Previous year question on apoptosis based on neet pg, usmle, plab and fmge or mci screening exams

Which of the following has a direct role in apoptosis?
A: Nitric oxide
B: Adenylcyclase
C: cAMP
D: Cytochrome C
Correct Ans:D
Explanation
Cytochrome c is involved in initiation of apoptosis. Upon release of cytochrome c to the
cytoplasm, the protein binds apoptotic protease activating factor-1 (Apaf-1).
Sample Previous Year Question on Apoptosis from Pathology based on previous
Year Questions of NEET PG, USMLE,PLAB,FMGE (MCI Screening). Please
visit www.medicoapps.org for more such Quizzes
Caspases are involved in:
A: Cell division
B:
Necrosi
s
C: Apoptosis
D: Inflammation
Correct Ans:C
Explanation
Caspases are molecules that lead to DNA cleavage and cell
death when activated by TNFs (known as death receptors)
and cause programmed cell death (apoptosis).
Ref: Harrison's Principles of Internal Medicine, 16th Edition, Page 1925.

Process of migration of leukocytes through the endothelium is through:
A: Phagocytosis
B:
Pinocytosi
s
C: Diapedesis
D: Apoptosis
Correct Ans:C
Explanation
The next step in the process of leukocyte recruitment is migration of the leukocytes through
the endothelium, called transmigration or diapedesis. Transmigration of leukocytes occurs
mainly in post-capillary venules. Chemokines act on the adherent leukocytes and stimulate
the cells to migrate through interendothelial spaces toward the chemical concentration
gradient, that is, toward the site of injury or infection where the chemokines are being
produced.
Ref: Robbins 8th edition, Chapter 2.
In apoptosis, Apaf-1 is activated by release of which of the following substances from the
mitochondria?
A: Bcl-2
B:
Ba
x
C: Bcl-XL
D: Cytochrome C
Correct Ans:D
Explanation
Apoptotic signals cause increased permeability of outer mitochondrial membrane, which
inturn releases the apoptotic trigger cytochrome c from the mitochondria to cytosol.
Cytochrome c is located between the inner and outer mitochondrial membrane. Its release
preceds the morphologic changes of apoptosis, showing that it occur early, consistent with
regulatory function.
When cytochrome c is released from the mitochondria, it binds to Apaf 1 and activates it,
triggering an initiator caspase and sets in motion the proteolytic events that kill the cell.

Ref: Robbins Pathologic Basis of Disease, 6th Edition, Pages 21- 22; Elements of Human
Cancer By Geoffrey M. Cooper, Page 190; Manual of Cable Osteosyntheses: History,
Technical Basis By Reiner Labitzke, Page 289; Recombinant Human Erythropoietin (rhEPO)
in Clinical Oncology By Mohammad Resa Nowrousian, Page 25
Which of the following organelles plays a pivotal role in Apoptosis?
A: Mitochondria
B: Endoplasmic Reticulum
C: Nucleus
D: Golgi Apparatus
Correct Ans:A
Explanation
Mitochondria is the organelle which plays a pivotal role in apoptosis.
Ref: Robbins pathologic basis of disease 6th edn/page 21.
The characteristic feature of apoptosis on light microscopy is:
A: Cellular swelling
B: Nuclear compaction
C: Intact cell membrane
D: Cytoplasmic eosinophlia
Correct Ans:B
Explanation
Characteristic apoptotic feature include cell membrane blebbing, Cell shrinkage, chromatin
condensation (nuclear compaction) and DNA fragmentation. Out of all the options given
nuclear compaction only fits into the characteristic features on light microscopy.

