High-Yield Image-Based Questions for INI-CET Medicine​

Q1. ​A 40-year-old female came to OP with a fever, weakness of the right side of her body, and bleeding episodes while brushing. Preliminary investigations revealed

S.Creatinine: 2 mg/dL (0.6-1.1 mg/dl)

Platelet count: 20,000 cells/cu.mm (1,50,000-4,00,000 cells/cu.mm)

Bleeding time: 10 mins (2-7 mins)

PT: 15 sec (11.5-13.5 seconds)

aPTT: 38 sec (21-35 seconds)

Peripheral smear revealed the following​ 

What is the likely diagnosis?

1. Immune thrombocytopenic purpura
2. IgA Vasculitis
3. Thrombotic thrombocytopenic purpura
4. Disseminated intravascular coagulation

Ans. 3) Thrombotic thrombocytopenic purpura​

Q2. A 50-year-old male presented with recurrent episodes of hematuria associated with loin pain for the past 6 months. He also gives a history of episodes of recurrent UTIs in his early childhood. IVP done showed the following.​ 

What is the most likely composition of renal stones in this patient?

1. ​Calcium oxalate
2. Struvite
3. Uric acid
4. Cystine

Ans. 1) Calcium oxalate  

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Q3. A 52-year-old man with a history of heavy alcohol consumption presents with jaundice, abdominal pain, and fatigue. A liver biopsy is performed to assess the extent of liver damage. Which of the following findings is most characteristic of this condition?

1. ​Russell bodies
2. Dutcher bodies
3. Mallory-Denk bodies
4. Kamino bodies

Ans. 3) Mallory-Denk bodies  

Q4. A 30-year-old male patient succumbed to death, history revealed that the patient was admitted for liver failure 1 week back. Biopsy done is as shown below. What type of inclusions are seen in the biopsy, and what is the likely diagnosis?​ 

1. Intracytoplasmic - ALD
2. Intranuclear - ALD
3. Intracytoplasmic - Viral hepatitis
4. Intranuclear - Viral hepatitis

Ans. 1) Intracytoplasmic - ALD

Q5. A 50-year-old man comes to your clinic for a routine check-up. He has no significant past history, exercises regularly, and reports no chest pain, palpitations, or shortness of breath. On physical examination, his blood pressure is 130/80 mmHg, and his pulse rate is 75 beats per minute and regular. You perform an ECG as part of the screening, shown below.​

What is the most likely finding based on this ECG?

1. ​Left ventricular hypertrophy
2. Normal sinus rhythm
3. First-degree AV block
4. Right bundle branch block

Ans. 2) Normal sinus rhythm

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Q6. A 40-year-old female presented with complaints of lower back pain for 6 months. Her Hb count was low, and a peripheral blood smear revealed normocytic normochromic anaemia. No other abnormalities were found on the preliminary evaluation. Her renal and liver function tests were within normal limits. Bone marrow biopsy is as shown below.​

What is the most likely electrolyte imbalance seen in this patient?

1. ​Hypotonic hyponatremia
2. Isotonic hyponatremia
3. Hypertonic hyponatremia
4. Hypernatremia

Ans. 2) Isotonic hyponatremia

Q7. A patient presented to ED with sudden onset breathlessness. Upon examination, you will notice the following signs:​ 

 What is the most appropriate definitive management for this patient?

1. ​IV 10% Calcium gluconate 10 mL
2. IV Regular insulin infusion at 0.1U/hour
3. Oral Vitamin D3 1L U daily
4. IV Sodium bicarbonate (NaHCO3)

Ans. 1) IV 10% Calcium gluconate 10 mL  

Q8. A 38-year-old female with complaints of abdominal pain, diarrhea, and occasional rectal bleeding is found to have a segment of her colon with a characteristic appearance on colonoscopy, as shown in the image given below. Based on this finding, which of the following conditions is most likely to be associated with this presentation?​

1. Ulcerative colitis
2. Crohn's disease
3. Ischemic colitis
4. Pseudomembranous colitis

Ans. 2) Crohn's disease

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Q9. A 35-year-old woman presents to the clinic with painful skin lesions with central ulceration and violaceous borders, as shown in the image. She reports a history of ulcerative colitis and mentions that the skin lesions appeared a few weeks after her gastrointestinal symptoms started. Which of the following statements is not true regarding the extra-intestinal manifestations of Inflammatory Bowel disease (IBD)?

