is the new FDA approved immune checkpoint inhibitor for endometrial carcinoma?

Accepted Answer

Pembrolizumab

Answer

Ipilimumab

Answer

Trastuzumab

Answer

Nivolumab

Question 7

Identify the correct match, regarding the drug and its adverse effect.

Accepted Answer

Verapamil - constipation

Answer

Aliskiren - hypokalemia

Answer

Hydralazine - heart failure

Answer

Atenolol - hemolytic anemia

Question 8

During polysomnography, which stage of sleep is represented by the marked areas when observing the following wave patterns?

EOG (Electrooculography)
EEG (Electroencephalography)
EMG (Electromyography)

Accepted Answer

NREM I sleep

Answer

REM sleep

Answer

NREM II sleep

Answer

NREM III sleep

Question 9

Which of the following is false about bipolar disorder?

Accepted Answer

Unipolar mania is more common than bipolar disorder

Answer

Genetic factors play important role

Answer

Rapid cycling is more common in females

Answer

Age of onset is earlier than unipolar depression

Question 10

Match the following:

1. Kleptomania
2. Pyromania
3. Mutilomania
4. Dipsomania

A. Intense desire to drink alcoholic drinks
B. Intense desire to mutilate
C. Intense desire to steal items of trivial value
D. Intense desire to burn things

Accepted Answer

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

Answer

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

Answer

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

Answer

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

INI-CET 2022

Anatomy

Internal Medicine

Pathology

Pharmacology

Physiology

Psychiatry