Anatomy
1 questionsWhich of the following nerves gives sensory supply to the orbit?
INI-CET 2025 - Anatomy INI-CET Practice Questions and MCQs
Question 11: Which of the following nerves gives sensory supply to the orbit?
- A. Trigeminal nerve (Correct Answer)
- B. Hypoglossal nerve
- C. Oculomotor nerve
- D. Vagus nerve
Explanation: ***Trigeminal nerve*** - The **Ophthalmic division (V1)** of the Trigeminal nerve (CN V) is the primary source of general sensation for structures within the orbit, including the globe, conjunctiva, and lacrimal gland. - Its key branches, which include the **frontal**, **lacrimal**, and **nasociliary nerves**, are responsible for carrying these sensory fibers. *Vagus nerve* - The Vagus nerve (CN X) is primarily involved in **parasympathetic control** of the thoracic and abdominal viscera, and motor supply to the pharynx and larynx. - It does not supply the orbit with any **general sensory** fibers; its distribution is mainly to the neck, chest, and abdomen. *Hypoglossal nerve* - The Hypoglossal nerve (CN XII) is a purely **somatic motor nerve** originating from the medulla. - Its function is restricted to supplying the **intrinsic and extrinsic muscles of the tongue**, having no role in orbital innervation or sensation. *Oculomotor nerve* - The Oculomotor nerve (CN III) is predominantly a **motor nerve** that supplies four of the six extraocular muscles and the **Levator palpebrae superioris**. - While it carries **parasympathetic fibers** to the ciliary ganglion, it does not provide **general sensory** supply to the orbital structures.
Anesthesiology
1 questionsA 65-year-old patient is on mechanical ventilation for acute respiratory distress syndrome (ARDS). Suddenly, the patient becomes hypotensive, tachycardic, and shows absent breath sounds on the left side with tracheal deviation to the right. What is the most common cause of this in patients receiving mechanical ventilation?
INI-CET 2025 - Anesthesiology INI-CET Practice Questions and MCQs
Question 11: A 65-year-old patient is on mechanical ventilation for acute respiratory distress syndrome (ARDS). Suddenly, the patient becomes hypotensive, tachycardic, and shows absent breath sounds on the left side with tracheal deviation to the right. What is the most common cause of this in patients receiving mechanical ventilation?
- A. Barotrauma due to high airway pressure (Correct Answer)
- B. Endotracheal tube malposition
- C. Oxygen toxicity
- D. High tidal volume
Explanation: ***Barotrauma due to high airway pressure*** - The clinical triad (hypotension, tachycardia, absent breath sounds, and tracheal deviation) is highly suggestive of a **Tension Pneumothorax**. - In mechanically ventilated patients, high inspiratory pressures (**Barotrauma**) are the most common cause of alveolar rupture leading to air leakage and subsequent tension pneumothorax. *High tidal volume* - While high tidal volume can cause barotrauma, it is a **setting** (cause), not the most descriptive immediate mechanism of the complication (pneumothorax) itself. - The primary harm from high tidal volume is often considered **Volutrauma**, leading to ventilator-induced lung injury (VILI) over a longer duration. *Endotracheal tube malposition* - Tube malposition (e.g., slipped into the right bronchus) causes absent breath sounds, usually on the **left side**, but does not typically cause rapid onset **tension physiology** (hypotension and tracheal shift). - It is a relative common complication, but does not usually lead directly to clinical deterioration as severe as tension pneumothorax. *Oxygen toxicity* - This complication occurs due to prolonged exposure to high fractions of inspired oxygen (**FiO2**) and primarily causes diffuse alveolar damage, thickening of the alveolar-capillary membrane, and impairment of gas exchange. - It is a **chronic injury** and does not cause acute, life-threatening mechanical collapse like tension pneumothorax.
Community Medicine
2 questionsIn a village of 100 children, 10 children have a past history of measles (i.e., they are not at risk now), 20 new cases of measles were reported this year. What is the incidence of measles in this population for the year?
Match the following: Vector/agent : 1. Louse - 2. Tick - 3. Mite - 4. Poxvirus Diseases caused : A. Epidemic typhus - B. Rocky Mounted Spotted Fever (RMSF) - C. Scrub typhus - D. Molluscum contagiosum
INI-CET 2025 - Community Medicine INI-CET Practice Questions and MCQs
Question 11: In a village of 100 children, 10 children have a past history of measles (i.e., they are not at risk now), 20 new cases of measles were reported this year. What is the incidence of measles in this population for the year?
