INI-CET 2025 Practice Questions

Q: The dental numbering system shown below represents: R 8 7 6 5 4 3 2 1 | 1 2 3 4 5 6 7 8 (permanent teeth) and R e d c b a | a b c d e (deciduous teeth) for upper and lower quadrants. Which dental numbering system is this?

Palmer's notation. ***Palmer's notation*** - This system, also known as the **Zsigmondy-Palmer notation**, utilizes numerical digits (1-8) for permanent teeth and lower-case letters (a-e) for deciduous teeth within each quadrant. - The defining characteristic shown is the use of a **quadrant symbol (or grid symbols)** to indicate the location relative to the midline and the occlusal plane (e.g., $\text{8}\rfloor$ for upper right third molar). ***Universal system*** - This system uses a continuous sequence of numbers (1-32) for permanent teeth starting from the **Maxillary Right Third Molar (tooth 1)** and proceeding clockwise. - It does not use quadrant diagrams or grid lines; deciduous teeth are designated using capitalized letters A through T. ***FDI formula*** - The FDI system (ISO 3950) is a **two-digit numbering system** where the first digit identifies the quadrant (1-4 for permanent; 5-8 for deciduous) and the second digit identifies the tooth type (1-8). - For example, the upper right central incisor is denoted as **11**, which is different from the single digit representation shown. ***Haderup system*** - This system uses positive (+) or negative (-) signs to indicate the jaw (maxilla/mandible) alongside the tooth number (1-8). - The sign's position relative to the number determines the side of the midline, such as $+1$ indicating the **upper right central incisor**.

Q: One of the following is not seen in a worker exposed to mercury in a thermometer manufacturing company:

Basophilic stippling. ***Basophilic stippling*** - **Basophilic stippling** is a characteristic finding in the peripheral blood smear of patients with **lead poisoning**, caused by the inhibition of pyrimidine 5'-nucleotidase, leading to aggregated RNA. - It is **not associated** with chronic mercury exposure, which primarily affects the neurological and renal systems. - This is the correct answer as basophilic stippling is NOT seen in mercury poisoning. *Tremors and Mad Hatter's disease* - **Tremors** (intention tremor) are a classic sign of chronic inhaled elemental mercury exposure, often leading to a condition historically known as **"Mad Hatter's disease"** (erethism). - **Erethism** is a neuropsychiatric syndrome characterized by irritability, shyness, insomnia, emotional lability, and loss of memory, resulting from mercury's neurotoxicity. - This IS seen in mercury-exposed workers. *Mees' lines* - **Mees' lines** (transverse white bands on the fingernails) are classically associated with **arsenic** and **thallium** poisoning, NOT mercury poisoning. - While the original explanation incorrectly linked this to mercury, Mees' lines are not a typical manifestation of mercury toxicity. - Mercury poisoning causes neurological (tremors, erethism) and renal manifestations, not Mees' lines. - This option is somewhat controversial but traditionally NOT considered a classic sign of mercury poisoning. *Peripheral neuropathy* - Exposure to **organic mercury compounds** (like methylmercury) is known to cause severe neurological damage, including **peripheral neuropathy**, visual field constriction, and hearing impairment. - Chronic high-level exposure to elemental mercury vapor can also lead to neuropathic symptoms. - This IS seen in mercury-exposed workers.

Q: As per Bharatiya Nyaya Sanhita (BNS), which of the following is not classified as grievous hurt?

