INI-CET 2021 Practice Questions

Q: A skull was recovered from a forest. According to inquest papers, a girl had gone missing 15 days back. The skull was sent to the forensic research lab. Which of the following would identify it as a female skull? 1. Large frontal and parietal eminence 2. Heavy cheek bones 3. Smooth glabella 4. Square orbits 5. Narrow mastoid

1,3 and 5. ***1,3 and 5*** - **Large frontal and parietal eminences** are characteristic features of a **female skull**, indicating a more rounded appearance. - A **smooth glabella** (the area between the eyebrows) is typical for females, as males tend to have a more prominent brow ridge. A **narrow mastoid** process is also characteristic in females. *2,3 and 4* - **Heavy cheekbones** and **square orbits** are features more commonly associated with a **male skull**. - While a **smooth glabella** is a female characteristic, its combination with male features makes this option incorrect. *1 and 4 only* - **Large frontal eminences** are indicative of a female skull, but **square orbits** are a feature of a **male skull**. - This combination presents conflicting information regarding gender identification. *3,4 and 5* - A **smooth glabella** and **narrow mastoid** are features of a **female skull**. - However, **square orbits** are typically found in **male skulls**, rendering this option incorrect.

Q: The dead body of a 20 year old man found in the sea was brought in for postmortem examination. Which of the following findings would you see in seawater drowning? 1. Hemoconcentration 2. Pulmonary edema 3. Hyponatremia 4. Hypernatremia 5. Hemolysis

1 and 4. ***1 and 4*** - In **seawater drowning**, the hypertonic seawater (3-4% salt) creates an osmotic gradient that pulls plasma fluid from the blood into the alveoli, leading to **hemoconcentration**. - The absorption of hypertonic seawater into the bloodstream results in **hypernatremia** and hyperchloremia. - These are the characteristic electrolyte and hematologic findings specific to seawater drowning. *2, 4 and 5* - While **hypernatremia** is correct, this option incorrectly includes **pulmonary edema** (which is non-specific to drowning type) and **hemolysis** (which is characteristic of freshwater drowning, not seawater). - **Hemolysis** occurs in freshwater drowning when hypotonic water enters the bloodstream, causing red blood cells to swell and lyse. *2, 3 and 5* - This option is incorrect as it includes findings characteristic of **freshwater drowning**: **hyponatremia** and **hemolysis**. - In freshwater drowning, hypotonic water absorption causes hemodilution (not hemoconcentration), leading to hyponatremia and hemolysis. - **Pulmonary edema** is present in both types but does not differentiate between them. *1 and 3* - While **hemoconcentration** is correct for seawater drowning, **hyponatremia** is incorrect. - Hyponatremia is a feature of freshwater drowning due to dilution of serum sodium by absorbed hypotonic water.

Q: The friend and victim had alcohol and got into an argument over a common girlfriend, following which the friend kills the victim by sitting on his chest and covering his nose and mouth. This is an example of?

Smothering. ***Smothering*** - This scenario describes **manual obstruction** of the mouth and nose, preventing air entry without external neck compression. - The act of sitting on the chest further restricts respiratory movements, contributing to **asphyxia**. *Gagging* - Gagging refers to the obstruction of the **oral cavity** due to material placed inside the mouth, typically to prevent speaking or crying out. - While it can contribute to asphyxia, the primary mechanism described here involves external covering of both nose and mouth. *Choking* - Choking involves the **internal obstruction** of the airway, usually by a foreign body lodged in the pharynx or larynx. - This scenario explicitly details external occlusion of the respiratory orifices, not internal blockage. *Throttling* - Throttling is a form of **manual strangulation** that involves direct compression of the neck by hands or forearm. - The description of covering the nose and mouth rather than compressing the neck rules out throttling.

Q: A karyotyping image is given below. What are the clinical features most likely to be expected in such patients?

