INI-CET 2022 Practice Questions

Q: As per the National Tuberculosis Elimination Program (NTEP), HIV TB prevalence of what percentage would deem a district a high priority district?

>10 %. ***>10%*** - As per the **National Tuberculosis Elimination Program (NTEP)** guidelines, a district is categorized as a **high-priority district** for HIV-TB co-infection if the prevalence of HIV among TB patients is **greater than 10%**. - This threshold helps in identifying regions that require enhanced focus and resources for **integrated HIV and TB care** and prevention strategies. - This is the specific cut-off defined by NTEP for prioritizing districts for targeted interventions. *>15%* - While 15% would also indicate a high prevalence, the specific threshold set by NTEP for deeming a district high priority is **>10%**, not >15%. - Districts with prevalence between 10% and 15% would already be classified as high priority at the >10% threshold. *>20%* - A prevalence of >20% would certainly indicate a severe problem, but the **NTEP's definition** for a high-priority district is specifically **>10%**. - Using a higher threshold like 20% would delay interventions in districts that already face significant challenges with HIV-TB co-infection. *>12%* - The NTEP guidelines use a specific cut-off of **>10%** for defining high-priority districts for HIV-TB co-infection. - While 12% exceeds the 10% threshold, it is not the defining threshold mentioned in the official guidelines for this classification.

Q: India is a country with different cultures and diverse languages. Which steps should a physician take to address the patient for better outcomes? 1. Insist on good communication 2. Insist on communication only via an interpreter 3. Treat them regardless of their cultural perceptions 4. The physician should consider the patient's religion and cultural perception Select the correct combination:

1,4. ***1,4*** - **Good communication** is paramount in healthcare, especially in a diverse country like India, to ensure **patient understanding**, **adherence** to treatment plans, and overall patient satisfaction. - Considering a patient's **religion and cultural perceptions** allows the physician to tailor treatment and communication in a sensitive and **respectful manner**, fostering trust and better **health outcomes**. *1,2* - While good communication (1) is vital, **insisting solely on an interpreter** (2) may not always be feasible or necessary, particularly if the physician and patient share a common language or if the patient prefers direct communication. This can also disrupt the flow of rapport building. - **Over-reliance on interpreters** can sometimes lead to misinterpretations or loss of non-verbal cues if the interpreter is not trained in medical interpretation. *2,3* - **Insisting only on an interpreter** (2) can be restrictive and may compromise direct patient-physician rapport, as discussed above. - **Treating patients regardless of their cultural perceptions** (3) is an ethnocentric approach that can lead to mistrust, non-adherence, and ultimately **poor health outcomes** as it disregards the patient's beliefs and values regarding health and illness. *3,4* - **Treating patients regardless of their cultural perceptions** (3) can result in a lack of understanding and non-adherence if the treatment conflicts with the patient's deeply held beliefs. - While considering religion and cultural perception (4) is crucial, this option includes an incorrect approach (3) that can undermine patient care.

Q: Recommended HPV vaccination schedule for 9 to 14-year-olds according to WHO SAGE guidelines is:

1 or 2 doses. ***1 or 2 doses*** - The **WHO Strategic Advisory Group of Experts (SAGE)** on Immunization recommends a simplified **one- or two-dose schedule** for girls and boys aged 9–14 years. - This recommendation, updated in April 2022, is based on evidence demonstrating comparable efficacy of **single-dose HPV vaccination** to multi-dose regimens in this age group, while improving accessibility and uptake. - **Key advantage**: Reduced doses improve vaccination completion rates and reduce programmatic costs without compromising protection. *3 doses* - A **three-dose schedule** (0, 1-2, 6 months) was the original recommendation but is **no longer recommended** for the 9–14 age group. - Three doses are now reserved for **immunocompromised individuals** or those starting vaccination at older ages in some guidelines. - Maintaining a three-dose schedule would increase costs and reduce completion rates unnecessarily. *3 or 4 doses* - **Four doses** have never been part of any WHO HPV vaccination recommendation. - This option represents an excessive and unsupported schedule that would create unnecessary barriers to vaccination coverage. *4 doses* - **Four doses** are not recommended by WHO SAGE for any age group or clinical scenario. - This would represent over-vaccination without evidence of additional benefit and would significantly impair program implementation.

