INI-CET 2025 Practice Questions

Q: A male presents with lesions as shown in the image and a history of unprotected sexual intercourse a few months ago. What is the most appropriate investigation to confirm the diagnosis?

Serology. ***Serology*** - The clinical presentation (diffuse body rash, often involving the palms and soles, following recent unprotected sexual exposure) is highly suggestive of **Secondary Syphilis**. - **Serological tests** (Non-treponemal tests like RPR/VDRL and specific Treponemal tests like TPPA/FTA-ABS) are the definitive and most appropriate confirmatory investigation for syphilis. *Tzanck smear* - This test is used primarily for the rapid diagnosis of vesicular lesions caused by herpes viruses, such as **Herpes Simplex Virus (HSV)** or **Varicella-Zoster Virus (VZV)**. - It is not indicated for the diagnosis of the typical maculopapular rash seen in secondary syphilis. *KOH* - **Potassium hydroxide (KOH) preparation** is a direct microscopy test specifically used to identify structures like hyphae and spores in the diagnosis of **superficial fungal infections**. - The patient's presentation with a rash secondary to sexually transmitted infection is not typically investigated using KOH. *Biopsy* - While a skin biopsy might confirm the diagnosis histologically (showing characteristic perivascular infiltrate), it is **invasive** and generally reserved for cases where serology is equivocal or the presentation is atypical. - **Serology** provides a systemic assessment and is the standard initial confirmatory test for syphilis.

Q: Which of the following is the most common inherited bleeding disorder?

Von Willebrand Disease. ***Von Willebrand Disease*** - VWD is the most common inherited bleeding disorder, with a prevalence estimated to be as high as 1% of the population, often showing an **autosomal dominant** inheritance pattern. - It results from a quantitative or qualitative defect in **von Willebrand factor (vWF)**, which impairs platelet adhesion and stabilizes **Factor VIII** [1][2]. *Disseminated Intravascular Coagulation* - DIC is an **acquired** life-threatening condition caused by systemic activation of coagulation, usually triggered by underlying severe diseases like **sepsis** or trauma, not inheritance. - It is characterized by simultaneous widespread thrombosis and severe bleeding due to the consumption of clotting factors and platelets. *Factor V Deficiency* - Factor V deficiency (Parahemophilia) is an extremely rare inherited bleeding disorder, transmitted in an **autosomal recessive** manner. - While inherited, its overall prevalence is substantially lower compared to VWD, making it not the most common. *Hemophilia* - Hemophilia (A and B) is the most common severe inherited bleeding disorder, known for causing deep tissue bleeding (e.g., **hemarthroses**). - It is an **X-linked recessive** condition, meaning it is less prevalent overall in the population compared to the high frequency of mild, often undiagnosed, VWD cases.

Q: The Kanagawa phenomenon observed on Wagatsuma agar is characteristic of which of the following organisms?

Vibrio parahaemolyticus. ***Vibrio parahaemolyticus*** - The **Kanagawa phenomenon** describes the ability of certain strains of *Vibrio parahaemolyticus* to produce a **heat-stable direct hemolysin (TDH)**. - This hemolysin causes **beta-hemolysis** (complete clearing) when the organism is grown on a specialized high-salt medium like **Wagatsuma agar**, distinguishing pathogenic strains. *Vibrio cholerae* - This organism causes **cholera** and typically produces yellow colonies on **TCBS agar** (Thiosulfate Citrate Bile Salts Sucrose). - Its primary virulence mechanism is the production of **cholera toxin**, and it does not exhibit the specific Kanagawa phenomenon. *Staphylococcus aureus* - *S. aureus* produces several hemolysins (alpha, beta, delta) but is generally identified using tests like the **coagulase test** and growth on **Mannitol Salt Agar**. - The Kanagawa phenomenon on Wagatsuma agar is a specific test reserved for identifying potentially pathogenic *Vibrio* species. *Burkholderia pseudomallei* - This bacterium causes **melioidosis** and is typically identified by its characteristic **wrinkled colony morphology** on media like Ashdown agar. - It is a Gram-negative bacillus common in Southeast Asia and is not associated with the specific hemolytic action defined by the Kanagawa test.