Ref: Cell Apoptosis Research Advances By Carter R. Kettleworth, Nova Publishers, 2007,
Page 147; Robbins Basic Pathology, 7th Edition, Page 27.
All of the following are features of Apoptosis, except:
B: Nuclear compaction
C: Intact cell membrane
D: Cytoplasmic eosiophilia
Correct Ans:A
Explanation
Characteristic apoptotic feature include cell membrane blebbing, Cell shrinkage, chromatin
condensation (nuclear compaction) and DNA fragmentation. As it can be seen cell shrinkage
and not cellular swelling in seen in apoptosis.
Ref: Cell Apoptosis Research Advances By Carter R. Kettleworth, Nova Publishers, 2007,
Page 147; Robbins Basic Pathology, 7th Edition, Page 27All of the following are features of
Apoptosis, except.
Caspases are involved in:
A: Cell division
B:
Necrosi
s
C: Apoptosis
D: Inflammation
Correct Ans:C
Explanation

Caspases are molecules that lead to DNA cleavage and cell
death when activated by TNFs (known as death receptors)
and cause programmed cell death (apoptosis).
Ref: Harrison's Principles of Internal Medicine, 16th Edition, Page 1925.
Which of the following organelles plays a pivotal role in Apoptosis:
A: Mitochondria
B: Endoplasmic Reticulum
C: Nucleus
D: Golgi Apparatus
Correct Ans:A
Explanation
Initiation of apoptosis occurs through two different pathways, intrinsic mitochondria
pathway and extrinsic death receptor mediated pathway. Mitochondria plays active role in
apoptosis.
Ref: Tanley L. Robbins, Ramzi S. Cotran, (2012) , Chapter 1, “Cell Injury”, In the book,
“Pocket Companion to Robbins and Cotran Pathologic Basis of Disease”, 8th Edition, USA,
Page 27; Robbin’s Basic Pathology, 7th Edition, Pages 28, 29; Essential of Apoptosis (2003),
Page 245
A gastric biopsy is performed on a patient with suspected graft-versus-host disease
following bone marrow transplantation. The biopsy demonstrates many isolated dying
epithelial cells in crypts showing fragmented, hyperchromatic nuclei and small discrete
blebs containing both cytoplasm and nuclear fragments. The biopsy proves which of the
following?
A: Apoptosis
B: Caseous necrosis

C: Coagulative necrosis
D: Gangrenous necrosis
Correct Ans:A
Explanation
The changes described are those of apoptosis, which is a form of programmed cell death.
Apoptosis can be seen in a variety of settings. In this case, it is occurring in the context of
graft-versus-host disease, which is mediated by CD8+ and CD4+ cells.
Apoptosis also occurs during embryogenesis, during hormone-dependent involution in the
adult (eg, during menstruation), during rapid proliferation of cell populations (eg, intestinal
crypt epithelia), and in the immune system (e.g., in developing thymus).
It can also occur after duct obstruction in organs such as pancreas and during some viral
diseases. The hallmark of this programmed method of cell death is the fragmentation of the
cell with formation of cytoplasmic blebs and apoptotic bodies that are phagocytized by
other healthy cells.
Caseous necrosis, such as is seen in tuberculosis, shows necrotic, amorphous granular
debris surrounded by a granulomatous response.
Coagulative necrosis, such as is seen in myocardial infarction, shows coagulated, anuclear
cell "ghosts."
Gangrenous necrosis is a commonly used surgical term (eg, in diabetic feet) that does not
have a precise pathologic counterpart.
Annexin V is associated with which of the following?
A: Necrosis
B: Apoptosis
C: Atherosclerosis
D: Inflammation
Correct Ans:B
Explanation
Annexin V is a calcium-dependent phospholipid binding protein that has a high affinity for
the phophatidylserine (PS), a plasma membrane phospholipid. One of the earliest features
of apoptosis is the translocation of PS from the inner to the outer leaflet of the plasma
membrane, thereby exposing PS to the external environment. Annexin V binds to PS
exposed on the cell surface and identifies cells at an earlier stage of apoptosis than assays

based on DNA fragmentation.
The Annexin V Assay, a classical technique for detecting apoptosis, is the most commonly
used method for detecting apoptosis by flow cytometry.
True about cysteinyl aspartate specific proteases (Caspases) is?
A: Involved in apoptosis
B:
Cause
necrosis
C: Involved in pain pathway
D: Are cytokines inhibitor
Correct Ans:A
Explanation
Caspases ( cysteinyl aspartate specific proteases) are the
effector proteins in the apoptotic cascade of cell death.
Human caspases are classified into two groups:
 Those related to apoptosis: caspases 2,3,6,7,8,9,10.
 Those related to apoptosis: caspases 1, 4, 5 and 11.
What is the FIRST manifestation of most cell injuries?
B:
Necrosi
s
C: Apoptosis
D: Chromatin condensation

