INI-CET 2026 Practice Questions

Q: A 16-year-old rape survivor presents at 16 weeks of pregnancy. All of the following are responsibilities of the examining doctor EXCEPT:

Parents' consent for medicolegal examination. ***Parents' consent for medicolegal examination*** - In cases involving sexual assault, a minor's own **consent** is sufficient for medical examination and treatment, and parental consent is **not mandatory** for such procedures. - Requiring parental consent can create a barrier to seeking timely medical and legal assistance in sensitive **medicolegal cases**. *Fetal tissues for DNA to be preserved* - In a pregnancy resulting from a sexual assault, preserving **fetal tissues** or products of conception is essential for **DNA profiling** to establish paternity. - This evidence is critical for legal proceedings in the **criminal case** against the perpetrator. *Inform the police* - Documentation and reporting to law enforcement authorities are mandatory in all cases of **sexual assault** as it is a serious cognizable offense. - The doctor has a legal obligation to assist in the **investigation** and collect forensic evidence according to established protocols. *MTP if needed can be conducted by one doctor's opinion* - Under the **MTP (Medical Termination of Pregnancy) Act**, for pregnancies up to 20 weeks, the opinion of only **one registered medical practitioner** is required. - Since the patient is at 16 weeks, the requirement is fulfilled by a single doctor's advice, making the procedure legally permissible.

Q: The injury shown in the image is best described as:

Laceration. ***Laceration*** - A **laceration** is a tearing of the skin and underlying tissues caused by a **blunt force impact** or shearing force, typically showing **irregular, jagged edges** and **tissue bridging** within the wound. - Key differentiating features include the presence of **tissue bridging** (nerve fibers, blood vessels, and connective tissue crossing the wound depth) and abrasions or bruising at the wound margins, which distinguish it from incised or stab wounds. *Contusion* - A **contusion** (bruise) is caused by blunt trauma that damages blood vessels without breaking the skin surface, presenting as a **discoloration** (ecchymosis) of the skin rather than a wound opening. - Unlike a laceration, there is **no breach in the continuity of the skin**, making it a closed injury rather than an open wound. *Stab injury* - A **stab injury** is a sharp force injury where the depth of the wound is greater than its length on the skin surface, typically showing **clean-cut margins**. - Crucially, stab wounds **lack tissue bridging** and marginal abrasion, which are hallmarks of a laceration. *Bomb blast* - A **bomb blast injury** is a complex injury resulting from **primary blast waves** (barotrauma), secondary fragments, or tertiary displacement, often presenting as a combination of **lacerations**, abrasions, and deep tissue damage. - While it may involve lacerations, the term itself refers to the **mechanism of injury** rather than the morphological description of the wound, which is specifically identified by its physical characteristics in this context.

Q: Regarding ESBL-producing organisms and their treatment, which of the following statements are correct? 1. 1st generation cephalosporins such as Cefazolin retain activity against ESBL producers, unlike 3rd generation 2. Carbapenems have proven clinical efficacy against ESBL-producing organisms 3. The beta-lactamase enzyme responsible for ESBL resistance is encoded on transferable plasmids 4. Piperacillin-Tazobactam is a reliable and effective alternative to Carbapenems

2, 3 and 4 only. ***2, 3 and 4 only*** - Carbapenems are the **drug of choice** for serious **Extended-Spectrum Beta-Lactamase (ESBL)** infections, as they are highly stable against hydrolysis by these beta-lactamases. - The resistance genes for ESBL are located on **plasmids**, allowing for rapid **horizontal gene transfer** between bacterial species, contributing to their widespread dissemination. - While the landmark MERINO trial showed higher mortality with **Piperacillin-Tazobactam** compared to meropenem for *E. coli* or *Klebsiella* bloodstream infections, it is still considered a potentially effective, **carbapenem-sparing alternative** in specific clinical scenarios (especially non-bloodstream infections or if the isolate is susceptible at a high inoculum). *1, 2 and 4 only* - 1st generation cephalosporins like **Cefazolin** are typically hydrolyzed by ESBLs and are not considered effective for treating invasive ESBL-producing infections. - This option incorrectly includes the assertion regarding 1st generation cephalosporins, which contradicts standard susceptibility patterns for ESBL-producing organisms. *1, 2 and 3 only* - Statement 4 is generally accepted as a valid, though nuanced, consideration in modern antibiotic stewardship programs (carbapenem-sparing strategies). - This option excludes Piperacillin-Tazobactam, which is increasingly utilized as a viable alternative for confirmed susceptible isolates, whereas statement 1 is factually incorrect regarding ESBL activity. *1, 2, 3 and 4 all* - Statement 1 is incorrect because **1st generation cephalosporins** (like Cefazolin) are poor choices for ESBL-producing organisms as they are readily hydrolyzed by the ESBL enzymes and are clinically ineffective. - Because Statement 1 is false, any option set including it must be incorrect.

