INI-CET 2025 Practice Questions

Q: A male patient presents with chronic diarrhea for 8 months. CT shows ahaustral appearance of the right colon. What is the most likely diagnosis?

Crohns disease. ***Crohns disease*** - Crohn's disease is characterized by **transmural inflammation**, which can lead to fibrosis and rigidity of the bowel wall, resulting in an ahaustral appearance. Its predilection for the **ileocecal region** makes right-sided colon involvement a classic presentation. - The disease course is chronic with relapsing and remitting symptoms like non-bloody diarrhea and abdominal pain. It is also known for its **skip lesions**, where inflamed segments of the bowel are interspersed with normal tissue. ***Ulcerative colitis*** - While chronic ulcerative colitis can cause an ahaustral or "**lead pipe**" colon, it classically starts in the **rectum** and extends proximally in a continuous manner. Isolated right colon involvement is very rare. - Inflammation in UC is limited to the **mucosa and submucosa**, unlike the transmural inflammation seen in Crohn's disease. ***Tubercular colitis*** - Intestinal tuberculosis commonly affects the **ileocecal region**, mimicking Crohn's disease clinically and radiologically. It can cause bowel wall thickening and strictures. - Differentiating features include the presence of **caseating granulomas** on histology, constitutional symptoms like fever and night sweats, and often a gaping ileocecal valve (**Fleischner sign**). ***Pseudomembranous enterocolitis*** - This is an **acute inflammatory condition** caused by *Clostridium difficile* toxins, usually following antibiotic therapy. It does not present as a chronic illness lasting for months. - Typical CT findings are acute, such as severe colonic wall thickening and edema (the "**accordion sign**"), not the chronic fibrotic changes that lead to an ahaustral appearance.

Q: Which of the following is not an ICD-10 diagnostic criterion for depression?

Persistent worry about everyday matters. ### Explanation The diagnosis of a **Depressive Episode** according to **ICD-10** is based on a specific cluster of symptoms. The criteria are divided into **Typical (Core)** symptoms and **Other common** symptoms. #### Why Option D is Correct **Persistent worry about everyday matters** is the hallmark feature of **Generalized Anxiety Disorder (GAD)**, not Depression. While anxiety often co-exists with depression (comorbidity), it is not a diagnostic criterion for a depressive episode under ICD-10. #### Why Other Options are Incorrect Options A, B, and C represent the **three core (typical) symptoms** of depression in ICD-10. For a diagnosis, at least two of these must be present for a minimum of **2 weeks**: * **Low mood (Depressed mood):** To a degree that is definitely abnormal for the individual, present for most of the day and almost every day. * **Loss of interest or pleasure (Anhedonia):** In activities that are normally enjoyable. * **Low energy (Fatigability):** Increased fatigability or marked decrease in activity. #### High-Yield Clinical Pearls for NEET-PG/INI-CET * **ICD-10 Classification:** Depression is coded under **F32** (Depressive episode) and **F33** (Recurrent depressive disorder). * **Somatic Syndrome:** ICD-10 allows for a "somatic" specifier if symptoms like early morning awakening (2 hours early), diurnal variation (worse in morning), and psychomotor retardation are present. * **Severity Grading:** * **Mild:** 2 core + 2 others. * **Moderate:** 2 core + 3–4 others. * **Severe:** 3 core + $\geq$ 4 others. * **DSM-5 Difference:** Unlike ICD-10, **DSM-5** requires 5 out of 9 symptoms (must include either depressed mood or anhedonia) and does not list "low energy" as a separate core category in the same way.

