INI-CET 2017 Practice Questions

Q: Which of the following layers has abundance of desmosomes? (AIIMS Nov 2017)

C. ***C*** - Layer C represents the **stratum spinosum** (prickle cell layer) of the epidermis, which is characterized by abundant **desmosomes**. - These desmosomes give the cells a **prickly appearance** when stained, as the cells shrink but the desmosomal attachments remain, pulling on the cell membranes. *A* - Layer A represents the **stratum corneum**, which is the outermost layer consisting of flattened, anucleated cells filled with **keratin**. - While desmosomes are present deeper in the epidermis, this layer is primarily involved in **protection** and shedding of dead cells. *B* - Layer B represents the **stratum granulosum**, characterized by cells containing **keratohyalin granules**. - These granules are precursors to keratin, and while desmosomes connect cells here, they are less prominent than in the stratum spinosum. *D* - Layer D represents the **stratum basale** (basal layer), which is the deepest epidermal layer of cuboidal or columnar cells. - These cells are responsible for **cell proliferation** and connect to the basement membrane via **hemidesmosomes**, and to each other via desmosomes, but not as abundantly as in the stratum spinosum.

Q: The kit shown here is used for management of which of the following? (AIIMS Nov 2017)

Lower abdominal pain (PID). ***Lower abdominal pain (PID)*** - The NACO STI kit shown is specifically designed for **lower abdominal pain syndrome**, which represents **Pelvic Inflammatory Disease (PID)** in women and related conditions in men. - PID kits contain specific antibiotics like **doxycycline** and **metronidazole** with longer treatment durations (typically 14 days) compared to discharge syndrome kits, addressing the ascending infection that characterizes PID. *Urethral or anorectal discharge* - Discharge syndrome kits contain different antibiotic combinations, typically **azithromycin** or **ceftriaxone** for shorter durations (single dose or 7 days maximum). - These kits are specifically labeled for **urethral discharge syndrome** and would not be appropriate for managing lower abdominal pain or PID. *Inguinal bubo* - **Inguinal bubo** syndrome requires specific management for **lymphogranuloma venereum** or **chancroid** with antibiotics like doxycycline for 21 days. - NACO has separate kits for bubo syndrome that include specific instructions for **lymph node management** and longer antibiotic courses. *Genital ulcer (Non-herpetic)* - **Genital ulcer syndrome** kits contain antibiotics targeting **syphilis** and **chancroid**, typically including **benzathine penicillin** or **azithromycin**. - These kits are specifically designed for ulcerative lesions and would not address the **ascending pelvic infection** characteristic of PID.

Q: A child has a pruritic rash as shown below. His mother is an asthmatic. Comment on the diagnosis:

Atopic dermatitis. ***Atopic dermatitis*** - The image shows a classic presentation of **eczematous rash** in the **flexural areas** (knees), which is characteristic of atopic dermatitis. - The history of a **mother with asthma** suggests an **atopic diathesis**, increasing the likelihood of atopic dermatitis in the child due to its strong genetic component and association with other atopic conditions (asthma, allergic rhinitis). *Seborrheic dermatitis* - Typically presents as **greasy, yellowish scales** on an erythematous base, commonly affecting the scalp, face (eyebrows, nasolabial folds), and chest. - While it can occur in infants ("cradle cap"), its morphology and locations are distinct from the rash seen in the image. *Allergic contact dermatitis* - This rash would typically be localized to areas of direct contact with an **allergen** and would not necessarily show the typical flexural distribution seen in the image. - It often presents with more acute **vesicles, bullae, and intense pruritus** strictly limited to the exposure site. *Erysipelas* - Erysipelas is a **superficial bacterial skin infection** characterized by a **well-demarcated, erythematous, raised, and warm plaque**, often with systemic symptoms like fever and chills. - The rash in the image does not present with the characteristic features of an acute bacterial infection.

Q: The skin condition shown in the image is associated with?

