INI-CET 2026 Practice Questions

Q: A 40-year-old female is scheduled for parotid surgery and is administered general Anaesthesia. Approximately 10 minutes into the procedure, the following findings are noted: - Rise in end-tidal CO2 (EtCO2) - Temperature: 104°F (40°C) - Heart rate: 150 bpm - Blood pressure: 180/110 mmHg What is the most likely diagnosis?

Malignant hyperthermia. ***Malignant hyperthermia*** - This is a pharmacogenetic disorder triggered by volatile inhalational anesthetics or succinylcholine, characterized by a hypermetabolic state. - The rapid rise in **end-tidal CO2 (EtCO2)** is often the earliest sign, followed by **tachycardia**, severe **hyperthermia**, and **hypertension** due to muscle rigidity. *Heat stroke* - Typically caused by environmental exposure or extreme physical exertion, not triggered by anesthetic agents. - Patients often present with altered mental status and dry skin, occurring much later and not immediately following induction. *Heat cramps* - This is a mild form of heat illness characterized by painful muscle spasms caused by salt and water depletion. - It does not present with the systemic hypermetabolic crisis seen here, such as the rapid rise in **EtCO2** or life-threatening tachycardia. *Heat pyrexia* - Also known as heat exhaustion, this condition involves systemic symptoms like dizziness and fatigue due to heat stress. - It lacks the acute, life-threatening hypermetabolic surge associated with anesthesia administration.

Q: During a lumbar puncture procedure, the spinal needle traverses several anatomical layers in a defined sequence before reaching the subarachnoid space. Given the structures listed below, which option correctly represents the order in which they are pierced? 1. Ligamentum flavum 2. Supraspinous ligament 3. Interspinous ligament 4. Dura mater 5. Subdural space 6. Arachnoid mater 7. Epidural space Which option correctly represents the order in which they are pierced?

2 → 3 → 1 → 7 → 4 → 5 → 6. ***2 → 3 → 1 → 7 → 4 → 5 → 6*** - The needle first penetrates the **supraspinous ligament**, followed by the **interspinous ligament**, and then the **ligamentum flavum** (the 'yellow ligament'), which provides a distinct 'pop' sensation upon entry. - After passing through the ligamentum flavum, the needle enters the **epidural space**, then pierces the **dura mater**, traverses the **subdural space**, and finally enters the **subarachnoid space** (after passing the arachnoid mater).*2 → 3 → 7 → 1 → 4 → 5 → 6* - This sequence incorrectly places the **epidural space** (7) before the **ligamentum flavum** (1). - The ligamentum flavum must be pierced to gain access from the superficial tissues into the epidural space, not vice versa.*3 → 2 → 1 → 7 → 4 → 5 → 6* - This sequence starts with the **interspinous ligament** (3), erroneously placing it before the **supraspinous ligament** (2). - The supraspinous ligament is the most superficial structure among the spinal ligaments involved in a midline lumbar puncture, thus it must be pierced first.*2 → 1 → 3 → 4 → 7 → 5 → 6* - This sequence incorrectly places the **ligamentum flavum** (1) before the **interspinous ligament** (3) and implies the dura is pierced before the epidural space. - Anatomically, the needle must pass through the interspinous ligament before reaching the deeper ligamentum flavum, and the epidural space lies between the ligamentum flavum and the dura.

Q: Regarding the cardiovascular effects of halothane on blood pressure, the following statements are given: 1. A drop of 20-30 mmHg in blood pressure is commonly observed 2. The fall in blood pressure begins early and is proportional to the depth of Anaesthesia 3. The fall in blood pressure reduces as the depth of Anaesthesia 4. The baroreceptor reflex mechanism is activated in response to the fall in blood pressure Which of the above statements are correct?

1, 2, and 4 only. ***1, 2, and 4 only*** - Halothane is a potent volatile anesthetic well-known for causing a dose-dependent **decrease in systemic arterial blood pressure**, often by 20-30 mmHg, primarily due to **myocardial depression** and peripheral vasodilation. - This hypotension begins early during induction and correlates directly with the **depth of anesthesia** (concentration), while blunting or impairing the **baroreceptor reflex** that would normally compensate for the pressure drop. - *1, 2, and 3 only* - This option is incorrect because the fall in blood pressure does not decrease with increased depth of anesthesia; rather, it worsens as the **depth of anesthesia increases** due to intensified myocardial suppression. - Myocardial contractility is significantly reduced in a **concentration-dependent manner**, leading to decreased cardiac output at higher MAC (minimum alveolar concentration) values. - *2, 3, and 4 only* - This option incorrectly includes statement 3, which falsely suggests that the fall in blood pressure mitigates at deeper levels of anesthesia. - Statement 1 is factually correct as the **typical hypotensive response** observed is in the range of 20-30 mmHg, making its exclusion from this subset incorrect. - *1, 3, and 4 only* - This option incorrectly includes statement 3, which contradicts the known **dose-dependent effect** of halothane where depth directly correlates to the severity of hypotension. - It also excludes statement 2, which is a correct description of the temporal relationship between anesthesia induction and the onset of hemodynamic instability.