Correct Ans:A
Explanation
Cellular swelling is the first manifestation of almost all forms of injury to cells. When it
affects many cells, it causes some pallor, increased turgor and increase in weight of the
organ. On microscopic examination, small clear vacuoles may be seen within the cytoplasm;
these represent distended and pinched-off segments of the ER. This pattern of nonlethal
injury is sometimes called hydropic change or vacuolar degeneration. Swelling of cells is
reversible.
Ref: Robbins 8th edition, Chapter 1.
The earliest manifestation of cell injury is:
A: Vasoconstriction
B: Increased vascular permeability
C: Phagocytosis
D: Apoptosis
Correct Ans:A
Explanation
Vasodilation is one of the earliest manifestations of acute inflammation; sometimes it
follows a transient constriction of arterioles, lasting a few seconds. Vasodilation first
involves the arterioles and then leads to opening of new capillary beds in the area. The
result is increased blood flow, which is the cause of heat and redness (erythema) at the site
of inflammation. Vasodilation is induced by the action of several mediators, notably
histamine and nitric oxide (NO), on vascular smooth muscle.
Ref: Robbins 8th edition, Chapter 2
Which of the following pathological process is associated with ‘Annexin V’?

A: Apoptosis
B:
Necrosi
s
C: Atherosclerosis
D: Inflammation
Correct Ans:A
Explanation
Identifying apoptotic cells:
 Staining of chromatin condensation
 Flow cytometry to visualize rapid cell shrinkage
 DNA changes detected by in situ techniques or by gel electrophoresis
 Annexin V as marker for apoptotic cell membrane having
phosphatidylserine on the cell exterior
Ref: Essential Pathology By Harsh Mohan, 2005, Page 38.
While advancing there is increased chance of developing cancers. Tumorigenesis in aging is
due to:
A: Telomerase reactivation
B:
Telomerase
inactivation
C: Increased apoptosis
D: Suppression of proto-oncogenes
Correct Ans:A
Explanation
Telomerase is a ribonucleoprotein that is expressed in stem cells and most cancer cells, but
not in somatic cells. More than 90% of human cancers express high levels of telomerase
that prevent telomere shortening to critical levels and allow indefinite cell proliferation.
Ref: Longo D.L. (2012). Chapter 84. Cancer Cell Biology and Angiogenesis. In D.L. Longo,
A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of
Internal Medicine, 18e.

In which of the following pathological processes caspases are involved in?
A: Apoptosis
B: Fatty change
C: Hydropic degeneration
D: Collagen hyalinosis
Correct Ans:A
Explanation
Apoptosis can be initiated by external signals that have features in common with those
used by ligands such as TNF- or by an internal pathway activated by DNA damage,
improperly folded proteins, or withdrawal of cell survival factors. Regardless of the mode of
initiation, the apoptotic program is carried out by a large family of cysteineproteases
termed caspases. The caspases are highly specific cytoplasmic proteases that are inactive
in normal cells but become activated by apoptotic signals.
Ref: Blumenthal D.K., Garrison J.C. (2011). Chapter 3. Pharmacodynamics: Molecular
Mechanisms of Drug Action. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman
& Gilman's The Pharmacological Basis of Therapeutics, 12e.
Which of the following cell organelle is mainly involved during apoptosis?
A: Nucleus
B: Mitochondria
C: Endoplasmic reticulum
D: Golgi complex
Correct Ans:B
Explanation
Loss of mitochondrial function is seen during apoptosis. Mitochondrial membrane integrity
is not maintained, causing the end of normal activity and release of cytochrome c into the
cytoplasm where it activates proteolytic enzymes called caspases. The initial caspases
activate a cascade of other caspases, resulting in protein degradation throughout the cell.
Ref: Mescher A.L. (2010). Chapter 3. The Cell Nucleus. In A.L. Mescher (Ed), Junqueira's
Basic Histology: Text & Atlas, 12e.

