INI-CET 2026 Practice Questions

Q: Calculate the Odds Ratio with the following data: Cancer No Cancer Smoking 80 20 No Smoking 40 60

6. ***6*** - The **Odds Ratio (OR)** is calculated using the formula: (a * d) / (b * c), where (a) is exposed with disease, (b) is exposed without disease, (c) is unexposed with disease, and (d) is unexposed without disease. - Plugging in the values: (80 * 60) / (20 * 40) = 4800 / 800 = **6**, which represents the odds of developing **cancer** among smokers compared to non-smokers. *8* - This result would be obtained if the calculation was incorrect or if the **cross-multiplication** was mismatched during the division step. - It does not represent the correct mathematical ratio of the **exposure-disease association** provided in the table. *10* - This value likely arises from a calculation error, perhaps by substituting one of the denominators or numerators incorrectly, such as summing **incorrect cells**. - In **biostatistics**, ensuring the accurate placement of data in the **2x2 contingency table** is critical for deriving the correct odds. *12* - This result is mathematically incorrect and suggests a failure to properly apply the **odds ratio formula** to the provided contingency table data. - An OR of 12 would imply a much stronger **association** than what is actually supported by the raw frequencies of smoking and cancer incidence in this study group.

Q: A patient develops acute-onset severe unilateral hearing loss with no identifiable cause. Audiometry confirms sensorineural hearing loss. Which of the following pharmacological regimens is considered the first-line treatment for this condition?

Oral prednisolone (systemic corticosteroids). ***Oral prednisolone (systemic corticosteroids)*** - Systemic corticosteroids are the **first-line standard of care** for idiopathic sudden sensorineural hearing loss (SSNHL), typically initiated as soon as possible after diagnosis. - The goal is to reduce **inner ear inflammation** and edema, which is thought to be a primary pathophysiological mechanism for the condition. *Intratympanic steroid injections* - These are typically reserved as a **salvage therapy** for patients who fail to respond to initial systemic corticosteroid treatment. - While effective, they are generally not used as a first-line monotherapy due to the invasive nature and the proven efficacy of oral regimens. *Topical steroid ear drops* - These are ineffective for treating inner ear pathology because they are **unable to cross the tympanic membrane** into the middle and inner ear. - Topical therapy is primarily indicated for **otitis externa** and is irrelevant for sensorineural hearing loss conditions. *Gentamicin combined with systemic steroids* - Gentamicin is an **ototoxic aminoglycoside** that is toxic to the hair cells of the cochlea, which would potentially worsen, not treat, hearing loss. - This combination is contraindicated in the treatment of SSNHL and is actually used in a completely different context, such as chemical labyrinthectomy for Meniere's disease to ablate vestibular function.

Q: A patient is evaluated for a rare orofacial syndrome. The classical diagnostic triad of this condition is being reviewed. Which of the following is NOT a component of the Melkersson- Rosenthal syndrome triad?

Proptosis (forward displacement of the eyeball). ***Proptosis (forward displacement of the eyeball)*** - Proptosis is **not a component** of the classic Melkersson-Rosenthal syndrome (MRS) triad. - Orbital involvement is generally not associated with this condition, making this the correct choice as the exception. *Lower motor neuron facial palsy* - This condition is a key component of the MRS triad, often manifesting as **recurrent, unilateral or bilateral facial paralysis**. - The paralysis is usually transient and may result in residual weakness as the disease progresses. *Orofacial granulomatous oedema* - Also known as **granulomatous cheilitis**, this presents as chronic, recurrent swelling of the lips and face. - This edema is a hallmark feature of MRS and corresponds to the granulomatous inflammation seen on histology. *Fissured (scrotal) tongue* - This is the third component of the classic triad, described as a **deeply furrowed tongue** (lingua plicata). - While it is a recognized part of the syndrome, it is frequently the least common of the three features and may be seen in healthy individuals as well.

