Community Medicine
1 questionsAccording to NPCBVI, blindness is defined as:
INI-CET 2025 - Community Medicine INI-CET Practice Questions and MCQs
Question 101: According to NPCBVI, blindness is defined as:
- A. Corrected visual acuity 6/60 in better eye
- B. Corrected visual acuity 3/60 in better eye
- C. Presenting visual acuity < 3/60 in better eye (Correct Answer)
- D. Presenting visual acuity 6/60 in better eye
Explanation: ***Presenting visual acuity < 3/60 in better eye*** - According to the **NPCBVI (National Programme for Control of Blindness and Visual Impairment)**, blindness is defined as **presenting visual acuity of less than 3/60** or visual field loss less than 10 degrees in the better eye. - **Presenting visual acuity** is defined as the visual acuity measured with the person's current spectacle correction (if any) or without correction. - This definition helps capture the true burden of vision loss in the community, including those who lack access to or compliance with corrective measures. *Corrected visual acuity 3/60 in better eye* - Using **"corrected visual acuity"** implies measurement taken with the best possible spectacle or contact lens correction, which is used for defining vision impairment according to **WHO standards**, but not the specific NPCBVI definition for blindness status in India. - The current NPCBVI definition uses **presenting acuity** to better reflect the functional vision status in real-world conditions. *Presenting visual acuity 6/60 in better eye* - A visual acuity of 6/60 (or less than 6/18 down to 6/60) in the better eye falls under the category of **Severe Visual Impairment** or low vision, but not clinical blindness, according to NPCBVI and WHO definitions. - The cut-off for clinical blindness is significantly lower, which is **less than 3/60**. *Corrected visual acuity 6/60 in better eye* - This measurement, regardless of whether it is presenting or corrected, falls into the category of **Visual Impairment** (low vision), specifically severe visual impairment (WHO Category 2). - The defining threshold for clinical blindness is acuity worse than 3/60, not 6/60.
Internal Medicine
4 questionsA 62-year-old male presents with sudden onset of shortness of breath and bilateral pedal edema. He is compliant with antihypertensive medications. Echocardiography reveals ejection fraction of 60 %, concentric left ventricular hypertrophy, left atrial enlargement, and grade 2 diastolic dysfunction. What is the most appropriate next step to improve his condition?
A 58-year-old male presents with burning micturition. Prostatic examination is normal. Urinalysis shows >50 pus cells per high power field, but urine culture shows no growth. What is the most likely diagnosis?
A 20-year-old male presents with fever, severe headache, vomiting, and photophobia. On examination, neck rigidity and Brudzinskis sign are positive. CT scan of the brain shows hydrocephalus. What is the most likely diagnosis?
Which of the following is not a cause of high anion gap metabolic acidosis?
INI-CET 2025 - Internal Medicine INI-CET Practice Questions and MCQs
Question 101: A 62-year-old male presents with sudden onset of shortness of breath and bilateral pedal edema. He is compliant with antihypertensive medications. Echocardiography reveals ejection fraction of 60 %, concentric left ventricular hypertrophy, left atrial enlargement, and grade 2 diastolic dysfunction. What is the most appropriate next step to improve his condition?
- A. Start digoxin to enhance myocardial contractility
- B. Perform coronary angiography to rule out ischemic cardiomyopathy
- C. Initiate loop diuretics and SGLT2 inhibitors for management of HFpEF (Correct Answer)
- D. Initiate ivabradine to reduce heart rate and improve diastolic filling
Explanation: ***Initiate loop diuretics and SGLT2 inhibitors for management of HFpEF*** - The clinical picture (sudden onset dyspnea, bilateral **pedal edema**) and echocardiography findings (EF $\ge$ 50%, **concentric LVH**, LA enlargement, **diastolic dysfunction**) define **Heart Failure with Preserved Ejection Fraction (HFpEF)** [3]. Echocardiography is essential to determine the aetiology and identify patients who will benefit from targeted therapy [1]. - **Loop diuretics** are essential for symptom relief (edema, congestion) [2], and **SGLT2 inhibitors** (e.g., empagliflozin, dapagliflozin) are recommended as foundational therapy for HFpEF, improving outcomes regardless of diabetes status. ***Perform coronary angiography to rule out ischemic cardiomyopathy*** - While coronary artery disease is a common cause of heart failure [3], the patient's EF is preserved (60%), making **ischemic cardiomyopathy** less likely as the primary cause of his acute presentation. - Coronary angiography is an invasive procedure and is not the immediate, most appropriate step for managing acute HF symptoms related to **volume overload** and diastolic dysfunction [4]. ***Start digoxin to enhance myocardial contractility*** - **Digoxin** is primarily used in **Heart Failure with Reduced Ejection Fraction (HFrEF)** (EF < 40%) to improve contractility and for rate control in atrial fibrillation. - Since the patient has preserved EF (60%), digoxin would offer little benefit and may increase the risk of toxicity without addressing the underlying **diastolic impairment**. ***Initiate ivabradine to reduce heart rate and improve diastolic filling*** - **Ivabradine** is indicated primarily in **HFrEF** (EF $\le$ 35%) for patients who are in sinus rhythm with a resting heart rate $\ge$ 70 bpm and are unable to tolerate or are maximized on beta-blockers. - It is not a standard or appropriate treatment for acutely decompensated HFpEF, where volume management and **SGLT2 inhibition** are key priorities.
