Anatomy
1 questionsOut of the following, which statements are correct? 1. Epidermis can regenerate from hair bulbs and sebaceous glands 2. Stratum corneum is the outermost cellular layer 3. Epidermis originates from the ectoderm 4. Dermis and hypodermis originate from the endoderm
INI-CET 2025 - Anatomy INI-CET Practice Questions and MCQs
Question 21: Out of the following, which statements are correct? 1. Epidermis can regenerate from hair bulbs and sebaceous glands 2. Stratum corneum is the outermost cellular layer 3. Epidermis originates from the ectoderm 4. Dermis and hypodermis originate from the endoderm
- A. 3,4
- B. 1,2
- C. 2,3
- D. 1,3 (Correct Answer)
Explanation: ***Correct Option: 1,3*** - **Statement 1 is correct:** Deep injuries or burns destroy the interfollicular epidermis, and regeneration must occur from stem cells found in the **adnexal structures**, primarily the **hair follicle bulge** [1] and sweat/sebaceous glands [2]. - **Statement 3 is correct:** The epidermis, being the outer epithelial layer, is derived embryologically from the **surface ectoderm**. *Incorrect Option: 1,2* - Statement 1 is correct. However, Statement 2 is incorrect because the **stratum corneum** is the outermost layer composed of **dead, anucleated keratinocytes** (corneocytes) [2], making it an acellular/non-cellular barrier, not the outermost cellular layer. - The outermost true cellular (viable) layer is the stratum granulosum. *Incorrect Option: 2,3* - Statement 2 is incorrect because the stratum corneum is composed of **dead cells** forming a protective layer; it is not considered a viable cellular layer [2]. - Statement 3 is correct, confirming the derivation of the epidermis from the **surface ectoderm**. *Incorrect Option: 3,4* - Statement 3 is correct. However, Statement 4 is incorrect because the connective tissue layers—the **dermis** and the **hypodermis**—are derived from the embryonic **mesoderm** (specifically the dermatome component of the somites), not the endoderm.
Anesthesiology
1 questionsA 50-year-old male patient underwent lower abdominal surgery under general anaesthesia. Vecuronium was administered as a muscle relaxant during the procedure. At the end of the surgery, which of the following is the most appropriate agent to reverse the effects of vecuronium?
INI-CET 2025 - Anesthesiology INI-CET Practice Questions and MCQs
Question 21: A 50-year-old male patient underwent lower abdominal surgery under general anaesthesia. Vecuronium was administered as a muscle relaxant during the procedure. At the end of the surgery, which of the following is the most appropriate agent to reverse the effects of vecuronium?
- A. Baclofen
- B. Neostigmine (Correct Answer)
- C. Atropine
- D. Drotaverine
Explanation: ***Neostigmine*** - Neostigmine is an **acetylcholinesterase inhibitor** that increases the amount of acetylcholine at the neuromuscular junction, effectively reversing the competitive block caused by **non-depolarizing muscle relaxants** like vecuronium. - It is the standard pharmacological agent used for reversal of intermediate-acting neuromuscular blockades at the end of general anesthesia. *Baclofen* - Baclofen is a **centrally acting skeletal muscle relaxant** that works as a GABAB receptor agonist, typically used for managing **spasticity**. - It has no meaningful effect on the **nicotinic acetylcholine receptors** at the neuromuscular junction and cannot reverse the paralytic effects of vecuronium. *Atropine* - Atropine is an **anticholinergic agent** used to block the muscarinic side effects (e.g., bradycardia, hypersalivation) that occur when **neostigmine** is administered. - While often given concurrently with neostigmine, atropine itself **does not reverse** the skeletal muscle paralysis induced by vecuronium. *Drotaverine* - Drotaverine is a **smooth muscle antispasmodic** (PDE IV inhibitor) primarily used for conditions such as biliary or renal colic. - It targets smooth muscle and is entirely ineffective in reversing the **neuromuscular blockade** affecting skeletal muscles caused by vecuronium.