Diabetes mellitus. ***Diabetes mellitus*** - The image shows **diabetic dermopathy** (also known as "shin spots"), which presents as hyperpigmented, atrophic macules or papules, usually on the shins. This condition is a common cutaneous manifestation of **diabetes mellitus**. - Other dermatological conditions associated with diabetes include **necrobiosis lipoidica diabeticorum**, **acanthosis nigricans**, and **erythrasma**, which are important to recognize in patients with diabetes. *Hypothyroidism* - Hypothyroidism is associated with **myxedema**, which typically manifests as non-pitting edema, dry and coarse skin, and hair loss. - While it can cause skin changes, it does not typically present with the pigmented, atrophic lesions seen in the image. *Hyperthyroidism* - Hyperthyroidism can cause skin changes such as **pretibial myxedema** (a specific form of localized skin thickening, typically on the shins, that is often associated with Graves' disease) and warm, moist skin due to increased metabolism. - The lesions shown in the image are not consistent with the typical presentation of pretibial myxedema or other hyperthyroid skin manifestations. *Sarcoidosis* - Sarcoidosis can present with various skin lesions, including **erythema nodosum**, lupus pernio, plaques, and papules. - The skin changes seen in the image, characterized by small, atrophic, hyperpigmented macules, do not fit the typical pattern of cutaneous sarcoidosis.

Q: A 50-year-old man presents with frontal bossing, enlarged tongue and following appearance of hand. Which of the following tests should be done in this patient?

Insulin like growth factor. ***Insulin like growth factor*** - The patient's symptoms of **frontal bossing**, **enlarged tongue (macroglossia)**, and the image showing an **enlarged hand** (suggestive of **acral enlargement**) are classic features of **acromegaly**. - **Insulin-like growth factor 1 (IGF-1)** is the best screening test for acromegaly because its levels are stable throughout the day and reflect integrated GH secretion; elevated IGF-1 is indicative of the condition. *Thyroid hormone assay* - This test measures **thyroid function** and is primarily used to diagnose conditions like **hypothyroidism** or **hyperthyroidism**. - While some symptoms of thyroid disorders can overlap with other conditions, the specific constellation of **acral enlargement**, **macroglossia**, and **frontal bossing** is not typical for thyroid dysfunction. *Serum prolactin* - **Serum prolactin** is primarily used to assess for **hyperprolactinemia**, which can cause symptoms like **galactorrhea** or **hypogonadism**. - While a **prolactinoma** (a pituitary tumor secreting prolactin) can sometimes coexist with a **growth hormone-secreting tumor**, prolactin itself is not the direct cause of acromegalic features, and its assay is not the initial diagnostic test for acromegaly. *Serum Testosterone* - **Serum testosterone** levels are assessed in cases of suspected **hypogonadism** or other **androgen-related disorders**. - The clinical presentation with **acral enlargement** and **facial changes** is not characteristic of testosterone deficiency or excess.

Q: Identify the sleep stage in the following Polysomnograph.

NREM stage 2. ***NREM stage 2*** - The **EEG** shows prominent **sleep spindles** (bursts of 12-14 Hz waves) and **K-complexes** (high-amplitude biphasic waves), which are characteristic features of NREM stage 2 sleep. - The EOG channels indicate slow eye movements or an absence of rapid eye movements, consistent with NREM sleep, while the **EMG shows moderate muscle tone**, higher than in REM sleep but lower than wakefulness. *NREM stage 3* - This stage is characterized by **delta waves**, which are slow waves with high amplitude (0.5-2 Hz, often >75 μV) on the EEG, comprising 20% or more of the epoch, and are not significantly visible here. - While muscle tone is still present, the EEG would primarily show widespread **slow-wave activity**, distinguishing it from the sleep spindles and K-complexes seen in the image. *REM* - **Rapid eye movements** would be clearly visible on the EOG channels, which are not prevalent in this polysomnograph. - The **EMG would show very low muscle tone** (atonia), which is not the case here, and the EEG would largely consist of low-voltage, mixed-frequency activity, similar to wakefulness. *NREM stage 1* - This stage is typically characterized by a **disappearance of alpha waves** from the EEG and the presence of **theta waves** (4-7 Hz). - While there may be slow eye movements on the EOG, **sleep spindles and K-complexes are absent** in NREM stage 1, making it distinct from the presented polysomnograph.