- A. 22.22 % (Correct Answer)
- B. 10 %
- C. 30 %
- D. 20 %
Explanation: ***22.22 %*** - Incidence is calculated as the ratio of **new cases** (20) to the **population at risk** (susceptible population) over the specified period. - The **population at risk** is the total population (100) minus those who are already immune (10), making the denominator 90. Incidence = (20/90) × 100 = **22.22 %**. *20 %* - This result is obtained by incorrectly using the **total population** (100) as the denominator (20/100 × 100), ignoring the already immune group. - Using the total population in the denominator leads to an underestimate of the true **attack rate** or incidence among the susceptible group. *10 %* - This figure represents the proportion of children who had suffered from measles in the past (10/100), reflecting a form of **past prevalence**, not incidence. - Incidence focuses exclusively on the **new cases** that developed within the year. *30 %* - This percentage represents the **cumulative prevalence** at the end of the year, including both old (10) and new (20) cases, divided by the total population (30/100). - Incidence requires the denominator to be the **population at risk** (those who could develop the disease), not the total population.
Question 12: Match the following: Vector/agent : 1. Louse - 2. Tick - 3. Mite - 4. Poxvirus Diseases caused : A. Epidemic typhus - B. Rocky Mounted Spotted Fever (RMSF) - C. Scrub typhus - D. Molluscum contagiosum
- A. 1-B, 2-A, 3-C, 4-D
- B. 1-D, 2-B, 3-C, 4-A
- C. 1-C, 2-B, 3-A, 4-D
- D. 1-A, 2-B, 3-C, 4-D (Correct Answer)
Explanation: ***1-A, 2-B, 3-C, 4-D*** - **1-A (Louse - Epidemic typhus):** Epidemic typhus is caused by *Rickettsia prowazekii*, transmitted to humans via the bite or feces of the **human body louse** (*Pediculus humanus corporis*). This is a classic louse-borne rickettsial disease. - **2-B (Tick - Rocky Mountain Spotted Fever):** RMSF is caused by *Rickettsia rickettsii* and transmitted by **hard ticks**, primarily *Dermacentor* species. It is the most severe tick-borne rickettsial illness in the United States. - **3-C (Mite - Scrub typhus):** Scrub typhus is caused by *Orientia tsutsugamushi*, transmitted by the bite of infected **larval mites** (chiggers) of the *Leptotrombidium* genus. It is endemic in the Asia-Pacific region. - **4-D (Poxvirus - Molluscum contagiosum):** Molluscum contagiosum is a benign viral skin infection caused by the **Molluscum contagiosum virus**, a member of the Poxviridae family. It spreads through direct contact, not via arthropod vectors. *1-B, 2-A, 3-C, 4-D* - The match **1-B** is incorrect: **Louse** transmits **Epidemic typhus (A)**, not Rocky Mountain Spotted Fever (B), which is tick-borne. - The match **2-A** is incorrect: **Tick** transmits **Rocky Mountain Spotted Fever (B)**, not Epidemic typhus (A), which is louse-borne. *1-D, 2-B, 3-C, 4-A* - The match **1-D** is incorrect: **Louse** is an arthropod vector for **Epidemic typhus (A)**, while **Molluscum contagiosum (D)** is a viral disease spread by direct contact, not lice. - The match **4-A** is incorrect: **Poxvirus** causes **Molluscum contagiosum (D)**, while **Epidemic typhus (A)** is a rickettsial infection transmitted by lice, not a poxvirus disease. *1-C, 2-B, 3-A, 4-D* - The match **1-C** is incorrect: **Louse** transmits **Epidemic typhus (A)**, not **Scrub typhus (C)**, which is transmitted by larval mites. - The match **3-A** is incorrect: **Mites** transmit **Scrub typhus (C)**, not **Epidemic typhus (A)**, which is a louse-borne disease.
Internal Medicine
4 questionsWhich of the following is not a recognised cause of recurrent renal stone formation?
Which of the following is one of the earliest presenting symptoms in a patient with Multiple Sclerosis?
Which of the following is the most common clinical feature observed during the progression of systemic lupus erythematosus (SLE)?
According to WHO, which of the following is the recommended diagnostic test for spinal tuberculosis?
INI-CET 2025 - Internal Medicine INI-CET Practice Questions and MCQs
Question 11: Which of the following is not a recognised cause of recurrent renal stone formation?