All of the following statements regarding apoptosis are TRUE, EXCEPT:
A: Considerable apoptosis may occur in tissues before it becomes apparent in histology
B:
Apoptotic cells appear round mass of the intensely eosinophilic
cytoplasm with dense nuclear chromatin fragments
C: Apoptosis of cells induce inflammatory reaction
D: Macrophages phagocytose the apoptotic cells and degrade them.
Correct Ans:C
Explanation
Apoptosis refers to preprogrammed natural or physiological cell death. It occurs without
any inflammatory reaction.
Features of apoptosis are:
 Death occur by shrinkage
 It affects isolated cells
 It is a gene initiated process, and DNA fragments are small and regular
Histologic features:
 Cell shrinkage
 Nuclear condensation and fragmentation
 Membrane budding
 Buds includes cell organelles
 Buds detach to form apoptotic bodies
 Phagocytosis of the apoptotic bodies occur
Ref: Textbook of Pathology By Datta page 48.
A patient is brought to the emergency department following carbon monoxide poisoning.
Hyperbaric oxygen was given, following which patient developed oxygen toxicity. What is
the likely mechanism of the toxicity?
A: Direct DNA damage
B: Apoptosis

C: Nuclear fragmentation
D: Mediated by free radicals
Correct Ans:D
Explanation
The free radical theory of oxygen toxicity explains the mechanism of oxygen toxicity.
According to the theory, various highly reactive and potentially cytotoxic free-radical
products of oxygen are generated metabolically in the cell.
These short-lived oxygen metabolites, including superoxide anion, hydroxyl radical,
hydrogen peroxide, and singlet oxygen, have been shown to be capable of effects such as
inactivation of sulfhydryl enzymes, interaction with and disruption of DNA, and peroxidation
of unsaturated membrane lipids with resultant loss of membrane integrity.
The cell is also equipped with an array of antioxidant defenses, including the enzymes
superoxide dismutase, catalase, glutathione peroxidase, vitamin E, and ascorbate. Under
hypoxia, the intracellular generation and influx of free radicals is believed to increase
markedly and may overwhelm the detoxifying capacity of the normal complement of
antioxidant defenses, with resultant cytotoxicity.
The pathology of oxygen toxicity in the lungs is non-specific and consists of atelectasis,
edema, alveolar hemorrhage, inflammation, fibrin deposition, and thickening and
hyalinization of alveolar membranes.
Ref: Yao & Artusio's Anesthesiology: Problem-Oriented Patient Management By Fun-Sun F.
Yao, Vinod Malhotra, M.D., 2012, Page 67 ; Pulmonary physiology by Michael G.
Levitzkypage, 2007, Page 245
The normal cellular counterparts of oncogenes are important for the following functions,
except:
A: Promotion of cell cycle progression
B:
Inhibition of
apoptosis
C: Promotion of DNA repair
D: Promotion of nuclear transcription
Correct Ans:C
Explanation
Oncogenes may function by inactivation of DNA repair genes, but not by promotion of DNA
repair.

Ref: Robbin’s Illustrated Pathology, 7th Edition, Pages 293, 295; Oncogenes By Geoffrey M. Cooper,
1995, Preview.
The normal cellular counterparts of oncogenes are important for the following functions,
except:
A: Promotion of cell cycle progression
B:
Inhibition of
apoptosis
C: Promotion of DNA repair
D: Promotion of nuclear transcription
Correct Ans:C
Explanation
Oncogenes may function by inactivation of DNA repair genes, but not by promotion of DNA
repair.
Ref: Robbin’s Illustrated Pathology, 7th Edition, Pages 293, 295; Oncogenes By Geoffrey M. Cooper,
1995, Preview.
Which among the following is TRUE regarding tumorigenesis during aging?
A: Telomerase reactivation
B:
Telomerase
inactivation
C: Increased apoptosis
D: Suppression of proto-oncogenes
Correct Ans:A
Explanation

