INI-CET 2022 Practice Questions

Q: Identify which of the following structure is a sebaceous gland:

2. ***Correct: (2) Sebaceous gland*** - The structure labeled (2) is a **sebaceous gland**, characterized by its **multicellular alveolar structure** typically associated with a hair follicle - Sebaceous glands are **holocrine glands** where the entire cell disintegrates to release sebum (oily secretion) - These glands are found throughout the body except on palms and soles, and produce **sebum for lubrication** of hair and skin - Histologically identified by **grape-like clusters of cells** with foamy cytoplasm due to lipid content *Incorrect: (3) Inner root sheath* - The structure labeled (3) represents the **inner root sheath** of the hair follicle - This is a **structural component**, not a glandular structure - Functions to provide support and guidance to the developing hair shaft - Composed of three layers: Henle's layer, Huxley's layer, and the cuticle *Incorrect: (4) Hair matrix* - The structure labeled (4) indicates the **hair matrix**, located at the base of the hair follicle - This is a **proliferative zone** with actively dividing cells responsible for hair growth - Not a glandular structure, but rather the germinative region where hair cells differentiate - Contains melanocytes that provide pigment to the growing hair *Incorrect: (1) Hair shaft* - The structure labeled (1) is the **hair shaft**, the visible keratinized portion of the hair - This is the **final product** of the hair follicle, composed of dead, keratinized cells - Not a glandular structure, but rather a modified epidermal structure - Extends from the hair follicle through the skin surface

Q: A woman presents with lesions on the inner thighs and peri-anal region. They are nodular, 4-6 mm in size and appear pale. The histopathological image shows multiple intracytoplasmic inclusion bodies consistent with Henderson-Patterson bodies. The diagnosis is:

Molluscum contagiosum. ***Molluscum contagiosum*** - The clinical presentation of **nodular, pale lesions** in the inner thighs and peri-anal region, combined with histopathology showing **Henderson-Patterson bodies** (large eosinophilic intracytoplasmic inclusions), is pathognomonic for molluscum contagiosum. - Henderson-Patterson bodies represent viral factories within infected keratinocytes, a key diagnostic feature of this **poxvirus** infection. *Trichodysplasia spinulosa* - This condition is characterized by **follicular papules** with prominent keratin spines, typically occurring on the face, and is associated with the **Trichodysplasia spinulosa-associated polyomavirus**. - It does not present with Henderson-Patterson bodies or the typical nodular lesions seen in molluscum contagiosum. *Condyloma acuminata* - These are **genital warts** caused by the **human papillomavirus (HPV)**, presenting as verrucous or cauliflower-like growths. - Histologically, they show **koilocytic atypia** (vacuolated cells with nuclear abnormalities), not Henderson-Patterson bodies. *Donovanosis* - Also known as **granuloma inguinale**, this is a chronic, progressive, ulcerative granulomatous disease caused by **Klebsiella granulomatis**. - Histopathology reveals **Donovan bodies** (intracellular bacteria within macrophages), which are distinct from Henderson-Patterson bodies and the clinical presentation of nodular lesions.

Q: A 7 year old child presents with fever, erythematous rash, and bone pain. $X$ - ray of the skull shows multiple lytic lesions. Skin biopsy shows prominent nuclear grooves with eosinophils as in the image below. Immunohistochemistry for S100, CD1a is also shown in the images below. What would be the diagnosis ?