Q: Match the following antibiotic with its most commonly associated organism: 1. Streptomycin a. Streptococcal pharyngitis 2. Amoxicillin b. H. pylori 3. Doxycycline c. Mycobacterium tuberculosis 4. Clarithromycin d. Chlamydia trachomatis

1-c, 2-a, 3-d, 4-b. ***1-c, 2-a, 3-d, 4-b*** - **Streptomycin** is a classic second-line agent used specifically for the treatment of **Mycobacterium tuberculosis**. - **Amoxicillin** is a first-line penicillin antibiotic frequently used to treat **Streptococcal pharyngitis** caused by Group A Streptococcus. - **Doxycycline** is the preferred treatment for **Chlamydia trachomatis** infections, an obligate intracellular bacteria. - **Clarithromycin** is a key component in the triple therapy regimen used to eradicate **H. pylori** in peptic ulcer disease. *1-c, 2-b, 3-d, 4-a* - While correctly matching **Streptomycin** and **Doxycycline**, it incorrectly assigns **Amoxicillin** to **H. pylori** (which requires a specific macrolide or nitroimidazole combination) and **Clarithromycin** to **Streptococcal pharyngitis**. - **Clarithromycin** is not the standard first-line treatment for uncomplicated **pharyngitis** unless the patient has a severe penicillin allergy. *1-a, 2-c, 3-b, 4-d* - This pairing is incorrect as **Streptomycin** is essential for **Mycobacterial** infections, not **Streptococcal pharyngitis**. - **Doxycycline** is not indicated for **H. pylori**, and **Amoxicillin** is not the drug of choice for **Mycobacterium tuberculosis**. *1-d, 2-a, 3-c, 4-b* - This option incorrectly lists **Streptomycin** as the treatment for **Chlamydia**, while it is primarily an anti-tuberculosis agent. - It also suggests **Doxycycline** treats **Mycobacterium tuberculosis**, which is not clinically standard for TB therapy.

Q: Which of the following is correctly matched (Anti-aging compound - Molecular pathway)?

Metformin - AMPK pathway. ***Metformin - AMPK pathway*** - **Metformin** is a well-studied geroprotector that functions primarily by activating **AMP-activated protein kinase (AMPK)**. - Activation of the **AMPK pathway** mimics the metabolic state of caloric restriction, leading to improved cellular energy homeostasis and insulin sensitivity. *Resveratrol - mTOR inhibition* - **Resveratrol** is primarily known as a **SIRT1 activator**, rather than a direct inhibitor of the **mTOR pathway**. - While it may indirectly influence downstream signaling, its primary recognized mechanism in the context of anti-aging is the modulation of **sirtuins**. *Caloric restriction - Sirtuin (SIRT-1)* - While **caloric restriction** does activate **SIRT1**, the provided pairing is often considered contextually ambiguous or broader in literature compared to the direct pharmacological pathway linkage of metformin and AMPK. - In many standardized formats, this is sometimes presented as a distractor based on the specific primary molecular targets being tested; however, the metformin-AMPK link is the most definitive primary mechanism of action in pharmacology curricula. *Rapamycin - IGF-1/Insulin pathway* - **Rapamycin** acts specifically as a potent inhibitor of the **mTOR complex 1 (mTORC1)**. - While mTOR signaling is downstream of the **IGF-1/Insulin pathway**, characterizing Rapamycin as an IGF-1/Insulin pathway modulator is inaccurate; it is fundamentally an **mTOR inhibitor**.

