INI-CET 2023 Practice Questions

Q: Which of the following structures is supplied by the superior gluteal nerve?

Gluteus minimus. ***Gluteus minimus*** - The **superior gluteal nerve** provides motor innervation to the gluteus medius, gluteus minimus, and tensor fasciae latae muscles. - This nerve originates from the sacral plexus **(L4, L5, S1)** and exits the pelvis through the greater sciatic foramen, superior to the piriformis muscle. *Gluteus maximus* - The gluteus maximus muscle is innervated by the **inferior gluteal nerve**, not the superior gluteal nerve. - The inferior gluteal nerve also arises from the sacral plexus **(L5, S1, S2)** and is crucial for hip extension and external rotation. *Piriformis* - The piriformis muscle receives its own direct branches from the sacral plexus **(S1, S2)** via the nerve to piriformis, distinct from the superior or inferior gluteal nerves. - It plays a key role in hip external rotation and abduction when the hip is flexed. *All of the options* - This option is incorrect because gluteus maximus is innervated by the inferior gluteal nerve, and piriformis has its own specific nerve supply. - The superior gluteal nerve specifically innervates only the gluteus medius, gluteus minimus, and tensor fasciae latae.

Q: What is the action of the muscle shown in the image below?

Retracts the scapula. ***Retracts the scapula*** - The image highlights the **rhomboid major** muscle, which originates from the spinous processes of T2-T5 vertebrae and inserts onto the medial border of the scapula. - Its primary action is to **retract** (pull medially) and rotate the scapula inferiorly, and also to help hold the scapula against the thoracic wall. *Medial rotation of the shoulder* - Medial rotation of the shoulder is primarily performed by muscles like the **subscapularis**, **pectoralis major**, **latissimus dorsi**, and **teres major**. - The rhomboids do not directly act on the glenohumeral joint for shoulder rotation. *Adduction of the shoulder* - Adduction of the shoulder (bringing the arm towards the body) is mainly performed by the **latissimus dorsi**, **pectoralis major**, and **teres major**. - The rhomboids' action on the scapula indirectly influences shoulder movement but does not directly adduct the shoulder joint. *Extension of the shoulder* - Shoulder extension is primarily achieved by the **latissimus dorsi**, **teres major**, and the posterior fibers of the **deltoid**. - The rhomboid major muscle's action focuses solely on the scapula, not direct extension of the shoulder joint.

Q: Match the following: A) Glossopharyngeal nerve B) Spinal accessory nerve C) Facial nerve D) Mandibular nerve 1) Shrugging of shoulder 2) Touch sensation from the posterior one-third of the tongue 3) Chewing 4) Taste from the anterior two-thirds of the tongue

A-2 , B-1 , C-4 , D-3. ***A-2 , B-1 , C-4 , D-3*** - **A) Glossopharyngeal nerve (CN IX)** is responsible for **general sensation and taste from the posterior one-third of the tongue** [1]. (2). - **B) Spinal Accessory nerve (CN XI)** innervates the **sternocleidomastoid** and **trapezius muscles**, which are involved in shrugging the shoulders (1). - **C) Facial nerve (CN VII)** carries **taste sensation from the anterior two-thirds of the tongue** [1] (4) via the chorda tympani. - **D) Mandibular nerve (V3)**, a branch of the trigeminal nerve, innervates the muscles of mastication, enabling **chewing** (3). *A-3 , B-1 , C-4 , D-2* - This option incorrectly associates the **glossopharyngeal nerve** with chewing, which is a function of the mandibular nerve (V3). - It also incorrectly associates the **mandibular nerve** with touch sensation from the posterior one-third of the tongue, which is a function of the glossopharyngeal nerve [1]. *A-2 , B-3 , C-4 , D-1* - This option incorrectly links the **spinal accessory nerve** with chewing; this nerve primarily controls shoulder and neck movements. - It also incorrectly assigns shrugging of the shoulder to the **mandibular nerve** instead of the spinal accessory nerve. *A-4 , B-1 , C-2 , D-3* - This choice incorrectly attributes **taste from the anterior two-thirds of the tongue** to the glossopharyngeal nerve, which supplies the posterior one-third [1]. - It also incorrectly links **touch sensation from the posterior one-third of the tongue** to the facial nerve, which is involved in taste from the anterior two-thirds [1].

Q: A 24-year-old male presents with asymptomatic scaly lesions over the body as shown in the image below. What is the likely diagnosis?