Dermatology
1 questionsWhich of the following are recognized side effects of topical corticosteroid use? a. Hypertrichosis b. Acneiform eruptions c. Skin atrophy d. Blue pigmentation of the skin
INI-CET 2025 - Dermatology INI-CET Practice Questions and MCQs
Question 21: Which of the following are recognized side effects of topical corticosteroid use? a. Hypertrichosis b. Acneiform eruptions c. Skin atrophy d. Blue pigmentation of the skin
- A. a, b, d
- B. a, c, d
- C. b, c, d
- D. a, b, c (Correct Answer)
Explanation: ***a, b, c*** - This option correctly includes three well-established local adverse effects of topical corticosteroids: **Hypertrichosis** (increased hair growth), **Acneiform eruptions** (steroid acne), and crucial connective tissue damage leading to **Skin atrophy**. - Other recognized local side effects include telangiectasias, striae, hypopigmentation, purpura, and delayed wound healing. *a, b, d* - This option incorrectly includes 'd. Blue pigmentation of the skin'; topical steroids primarily cause **hypopigmentation** due to melanocyte suppression, not true blue discoloration. - Blue pigmentation (e.g., slate-grey or blue-black) is typically associated with drugs like **Minocycline** or conditions like **Ochronosis** (Alkaptonuria). *a, c, d* - This option incorrectly lists 'd. Blue pigmentation of the skin' (as explained above) and simultaneously omits 'b. **Acneiform eruptions**', which is a very common side effect, especially with high-potency steroids applied to the face. - **Steroid acne** results from follicular occlusion and changes in the sebaceous unit, presenting as monomorphic papules and pustules. *b, c, d* - This option incorrectly includes 'd. Blue pigmentation of the skin' while omitting 'a. **Hypertrichosis**', an effect common due to the stimulation of hair follicles by circulating corticosteroid metabolites. - The development of **hypertrichosis** is concentration-dependent and especially noticeable in women using potent topical steroids on the face.
Internal Medicine
1 questionsA 12-year-old child is diagnosed with systemic lupus erythematosus (SLE) and presents with nephrotic-range proteinuria. Renal biopsy reveals "wire loop lesions." Which of the following is the drug of choice in this case?
INI-CET 2025 - Internal Medicine INI-CET Practice Questions and MCQs
Question 21: A 12-year-old child is diagnosed with systemic lupus erythematosus (SLE) and presents with nephrotic-range proteinuria. Renal biopsy reveals "wire loop lesions." Which of the following is the drug of choice in this case?
- A. IV Steroids + cyclophosphamide (Correct Answer)
- B. Mycophenolate mofetil
- C. Cyclophosphamide only
- D. IV Steroids only
Explanation: ***IV Steroids + cyclophosphamide*** - The presence of "wire loop lesions" on renal biopsy signifies **Diffuse Proliferative Lupus Nephritis (Class IV)**, which is the most common and severe form of Lupus Nephritis. - Induction therapy for Class IV LN requires a combination of high-dose corticosteroids (IV methylprednisolone) and a potent cytotoxic agent, making **cyclophosphamide** the standard aggressive regimen [1]. *IV Steroids only* - Although high-dose steroids (pulses) are essential for controlling acute inflammation, they are **insufficient as monotherapy** for the severe, widespread immune complex deposition seen in **Class IV LN** [1]. - Steroid monotherapy is typically used for less aggressive forms, such as Class I or II (minimal or mesangial) LN. *Mycophenolate mofetil* - **Mycophenolate mofetil (MMF)**, combined with steroids, is an alternative induction therapy, particularly favored for maintenance but is less reliably potent than cyclophosphamide in severe, life-threatening flares of **Class IV** in some regimens. - MMF alone is never used for induction; it must be administered with high-dose **corticosteroids** to manage acute disease activity. *Cyclophosphamide only* - **Cyclophosphamide** is a powerful induction agent, but it must always be combined with high-dose **corticosteroids** during the induction phase to maximize anti-inflammatory effects and achieve remission effectively [1]. - Administration of a cytotoxic agent without simultaneous acute inflammation control is substandard care.
Obstetrics and Gynecology
1 questionsWhich of the following is not used in the treatment of postpartum hemorrhage (PPH)?
INI-CET 2025 - Obstetrics and Gynecology INI-CET Practice Questions and MCQs
Question 21: Which of the following is not used in the treatment of postpartum hemorrhage (PPH)?
