Internal Medicine
1 questionsA male patient presents with chronic diarrhea for 8 months. CT shows ahaustral appearance of the right colon. What is the most likely diagnosis?
INI-CET 2025 - Internal Medicine INI-CET Practice Questions and MCQs
Question 41: A male patient presents with chronic diarrhea for 8 months. CT shows ahaustral appearance of the right colon. What is the most likely diagnosis?
- A. Ulcerative colitis
- B. Tubercular colitis
- C. Crohns disease (Correct Answer)
- D. Pseudomembranous enterocolitis
Explanation: ***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.
Pharmacology
1 questionsWhich of the following statements is incorrect?
INI-CET 2025 - Pharmacology INI-CET Practice Questions and MCQs
Question 41: Which of the following statements is incorrect?
- A. Alcohol in low dose causes brain stimulation and in higher doses, causes brain suppression
- B. Cannabis use can result in self-driven, repetitive behaviours (Correct Answer)
- C. Opioids are very effective analgesics
- D. Volatile inhalational agents (when abused) are mostly toxic to humans
Explanation: ***Cannabis use can result in self-driven, repetitive behaviours*** - This statement is **incorrect**. Repetitive, purposeless, or **stereotyped behaviors** (**stereotypies**) are typically associated with chronic use or intoxication with **stimulants** (e.g., cocaine, amphetamines/methamphetamine), not cannabis. - Cannabis (THC) primarily acts as a depressant/hallucinogen, often causing symptoms like impaired coordination, anxiety, paranoia, altered time perception, and the **amotivational syndrome**, rather than stimulant-like stereotypies. ***Alcohol in low dose causes brain stimulation and in higher doses, causes brain suppression*** - This statement is **correct**. In low doses, alcohol causes **disinhibition** and euphoria due to selective suppression of inhibitory neurons (apparent stimulation). - In higher doses, alcohol progressively depresses the entire Central Nervous System (CNS), leading to sedation, coma, and **respiratory suppression**. ***Opioids are very effective analgesics*** - This statement is **correct**. Opioids act by agonizing **mu-opioid receptors** in the CNS, spinal cord, and peripheral nerves, causing profound **analgesia**. - They are considered the gold standard for managing severe, acute, and chronic pain, though their use is limited by addiction potential and side effects. ***Volatile inhalational agents are mostly toxic to humans*** - This statement is **correct** for recreational/abused inhalational agents (like toluene, butane, nitrites). - Abuse of these agents can cause severe immediate toxicity (e.g., **sudden sniffing death**) and long-term damage, particularly to the brain (encephalopathy), liver, and kidneys.
Psychiatry
4 questionsWhich of the following is not an ICD-10 diagnostic criterion for depression?
All of the following statements are correct except:
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?
Which of the following drugs are used in the management of acute mania?
INI-CET 2025 - Psychiatry INI-CET Practice Questions and MCQs
Question 41: Which of the following is not an ICD-10 diagnostic criterion for depression?
- A. Low energy levels
- B. Low mood for most of the day
- C. Loss of interest in pleasurable things
- D. Persistent worry about everyday matters (Correct Answer)
Explanation: ### 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.
Question 42: All of the following statements are correct except:
- A. Opioid withdrawal is rarely fatal
- B. Buprenorphine can be used for the management of opioid withdrawal
- C. Flumazenil is used for the management of long-term alcohol dependence syndrome (Correct Answer)
- D. Cannabis withdrawal is associated with minimal physical symptoms
Explanation: ### **Explanation** The correct answer is **C**, as **Flumazenil** is a competitive **GABA-A receptor antagonist** used specifically for the reversal of **Benzodiazepine (BZD) overdose**, not for alcohol dependence. #### **Why Option C is Incorrect (The Concept):** * **Alcohol dependence** is managed using **Disulfiram** (aversion therapy), **Acamprosate** (anticraving), or **Naltrexone** (anticraving). * While both alcohol and BZDs act on GABA receptors, Flumazenil has no role in long-term alcohol sobriety. In fact, using Flumazenil in a patient with combined alcohol/BZD dependence can **precipitate seizures** by lowering the seizure threshold. #### **Analysis of Other Options:** * **Option A:** **Opioid withdrawal** is characterized by intense distress (lacrimation, rhinorrhea, piloerection, diarrhea) but is **rarely fatal** in healthy adults. This distinguishes it from Alcohol or BZD withdrawal, which can cause life-threatening seizures and delirium tremens. * **Option B:** **Buprenorphine** is a **partial mu-opioid agonist**. It is highly effective for detoxification (withdrawal management) and long-term maintenance therapy because of its long half-life and "ceiling effect" on respiratory depression. * **Option C:** **Cannabis withdrawal** is primarily psychological (irritability, insomnia, anxiety). While it includes mild tremors or sweating, it is noted for having **minimal physical symptoms** compared to sedative-hypnotics or opioids. --- ### **High-Yield Clinical Pearls for INI-CET:** * **Drug of Choice (DOC) for Alcohol Withdrawal:** Benzodiazepines (e.g., **Chlordiazepoxide** or **Lorazepam**). * **DOC for Opioid Overdose:** **Naloxone** (Pure opioid antagonist). * **Wernicke’s Encephalopathy Triad:** Confusion, Ataxia, and Ophthalmoplegia (due to Thiamine/B1 deficiency). * **Cannabis:** The most common physical sign of acute intoxication is **Conjunctival injection** (red eyes) and tachycardia.
Question 43: 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?