Pityriasis Rosea. ***Pityriasis Rosea*** - The image shows numerous **scaly, erythematous plaques** distributed over the trunk, with a characteristic "Christmas tree" pattern often observed in Pityriasis Rosea. - The lesions are described as **asymptomatic**, which is consistent with Pityriasis Rosea, although mild pruritus can occur. *Atopic Dermatitis* - Typically presents with **intensely pruritic, erythematous, and eczematous lesions** often found in flexural areas (e.g., antecubital and popliteal fossae). - While it can be widespread, the morphology of the lesions (eczematous vs. scaly plaques) and the absence of pruritus make this less likely. *Lichen planus* - Characterized by **pruritic, violaceous, polygonal papules** and plaques, often appearing on the flexor surfaces of wrists, ankles, and oral mucosa. - The appearance of the lesions in the image does not match the typical morphology of lichen planus. *Seborrheic Dermatitis* - Primarily affects areas with a high density of sebaceous glands, such as the **scalp, face (nasolabial folds, eyebrows), and chest**. - Presents with **greasy, yellowish scales** on an erythematous base, which is distinct from the dry, scaly plaques seen in the image.

Q: A 60-year-old female presents with eczematous itching lesions. Biopsy revealed a subepidermal cleft with Direct Immunofluorescence showing Linear C3 & IgG deposition along the basement membrane zone. What is the likely diagnosis?

Bullous Pemphigoid. ***Bullous Pemphigoid*** - The presence of **eczematous itching lesions**, a **subepidermal cleft**, and **linear C3 and IgG deposition along the basement membrane zone** on direct immunofluorescence (DIF) are classic diagnostic features of Bullous Pemphigoid. - This autoimmune blistering disease typically affects older individuals and is characterized by antibodies targeting components of the **hemidesmosomes**, specifically BP180 and BP230. *Pemphigus foliaceus* - This condition involves **intraepidermal blistering**, specifically within the granular layer, rather than a subepidermal cleft. - DIF in Pemphigus foliaceus shows **intercellular IgG deposition** in the epidermis, not linear deposition along the basement membrane zone. *Pemphigus Vulgaris* - Pemphigus Vulgaris is characterized by **intraepidermal blistering** above the basal cell layer (**suprabasal clefting**), leading to fragile bullae that rupture easily. - DIF typically reveals **intercellular IgG and C3 deposition** in a "chicken wire" pattern throughout the epidermis, which differs from the linear pattern seen in this case. *Dermatitis herpetiformis* - While Dermatitis herpetiformis is also an autoimmune blistering disease with itching lesions, its characteristic DIF finding is **granular IgA deposition** in the dermal papillae, not linear C3 and IgG at the basement membrane zone. - Histopathology in Dermatitis herpetiformis shows **subepidermal vesicles** with neutrophil infiltration in the dermal papillae, but the direct immunofluorescence pattern is distinct.

Q: Identify the ECG given below?

Torsades de pointes. ***Torsades de pointes*** - The ECG shows a polymorphic ventricular tachycardia where the **QRS complexes appear to twist around the baseline**, a classic feature of Torsades de pointes. - This condition is often associated with **QT prolongation**, which is evident in some of the strips preceding the tachyarrhythmia. *Viral myocarditis* - While viral myocarditis can lead to various ECG abnormalities, it typically doesn't present with this specific **polymorphic ventricular tachycardia** morphology. - Common ECG findings in myocarditis include non-specific ST-T wave changes, sinus tachycardia, or conduction blocks, rather than the characteristic "twisting" pattern seen here. *Cardiac tamponade* - Cardiac tamponade is characterized by **electrical alternans** (alternating QRS amplitude), low voltage, and sinus tachycardia on ECG. - It does not cause a polymorphic ventricular tachycardia with the appearance of QRS complexes twisting around the baseline. *Pericarditis* - Pericarditis typically presents with **diffuse ST-segment elevation** (often concave up) and PR-segment depression. - It does not manifest as a polymorphic ventricular tachycardia like Torsades de pointes.

Q: Which of the following describes aortic regurgitation murmur?

Diastolic murmur. ***Diastolic murmur*** - Aortic regurgitation occurs when the **aortic valve does not close completely**, leading to blood flowing back into the **left ventricle during diastole** [1]. - This backflow of blood during the **relaxation phase** of the heart creates the characteristic diastolic murmur [1]. *Ejection systolic murmur* - This murmur type is typically heard during **systole** and is associated with conditions like **aortic stenosis**, where there is turbulent flow across a narrowed aortic valve during ejection [3]. - It does not describe the sound of blood flowing back into the ventricle during **diastole**, which characterizes aortic regurgitation. *Ventricular contraction* - **Ventricular contraction** occurs during **systole** and is the mechanism by which blood is ejected from the ventricles [2]. - While related to cardiac cycle, it does not directly describe the timing or nature of the murmur caused by aortic regurgitation. *Systolic murmur* - A **systolic murmur** is heard when the ventricles contract, such as in conditions like **aortic stenosis** or **mitral regurgitation** [3]. - Aortic regurgitation is specifically a **diastolic event** as blood leaks back into the left ventricle during ventricular relaxation [1].

Q: All of the following are the causes of High output cardiac failure, except?

