Anesthesiology
1 questionsPatient was planned for surgery under GA, in the induction phase rocuronium was given 85mg but the anesthetist did not succeed in intubating. Which could be the best reversal agent used?
INI-CET 2024 - Anesthesiology INI-CET Practice Questions and MCQs
Question 101: Patient was planned for surgery under GA, in the induction phase rocuronium was given 85mg but the anesthetist did not succeed in intubating. Which could be the best reversal agent used?
- A. Neostigmine (non-specific acetylcholinesterase inhibitor)
- B. Glycopyrrolate (anticholinergic agent)
- C. Edrophonium (non-specific acetylcholinesterase inhibitor)
- D. Sugammadex (specific reversal agent for rocuronium) (Correct Answer)
Explanation: ***Sugammadex (specific reversal agent for rocuronium)*** - **Sugammadex** is a modified gamma-cyclodextrin that forms a tight, water-soluble complex with **rocuronium**, effectively encapsulating and inactivating it. - It is highly effective for rapid reversal of **rocuronium**-induced neuromuscular blockade, especially in situations where immediate reversal is critical, such as a "cannot intubate, cannot ventilate" scenario. *Neostigmine (non-specific acetylcholinesterase inhibitor)* - **Neostigmine** acts by inhibiting **acetylcholinesterase**, increasing the amount of acetylcholine at the neuromuscular junction to overcome the competitive block. - Its reversal effect is slower and less reliable than sugammadex, especially after a large dose of rocuronium or deep blockade. *Glycopyrrolate (anticholinergic agent)* - **Glycopyrrolate** is an **anticholinergic** agent used to counteract the muscarinic side effects (e.g., bradycardia, salivation) of **acetylcholinesterase inhibitors** like neostigmine, but it has no direct reversal effect on neuromuscular blockade. - It is typically co-administered with neostigmine, not used as a standalone reversal agent for **rocuronium**. *Edrophonium (non-specific acetylcholinesterase inhibitor)* - **Edrophonium** is a short-acting **acetylcholinesterase inhibitor**, similar to neostigmine but with a more rapid onset and shorter duration of action. - It is less potent and effective than neostigmine for reversing moderate to deep neuromuscular blockade and would not be the best choice after a significant dose of **rocuronium**.
Internal Medicine
2 questionsAll of the following regarding ankylosing spondylitis are true except:
A 50-year-old male with a history of chronic alcoholism presents with altered sensorium and signs of portal hypertension. What is the most appropriate initial management step?
INI-CET 2024 - Internal Medicine INI-CET Practice Questions and MCQs
Question 101: All of the following regarding ankylosing spondylitis are true except:
- A. HLA B27 is positive in >90%
- B. More common in males than females
- C. Non-erosive arthritis (Correct Answer)
- D. Typically occurs in late teens to early adulthood (peak onset 20s-30s), but can present after 40 in rare cases
Explanation: ***Non-erosive arthritis*** - Ankylosing spondylitis is characterized by **erosive changes**, particularly at the discovertebral and sacroiliac joints, which can lead to **syndesmophyte formation** and eventual *ankylosis* (fusion) of the spine [1]. - The disease involves inflammation and subsequent **ossification of ligaments**, leading to structural damage rather than being purely non-erosive [1]. *HLA B27 is positive in >90%* - A strong association with **HLA-B27** is a hallmark of ankylosing spondylitis, with over 90% of Caucasian patients testing positive, making it a key diagnostic marker [1]. - While not universally present, its high prevalence further supports this statement as being true [1]. *More common in males than females* - Ankylosing spondylitis typically has a male-to-female predominance, with males generally experiencing **more severe disease progression** and spinal involvement. - While the diagnostic criteria have evolved to recognize a more equitable distribution, the classic presentation often highlights male prevalence. *Typically occurs in late teens to early adulthood (peak onset 20s-30s), but can present after 40 in rare cases* - The onset of ankylosing spondylitis symptoms most commonly occurs in **young adults**, typically between the ages of 20 and 40 [1]. - While less common, a small percentage of patients may experience symptom onset later in life, though this is less typical of the disease's natural history.
Question 102: A 50-year-old male with a history of chronic alcoholism presents with altered sensorium and signs of portal hypertension. What is the most appropriate initial management step?