- A. Autistic thinking (Correct Answer)
- B. Verbigeration
- C. Neologism
- D. Loosening of association
Explanation: ### Explanation The correct answer is **Autistic thinking**. **1. Why Autistic Thinking is Correct:** Autistic thinking (also known as **dereistic thinking**) is a hallmark of schizophrenia, first described by Eugen Bleuler as one of the **4 As**. It refers to a private, highly subjective internal world where the patient’s thoughts are governed by **personal logic** and fantasies rather than objective reality. * In this case, the patient uses **paralogical reasoning** (specifically **predicate logic** or Von Domarus principle): "A has property X, B has property X, therefore A is B." * Because both Hanuman and the patient share the predicate "celibacy," the patient concludes they are the same entity. This disregard for external reality in favor of internal symbolism is the essence of autistic thinking. **2. Why Other Options are Incorrect:** * **Verbigeration:** Also known as "word salad" or "palilalia," this involves the senseless repetition of specific words or phrases. The patient’s statement here is a structured (though illogical) sentence, not repetitive babbling. * **Neologism:** This refers to the creation of **new words** that have a private meaning to the patient but are meaningless to others. No new words were coined in the prompt. * **Loosening of Association:** This is a lack of logical connection between sequential sentences (Knight’s Move thinking). While the logic here is flawed, the sentence itself follows a specific internal "theme," making "Autistic thinking" the more specific psychopathological term for this type of identity-based logic. **3. High-Yield Clinical Pearls for INI-CET:** * **Bleuler’s 4 As of Schizophrenia:** **A**utistic thinking, **A**mbivalence, **A**ffective flattening, and **A**ssociative looseness. * **Von Domarus Principle:** The specific type of paralogical thinking where identity is assumed based on identical predicates (as seen in this question). * **Dereism vs. Autism:** While often used interchangeably, **dereism** emphasizes the detachment from reality, while **autism** emphasizes the preoccupation with the inner world.
Question 44: Which of the following drugs are used in the management of acute mania?
- A. Only 1 (Lithium)
- B. 1, 2 & 3 (Lithium, Valproate & Haloperidol) (Correct Answer)
- C. 1, 2 & 4 (Lithium, Valproate & Amitriptyline)
- D. 2 & 4 (Valproate & Amitriptyline)
Explanation: ### **Explanation: Management of Acute Mania** The management of **acute mania** focuses on rapid stabilization of mood and control of psychomotor agitation. The treatment of choice involves **Mood Stabilizers** and/or **Antipsychotics**. #### **1. Why Option B is Correct (1, 2 & 3)** * **Lithium (1):** The "Gold Standard" mood stabilizer. It is highly effective for acute mania, though it has a slow onset of action (5–7 days). * **Valproate (2):** An anticonvulsant mood stabilizer often preferred over Lithium in **Rapid Cycling** or **Mixed Episodes** due to its faster onset and better tolerability in certain patients. * **Haloperidol (3):** A high-potency typical antipsychotic. In acute mania, antipsychotics (both typical like Haloperidol and atypical like Olanzapine/Risperidone) are used for rapid control of agitation, aggression, and psychotic symptoms. #### **2. Why Other Options are Incorrect** * **Amitriptyline (4):** This is a **Tricyclic Antidepressant (TCA)**. Antidepressants are **contraindicated** in acute mania as they can worsen the manic state or trigger a "switch" from depression into mania. Therefore, any option containing Amitriptyline (C and D) is incorrect. * **Option A** is incomplete because while Lithium is used, it is not the *only* drug; Valproate and Haloperidol are equally standard first-line interventions. --- ### **High-Yield Clinical Pearls for NEET-PG / INI-CET** * **Drug of Choice (DOC):** For classic acute mania, **Lithium** is the DOC. For rapid cycling Bipolar Disorder, **Valproate** is the DOC. * **Therapeutic Index:** Lithium has a narrow therapeutic index. For acute mania, target serum levels are **0.8–1.2 mEq/L**. * **Pregnancy:** Avoid Lithium in the first trimester (risk of **Ebstein’s Anomaly**). Avoid Valproate (risk of **Neural Tube Defects**). * **Combination Therapy:** In severe mania, a combination of a mood stabilizer (Lithium/Valproate) plus an antipsychotic is more effective than monotherapy.
Radiology
4 questionsBased on the provided X-ray image, identify the type of thyroid malignancy.
Eye of the tiger appearance on MRI is associated with:
Honda or H sign on STIR MRI is characteristic of which condition?
Identify the investigation modality shown in the image.
INI-CET 2025 - Radiology INI-CET Practice Questions and MCQs
Question 41: Based on the provided X-ray image, identify the type of thyroid malignancy.
- A. Papillary carcinoma
- B. Hurthle cell carcinoma
- C. Follicular carcinoma (Correct Answer)
- D. Thyroid lymphoma
Explanation: ***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 42: Eye of the tiger appearance on MRI is associated with:
- A. Pantothenate kinase-associated degeneration (Correct Answer)
- B. Wilson disease
- C. Krabbe disease
- D. Huntington chorea
Explanation: ***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.
Question 43: Honda or H sign on STIR MRI is characteristic of which condition?
- A. Multiple myeloma
- B. Sacral insufficiency fracture (Correct Answer)
- C. Acute osteomyelitis
- D. Bone marrow edema
Explanation: ***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.
Question 44: Identify the investigation modality shown in the image.
- A. X-ray defecogram (Correct Answer)
- B. Barium swallow
- C. MR defecogram
- D. X-ray barium enema
Explanation: ***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.