Dermatology
2 questionsA man presents with a rash on his flank with itching for the past 2 weeks. The patient has tried several over-the-counter medications, including lotrimin and hydrocortisone, without any improvement. In physical examination, the rash is seen on his palms and the sole of one foot, but no oral lesions are found. What is the likely diagnosis?
Match the following woods lamp findings: 1. Erythrasma, 2. Pityriasis versicolor, 3. Tinea capitis, 4. Vitiligo || a. Yellow b. Coral red fluorescence c. Pink d. Green e. Milky white
INI-CET 2023 - Dermatology INI-CET Practice Questions and MCQs
Question 111: A man presents with a rash on his flank with itching for the past 2 weeks. The patient has tried several over-the-counter medications, including lotrimin and hydrocortisone, without any improvement. In physical examination, the rash is seen on his palms and the sole of one foot, but no oral lesions are found. What is the likely diagnosis?
- A. Tinea corporis
- B. Pityriasis rosea
- C. Secondary syphilis (Correct Answer)
- D. Contact dermatitis
Explanation: ***Secondary syphilis*** - The rash presenting on the **palms and soles** is highly characteristic of **secondary syphilis**, which helps differentiate it from many other dermatological conditions. - The lack of improvement with antifungal (Lotrimin) and corticosteroid (hydrocortisone) treatments further supports a diagnosis other than a fungal infection or inflammatory dermatitis. *Tinea corporis* - This fungal infection typically presents as an **annular (ring-shaped) rash** with central clearing and well-demarcated borders, often on the trunk or limbs. - It would likely show some improvement, even if partial, with **Lotrimin (an antifungal medication)**, which is not the case here. *Pityriasis rosea* - This condition is characterized by an initial **"herald patch"** followed by smaller, oval, pinkish-red patches that often align along skin cleavage lines in a **"Christmas tree" pattern** on the trunk. - It typically spares the palms and soles, which are involved in this patient's presentation. *Contact dermatitis* - This is an inflammatory skin reaction due to contact with an allergen or irritant, presenting as **pruritic (itchy) erythematous (red) patches, possibly with vesicles or bullae**, limited to exposed areas. - While hydrocortisone might offer some relief, the presentation on palms and soles without clear exposure and the lack of response to treatment make it less likely.
Question 112: Match the following woods lamp findings: 1. Erythrasma, 2. Pityriasis versicolor, 3. Tinea capitis, 4. Vitiligo || a. Yellow b. Coral red fluorescence c. Pink d. Green e. Milky white
- A. 1-d, 2-a, 3-c, 4-e
- B. 1-b, 2-a, 3-d, 4-e (Correct Answer)
- C. 1-a, 2-c, 3-e, 4-d
- D. 1-b, 2-d, 3-a, 4-c
Explanation: ***1-b, 2-a, 3-d, 4-e*** - **Erythrasma** is caused by *Corynebacterium minutissimum* and produces **porphyrins** that fluoresce **coral red** under a Wood's lamp [1]. - **Pityriasis versicolor** is caused by *Malassezia furfur* and typically fluoresces **yellow to yellowish-green** [2]. - **Tinea capitis** (especially due to *Microsporum* species) shows **green fluorescence** of infected hairs. - **Vitiligo** lesions, due to a complete absence of melanin, appear as **milky white** or bright white areas under a Wood's lamp [3]. *1-d, 2-a, 3-c, 4-e* - This option incorrectly states that Erythrasma fluoresces green. Green fluorescence is characteristic of *Microsporum* species causing **Tinea capitis**. - Additionally, Tinea capitis is incorrectly associated with pink fluorescence, which is not a typical finding. *1-a, 2-c, 3-e, 4-d* - This option incorrectly states that Erythrasma fluoresces yellow. Yellow fluorescence is associated with **Pityriasis versicolor** [2]. - It also incorrectly assigns milky white fluorescence to Tinea capitis and green fluorescence to Vitiligo. *1-b, 2-d, 3-a, 4-c* - This option incorrectly associates Pityriasis versicolor with green fluorescence. While some variations exist, **yellow** is the more characteristic finding [2]. - It also incorrectly links Tinea capitis to yellow fluorescence and Vitiligo to pink, which are not typical Wood's lamp findings for these conditions.
Internal Medicine
1 questionsKEYNOTE-189 trial for pembrolizumab is done for?
INI-CET 2023 - Internal Medicine INI-CET Practice Questions and MCQs
Question 111: KEYNOTE-189 trial for pembrolizumab is done for?
