INI-CET 2023 Practice Questions

Q: Which of the following is used to detect abnormal gene sequences EXCEPT?

Flow cytometry. ***Flow cytometry*** - **Flow cytometry** is primarily used to analyze **cell populations** based on their physical and biochemical characteristics (e.g., size, granularity, and protein expression) by passing them single file through a laser beam, not for direct gene sequencing. - It detects and quantifies cells labeled with **fluorescent antibodies**, making it useful for immunophenotyping, cell sorting, and DNA content analysis, but not for identifying specific gene sequences or mutations. *RFLP analysis* - **Restriction fragment length polymorphism (RFLP) analysis** detects variations in **DNA sequences** by using **restriction enzymes** to cut DNA at specific sites. - Differences in fragment lengths indicate **polymorphisms** or **mutations** within the recognition sites, thereby identifying abnormal gene sequences. *Pyrosequencing* - **Pyrosequencing** is a method of **DNA sequencing** that determines the sequence of nucleotides by detecting the release of pyrophosphate during DNA synthesis. - It is used to identify **single nucleotide polymorphisms (SNPs)** and **short genetic variations**, making it suitable for detecting abnormal gene sequences. *FISH* - **Fluorescence in situ hybridization (FISH)** uses **fluorescently labeled DNA probes** that bind to specific complementary **DNA sequences** on chromosomes. - It is a powerful cytogenetic technique for detecting **chromosomal abnormalities**, such as deletions, translocations, and amplifications, thereby identifying abnormal gene sequences.

Q: A 62-year-old patient presents with pain in the calf muscles while walking. The pain subsides with rest. Which of the following is not typically seen in intermittent claudication?

Rest pain at night in advanced stages. ***Rest pain at night in advanced stages*** - Intermittent claudication is defined by pain with exercise that resolves with rest [1]. **Rest pain** indicates critical limb ischemia, a more advanced stage of peripheral artery disease, and is distinct from intermittent claudication itself, although it can develop from it [1]. - While rest pain can occur in patients with severe peripheral artery disease, it is **not typically seen in intermittent claudication**, but rather represents progression to a more severe form of the disease. *Pain gradually increases* - The pain of intermittent claudication typically **gradually increases** during physical activity as the oxygen demand of the muscles exceeds the compromised blood supply. - This progressive pain forces the patient to stop activity, at which point the pain subsides with rest. *Caused most commonly by atherosclerosis* - **Atherosclerosis** is the underlying pathology in the vast majority of cases of peripheral artery disease, leading to stenosis or occlusion of the arteries that supply the lower limbs [1]. - This narrowing of the arterial lumen restricts blood flow, causing inadequate oxygen delivery to muscles during exertion. *Level of occlusion cannot be decided based on symptoms* - The **anatomical level of arterial occlusion** can often be inferred to some extent by the location of the claudication pain (e.g., buttock claudication suggests aortoiliac disease, calf claudication suggests femoropopliteal disease) [1]. - However, the precise extent and severity of the occlusion cannot be solely determined by symptoms, and imaging studies like **duplex ultrasound** or angiography are required for definitive diagnosis.

Q: Order of drawing blood in vacutainers should be in the following sequence to prevent contamination:

Blood culture → Citrate → Plain → EDTA → Fluoride. ***Blood culture → Citrate → Plain → EDTA → Fluoride*** - This sequence is the recommended order of draw to prevent **cross-contamination** between different additives, which could interfere with laboratory test results. - Starting with **blood cultures** minimizes contamination risk for microbiological analysis [1], followed by tubes containing anticoagulants like **citrate** (for coagulation studies), then **plain** tubes (for serum), followed by **EDTA** (for hematology), and finally **fluoride** (for glucose). - This order prevents carryover of additives that could affect subsequent test results. *Plain → Blood culture → Citrate → EDTA → Fluoride* - Drawing a **plain tube** first is incorrect as it might introduce skin flora into the blood culture bottle if performed later. - **Blood culture** should always be drawn first to ensure sterility and prevent contamination from other tube additives [1]. *Citrate → Blood culture → Plain → EDTA → Fluoride* - Drawing the **citrate tube** before blood culture is incorrect due to the risk of introducing citrate anticoagulant into the blood culture, which could inhibit bacterial growth. - The **blood culture** bottle requires the highest priority for sterility [1]. *Blood culture → Plain → EDTA → Citrate → Fluoride* - Placing the **plain tube** before **citrate tube** is incorrect according to CLSI guidelines. - Drawing the **EDTA tube** before the **citrate tube** can lead to contamination of the citrate sample with EDTA, potentially affecting coagulation tests by chelating calcium. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 296-297.