Q: A patient presents with complaints of fever and abdominal distention. He is having history of bloody diarrhea off and on for previous 6 months. X-ray abdomen is shown below. What is the diagnosis?

Toxic megacolon. ***Toxic megacolon*** - The image shows **marked dilation of the colon** with loss of haustral markings, consistent with megacolon. - The clinical picture of fever, abdominal distention, and bloody diarrhea in a patient with a history of inflammatory bowel disease (implied by chronic bloody diarrhea) strongly suggests **toxic megacolon**. - Toxic megacolon is a life-threatening complication of IBD requiring urgent management. *Pneumatosis intestinalis* - This condition involves **gas within the wall of the bowel**, which would appear as characteristic lucencies outlining the bowel wall on X-ray. - While it can be seen in severe bowel ischemia, it is not the primary finding of diffuse colonic dilation seen here. *Volvulus* - Volvulus is a **twisting of a loop of intestine** around its mesentery, leading to obstruction and ischemia. - While it can cause colonic dilation, the dilation is typically localized to the twisted segment (e.g., a "coffee bean" sign in sigmoid volvulus) rather than the diffuse involvement seen here. *Intestinal perforation* - Intestinal perforation is characterized by the presence of **free air under the diaphragm** (pneumoperitoneum) on an upright chest X-ray or lateral decubitus abdominal film. - While a severely dilated and inflamed colon can perforate, there is no clear evidence of free air outside the bowel wall in this X-ray. *Paralytic ileus* - Paralytic ileus causes **generalized bowel dilation** and can present with abdominal distention. - However, it typically involves both small and large bowel, lacks the **loss of haustral markings** specific to toxic megacolon, and does not typically present with **fever and bloody diarrhea** in the context of chronic inflammatory bowel disease.

Q: Phonocardiogram tracing is shown below with corresponding ECG. Identify the phase corresponding with $S_{2}$ in phonocardiogram.

Isovolumetric relaxation. ***Isovolumetric relaxation*** - **S₂ (second heart sound)** occurs due to closure of the **aortic and pulmonary semilunar valves** at the end of systole, marking the onset of isovolumetric relaxation. - On the **ECG**, S₂ corresponds to the **end of the T wave**, when ventricular pressure drops below aortic pressure causing valve closure. *Isovolumetric contraction* - This phase corresponds to **S₁ (first heart sound)** caused by closure of the **mitral and tricuspid valves** at the beginning of systole. - Occurs on the ECG around the **QRS complex**, not at the timing of S₂. *Rapid ejection* - This phase occurs **between S₁ and S₂** when blood is actively ejected from the ventricles into the aorta and pulmonary artery. - The **semilunar valves are open** during this phase, so no heart sounds are produced. *Rapid ventricular filling* - This phase occurs **after S₂** during early diastole when the **AV valves open** and blood rapidly fills the ventricles. - May be associated with **S₃ gallop** in pathological conditions, but not with S₂.

Q: A car accident patient complains of breathlessness. On examination BP is $110 / 70 \mathrm{mmHg}$ with GCS of 15/15. On examination, trachea is deviated to the right side, with reduced breath sounds in left infra-axillary area and inframammary areas. $S_{1}$ and $S_{2}$ are normal in intensity and splitting. CXR is shown below. What is the best step in management of the patient?