- A. Hypercalciuria
- B. Hypercitraturia (Correct Answer)
- C. Hyperuricosuria
- D. Hyperoxaluria
Explanation: ***Hypercitraturia*** - It is generally **protective** against calcium stone formation because **citrate** binds to calcium in the urine, making it more soluble and inhibiting crystal nucleation. [1] - **Hypocitraturia** (low urinary citrate), not hypercitraturia, is a well-recognized metabolic risk factor for the formation of **calcium oxalate stones**. *Hyperoxaluria* - **Oxalate** readily binds with calcium to form **calcium oxalate stones**, the most common type of kidney stone. - Both primary and secondary hyperoxaluria significantly increase the degree of urinary **supersaturation**, driving stone formation. *Hypercalciuria* - High levels of urinary calcium increases urine saturation, leading to the precipitation of calcium salts, primarily forming **calcium oxalate** or **calcium phosphate** stones. [1] - It is the most frequent metabolic abnormality observed in patients with **recurrent nephrolithiasis**. *Hyperuricosuria* - Excess urinary **uric acid** directly causes **uric acid stones**, especially in acidic urine. [1] - Importantly, uric acid crystals can also serve as a **nidus** for the heterogeneous nucleation of **calcium oxalate** stones, increasing overall stone risk. [1]
Question 12: Which of the following is one of the earliest presenting symptoms in a patient with Multiple Sclerosis?
- A. Ataxia
- B. Vertigo
- C. Facial palsy
- D. Sensory disturbances (Correct Answer)
Explanation: ***Sensory disturbances*** - **Sensory symptoms**, such as numbness, tingling (paresthesias), or hypoesthesia, are among the most common **initial complaints** (up to 40% of patients) in Multiple Sclerosis, often affecting the limbs or trunk [1]. - These symptoms occur due to demyelination in the **spinal cord** or **sensory pathways** in the brainstem. *Ataxia* - While **ataxia** (coordination problems) is a characteristic symptom of MS, usually resulting from cerebellar or posterior column involvement, it is less frequently the **absolute earliest** presentation [1]. - Ataxia often signifies later-stage progression or a focus of demyelination within the cerebellum or its connections [1]. *Vertigo* - **Vertigo** can occur in MS due to demyelination of the **vestibular pathways** in the brainstem (e.g., lesions affecting the **Medial Longitudinal Fasciculus (MLF)**) [1]. - However, isolated vertigo is typically a less common initial symptom compared to **sensory changes** or optic neuritis. *Facial palsy* - **Facial palsy** (Cranial Nerve VII involvement) can result from a plaque in the pons, but it is a relatively **rare** initial manifestation of Multiple Sclerosis. - Early cranial nerve involvement is more classically presented as **Optic Neuritis** or Diplopia (e.g., Internuclear Ophthalmoplegia).
Question 13: Which of the following is the most common clinical feature observed during the progression of systemic lupus erythematosus (SLE)?
- A. Nephrotic syndrome
- B. Arthralgia & myalgia (Correct Answer)
- C. Anemia and thrombocytopenia
- D. Photosensitivity
Explanation: ### Arthralgia & myalgia - **Arthralgia (joint pain)** and **myalgia (muscle pain)** are documented as the most common initial and persistent clinical features, occurring in over 90% of SLE patients [1]. - The arthritis in SLE is typically non-erosive and symmetrical, often affecting the small joints of the hands, wrists, and knees. *Photosensitivity* - While very common and a key diagnostic criterion, it occurs in about 40-50% of patients, making it less frequent than diffuse joint and muscle pain [1]. - It is a prominent feature of cutaneous involvement, often leading to the characteristic **malar rash** or discoid lesions after sun exposure [1]. *Nephrotic syndrome* - Renal involvement (**Lupus nephritis**) is serious, but clinically overt nephrotic syndrome (heavy proteinuria, edema) is found only in a subset of patients with Type III, IV, or V nephritis. - Overall, symptomatic renal disease affects about 50-60% of patients, less frequent than musculoskeletal symptoms. *Anemia and thrombocytopenia* - **Hematologic abnormalities** (anemia, leukopenia, and thrombocytopenia) are common and considered diagnostic criteria but occur in roughly 50% or less of patients. - **Anemia of chronic disease** is the most frequent hematologic finding, while **thrombocytopenia** is less common than arthralgia.
Question 14: According to WHO, which of the following is the recommended diagnostic test for spinal tuberculosis?
- A. CT scan
- B. CB-NAAT
- C. Culture and Sensitivity (Correct Answer)
- D. X-ray
Explanation: Culture and Sensitivity - It is considered the gold standard for definitive diagnosis of tuberculosis (TB) as it allows the isolation and confirmation of viable Mycobacterium tuberculosis organisms [2]. - It is essential for performing comprehensive Drug Susceptibility Testing (DST), which is critical for guiding the management of complex cases like spinal TB and detecting any drug resistance [3]. X-ray - X-rays are primarily useful for initial screening and assessing the extent of bony destruction, such as vertebral collapse (Pott's spine), but are not confirmatory [1]. - They are limited as they cannot provide bacteriological evidence or detect the presence of the M. tuberculosis organism, which is required for definitive diagnosis. CT scan - CT scans offer detailed imaging of bony morphology, disc involvement, and soft tissue pathology (e.g., paraspinal abscesses) superior to X-rays. - It remains an imaging modality and cannot replace the necessity of histopathological or microbiological confirmation and Drug Susceptibility Testing. CB-NAAT - CB-NAAT (e.g., Xpert MTB/RIF) is highly recommended by WHO for rapid diagnosis and detection of Rifampicin resistance from samples [3]. - While highly accurate, it detects nucleic acid and does not enable full Drug Susceptibility Testing against all first and second-line drugs, which Culture and Sensitivity provides.