Q: All the following are ligand-gated ion channels EXCEPT:

H2 receptor. ***H2 receptor*** - The **H2 receptor** is a classic example of a **G-protein coupled receptor (GPCR)**, specifically linked via **Gs protein** to adenylate cyclase, not a ligand-gated ion channel. - It mediates gastric acid secretion through the activation of **cAMP** secondary messenger pathways rather than direct ion flux. *5-HT3 receptor* - The **5-HT3 receptor** is a unique serotonin receptor that functions as a **ligand-gated ion channel** (ionotropic). - It is permeable to cations like **Na+**, **K+**, and **Ca2+**, leading to rapid depolarization. *GABA-A receptor* - The **GABA-A receptor** is a well-known **ligand-gated ion channel** that allows the influx of **chloride ions** (Cl-). - Upon binding GABA, it induces an **inhibitory postsynaptic potential (IPSP)**, leading to neuronal hyperpolarization. *Nicotinic receptor* - The **nicotinic acetylcholine receptor (nAChR)** is the prototypical ligand-gated ion channel found at the **neuromuscular junction**. - It opens a non-selective cation channel upon the binding of **acetylcholine**, triggering muscle fiber depolarization.

Q: A wound swab reveals gram-positive cocci in clusters, catalase-positive, sensitive to Cefoxitin and Oxacillin. What is the drug of choice?

Cloxacillin. ***Cloxacillin*** - The organism identified is a **Methicillin-Sensitive Staphylococcus aureus (MSSA)**, as indicated by the **positive sensitivity to Cefoxitin and Oxacillin**, which are used to test for methicillin resistance. - **Cloxacillin** (or other penicillinase-resistant penicillins like Nafcillin or Oxacillin) is the drug of choice for MSSA due to superior efficacy compared to broader-spectrum alternatives. *Ceftriaxone* - This is a **third-generation cephalosporin** that lacks robust activity against MSSA compared to anti-staphylococcal penicillins. - It is not the preferred agent for **staphylococcal infections** unless there is a specific contraindication to penicillins or in specialized clinical contexts. *Vancomycin* - This drug is indicated as the first-line treatment for **Methicillin-Resistant Staphylococcus aureus (MRSA)**. - It has a slower bactericidal effect compared to **beta-lactams** and is reserved for cases of penicillin allergy or resistant strains. *Amoxicillin/Clavulanate* - While this combination is effective against many beta-lactamase-producing bacteria, it is not the gold-standard treatment for **severe S. aureus infections**. - It is typically utilized for polymicrobial infections or oral step-down therapy rather than preferred IV treatment for MSSA.

Q: Which of the following drug-receptor target pairings are correctly matched? 1. Trastuzumab - HER2 receptor 2. Sunitinib - HER1 (EGFR) 3. Gefitinib - HER1 (EGFR)

1 and 3 are correct. ***1 and 3 are correct*** - **Trastuzumab** is a monoclonal antibody specifically designed to bind to the extracellular domain of the **HER2 receptor** (human epidermal growth factor receptor 2), inhibiting downstream signaling in HER2-positive cancers such as breast cancer. - **Gefitinib** is a tyrosine kinase inhibitor that specifically targets the intracellular domain of **HER1 (EGFR)**, making it effective in non-small cell lung cancer with specific EGFR mutations. *Only 1 is correct* - This option is incorrect because it fails to acknowledge that **Gefitinib** is also a correctly matched pair for **HER1 (EGFR)** inhibition. - It overlooks the significant role of tyrosine kinase inhibitors in modern targeted oncology therapies. *2 and 3 are correct* - This is incorrect because **Sunitinib** does not target **HER1 (EGFR)**; rather, it is a multi-targeted receptor tyrosine kinase inhibitor predominantly targeting **VEGFR** (vascular endothelial growth factor receptor) and **PDGFR** (platelet-derived growth factor receptor). - Its primary clinical indication is for renal cell carcinoma and gastrointestinal stromal tumors, differing mechanistically from EGFR-targeted therapies. *All are correct* - This option is incorrect because the inclusion of **Sunitinib** as a **HER1 (EGFR)** inhibitor is pharmacologically inaccurate. - Sunitinib is an anti-angiogenic agent targeting growth factor receptors related to vascular proliferation rather than the EGFR family.

Q: A novel anti-aging compound induces autophagy by inhibiting EP300 histone acetyltransferase, leading to deacetylation of autophagy-related proteins. Which known anti-aging agent works by the same mechanism?

