INI-CET 2023 Practice Questions

Q: Anterior relations of third part of duodenum are all except?

Fundus of gallbladder. ***Fundus of gallbladder*** - The **fundus of the gallbladder** is located more superiorly and anteriorly, typically lying near the ninth costal cartilage, and is not an anterior relation of the third part of the duodenum. - The third part of the duodenum lies mainly at the level of the **L3 vertebra**, far removed from the gallbladder fundus. *Jejunum* - The **jejunum**, being part of the mobile small intestine, can lie anterior to the third part of the duodenum. - These two structures are anatomically close and can overlap. *Root of mesentery* - The **root of the mesentery** crosses anterior to the third part of the duodenum, attaching to the posterior abdominal wall. - This is a key anatomical landmark that helps fix the position of the small intestine. *Superior mesenteric artery* - The **superior mesenteric artery** and vein both cross **anterior** to the third part of the duodenum as they emerge from beneath the pancreas. - This anatomical relationship is clinically relevant in conditions like superior mesenteric artery syndrome.

Q: Which of the following microorganisms will be resistant to meropenem and aminoglycosides but sensitive to piperacillin tazobactam and cotrimoxazole?

Stenotrophomonas. ***Stenotrophomonas maltophilia*** - *Stenotrophomonas maltophilia* exhibits **intrinsic resistance to carbapenems (like meropenem)** due to the presence of L1 and L2 metallo-beta-lactamases and chromosomally encoded beta-lactamases. - It is **resistant to aminoglycosides** via aminoglycoside-modifying enzymes and efflux pump mechanisms. - **Trimethoprim-sulfamethoxazole (cotrimoxazole) is the drug of choice** with consistent susceptibility, making it the first-line treatment. - **Susceptibility to piperacillin-tazobactam is variable** - while some isolates may show in vitro susceptibility, clinical efficacy is inconsistent and it is not considered a reliable first-line agent. Among the options given, this organism best fits the described pattern. *Pseudomonas aeruginosa* - **Generally susceptible to carbapenems (meropenem) and aminoglycosides**, which are important therapeutic options. - Does not match the resistance pattern described in the question. *Acinetobacter baumannii* - Shows **multidrug resistance including carbapenems and aminoglycosides** in most clinical isolates. - However, typically also **resistant to piperacillin-tazobactam and cotrimoxazole**, making it inconsistent with the described susceptibility pattern. *Burkholderia cepacia complex* - Exhibits **intrinsic resistance to multiple antibiotics** including aminoglycosides and often carbapenems. - **Variable and often resistant to piperacillin-tazobactam**, and susceptibility to cotrimoxazole is inconsistent. - Does not reliably match the described antibiotic profile.

Q: A 30-year-old pregnant female diagnosed with fibroid presented with fever, mild leukocytosis, and pain at 28 weeks. What is the likely cause?

Red degeneration of fibroid. ***Red degeneration of fibroid*** - **Red degeneration** (also known as carneous degeneration) is common in pregnancy due to rapid fibroid growth outstripping its blood supply, leading to **ischemic necrosis** and causing pain, fever, and leukocytosis. - This complication typically occurs during the **second and third trimesters** due to hormonal changes and increased vascularity, consistent with the 28-week presentation. *Fibroid infection* - While possible, **fibroid infection** is a rarer complication, often secondary to other procedures or prolonged degeneration. - It would likely present with more pronounced signs of infection, such as higher fever, significant leukocytosis, and possibly discharge or septic symptoms, which are not explicitly stated as severe here. *Fibroid torsion* - **Torsion** usually occurs with pedunculated fibroids when the stalk twists, leading to acute, severe pain and potentially necrosis. - This presentation does not specifically mention a pedunculated fibroid or the sudden, sharp, localized pain typically associated with torsion of an appendage. *Labor pain* - At 28 weeks, **labor pain** would indicate preterm labor, which would typically involve regular, escalating uterine contractions and cervical changes. - The symptoms of fever and leukocytosis are not characteristic of uncomplicated labor pain, suggesting an underlying inflammatory or degenerative process with the fibroid.

Q: A patient complained of whitish discharge from the vagina and yellow staining on their clothes. There is no itching, no redness, and pH is acidic. What is the likely cause?