Q: Which of the following cells is shown in the given image?

Hairy cell. ***Hairy cell*** - The image displays prominent **cytoplasmic projections** or "hairs" on the cell surface, which are characteristic features of **hairy cells** (lymphocytes seen in hairy cell leukemia) [1]. - These cells typically have an irregularly shaped nucleus and cytoplasm rich in ribosomes, as suggested by the granular appearance [1]. *Sickle cell* - **Sickle cells** are **red blood cells** that have a characteristic crescent or sickle shape due to abnormal hemoglobin polymerization. - The cell in the image is a **white blood cell** with a large nucleus and cytoplasmic extensions, clearly not a red blood cell. *Gaucher cell* - **Gaucher cells** are **macrophages** that accumulate glucocerebroside, giving them a characteristic **"crinkled paper"** or **"chicken scratch"** cytoplasm. - While they are large cells, they lack the distinct, fine, hair-like projections seen in the provided image. *Target cell* - **Target cells** are **red blood cells** with a central bullseye appearance due to an abnormal distribution of hemoglobin, often seen in thalassemia or liver disease. - The presented image is not a red blood cell and does not demonstrate the morphology of a target cell. **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, p. 612.

Q: A child presenting with the following appearance is at risk of developing?

Pure red cell aplasia. ***Pure red cell aplasia*** - The image shows a "slapped cheek" rash, which is characteristic of **erythema infectiosum** (fifth disease) caused by **Parvovirus B19**. - Parvovirus B19 has a tropism for **erythroid progenitor cells** in the bone marrow, leading to a temporary cessation of red blood cell production, especially critical in individuals with underlying hemolytic anemias. *Immunodeficiency* - While viral infections can be more severe in immunodeficient individuals, the presented rash is specifically characteristic of **Parvovirus B19 infection**, not a general sign of immunodeficiency. - Immunodeficiency would typically involve recurrent, severe, or unusual infections, which are not directly indicated by the rash alone. *Lymphoproliferative disorder* - Lymphoproliferative disorders involve abnormal proliferation of lymphocytes and typically do not present with a "slapped cheek" rash. - Clinical signs would more likely include **lymphadenopathy**, hepatosplenomegaly, and cytopenias, not the classic facial rash seen here. *Gingivostomatitis* - **Gingivostomatitis** is an inflammation of the gums and oral mucosa, often caused by herpes simplex virus, presenting with **sores and ulcers in the mouth**. - The rash seen in the image is on the **cheeks and body**, not primarily oral, and is a classic presentation of erythema infectiosum.

Q: A child with fever for 6 days, strawberry tongue, conjunctival congestion with peeling of skin. What will be the treatment option for this child?

IVIG. ***IVIG*** - The constellation of **fever for 6 days (prolonged fever)**, **strawberry tongue**, **conjunctival congestion**, and **peeling skin** is highly indicative of **Kawasaki disease**. - **Intravenous immunoglobulin (IVIG) 2 g/kg as a single infusion** is the cornerstone of treatment for Kawasaki disease to reduce the risk of **coronary artery aneurysms** (from ~25% to <5%). - IVIG should be administered within **10 days of fever onset** for maximum efficacy. - **High-dose aspirin** (80-100 mg/kg/day) is given concurrently until the fever subsides, then switched to low-dose aspirin (3-5 mg/kg/day) for antiplatelet effect. *Antibiotics* - Kawasaki disease is a **vasculitis**, not a bacterial infection, so antibiotics are ineffective. - While other conditions like scarlet fever can present with strawberry tongue, the prolonged fever and other classic Kawasaki features differentiate it. *Steroids* - While steroids can reduce inflammation, they are **not the primary treatment** for Kawasaki disease and are typically used in conjunction with IVIG in **refractory cases** or for IVIG-resistant disease. - **Monotherapy with steroids** is not recommended for acute Kawasaki disease due to potential for increased aneurysm risk. *Antipyretics* - **Antipyretics** like acetaminophen can help manage the fever symptomatically. - However, they **do not treat the underlying vasculitis** or prevent the serious cardiac complications of Kawasaki disease. - Note: **NSAIDs like ibuprofen should be avoided** when high-dose aspirin is being used due to risk of drug interactions.