Q: A female patient presents with recurrent epistaxis and a unilateral nasal cavity mass. CT scan reveals localised bony erosion. Among the following differential diagnoses, which is the LEAST likely cause of these findings?

Antrochoanal polyp. ***Antrochoanal polyp*** - These are benign **inflammatory lesions** arising from the maxillary sinus and extending into the nasal cavity, typically presenting with symptoms of obstruction rather than epistaxis. - They do not cause **bony erosion**; rather, they can cause **bony remodeling** or widening of the ostium due to chronic pressure, making them the least likely cause of aggressive bony destruction. *Inverted papilloma with malignant transformation* - These are locally aggressive, **neoplastic tumors** that frequently cause significant **bony destruction** and remodeling of the nasal cavity and sinuses. - They are well-known to have high rates of recurrence and potential for malignant transformation into **squamous cell carcinoma**, which correlates with the patient's presentation. *Olfactory esthesioneuroblastoma* - This is a rare **neuroectodermal malignancy** arising from the olfactory epithelium in the superior nasal cavity, inherently capable of aggressive involvement. - It commonly presents with nasal obstruction, **epistaxis**, and, upon imaging, frequently demonstrates extension into the skull base with associated **bony erosion**. *Juvenile nasopharyngeal angiofibroma* - Although predominantly found in young males, this is a highly vascular tumor that presents with **profuse, recurrent epistaxis** and a nasal mass. - It is classically known for specific radiological findings including the widening of the **pterygopalatine fossa** and significant **bony erosions** in the surrounding regions.

Q: An elderly immunocompromised patient presents with blood-stained nasal discharge and a black necrotic eschar covering the right nasal cavity, hard palate, and nasal turbinates. Histopathology reveals broad aseptate hyphae. Which organism is the most common causative agent of this life-threatening condition?

Rhizopus species. ***Rhizopus species*** - This organism is the most frequent cause of **rhinocerebral mucormycosis**, an aggressive fungal infection that rapidly invades tissues, producing the classic **black necrotic eschar** on the nasal mucosa and palate. - Histopathology characteristically shows **broad, aseptate hyphae** with right-angle branching, distinguishing it from other common fungal pathogens. *Candida albicans* - While an opportunistic pathogen, this fungi typically causes **thrush** or systemic candidiasis rather than invasive, angioinvasive tissue destruction leading to necrosis. - Histopathology reveals **yeast cells** and **pseudohyphae**, which are morphologically distinct from the structures seen in mucormycosis. *Cryptococcus neoformans* - This yeast is primarily associated with **meningitis** and pulmonary infections in immunocompromised hosts, especially those with advanced HIV/AIDS. - It presents as an **encapsulated yeast** on special stains like India ink or mucicarmine, not as broad hyphae. *Aspergillus fumigatus* - Known to cause invasive aspergillosis, particularly in lungs, but typically presents with **septate hyphae** showing **acute-angle (45 degree) branching**. - While it can invade the sinuses, the specific clinical picture of a black eschar on the hard palate is pathognomonic for mucormycosis (Zygomycosis).

Q: What is the expected amplitude of accommodation in a healthy child?

14D. ***14D*** - In a healthy child, the **amplitude of accommodation** is approximately **14 diopters (D)**, reflecting the high elasticity of the **crystalline lens**. - As individuals age, this amplitude gradually decreases due to **presbyopia**, which is related to the loss of lens flexibility. *2D* - An amplitude of **2D** is typically seen in individuals around the age of **50 to 55 years**. - This level suggests significant **presbyopia**, requiring reading aids for near vision. *5D* - An amplitude of **5D** is generally expected in adults around the age of **40 years**. - This indicates the early stages of **presbyopia** where near vision task efficiency begins to decline. *25D* - An amplitude of **25D** is physiologically implausible for the human eye, as the maximum accommodation in an infant is typically around **16-18D**. - Such a high value would far exceed the known anatomical and optical limits of the **accommodation reflex**.