Q: A patient presents with focal hair loss accompanied by pruritus and scalp scaling. Which of the following treatments is most suitable?

Oral antifungals. ***Oral antifungals*** - The clinical presentation of focal hair loss, pruritus, and scaling is highly characteristic of **tinea capitis**, a dermatophyte infection of the scalp. - **Griseofulvin** or **terbinafine** are the gold-standard systemic treatments required to penetrate the hair shaft and successfully eradicate the fungal infection. *Methotrexate* - This is an **immunosuppressive agent** typically reserved for severe inflammatory conditions like psoriasis or rheumatoid arthritis. - It has no role in treating common fungal scalp infections and could potentially worsen the condition by causing immunosuppression. *Topical corticosteroids* - While these may alleviate itching and inflammation, they do not treat the underlying fungal pathogen in **tinea capitis**. - Using steroids alone can lead to **tinea incognito**, where the infection continues to spread and proliferate while the classic appearance is masked by the steroid effect. *Oral antibiotics* - Antibiotics are indicated for **bacterial infections**, such as impetigo or secondary folliculitis, not fungal etiologies. - They are ineffective against dermatophytes and contribute to unnecessary antibiotic resistance.

Q: A patient is found to have a dark black lesion on the plantar surface of the foot. What is the most appropriate initial investigation?

Skin biopsy. ***Skin biopsy*** - A suspicious **pigmented lesion**, specifically one that is darkly pigmented on the acral surface (plantar surface of the foot), raises immediate concern for **acral lentiginous melanoma**. - An **excision biopsy** with an appropriate margin is the definitive diagnostic procedure to obtain a **histopathological diagnosis** and determine the **Breslow thickness**. *KOH mount* - This is utilized to identify **fungal infections** (dermatophytes) through the visualization of **hyphae** or yeast. - It is unsuitable for this case because a dark black lesion is suggestive of a **melanocytic neoplasm** rather than a fungal infection. *Gram stain* - This diagnostic tool is used for the rapid identification of **bacterial pathogens** in samples like pus, sputum, or blood. - It has no utility in the diagnosis of skin malignancies, as it provides no information regarding **cellular atypia** or **melanocytic lineage**. *Tzanck smear* - This test is employed to diagnose **herpesvirus infections** (like HSV or VZV) by looking for **multinucleated giant cells**. - It is not indicated for screening or diagnosing **dermal malignancies** such as melanoma.

Q: During tattooing, in which layer of the skin is the pigment/ink primarily deposited?

Dermis. ***Dermis*** - The **dermis** is the stable layer of the skin that lies beneath the epidermis, containing an extracellular matrix of **collagen and elastin** that anchors the ink particles. - Because the dermis does not undergo the continuous **desquamation** (shedding) process like the epidermis, tattoo ink remains permanently trapped within **dermal fibroblasts** and **macrophages**. *Epidermis* - The epidermis, specifically the **stratum corneum**, constantly sheds cells; ink placed here would be lost within a few weeks as the skin regenerates. - Tattoo needles are specifically designed to penetrate through the epidermis to reach the underlying **dermal layer**. *Subcutaneous tissue* - While some ink may inadvertently reach the **subcutaneous tissue (hypodermis)**, deposition here results in a

Q: Match each clinical sign in Column A with its corresponding dermatological condition in Column B: Column A (Clinical Sign) Column B (Condition) Positive Nikolsky sign Pemphigus vulgaris Pseudo-Nikolsky sign Stevens-Johnson syndrome False Nikolsky sign Bullous pemphigoid Cerebriform tongue Pemphigus vegetans Which of the following is the correct match?