Q: A 10-week-old baby came for vaccination. The baby had a previous history of inconsolable crying and fever (40°C) after vaccination at 6 weeks. What should be given now?

Give DT only. ***Give DT only*** - The previous severe adverse reaction (**inconsolable crying** and **fever of 40°C**) is a specific contraindication to the **pertussis component** of the DPT vaccine. - According to **pediatric vaccination guidelines**, severe reactions (fever ≥40°C, inconsolable crying >3 hours) are absolute contraindications to further pertussis-containing vaccines. - The **diphtheria and tetanus toxoids** were not associated with the adverse reaction and should be safely continued. - **DT vaccine (without pertussis)** provides essential protection against diphtheria and tetanus while avoiding the problematic pertussis component. *Don't give DPT* - This option is imprecise because it doesn't specify what should be given instead. - While it correctly identifies that full DPT should be avoided, it fails to address the need for continued protection against diphtheria and tetanus. - The medically appropriate approach is to give **DT vaccine**, not to simply withhold vaccination. *Defer for 1 month* - Deferring vaccination does not address the core issue that the **pertussis component specifically** caused the severe reaction. - This approach would unnecessarily **delay protection** against diphtheria and tetanus, which the baby can safely receive immediately as DT vaccine. - The problem is not timing but the vaccine component itself. *Give DPT* - Administration of the full DPT vaccine is **absolutely contraindicated** given the history of severe adverse reactions (fever ≥40°C and inconsolable crying). - Repeating DPT risks another severe reaction and potential permanent neurological complications. - This would be a dangerous and inappropriate management decision.

Q: A 53-year-old patient presents with per rectal bleeding. Which is the most appropriate investigation to evaluate for colorectal pathology?

Colonoscopy. ***Colonoscopy*** - **Gold standard investigation** for per rectal bleeding and suspected colorectal pathology - Allows **direct visualization** of the entire colon and rectum - Enables **biopsy** of any suspicious lesions for histopathological diagnosis - Can identify various causes: **polyps, diverticula, inflammatory bowel disease, and colorectal cancer** - Therapeutic potential for polypectomy during the same procedure *CECT (Contrast-enhanced CT scan)* - Can detect large masses and assess for metastasis but not the primary diagnostic tool - Does not allow direct visualization of the mucosa or biopsy capability - Not suitable for identifying subtle mucosal lesions or early pathology - May be used as an adjunct for staging after diagnosis *CA-19-9 levels* - Tumor marker primarily associated with **pancreatic cancer** - Not routinely used for diagnosis or screening of colorectal malignancies - Lacks sensitivity and specificity for colorectal pathology - Not appropriate as initial investigation for per rectal bleeding *CEA levels (Carcinoembryonic antigen)* - Tumor marker that can be elevated in colorectal cancer - Primarily used for **monitoring treatment response** and **detecting recurrence** - Not sensitive or specific enough for initial diagnosis - Cannot replace endoscopic evaluation for per rectal bleeding

Q: A 45-year-old woman with early-stage breast cancer is discussing treatment options with her surgeon. Which of the following statements regarding breast conservation surgery is NOT true?

Axillary dissection. ***Axillary dissection*** - **Axillary dissection is NOT a routine component of breast conservation surgery** for early-stage breast cancer. - In early-stage disease, **sentinel lymph node biopsy (SLNB)** has largely replaced routine axillary dissection as it provides accurate staging with significantly less morbidity. - Axillary dissection is only performed when there is **proven extensive lymph node involvement** or when SLNB shows metastatic disease requiring further assessment. - Therefore, this statement is **NOT true** regarding routine breast conservation surgery. *Wide local excision* - **Wide local excision (lumpectomy)** is the primary surgical component of breast conservation therapy. - It involves removing the cancerous tumor along with a margin of healthy breast tissue to achieve clear margins while preserving the breast. *Sentinel lymph node biopsy* - **SLNB** is a standard procedure performed with breast conservation surgery to assess for regional lymph node metastasis. - It identifies and removes the first few lymph nodes draining the tumor, allowing accurate staging with minimal morbidity. *Post-operative radiotherapy* - **Post-operative radiotherapy** to the preserved breast is a critical and essential component of breast conservation therapy. - It significantly reduces the risk of local recurrence by treating any microscopic tumor cells that may remain after surgery.

