INI-CET 2023 Practice Questions

Q: Blackfoot disease is seen in which of the following?

Arsenic. ***Arsenic*** - Chronic arsenic exposure can lead to **Blackfoot disease**, a severe peripheral vascular disease causing **gangrene** and limb loss, particularly affecting the lower extremities. - This condition is characterized by **dark pigmentation** and ischemic changes in the affected limbs due to vascular compromise. *Mercury* - Mercury poisoning (e.g., **Minamata disease**) primarily affects the **nervous system** and kidneys, causing symptoms like tremor, neuropsychiatric disturbances, and renal dysfunction. - It does not typically cause **Blackfoot disease** or similar peripheral ischemic conditions. *Copper* - Copper toxicity can lead to **liver damage** (e.g., in Wilson's disease), neurological symptoms, and gastrointestinal issues. - Excessive copper does not cause **Blackfoot disease**. *Cadmium* - Cadmium toxicity primarily targets the **kidneys** (leading to renal tubular dysfunction), bones (**osteomalacia** as seen in Itai-itai disease), and lungs. - It is not associated with **Blackfoot disease**.

Q: Black foot disease with peripheral neuropathy is seen in which metal poisoning?

Arsenic. ***Arsenic*** - Chronic arsenic exposure is associated with **Blackfoot disease**, a severe form of peripheral vascular disease leading to gangrene. - **Peripheral neuropathy** is another common manifestation of chronic arsenic poisoning, characterized by tingling, numbness, and weakness. *Mercury* - Mercury poisoning (Minamata disease) primarily causes **neurological symptoms** like tremors, ataxia, and cognitive impairment, but not specifically Blackfoot disease. - It does not typically lead to severe peripheral vascular disease and gangrene. *Lead* - Lead poisoning (plumbism) is known for causing **neuropathy** (especially motor neuropathy, "wrist drop") and **abdominal pain**, but not Blackfoot disease. - It also affects hematological (anemia) and renal systems. *Cadmium* - Cadmium poisoning (Itai-itai disease) primarily affects the **bones** (osteomalacia, osteoporosis) and **kidneys**. - While it can cause renal damage, it does not typically lead to Blackfoot disease or prominent peripheral neuropathy.

Q: A 35-year-old patient with a history of dysentery for 6 weeks complains of pain in the right upper abdomen. On ultrasound, a hypoechoic hyperdense lesion is seen in the liver. Identify the condition based on the given image?

Amoebic liver abscess. ***Amoebic liver abscess*** - The patient's history of **dysentery** (amoebic colitis) 6 weeks prior strongly points to an amoebic infection, as *Entamoeba histolytica* can spread from the colon to the liver via the portal vein. - The ultrasound finding of a **hypoechoic lesion** in the liver is characteristic of an abscess, and in the context of recent dysentery, it is highly suggestive of an amoebic liver abscess. *Hydatid cyst* - Hydatid cysts are caused by *Echinococcus granulosus* and are typically seen in patients with a history of **sheep herding** or exposure to dogs. - Ultrasound findings often show **daughter cysts** or a "water lily" sign, which are not described here or evident in the image. *Hemangioma* - Hemangiomas are the **most common benign liver tumors** and are typically **hyperechoic** on ultrasound, unlike the hypoechoic lesion described. - They are usually **asymptomatic** and not associated with a history of dysentery or acute pain. *Pyogenic liver abscess* - While a pyogenic liver abscess can present as a hypoechoic lesion on ultrasound and cause pain, it is typically associated with **biliary tract infection**, diverticulitis, or other sources of bacterial infection, not usually dysentery alone. - Pyogenic abscesses are often **multiple** and frequently occur in the setting of conditions like cholangitis or appendicitis.

Q: A 35-year-old patient with a history of dysentery for 6 weeks complains of pain in the right upper abdomen. On ultrasound, a hypoechoic hyperdense lesion is seen in the liver. Identify the condition based on the given image?

Amoebic liver abscess. ***Amoebic liver abscess*** - The history of **dysentery** (often caused by *Entamoeba histolytica*) 6 weeks prior strongly points to an amoebic infection. - The presence of a **hypoechoic, hyperdense lesion** in the liver on ultrasound is characteristic of an amoebic liver abscess, which is a common extraintestinal manifestation of amoebiasis. *Hemangioma* - A hemangioma is a **benign vascular tumor** of the liver, typically asymptomatic and discovered incidentally. - It would not be causally linked to a recent history of dysentery. *Pyogenic liver abscess* - While a pyogenic (bacterial) liver abscess can also present as an abscess on imaging, a **clear history of dysentery** strongly favors an amoebic cause. - Pyogenic abscesses are often associated with other sources of infection like biliary obstruction or diverticulitis. *Hydatid cyst* - A hydatid cyst is caused by the parasite **_Echinococcus granulosus_** and is more common in endemic regions. - Although it appears as a cystic lesion, it is not directly linked to a history of dysentery as its mode of transmission differs.

