INI-CET High-Yield Questions for Medicine

Introduction

Conquering the INI-CET requires strategic preparation, and focusing on high-yield topics is a winning tactic. This blog hones in on exactly that – a compilation of high-yield questions in Medicine that have a high probability of appearing on the INI-CET. By familiarizing yourself with these questions and their explanations, you'll strengthen your understanding of medical concepts and boost your confidence on exam day.

1. A 10-year-old boy is brought to the clinic by his mother with complaints of developing lesions shown below. She says that he has chronic diarrhea and has always been thin and skinny. Blood work was done. Using the images below, identify the diagnosis and mark the option with correlating statements.

a) Anti-endomysial Ab is used for screening test

b) Investigation of choice is a small intestine mucosal biopsy

c) Most common cause of death is osmotic diarrhea

d)Dietary restrictions can reduce the severity of the disease

e) It predominantly affects absorption in the distal parts of the intestine

f) Diabetes mellitus can be one of its complications in the future

1. b, c, f
2. a, d, e
3. b, d, f
4. a, c, e

Solution:

Correct Option C - b, d, f:

• The clinical history of malabsorption with blood work showing anemia points to a diagnosis of celiac sprue. 
• The second image shows vesicobullous lesions of dermatitis herpetiformis. 

Correct statements:

• Investigation of choice is a small intestine mucosal biopsy
• Dietary restrictions can reduce the severity of the disease by reducing antigenic stimulus
• Diabetes mellitus can be one of its future complications
• Most common cause of death in celiac sprue is due to lymphoma of the gut 
• Though Anti-endomysial Ab is one of the Abs involved in celiac sprue, anti-TTG (tissue transglutaminase) is the screening test
• It mainly affects absorption in proximal parts of the intestine

Celiac Sprue/Gluten Sensitive Enteropathy:

1. BROW cereals are contraindicated. Quinoa and maize are used. Poha may be used in resource-limited settings. 
2. Pruritic vesicles on elbows & knees indicated dermatological involvement in these patients called dermatitis herpetiformis. Anti-Epidermal Transglutaminase Ab is seen.
3. Type 1 DM can be seen in some patients.
4. May develop lymphoma of the gut, and happens to be the most common cause of death is celiac sprue.

2. A 30-year-old male was brought to the clinic with breathlessness that increases while sitting and resolves on lying down. On auscultation, tumor plop sound and mid diastolic murmur are heard. Which of the following is the investigation of choice in this condition?

1. Transthoracic echocardiography
2. Ultrasonography
3. ECG
4. Troponin

Correct Option 1 - Transthoracic Echocardiography:

• The condition described in the question is atrial myxoma.
• It is characterized by breathlessness while sitting that resolves when lying down (platypnea), dyspnea when exerting effort, effort intolerance, and a transient ischemic attack.
• Auscultation reveals a tumor plop sound with a mid or late diastolic murmur.

Incorrect Options:

Options 2, 3 & 4:

• These are not the investigation of choices in Atrial myxoma

3. A 55-year-old male presents to the clinic with symptoms of progressive shortness of breath, fatigue, and exercise intolerance. Cardiac examination reveals a displaced point of maximal impulse. A myocardial biopsy is performed, and histological examination reveals the following:

Which of the following is the most likely underlying cause of the observed histological finding?

1. Tobacco smoking
2. Genetic mutations
3. Viral infection
4. Ischemic injury

Correct Option B - Genetic mutations:

• The "ninja star nucleus" appearance is a characteristic histological finding seen in certain genetic mutations associated with dilated cardiomyopathy.
• These genetic mutations can lead to abnormalities in the structure and function of myocardial cells, resulting in the dilatation of all cardiac chambers and reduced systolic function.
• TITIN or TTN mutation is most frequently implicated. Ninja star nuclei are commonly seen in Titin gene mutations.

Incorrect Options:

Option A - Tobacco smoking: Alcohol abuse can lead to alcoholic cardiomyopathy, which is a type of dilated cardiomyopathy. 

