INI-CET 2025 Practice Questions

Q: In a given population: - less than 15 years: 6000 - 15 to 64 years: 12000 - 65 years and above: 2000 Calculate the dependency ratio.

66 %. ***66 %*** - The **Dependency Ratio** measures the ratio of the economically dependent population to the economically productive population, usually expressed as a percentage. - **Dependent Population** (aged < 15 and ≥ 65): 6000 + 2000 = **8000** - **Productive Population** (aged 15-64): **12000** - **Dependency Ratio**: (8000 / 12000) × 100 = **66.67%** (rounded to 66%) *Incorrect: 33 %* - This figure is significantly lower than the true ratio and results from calculating the ratio of the dependent population to the **total population**, which is not the standard definition of the Dependency Ratio. - 33.3% represents the dependent population (8000) as a proportion of the total population (20000), not the dependency burden on the working population. *Incorrect: 50 %* - This result is obtained if only the young dependent group is used in the numerator (Young Dependency Ratio = 6000 / 12000 = **50%**). - However, the total Dependency Ratio must account for **both young and old dependents** to accurately reflect the economic burden. *Incorrect: 75 %* - Obtaining 75% would require the dependent population to be 9000 (i.e., 9000 / 12000), which is higher than the actual 8000 dependents. - This option represents an overestimation of the dependent burden on the working population.

Q: In a study done in a hospital, patients were categorized into three groups based on disease prevalence (Low, Medium, High), and individuals were then randomly selected from each group. What type of sampling is this?

Stratified random sampling. ***Correct: Stratified random sampling*** - This method involves dividing the population into non-overlapping subgroups (**strata**) based on a characteristic (here, disease prevalence: Low, Medium, High). - Subsequently, a **simple random sample** is drawn from *each* stratum independently to ensure representation from all groups. - This ensures that each subgroup is adequately represented in the final sample, making it ideal when the population has distinct subgroups. *Incorrect: Simple random sampling* - Every individual in the entire population has an equal and independent chance of being selected. - It does not involve dividing the population into specific subgroups or categories before selection. - This method may underrepresent or overrepresent certain subgroups by chance. *Incorrect: Systematic random sampling* - This involves selecting every *k*th element after a random start point, where *k* is the sampling interval (Population Size/Sample Size). - Like simple random sampling, it does not involve creating predefined strata based on characteristics like disease prevalence. - It's a simpler alternative to simple random sampling but doesn't ensure representation of specific subgroups. *Incorrect: Cluster random sampling* - The population is divided into natural groupings (**clusters**), such as geographical areas or schools. - Unlike stratification, entire clusters are randomly selected, and *all* individuals within the selected clusters (or a random sample thereof) are included in the study. - This differs from stratified sampling where we sample from ALL strata; in cluster sampling, we sample only SOME clusters.

Q: Which of the following diagnoses can cause stridor in infants? 1. Laryngomalacia 2. Congenital hemangioma 3. Subglottic stenosis 4. Recurrent respiratory papillomatosis (RRP)

1, 3 and 4. ***1, 3 and 4*** - This option correctly identifies the three most common and clinically significant causes of stridor in infants - **Laryngomalacia (1)** is the most common cause of congenital stridor (60-75% of cases), presenting with inspiratory stridor that worsens with agitation - **Subglottic stenosis (3)** is the second most common cause of congenital stridor, presenting with biphasic stridor and may be congenital or acquired - **Recurrent respiratory papillomatosis/RRP (4)** caused by HPV (types 6 and 11) causes progressive airway obstruction with stridor and hoarseness - While congenital (subglottic) hemangiomas can cause stridor, they are less common than the above three conditions and typically present between 1-3 months of age *Incorrect: 1 and 3* - This option is incomplete as it excludes **RRP (4)**, which is an important cause of pediatric airway obstruction - RRP typically presents in early childhood and requires serial surgical debulking *Incorrect: 2 and 3* - This option incorrectly excludes **Laryngomalacia (1)**, which is the single most common cause of stridor in infants - Missing laryngomalacia in the differential diagnosis would be a significant oversight *Incorrect: 1 and 4* - This option fails to include **Subglottic stenosis (3)**, the second most common cause of congenital stridor - Subglottic stenosis can be life-threatening and requires urgent evaluation and management

Q: Choose the most appropriate candidates for cochlear implants: 1. Ototoxicity 2. Congenital hearing loss 3. Ossicular fixation 4. Otosclerosis