- A. Misoprostol
- B. Carboprost
- C. Dinoprostone (Correct Answer)
- D. Oxytocin
Explanation: ***Dinoprostone*** - Dinoprostone is a prostaglandin E2 analogue primarily indicated for **cervical ripening** or **induction of labor**. - It is not routinely used in the treatment of PPH because it is less effective than other uterotonics (like **Misoprostol** or **Carboprost**) for emergent control of uterine atony. *Misoprostol* - This is a synthetic **Prostaglandin E1 analogue** and an effective **uterotonic** agent used widely for PPH treatment, especially refractory cases or in low-resource settings. - It is effective when administered by various routes (oral, sublingual, or **rectal**) and is beneficial due to its low cost and **heat stability**. *Carboprost* - Carboprost (15-methyl prostaglandin F2 $\alpha$) is a potent uterotonic agent reserved for treating PPH due to **uterine atony** when the first line (Oxytocin) has failed. - It works by inducing intense **myometrial contractions**, but caution is needed as it is contraindicated in patients with active **asthma**. *Oxytocin* - This is the **most essential** and **first-line** uterotonic drug used for the prevention and treatment of **atonic postpartum hemorrhage**. - It is usually administered intravenously as a bolus followed by an infusion, functioning by increasing the frequency and force of **uterine contractions**.
Orthopaedics
1 questionsA 17-year-old boy presents with a progressively increasing swelling over the tibia along with fever. Radiological examination reveals a Codman triangle and sunburst appearance. What is the most likely diagnosis?
INI-CET 2025 - Orthopaedics INI-CET Practice Questions and MCQs
Question 21: A 17-year-old boy presents with a progressively increasing swelling over the tibia along with fever. Radiological examination reveals a Codman triangle and sunburst appearance. What is the most likely diagnosis?
- A. Ewing sarcoma
- B. Giant cell tumour
- C. Chondrosarcoma
- D. Osteosarcoma (Correct Answer)
Explanation: ***Osteosarcoma*** - This is the most common primary malignant bone tumor in adolescents, often presenting with pain and swelling, typically affecting the **metaphysis** of long bones (like the tibia). - The presence of the **Codman triangle** (periosteal elevation) and the **sunburst appearance** (spicules of bone radiating outwards) are pathognomonic radiological signs due to aggressive bone formation. *Ewing sarcoma* - While also affecting adolescents and associated with systemic features like **fever** (mimicking infection), its classic radiological sign is the **'onion-peel' (laminated) periosteal reaction**. - It typically involves the **diaphysis** of long bones or flat bones, unlike the metaphyseal involvement seen here. *Giant cell tumour* - This tumor usually affects slightly older adults (20-40 years) and predominantly involves the **epiphysis** of long bones. - Radiographically, GCT exhibits a non-sclerotic, **'soap bubble' appearance** (multiloculated lytic lesion) but does not feature the aggressive Codman triangle or sunburst pattern. *Chondrosarcoma* - This diagnosis is unlikely in a 17-year-old, as it typically presents in older adults (40-70 years). - The radiologic hallmark of chondrosarcoma is the presence of **ring-and-arc** or **'popcorn' calcifications** within the cartilaginous matrix, not the ossifying reactions seen in this case.
Pediatrics
2 questionsA 6-week-old infant presents with a history of non-bilious, non-projectile vomiting starting at 3 weeks of age. The infant's abdominal examination is normal. Which of the following is the most likely diagnosis?
A 3-year-old child is brought to the clinic with a history of cyanosis since infancy. Which of the following is a component of Tetralogy of Fallot (TOF)?
INI-CET 2025 - Pediatrics INI-CET Practice Questions and MCQs
Question 21: A 6-week-old infant presents with a history of non-bilious, non-projectile vomiting starting at 3 weeks of age. The infant's abdominal examination is normal. Which of the following is the most likely diagnosis?
- A. Gastroesophageal reflux disease (GERD) (Correct Answer)
- B. Cow Milk Protein Allergy
- C. Intestinal obstruction
- D. Pyloric stenosis
Explanation: ***Gastroesophageal reflux disease (GERD)*** - This is the most common cause of non-bilious, **non-projectile** vomiting (regurgitation) in healthy infants, often starting early and peaking around 4-5 months of age. - The history is consistent with simple **physiologic reflux**, characterized by non-forceful spitting up and a **normal abdominal examination**. *Pyloric stenosis* - Classically involves **projectile** non-bilious vomiting that becomes progressively worse, which contradicts the non-projectile description. - A physical exam would typically reveal an **olive-like mass** (hypertrophied pylorus) or visible gastric peristalsis, which is stated to be absent. *Cow Milk Protein Allergy* - Although vomiting can occur, it is usually accompanied by other symptoms like **bloody stools**, severe irritability, or **eczema**, which are not mentioned. - Isolated, mild, non-projectile vomiting without systemic signs is less specific for a protein allergy than for GERD. *Intestinal obstruction* - Obstruction distal to the ampulla of Vater (e.g., malrotation, atresia) typically causes **bilious vomiting**, which is absent in this case. - Such conditions usually lead to an **abnormal abdominal examination** or signs of acute illness, which are not present here.