Question 102: A 58-year-old male presents with burning micturition. Prostatic examination is normal. Urinalysis shows >50 pus cells per high power field, but urine culture shows no growth. What is the most likely diagnosis?
- A. Granulomatous prostatitis
- B. Chronic bacterial prostatitis
- C. Acute bacterial prostatitis
- D. Sterile pyuria (Correct Answer)
Explanation: ***Sterile pyuria*** - The combination of **pyuria** (>50 pus cells/HPF) and a **negative urine culture (no growth)** is known as sterile pyuria. This can be idiopathic or indicate conditions like **urethritis**, **tuberculosis**, or non-bacterial infections [1]. - The presence of symptoms (burning micturition) combined with pyuria and a normal prostate examination rules out typical bacterial prostatitis scenarios [1]. ***Chronic bacterial prostatitis*** - While chronic bacterial prostatitis involves recurrent symptomatic episodes and may sometimes show pyuria, it is characterized by **recurrent positive urine cultures** (often *E. coli*) and localization of bacteria to prostatic fluid. - The prostatic examination is often normal, but the hallmark is the presence of bacteria in the urine/prostatic fluid, which is absent here. ***Acute bacterial prostatitis*** - This presents with signs of systemic infection (fever, chills) and a very tender, boggy prostate, which is not mentioned, and the exam here is noted as **normal** [1]. - It always involves a **positive urine culture** due to the high bacterial load in the urine. ***Granulomatous prostatitis*** - This is a rare inflammatory condition, often related to fungal infections or **BCG therapy**, and typically manifests as a firm, nodular prostate that mimics prostate cancer. - While it can cause sterile pyuria, the presentation is usually dominated by prostatic enlargement or hardness, which is contradicted by the **normal prostatic examination** given in the prompt.
Question 103: A 20-year-old male presents with fever, severe headache, vomiting, and photophobia. On examination, neck rigidity and Brudzinskis sign are positive. CT scan of the brain shows hydrocephalus. What is the most likely diagnosis?
- A. Viral Encephalitis
- B. Bacterial Meningitis (Correct Answer)
- C. Subarachnoid Hemorrhage
- D. Normal Pressure Hydrocephalus
Explanation: ***Bacterial Meningitis*** - The clinical triad of **fever**, **headache**, and **neck rigidity** (nuchal rigidity) is classic for acute meningitis [1]. - Positive meningeal signs like **Brudzinski's sign** confirm meningeal irritation, and hydrocephalus may occur due to impaired CSF flow or absorption (communicating or non-communicating) [1]. ***Normal Pressure Hydrocephalus*** - Characterized by the triad of gait disturbance, urinary incontinence, and **dementia** (Wacky, Wobbly, Wet). - Does not typically present with acute systemic symptoms like **fever** or acute signs of meningeal irritation (neck rigidity/Brudzinski's). ***Viral Encephalitis*** - While it presents with fever and headache, the hallmark is altered mental status (confusion, seizures) and focal neurological deficits, indicating **parenchymal involvement**. - Severe, rigid **neck stiffness** (a major sign of meningeal irritation) is usually less prominent compared to bacterial meningitis [1]. ***Subarachnoid Hemorrhage*** - Presents with a sudden worst headache of life (**thunderclap headache**) and meningeal signs (neck rigidity, photophobia) [1]. - **Fever** is usually low-grade (if present) and develops later, unlike the often high fever seen in bacterial meningitis.
Question 104: Which of the following is not a cause of high anion gap metabolic acidosis?