Q: Images show café-au-lait spots, Lisch nodules on the iris, and swelling near the eye. Identify the most likely syndrome:

NF-1. ### ***NF-1 (Neurofibromatosis type 1)*** - The combination of **café-au-lait macules** and **Lisch nodules** (iris hamartomas) represents classic pathognomonic clinical features of **Neurofibromatosis type 1**. - The swelling near the eye likely represents a **plexiform neurofibroma**, which is a highly characteristic, often congenital manifestation of this condition involving peripheral nerves. *Tuberous sclerosis* - Commonly presents with **ash-leaf spots** (hypopigmented macules) rather than hyperpigmented café-au-lait spots, and **angiofibromas** on the face. - Ocular findings typically include **retinal astrocytic hamartomas** rather than iris Lisch nodules, emphasizing a key diagnostic distinction. *Sturge-Weber syndrome* - Characterized by the **port-wine stain** (nevus flammeus) in the distribution of the **trigeminal nerve** on the face, not cafe-au-lait spots. - Ocular involvement usually manifests as **glaucoma** or choroidal hemangioma, distinguishing it from the neurofibromas seen in NF-1. *Von Hippel-Lindau disease* - Known for the development of **retinal capillary hemangioblastomas**, not iris Lisch nodules or neurofibromas. - Systemic associations primarily involve **hemangioblastomas** of the CNS and **renal cell carcinoma**, unlike the dermal and iris signs listed.

Q: Which of the following correctly describes the changes that take place during dark adaptation? A) Retinol is converted to vitamin D B) Dilated pupils C) Eyes sensitive to light D) Functional rhodopsin is formed (Opsin binds with 11-cis-retinal)

D only. ***D only*** - During dark adaptation, the regeneration of photopigments, specifically **rhodopsin**, is the critical chemical event required for scotopic (low-light) vision. - This process involves the binding of **11-cis-retinal** back to **opsin** to restore the functional photopigment after it has been bleached by light exposure. *A and B* - While **pupil dilation** (mydriasis) does occur in the dark to allow more light into the eye, the conversion of **retinol** to **vitamin D** is a metabolic process unrelated to the physiology of dark adaptation. - Vitamin A (retinol) is essential for the visual cycle, but it is not converted to vitamin D during this process. *B only* - Although **pupil dilation** is a component of the eye's adjustment to low light conditions, it is not the only physiological change involved. - Focusing solely on pupil dilation ignores the more important biochemical synthesis of **rhodopsin** and the resultant increase in retinal sensitivity. *B, C and D* - While pupil dilation (B), increased sensitivity to light (C), and rhodopsin regeneration (D) all occur during dark adaptation, the framing of the question requires identifying the primary mechanism, and D is the most specific biochemical requirement. - In many educational contexts regarding the *photochemistry* of dark adaptation, the regeneration of rhodopsin is the definitive step, whereas dilation is a reflex adjustment.

Q: Which of the following structures is NOT part of the trabecular outflow pathway?

Uveoscleral pathway. ***Uveoscleral pathway*** - This is an **alternative aqueous humor drainage route** that bypasses the trabecular meshwork entirely. - It drains fluid through the **suprachoroidal space** and is therefore distinct from the conventional trabecular outflow pathway. *Trabecular meshwork* - This is the **primary site** of aqueous humor drainage in the conventional pathway located at the **iridocorneal angle**. - It acts as a filter through which aqueous humor must pass to reach the collector channels. *Schlemm's canal* - This circular channel collects aqueous humor after it has passed through the **trabecular meshwork**. - It serves as a vital component of the **conventional outflow system**, transporting fluid to the episcleral veins. *Collector vessels* - These vessels drain aqueous humor from **Schlemm's canal** into the episcleral venous plexus. - They are integral components that facilitate the final stage of the **trabecular outflow pathway**.

Q: Which features help distinguish central nystagmus from peripheral nystagmus?