Increased normal vaginal discharge. ***Increased normal vaginal discharge*** - The presence of a whitish discharge and yellow staining on clothes, without **itching** or **redness**, and with an **acidic pH**, is characteristic of a **normal physiological discharge**. - Normal vaginal discharge can vary in color and consistency, and its volume can increase due to hormonal changes (e.g., during ovulation or pregnancy) or sexual arousal. *Trichomoniasis* - This infection typically causes a **frothy, greenish-yellow discharge** with a **foul odor**, often accompanied by **itching**, redness, and a **pH greater than 4.5**. - The absence of itching and the acidic pH rule out trichomoniasis in this scenario. *Candidiasis* - **Candidiasis** (yeast infection) presents with a **thick, white, 'cottage cheese' like discharge**, accompanied by **intense itching**, burning, and redness, with a **normal to acidic pH (less than 4.5)**. - The lack of itching and redness, along with a simple whitish discharge, does not align with candidiasis. *Bacterial vaginosis* - **Bacterial vaginosis** is characterized by a **thin, grayish-white discharge** with a **"fishy" odor**, especially after intercourse, and a **vaginal pH greater than 4.5**. - The absence of a fishy odor and the acidic pH make bacterial vaginosis an unlikely diagnosis.

Q: What are clue cells?

Vaginal epithelial cells lined by bacteria. ***Vaginal epithelial cells lined by bacteria*** - **Clue cells** are definitive diagnostic features of **bacterial vaginosis**, identified on microscopy. - They are specifically **vaginal epithelial cells** that appear "cluey" or stippled due to their surface being obscured by numerous adherent bacteria, primarily *Gardnerella vaginalis*. *Uterine endothelial cells lined by bacteria* - The **endometrium** (uterine lining) is composed of epithelial cells, not typically referred to as endothelial cells in this context, and is not where clue cells are found. - Presence of bacteria adherent to uterine cells would suggest an **endometritis** or other uterine infection, not bacterial vaginosis. *Cervical epithelial cells lined by bacteria* - While bacteria can adhere to **cervical epithelial cells**, especially in the presence of infection, these are not typically called **clue cells**. - **Clue cells** are characteristic of the vaginal environment and are specifically associated with bacterial vaginosis. *Abdominal cells lined by bacteria* - **Abdominal cells** are not relevant to the definition of clue cells, which are found in the vaginal canal. - The presence of bacteria on abdominal cells would indicate a completely different pathology, such as a **peritoneal infection**.

Q: The patient presented with a retroverted uterus, dysmenorrhea, and dyspareunia. What is the next step of the investigation?

USG. ***USG*** - **Transvaginal ultrasound (TVS)** is the initial imaging modality of choice for evaluating uterine position, assessing for causes of dysmenorrhea and dyspareunia (e.g., **endometriosis**, adenomyosis, fibroids), and can visualize the retroverted uterus. - It is **non-invasive**, readily available, and provides good resolution of pelvic organs, making it suitable for first-line investigation. *HSG* - **Hysterosalpingography (HSG)** is primarily used to assess **fallopian tube patency** in cases of infertility. - It will **not provide detailed information** about the uterine position or other pelvic pathologies contributing to pain. *Laparotomy* - **Laparotomy** is a major surgical procedure involving a large abdominal incision, typically reserved for **definitive diagnosis and treatment** of significant pelvic pathology when less invasive methods are insufficient. - It is **not an initial investigatory step** for symptoms like dysmenorrhea and dyspareunia. *Diagnostic Laparoscopy* - **Diagnostic laparoscopy** is a minimally invasive surgical procedure that allows direct visualization of pelvic organs, often used to **confirm endometriosis** or other pathologies. - While it offers definitive diagnosis, it is an **invasive procedure** and usually performed **after initial non-invasive imaging** (like USG) has been completed.

Q: What is not an advantage of USG over mammography?

Superior detection of microcalcifications. ***Superior detection of microcalcifications*** - **Mammography** is the gold standard for detecting **microcalcifications**, which can be a key indicator of **ductal carcinoma in situ (DCIS)** or early invasive breast cancer. - **Ultrasound (USG)** has limited sensitivity for detecting and characterizing microcalcifications. *Can be used for guided biopsy* - **USG-guided biopsy** is a common and advantageous technique for obtaining tissue samples from suspicious lesions in the breast or other organs. - This allows for **real-time visualization** of the needle, improving accuracy and reducing complications. *Can be used to differentiate solid VS cystic* - **USG** excels at distinguishing between **solid masses and fluid-filled cysts** due to differences in sound wave reflection. - This capability is crucial in characterizing breast lesions and often eliminates the need for further invasive procedures for benign cysts. *In young females with dense breasts* - **Dense breast tissue** in young females can obscure lesions on mammography, making interpretation difficult. - **USG** is particularly valuable in this population because it is not hindered by breast density and can provide a clearer view of underlying pathology.