Severe body pain for 5 days. ### Explanation: Grievous Hurt under BNS Under the **Bharatiya Nyaya Sanhita (BNS)**, the definition of **Grievous Hurt** is provided in **Section 114** (which corresponds to the erstwhile Section 320 of the IPC). The criteria for an injury to be classified as "grievous" are specific and legalistic. #### Why Option B is Correct: **Severe body pain for 5 days** does not meet the legal threshold. According to the **8th clause** of Section 114 BNS, any hurt which endangers life or which causes the sufferer to be in **severe bodily pain** or unable to follow his ordinary pursuits must last for a minimum period of **20 days** to be classified as grievous hurt. Since the duration here is only 5 days, it is classified as **Simple Hurt**. #### Analysis of Incorrect Options: * **A. Emasculation:** This is the **1st clause** of grievous hurt. it refers to the depriving of a male of his masculine vigor (impotency). * **C. Dislocation of elbow:** Under the **6th clause**, any fracture or **dislocation of a bone or tooth** is considered grievous hurt, regardless of the healing time. * **D. Loss of a member:** Under the **3rd clause**, the permanent privation (loss) of any **member or joint** is classified as grievous hurt. --- ### High-Yield Clinical Pearls for INI-CET: * **BNS Section 114:** Replaces IPC 320. The 8 clauses defining grievous hurt remain essentially the same. * **The "20-Day Rule":** This is a frequent exam favorite. If a patient is hospitalized or in pain for **19 days**, it is simple hurt; **20 days or more** makes it grievous. * **Fractures:** Even a small crack in a bone (fissured fracture) or a subluxation of a tooth is **Grievous Hurt**, even if it heals in less than 20 days. * **Permanent Disfiguration:** Permanent scarring of the **face (4th clause)** or **head (5th clause)** is grievous hurt. This is often tested in cases of acid attacks or deep lacerations.

Q: In which of the following poisonings does silver nitrate impregnated filter paper turn black when exposed to gastric lavage contents?

Aluminium phosphide. ***Aluminium phosphide*** - Aluminium phosphide ($AlP$) reacts vigorously with water or gastric acid to release highly toxic **phosphine gas** ($PH_3$). - Phosphine gas is a strong reducing agent that reacts with **silver nitrate ($AgNO_3$)** impregnated paper, reducing it to black **metallic silver ($Ag$)** and thus turning the paper black, a method known as the field test for Celphos. ***Malathion*** - Malathion is an **organophosphate insecticide**, and its poisoning is diagnosed primarily by clinical features of cholinergic crisis (SLUDGE syndrome) and measuring depressed **serum/RBC cholinesterase levels**. - Organophosphates do not release phosphine gas and therefore do not produce a positive reaction with silver nitrate filter paper. ***Barbiturates*** - Barbiturate poisoning is confirmed using tests like the **Dille-Koppanyi test** (for color change) or advanced **chromatographic methods** on blood or urine samples. - The barbiturate structure does not produce a reducing gas like phosphine upon reaction, so the silver nitrate paper test would remain negative. ***Opium*** - Opium poisoning (due to alkaloids like **morphine**) is confirmed by detecting the drug or its metabolites in urine or blood using **immunoassays** or gas/liquid chromatography. - Opium alkaloids are not detected by this specific qualitative test, as it is designed to detect the highly reducing nature of phosphine gas.

Q: The triad of abrasions, bruises and punctate lacerations are typically seen in:

Road traffic accidents. ***Correct: Road traffic accidents*** - This specific combination of injuries—**abrasions** (due to sliding/friction), **bruises** (due to blunt force), and **punctate lacerations** (often caused by glass, debris, or gravel impacts)—is highly characteristic of **Road Traffic Accidents (RTAs)**. - These injuries reflect the simultaneous interplay of both **blunt impact** and **shearing/grinding forces** sustained as the body strikes the vehicle interior or the external road surface. - The **triad** is a classic forensic finding that distinguishes RTAs from other patterns of traumatic injury. *Incorrect: Fall from height* - Injuries from a fall are typically dominated by **high-energy blunt trauma** resulting in internal organ damage and severe skeletal fractures, such as bilateral calcaneal or vertebral fractures. - While abrasions and bruises are present at points of impact, the organized triad including numerous small, **punctate lacerations** is less distinct than in RTAs. *Incorrect: Bomb blast injuries* - Blast injuries are primarily categorized by specific mechanisms: primary (barotrauma), secondary (penetrating injuries from flying fragments), and tertiary (blunt force from body displacement). - The dominant findings are **severe organ damage** (like blast lung) and penetrating injuries; while trauma occurs, the described superficial triad is not the main characteristic pattern. *Incorrect: Firearm injuries* - Forensic examination of firearm injuries focuses on the **entry and exit wounds**, which are typically perforating or penetrating defects. - Characteristic features include the **abrasion collar**, contusion ring, and presence of GSR residue (soot or tattooing), rather than a diffuse superficial triad across multiple body areas.