Option C - Viral infection: While viral myocarditis can lead to dilated cardiomyopathy with dilatation of cardiac chambers and reduced systolic function, the specific histological finding of a "ninja star nucleus" is not typically associated with viral infections. 

Option D - Ischemic injury: Ischemic cardiomyopathy is a type of dilated cardiomyopathy that occurs as a result of chronic coronary artery disease and reduced blood flow to the heart muscle. 

Dilated Cardiomyopathy:

1. Dilation of four chambers of the heart. 
2. Ninja star nucleus (usually seen in the mutations of the titin gene)
3. Titin (largest protein in the body) A Autosomal Dominant inheritance
4. LMNA gene mutations

4. A 48-year-old man presents with mild shortness of breath. A chest radiograph revealed bi-basilar reticular markings. What is the probable diagnosis in a patient with the below-given flow volume curve after spirometry?

1. Emphysema
2. Interstitial lung disease
3. Bronchial asthma
4. Endobronchial neoplasm

Correct option: B - Interstitial lung disease

The probable diagnosis in this patient based on the restrictive pattern in the flow volume curve is interstitial lung disease

Features of the flow volume curve above:

• TLC: Decreased
• Vital capacity: Decreased
• Residual volume: Decreased
• The flow volume curve is shifted to the right side (normally it is present in the center)
• All the above features are seen in the restrictive type of lung disease flow volume curve

Incorrect options: A, C and D

Option A: Emphysema

• The flow volume curve shown above is for restrictive lung disease
• However, emphysema shows a pattern of obstructive lung disease

Option C: Bronchial asthma

• The flow volume curve shown above is for restrictive lung disease
• However, bronchial asthma shows a pattern of obstructive lung disease

Option D: Endobronchial neoplasm

• The flow volume curve shown above is for restrictive lung disease
• However, endobronchial neoplasm shows a pattern of obstructive lung disease.

5. A 45-year-old woman visits the clinic with complaints of abdominal pain, fever, and skin lesions. She reports experiencing muscle aches, joint pain, and fatigue for the past few weeks. On examination, palpable skin nodules, particularly on the lower extremities, are noted. The biopsy of a skin lesion is shown in the image.

Which of the following statements about the patient's condition is incorrect?

1. It is associated with medium vessel involvement
2. The most common vessel affected is the renal vessel
3. The patient's condition is most likely rheumatoid arthritis
4. The microscopic image shows segmental, transmural fibrinoid necrosis

Correct Option C - The patient's condition is most likely rheumatoid arthritis:

• The clinical scenario and the microscopic image described are consistent with Polyarteritis Nodosa (PAN).
• Segmental, transmural fibrinoid necrosis on histopathological examination.
• Clinical manifestations related to organ system involvement in PAN:
  • Renal - Renal failure, hypertension
  • Musculoskeletal - Arthritis, arthralgia, myalgia
  • PNS- Peripheral neuropathy, mononeuritis multiplex
  • GIT- Abdominal pain, nausea and vomiting, bleeding, bowel infarction
  • Skin - Rash, purpura, nodules, cutaneous infarcts, livedo reticularis, Raynaud’s phenomenon
  • Cardiac - Congestive heart failure, myocardial infarction, pericarditis
  • CNS- Cerebral vascular accident, altered mental status, seizures

Incorrect Options:

Option A - It is associated with medium vessel involvement: PAN is characterized by inflammation of medium-sized vessels, leading to multiple organ involvement.

Option B - The most common vessel affected in PAN is the renal vessel: While PAN can affect various medium-sized vessels, the renal vessel is commonly involved.

Option D - The microscopic image shows segmental, transmural fibrinoid necrosis: The microscopic image supports the diagnosis of PAN, as it shows the characteristic feature of segmental, transmural fibrinoid necrosis seen in the affected medium-sized vessels.