Q: Combination of appearance in CTEV

Equinus, inversion, forefoot adduction, cavus. ***Equinus, inversion, forefoot adduction, cavus*** - The classic presentation of **clubfoot** (CTEV) involves a characteristic combination of deformities: **equinus** (fixed plantarflexion of the ankle), **inversion** (tilting of the heel inward), **forefoot adduction** (inward turning of the front of the foot), and **cavus** (an abnormally high arch). - These four components are essential for the diagnosis and classification of CTEV. *Equinus, eversion, forefoot adduction, cavus* - This option incorrectly lists **eversion** instead of inversion. Eversion involves the outward tilting of the heel and is not a feature of CTEV. - While equinus, forefoot adduction, and cavus are typical, the presence of eversion rules out classic CTEV. *Equinus, inversion, forefoot adduction, planus* - This option incorrectly lists **planus** (pes planus or flatfoot) instead of cavus. Cavus (high arch) is a defining characteristic of CTEV, not a flatfoot. - While equinus, inversion, and forefoot adduction are correct, the presence of planus makes this option incorrect. *Equinus, eversion, forefoot abduction, cavus* - This option incorrectly lists both **eversion** and **forefoot abduction**. Eversion is the outward tilting of the heel, and forefoot abduction is the outward turning of the front of the foot. - Both eversion and forefoot abduction are opposite to the deformities seen in classical CTEV.

Q: A 49 year old female presents with a breast lump. Which of the following findings is in accordance with basal-like breast cancer?

ER-, PR-, HER2-. ***ER-, PR-, HER2-*** - **Basal-like breast cancer** is characterized by its **triple-negative** status, meaning it does not express estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER2) [1]. - This specific immunophenotype is crucial for diagnosis and influences treatment strategies, as these cancers do not respond to therapies targeting these receptors [1]. *ER+, PR-, HER2-* - This profile describes a **hormone-sensitive** cancer (ER positive) but without PR or HER2 expression. - While it responds to endocrine therapies, it is distinct from basal-like cancer due to its ER positivity. *ER-, PR-, HER2+* - This profile indicates a cancer that is **HER2-positive**, meaning it overexpresses HER2, and can be targeted with anti-HER2 therapies like trastuzumab. - This is a separate molecular subtype of breast cancer often referred to as HER2-enriched, which is distinct from basal-like [2]. *ER+, PR+, HER2-* - This is the most common subtype, known as **luminal A** or **luminal B** depending on grade and Ki-67 expression, characterized by sensitivity to endocrine therapy [2]. - This hormone receptor-positive and HER2-negative profile is very different from the triple-negative basal-like breast cancer. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1064-1066. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1060.

Q: A 35-year-old man presented with knee pain. The x-ray of his knee joint is given below. What is the probable diagnosis?

Paget's disease. ***Paget's disease*** - X-rays of Paget's disease show **thickened, sclerotic bone** with coarse trabeculae, often giving a cotton wool appearance, which is consistent with the image. - The disease involves increased bone turnover, leading to **disorganized bone remodeling** and enlarged, weakened bones. *Osteoarthritis* - Osteoarthritis typically presents with **joint space narrowing**, osteophytes, subchondral sclerosis, and cysts, which are not the predominant features in the given image. - It is primarily a degenerative joint disease affecting articular cartilage, rather than the extensive bone remodeling seen here. *Osteosarcoma* - Osteosarcoma is a malignant bone tumor characterized by a **destructive lesion** with associated soft tissue mass, sunburst periosteal reaction, or Codman's triangle. - The image does not show typical osteosarcoma features but rather diffuse bone remodeling. *Multiple myeloma* - Multiple myeloma usually presents with **punched-out lytic lesions** on X-ray, diffuse osteopenia, or generalized osteoporosis. - The image does not show lytic lesions characteristic of multiple myeloma.