Q: One of the following statements regarding venom is incorrect:

Elapidae - Myotoxic. ***Elapidae - Myotoxic*** - This statement is **incorrect**. Venom from the **Elapidae** family (e.g., cobras, kraits, mambas) is **predominantly neurotoxic**, affecting the nervous system and causing paralysis. - The primary target of Elapidae venom is the **neuromuscular junction**, leading to respiratory failure, not muscle degeneration (myotoxicity). - While some Elapidae subspecies (certain sea snakes, Australian elapids) may have myotoxic components, the family is **classically characterized as neurotoxic**, especially in the Indian context where cobras and kraits are the main representatives. ***Common cobra - Neurotoxic*** - This statement is **correct**. The venom of the **Common Cobra** (Naja naja), which belongs to the Elapidae family, is highly **neurotoxic**. - It primarily contains long and short-chain neurotoxins that cause rapid, progressive **paralysis** and respiratory failure. ***Common krait - Neurotoxic*** - This statement is **correct**. **Common Krait** (Bungarus caeruleus), also an Elapid, possesses venom that is highly potent and entirely **neurotoxic**. - Krait venom often causes severe, often delayed, **neuromuscular blockade** and paralysis, making it one of the most dangerous snakes in India. ***Viperidae - Hemotoxic*** - This statement is **correct**. Venom from the **Viperidae** family (e.g., Russell's viper, saw-scaled viper) is mainly **hemotoxic** and **cytotoxic**. - It primarily targets the blood and vascular system, causing coagulopathy, massive tissue necrosis, bleeding disorders, and often **disseminated intravascular coagulation (DIC)**.

Q: Carbamazepine and erythromycin were given to a patient, and he presented with ataxia and dizziness. Which of the following is the reason for the symptoms?

Toxicity of carbamazepine. ***Toxicity of carbamazepine*** - Erythromycin is a potent inhibitor of the hepatic **CYP3A4 enzyme**, which is primarily responsible for the metabolism and subsequent clearance of carbamazepine. - Inhibition of carbamazepine metabolism leads to increased plasma concentration, resulting in **CNS side effects** such as **ataxia, dizziness**, nystagmus, and drowsiness. *Toxicity of erythromycin* - Erythromycin toxicity typically presents with **gastrointestinal symptoms** (e.g., nausea, vomiting, diarrhea) or cardiac issues like **QT prolongation**. - The described symptoms, ataxia and dizziness, are classic manifestations of **anticonvulsant toxicity**, not macrolide toxicity. *Erythromycin speeds up carbamazepine metabolism* - This statement is incorrect; erythromycin **inhibits** CYP3A4, thus slowing down carbamazepine metabolism and resulting in drug accumulation. - If metabolism were sped up (i.e., enzyme induction), the patient would likely experience sub-therapeutic carbamazepine levels, increasing the risk of **seizure recurrence**. *Sub-therapeutic carbamazepine levels causing seizures* - Recurrent seizures are caused by **sub-therapeutic levels** of carbamazepine, often due to enzyme induction (e.g., by phenytoin, carbamazepine itself) or non-compliance. - The symptoms of ataxia and dizziness indicate **supratherapeutic levels** (toxicity), which is the opposite of the low levels that cause breakthrough seizures.

Q: Loading dose of an oral drug depends on all of the following except?