Q: A patient presents with ascites and omental caking. Imaging reveals solid components in an adnexal mass, and there is a long-standing history of symptoms. CA-125 is positive. What is the most probable diagnosis?

Serous ovarian tumor. ***Serous ovarian tumor*** - This is the most common type of epithelial ovarian cancer, often presenting late with extensive **peritoneal dissemination**, causing **ascites** and **omental caking** (carcinomatosis). - High elevation of the tumor marker **CA-125** is characteristic and strongly supports this diagnosis in the setting of advanced disease. *Mucinous ovarian tumor* - These tumors often grow large but are typically confined to the ovary or manifest as **pseudomyxoma peritonei** if ruptured, which is different from typical omental caking. - While they can elevate CA-125, the elevation is less common and less pronounced than in serous carcinoma. *Endometrioid tumor* - This type has a strong association with **endometriosis** and concurrent or preceding **endometrial cancer**, a feature not mentioned in the presentation. - While they are often CA-125 positive, the combined clinical picture of omental caking plus ascites points preferentially to **Serous carcinoma**. *Granulosa cell tumor* - This is a sex-cord stromal tumor that is typically detected earlier due to its **endocrine activity**, often causing signs of **estrogen excess** (e.g., post-menopausal bleeding). - The key tumor marker for this type is **inhibin**, not CA-125.

Q: Which of the following is an incorrect gene-disease association?

TP53 - Mucosal Neuroma. ***TP53 - Mucosal Neuroma*** - This is an **incorrect association**. Mucosal neuromas are a hallmark feature of **Multiple Endocrine Neoplasia type 2B (MEN 2B)** [2]. - MEN 2B is caused by a germline gain-of-function mutation in the **RET proto-oncogene**, not the TP53 tumor suppressor gene (which is associated with **Li-Fraumeni syndrome**). *STK11 - Breast Cancer* - This is a **correct association**. Mutations in the **STK11** gene cause **Peutz-Jeghers syndrome (PJS)**. - Patients with PJS have a significantly increased risk of developing several malignancies, including gastrointestinal cancers and non-GI cancers like **breast cancer**. *PTEN - Thyroid Carcinoma* - This is a **correct association**. Germline mutations in the **PTEN** gene are responsible for **Cowden Syndrome**. - Cowden Syndrome is characterized by hamartomas and a high lifetime risk of developing cancers, most notably **follicular thyroid carcinoma** and breast cancer. *BRCA2 - Prostate Carcinoma* - This is a **correct association**. Germline mutations in **BRCA2** are strongly linked to hereditary breast and ovarian cancer syndromes [1]. - Men with **BRCA2** mutations have a substantially elevated risk of developing **prostate carcinoma**, often presenting with high-grade, aggressive disease. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Pancreas, pp. 898-899. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1139-1140.

Q: Imipramine and Diphenhydramine are given together to a patient. Why is this combination considered irrational?

Both have anticholinergic action. ***Both have anticholinergic action*** - Imipramine, being a **Tricyclic Antidepressant (TCA)**, possesses significant **anticholinergic properties** (Muscarinic receptor blockade). - Diphenhydramine, a first-generation antihistamine, is also a highly effective **anticholinergic agent**; their co-administration leads to severe, potentially fatal, additive anticholinergic effects (e.g., acute confusion, severe urinary retention, paralytic ileus). *Both cause serotonin syndrome* - While Imipramine is a weak **Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)**, Diphenhydramine does not directly contribute significantly to **serotonin toxicity**. - The primary and most hazardous interaction is the severe risk of **anticholinergic crisis**, not Serotonin Syndrome. *Both cause hypotension* - Imipramine can cause **orthostatic hypotension** due to its **alpha-1 adrenergic blockade** effects. - Although side effects include hypotension, the combined risk of severe **anticholinergic side effects** (delirium, ileus) is the overwhelming reason this combination is irrational. *Both cause increased sedation* - Both drugs are highly sedating, which is a valid concern for driving and daily function, mediated by **H1 receptor antagonism**. - However, while increased sedation is a risk, the combination is specifically deemed irrational because of the risk of life-threatening **anticholinergic toxicity**, which is a more critical pharmacological interaction than simple additive sedation.