Q: What is the correct sequence of management in a patient who presents to the casualty with an RTA? 1. Cervical spine stabilization 2. Intubation 3. IV cannulation 4. CECT

1,2,3,4. ***1,2,3,4*** - This sequence follows the **ATLS (Advanced Trauma Life Support)** protocol, prioritizing immediate life threats in order. - **Cervical spine stabilization** is the **first action upon patient contact** to prevent secondary neurological injury in any trauma patient. - **Airway management (intubation)** is then performed **with maintained in-line c-spine stabilization** - these occur nearly simultaneously but c-spine protection is instituted first. - **IV cannulation (circulation)** follows to establish vascular access for resuscitation and medications. - **CECT (imaging)** is performed last, once the patient is stabilized after addressing immediate life threats. - This follows the **ATLS Primary Survey: Airway (with c-spine protection) → Breathing → Circulation → Disability → Exposure**. *2,1,4,3* - This incorrectly places intubation **before** cervical spine stabilization is initiated. - In ATLS, **c-spine protection must be applied immediately upon patient contact** before any airway manipulation. - Delaying IV cannulation until after CECT is inappropriate as circulatory access is critical for early resuscitation. *1,3,2,4* - While this correctly starts with cervical spine stabilization, it incorrectly places **IV cannulation before intubation**. - In the ATLS primary survey, **Airway comes before Circulation** - securing the airway takes priority over establishing IV access. - This sequence could delay critical airway management in a patient with respiratory compromise. *2,1,3,4* - This sequence places **intubation before cervical spine stabilization**, which violates ATLS principles. - **C-spine stabilization must be the first action** upon approaching any trauma patient to prevent secondary spinal cord injury. - While intubation with in-line stabilization is possible, the c-spine protection must be instituted first, not after beginning airway manipulation.

Q: A patient presents with pneumothorax on chest x-ray. Which of the following is NOT a boundary of the triangle of safety for intercostal chest drain (ICD) insertion?

Mid - clavicular line. ***Mid-clavicular line*** - The **mid-clavicular line** is **NOT** a boundary of the triangle of safety; it is a vertical reference line located centrally on the thorax. - The triangle of safety is located in the **mid-axillary region**, not at the mid-clavicular line. - The mid-clavicular line is used for other procedures but is **anterior to the safe zone** for ICD insertion. *Base of axilla* - The **base of the axilla** forms the **superior boundary** of the triangle of safety. - This boundary is typically at the level of the **5th intercostal space** (nipple level in males). - It helps guide ICD insertion away from the **brachial plexus** and axillary vessels. *Lateral border of latissimus dorsi* - The **lateral border of the latissimus dorsi muscle** forms the **posterior boundary** of the triangle of safety. - This landmark ensures the insertion is anterior to major back muscles and avoids injury to the long thoracic nerve. *Lateral edge of pectoralis major* - The **lateral edge of the pectoralis major muscle** forms the **anterior boundary** of the triangle of safety. - This ensures the ICD is inserted lateral to the pectoral muscle, avoiding breast tissue and superficial vessels.

Q: Which of the following cancers are correctly matched with the criteria for the minimum number of lymph nodes required for pathological staging? A. CA stomach -10 B. CA colon -12 C. CA gall bladder -6 D. CA breast -15

B,C. ***B,C (Correct Answer)*** - **Colorectal cancer (B)** requires a minimum of **12 lymph nodes** for adequate pathological staging - **correctly matched** ✅ - **Gallbladder cancer (C)** requires at least **6 lymph nodes** for proper staging - **correctly matched** ✅ - These are the only two correctly matched pairs in the question - Adequate lymph node retrieval is essential to prevent **understaging** and ensure accurate prognostic assessment *A,B,C (Incorrect)* - While B and C are correct, **gastric cancer (A)** requires a minimum of **15 lymph nodes**, not 10 - The inclusion of A makes this combination incorrect *A,B,C,D (Incorrect)* - **Gastric cancer (A)** requires **15 lymph nodes**, not 10 - **incorrectly matched** - **Breast cancer (D)** requires a minimum of **10 lymph nodes**, not 15 - **incorrectly matched** - Only B and C are correctly matched *A,C,D (Incorrect)* - **Gastric cancer (A)** requires **15 lymph nodes**, not 10 - **incorrectly matched** - **Breast cancer (D)** requires **10 lymph nodes**, not 15 - **incorrectly matched** - C is correct, but A and D are both incorrectly matched

