INI-CET 2025 Practice Questions

Q: Which of the following nerves gives sensory supply to the orbit?

Trigeminal nerve. ***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.

Q: 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?

22.22 %. ***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.

Q: 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

1-A, 2-B, 3-C, 4-D. ***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.

Q: Which of the following is not a recognised cause of recurrent renal stone formation?

Hypercitraturia. ***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]

Q: Which of the following is one of the earliest presenting symptoms in a patient with Multiple Sclerosis?

Sensory disturbances. ***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).

Q: Which of the following is the most common clinical feature observed during the progression of systemic lupus erythematosus (SLE)?

Arthralgia & myalgia. ### 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.

Q: According to WHO, which of the following is the recommended diagnostic test for spinal tuberculosis?

Culture and Sensitivity. 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.

Question 1

Which of the following nerves gives sensory supply to the orbit?

Accepted Answer

Trigeminal nerve

Answer

Hypoglossal nerve

Answer

Oculomotor nerve

Answer

Vagus nerve

Question 2

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?

Accepted Answer

Barotrauma due to high airway pressure

Answer

Endotracheal tube malposition

Answer

Oxygen toxicity

Answer

High tidal volume

Question 3

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?

Accepted Answer

22.22 %

Answer

10 %

Answer

30 %

Answer

20 %

Question 4

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

Accepted Answer

1-A, 2-B, 3-C, 4-D

Answer

1-B, 2-A, 3-C, 4-D

Answer

1-D, 2-B, 3-C, 4-A

Answer

1-C, 2-B, 3-A, 4-D

Question 5

Which of the following is not a recognised cause of recurrent renal stone formation?

Accepted Answer

Hypercitraturia

Answer

Hypercalciuria

Answer

Hyperuricosuria

Answer

Hyperoxaluria

Question 6

Which of the following is one of the earliest presenting symptoms in a patient with Multiple Sclerosis?

Accepted Answer

Sensory disturbances

Answer

Ataxia

Answer

Vertigo

Answer

Facial palsy

Question 7

Which of the following is the most common clinical feature observed during the progression of systemic lupus erythematosus (SLE)?

Accepted Answer

Arthralgia & myalgia

Answer

Nephrotic syndrome

Answer

Anemia and thrombocytopenia

Answer

Photosensitivity

Question 8

According to WHO, which of the following is the recommended diagnostic test for spinal tuberculosis?

Accepted Answer

Culture and Sensitivity

Answer

CT scan

Answer

CB-NAAT

Answer

X-ray

Question 9

Which of the following best defines blindness?

Accepted Answer

Visual acuity less than 3/60 in the better eye after best possible correction

Answer

Visual field less than 10 degrees from fixation in the better eye

Answer

Inability to perceive light in both eyes

Answer

Visual acuity less than 6/60 in the better eye

Question 10

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?

Accepted Answer

Perform needle thoracostomy immediately

Answer

CT Chest

Answer

Airway, breathing, and circulation (ABC) assessment

Answer

Chest tube insertion

INI-CET 2025

Anatomy

Anesthesiology

Community Medicine

Internal Medicine

Ophthalmology

Surgery