Q: What is the interpretation of the given pedigree chart?

Autosomal dominant. ***Autosomal dominant*** - The trait appears in **every generation**, indicated by affected individuals in the first, second, and third generations [1]. - Both males and females are affected relatively equally, and affected individuals transmit the trait to approximately half of their offspring, consistent with **vertical transmission** [1]. - **Male-to-male transmission** is present, which definitively rules out X-linked inheritance patterns [1]. *Incomplete penetrance* - This pattern would typically show some individuals who carry the disease-causing genotype but **do not express the phenotype** (unaffected). - In this pedigree, all individuals who are expected to express the trait based on the clear dominant pattern are indeed affected. *Autosomal recessive* - This mode of inheritance would typically show **skipped generations**, meaning affected individuals would often have unaffected parents who are carriers [1]. - In this chart, every affected individual has at least one affected parent, ruling out an autosomal recessive pattern [1]. X-linked dominant - In X-linked dominant inheritance, **no male-to-male transmission** would be observed, as fathers pass their X chromosome only to daughters. - The presence of affected males transmitting the trait to male offspring rules out this inheritance pattern. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 148-151.

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

Blue, Red, Violet, Grey. ***Blue, Red, Violet, Grey*** - This sequence follows the **CLSI (Clinical and Laboratory Standards Institute) order of draw** guidelines, which are critical for preventing **cross-contamination** between additives of different vacutainers. - The order starts with tubes for **coagulation studies** (blue top with sodium citrate), followed by serum tubes (red top), EDTA tubes (violet top for hematology), and finally glycolytic inhibitor tubes (grey top for glucose). - This prevents tissue thromboplastin contamination and anticoagulant carryover that could affect laboratory test results. *Grey, Blue, Red, Violet* - This order is incorrect as it places the **grey top tube** (containing fluoride/oxalate) first, which could contaminate subsequent tubes with its additives and affect tests. - The **blue top tube** for coagulation studies should come early in the sequence to minimize tissue thromboplastin contamination. *Blue, Violet, Red, Grey* - This sequence is incorrect because the **violet top tube** (EDTA) is placed before the **red top tube** (serum). - **EDTA contamination** can chelate calcium and other cations, interfering with chemistry tests performed on serum in the red top tube. *Red, Blue, Violet, Grey* - This order is incorrect as the **red top tube** is placed first, followed by the **blue top tube** (citrate). - The blue top tube should precede tubes with clot activators to **prevent tissue thromboplastin** from contaminating coagulation samples, which would lead to falsely shortened clotting times.

Q: A 52-year-old female patient presents with HER-2 positive breast cancer that has become resistant to trastuzumab treatment. The oncologist is considering the next line of treatment for the patient. Which of the following options would be the most appropriate choice?

Lapatinib. ***Lapatinib*** - Lapatinib is an oral **dual tyrosine kinase inhibitor** that targets both **HER2** and **EGFR** receptors, specifically approved for **trastuzumab-resistant HER2-positive breast cancer**. - Unlike trastuzumab (a monoclonal antibody that binds the extracellular domain), lapatinib inhibits the **intracellular tyrosine kinase domain** of HER2, providing an **alternative mechanism** to overcome resistance. - Often used in combination with capecitabine for patients who have progressed on trastuzumab-containing regimens. - **Clinical evidence**: The EGF100151 trial demonstrated efficacy in trastuzumab-refractory disease. *Vemurafenib* - Vemurafenib is a **BRAF V600E/K inhibitor** used primarily for **metastatic melanoma** with BRAF mutations. - It has **no activity against HER2** and is not indicated for breast cancer. - Would not provide benefit in this clinical scenario. *Erlotinib* - Erlotinib is a selective **EGFR tyrosine kinase inhibitor** used for **EGFR-mutant non-small cell lung cancer** and **pancreatic cancer** (with gemcitabine). - While it inhibits EGFR (which lapatinib also targets), erlotinib has **insufficient HER2 inhibition** to be effective in HER2-driven breast cancer. - Not approved or effective for trastuzumab-resistant HER2-positive breast cancer. *Sorafenib* - Sorafenib is a **multi-kinase inhibitor** targeting **RAF kinases, VEGFR-2/3, and PDGFR-β**, approved for **hepatocellular carcinoma, renal cell carcinoma, and thyroid cancer**. - It does **not specifically target HER2** signaling and has no established role in HER2-positive breast cancer. - Would not address the mechanism of disease in this patient.