Q: A 55-year-old female smoker presents with a breast lump and is seeking medical evaluation. On examination, a palpable mass is detected in the breast. The patient's smoking history is significant, with a 30-year smoking habit. Which of the following conditions is strongly associated with smoking in relation to breast health?

Breast cancer. ***Breast cancer*** - **Smoking** is a well-established risk factor for various cancers, including **breast cancer**, due to the presence of carcinogens in tobacco smoke [1]. - The patient's age and palpable lump further raise suspicion for malignancy, prompting thorough investigation. [1] *Duct ectasia* - Characterized by widening and inflammation of the **milk ducts**, which can cause nipple discharge, tenderness, and a palpable mass. - While smoking can be a risk factor, the more significant association in this age group and with a palpable lump leans towards malignancy. *Fibroadenoma* - These are **benign breast tumors** composed of glandular and stromal tissue, most common in younger women. - They are typically rubbery, mobile masses and are not strongly linked to smoking. *Mondor disease* - This is a rare, **benign condition** characterized by thrombophlebitis of the superficial veins of the breast or chest wall. - It typically presents as a painful, cord-like structure and is not directly associated with smoking.

Question 1

Which of the following is used to detect abnormal gene sequences EXCEPT?

Accepted Answer

Flow cytometry

Answer

RFLP analysis

Answer

Pyrosequencing

Answer

FISH

Question 2

A 62-year-old patient presents with pain in the calf muscles while walking. The pain subsides with rest. Which of the following is not typically seen in intermittent claudication?

Accepted Answer

Rest pain at night in advanced stages

Answer

Pain gradually increases

Answer

Caused most commonly by atherosclerosis

Answer

Level of occlusion cannot be decided based on symptoms

Question 3

Order of drawing blood in vacutainers should be in the following sequence to prevent contamination:

Accepted Answer

Blood culture → Citrate → Plain → EDTA → Fluoride

Answer

Plain → Blood culture → Citrate → EDTA → Fluoride

Answer

Citrate → Blood culture → Plain → EDTA → Fluoride

Answer

Blood culture → Plain → EDTA → Citrate → Fluoride

Question 4

Which of the following cells is shown in the given image?

Accepted Answer

Hairy cell

Answer

Sickle cell

Answer

Gaucher cell

Answer

Target cell

Question 5

A child presenting with the following appearance is at risk of developing?

Accepted Answer

Pure red cell aplasia

Answer

Immunodeficiency

Answer

Lymphoproliferative disorder

Answer

Gingivostomatitis

Question 6

A child with fever for 6 days, strawberry tongue, conjunctival congestion with peeling of skin. What will be the treatment option for this child?

Accepted Answer

IVIG

Answer

Antibiotics

Answer

Steroids

Answer

Antipyretics

Question 7

A 10-week-old baby came for vaccination. The baby had a previous history of inconsolable crying and fever (40°C) after vaccination at 6 weeks. What should be given now?

Accepted Answer

Give DT only

Answer

Don't give DPT

Answer

Defer for 1 month

Answer

Give DPT

Question 8

A 53-year-old patient presents with per rectal bleeding. Which is the most appropriate investigation to evaluate for colorectal pathology?

Accepted Answer

Colonoscopy

Answer

CECT (Contrast-enhanced CT scan)

Answer

CA-19-9 levels

Answer

CEA levels

Question 9

A 45-year-old woman with early-stage breast cancer is discussing treatment options with her surgeon. Which of the following statements regarding breast conservation surgery is NOT true?

Accepted Answer

Axillary dissection

Answer

Post-operative radiotherapy

Answer

Wide local excision

Answer

Sentinel lymph node biopsy

Question 10

A 55-year-old female smoker presents with a breast lump and is seeking medical evaluation. On examination, a palpable mass is detected in the breast. The patient's smoking history is significant, with a 30-year smoking habit. Which of the following conditions is strongly associated with smoking in relation to breast health?

Accepted Answer

Breast cancer

Answer

Duct ectasia

Answer

Fibroadenoma

Answer

Mondor disease

INI-CET 2023

Biochemistry

Internal Medicine

Pathology

Pediatrics

Surgery