Langerhans cell histiocytosis. ***Langerhans cell histiocytosis*** - The combination of **fever**, **erythematous rash**, **bone pain with lytic lesions**, and **prominent nuclear grooves with eosinophils** on skin biopsy, along with positive **S100** and **CD1a** immunohistochemistry, is highly characteristic of Langerhans cell histiocytosis [1]. - This condition is a clonal proliferation of Langerhans cells, which can affect bone, skin, and other organs, particularly in children [1]. *Erdheim-Chester disease* - This is a rare, non-Langerhans cell histiocytosis typically affecting adults, characterized by **xanthogranulomatous infiltration** of various organs. - While it can involve bones with **sclerotic lesions**, **lytic lesions** are uncommon, and the histological features with **nuclear grooves** and **eosinophils** are distinct from LCH. *Juvenile xanthogranuloma* - This is a benign, usually solitary, self-resolving histiocytic proliferation that typically presents as a **cutaneous nodule** in infants or young children. - Systemic involvement is rare, and it does not typically cause **lytic bone lesions** or exhibit the characteristic nuclear features of Langerhans cells. *Rosai-Dorfman disease* - This is a rare, benign histicocytic disorder characterized by **massive lymphadenopathy**, particularly cervical, and is often associated with the presence of **emperipolesis** (lymphocytes within histiocytes). - It does not typically present with **lytic bone lesions**, **eosinophilic infiltration**, or positive staining for **CD1a** or **S100** in the same manner as LCH. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 629-630.

Q: Iron in tissues is stained by:

Prussian blue. ***Prussian blue*** - The **Prussian blue reaction**, also known as **Perls' stain**, specifically detects **ferric iron (Fe³⁺)** in tissues [3]. - It forms a **bright blue precipitate** (ferric ferrocyanide) when ferric iron reacts with potassium ferrocyanide in an acidic solution. *Masson's trichrome* - This stain is primarily used to differentiate **collagen fibers** from muscle fibers, which appear blue/green and red, respectively [1]. - It does not specifically stain or identify iron deposits in tissues. *PAS* - The **Periodic acid-Schiff (PAS) stain** is used to identify **carbohydrates** such as glycogen, mucosubstances, and fungal cell walls, which appear magenta. - It is not used for the detection of iron. *Congo red* - **Congo red** is a specialized stain used for identifying **amyloid deposits**, which appear pink-red and show apple-green birefringence under polarized light [2]. - It is not used for staining iron in tissues. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 25-26. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 268-269. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 394-395.

Q: Which of the following is the primary tissue dependent on insulin for glucose uptake?

Muscle. ***Muscle (Correct Answer)*** - **Skeletal muscle** is the **primary insulin-dependent tissue** for glucose uptake, accounting for approximately **80-90% of insulin-stimulated glucose disposal** in the postprandial state. - Insulin promotes the translocation of **GLUT4 transporters** to the cell membrane in muscle cells, enabling rapid and substantial glucose uptake. - This makes muscle the most quantitatively significant site for insulin-mediated glucose clearance from the bloodstream. *Adipose tissue (Incorrect)* - While **adipose tissue** does exhibit insulin-dependent glucose uptake via **GLUT4 transporters**, its contribution to overall glucose disposal is **much smaller** compared to skeletal muscle. - Glucose uptake in adipocytes is important for **lipogenesis** and triglyceride storage, but represents only a minor fraction of total body insulin-stimulated glucose uptake. *Brain (Incorrect)* - The **brain** has a constant, high glucose requirement but utilizes **insulin-independent** glucose uptake mechanisms, primarily through **GLUT1 and GLUT3 transporters**. - Glucose uptake in the brain is regulated by **blood glucose concentration gradients**, not by insulin signaling. - This ensures continuous glucose supply to the brain regardless of insulin levels. *Pancreas (Incorrect)* - The **pancreas**, particularly beta cells, employs **insulin-independent** glucose uptake via **GLUT1 and GLUT2 transporters**. - These transporters function as **glucose sensors**, allowing beta cells to detect blood glucose levels and regulate insulin secretion accordingly. - The pancreas produces insulin but does not depend on insulin for its own glucose uptake.

Q: What is the normal insensible water loss?