Gynecomastia and long limbs. ***Gynecomastia and long limbs*** - The given karyotype shows **47, XXY**, which is characteristic of **Klinefelter syndrome**. - **Gynecomastia** and **long limbs** (tall stature with disproportionately long legs and arms) are classic features of Klinefelter syndrome due to the extra X chromosome's effect on hormonal balance and growth. *Flat occiput* - A **flat occiput** is a characteristic feature of **Down syndrome (Trisomy 21)**, not Klinefelter syndrome. - Down syndrome also presents with other distinct features such as epicanthic folds, a single palmar crease, and intellectual disability. *Webbing of neck and lymphedema* - **Webbing of the neck** and **lymphedema** (especially of the hands and feet) are prominent features of **Turner syndrome (45, X0)**. - Turner syndrome is a sex chromosome aneuploidy affecting females, characterized by short stature, ovarian dysgenesis, and often congenital heart defects like coarctation of the aorta. *Short stature and polydactyly* - While **short stature** can be associated with various genetic conditions (e.g., Turner syndrome, achondroplasia), it is generally **not a primary feature of Klinefelter syndrome**, which typically involves tall stature. - **Polydactyly** (extra fingers or toes) is a feature of several genetic syndromes, such as Patau syndrome (Trisomy 13) or Bardet-Biedl syndrome, and is not associated with Klinefelter syndrome.

Q: What is the minimum percentage for normal sperm morphology according to WHO criteria in seminal fluid analysis?

4 %. ***4 %*** - According to the **World Health Organization (WHO) 2010 criteria** (maintained in WHO 2021, 6th edition), a minimum of **4% normal forms** is considered the lower reference limit for **sperm morphology**. - This seemingly low percentage reflects the **strict criteria (Tygerberg's strict criteria)** used for assessing sperm shape and structure, which evaluates the head, midpiece, and tail dimensions. - Values ≥4% are considered within normal range for **male fertility potential**. *8 %* - An 8% normal morphology would be considered **above the lower reference limit** according to current WHO guidelines. - While quantitatively better and indicating good sperm quality, it is not the *minimum* threshold required for classification as normal. *6 %* - A **6% normal morphology** is above the 4% minimum threshold set by WHO for normal sperm morphology. - This value is not the designated **lower reference limit** for identifying normal morphology as per the standard recommendations. *10 %* - A 10% normal morphology indicates **very good sperm morphology**, well above the lower reference limit. - However, the question asks for the **minimum percentage** for normal classification, and 10% is not that lower threshold.

Q: Which of the following instruments are used in the caesarean section? 1. Bard-Parker blade 2. Doyen's retractor 3. Cusco's speculum 4. Allis forceps 5. Shirodkar's uterine clamp 6. Green Armytage forceps

1,2,4,6. ***Correct: 1,2,4,6*** - **Bard-Parker blade** (scalpel) is used for making the abdominal and uterine incisions in caesarean section. - **Doyen's retractor** is a common abdominal wall retractor used in C-sections to provide good exposure of the uterus. - **Allis forceps** are used to grasp and hold tissues, often the rectus sheath or uterine edges, for traction or approximation during the procedure. - **Green Armytage forceps** are specialized obstetric forceps primarily used to clamp the uterine edges after incision to control bleeding. *Incorrect: 1,2,3,6* - This option incorrectly includes **Cusco's speculum**, which is a vaginal speculum used for gynecological examinations and procedures like colposcopy or Pap smears, not for a caesarean section. - While Bard-Parker blade, Doyen's retractor, and Green Armytage forceps are correct, the inclusion of Cusco's speculum makes this option incorrect. *Incorrect: 1,2,5,6* - This option incorrectly includes **Shirodkar's uterine clamp**. Shirodkar's procedure refers to a type of cervical cerclage, and there isn't a widely recognized "Shirodkar's uterine clamp" used in standard caesarean sections. - Bard-Parker blade, Doyen's retractor, and Green Armytage forceps are correct, but the presence of Shirodkar's uterine clamp makes the option incorrect in the context of a typical C-section. *Incorrect: 1,2,3,5* - This option incorrectly includes both **Cusco's speculum** and **Shirodkar's uterine clamp**. - As explained, Cusco's speculum is for vaginal examination, and Shirodkar's clamp is not a standard instrument for caesarean sections.

Q: What is the normal cervical length?