1 and 2. ### Explanation The core principle of a **Cochlear Implant (CI)** is to bypass a non-functional or damaged cochlea (specifically the hair cells) and directly stimulate the **Auditory Nerve**. Therefore, the ideal candidate must have **Severe to Profound Sensorineural Hearing Loss (SNHL)** with a functioning auditory nerve. #### Why 1 and 2 are Correct: * **Ototoxicity (1):** Drugs like aminoglycosides or cisplatin cause permanent damage to the **outer and inner hair cells** of the cochlea, resulting in bilateral SNHL. Since the auditory nerve remains intact, these patients are excellent candidates for CI. * **Congenital Hearing Loss (2):** Children born with bilateral profound SNHL (Pre-lingual) are the primary target for CI. Early implantation (ideally before age 2) is crucial for the development of speech and language due to **neural plasticity**. #### Why 3 and 4 are Incorrect: * **Ossicular Fixation (3) & Otosclerosis (4):** These conditions primarily cause **Conductive Hearing Loss (CHL)** because the pathology lies in the middle ear (mechanical conduction). * **Otosclerosis** is typically managed with a **Stapedectomy** or hearing aids. * *Note:* While "Far-advanced Otosclerosis" can lead to SNHL, it is not the primary or most common indication compared to the options provided. --- ### High-Yield Clinical Pearls for INI-CET: * **Site of Action:** CI bypasses the **Organ of Corti** to stimulate the **Spiral Ganglion** of the auditory nerve. * **Prerequisite:** A visible **Auditory Nerve** on MRI (Internal Auditory Canal) is mandatory before surgery. * **Contraindications:** * **Michel Aplasia** (Complete absence of inner ear structures). * **Aplasia of the Auditory Nerve**. * Active middle ear infections. * **Mondini Dysplasia:** This is a partial aplasia of the cochlea (1.5 turns instead of 2.5); these patients **can** still receive a CI.

Q: A 50-year-old female complains of an episode of acute vertigo with vomiting and unsteadiness and light-headedness, which was triggered by changing her head position in the morning. She denied hearing loss, recent viral illness, medication use, head injury, or trauma. Choose the most appropriate diagnosis:

BPPV. ### **Explanation: Benign Paroxysmal Positional Vertigo (BPPV)** The clinical presentation of **recurrent, brief episodes of vertigo triggered by head movements** (like rolling over in bed or getting up in the morning) without associated hearing loss is classic for **BPPV**. #### **Why BPPV is the Correct Answer** * **Mechanism:** It is caused by **canalolithiasis** (displaced otoconia, usually from the utricle into the **posterior semicircular canal**). * **Key Features:** Vertigo is **positional**, lasts for **seconds to minutes**, and is associated with autonomic symptoms like nausea/vomiting. * **Absence of "Red Flags":** The lack of hearing loss, tinnitus, or recent viral prodrome helps differentiate it from other vestibular disorders. #### **Why Other Options are Incorrect** * **Vestibular Neuritis:** Presents as a **prolonged, single episode** of severe vertigo (lasting days) often following a **viral upper respiratory infection**. It is not transiently triggered by head movement. * **Acoustic Neuroma:** A slow-growing tumor of the CN VIII. It typically presents with **progressive unilateral sensorineural hearing loss (SNHL)** and tinnitus rather than acute positional vertigo. * **Meniere Disease:** Characterized by a triad of **episodic vertigo (lasting 20 mins to hours)**, fluctuating SNHL, and **tinnitus/aural fullness**. #### **High-Yield Clinical Pearls for INI-CET** * **Gold Standard Diagnosis:** **Dix-Hallpike Maneuver** (look for geotropic, rotatory nystagmus with latency and fatigability). * **Treatment of Choice:** **Epley Maneuver** (Canalith Repositioning Procedure). * **Most Common Canal Involved:** **Posterior Semicircular Canal** (90% of cases). * **Nystagmus Characteristics:** In BPPV, the nystagmus is **paroxysmal** (starts after a few seconds) and **fatigable** (decreases with repeated testing).

Q: Acute hemorrhagic conjunctivitis is caused by which of the following combinations?

Coxsackie A and Enterovirus 70. ### **Explanation: Acute Hemorrhagic Conjunctivitis (AHC)** **Acute Hemorrhagic Conjunctivitis (AHC)** is a highly contagious, self-limiting viral infection characterized by rapid onset, lid edema, and pathognomonic **subconjunctival hemorrhages**. #### **1. Why Option A is Correct** The primary etiological agents for AHC are **Enterovirus 70 (EV-70)** and **Coxsackievirus A24 (CA24)** variant. These are small RNA viruses belonging to the *Picornaviridae* family. * **Enterovirus 70** was the first identified cause during the 1969 pandemic. * **Coxsackie A24** is responsible for several subsequent large-scale outbreaks worldwide. #### **2. Why Other Options are Incorrect** * **Options B, C, and D:** These include **Coxsackie B**. While Coxsackievirus B is a common cause of myocarditis, pleurodynia (Bornholm disease), and meningitis, it is **not** a recognized cause of acute hemorrhagic conjunctivitis. The ocular tropism is specific to the **A24 variant** of Coxsackie A. --- ### **High-Yield Clinical Pearls for NEET-PG / INI-CET** * **Incubation Period:** Extremely short, typically **12 to 48 hours**. * **Clinical Hallmark:** Multiple **petechial hemorrhages** on the bulbar conjunctiva that may coalesce to form a large subconjunctival hemorrhage. * **Neurological Association:** A rare but serious complication of **Enterovirus 70** is a **polio-like paralysis** (radiculomyelitis), which can occur several weeks after the conjunctivitis resolves. * **Differential Diagnosis:** * **Epidemic Keratoconjunctivitis (EKC):** Caused by **Adenovirus (Serotypes 8, 19, 37)**. It presents with prominent pseudomembranes and corneal involvement (subepithelial infiltrates) but less frequent hemorrhage compared to AHC. * **Management:** Supportive treatment only (cold compresses, lubricants); antibiotics are used only to prevent secondary bacterial infection.