Also Read: INI-CET Previous Year Question Papers

6. A 34-year-old female presents with complaints of palpitations and heat intolerance. She gave a history of consuming ayurvedic tablets for weight loss. Lab investigation revealed reduced levels of TSH and elevated levels of T4 and T3. What is the condition this patient is suffering from:

1. Grave’s disease
2. Thyrotoxicosis factitia
3. Toxic multinodular goitre
4. Pituitary adenoma

Correct Option B - Thyrotoxicosis factitia:

• Thyrotoxicosis factitia refers to thyrotoxicosis caused by the ingestion of exogenous sources of thyroid hormones, such as medications or supplements, with a normal functioning thyroid gland.
• In this case, the patient's symptoms of palpitations and heat intolerance, along with the history of consuming ayurvedic tablets (containing levothyroxine) for weight loss and thyroid profile, strongly suggest thyrotoxicosis factitia as the underlying condition.

Incorrect Options:

Option A - Grave’s disease: Grave's disease is an autoimmune disorder characterized by the production of autoantibodies that stimulate the thyroid gland to overproduce thyroid hormones.

Option C - Toxic multinodular goitre: Toxic multinodular goiter refers to the presence of multiple nodules in the thyroid gland, some of which autonomously produce thyroid hormones, leading to hyperthyroidism.

Option D - Pituitary adenoma: Pituitary adenoma is a condition in which there will be an increased synthesis of TSH, which results in increased T4 and T3 levels.

7. A 50-year-old presents with myoclonus. He has a history of beef consumption but not of childhood febrile seizures. His son describes events that are characteristic of rapidly progressive dementia. An EEG is performed. What would be the characteristic findings on his EEG?

1. Spike and Slow wave pattern
2. Positive wave that is preceded by and followed by negative waves
3. Periodic Sharp Wave Complexes
4. Polyspike pattern

Correct Option C - Periodic Sharp Wave Complexes:

• Given the clinical presentation of myoclonus and rapidly progressive dementia in a patient with a history of beef consumption, the most likely diagnosis is Creutzfeldt-Jakob disease (CJD), a prion disease.
• Periodic Sharp Wave Complexes occur in vCJD. They are high-voltage bursts that show periodicity and only go upward.

• A similar pattern is seen in children with Subacute Sclerosing Panencephalitis (SSPE).

Incorrect Options:

Option A - Spike and Slow wave pattern:

• This EEG pattern is characteristic of absent seizures. In case of typical absent seizures the frequency observed is usually less than 3Hz and in atypical absent seizures it is less than 2.5Hz.

Option B - Positive wave that is preceded by and followed by negative waves:

• This is a description of triphasic wave. It is commonly observed in metabolic encephalopathies.

Option D - Polyspike pattern:

• A polyspike pattern of about 4-6Hz is characteristically observed in juvenile myoclonic epilepsy / JANZ syndrome.

8. A 62-year-old male, who is a known case of hypertension and T2DM, experiences weakness in his left arm and difficulty in speech while climbing stairs at home. His BP is 130/85mmHg, NIHSS score is >5 and he gives no history of recent head injury. NCCT head findings are shown below. He managed to reach the hospital in 45 minutes What is the next step in the management of this patient?

1. Thrombolysis
2. CT Angiography
3. MR venography
4. Thrombectomy

Correct Option A – Thrombolysis:

The symptoms and NCCT findings (Hyperdense MCA sign (right MCA, M1 segment)) are suggestive of acute ischemic stroke, and thrombolysis is the best next step in management

• The patient reached the hospital within 4.5 hours (Window period for thrombolysis)
• No contraindications for thrombolysis present

Incorrect Options:

Option B - CT angiography: Perfusion scan is done when

• the patient is not a candidate for thrombolysis or after failed recanalization of the occluded vessel in the initial 6 hrs or to check for resolution of thrombus post thrombolysis therapy
• When a patient presents between 6-24 hours, to see for large vessel occlusion

Option C - MR venography:

• It is an IOC for cerebral venous thrombosis (involves sagittal/lateral sinus) that manifests as headache, seizures, paraplegia, and raised ICP.