- A. Ketoacidosis
- B. Acute kidney injury
- C. Toxins
- D. Diarrhea (Correct Answer)
Explanation: Diarrhea causes non-anion gap metabolic acidosis (NAGMA) because the excessive loss of bicarbonate-rich fluid (HCO3-) from the lower GI tract requires the retention of chloride (Cl-) to maintain electrical neutrality, leading to hyperchloremia (HCO3- loss replaced by Cl-) [2]. The resulting acidosis has a normal anion gap because the lost bicarbonate is effectively replaced by another unmeasured ion (chloride), keeping the calculated gap ([Na+] - ([Cl-] + [HCO3-])) within the normal range [1]. Severe acute kidney injury (AKI) causes high anion gap metabolic acidosis (HAGMA) due to the retention of unmeasured organic acids resulting from decreased glomerular filtration rate (GFR) [2]. Ketoacidosis (Diabetic, Alcoholic, Starvation) is a classic cause of high anion gap metabolic acidosis (HAGMA) [3]. The metabolic acidosis results from the overproduction and accumulation of ketone bodies (beta-hydroxybutyrate and acetoacetate), which are unmeasured organic acids [3]. Many toxins, such as Methanol, Ethylene glycol, and high doses of Salicylates, cause high anion gap metabolic acidosis (HAGMA) [1].
Ophthalmology
5 questionsA patient presented 2 weeks after cataract surgery with decreased vision. On examination, there were anterior chamber cells and flare with hazy vitreous. What is the most likely cause and organism?
Which of the following lasers is used in refractive surgery?
In optic neuritis, which is true?
Which of the following investigations allows examination of all layers of the retina?
All of the following are done in the treatment of amblyopia, except:
INI-CET 2025 - Ophthalmology INI-CET Practice Questions and MCQs
Question 101: A patient presented 2 weeks after cataract surgery with decreased vision. On examination, there were anterior chamber cells and flare with hazy vitreous. What is the most likely cause and organism?
- A. Endophthalmitis with Staphylococcus
- B. Endophthalmitis with Propionibacterium (Correct Answer)
- C. Sympathetic ophthalmia
- D. Toxic anterior segment syndrome
Explanation: ***Endophthalmitis with Propionibacterium*** - ***Propionibacterium acnes*** (now ***Cutibacterium acnes***) is the classic organism responsible for **delayed-onset** or subacute endophthalmitis, which typically presents weeks to months following cataract surgery. - This indolent infection is characterized by low-grade inflammation, **vitritis**, and often subtle findings, making the 2-week history highly suggestive of this causative agent. ***Endophthalmitis with Staphylococcus*** - **Acute post-operative endophthalmitis**, most commonly caused by *Staphylococcus epidermidis*, typically presents much earlier, usually within **1 to 7 days** post-surgery, with rapid decline in vision. - *Staphylococcus aureus* causes a highly virulent, fulminant acute infection that would almost certainly present less than 2 weeks post-op. ***Sympathetic ophthalmia*** - This is a rare, bilateral, granulomatous **panuveitis** that occurs after a penetrating trauma or surgery to one eye. - While it can present weeks after surgery, it is an autoimmune condition and would not typically be caused by a specific pathogen like *Propionibacterium* or *Staphylococcus*. ***Toxic anterior segment syndrome*** - TASS is an acute, **sterile inflammatory** response to non-infectious toxic substances (like detergents or preservatives) introduced during surgery. - TASS presents very early (12–48 hours post-op), is confined mainly to the **anterior segment**, and does not involve significant **vitritis**.
Question 102: Which of the following lasers is used in refractive surgery?
- A. Argon
- B. Diode
- C. Nd:YAG
- D. Excimer laser (Correct Answer)
Explanation: ***Excimer laser*** - The **Excimer laser** is the gold standard for refractive procedures like **LASIK** (Laser-Assisted *in Situ* Keratomileusis) and **PRK** (Photorefractive Keratectomy). - It uses **photoablation** (non-thermal tissue removal) to precisely reshape the corneal stroma and correct refractive errors (myopia, hyperopia, astigmatism). *Nd:YAG* - The **Nd:YAG** (Neodymium-doped Yttrium Aluminum Garnet) laser is a **photodisruptive** laser commonly used in the posterior segment. - Its primary application is in treating **posterior capsular opacification** (YAG capsulotomy) and performing **peripheral iridotomy** for glaucoma. *Argon* - The Argon laser is a **photocoagulation** laser that produces thermal burns by heating pigmented tissue. - It is mainly used for treating proliferative **diabetic retinopathy** (**panretinal photocoagulation**) and managing **retinal vascular occlusions**. *Diode* - Diode lasers are versatile, typically employed for thermal procedures like **transscleral cyclophotocoagulation** (TSCPC) to reduce aqueous humor production in glaucoma. - They are also utilized for some forms of retinal photocoagulation due to their small size and cost-effectiveness, but not for corneal reshaping.
Question 103: In optic neuritis, which is true?