Q: A surgeon examined the case of hernia. Forcefully reduces the sac in abdominal cavity, without actually pushing back the contents. Identify the type of hernia.

Reduction en masse. ***Reduction en masse*** - **Reduction en masse** is a dangerous complication that occurs during attempted hernia reduction where the entire hernia sac, along with its incarcerated contents, is pushed back into the abdominal cavity. - The key feature is that **the contents remain trapped within the sac** after reduction, creating a false sense of successful reduction. - The scenario explicitly describes this: "forcefully reduces the sac... without actually pushing back the contents" - this is the textbook definition of reduction en masse. - This complication is dangerous because the incarcerated/strangulated bowel remains undetected inside the abdomen, potentially leading to **peritonitis and bowel necrosis**. - The hernia defect appears reduced externally, but the obstruction persists internally. *Incarcerated hernia* - An **incarcerated hernia** is the state where hernia contents are trapped and cannot be reduced back into the abdominal cavity. - This represents the **pre-existing condition** before the forceful reduction attempt was made. - While incarceration may have been present initially, the question asks about the outcome after the surgeon "forcefully reduces the sac" - this action creates a reduction en masse. *Sliding hernia* - A **sliding hernia** involves a retroperitoneal organ (colon, bladder, ovary) forming part of the hernia sac wall itself. - This is a structural variant unrelated to the reduction complication described in the scenario. *Maydl's hernia* - **Maydl's hernia** (W-hernia or retrograde strangulation) involves a loop of bowel where both ends remain in the abdomen while the intermediate segment is trapped in the hernia sac. - The strangulated segment is the intra-abdominal portion, not the part in the sac. - This is a specific type of hernia content configuration, not related to the reduction complication described.

Question 1

Anterior relations of third part of duodenum are all except?

Accepted Answer

Fundus of gallbladder

Answer

Jejunum

Answer

Root of mesentery

Answer

Superior mesenteric artery

Question 2

Which of the following microorganisms will be resistant to meropenem and aminoglycosides but sensitive to piperacillin tazobactam and cotrimoxazole?

Accepted Answer

Stenotrophomonas

Answer

Pseudomonas

Answer

Acinetobacter

Answer

Burkholderia cepacia

Question 3

A 30-year-old pregnant female diagnosed with fibroid presented with fever, mild leukocytosis, and pain at 28 weeks. What is the likely cause?

Accepted Answer

Red degeneration of fibroid

Answer

Fibroid infection

Answer

Fibroid torsion

Answer

Labor pain

Question 4

A patient complained of whitish discharge from the vagina and yellow staining on their clothes. There is no itching, no redness, and pH is acidic. What is the likely cause?

Accepted Answer

Increased normal vaginal discharge

Answer

Trichomoniasis

Answer

Candidiasis

Answer

Bacterial vaginosis

Question 5

What are clue cells?

Accepted Answer

Vaginal epithelial cells lined by bacteria

Answer

Uterine epithelial cells lined by bacteria

Answer

Cervical epithelial cells lined by bacteria

Answer

Abdominal cells lined by bacteria

Question 6

The patient presented with a retroverted uterus, dysmenorrhea, and dyspareunia. What is the next step of the investigation?

Accepted Answer

USG

Answer

HSG

Answer

Laparotomy

Answer

Diagnostic Laparoscopy

Question 7

What is not an advantage of USG over mammography?

Accepted Answer

Superior detection of microcalcifications

Answer

Can be used for guided biopsy

Answer

In young females with dense breasts

Answer

Can be used to differentiate solid VS cystic

Question 8

A surgeon examined the case of hernia. Forcefully reduces the sac in abdominal cavity, without actually pushing back the contents. Identify the type of hernia.

Accepted Answer

Reduction en masse

Answer

Sliding hernia

Answer

Incarcerated hernia

Answer

Maydl's hernia

INI-CET 2023

Anatomy

Microbiology

Obstetrics and Gynecology

Radiology

Surgery