- A. Perform upper gastrointestinal endoscopy (UGIE)
- B. Administer chlordiazepoxide
- C. Administer thiamine
- D. Administer lactulose (Correct Answer)
Explanation: ***Administer lactulose*** - The patient's presentation with altered sensorium and chronic alcoholism, coupled with signs of portal hypertension, strongly suggests **hepatic encephalopathy**. [1] - **Lactulose** is the most appropriate initial management step because it helps to reduce ammonia absorption from the gut by acidifying the colon and acting as an osmotic laxative, thereby improving neurological function. [1] *Perform upper gastrointestinal endoscopy (UGIE)* - While **portal hypertension** can lead to varices and bleeding, an UGIE is an invasive procedure and not the immediate priority for a patient presenting with altered sensorium due to suspected hepatic encephalopathy. - UGIE would be indicated if there were active **gastrointestinal bleeding** (e.g., hematemesis, melena) or hemodynamic instability, which are not explicitly mentioned as the primary concern. *Administer chlordiazepoxide* - **Chlordiazepoxide** is a benzodiazepine used to treat **alcohol withdrawal syndrome** (delirium tremens), which can also cause altered mental status. - However, given the signs of portal hypertension, **hepatic encephalopathy** is a more likely cause of altered sensorium, and benzodiazepines can worsen it by precipifying sedation. *Administer thiamine* - **Thiamine** administration is crucial in chronic alcoholics to prevent and treat **Wernicke-Korsakoff syndrome**, which can cause altered mental status, ophthalmoplegia, and ataxia. [2] - While important in all chronic alcoholics, addressing the potentially life-threatening ammonia toxicity in **hepatic encephalopathy** with lactulose takes precedence in the immediate management of altered sensorium.
Microbiology
1 questionsChoose the correct option regarding graft rejection.
INI-CET 2024 - Microbiology INI-CET Practice Questions and MCQs
Question 101: Choose the correct option regarding graft rejection.
- A. CD4 and CD8 both play a role in graft rejection (Correct Answer)
- B. None of the options
- C. CD8 only plays a role in graft rejection
- D. CD4 only plays a role in graft rejection
Explanation: ***CD4 and CD8 both play a role in graft rejection*** - **CD4+ T cells** (helper T cells) recognize donor MHC class II molecules and differentiate into effector cells that produce cytokines, promoting inflammation and activating other immune cells involved in rejection - **CD8+ T cells** (cytotoxic T lymphocytes, CTLs) recognize donor MHC class I molecules and directly kill donor cells in the graft, leading to tissue destruction - Both T cell subsets are crucial for initiating and mediating different aspects of the immune response against transplanted organs *CD8 only plays a role in graft rejection* - This is incorrect because while **CD8+ T cells** are vital for direct cytotoxicity, **CD4+ T cells** are also essential for orchestrating the overall immune response - **CD4+ T cells** provide help to B cells and CD8+ T cells, and their cytokines can also directly injure graft tissue *CD4 only plays a role in graft rejection* - This is incorrect because although **CD4+ T cells** are critical for initiating and amplifying the immune response through cytokine production and activation of other cells, **CD8+ T cells** are directly responsible for killing graft cells - Both cell types contribute significantly to the complex pathophysiology of graft rejection
Ophthalmology
1 questionsA patient presents with superior quadrant vision loss since one week. Patient has Rheumatic Heart Disease (RHD) and is not taking medications. What is the most likely diagnosis?
INI-CET 2024 - Ophthalmology INI-CET Practice Questions and MCQs
Question 101: A patient presents with superior quadrant vision loss since one week. Patient has Rheumatic Heart Disease (RHD) and is not taking medications. What is the most likely diagnosis?
- A. CRAO
- B. CRVO
- C. BRAO (Correct Answer)
- D. BRVO
Explanation: ***BRAO*** - **Branch retinal artery occlusion** (BRAO) presents with **sudden, painless sectoral or quadrant visual field loss** corresponding to the distribution of the occluded arterial branch. - Superior quadrant vision loss indicates **inferior retinal involvement** (visual field is inverted on retina). - **Rheumatic heart disease** not on anticoagulation poses high risk for **cardiac emboli** from valvular vegetations or atrial fibrillation, which preferentially cause **arterial occlusions** (BRAO/CRAO). - Fundoscopy shows **retinal whitening** in the affected area with a clear demarcation line. *BRVO* - **Branch retinal vein occlusion** causes quadrant vision loss but is **NOT typically embolic** in nature. - BRVO is associated with systemic **vascular risk factors** (hypertension, diabetes, hyperlipidemia), not cardiac emboli. - Fundoscopy shows **flame-shaped hemorrhages** and cotton-wool spots in a wedge distribution. *CRAO* - **Central retinal artery occlusion** presents with **complete, sudden painless monocular vision loss** affecting the entire visual field. - Shows classic **"cherry-red spot"** at the fovea due to diffuse retinal ischemia. - Would not present with isolated quadrant vision loss. *CRVO* - **Central retinal vein occlusion** causes **complete monocular vision loss** with "blood and thunder" appearance on fundoscopy. - Presents with diffuse retinal hemorrhages throughout the retina, not isolated to one quadrant.