- A. Nivolumab with chemo given for NSCLC
- B. Only Pembrolizumab for NSCLC
- C. Pembrolizumab with chemo given for NSCLC (Correct Answer)
- D. Only nivolumab for NSCLC
Explanation: ***Pembrolizumab with chemo given for NSCLC*** - The **KEYNOTE-189 trial** investigated the efficacy of **pembrolizumab** in combination with chemotherapy as first-line treatment for **metastatic nonsquamous non-small cell lung cancer (NSCLC)**. - This trial demonstrated significant improvements in overall survival and progression-free survival, leading to the approval of pembrolizumab in this setting. *Nivolumab with chemo given for NSCLC* - **Nivolumab** is another PD-1 inhibitor, but studies specifically combining nivolumab with chemotherapy for NSCLC (e.g., CheckMate 227) are distinct from KEYNOTE-189. - While both drugs are used in NSCLC, their pivotal trials and specific combination regimens differ. *Only Pembrolizumab for NSCLC* - Although pembrolizumab monotherapy is approved for certain NSCLC patients with high PD-L1 expression, the **KEYNOTE-189 trial specifically focused on a combination approach** with chemotherapy. - Other KEYNOTE trials, like KEYNOTE-024, evaluated pembrolizumab monotherapy in NSCLC. *Only nivolumab for NSCLC* - **Nivolumab monotherapy** has been studied and approved for NSCLC, particularly in the second-line setting or for patients with high PD-L1 expression, but this was not the focus of the KEYNOTE-189 trial. - Trials like CheckMate 017 and 057 investigated nivolumab as a single agent in NSCLC.
Pharmacology
7 questionsA female patient presented with vulvovaginal pruritus. On detailed history taking, it was found that she was on some antidiabetic drugs. Which antidiabetic drug can cause the above-mentioned side effect?
The first drug approved for Rett syndrome is?
Which of the following is true about clinical therapeutic index?
What is the treatment for HER-2 positive trastuzumab resistant breast cancer?
Which nomogram scale is used for aminoglycoside dosage?
Osimertinib is used in NSCLC with which mutation?
Match the following: Column A: a. Beta 1 b. Beta 2 c. Beta 3 Column B: 1. Mirabegron 2. Betaxolol 3. Salbutamol
INI-CET 2023 - Pharmacology INI-CET Practice Questions and MCQs
Question 111: A female patient presented with vulvovaginal pruritus. On detailed history taking, it was found that she was on some antidiabetic drugs. Which antidiabetic drug can cause the above-mentioned side effect?
- A. Metformin
- B. Canagliflozin (Correct Answer)
- C. Linagliptin
- D. Liraglutide
Explanation: ***Canagliflozin*** - Canagliflozin is a **sodium-glucose co-transporter 2 (SGLT2) inhibitor**. These drugs work by increasing **urinary glucose excretion**. - The increased glucose in the urine (glycosuria) creates a favorable environment for fungal and bacterial growth, leading to common side effects such as **vulvovaginal candidiasis** (yeast infections) and urinary tract infections, which manifest as pruritus. *Metformin* - Metformin is a **biguanide** that primarily reduces hepatic glucose production and increases insulin sensitivity. - Its common side effects are gastrointestinal, such as **diarrhea, nausea, and abdominal discomfort**, but it does not typically cause genitourinary infections or pruritus. *Linagliptin* - Linagliptin is a **dipeptidyl peptidase-4 (DPP-4) inhibitor** that increases endogenous GLP-1 and GIP levels, enhancing glucose-dependent insulin secretion. - Common side effects include **nasopharyngitis** and **headache**, but it is not associated with vulvovaginal pruritus. *Liraglutide* - Liraglutide is a **glucagon-like peptide-1 (GLP-1) receptor agonist** that increases glucose-dependent insulin secretion, suppresses glucagon secretion, and slows gastric emptying. - Its most common side effects are **gastrointestinal (nausea, vomiting), decreased appetite, and pancreatitis (rare)**, but it generally does not cause vulvovaginal pruritus.
Question 112: The first drug approved for Rett syndrome is?