Q: Eye of the tiger appearance on MRI is associated with:

Pantothenate kinase-associated degeneration. ***Pantothenate kinase-associated degeneration*** - The "eye of the tiger" sign is pathognomonic for **Pantothenate kinase-associated neurodegeneration (PKAN)**, a form of Neurodegeneration with Brain Iron Accumulation (NBIA). - It appears as a central area of high signal intensity (oedema/gliosis) surrounded by a rim of low signal intensity (iron deposition) in the **globus pallidus** on T2-weighted MRI. ***Wilson disease*** - Characterized by **copper deposition** in the liver, brain (e.g., basal ganglia, thalamus), and cornea (**Kayser-Fleischer rings**). - MRI findings typically show increased T2 signal intensity in the putamen, midbrain, and basal ganglia, but do not produce the classic "eye of the tiger" sign. ***Krabbe disease*** - This is a lysosomal storage disease (leukodystrophy) caused by a deficiency of the enzyme **galactocerebrosidase**. - MRI typically shows extensive white matter abnormalities and atrophy, but it is not associated with the **globus pallidus** changes seen in the "eye of the tiger" sign. ***Huntington chorea*** - A progressive brain disorder characterized by prominent atrophy of the **caudate nucleus** and putamen (striatum). - MRI primarily demonstrates severe **caudate atrophy** and is not associated with the characteristic PKAN finding in the globus pallidus.

Q: Honda or H sign on STIR MRI is characteristic of which condition?

Sacral insufficiency fracture. ***Sacral insufficiency fracture*** - The **Honda sign** (also known as the H sign or butterfly sign) is a characteristic finding on **STIR MRI** of the sacrum, particularly suggestive of a **sacral insufficiency fracture** caused by chronic microtrauma in osteoporotic bone. - It represents bilateral vertical fracture lines through the sacral alae connected by a horizontal fracture line through the body of S3 (or S2/S4), showing **medullary edema**/fracture line hyperintensity on STIR sequences. ***Multiple myeloma*** - Myeloma typically presents on MRI as multiple **focal lesions** (plasmacytomas) or diffuse marrow infiltration, often showing low signal intensity on T1 and variable T2/STIR signals. - While sacral involvement is possible, the classic H sign or Honda sign is not a typical presentation; rather, it often shows **lytic lesions** on plain films/CT. ***Acute osteomyelitis*** - Acute osteomyelitis of the sacrum would show localized **marrow edema** with corresponding T1 hypointensity and contrast-enhancing soft tissue/periosteal reaction. - It is usually unilateral and focal, lacking the characteristic H pattern of stress or insufficiency fractures. ***Bone marrow edema*** - Bone marrow edema is a generalized finding on STIR, indicating pathology such as trauma, infection, tumor infiltration, or avascular necrosis (AVN). - While the H sign is a type of bone marrow edema pattern, the sign itself is specific to a **sacral insufficiency fracture**, not a general edema observation.

Q: Identify the investigation modality shown in the image.

X-ray defecogram. ***X-ray defecogram*** - This is a dynamic fluoroscopic study, also known as **evacuation proctography**, which visualizes the rectum and anal canal during the act of defecation. - The images show contrast material within the rectum and its expulsion, allowing for the assessment of anorectal angle, pelvic floor descent, and identification of pathologies like **rectocele**, **enterocele**, or **intussusception**. *Barium swallow* - A barium swallow is a radiographic study used to examine the **upper gastrointestinal tract**, specifically the pharynx, esophagus, and stomach. - The image clearly depicts the pelvic anatomy and rectum, not the upper GI tract. *MR defecogram* - While also a dynamic study of defecation, an MR defecogram utilizes **magnetic resonance imaging (MRI)**, which provides superior soft-tissue contrast and does not use ionizing radiation. - The image shown is a plain radiograph (X-ray), which has a different appearance compared to an MRI scan. *X-ray barium enema* - A barium enema is used to visualize the anatomy of the **entire large intestine** to detect structural abnormalities like polyps, tumors, or diverticula. - It is typically a static study of the colon's morphology, whereas a defecogram is a functional study focused on the dynamics of evacuation.

Q: Based on the provided X-ray image, identify the type of thyroid malignancy.

