INI-CET 2025 Practice Questions

Q: 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

1,3. ***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.

Q: 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?

Neostigmine. ### **Explanation** The correct answer is **B. Neostigmine**. #### **Mechanism of Action** **Vecuronium** is a **non-depolarizing neuromuscular blocking agent (NDMR)** that works by competitively inhibiting nicotinic acetylcholine receptors at the neuromuscular junction. To reverse its effects, we must increase the concentration of acetylcholine (ACh) at the synapse. **Neostigmine** is an **acetylcholinesterase inhibitor**. By inhibiting the enzyme that breaks down ACh, it increases the availability of ACh, which then outcompetes the vecuronium molecules for the receptor sites, thereby restoring muscle power. #### **Analysis of Incorrect Options** * **A. Baclofen:** This is a **GABA-B agonist** used as a centrally acting muscle relaxant for chronic spasticity (e.g., multiple sclerosis). it has no role in reversing surgical neuromuscular blockade. * **C. Atropine:** This is an **anticholinergic (muscarinic antagonist)**. While it is almost always given *alongside* neostigmine to prevent bradycardia and secretions caused by increased ACh at muscarinic sites, it does not reverse the muscle relaxant effect itself. * **D. Drotaverine:** This is an **antispasmodic** (phosphodiesterase-4 inhibitor) used primarily for smooth muscle relaxation in cases of biliary or renal colic. #### **High-Yield Clinical Pearls for INI-CET** * **The "Gold Standard" Pair:** Neostigmine is co-administered with **Glycopyrrolate** (preferred over Atropine) to counteract the parasympathetic side effects (bradycardia, salivation, bronchospasm). * **Sugammadex:** A newer, high-yield reversal agent specifically for **Rocuronium** and **Vecuronium**. It works by **encapsulation** (chelating the drug) rather than enzyme inhibition. * **Monitoring:** Reversal should ideally be guided by **Train-of-Four (TOF)** monitoring; a TOF ratio of **>0.9** indicates adequate recovery from blockade.

Q: 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, b, c. ***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.

Q: 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?

IV Steroids + cyclophosphamide. ***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.

Q: Which of the following is not used in the treatment of postpartum hemorrhage (PPH)?

Dinoprostone. ***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**.

Q: 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?

Osteosarcoma. ***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.

Q: 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?

Gastroesophageal reflux disease (GERD). ***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.

Q: 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)?

Infundibular pulmonary stenosis. ***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.

Q: Sodium thiopentone is regarded as an ultrashort-acting drug due to

Rapid redistribution. ***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.

Q: Which of the following psychoactive substances is a new, rapidly acting antidepressant?

Ketamine. ***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**.

Question 1

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

Accepted Answer

1,3

Answer

3,4

Answer

1,2

Answer

2,3

Question 2

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?

Accepted Answer

Neostigmine

Answer

Baclofen

Answer

Atropine

Answer

Drotaverine

Question 3

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

Accepted Answer

a, b, c

Answer

a, b, d

Answer

a, c, d

Answer

b, c, d

Question 4

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?

Accepted Answer

IV Steroids + cyclophosphamide

Answer

Mycophenolate mofetil

Answer

Cyclophosphamide only

Answer

IV Steroids only

Question 5

Which of the following is not used in the treatment of postpartum hemorrhage (PPH)?

Accepted Answer

Dinoprostone

Answer

Misoprostol

Answer

Carboprost

Answer

Oxytocin

Question 6

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?

Accepted Answer

Osteosarcoma

Answer

Ewing sarcoma

Answer

Giant cell tumour

Answer

Chondrosarcoma

Question 7

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?

Accepted Answer

Gastroesophageal reflux disease (GERD)

Answer

Cow Milk Protein Allergy

Answer

Intestinal obstruction

Answer

Pyloric stenosis

Question 8

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)?

Accepted Answer

Infundibular pulmonary stenosis

Answer

Inter atrial septal defect

Answer

Left ventricular hypertrophy (LVH)

Answer

Transposition of the great arteries (TGA)

Question 9

Sodium thiopentone is regarded as an ultrashort-acting drug due to

Accepted Answer

Rapid redistribution

Answer

Short elimination half-life

Answer

Metabolism

Answer

Excretion

Question 10

Which of the following psychoactive substances is a new, rapidly acting antidepressant?

Accepted Answer

Ketamine

Answer

Bupropion

Answer

Haloperidol

Answer

Cannabinoids

INI-CET 2025

Anatomy

Anesthesiology

Dermatology

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pediatrics

Pharmacology