Q: All the following are true about acute cholecystitis, except

Preferential visualization of gall bladder in HIDA scan. ***Preferential visualization of gall bladder in HIDA scan*** - In acute cholecystitis, the **cystic duct** becomes obstructed, preventing bile flow into the gallbladder. - A **HIDA scan** (hepatobiliary iminodiacetic acid scan) would show **non-visualization of the gallbladder** due to this obstruction, not preferential visualization. *Gall bladder thickness >3 mm on USG* - An **ultrasound (USG)** finding of gallbladder wall thickening **greater than 3 mm** is a common indicator of inflammation in acute cholecystitis. - This thickening is due to **edema** and inflammation of the gallbladder wall. *Murphy's sign positive* - A **positive Murphy's sign** involves tenderness and an inspiratory arrest upon palpation of the right upper quadrant, specifically over the gallbladder. - This clinical sign is a **classic indicator** of acute cholecystitis. *Leukocytosis* - **Leukocytosis**, an elevated white blood cell count, is a common systemic inflammatory response seen in acute cholecystitis. - It reflects the body's reaction to the **inflammation and possible infection** within the gallbladder.

Question 1

As per the National Tuberculosis Elimination Program (NTEP), HIV TB prevalence of what percentage would deem a district a high priority district?

Accepted Answer

>10 %

Answer

>15 %

Answer

>20 %

Answer

>12 %

Question 2

India is a country with different cultures and diverse languages. Which steps should a physician take to address the patient for better outcomes?

1. Insist on good communication
2. Insist on communication only via an interpreter
3. Treat them regardless of their cultural perceptions
4. The physician should consider the patient's religion and cultural perception

Select the correct combination:

Accepted Answer

1,4

Answer

1,2

Answer

2,3

Answer

3,4

Question 3

Recommended HPV vaccination schedule for 9 to 14-year-olds according to WHO SAGE guidelines is:

Accepted Answer

1 or 2 doses

Answer

3 doses

Answer

3 or 4 doses

Answer

4 doses

Question 4

Combination of appearance in CTEV

Accepted Answer

Equinus, inversion, forefoot adduction, cavus

Answer

Equinus, eversion, forefoot adduction, cavus

Answer

Equinus, inversion, forefoot adduction, planus

Answer

Equinus, eversion, forefoot abduction, cavus

Question 5

A 49 year old female presents with a breast lump. Which of the following findings is in accordance with basal-like breast cancer?

Accepted Answer

ER-, PR-, HER2-

Answer

ER+, PR-, HER2-

Answer

ER-, PR-, HER2+

Answer

ER+, PR+, HER2-

Question 6

A 35-year-old man presented with knee pain. The x-ray of his knee joint is given below. What is the probable diagnosis?

Accepted Answer

Paget's disease

Answer

Osteoarthritis

Answer

Osteosarcoma

Answer

Multiple myeloma

Question 7

What is the correct sequence of management in a patient who presents to the casualty with an RTA?

1. Cervical spine stabilization
2. Intubation
3. IV cannulation
4. CECT

Accepted Answer

1,2,3,4

Answer

2,1,4,3

Answer

1,3,2,4

Answer

2,1,3,4

Question 8

A patient presents with pneumothorax on chest x-ray. Which of the following is NOT a boundary of the triangle of safety for intercostal chest drain (ICD) insertion?

Accepted Answer

Mid - clavicular line

Answer

Base of axilla

Answer

Lateral border of latissimus dorsi

Answer

Lateral edge of pectoralis major

Question 9

Which of the following cancers are correctly matched with the criteria for the minimum number of lymph nodes required for pathological staging?
A. CA stomach -10
B. CA colon -12
C. CA gall bladder -6
D. CA breast -15

Accepted Answer

B,C

Answer

A,B,C

Answer

A,B,C,D

Answer

A,C,D

Question 10

All the following are true about acute cholecystitis, except

Accepted Answer

Preferential visualization of gall bladder in HIDA scan

Answer

Gall bladder thickness >3 mm on USG

Answer

Murphy's sign positive

Answer

Leukocytosis

INI-CET 2022

Community Medicine

Orthopaedics

Pathology

Radiology

Surgery