50 mL/hour. ***50 mL/hour*** - **Insensible water loss** occurs primarily through the **skin** and **respiratory tract** and typically amounts to approximately 1200 mL per day in an adult. - Dividing 1200 mL by 24 hours yields an average of **50 mL/hour**, representing normal physiological fluid loss not readily measurable. *150 mL/hour* - This value represents a significantly **elevated rate** of insensible water loss, which would suggest a patient experiencing **fever**, **tachypnea**, or a **hot environment**. - A sustained loss at this rate would quickly lead to **dehydration** if not compensated for by increased fluid intake. *200 mL/hour* - This is an **extreme rate** of water loss, indicating a severe condition such as **severe burns** affecting a large body surface area, **heat stroke**, or profound **hyperventilation**. - Such a high rate of fluid loss would be a medical emergency requiring aggressive fluid resuscitation. *100 mL/hour* - This rate of insensible water loss is **double the normal physiological rate** and, while not as extreme as 150 or 200 mL/hour, still implies increased metabolic activity or environmental stress. - It could be seen in individuals with moderate fever, increased physical activity, or in warmer ambient temperatures, and could contribute to mild dehydration over time.

Q: A woman must vomit whenever she eats spicy food. Arrange the sequence of events during vomiting. 1. LES is open and UES is closed 2. Strong contractions in the stomach 3. Inspiration against a closed glottis 4. Relaxation of the pyloric sphincter 5. LES opens and UES opens 6. Reverse peristalsis in the small intestine LES: Lower esophageal sphincter UES: Upper esophageal sphincter

6,4,2,3,1,5. ***6,4,2,3,1,5*** - The correct sequence of vomiting begins with **reverse peristalsis in the small intestine (6)**, which propels intestinal contents retrograde toward the stomach. - The **pyloric sphincter then relaxes (4)**, allowing duodenal contents to enter the stomach and mix with gastric contents. - **Strong stomach contractions (2)** follow, building initial pressure within the gastric lumen. - **Deep inspiration against a closed glottis (3)** is critical—this generates high intra-abdominal and intrathoracic pressure (the essential expulsive force). - The **LES opens while UES remains closed (1)**, allowing gastric contents to move into the esophagus. - Finally, the **UES opens (5)**, permitting expulsion of contents through the mouth. *4,6,2,1,3,5* - Incorrect because **pyloric sphincter relaxation precedes reverse peristalsis**, which is physiologically backwards—intestinal contents must first move toward the stomach before the pylorus can allow them entry. - The positioning of glottis closure late in the sequence misrepresents when intra-abdominal pressure is generated. *4,6,2,5,3,1* - This sequence incorrectly places **both sphincters opening (5) before the critical pressure-generating step (3)**, which would result in premature expulsion without adequate force. - The inspiration against closed glottis must occur before final sphincter opening to create the necessary expulsive pressure. *6,4,2,5,1,3* - This option misorders the final events by having **both sphincters open (5) before adequate pressure generation (3)** and before the sequential LES opening (1). - The glottis closure step is positioned too late—it must precede sphincter opening to generate the high intra-abdominal pressure required for forceful expulsion.

Q: Which of the following findings are seen in a high-resolution CT scan of fungal pneumonia? 1. Interlobular septations 2. Peripheral wedge-shaped consolidation 3. Pleural effusion 4. Cavitatory lesions with surrounding ground glass opacities

1,2,4. ***1,2,4*** - **Interlobular septations** and **peripheral wedge-shaped consolidations** are common findings due to the **vascular invasion** and **infarction** characteristic of fungal pneumonia. - **Cavitary lesions with surrounding ground-glass opacity**, also known as the **halo sign**, are highly suggestive of invasive fungal infections like aspergillosis. *1,2,3* - While interlobular septations and peripheral wedge-shaped consolidations are seen in fungal pneumonia, **pleural effusion** is less common and not a primary diagnostic feature. - The absence of the characteristic cavitary lesions with ground-glass opacities makes this option incomplete. *2,3,4* - This option correctly includes peripheral wedge-shaped consolidation and cavitary lesions with ground-glass opacity, but the inclusion of **pleural effusion** and exclusion of **interlobular septations** make it less accurate. - Interlobular septations are a significant indicator of **lymphatic involvement** as seen in fungal diseases. *1,3,4* - Although interlobular septations and cavitary lesions with ground-glass opacities are relevant, the presence of **pleural effusion** as a primary finding is less typical for fungal pneumonia. - The absence of **peripheral wedge-shaped consolidation**, which arises from vascular occlusion, makes this option less comprehensive.