Telomerase is a ribonucleoprotein that is expressed in stem cells and most cancer cells, but
not in somatic cells. More than 90% of human cancers express high levels of telomerase
that prevent telomere shortening to critical levels and allow indefinite cell proliferation.
Which of the following factor is essential for tumor metastasis?
A: Angiogenesis
B: Tumorigenesis
C: Apoptosis
D: Inhibition of Tyrosine kinase activity
Correct Ans:A
Explanation
A critical element in the growth of primary tumors and formation of metastatic sites is
the angiogenic switch: the ability of the tumor to promote the formation of new capillaries
from preexisting host vessels.
Stimuli for tumor angiogenesis include hypoxemia, inflammation, and genetic lesions in
oncogenes or tumor suppressors that alter tumor cell gene expression. Angiogenesis
consists of several steps, including the stimulation of endothelial cells (ECs) by growth
factors, the degradation of the ECM by proteases, proliferation of ECs and migration into the
tumor, and the eventual formation of new capillary tubes.
In apoptosis, Apaf-1 is activated by release of which of the following substances from the
mitochondria?
A: Bcl-2
B: Ba

x
C: Bcl-XL
D: Cytochrome C
Correct Ans:D
Explanation
Apoptotic signals cause increased permeability of outer mitochondrial membrane, which
inturn releases the apoptotic trigger cytochrome c from the mitochondria to cytosol.
Cytochrome c is located between the inner and outer mitochondrial membrane. Its release
preceds the morphologic changes of apoptosis, showing that it occur early, consistent with
regulatory function.
When cytochrome c is released from the mitochondria, it binds to Apaf 1 and activates it,
triggering an initiator caspase and sets in motion the proteolytic events that kill the cell.
Ref: Robbins Pathologic Basis of Disease, 6th Edition, Pages 21- 22; Elements of Human
Cancer By Geoffrey M. Cooper, Page 190; Manual of Cable Osteosyntheses: History,
Technical Basis By Reiner Labitzke, Page 289; Recombinant Human Erythropoietin (rhEPO)
in Clinical Oncology By Mohammad Resa Nowrousian, Page 25
Which of the following feature is NOT true regarding Chlamydia Trachomatis?
A: Elementary body is metabolically active
B:
Life cycle is
biphasic
C: It inhibits apoptosis of epithelial cells
D: Has an ability to inhibit lysosomal fusion
Correct Ans:A
Explanation
The replicative cycle of chlamydiae involves two forms of the organism
(biphasic): a small, hardy infectious form termed the elementary body (EB), and
a larger fragile intracellular replicative form termed the reticulate body
(RB). The EB is a metabolically inert form that neither expends energy nor
synthesizes protein. It enters the cell in an endocytotic vacuole and begins the
process of converting to the replicative RB.

The ability to inhibit lysosomal fusion is unique to chlamydia and enables the EB
to survive in a vesicle referred to as an inclusion. C trachomatis also inhibits
apoptosis of epithelial cells, thus enabling completion of its replicative cycle.
Ref: Ray C.G., Ryan K.J. (2010). Chapter 39. Chlamydia. In C.G. Ray, K.J.
Ryan (Eds), Sherris Medical Microbiology, 5e.
A gastric biopsy is performed on a patient with suspected graft-versus-host disease
following bone marrow transplantation. The biopsy demonstrates many isolated dying
epithelial cells in crypts showing fragmented, hyperchromatic nuclei and small discrete
blebs containing both cytoplasm and nuclear fragments. The biopsy demonstrates which of
the following?
A: Apoptosis
B: Caseous neurosis
C: Coagulative necrosis
D: Gangrenous necrosis
Correct Ans:B
Explanation
The changes described are those of apoptosis, which is a form of programmed cell death.
Apoptosis can be seen in a variety of settings. In this case, it is occurring in the context of
graft-versus-host disease, which is mediated by CD8+ and CD4+ cells. Apoptosis also
occurs during embryogenesis, during hormone-dependent involution in the adult (eg,
during menstruation), during rapid proliferation of cell populations (eg, intestinal crypt
epithelia), and in the immune system (e.g., in developing thymus). It can also occur after
duct obstruction in organs such as pancreas and during some viral diseases. The hallmark
of this programmed method of cell death is the fragmentation of the cell with formation of
cytoplasmic blebs and apoptotic bodies that are phagocytized by other healthy cells.
Caseous necrosis, such as is seen in tuberculosis, shows necrotic, amorphous granular
debris surrounded by a granulomatous response.
Coagulative necrosis, such as is seen in myocardial infarction, shows coagulated, anuclear
cell "ghosts."
Gangrenous necrosis is a commonly used surgical term (eg, in diabetic feet) that does not
have a precise pathologic counterpart.
Ref: Jan B.V., Lowry S.F. (2010). Chapter 2. Systemic Response to Injury and Metabolic
Support. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B.
Matthews, R.E. Pollock (Eds), Schwartz's Principles of Surgery, 9e.