- A. L-carnitine
- B. Naltrexone
- C. Trofinetide (Correct Answer)
- D. Folinic acid
Explanation: ***Trofinetide*** - **Trofinetide** (marketed as Daybue) is the first drug specifically approved by the FDA for the treatment of Rett syndrome, receiving approval in March 2023. - It is an analog of the **N-terminal tripeptide of insulin-like growth factor-1 (IGF-1)** and is thought to reduce neuroinflammation and support synaptic function in the brain, improving core symptoms of Rett syndrome. *L-carnitine* - **L-carnitine** is a nutritional supplement that has been studied in Rett syndrome for potential mitochondrial dysfunction, but it is not a primary treatment or an FDA-approved drug for the condition. - While sometimes used adjunctively, there is limited evidence for its efficacy as a standalone therapy in Rett syndrome. *Naltrexone* - **Naltrexone** is an opioid antagonist typically used to treat opioid and alcohol dependence. - It has been explored in some neurodevelopmental disorders, but it is not approved for or considered a primary treatment for Rett syndrome. *Folinic acid* - **Folinic acid** is a form of folic acid that can bypass metabolic blocks in folate pathways, sometimes used in conditions with cerebral folate deficiency. - While metabolic abnormalities can occur in Rett syndrome, folinic acid is not an FDA-approved drug for Rett syndrome.
Question 113: Which of the following is true about clinical therapeutic index?
- A. Dose in which efficacy and toxicity can be balanced in an individual (Correct Answer)
- B. Therapeutic index is LD50/ED50
- C. It is only used for a specific individual
- D. It measures therapeutic index in populations rather than individuals
Explanation: ***Dose in which efficacy and toxicity can be balanced in an individual*** - The **clinical therapeutic index** refers to the optimal range of drug dosage that produces the maximum desired therapeutic effect with minimal adverse side effects **in a specific patient**. - It involves a personalized approach to find the **balance between efficacy and toxicity** for individual patient care. *It is only used for specific individual* - While it is applied to specific individuals, the concept of a **clinical therapeutic index** is derived from a broader understanding of drug pharmacokinetics and pharmacodynamics established in clinical trials. - This statement is too restrictive, as population data informs the individual application. *Measures therapeutic index in a population vs individual* - The traditional **therapeutic index (TI)** is typically a population-based measure (LD50/ED50 or TD50/ED50), whereas the **clinical therapeutic index** focuses on the individual patient. - This option incorrectly suggests that the clinical TI measures population rather than focusing on the individual’s treatment optimization. *Therapeutic index is ED50/LD50* - The classic definition of the **therapeutic index (TI)** is **LD50/ED50** (Lethal Dose 50% / Effective Dose 50%), which is a ratio for preclinical animal studies. - For humans, the more relevant measure is the **therapeutic window** or the ratio of **TD50/ED50** (Toxic Dose 50% / Effective Dose 50%), but this is still a population measure, not the clinical therapeutic index for an individual.
Question 114: What is the treatment for HER-2 positive trastuzumab resistant breast cancer?
- A. Sorafenib
- B. Lapatinib (Correct Answer)
- C. Vemurafenib
- D. Erlotinib
Explanation: ***Lapatinib*** - Lapatinib is a **dual tyrosine kinase inhibitor** that targets both **HER-2** and **epidermal growth factor receptor (EGFR)**, acting as a **small molecule inhibitor** that binds to the intracellular domain of these receptors. - Unlike trastuzumab (a monoclonal antibody targeting the extracellular domain), Lapatinib's **intracellular mechanism of action** allows it to overcome common mechanisms of trastuzumab resistance, such as receptor truncation or masking of the extracellular epitope. - It is specifically approved for the treatment of **HER-2 positive metastatic breast cancer** in combination with capecitabine after progression on trastuzumab-containing regimens. *Sorafenib* - Sorafenib is a **multi-kinase inhibitor** primarily targeting RAF, VEGFR, and PDGFR, and is used in renal cell carcinoma and hepatocellular carcinoma. - It does not specifically target HER-2 and is **not indicated** for HER-2 positive trastuzumab-resistant breast cancer. *Vemurafenib* - Vemurafenib is a **BRAF inhibitor** used for treating BRAF V600E mutation-positive melanoma. - This drug has no direct indications or demonstrated efficacy for **HER-2 positive breast cancer** and does not address trastuzumab resistance mechanisms. *Erlotinib* - Erlotinib is an **EGFR tyrosine kinase inhibitor** primarily used for non-small cell lung cancer with activating EGFR mutations. - While it targets EGFR, it does **not effectively target HER-2** and lacks the dual inhibition necessary to overcome trastuzumab resistance in HER-2 positive breast cancer.
Question 115: Which nomogram scale is used for aminoglycoside dosage?