Question 1

Identify which of the following structure is a sebaceous gland:

Accepted Answer

2

Answer

3

Answer

4

Answer

1

Question 2

A woman presents with lesions on the inner thighs and peri-anal region. They are nodular, 4-6 mm in size and appear pale. The histopathological image shows multiple intracytoplasmic inclusion bodies consistent with Henderson-Patterson bodies. The diagnosis is:

Accepted Answer

Molluscum contagiosum

Answer

Trichodysplasia spinulosa

Answer

Condyloma acuminata

Answer

Donovanosis

Question 3

A 7 year old child presents with fever, erythematous rash, and bone pain. $X$ - ray of the skull shows multiple lytic lesions. Skin biopsy shows prominent nuclear grooves with eosinophils as in the image below. Immunohistochemistry for S100, CD1a is also shown in the images below. What would be the diagnosis ?

Accepted Answer

Langerhans cell histiocytosis

Answer

Erdheim-Chester disease

Answer

Juvenile xanthogranuloma

Answer

Rosai-Dorfman disease

Question 4

Match the following cell types/patterns (Column A) with their associated malignancies (Column B):

Column A (Cell types/patterns):
a) Faggot cell
b) Popcorn cell
c) Starry sky pattern
d) Cerebriform nuclei

Column B (Associated malignancies):
1) Acute promyelocytic leukemia
2) Lymphocyte-predominant Hodgkin's lymphoma
3) Burkitt lymphoma
4) Sezary syndrome

Accepted Answer

1-a, 2-b, 3-c, 4-d

Answer

1-a, 2-d, 3-c, 4-b

Answer

1-b, 2-c, 3-a, 4-d

Answer

1-b, 2-a, 3-d, 4-c

Question 5

A 35 year old woman presents with fatigue. Investigations revealed the following: Hb, 5 g/dL; MCH, 24; low MCV; leukocytes, 11,000/ uL, and platelets, 5 lakhs. The peripheral smear is shown below. What is the diagnosis?

Normal values:
- Mean cell volume (MCV); 90 ± 8 fL
- Mean cell Hb(MCH); 30 ± 3 pg

Accepted Answer

Iron - deficiency anemia

Answer

Essential thrombocytosis

Answer

Thalassemia major

Answer

Megaloblastic anemia

Question 6

Iron in tissues is stained by:

Accepted Answer

Prussian blue

Answer

Masson's trichrome

Answer

PAS

Answer

Congo red

Question 7

Which of the following is the primary tissue dependent on insulin for glucose uptake?

Accepted Answer

Muscle

Answer

Adipose tissue

Answer

Brain

Answer

Pancreas

Question 8

What is the normal insensible water loss?

Accepted Answer

50 mL/hour

Answer

150 mL/hour

Answer

200 mL/hour

Answer

100 mL/hour

Question 9

A woman must vomit whenever she eats spicy food. Arrange the sequence of events during vomiting.

1. LES is open and UES is closed
2. Strong contractions in the stomach
3. Inspiration against a closed glottis
4. Relaxation of the pyloric sphincter
5. LES opens and UES opens
6. Reverse peristalsis in the small intestine

LES: Lower esophageal sphincter
UES: Upper esophageal sphincter

Accepted Answer

6,4,2,3,1,5

Answer

4,6,2,1,3,5

Answer

4,6,2,5,3,1

Answer

6,4,2,5,1,3

Question 10

Which of the following findings are seen in a high-resolution CT scan of fungal pneumonia?

1. Interlobular septations
2. Peripheral wedge-shaped consolidation
3. Pleural effusion
4. Cavitatory lesions with surrounding ground glass opacities

Accepted Answer

1,2,4

Answer

1,2,3

Answer

2,3,4

Answer

1,3,4

INI-CET 2022

Anatomy

Dermatology

Pathology

Physiology

Radiology