- A. Unilateral vision loss with decreased color vision
- B. Pain on eye movement only
- C. Bilateral vision loss is common
- D. Unilateral vision loss, pain on eye movement, and decreased color vision (Correct Answer)
Explanation: ***Unilateral vision loss, pain on eye movement, and decreased color vision*** - This combination represents the **classic triad** of optic neuritis: sudden **unilateral vision loss**, **pain with eye movement** (present in >90% of cases), and **dyschromatopsia** (decreased color discrimination, especially red-green). - These three features together provide the most comprehensive and accurate clinical picture of typical **inflammatory optic neuritis**, often associated with **multiple sclerosis**. *Unilateral vision loss with decreased color vision* - While **unilateral presentation** and **dyschromatopsia** are indeed characteristic features of optic neuritis, this option omits the highly specific symptom of **pain on eye movement**. - **Pain with eye movement** is present in over 90% of optic neuritis cases and is a key differentiating feature from other causes of **acute vision loss**. *Pain on eye movement only* - Although **retrobulbar pain** with eye movement is highly characteristic and present in most cases, focusing solely on this symptom ignores the primary visual manifestations. - Optic neuritis by definition involves **optic nerve inflammation** causing **visual dysfunction**, including decreased acuity and **color vision deficits**. *Bilateral vision loss is common* - **Bilateral optic neuritis** is actually uncommon in typical cases and suggests **atypical forms** such as **Neuromyelitis Optica Spectrum Disorder (NMOSD)** or **autoimmune optic neuropathy**. - Classic optic neuritis associated with **multiple sclerosis** typically presents **unilaterally**, with the fellow eye remaining unaffected initially.
Question 104: Which of the following investigations allows examination of all layers of the retina?
- A. OCT (Correct Answer)
- B. B-scan ultrasonography
- C. Perimetry
- D. Fundus fluorescein angiography
Explanation: ***Optical Coherence Tomography (OCT)*** - **OCT provides high-resolution, cross-sectional images of the retina**, allowing visualization and precise measurement of **all retinal layers** from the **Internal Limiting Membrane (ILM)** to the **Retinal Pigment Epithelium (RPE)**. - It is the **gold standard** for detailed morphological analysis of retinal architecture. - Crucial for diagnosing and monitoring **macular edema**, **age-related macular degeneration (ARMD)**, **diabetic retinopathy**, and other macular pathologies. - Provides **in vivo histological imaging** of retinal layers with resolution approaching 3-5 microns. *B-scan ultrasonography* - Uses sound waves to image the eye, primarily utilized when **ocular media are opaque** (e.g., dense cataract, vitreous hemorrhage). - Provides a **general structural outline** of the posterior segment but **cannot resolve individual microscopic retinal layers**. - Useful for detecting retinal detachment, intraocular masses, and posterior segment pathology when direct visualization is not possible. *Perimetry* - **Visual field testing** that measures the **functional sensitivity** of vision across the visual field. - Assesses the **overall functional integrity** of the retina and visual pathway, correlating with retinal ganglion cell function. - Does **not provide anatomical imaging** or visualization of individual retinal layers. - Important for glaucoma assessment and neurological visual pathway disorders. *Fundus fluorescein angiography (FFA)* - Involves injecting fluorescent dye and capturing images to study the **circulation of the retina and choroid**. - Primarily evaluates **vascular leakage**, **non-perfusion areas**, **microaneurysms**, and **neovascularization**. - Provides **en face (surface) vascular imaging**, not cross-sectional layer visualization. - Does not display individual retinal layers in the manner that OCT does.
Question 105: All of the following are done in the treatment of amblyopia, except:
- A. Refractive error correction
- B. Strabismus surgery (Correct Answer)
- C. Video game therapy
- D. Patching (occlusion therapy)
Explanation: ***Strabismus surgery*** - Strabismus surgery is primarily performed to **correct ocular misalignment** (deviation) in strabismic amblyopia, improving cosmesis and binocular potential. - However, **surgery alone does NOT treat amblyopia** – it addresses the anatomical deviation but not the visual deficit itself. - Amblyopia treatment (patching, penalization, or vision therapy) must be performed **before and/or after surgery** to improve visual acuity in the amblyopic eye. - This makes it the exception as it's not a direct treatment modality for the amblyopic visual deficit. *Incorrect: Refractive error correction* - **Correcting refractive errors** with spectacles or contact lenses is the **absolute first step** in all amblyopia treatment. - This is especially crucial in **refractive amblyopia** (anisometropic or isoametropic). - Often, correction alone can lead to significant visual improvement in mild cases. *Incorrect: Video game therapy* - **Dichoptic video game therapy** (e.g., Luminopia) is an **emerging, evidence-based treatment** for amblyopia. - FDA-approved therapies use binocular games to promote visual development in the amblyopic eye. - Used as primary therapy or adjunct to patching, particularly in older children or cases with poor compliance. *Incorrect: Patching (occlusion therapy)* - **Occlusion therapy** (patching the better eye) is the **gold standard treatment** for amblyopia. - Forces the brain to use the amblyopic eye, promoting visual development. - Duration and regimen depend on severity and age, with part-time or full-time patching protocols.