3 cm. ***3 cm*** - The **normal cervical length** in a non-pregnant woman typically measures **3-4 cm**, with **3 cm** being the commonly cited average. - During pregnancy, cervical length is monitored via transvaginal ultrasound, and a length ≥3 cm is considered reassuring for pregnancy maintenance. - This measurement is crucial for assessing the risk of preterm labor and cervical incompetence. *10 cm* - A cervical length of **10 cm is anatomically impossible** and not consistent with normal female reproductive anatomy. - The entire uterus (fundus to external os) measures approximately 7-8 cm in a non-pregnant state, making 10 cm for cervix alone unrealistic. *5 cm* - While **5 cm is within the upper range** of normal cervical length, it is longer than the typical average. - Cervical length can vary between 3-5 cm in healthy women, but **3-4 cm is most commonly cited** as the standard reference. *7 cm* - A cervical length of **7 cm is longer than normal** and would be considered abnormally elongated. - This measurement approximates the entire uterine length (fundus to external os), not just the cervix.

Q: Which of the following is true? 1. BRCA1 is an oncogene 2. HER2neu is amplified only in a fraction of breast cancer 3. EGFR (+) is seen in non-small cell lung cancer 4. N-MYC is a tumor suppressor gene

2,3. ***Correct Option: 2,3*** - **Statement 2 is TRUE**: HER2neu amplification occurs in only a fraction (~15-20%) of breast cancers, making it a specific subset requiring targeted therapy with trastuzumab (Herceptin) [1]. - **Statement 3 is TRUE**: EGFR (epidermal growth factor receptor) mutations or overexpression are commonly seen in non-small cell lung cancer (NSCLC) and serve as important therapeutic targets for tyrosine kinase inhibitors. *Incorrect Option: 1,3* - Statement 1 is **FALSE**: BRCA1 is a **tumor suppressor gene**, not an oncogene. It functions in DNA double-strand break repair, and loss-of-function mutations increase the risk of breast and ovarian cancers. - Statement 3 is TRUE, but the inclusion of the false statement about BRCA1 makes this option incorrect. *Incorrect Option: 1,2* - Statement 1 is **FALSE**: BRCA1 is a **tumor suppressor gene**, not an oncogene. - Statement 2 is TRUE [1], but the false classification of BRCA1 invalidates this option. *Incorrect Option: All of the options* - Statement 1 is **FALSE**: BRCA1 is a tumor suppressor gene, not an oncogene. - Statement 4 is **FALSE**: N-MYC is an **oncogene** that is amplified in neuroblastoma and other cancers, not a tumor suppressor gene. - Since two of the four statements are incorrect, "All of the options" cannot be true. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1059-1060.

Q: A karyotyping image is given below. What are the clinical features most likely to be expected in such patients?

Gynecomastia and long limbs. ***Gynecomastia and long limbs*** - The karyotype shows **47, XXY**, which is characteristic of **Klinefelter syndrome** [1]. - **Gynecomastia** (breast development in males) and disproportionately **long limbs** with tall stature [1] are classic features of Klinefelter syndrome due to the extra X chromosome. - Other features include small testes, infertility, and reduced secondary sexual characteristics [1]. *Flat occiput* - **Flat occiput** is a characteristic feature of **Down syndrome** (Trisomy 21), which shows karyotype 47, XX or XY, +21. - The given karyotype shows a normal set of autosomes with normal chromosome 21 count, ruling out Down syndrome. *Epicanthal folds and single palmar crease* - These are also characteristic features of **Down syndrome** (Trisomy 21). - **Epicanthal folds** (skin folds at the inner corner of the eyes) and **single palmar crease** (simian crease) are common dysmorphic features in trisomy 21. - The karyotype shown is 47, XXY, not trisomy 21. *Webbed neck and shield chest* - **Webbed neck** and **shield chest** are characteristic features of **Turner syndrome** (45, X) [1]. - Turner syndrome affects phenotypic females with monosomy X, showing karyotype 45, X [1]. - The given karyotype shows 47, XXY with male sex chromosomes (XY + extra X), not monosomy X. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 173-177.

Q: Which of the following can be prevented by transfusing irradiated RBCs?