Ophthalmology
1 questionsWhich of the following best defines blindness?
INI-CET 2025 - Ophthalmology INI-CET Practice Questions and MCQs
Question 11: Which of the following best defines blindness?
- A. Visual acuity less than 3/60 in the better eye after best possible correction (Correct Answer)
- B. Visual field less than 10 degrees from fixation in the better eye
- C. Inability to perceive light in both eyes
- D. Visual acuity less than 6/60 in the better eye
Explanation: ***Visual acuity less than 3/60 in the better eye after best possible correction*** - This defines **blindness** according to the **WHO/ICD-11 classification** (Category 3 and 4). - VA < 3/60 to 1/60 is **Category 3 blindness**, and VA < 1/60 to light perception is **Category 4 blindness**. - This is the internationally accepted standard definition of blindness. *Visual acuity less than 6/60 in the better eye* - In **India**, the National Programme for Control of Blindness and Visual Impairment (NPCB&VI) defines blindness as VA < 6/60 in the better eye with best correction. - However, the **WHO international standard** uses the more stringent criterion of < 3/60. - For global standardization and comparison, the **WHO definition (< 3/60)** is considered the primary reference. *Visual field less than 10 degrees from fixation in the better eye* - This is an **alternative criterion** for defining blindness according to WHO guidelines. - A person with VF < 10° (or < 20° in some definitions) is considered legally blind even if VA is better than 3/60. - Both VA and VF criteria are valid, but the question asks for the "best" single definition, where the **VA criterion** is most commonly cited. *Inability to perceive light in both eyes* - This represents **No Light Perception (NLP)** or **total blindness** (WHO Category 5). - This is the most severe form of blindness but is too restrictive as a general definition, as it excludes individuals with light perception or minimal vision who are still legally and functionally blind.
Surgery
1 questionsA 40-year-old male presents to the emergency department with severe respiratory distress, BP: 70/59 mmHg, tracheal deviation to the right, distended neck veins, and absent breath sounds on the left side. These findings are suggestive of a tension pneumothorax. What is the most appropriate immediate next step in management?
INI-CET 2025 - Surgery INI-CET Practice Questions and MCQs
Question 11: A 40-year-old male presents to the emergency department with severe respiratory distress, BP: 70/59 mmHg, tracheal deviation to the right, distended neck veins, and absent breath sounds on the left side. These findings are suggestive of a tension pneumothorax. What is the most appropriate immediate next step in management?
- A. CT Chest
- B. Airway, breathing, and circulation (ABC) assessment
- C. Chest tube insertion
- D. Perform needle thoracostomy immediately (Correct Answer)
Explanation: ***Perform needle thoracostomy immediately*** * Tension pneumothorax is a **clinical diagnosis** and a life-threatening emergency requiring immediate intervention without waiting for imaging confirmation. * The classic triad of **hypotension (BP 70/59 mmHg), tracheal deviation, and distended neck veins** with absent breath sounds confirms the diagnosis. * **Immediate needle decompression** (2nd intercostal space, midclavicular line on affected side) is the correct first step to rapidly decompress the tension and restore venous return to the heart. * This is performed as part of the **primary survey** in ATLS protocol - tension pneumothorax is identified and treated during the "B" (breathing) assessment. * Delaying intervention to "complete an assessment" when the diagnosis is evident would be life-threatening. *Airway, breathing, and circulation (ABC) assessment* * While ABC assessment is fundamental in trauma management, the clinical findings described (tracheal deviation, absent breath sounds, hypotension) **are already the result of assessment**. * The patient requires **immediate intervention**, not further assessment. * In ATLS, tension pneumothorax is treated **during** the primary survey as soon as it is identified - you do not defer treatment to "complete" the assessment. *Chest tube insertion* * Tube thoracostomy (chest tube) is the **definitive management** for pneumothorax. * However, in a hemodynamically unstable patient with tension pneumothorax, **needle decompression must be performed first** for rapid relief. * Chest tube insertion follows after initial stabilization and is more time-consuming to perform. *CT Chest* * **CT imaging is contraindicated** in hemodynamically unstable patients (BP 70/59 mmHg). * Tension pneumothorax is a clinical diagnosis requiring immediate intervention - imaging would cause fatal delay. * CT chest may be considered only in **stable patients** with diagnostic uncertainty.