Q: Which of the following statements regarding Thalidomide is correct? a. It acts as an antimetabolite and is useful as an immunosuppressant b. It is used in the treatment of multiple myeloma c. It is used in the management of Type 2 lepra reaction (ENL) d. It is teratogenic

b, c, d. ***b, c, d*** - Statements b, c, and d are correct: Thalidomide is an **Immunomodulatory Drug (IMiD)** used effectively in the treatment of **multiple myeloma**, it is the drug of choice for **Erythema Nodosum Leprosum (ENL)** (Type 2 lepra reaction), and it is historically significant for causing **phocomelia** (teratogenicity). - Its mechanism involves downregulation of **pro-inflammatory cytokines** like TNF-alpha, which underlies its use in ENL, and anti-angiogenic/anti-proliferative effects against myeloma cells. *a, b, c* - Statement 'a' is incorrect because Thalidomide is an **Immunomodulatory Drug (IMiD)**, not an **antimetabolite** (a class of drugs that inhibit DNA/RNA synthesis). - Inclusion of the incorrect mechanism ('a') invalidates this set, despite 'b' (multiple myeloma) and 'c' (ENL) being correct clinical applications. *a, c, d* - This combination is incorrect primarily because it includes statement 'a', which wrongly defines Thalidomide as an **antimetabolite**. - Crucially, this option omits statement 'b', which is a major, current indication for Thalidomide in **multiple myeloma**. *a, b, d* - This combination wrongly includes the factual error of statement 'a' (it is not an **antimetabolite**). - It also misses statement 'c', which is the prominent use of Thalidomide in **Type 2 lepra reaction (ENL)**.

Q: According to the Drugs and Cosmetics Rules, match the following medications with their corresponding schedules: 1. Insulin, 2. Hepatitis B vaccine, 3. Morphine, 4. Veterinary drugs. Schedules: A. Schedule H, B. Schedule Z, C. Schedule G, D. Schedule X.

1-C, 2-A, 3-D, 4-B. ***1-C, 2-A, 3-D, 4-B*** - **Insulin** (1) is properly categorized under **Schedule G** (C), specifying drugs that must be taken only under the supervision of a registered medical practitioner. - The **Hepatitis B vaccine** (2) falls under **Schedule H** (A - general prescription drugs), **Morphine** (3) is correctly placed under **Schedule X** (D - narcotics/psychotropics), and **Veterinary drugs** (4) are covered by **Schedule Z** (B - proprietary veterinary medicines). *1-C, 2-D, 3-B, 4-A* - This option incorrectly assigns the **Hepatitis B vaccine** (2) to Schedule D (which deals with standards of imported drugs) instead of Schedule H. - It incorrectly places **Morphine** (3) under Schedule B (fees for tests and analysis) instead of the appropriate Schedule X. *1-B, 2-A, 3-D, 4-C* - This option incorrectly assigns **Insulin** (1) to Schedule B (fees for test or analysis by the Central Drugs Laboratory) instead of Schedule G. - It incorrectly places **Veterinary drugs** (4) under Schedule C (which deals with biological products intended for parenteral administration). *1-D, 2-B, 3-A, 4-C* - This option incorrectly assigns **Insulin** (1) to Schedule D (rules regarding the importation of drugs) and **Morphine** (3) to Schedule A (forms of application for licenses). - It also incorrectly links the **Hepatitis B vaccine** (2) to Schedule B (fees for tests rather than a drug category).

Q: Which of the following is the investigation of choice for spinal TB?