Q: A surgeon examined a case of hernia and was able to retract the hernial sac on examination but not the contents. Identify the type of hernia depicted in the image.

Reduction en masse. ***Reduction en masse*** - This occurs when the **hernia sac** is reduced into the abdomen but the contents remain incarcerated within the sac, still outside the peritoneal cavity. The image clearly depicts the sac being pushed back, while the bowel loop within it remains constricted at the neck. - This is a dangerous situation because the **incarcerated bowel** is not visible externally, yet remains at risk of strangulation and is often unrecognized. *Sliding hernia* - A sliding hernia involves a portion of the **retroperitoneal organ** (like the colon or bladder) forming part of the posterior wall of the hernia sac. - This typically occurs gradually, and the sac itself is not mistakenly reduced without its contents while the contents remain trapped. *Incarcerated hernia* - An incarcerated hernia means the contents of the hernia sac are **trapped** and cannot be manually reduced back into the abdominal cavity. - While the image shows incarcerated contents, the specific problem here is that the *sac* has been reduced without its contents, which is a particular complication rather than just general incarceration. *Maydl's hernia* - Maydl's hernia (also known as a W-hernia) describes a scenario where **two loops of bowel** are contained within the hernia sac, with a connecting loop of bowel located within the abdominal cavity, forming a 'W' shape. - The illustration shows only one loop of bowel within the sac and does not suggest the specific 'W' configuration or intra-abdominal strangulation of the connecting segment.

Question 1

Blackfoot disease is seen in which of the following?

Accepted Answer

Arsenic

Answer

Mercury

Answer

Copper

Answer

Cadmium

Question 2

Black foot disease with peripheral neuropathy is seen in which metal poisoning?

Accepted Answer

Arsenic

Answer

Mercury

Answer

Lead

Answer

Cadmium

Question 3

A 35-year-old patient with a history of dysentery for 6 weeks complains of pain in the right upper abdomen. On ultrasound, a hypoechoic hyperdense lesion is seen in the liver. Identify the condition based on the given image?

Accepted Answer

Amoebic liver abscess

Answer

Hydatid cyst

Answer

Hemangioma

Answer

Pyogenic liver abscess

Question 4

A 35-year-old patient with a history of dysentery for 6 weeks complains of pain in the right upper abdomen. On ultrasound, a hypoechoic hyperdense lesion is seen in the liver. Identify the condition based on the given image?

Accepted Answer

Amoebic liver abscess

Answer

Hemangioma

Answer

Pyogenic liver abscess

Answer

Hydatid cyst

Question 5

What is the interpretation of the given pedigree chart?

Accepted Answer

Autosomal dominant

Answer

Incomplete penetrance

Answer

Autosomal recessive

Answer

X-linked dominant

Question 6

Identify the correct statement regarding Amyloidosis?

Accepted Answer

Amyloid deposits have beta pleated sheet conformation

Answer

Secondary amyloidosis is AL

Answer

Amyloidosis is called so because of deposition of complex carbohydrates

Answer

All of the options

Question 7

Match the following columns
A. Caplan syndrome
B. Mesothelioma
C. Silicosis
D. Asbestosis

1. Pleural effusion without shift
2. Crazy Paving
3. Lower lobe involved
4. Described in coal workers

Accepted Answer

A4-B1-C3-D2

Answer

A4-B1-C3-D3

Answer

A2-B1-C4-D3

Answer

A4-B3-C1-D2

Question 8

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

Accepted Answer

Blue, Red, Violet, Grey

Answer

Grey, Blue, Red, Violet

Answer

Blue, Violet, Red, Grey

Answer

Red, Blue, Violet, Grey

Question 9

A 52-year-old female patient presents with HER-2 positive breast cancer that has become resistant to trastuzumab treatment. The oncologist is considering the next line of treatment for the patient. Which of the following options would be the most appropriate choice?

Accepted Answer

Lapatinib

Answer

Vemurafenib

Answer

Erlotinib

Answer

Sorafenib

Question 10

A surgeon examined a case of hernia and was able to retract the hernial sac on examination but not the contents. Identify the type of hernia depicted in the image.

Accepted Answer

Reduction en masse

Answer

Sliding hernia

Answer

Incarcerated hernia

Answer

Maydl's hernia

INI-CET 2023

Community Medicine

Forensic Medicine

Internal Medicine

Pathology

Pharmacology

Surgery