INI-CET 2025 Practice Questions

Q: 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?

Sterile pyuria. ***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.

Q: 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?

Bacterial Meningitis. ***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.

Q: Which of the following is not a cause of high anion gap metabolic acidosis?

Diarrhea. 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].

Q: Which of the following investigations allows examination of all layers of the retina?

OCT. ### **Explanation** **Optical Coherence Tomography (OCT)** is the correct answer because it functions as an **"optical biopsy"** of the retina. It uses low-coherence interferometry (near-infrared light) to produce high-resolution, **cross-sectional images**. This allows clinicians to visualize and measure all **ten layers of the retina** individually, from the Internal Limiting Membrane (ILM) to the Retinal Pigment Epithelium (RPE) and even the underlying choroid. #### **Why the other options are incorrect:** * **B-scan Ultrasonography:** This is a two-dimensional acoustic imaging technique. While excellent for detecting gross structural changes (like retinal detachment or intraocular tumors) when the ocular media is opaque (e.g., dense cataract or vitreous hemorrhage), it lacks the resolution to distinguish individual retinal layers. * **Perimetry:** This is a **functional** test (not structural) used to map the visual field. It identifies blind spots (scotomas) but cannot visualize the anatomical layers of the retina. * **Fundus Fluorescein Angiography (FFA):** This is a dynamic study of the **retinal vasculature**. While it is the gold standard for detecting leaks, neovascularization, and capillary non-perfusion, it provides a "top-down" view and cannot differentiate the depth or thickness of specific retinal layers. --- ### **High-Yield Clinical Pearls for INI-CET:** * **OCT Principle:** Based on **Michelson Interferometry**. * **Resolution:** OCT has a resolution of **5–10 microns**, which is significantly higher than B-scan (~150 microns). * **Key Indications:** Best for diagnosing **Macular Hole**, **Epiretinal Membrane**, and **Cystoid Macular Edema (CME)**. * **Inverted Image:** In OCT, the RPE is the most hyper-reflective (brightest) outer band. * **Swept-Source OCT (SS-OCT):** The newest generation that uses longer wavelengths to penetrate deeper into the **choroid**.

Question 1

According to NPCBVI, blindness is defined as:

Accepted Answer

Presenting visual acuity < 3/60 in better eye

Answer

Corrected visual acuity 6/60 in better eye

Answer

Corrected visual acuity 3/60 in better eye

Answer

Presenting visual acuity 6/60 in better eye

Question 2

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?

Accepted Answer

Initiate loop diuretics and SGLT2 inhibitors for management of HFpEF

Answer

Start digoxin to enhance myocardial contractility

Answer

Perform coronary angiography to rule out ischemic cardiomyopathy

Answer

Initiate ivabradine to reduce heart rate and improve diastolic filling

Question 3

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?

Accepted Answer

Sterile pyuria

Answer

Granulomatous prostatitis

Answer

Chronic bacterial prostatitis

Answer

Acute bacterial prostatitis

Question 4

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?

Accepted Answer

Bacterial Meningitis

Answer

Viral Encephalitis

Answer

Subarachnoid Hemorrhage

Answer

Normal Pressure Hydrocephalus

Question 5

Which of the following is not a cause of high anion gap metabolic acidosis?

Accepted Answer

Diarrhea

Answer

Ketoacidosis

Answer

Acute kidney injury

Answer

Toxins

Question 6

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?

Accepted Answer

Endophthalmitis with Propionibacterium

Answer

Endophthalmitis with Staphylococcus

Answer

Sympathetic ophthalmia

Answer

Toxic anterior segment syndrome

Question 7

Which of the following lasers is used in refractive surgery?

Accepted Answer

Excimer laser

Answer

Argon

Answer

Diode

Answer

Nd:YAG

Question 8

In optic neuritis, which is true?

Accepted Answer

Unilateral vision loss, pain on eye movement, and decreased color vision

Answer

Unilateral vision loss with decreased color vision

Answer

Pain on eye movement only

Answer

Bilateral vision loss is common

Question 9

Which of the following investigations allows examination of all layers of the retina?

Accepted Answer

OCT

Answer

B-scan ultrasonography

Answer

Perimetry

Answer

Fundus fluorescein angiography

Question 10

All of the following are done in the treatment of amblyopia, except:

Accepted Answer

Strabismus surgery

Answer

Refractive error correction

Answer

Video game therapy

Answer

Patching (occlusion therapy)

INI-CET 2025

Community Medicine

Internal Medicine

Ophthalmology