MRI. ***MRI*** - **Magnetic Resonance Imaging (MRI)** is the investigation of choice, as it provides excellent visualization of soft tissues, including the **spinal cord**, nerve roots, and early features like **bone marrow edema** and **paraspinal abscesses**. - It can clearly define the extent of the disease, including disc involvement, **epidural space compression**, and neural compromise, which is crucial for surgical planning. *Ultrasound* - **Ultrasound** is primarily used for assessing soft tissue masses and guiding aspirations but has limited ability to image deep structures like the **vertebral column** and spinal canal. - It cannot adequately assess the extent of **bone destruction**, vertebral body involvement, or **intradural pathology** associated with spinal TB. *CT scan* - **CT scan** is superior to conventional radiography for demonstrating **lytic bone destruction**, calcification, and fine bony detail associated with TB. - However, it is less effective than MRI in visualizing **soft tissue involvement**, **early marrow changes**, or the degree of **cord compression**. *CBNAAT* - **CBNAAT (Cartridge-Based Nucleic Acid Amplification Test)** is a **microbiological test** used for the rapid diagnosis of TB and detection of rifampicin resistance. - It requires a **tissue or fluid sample** (e.g., from aspiration or biopsy) and is used for **pathological confirmation**, not as the primary radiological investigation of choice.

Question 1

A male presents with lesions as shown in the image and a history of unprotected sexual intercourse a few months ago. What is the most appropriate investigation to confirm the diagnosis?

Accepted Answer

Serology

Answer

Tzanck smear

Answer

KOH

Answer

Biopsy

Question 2

Which of the following is the most common inherited bleeding disorder?

Accepted Answer

Von Willebrand Disease

Answer

Hemophilia

Answer

Factor V Deficiency

Answer

Disseminated Intravascular Coagulation

Question 3

The Kanagawa phenomenon observed on Wagatsuma agar is characteristic of which of the following organisms?

Accepted Answer

Vibrio parahaemolyticus

Answer

Vibrio cholerae

Answer

Staphylococcus aureus

Answer

Burkholderia pseudomallei

Question 4

A patient presents with ascites and omental caking. Imaging reveals solid components in an adnexal mass, and there is a long-standing history of symptoms. CA-125 is positive. What is the most probable diagnosis?

Accepted Answer

Serous ovarian tumor

Answer

Granulosa cell tumor

Answer

Endometrioid tumor

Answer

Mucinous ovarian tumor

Question 5

Which of the following is an incorrect gene-disease association?

Accepted Answer

TP53 - Mucosal Neuroma

Answer

BRCA2 - Prostate Carcinoma

Answer

STK11 - Breast Cancer

Answer

PTEN - Thyroid Carcinoma

Question 6

Imipramine and Diphenhydramine are given together to a patient. Why is this combination considered irrational?

Accepted Answer

Both have anticholinergic action

Answer

Both cause serotonin syndrome

Answer

Both cause hypotension

Answer

Both cause increased sedation

Question 7

Which of the following statements regarding Thalidomide is correct?
a. It acts as an antimetabolite and is useful as an immunosuppressant
b. It is used in the treatment of multiple myeloma
c. It is used in the management of Type 2 lepra reaction (ENL)
d. It is teratogenic

Accepted Answer

b, c, d

Answer

a, b, d

Answer

a, b, c

Answer

a, c, d

Question 8

According to the Drugs and Cosmetics Rules, match the following medications with their corresponding schedules: 1. Insulin, 2. Hepatitis B vaccine, 3. Morphine, 4. Veterinary drugs. Schedules: A. Schedule H, B. Schedule Z, C. Schedule G, D. Schedule X.

Accepted Answer

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

Answer

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

Answer

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

Answer

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

Question 9

Which investigation is contraindicated in pregnancy?

Accepted Answer

CT scan

Answer

MRI

Answer

Ultrasound

Answer

Doppler

Question 10

Which of the following is the investigation of choice for spinal TB?

Accepted Answer

MRI

Answer

Ultrasound

Answer

CT scan

Answer

CBNAAT

INI-CET 2025

Dermatology

Internal Medicine

Microbiology

Obstetrics and Gynecology

Pathology

Pharmacology

Radiology