Pediatrics
1 questionsAccording to neonatal resuscitation protocol, how much oxygen to give in a term neonate with apnea and bradycardia initially?
INI-CET 2024 - Pediatrics INI-CET Practice Questions and MCQs
Question 101: According to neonatal resuscitation protocol, how much oxygen to give in a term neonate with apnea and bradycardia initially?
- A. 100%
- B. 21% (Correct Answer)
- C. 50%
- D. 30%
Explanation: ***21%*** - According to **NRP (Neonatal Resuscitation Program) 2020 guidelines**, for **term neonates (≥35 weeks gestation)** requiring resuscitation, the initial recommendation is to use **room air (21% oxygen)** to minimize the risk of hyperoxia and oxidative injury. - Multiple randomized controlled trials have demonstrated that room air is as effective as 100% oxygen for initial resuscitation. - Supplemental oxygen is only added if **oxygen saturation targets** are not met despite adequate ventilation, and should be titrated using **pulse oximetry**. *30%* - This concentration is **higher than room air** and is not the initial recommendation for term neonates needing resuscitation. - Starting with a higher oxygen concentration can lead to **oxidative stress** without immediate benefit. - Higher initial concentrations (21-30%) are reserved for **preterm neonates (<35 weeks)**. *100%* - Administering **100% oxygen** can be harmful to a neonate, potentially causing **oxidative injury** to developing organs, including the lungs, brain, and retina. - This was the old practice but has been **discontinued** based on evidence showing increased mortality and morbidity. - High concentrations are no longer recommended even in severe cases; oxygen should be titrated to saturation targets. *50%* - While lower than 100%, 50% oxygen is still **not the initial recommended concentration** for term neonates in resuscitation protocols. - The goal is to start with **21% oxygen** and gradually increase based on **pulse oximetry monitoring** and target saturation ranges if 21% is insufficient.
Pharmacology
2 questionsCannabidiol is not used for
Which of the following anti-leprosy drugs can cause skin hyperpigmentation?
INI-CET 2024 - Pharmacology INI-CET Practice Questions and MCQs
Question 101: Cannabidiol is not used for
- A. Rett syndrome (Correct Answer)
- B. Lennox-Gastaut syndrome
- C. Dravet syndrome
- D. Tuberous sclerosis complex
Explanation: ***Rett syndrome*** - **Cannabidiol (CBD)** is not an approved or commonly used treatment for Rett syndrome, which is a **neurodevelopmental disorder** primarily affecting girls. - Treatment for Rett syndrome focuses on managing symptoms with supportive care, **physiotherapy**, occupational therapy, and medications for specific issues like seizures or gastrointestinal problems. *Dravet syndrome* - **Cannabidiol (Epidiolex)** is approved in many regions for the treatment of seizures associated with **Dravet syndrome**, a severe form of epilepsy. - It works by modulating the **endocannabinoid system**, which plays a role in seizure control. *Lennox-Gastaut syndrome* - **Cannabidiol (Epidiolex)** is also approved for the treatment of seizures associated with **Lennox-Gastaut syndrome**, another severe and intractable childhood epilepsy. - Its efficacy in reducing seizure frequency in LGS has been demonstrated in clinical trials. *Tuberous sclerosis complex* - While not as widely established as for Dravet or Lennox-Gastaut, **cannabidiol (Epidiolex)** has shown promise and is approved in some regions for treating seizures associated with **tuberous sclerosis complex (TSC)**. - TSC is a genetic disorder causing benign tumors in multiple organs, often leading to epilepsy.
Question 102: Which of the following anti-leprosy drugs can cause skin hyperpigmentation?