Spermidine. ***Spermidine*** - Spermidine is a naturally occurring polyamine that functions as an **epigenetic modulator** by inhibiting **EP300 histone acetyltransferase**. - This inhibition leads to the **deacetylation** of autophagy-related proteins, which effectively **induces autophagy** and promotes cellular longevity. *Rapamycin* - Rapamycin acts by inhibiting the **mechanistic target of rapamycin (mTOR)** pathway, a highly conserved nutrient-sensing kinase. - Its primary mode of action on autophagy is through the inhibition of mTORC1 rather than modulating histone acetylation. *Metformin* - Metformin exerts its effects primarily by activating **AMP-activated protein kinase (AMPK)**, which regulates cellular metabolism and energy homeostasis. - While it can indirectly upregulate autophagy, it does not function by inhibiting histone acetyltransferases like EP300. *Resveratrol* - Resveratrol functions primarily as an activator of **Sirtuin 1 (SIRT1)**, an NAD+-dependent protein deacetylase. - It promotes longevity through the activation of deacetylases, distinct from the direct inhibition of acetyltransferase activity found with spermidine.

Question 1

A 16-year-old rape survivor presents at 16 weeks of pregnancy. All of the following are
responsibilities of the examining doctor EXCEPT:

Accepted Answer

Parents' consent for medicolegal examination

Answer

Fetal tissues for DNA to be preserved

Answer

Inform the police

Answer

MTP if needed can be conducted by one doctor's opinion

Question 2

The injury shown in the image is best described as:

Accepted Answer

Laceration

Answer

Contusion

Answer

Stab injury

Answer

Bomb blast

Question 3

Regarding ESBL-producing organisms and their treatment, which of the following statements
are correct?
1. 1st generation cephalosporins such as Cefazolin retain activity against ESBL producers, unlike
3rd generation
2. Carbapenems have proven clinical efficacy against ESBL-producing organisms
3. The beta-lactamase enzyme responsible for ESBL resistance is encoded on transferable
plasmids
4. Piperacillin-Tazobactam is a reliable and effective alternative to Carbapenems

Accepted Answer

2, 3 and 4 only

Answer

1, 2 and 4 only

Answer

1, 2 and 3 only

Answer

1, 2, 3 and 4 all

Question 4

Which of the following statements is correct regarding Ticagrelor?

Accepted Answer

It exerts its antiplatelet effect by directly blocking the P2Y12 ADP receptor

Answer

It is associated with reduced risk of intracranial bleeding compared to Clopidogrel

Answer

It requires hepatic enzymatic activation to produce its active metabolite

Answer

Its antiplatelet action is irreversible and persists until new platelets are formed

Question 5

Match the following antibiotic with its most commonly associated organism:

1. Streptomycin a. Streptococcal pharyngitis

2. Amoxicillin b. H. pylori

3. Doxycycline c. Mycobacterium tuberculosis

4. Clarithromycin d. Chlamydia trachomatis

Accepted Answer

1-c, 2-a, 3-d, 4-b

Answer

1-c, 2-b, 3-d, 4-a

Answer

1-a, 2-c, 3-b, 4-d

Answer

1-d, 2-a, 3-c, 4-b

Question 6

Which of the following is correctly matched (Anti-aging compound - Molecular pathway)?

Accepted Answer

Metformin - AMPK pathway

Answer

Resveratrol - mTOR inhibition

Answer

Caloric restriction - Sirtuin (SIRT-1)

Answer

Rapamycin - IGF-1/Insulin pathway

Question 7

All the following are ligand-gated ion channels EXCEPT:

Accepted Answer

H2 receptor

Answer

5-HT3 receptor

Answer

GABA-A receptor

Answer

Nicotinic receptor

Question 8

A wound swab reveals gram-positive cocci in clusters, catalase-positive, sensitive to Cefoxitin
and Oxacillin. What is the drug of choice?

Accepted Answer

Cloxacillin

Answer

Ceftriaxone

Answer

Vancomycin

Answer

Amoxicillin/Clavulanate

Question 9

Which of the following drug-receptor target pairings are correctly matched? 1. Trastuzumab -
HER2 receptor 2. Sunitinib - HER1 (EGFR) 3. Gefitinib - HER1 (EGFR)

Accepted Answer

1 and 3 are correct

Answer

Only 1 is correct

Answer

2 and 3 are correct

Answer

All are correct

Question 10

A novel anti-aging compound induces autophagy by inhibiting EP300 histone acetyltransferase,
leading to deacetylation of autophagy-related proteins. Which known anti-aging agent works by the
same mechanism?

Accepted Answer

Spermidine

Answer

Rapamycin

Answer

Metformin

Answer

Resveratrol

INI-CET 2026

Forensic Medicine

Pharmacology