Graft versus host disease. Graft versus host disease - **Irradiation** of red blood cell (RBC) products inactivates proliferating donor **T-lymphocytes**, which are responsible for mediating transfusion-associated **graft-versus-host disease (TA-GVHD)**. - TA-GVHD is a severe and often fatal complication where donor immune cells attack recipient tissues. *HLA Alloimmunization* - **HLA alloimmunization** is prevented by **leukoreduction**, which removes donor leukocytes expressing HLA antigens, not by irradiation. - Irradiation targets the proliferative capacity of T-lymphocytes, but does not remove the cells themselves or prevent the presentation of HLA antigens. *Transfusion Related Acute Lung Injury (TRALI)* - **TRALI** is primarily associated with **donor antibodies** (anti-HLA or anti-HNA) in plasma that react with recipient neutrophils, leading to lung injury. - It is prevented by selecting plasma donors who have not been pregnant or by using male-only plasma, not by irradiating RBCs. *Immunomodulation* - **Transfusion-related immunomodulation (TRIM)** is a broad effect associated with multiple blood components, including cytokines and biological response modifiers in the transfused products. - While leukoreduction may reduce some aspects of TRIM, irradiation is not specifically used to prevent or reduce this phenomenon.

Question 1

A skull was recovered from a forest. According to inquest papers, a girl had gone missing 15 days back. The skull was sent to the forensic research lab. Which of the following would identify it as a female skull?

1. Large frontal and parietal eminence
2. Heavy cheek bones
3. Smooth glabella
4. Square orbits
5. Narrow mastoid

Accepted Answer

1,3 and 5

Answer

2,3 and 4

Answer

1 and 4 only

Answer

3,4 and 5

Question 2

The dead body of a 20 year old man found in the sea was brought in for postmortem examination. Which of the following findings would you see in seawater drowning?

1. Hemoconcentration
2. Pulmonary edema
3. Hyponatremia
4. Hypernatremia
5. Hemolysis

Accepted Answer

1 and 4

Answer

2,4 and 5

Answer

2,3 and 5

Answer

1 and 3

Question 3

The friend and victim had alcohol and got into an argument over a common girlfriend, following which the friend kills the victim by sitting on his chest and covering his nose and mouth. This is an example of?

Accepted Answer

Smothering

Answer

Gagging

Answer

Choking

Answer

Throttling

Question 4

A karyotyping image is given below. What are the clinical features most likely to be expected in such patients?

Accepted Answer

Gynecomastia and long limbs

Answer

Flat occiput

Answer

Webbing of neck and lymphedema

Answer

Short stature and polydactyly

Question 5

What is the minimum percentage for normal sperm morphology according to WHO criteria in seminal fluid analysis?

Accepted Answer

4 %

Answer

8 %

Answer

6 %

Answer

10 %

Question 6

Which of the following instruments are used in the caesarean section?

1. Bard-Parker blade
2. Doyen's retractor
3. Cusco's speculum
4. Allis forceps
5. Shirodkar's uterine clamp
6. Green Armytage forceps

Accepted Answer

1,2,4,6

Answer

1,2,3,6

Answer

1,2,5,6

Answer

1,2,3,5

Question 7

What is the normal cervical length?

Accepted Answer

3 cm

Answer

10 cm

Answer

5 cm

Answer

7 cm

Question 8

Which of the following is true?

1. BRCA1 is an oncogene
2. HER2neu is amplified only in a fraction of breast cancer
3. EGFR (+) is seen in non-small cell lung cancer
4. N-MYC is a tumor suppressor gene

Accepted Answer

2,3

Answer

1,3

Answer

1,2

Answer

All of the options

Question 9

A karyotyping image is given below. What are the clinical features most likely to be expected in such patients?

Accepted Answer

Gynecomastia and long limbs

Answer

Flat occiput

Answer

Webbed neck and shield chest

Answer

Epicanthal folds and single palmar crease

Question 10

Which of the following can be prevented by transfusing irradiated RBCs?

Accepted Answer

Graft versus host disease

Answer

HLA Alloimmunization

Answer

Transfusion Related Acute Lung Injury (TRALI)

Answer

Immunomodulation

INI-CET 2021

Forensic Medicine

Internal Medicine

Obstetrics and Gynecology

Pathology