- A. Hartford nomogram (Correct Answer)
- B. Hallstead scale
- C. Salazar scale
- D. Rumack Matthew nomogram
Explanation: ***Hartford nomogram*** - The **Hartford nomogram** is the standard tool for determining **once-daily (extended-interval) aminoglycoside dosing** based on **creatinine clearance**. - It helps clinicians optimize aminoglycoside therapy by allowing for less frequent dosing while maintaining therapeutic drug levels and minimizing **nephrotoxicity** and **ototoxicity**. - Developed at Hartford Hospital, this nomogram guides dosing intervals (24, 36, or 48 hours) based on a single serum level drawn 6-14 hours post-dose. *Hallstead scale* - The **Hallstead scale** is not a standard nomogram used in clinical practice for drug dosing. - This term does not correspond to a recognized clinical tool for medication management or aminoglycoside therapy. *Salazar scale* - The **Salazar-Corcoran equation** is used for estimating **creatinine clearance in obese patients**, not as a nomogram for aminoglycoside dosing. - While it may be used in the pharmacokinetic assessment before aminoglycoside dosing, it is not a dosing nomogram itself. *Rumack Matthew nomogram* - The **Rumack-Matthew nomogram** is used for assessing the risk of **hepatotoxicity** after an **acetaminophen overdose** by plotting plasma acetaminophen levels against time. - It is not used for aminoglycoside dosage or therapeutic drug monitoring.
Question 116: Osimertinib is used in NSCLC with which mutation?
- A. L858R mutation
- B. M790T mutation
- C. T890M mutation
- D. T790M mutation (Correct Answer)
Explanation: ***T790M mutation*** - **Osimertinib** is a third-generation **EGFR tyrosine kinase inhibitor (TKI)** specifically designed to overcome resistance to earlier generation EGFR TKIs. - The **T790M mutation** in the EGFR gene is the most common mechanism of acquired resistance to first and second-generation EGFR TKIs in non-small cell lung cancer (NSCLC). *L858R mutation* - The **L858R mutation** is an activating **EGFR mutation** typically sensitive to first and second-generation EGFR TKIs. - While patients with **L858R** may eventually develop resistance, **osimertinib** is primarily used in the setting of acquired resistance, often mediated by **T790M**. *M790T mutation* - This is not a recognized common or clinically significant activating or resistance mutation in the **EGFR gene** for NSCLC. - The correct resistance mutation that **osimertinib** targets is **T790M**, not **M790T**. *T890M mutation* - This is a typographical error for the clinically relevant **T790M mutation**. - The number sequence is critical for identifying specific amino acid substitutions in gene mutations.
Question 117: Match the following: Column A: a. Beta 1 b. Beta 2 c. Beta 3 Column B: 1. Mirabegron 2. Betaxolol 3. Salbutamol
- A. a-2, b-3 ,c-1 (Correct Answer)
- B. a-2, b-1, c-3
- C. a-3, b-2, c-1
- D. a-3, b-1, c-2
Explanation: ***a-2, b-3, c-1*** - This pairing correctly matches **Betaxolol** with **Beta 1 selective** antagonism, **Salbutamol** with **Beta 2 selective** agonism, and **Mirabegron** with **Beta 3 selective** agonism. - **Betaxolol** is a beta-1 selective adrenergic receptor antagonist, primarily used in ophthalmology to reduce intraocular pressure and as an antihypertensive. **Salbutamol** is a selective beta-2 adrenergic agonist used as a bronchodilator in asthma and COPD, causing relaxation of bronchial smooth muscle. **Mirabegron** is a selective beta-3 adrenergic agonist used to treat overactive bladder by relaxing the detrusor muscle. *a-2, b-1, c-3* - This option incorrectly assigns **Mirabegron** to Beta 2. Mirabegron is a **Beta 3 selective agonist**. - It also incorrectly assigns **Salbutamol** to Beta 3. Salbutamol is a **Beta 2 selective agonist**. *a-3, b-2, c-1* - This option incorrectly assigns **Salbutamol** to Beta 1. Salbutamol is a **Beta 2 selective agonist**. - It also incorrectly assigns **Betaxolol** to Beta 2. Betaxolol is a **Beta 1 selective antagonist**. *a-3, b-1, c-2* - This option incorrectly assigns **Salbutamol** to Beta 1 and **Betaxolol** to Beta 3. - **Salbutamol** is a Beta 2 selective agonist, and **Betaxolol** is a Beta 1 selective antagonist.