Half-life. ***Correct Answer: Half-life*** - **Half-life** primarily determines the **maintenance dose** and **dosing interval**, not the loading dose - The **loading dose (LD)** is calculated to rapidly achieve the desired therapeutic **plasma concentration** using the formula: **LD = (Cp × Vd) / F** - Half-life determines how long it takes to reach steady state (4-5 half-lives) and how frequently maintenance doses should be given - The loading dose bypasses the waiting time by immediately achieving therapeutic levels *Incorrect: Volume of distribution* - **Vd** is a mandatory parameter in the calculation of the loading dose formula - It determines how widely the drug distributes in the body relative to the target plasma concentration - A higher **Vd** necessitates a higher loading dose to saturate tissue binding sites and achieve therapeutic plasma levels quickly *Incorrect: Plasma concentration* - The loading dose is specifically calculated to quickly achieve the desired therapeutic **steady-state plasma concentration (Cp)** - The target concentration (Cp) is central to the loading dose calculation and appears in the numerator of the formula - The goal of the loading dose is to bypass the time required to reach this concentration with maintenance doses alone *Incorrect: Bioavailability* - **Bioavailability (F)** represents the fraction of the administered drug that reaches systemic circulation - It is crucial for oral drugs where absorption may be incomplete due to first-pass metabolism or incomplete absorption - The loading dose formula includes **F** in the denominator (LD = (Cp × Vd) / F) to adjust for incomplete absorption

Question 1

The dental numbering system shown below represents: R 8 7 6 5 4 3 2 1 | 1 2 3 4 5 6 7 8 (permanent teeth) and R e d c b a | a b c d e (deciduous teeth) for upper and lower quadrants. Which dental numbering system is this?

Accepted Answer

Palmer's notation

Answer

FDI formula

Answer

Universal system

Answer

Haderup system

Question 2

One of the following is not seen in a worker exposed to mercury in a thermometer manufacturing company:

Accepted Answer

Basophilic stippling

Answer

Tremors and Mad Hatter's disease

Answer

Peripheral neuropathy

Answer

Mees' lines

Question 3

As per Bharatiya Nyaya Sanhita (BNS), which of the following is not classified as grievous hurt?

Accepted Answer

Severe body pain for 5 days

Answer

Emasculation

Answer

Dislocation of elbow

Answer

Loss of a member

Question 4

In which of the following poisonings does silver nitrate impregnated filter paper turn black when exposed to gastric lavage contents?

Accepted Answer

Aluminium phosphide

Answer

Malathion

Answer

Opium

Answer

Barbiturates

Question 5

The triad of abrasions, bruises and punctate lacerations are typically seen in:

Accepted Answer

Road traffic accidents

Answer

Fall from height

Answer

Firearm injuries

Answer

Bomb blast injuries

Question 6

One of the following statements regarding venom is incorrect:

Accepted Answer

Elapidae - Myotoxic

Answer

Viperidae - Hemotoxic

Answer

Common krait - Neurotoxic

Answer

Common cobra - Neurotoxic

Question 7

Carbamazepine and erythromycin were given to a patient, and he presented with ataxia and dizziness. Which of the following is the reason for the symptoms?

Accepted Answer

Toxicity of carbamazepine

Answer

Toxicity of erythromycin

Answer

Erythromycin speeds up carbamazepine metabolism

Answer

Sub-therapeutic carbamazepine levels causing seizures

Question 8

Loading dose of an oral drug depends on all of the following except?

Accepted Answer

Half-life

Answer

Volume of distribution

Answer

Plasma concentration

Answer

Bioavailability

Question 9

Which among the following psychoactive substances has antidepressant properties?

Accepted Answer

Ketamine

Answer

Cannabidiol

Answer

Mephedrone

Answer

Bupropion

Question 10

A patient has burns involving the face, both upper limbs and front of the chest. What is the percentage of burns involved?

Accepted Answer

30 to 37

Answer

25 to 48

Answer

27 to 30

Answer

38 to 42

INI-CET 2025

Anatomy

Community Medicine

Forensic Medicine

Pharmacology

Psychiatry

Surgery