Question 22: A 3-year-old child is brought to the clinic with a history of cyanosis since infancy. Which of the following is a component of Tetralogy of Fallot (TOF)?
- A. Inter atrial septal defect
- B. Infundibular pulmonary stenosis (Correct Answer)
- C. Left ventricular hypertrophy (LVH)
- D. Transposition of the great arteries (TGA)
Explanation: ***Infundibular pulmonary stenosis*** - This is the most common anatomic type of **pulmonary stenosis** seen in TOF, caused by hypertrophy of the muscle below the pulmonary valve (infundibulum). - The degree of this stenosis dictates the direction of flow across the VSD and, consequently, the severity of **cyanosis**. *Inter atrial septal defect* - An ASD is not a primary component of TOF. When TOF is associated with an ASD, the condition is termed **Pentalogy of Fallot**. - ASD typically causes a **left-to-right shunt** and is usually an acyanotic or late-onset cyanotic condition, unlike classic TOF. *Left ventricular hypertrophy (LVH)* - The pressure overload due to **pulmonary stenosis** and the large **VSD** leads to **Right Ventricular Hypertrophy (RVH)**. - LVH suggests conditions like severe **aortic stenosis** or systemic overloading, not the typical hemodynamics of TOF. *Transposition of the great arteries (TGA)* - **TGA** is a separate, distinct cyanotic congenital heart disease where the great arteries are transposed (aorta from RV, pulmonary artery from LV). - The components of TOF involve a single great artery relationship but with a large **Ventricular Septal Defect (VSD)** and overriding aorta.
Pharmacology
2 questionsSodium thiopentone is regarded as an ultrashort-acting drug due to
Which of the following psychoactive substances is a new, rapidly acting antidepressant?
INI-CET 2025 - Pharmacology INI-CET Practice Questions and MCQs
Question 21: Sodium thiopentone is regarded as an ultrashort-acting drug due to
- A. Short elimination half-life
- B. Metabolism
- C. Excretion
- D. Rapid redistribution (Correct Answer)
Explanation: ***Rapid redistribution*** - The ultrashort action of **thiopentone** is primarily due to its rapid **redistribution** from the central compartment (brain) to peripheral tissues (muscle and fat). - This rapid drop in plasma and brain concentration leads to swift termination of the drug's hypnotic effect. *Metabolism* - While thiopentone is metabolized primarily by the **liver**, its metabolic clearance is relatively slow, contributing to its long elimination half-life rather than its quick onset/offset. *Excretion* - Thiopentone is only minimally excreted unchanged by the **kidneys**; renal excretion is not the reason for the ultrashort duration of action. *Short elimination half-life* - Thiopentone actually has a **long elimination half-life** (around 10–12 hours) because of its high lipid solubility, long protein binding, and slow systemic metabolism. - The duration of action is governed by redistribution, not by the elimination half-life.
Question 22: Which of the following psychoactive substances is a new, rapidly acting antidepressant?
- A. Ketamine (Correct Answer)
- B. Bupropion
- C. Haloperidol
- D. Cannabinoids
Explanation: ***Ketamine*** - It is an **NMDA receptor antagonist** that produces a rapid and often sustained antidepressant effect, typically within hours, making it a new class of rapidly acting antidepressants. - **Esketamine** (a derivative) is specifically approved for **treatment-resistant depression** and acute suicidal ideation. *Bupropion* - This is a traditional antidepressant classified as a **Norepinephrine and Dopamine Reuptake Inhibitor (NDRI)**. - Like most conventional antidepressants (SSRIs, SNRIs), Bupropion has a **delayed onset of action**, usually requiring weeks for clinical efficacy. *Haloperidol* - This substance is a typical or first-generation **antipsychotic** used primarily to treat conditions involving psychosis, such as schizophrenia and acute mania. - Its primary function involves potent blockade of **Dopamine D2 receptors**, and it is not used in the management of primary depression. *Cannabinoids* - These agents primarily modulate the **endocannabinoid system (CB1 and CB2 receptors)**, and while they have CNS effects, they are generally not used as primary, rapid-acting antidepressants. - Research into cannabinoids for mood is complex, and they may sometimes lead to dysphoria or **anxiety/psychosis exacerbation**.