Which of the following features characterizes apoptosis but not necrosis?
A: Disaggregation of polyribosomes
B: Eosinophilia
C: Inflammation
D: Peripheral aggregation of chromatin
Correct Ans:D
Explanation
Apoptosis is a form of cell death that serves to eliminate unwanted cells during
development, maintain cell numbers in intact organs or tissues, and eliminate immune cells
after an immune response has faded. Apoptosis also occurs in response to noxious agents
and in the aging process. The process is the result of execution of an internal program
mediated by the expression of a number of different genes. In the process of apoptosis,
cells shrink and cytoplasmic organelles become more densely packed. Cytoplasmic blebs
may form, and apoptotic bodies (membrane-bound cellular fragments) can be produced.
The most characteristic feature of apoptosis is a distinctive peripheral aggregation of
chromatin, sometimes accompanied by breaking up of the nucleus into several fragments.
In necrosis, the chromatin may become more pale (karyolysis), or form irregular clumps,
and the nucleus itself may shrink into a dense pyknotic body.
Disaggregation of polyribosomes is characteristic of the initial stages of cellular injury and
necrosis.
Eosinophilia characterizes both apoptosis and necrosis. Inflammation is typically absent in
apoptosis, in contrast to necrosis.
Ref: Jan B.V., Lowry S.F. (2010). Chapter 2. Systemic Response to Injury and Metabolic
Support. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B.
Matthews, R.E. Pollock (Eds), Schwartz's Principles of Surgery, 9e.
The role of mitochondria is in all of the following, except:
A: ATP production
B:
Apoptosi
s
C: Tricarboxylic acid cycle

D: Fatty acid biosynthesis
Correct Ans:D
Explanation
Mitochondria is not involved in Fatty acid biosynthesis. Fatty acid biosynthesis takes place
in cytosol.
Which of the following growth factor maintain the neurons by reducing apoptosis therefore
the memory cells does not undergo apoptosis?
A: Platelet derived growth factor
B:
Nerve growth
factor
C: Insulin like growth factor
D: Fibroblast growth factor
Correct Ans:B
Explanation
The first neurotrophin to be characterized was nerve growth factor (NGF), a protein growth
factor that is necessary for the growth and maintenance of sympathetic neurons and some
sensory neurons.
NGF is picked up by neurons and is transported in retrograde fashion from the endings of
the neurons to their cell bodies. It is also present in the brain and appears to be responsible
for the growth and maintenance of cholinergic neurons in the basal forebrain and the
striatum.
There is evidence that the maintenance of neurons by NGF is due to a reduction in
apoptosis.
Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 4. Excitable Tissue:
Nerve. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of
Medical Physiology, 24e.

Release of proenzymes from the pancreatic acinar cells is accomplished by which of the
following processes?
A: Exocytosis
B: Transcytosis
C: Apoptosis
D: Endocytosis
Correct Ans:A
Explanation
The membrane of the zymogen granule fuses with the apical cell membrane to release the
proenzymes synthesized by the pancreatic acinar cells into the acinar lumen. This
isexocytosis.
Transcytosis describes the transit through the cytoplasm of certain materials, such as
immunoglobulin A, from one surface of a cell to another. Such materials are taken up into
vesicles by receptor-mediated endocytosis and are subsequently released by
exocytosis. Endocytosis and phagocytosis are processes by which materials are taken into
cells by invagination or other deformation of the plasma membrane. Apoptosis is
programmed cell death, an important cellular process, but not related to secretion.
Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 2. Overview of
Cellular Physiology in Medical Physiology. In K.E. Barrett, S.M. Barman, S. Boitano, H.L.
Brooks (Eds), Ganong's Review of Medical Physiology, 24e.

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Previous year question on apoptosis based on neet pg, usmle, plab and fmge or mci screening exams