Option D – Thrombectomy:

• It is done for patients who are not a candidate for thrombolysis or failed recanalization of occluded vessel, and CT angiography shows thrombosis or occlusion in ICA, M1/M2 branches of MCA or basilar artery in initial 6 hours)

9. A patient has presented to the clinic after experiencing a stroke. He is having difficulty processing simple calculations, has impaired writing, and is unable to name individual fingers. Additionally, he is unable to distinguish between the examiner's right and left arm. What is his likely diagnosis?

1. Charles Bonnet syndrome
2. Cotard's syndrome
3. Korsakoff's syndrome
4. Gerstmann’s Syndrome

Correct Option:

Option D- Gerstmann’s Syndrome:

Gerstmann’s Syndrome is characterized by a constellation of symptoms including:

• Difficulty processing simple calculations (acalculia)
• Impaired writing ability (dysgraphia)
• Difficulty distinguishing between fingers (finger anomia)
• Inability to distinguish between right and left sides of the body (right-left disorientation).

These symptoms typically result from damage to the dominant parietal lobe of the brain, often due to a stroke or other neurological conditions.

Incorrect Options:

Option A - Charles Bonnet syndrome:

• Charles Bonnet Syndrome (CBS) is a medical condition that causes complex visual hallucinations along with visual field loss or visual acuity loss. This disease affects people with visual impairment or vision loss, and the pathways leading to CBS can involve any part of the visual pathway, including the brain, optic nerve, or eyes.

Option B - Cotard's syndrome:

• Cotard’s syndrome is a series of delusions where one believes they have lost organs, blood, body parts, their soul or are dead.

Option C - Korsakoff's syndrome:

• Korsakoff's syndrome is a memory disorder caused by vitamin B1 deficiency and alcoholism. It damages nerve cells, supporting cells in the brain and spinal cord, and the memory center of the brain.
• Symptoms include amnesia, tremors, coma, disorientation, and vision problems.

10. A 2-month-old infant is brought to the pediatric emergency department with fever, irritability, and poor feeding. The infant's mother reports that the baby has been lethargic and difficult to console. Suspecting acute bacterial meningitis, the physician plans to initiate antibiotic therapy promptly. Which antibiotic regimen is the most appropriate initial treatment for this baby?

1. Ceftriaxone and vancomycin
2. Ampicillin and cefotaxime
3. Ampicillin and ceftriaxone
4. Ampicillin, cefixime, and vancomycin

Correct Option B - Ampicillin and cefotaxime:

• In infants under 3 months of age, acute bacterial meningitis is commonly caused by pathogens such as Listeria monocytogenes.
• Therefore, the initial antibiotic regimen should cover this organism.
• The recommended antibiotics for this age group are ampicillin plus a third-generation cephalosporin such as cefotaxime.
• The combination of ampicillin and cefotaxime provides broad coverage against common pathogens, including Listeria monocytogenes and Group B Streptococcus (GBS).

Incorrect Options:

Option A - Ceftriaxone and vancomycin: While ceftriaxone is a component of antibiotic therapy for acute bacterial meningitis, vancomycin is not typically used in this age group unless there is a specific indication, such as suspected methicillin-resistant Staphylococcus aureus (MRSA) infection.

Option C - Ampicillin and ceftriaxone: While ampicillin is appropriate for coverage of Listeria monocytogenes, ceftriaxone is not used in infants due to the risk of jaundice.

Option D - Ampicillin, cefixime, and vancomycin: This regimen includes unnecessary antibiotics and does not provide optimal coverage for the likely pathogens in infants under 3 months of age.

Conclusion

The questions discussed in this blog represent the areas most likely to be tested and, therefore, should form a core part of your study strategy. Focusing on these topics will help you maximize your study efficiency and increase your chances of a top score. Utilize these high-yield questions alongside your comprehensive study plan, including practice tests and in-depth textbook reviews. Stay focused, stay sharp, and conquer the INI-CET with flying colors!