- A. Clofazimine (Correct Answer)
- B. Rifampicin
- C. Ofloxacin
- D. Dapsone
Explanation: ***Clofazimine*** - **Clofazimine** is known to cause dose-dependent **hyperpigmentation** of the skin, ranging from reddish-brown to dark brown, and can also discolor bodily fluids. - This side effect is due to the drug's accumulation in macrophages and subsequent deposition in the dermis and subcutaneous fat. *Rifampicin* - **Rifampicin** can cause harmless **reddish-orange discoloration** of urine, sweat, tears, and other bodily secretions. - It is not typically associated with **skin hyperpigmentation** (darkening of the skin itself). *Ofloxacin* - **Ofloxacin** is a fluoroquinolone antibiotic primarily used in leprosy treatment as a second-line agent. - Its common side effects include gastrointestinal disturbances and nervous system effects, but **skin hyperpigmentation** is not a characteristic adverse event. *Dapsone* - **Dapsone** is a sulfone drug and a cornerstone of leprosy treatment, but it is not associated with **skin hyperpigmentation**. - Its most notable side effects include **hemolysis**, especially in patients with **G6PD deficiency**, and methemoglobinemia.
Physiology
1 questionsAll of the following are true about the adrenal gland EXCEPT:
INI-CET 2024 - Physiology INI-CET Practice Questions and MCQs
Question 101: All of the following are true about the adrenal gland EXCEPT:
- A. Zona fasciculata secretes cortisol
- B. Medulla produces mineralocorticoids (Correct Answer)
- C. Zona glomerulosa produces aldosterone
- D. Zona reticularis secretes androgens
Explanation: ***Medulla produces mineralocorticoids*** - The **adrenal medulla** primarily produces **catecholamines** (epinephrine and norepinephrine), not mineralocorticoids. - **Mineralocorticoids** (like aldosterone) are secreted by the **zona glomerulosa** in the adrenal cortex. *Zona fasciculata secretes cortisol* - The **zona fasciculata** is the middle and largest layer of the adrenal cortex. - Its primary function is the secretion of **glucocorticoids**, mainly **cortisol**, which is crucial for stress response and metabolism. *Zona glomerulosa produces aldosterone* - The **zona glomerulosa** is the outermost layer of the adrenal cortex. - It is responsible for producing **mineralocorticoids**, with **aldosterone** being the most significant. *Zona reticularis secretes androgens* - The **zona reticularis** is the innermost layer of the adrenal cortex, adjacent to the medulla. - It primarily secretes **adrenal androgens** (like DHEA and androstenedione), which are precursors to sex hormones.
Psychiatry
1 questionsIn which of the following patients would supportive therapy be most challenging to implement effectively?
INI-CET 2024 - Psychiatry INI-CET Practice Questions and MCQs
Question 101: In which of the following patients would supportive therapy be most challenging to implement effectively?
- A. Patient who is severely ill and has significant ego dysfunction
- B. Person who is motivated and has good self-control
- C. Person with good cognitive and functional abilities
- D. Patient who is severely ill and uncooperative (Correct Answer)
Explanation: ***Patient who is severely ill and uncooperative*** - A **severely ill** patient who is **uncooperative** presents the most **immediate and direct barrier** to implementing supportive therapy effectively. Their **active resistance** to therapeutic interventions (refusing medication, declining to engage, missing appointments) makes it practically impossible to deliver care. - **Uncooperativeness** represents active opposition to treatment, requiring resolution before any therapeutic work can proceed. Without patient engagement, even the most basic supportive interventions cannot be implemented. - While other patients may have limitations, an uncooperative patient fundamentally blocks the therapeutic alliance necessary for any psychotherapy. *Patient who is severely ill and has significant ego dysfunction* - **Ego dysfunction** (impaired reality testing, poor impulse control, weak sense of self) is indeed challenging and represents a relative contraindication to insight-oriented therapies. - However, patients with ego dysfunction may still **passively participate** in supportive therapy, especially when the therapy is structured and focused on basic stabilization rather than insight. - The key difference: ego dysfunction is a **structural limitation** requiring adaptation of technique, whereas uncooperativeness is an **active barrier** preventing any intervention. A patient with ego dysfunction can still potentially benefit from modified supportive approaches, but an uncooperative patient cannot be engaged at all. *Person who is motivated and has good self-control* - This patient would be the **easiest to treat** with supportive therapy due to their intrinsic motivation and ability to manage their own behavior. - Their **motivation** and **self-control** would facilitate adherence to treatment plans and active participation in their care, making implementation straightforward. *Person with good cognitive and functional abilities* - This patient would be **highly amenable to supportive therapy** as their cognitive and functional capacities allow them to understand and participate in treatment. - Good cognitive and functional abilities enable them to comprehend instructions, manage their own care, and engage effectively with healthcare providers, presenting minimal implementation challenges.