Q: A 7-year-old child with a history of ear infection is complaining of lockjaw and limb spasm/fever/neck rigidity. Choose the most appropriate diagnosis:

Tetanus. ***Tetanus*** - The striking combination of **lockjaw (trismus)** and generalized **limb spasms** is the hallmark clinical presentation of **Tetanus**, caused by the neurotoxin from *Clostridium tetani*. - The presence of **fever** and **neck rigidity** alongside an antecedent **ear infection** (potential portal of entry) strongly supports this diagnosis. - Tetanus causes sustained muscle contractions due to the inhibition of inhibitory neurons, leading to characteristic trismus, risus sardonicus, and opisthotonus. - Note: This is distinct from metabolic **tetany** (hypocalcemia), which causes carpopedal spasm without fever or lockjaw. *Incorrect: Meningitis* - While meningitis causes **fever** and **neck rigidity** (nuchal rigidity), it does not typically present with severe **lockjaw (trismus)** or sustained generalized **muscle spasms**. - Meningitis usually presents with headache, photophobia, altered consciousness, and positive Kernig's/Brudzinski's signs. *Incorrect: Bezold abscess* - A Bezold abscess is a deep neck abscess complicating mastoiditis, causing localized symptoms like neck pain, swelling, and **torticollis** (fixed head tilt). - It does not cause neuromuscular hyperexcitability resulting in **lockjaw** and widespread **limb spasms**. *Incorrect: Sinus thrombosis* - Lateral sinus thrombosis is a complication of otitis media presenting with **picket-fence fever**, headache, and signs of raised intracranial pressure. - It does not cause the characteristic muscle spasms and lockjaw seen in this presentation.

Question 1

In a given population:
- less than 15 years: 6000
- 15 to 64 years: 12000
- 65 years and above: 2000

Calculate the dependency ratio.

Accepted Answer

66 %

Answer

50 %

Answer

75 %

Answer

33 %

Question 2

In a study done in a hospital, patients were categorized into three groups based on disease prevalence (Low, Medium, High), and individuals were then randomly selected from each group. What type of sampling is this?

Accepted Answer

Stratified random sampling

Answer

Systematic random sampling

Answer

Cluster random sampling

Answer

Simple random sampling

Question 3

Which of the following diagnoses can cause stridor in infants?

1. Laryngomalacia
2. Congenital hemangioma
3. Subglottic stenosis
4. Recurrent respiratory papillomatosis (RRP)

Accepted Answer

1, 3 and 4

Answer

1 and 3

Answer

2 and 3

Answer

1 and 4

Question 4

Choose the most appropriate candidates for cochlear implants:
1. Ototoxicity
2. Congenital hearing loss
3. Ossicular fixation
4. Otosclerosis

Accepted Answer

1 and 2

Answer

3 and 4

Answer

2 and 3

Answer

1 and 4

Question 5

A 50-year-old female complains of an episode of acute vertigo with vomiting and unsteadiness and light-headedness, which was triggered by changing her head position in the morning. She denied hearing loss, recent viral illness, medication use, head injury, or trauma. Choose the most appropriate diagnosis:

Accepted Answer

BPPV

Answer

Vestibular neuritis

Answer

Acoustic neuroma

Answer

Meniere disease

Question 6

Which of the following is incorrect regarding Juvenile Nasopharyngeal Angiofibroma (JNA)?

Accepted Answer

Unilateral cervical lymph nodes are a common feature

Answer

Biopsy is contraindicated

Answer

Epistaxis is the most common presenting symptom

Answer

Only seen in young boys

Question 7

Acute hemorrhagic conjunctivitis is caused by which of the following combinations?

Accepted Answer

Coxsackie A and Enterovirus 70

Answer

Coxsackie B and Enterovirus 70

Answer

Coxsackie A, Coxsackie B and Enterovirus 70

Answer

Coxsackie A and Coxsackie B

Question 8

Which of the following is seen in proliferative diabetic retinopathy?

Accepted Answer

Tractional retinal detachment

Answer

No retinal detachment

Answer

Exudative retinal detachment

Answer

Rhegmatogenous retinal detachment

Question 9

Following a fungal corneal ulcer, a farmer underwent corneal transplant surgery. What is the preservative used for storing the donor corneal graft and the suture material used in the procedure?

Accepted Answer

McCarey-Kaufman, Nylon

Answer

Polyethylene glycol, Nylon

Answer

Moist chamber, Vicryl

Answer

Ethanol, Silk

Question 10

A 7-year-old child with a history of ear infection is complaining of lockjaw and limb spasm/fever/neck rigidity. Choose the most appropriate diagnosis:

Accepted Answer

Tetanus

Answer

Meningitis

Answer

Bezold abscess

Answer

Sinus thrombosis

INI-CET 2025

Community Medicine

ENT

Microbiology

Ophthalmology

Pediatrics