A-1, B-3, C-2, D-4. ***A-1, B-3, C-2, D-4*** - A **Positive Nikolsky sign** involves the separation of the epidermis from the dermis with lateral pressure, which is classically seen in **Pemphigus vulgaris** due to autoantibodies against **desmogleins**. - The other matches are: Pseudo-Nikolsky sign (also known as Asboe-Hansen sign) for **Stevens-Johnson syndrome** (or toxic epidermal necrolysis), False Nikolsky sign for **Bullous pemphigoid** (subepidermal split leads to less fragility), and **Cerebriform tongue** for **Pemphigus vegetans**. *A-2, B-1, C-3, D-4* - The **Nikolsky sign** would be incorrectly matched with **Stevens-Johnson syndrome** as the primary index condition. - This sequence fails to correctly identify the **Pseudo-Nikolsky sign** and the specific clinical correlation for **Bullous pemphigoid**. *A-1, B-2, C-3, D-4* - While A-1 is correct, this match incorrectly pairs **Pseudo-Nikolsky sign** with **Pemphigus vulgaris**. - It also misidentifies the clinical association for **Bullous pemphigoid** regarding the Nikolsky sign status. *A-4, B-2, C-1, D-3* - This option incorrectly lists the **cerebriform tongue** as a sign of **Pemphigus vulgaris** rather than **Pemphigus vegetans**. - It completely swaps the associations for the **Nikolsky sign** variants, leading to incorrect dermatological diagnoses.

Q: Which of the following drugs is classified as a novel antidepressant?

Vilazodone. ***Vilazodone*** - Classified as a **serotonin partial agonist-reuptake inhibitor (SPARI)**, it combines **SSRI** activity with **5-HT1A receptor partial agonism**. - Its unique mechanism of action contributes to its status as a **novel antidepressant**, often associated with a lower incidence of sexual side effects compared to traditional SSRIs. *Trazodone* - This is an older **serotonin antagonist and reuptake inhibitor (SARI)**, primarily utilized today at lower doses for its **sedative-hypnotic properties** rather than as a first-line antidepressant. - It is not classified as a novel antidepressant due to its chemical structure and established long-term history of clinical use. *Blonanserin* - This is an **atypical antipsychotic** drug, not an antidepressant, primarily used for the treatment of **schizophrenia**. - It functions as a **dopamine D2 and serotonin 5-HT2A receptor antagonist**. *Etizolam* - This is a **thienodiazepine derivative**, structurally related to **benzodiazepines**, primarily used for its **anxiolytic**, hypnotic, and anticonvulsant effects. - It acts as a **GABA-A receptor positive allosteric modulator** and has no primary antidepressant classification.

Q: A patient with chronic alcoholism presents with severe memory problems. Which of the following features is most characteristic of Korsakoff syndrome?

Inability to form new memories (anterograde amnesia). ***Inability to form new memories (anterograde amnesia)*** - Korsakoff syndrome is a chronic neuropsychiatric condition characterized by severe **anterograde amnesia**, where patients have a profound inability to form new memories. - It is frequently associated with **confabulation**, a process where patients fill in memory gaps with fabricated information, often due to damage in the **diencephalon** (specifically the **mediodorsal nucleus of the thalamus** and **mammillary bodies**). *Loss of personal identity* - This feature is characteristic of **dissociative amnesia**, a psychological condition typically triggered by trauma or severe stress. - Korsakoff syndrome specifically affects episodic and declarative memory but does not usually compromise the patient's core sense of self or identity. *Impairment of unconscious (implicit) memory* - Implicit memory (such as procedural memory for skills) remains largely **preserved** in patients with Korsakoff syndrome. - The deficit in this condition is primarily limited to **explicit memory** (declarative memory), distinguishing it from other neurodegenerative dementias. *Confusion, unsteady gait, and eye movement paralysis* - This describes the **classic triad** of **Wernicke encephalopathy** (confusion, ataxia, ophthalmoplegia), which is the acute, reversible precursor to Korsakoff syndrome. - While the conditions are related, the triad specifically represents the **acute phase** rather than the chronic amnestic syndrome of Korsakoff.

Q: An elderly patient dies, and autopsy reveals neuritic plaques in the brain. What is the most likely diagnosis?

Alzheimer’s disease. ***Alzheimer’s disease*** - The presence of **neuritic plaques** (composed of extracellular **beta-amyloid** deposits) and **neurofibrillary tangles** (intracellular hyperphosphorylated **tau protein**) is the pathologic hallmark of **Alzheimer’s disease**. - These findings lead to widespread **cortical atrophy**, particularly in the **hippocampus** and temporal lobes, correlating with the progressive dementia seen in this condition. *Parkinson’s disease* - The pathological hallmark is **Lewy bodies**, which are intracellular inclusions of **alpha-synuclein** found primarily in the **substantia nigra**. - Clinically manifests with motor symptoms like **bradykinesia**, **resting tremor**, and **rigidity** rather than primarily memory loss. *Creutzfeldt-Jakob disease* - Characterized pathologically by **spongiform changes** (vacuolation) in the cerebral cortex and grey matter. - This is a **prion disease** that typically presents with rapidly progressive dementia and **myoclonus**, often showing characteristic **periodic sharp wave complexes** on EEG. *Huntington’s disease* - Pathologically characterized by severe atrophy of the **caudate nucleus** and putamen (striatum) due to neuronal degeneration. - Clinically presents with **chorea**, behavioral disturbances, and dementia, usually displaying an **autosomal dominant** inheritance pattern.