Cor pulmonale. ***Cor pulmonale*** - **Cor pulmonale** is **right-sided heart failure** [1] caused by **pulmonary hypertension**, which is typically a low-output state unless accompanied by other contributing factors. - While it affects cardiac function, it fundamentally involves increased pulmonary vascular resistance leading to ventricular dysfunction, not an increase in **cardiac output**. *Systemic AV shunt* - A **systemic AV shunt** can cause high-output heart failure by diverting a significant volume of blood directly from the arterial to the venous system, bypassing the capillary beds. - This significantly **increases venous return** and **cardiac preload**, requiring the heart to pump more blood to maintain adequate systemic perfusion. *Beri beri* - **Beri-beri heart disease**, caused by severe **thiamine (vitamin B1) deficiency**, leads to high-output cardiac failure due to **peripheral vasodilation**. - This vasodilation markedly **reduces systemic vascular resistance**, increasing venous return and necessitating a higher cardiac output to maintain blood pressure. *Anemia* - **Severe anemia** causes high-output cardiac failure because the reduced oxygen-carrying capacity of the blood forces the heart to significantly **increase cardiac output** to meet the body's metabolic demands. - This compensatory mechanism involves both an **increased heart rate** and **stroke volume** to ensure adequate tissue oxygenation despite lower hemoglobin levels.

Q: What should be done as an immediate measure for ongoing bleeding in a patient with pelvic bone fracture?

Use Pelvic Binders. **Use Pelvic Binders** - **Pelvic binders** apply circumferential compression, which helps to stabilize the fracture and reduce the pelvic volume. - This mechanical stabilization significantly reduces ongoing hemorrhage from venous and bone surface bleeding in unstable pelvic fractures. *Rapid blood transfusion* - While critically important for managing **hemorrhagic shock**, blood transfusion alone does not address the source of ongoing bleeding. - It is a supportive measure, not an immediate means to stop the bleeding from an unstable pelvic fracture. *Internal definitive fixation* - **Internal definitive fixation** is a surgical procedure aimed at permanently stabilizing the fracture and would typically be performed after initial resuscitation and bleeding control. - It is not an immediate measure for **ongoing life-threatening hemorrhage** and carries procedural risks. *External fixation* - **External fixation** can stabilize an unstable pelvic fracture and helps in controlling bleeding, but applying a **pelvic binder** is a quicker and less invasive initial step. - External fixation is usually performed by a surgeon in a controlled environment, not as the very first immediate bedside measure to stop bleeding.

Question 1

Which of the following structures is supplied by the superior gluteal nerve?

Accepted Answer

Gluteus minimus

Answer

Gluteus maximus

Answer

Piriformis

Answer

All of the options

Question 2

What is the action of the muscle shown in the image below?

Accepted Answer

Retracts the scapula

Answer

Medial rotation of the shoulder

Answer

Adduction of the shoulder

Answer

Extension of the shoulder

Question 3

Match the following:
A) Glossopharyngeal nerve
B) Spinal accessory nerve
C) Facial nerve
D) Mandibular nerve

1) Shrugging of shoulder
2) Touch sensation from the posterior one-third of the tongue
3) Chewing
4) Taste from the anterior two-thirds of the tongue

Accepted Answer

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

Answer

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

Answer

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

Answer

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

Question 4

A 24-year-old male presents with asymptomatic scaly lesions over the body as shown in the image below. What is the likely diagnosis?

Accepted Answer

Pityriasis Rosea

Answer

Atopic Dermatitis

Answer

Lichen planus

Answer

Seborrheic Dermatitis

Question 5

Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split.
Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.

Accepted Answer

Statements 1 & 2 are correct, 2 is not explaining 1

Answer

Statements 1 and 2 are correct and 2 is the correct explanation for 1

Answer

Statements 1 and 2 are incorrect

Answer

Statement 1 is incorrect

Question 6

A 60-year-old female presents with eczematous itching lesions. Biopsy revealed a subepidermal cleft with Direct Immunofluorescence showing Linear C3 & IgG deposition along the basement membrane zone. What is the likely diagnosis?

Accepted Answer

Bullous Pemphigoid

Answer

Pemphigus foliaceus

Answer

Pemphigus Vulgaris

Answer

Dermatitis herpetiformis

Question 7

Identify the ECG given below?

Accepted Answer

Torsades de pointes

Answer

Viral myocarditis

Answer

Cardiac tamponade

Answer

Pericarditis

Question 8

Which of the following describes aortic regurgitation murmur?

Accepted Answer

Diastolic murmur

Answer

Ejection systolic murmur

Answer

Ventricular contraction

Answer

Systolic murmur

Question 9

All of the following are the causes of High output cardiac failure, except?

Accepted Answer

Cor pulmonale

Answer

Systemic AV shunt

Answer

Beri beri

Answer

Anemia

Question 10

What should be done as an immediate measure for ongoing bleeding in a patient with pelvic bone fracture?

Accepted Answer

Use Pelvic Binders

Answer

Rapid blood transfusion

Answer

External fixation

Answer

Internal definitive fixation

INI-CET 2023

Anatomy

Dermatology

Internal Medicine

Orthopaedics