1. ​Osteoporosis and Osteonecrosis are the least common extra-intestinal manifestations of IBD.
2. Pyoderma gangrenosum is common in Ulcerative colitis.
3. Primary Sclerosing Cholangitis is common in Ulcerative colitis.
4. Renal calculi is common in Crohn’s disease.

Ans. 1) Osteoporosis and osteonecrosis are the least common extraintestinal manifestations of IBD.

Q10. A 25-year-old male with thalassemia major presents to the clinic with increased fatigue, joint pain, and symptoms of hyperglycemia. On examination, he has a discoloration of the skin as shown. His medical history includes multiple blood transfusions over the years. Which of the following is the most appropriate initial step in managing his condition?​

1. Initiate a low-carbohydrate diet
2. Start iron chelation therapy
3. Begin insulin therapy
4. Schedule a follow-up for skin assessment

Ans. 3) Begin insulin therapy

Q11. A 54-year-old female presents with significant weight loss and a characteristic rash as in the image. Blood tests reveal elevated plasma glucagon levels exceeding 1000 pg/mL. A CT scan shows a large mass in the tail of the pancreas. Which of the following statements regarding her condition is correct?​

1. ​The mass is commonly found in the head of the pancreas
2. The initial treatment includes antibiotics and steroids
3. The rash seen is necrolytic migratory erythema
4. Surgical resection is the treatment option for this condition

Ans. 3) The rash seen is necrolytic migratory erythema  

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Q12. A 30-year-old woman presents with a history of recurrent fever, myalgia, photosensitivity, and joint pain. On examination, multiple erythematous plaques with adherent scales are noted on her face and scalp. What is the most likely diagnosis?​

1. Urticarial eruptions
2. Malar rash
3. Subacute cutaneous lupus erythematosus (SCLE)
4. Discoid lupus erythematosus

Ans. 4) Discoid lupus erythematosus

Q13. A 40-year-old male presents with a 6-month history of progressive fatigue and pruritus. He reports a recent onset of jaundice. His past medical history is significant for ulcerative colitis. Laboratory tests reveal elevated serum alkaline phosphatase and bilirubin, and atypical pANCA are positive. An MRCP is given below. Which of the following is the most likely diagnosis?

1. Primary Biliary Cholangitis
2. Primary Sclerosing Cholangitis
3. Choledocholithiasis
4. Chronic Pancreatitis

​Ans. 2) Primary Sclerosing Cholangitis

Q14. A 30-year-old woman presents with progressive jaundice and pruritus. She has a past medical history of ulcerative colitis. Her LFT revealed an elevated alkaline phosphatase & gamma-glutamyl transferase (GGT) and a prolonged prothrombin time. The liver biopsy is shown below. Which of the following serologic findings is most likely to be present in this patient?​

1. Anti-liver kidney microsomal-1 antibodies (Anti-LKM-1)
2. Anti-mitochondrial antibody (AMA)
3. Perinuclear anti-neutrophil cytoplasmic antibody (pANCA)
4. Anti-centromere antibody

​Ans. 3) Perinuclear anti-neutrophil cytoplasmic antibody (pANCA)

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Q15. A 68-year-old man with a history of cirrhosis presents with increased fatigue, and examination reveals multiple vascular lesions on the skin. His liver function tests show significant elevations in AST and ALT. What is the primary pathophysiological mechanism responsible for the formation of these lesions in cirrhosis?​

1. Due to engorged superficial veins
2. Chronic Hypoxia
3. Because of platelet-derived growth factor
4. Increased vascularity due to estrogen

​Ans. 4) Increased vascularity due to estrogen  

Q15. A 58-year-old obese female with a history of DVT and recent appendectomy presents with worsening abdominal pain, swelling, fatigue, dark stools, and leg swelling. Examination reveals splenomegaly and findings, which are shown in the image below. Which of the following pathologies is most likely responsible for this condition?

1. Constrictive pericarditis
2. Veno-occlusive disease
3. Portal vein thrombosis
4. Inferior vena caval webs

Ans. 3) Portal vein thrombosis

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