Follicular carcinoma. ***Follicular carcinoma*** - This is the **correct answer** based on the X-ray showing bone metastases. - Follicular carcinoma characteristically spreads via **hematogenous (bloodstream) route** to distant sites, particularly **bones and lungs**. - Bone metastases from thyroid cancer are **most commonly** due to follicular carcinoma, presenting as **lytic lesions** on X-ray. - Follicular carcinoma accounts for 10-15% of thyroid cancers but is responsible for the majority of thyroid cancer bone metastases. *Incorrect: Papillary carcinoma* - Although papillary carcinoma is the **most common thyroid malignancy** (80% of cases), it predominantly spreads via **lymphatic route** to regional lymph nodes. - Distant hematogenous metastases to bone are **uncommon** in papillary carcinoma. - When papillary carcinoma does metastasize distantly, lungs are more commonly affected than bones. *Incorrect: Hurthle cell carcinoma* - This is an **aggressive variant of follicular carcinoma** (Hürthle cell or oncocytic variant). - While it can spread hematogenously, it is significantly **rarer** than conventional follicular carcinoma. - It represents only 3-5% of differentiated thyroid cancers. *Incorrect: Thyroid lymphoma* - Primary thyroid lymphoma is a **rare malignancy** typically presenting as a rapidly enlarging neck mass. - Usually occurs in elderly patients with a history of **Hashimoto's thyroiditis**. - Distant bone metastases are **not characteristic** of primary thyroid lymphoma.

Question 1

A male patient presents with chronic diarrhea for 8 months. CT shows ahaustral appearance of the right colon. What is the most likely diagnosis?

Accepted Answer

Crohns disease

Answer

Ulcerative colitis

Answer

Tubercular colitis

Answer

Pseudomembranous enterocolitis

Question 2

Which of the following statements is incorrect?

Accepted Answer

Cannabis use can result in self-driven, repetitive behaviours

Answer

Alcohol in low dose causes brain stimulation and in higher doses, causes brain suppression

Answer

Opioids are very effective analgesics

Answer

Volatile inhalational agents (when abused) are mostly toxic to humans

Question 3

Which of the following is not an ICD-10 diagnostic criterion for depression?

Accepted Answer

Persistent worry about everyday matters

Answer

Low energy levels

Answer

Low mood for most of the day

Answer

Loss of interest in pleasurable things

Question 4

All of the following statements are correct except:

Accepted Answer

Flumazenil is used for the management of long-term alcohol dependence syndrome

Answer

Opioid withdrawal is rarely fatal

Answer

Buprenorphine can be used for the management of opioid withdrawal

Answer

Cannabis withdrawal is associated with minimal physical symptoms

Question 5

A patient with schizophrenia says, "Lord Hanuman was celibate, I am celibate too, so I am Lord Hanuman." Which thought abnormality is present in this patient?

Accepted Answer

Autistic thinking

Answer

Verbigeration

Answer

Neologism

Answer

Loosening of association

Question 6

Which of the following drugs are used in the management of acute mania?

Accepted Answer

1, 2 & 3 (Lithium, Valproate & Haloperidol)

Answer

Only 1 (Lithium)

Answer

1, 2 & 4 (Lithium, Valproate & Amitriptyline)

Answer

2 & 4 (Valproate & Amitriptyline)

Question 7

Eye of the tiger appearance on MRI is associated with:

Accepted Answer

Pantothenate kinase-associated degeneration

Answer

Wilson disease

Answer

Krabbe disease

Answer

Huntington chorea

Question 8

Honda or H sign on STIR MRI is characteristic of which condition?

Accepted Answer

Sacral insufficiency fracture

Answer

Multiple myeloma

Answer

Acute osteomyelitis

Answer

Bone marrow edema

Question 9

Identify the investigation modality shown in the image.

Accepted Answer

X-ray defecogram

Answer

Barium swallow

Answer

MR defecogram

Answer

X-ray barium enema

Question 10

Based on the provided X-ray image, identify the type of thyroid malignancy.

Accepted Answer

Follicular carcinoma

Answer

Papillary carcinoma

Answer

Hurthle cell carcinoma

Answer

Thyroid lymphoma

INI-CET 2025

Internal Medicine

Pharmacology

Psychiatry

Radiology

Surgery