Chest tube insertion. ***Chest tube insertion*** - The patient's symptoms (breathlessness, tracheal deviation to the right, reduced breath sounds in the left infra-axillary and inframammary areas) combined with the CXR findings indicate a **left-sided hemothorax or pneumothorax** causing mediastinal shift. - A chest tube will **drain the accumulated air or fluid**, re-expand the lung, and relieve the mediastinal shift, thereby improving breathing. - This is **NOT a tension pneumothorax** (patient is hemodynamically stable with BP 110/70 mmHg), so definitive chest tube insertion is preferred over needle decompression. *Needle aspiration* - Needle thoracostomy is indicated for **tension pneumothorax**, which presents with hemodynamic instability, severe respiratory distress, and requires immediate decompression. - This patient is **hemodynamically stable** (normal BP, GCS 15/15), indicating a simple pneumothorax or hemothorax that requires **chest tube** for definitive drainage rather than temporary needle aspiration. *Pericardiocentesis* - **Pericardiocentesis** is indicated for **cardiac tamponade**, which presents with muffled heart sounds, hypotension, and distended neck veins (Beck's triad). - The patient's **normal blood pressure, normal heart sounds** (S₁ and S₂ normal), and clinical findings pointing to pleural pathology rule out cardiac tamponade. *Immediate thoracotomy* - **Immediate thoracotomy** is reserved for massive hemothorax with **>1500 mL initial drainage** or **>200 mL/hour persistent bleeding** after chest tube insertion, or for major vessel/cardiac injuries. - Initial management should be **chest tube insertion** for drainage and assessment before proceeding to thoracotomy.

Question 1

Which of the following layers has abundance of desmosomes? (AIIMS Nov 2017)

Accepted Answer

C

Answer

A

Answer

B

Answer

D

Question 2

The kit shown here is used for management of which of the following? (AIIMS Nov 2017)

Accepted Answer

Lower abdominal pain (PID)

Answer

Inguinal bubo

Answer

Genital ulcer (Non-herpetic)

Answer

Urethral or anorectal discharge

Question 3

A child has a pruritic rash as shown below. His mother is an asthmatic. Comment on the diagnosis:

Accepted Answer

Atopic dermatitis

Answer

Seborrheic dermatitis

Answer

Allergic contact dermatitis

Answer

Erysipelas

Question 4

The skin condition shown in the image is associated with?

Accepted Answer

Diabetes mellitus

Answer

Hypothyroidism

Answer

Hyperthyroidism

Answer

Sarcoidosis

Question 5

A 50-year-old man presents with frontal bossing, enlarged tongue and following appearance of hand. Which of the following tests should be done in this patient?

Accepted Answer

Insulin like growth factor

Answer

Thyroid hormone assay

Answer

Serum prolactin

Answer

Serum Testosterone

Question 6

This 50-year-old patient developed syncope after having a coffee. ECG was done .Which is the most appropriate therapy for a patient suffering from the condition shown below?

Accepted Answer

DC shock

Answer

Lignocaine

Answer

Amiodarone

Answer

Esmolol

Answer

Magnesium sulfate

Question 7

Identify the sleep stage in the following Polysomnograph.

Accepted Answer

NREM stage 2

Answer

NREM stage 3

Answer

REM

Answer

NREM stage 1

Question 8

A patient presents with complaints of fever and abdominal distention. He is having history of bloody diarrhea off and on for previous 6 months. X-ray abdomen is shown below. What is the diagnosis?

Accepted Answer

Toxic megacolon

Answer

Pneumatosis intestinalis

Answer

Volvulus

Answer

Intestinal perforation

Answer

Paralytic ileus

Question 9

Phonocardiogram tracing is shown below with corresponding ECG. Identify the phase corresponding with $S_{2}$ in phonocardiogram.

Accepted Answer

Isovolumetric relaxation

Answer

Isovolumetric contraction

Answer

Rapid ejection

Answer

Rapid ventricular filling

Question 10

A car accident patient complains of breathlessness. On examination BP is $110 / 70 \mathrm{mmHg}$ with GCS of 15/15. On examination, trachea is deviated to the right side, with reduced breath sounds in left infra-axillary area and inframammary areas. $S_{1}$ and $S_{2}$ are normal in intensity and splitting. CXR is shown below. What is the best step in management of the patient?

Accepted Answer

Chest tube insertion

Answer

Needle aspiration

Answer

Pericardiocentesis

Answer

Immediate thoracotomy

INI-CET 2017

Anatomy

Community Medicine

Dermatology

Internal Medicine

Physiology

Surgery