Question 1

A 40-year-old female is scheduled for parotid surgery and is administered general Anaesthesia.
Approximately 10 minutes into the procedure, the following findings are noted:
- Rise in end-tidal CO2 (EtCO2)
- Temperature: 104°F (40°C)
- Heart rate: 150 bpm
- Blood pressure: 180/110 mmHg
What is the most likely diagnosis?

Accepted Answer

Malignant hyperthermia

Answer

Heat stroke

Answer

Heat cramps

Answer

Heat pyrexia

Question 2

During a lumbar puncture procedure, the spinal needle traverses several anatomical layers in a
defined sequence before reaching the subarachnoid space. Given the structures listed below,
which option correctly represents the order in which they are pierced?
1. Ligamentum flavum
2. Supraspinous ligament
3. Interspinous ligament
4. Dura mater
5. Subdural space
6. Arachnoid mater
7. Epidural space
Which option correctly represents the order in which they are pierced?

Accepted Answer

2 → 3 → 1 → 7 → 4 → 5 → 6

Answer

2 → 3 → 7 → 1 → 4 → 5 → 6

Answer

3 → 2 → 1 → 7 → 4 → 5 → 6

Answer

2 → 1 → 3 → 4 → 7 → 5 → 6

Question 3

Regarding the cardiovascular effects of halothane on blood pressure, the following statements
are given:
1. A drop of 20-30 mmHg in blood pressure is commonly observed
2. The fall in blood pressure begins early and is proportional to the depth of Anaesthesia
3. The fall in blood pressure reduces as the depth of Anaesthesia

4. The baroreceptor reflex mechanism is activated in response to the fall in blood pressure
Which of the above statements are correct?

Accepted Answer

1, 2, and 4 only

Answer

1, 2, and 3 only

Answer

2, 3, and 4 only

Answer

1, 3, and 4 only

Question 4

A patient presents with focal hair loss accompanied by pruritus and scalp scaling. Which of the
following treatments is most suitable?

Accepted Answer

Oral antifungals

Answer

Methotrexate

Answer

Topical corticosteroids

Answer

Oral antibiotics

Question 5

A patient is found to have a dark black lesion on the plantar surface of the foot. What is the most
appropriate initial investigation?

Accepted Answer

Skin biopsy

Answer

KOH mount

Answer

Gram stain

Answer

Tzanck smear

Question 6

During tattooing, in which layer of the skin is the pigment/ink primarily deposited?

Accepted Answer

Dermis

Answer

Epidermis

Answer

Subcutaneous tissue

Answer

Muscle and vascular tissue

Question 7

Match each clinical sign in Column A with its corresponding dermatological condition in Column
B:

Column A (Clinical Sign) Column B (Condition)

Positive Nikolsky sign Pemphigus vulgaris

Pseudo-Nikolsky sign Stevens-Johnson syndrome

False Nikolsky sign Bullous pemphigoid

Cerebriform tongue Pemphigus vegetans

Which of the following is the correct match?

Accepted Answer

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

Answer

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

Answer

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

Answer

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

Question 8

Which of the following drugs is classified as a novel antidepressant?

Accepted Answer

Vilazodone

Answer

Trazodone

Answer

Blonanserin

Answer

Etizolam

Question 9

A patient with chronic alcoholism presents with severe memory problems. Which of the
following features is most characteristic of Korsakoff syndrome?

Accepted Answer

Inability to form new memories (anterograde amnesia)

Answer

Loss of personal identity

Answer

Impairment of unconscious (implicit) memory

Answer

Confusion, unsteady gait, and eye movement paralysis

Question 10

An elderly patient dies, and autopsy reveals neuritic plaques in the brain. What is the most likely
diagnosis?

Accepted Answer

Alzheimer’s disease

Answer

Parkinson’s disease

Answer

Creutzfeldt-Jakob disease

Answer

Huntington’s disease

INI-CET 2026

Anesthesiology

Dermatology

Psychiatry