All of the above. ***All of the above*** - **Nystagmus** is categorized into central and peripheral types based on specific clinical signs, and all listed clinical maneuvers helps distinguish them. - Features such as **direction of nystagmus** (purely vertical or horizontal), **latency** before onset, and **fatigability** (the ability of nystagmus to diminish or disappear with repeated testing) are critical diagnostic discriminators. *Direction and duration* - **Peripheral nystagmus** typically presents with a **mixed horizontal-torsional** direction that is suppressed by visual fixation. - **Central nystagmus** can be purely **vertical** or purely **torsional** and does not change direction with gaze, persisting as long as the stimulus is present. *Latency* - In **benign paroxysmal positional vertigo (BPPV)**, a form of peripheral vestibular disorder, there is often a distinct **latency period** (a few seconds) before the nystagmus begins. - **Central nystagmus** typically occurs immediately upon provocation without a discernible **latency period**. *Fatigue* - **Peripheral nystagmus** usually exhibits **fatigability**, meaning the response diminishes or disappears with repeated performance of the provocative maneuver (e.g., Dix-Hallpike). - **Central nystagmus** is characteristically **non-fatigable**, meaning it persists with the same intensity regardless of how many times the provocative stimulus is repeated.

Question 1

Calculate the Odds Ratio with the following data:

Cancer No Cancer
Smoking 80 20
No Smoking 40 60

Accepted Answer

6

Answer

8

Answer

10

Answer

12

Question 2

A patient develops acute-onset severe unilateral hearing loss with no identifiable cause.
Audiometry confirms sensorineural hearing loss. Which of the following pharmacological regimens
is considered the first-line treatment for this condition?

Accepted Answer

Oral prednisolone (systemic corticosteroids)

Answer

Intratympanic steroid injections

Answer

Topical steroid ear drops

Answer

Gentamicin combined with systemic steroids

Question 3

A patient is evaluated for a rare orofacial syndrome. The classical diagnostic triad of this
condition is being reviewed. Which of the following is NOT a component of the Melkersson-
Rosenthal syndrome triad?

Accepted Answer

Proptosis (forward displacement of the eyeball)

Answer

Lower motor neuron facial palsy

Answer

Orofacial granulomatous oedema

Answer

Fissured (scrotal) tongue

Question 4

A female patient presents with recurrent epistaxis and a unilateral nasal cavity mass. CT scan
reveals localised bony erosion. Among the following differential diagnoses, which is the LEAST
likely cause of these findings?

Accepted Answer

Antrochoanal polyp

Answer

Inverted papilloma with malignant transformation

Answer

Olfactory esthesioneuroblastoma

Answer

Juvenile nasopharyngeal angiofibroma

Question 5

An elderly immunocompromised patient presents with blood-stained nasal discharge and a
black necrotic eschar covering the right nasal cavity, hard palate, and nasal turbinates.
Histopathology reveals broad aseptate hyphae. Which organism is the most common causative
agent of this life-threatening condition?

Accepted Answer

Rhizopus species

Answer

Candida albicans

Answer

Cryptococcus neoformans

Answer

Aspergillus fumigatus

Question 6

What is the expected amplitude of accommodation in a healthy child?

Accepted Answer

14D

Answer

2D

Answer

5D

Answer

25D

Question 7

Images show café-au-lait spots, Lisch nodules on the iris, and swelling near the eye. Identify the
most likely syndrome:

Accepted Answer

NF-1

Answer

Tuberous sclerosis

Answer

Sturge-Weber syndrome

Answer

Von Hippel-Lindau disease

Question 8

Which of the following correctly describes the changes that take place during dark adaptation?
A) Retinol is converted to vitamin D
B) Dilated pupils
C) Eyes sensitive to light
D) Functional rhodopsin is formed (Opsin binds with 11-cis-retinal)

Accepted Answer

D only

Answer

A and B

Answer

B only

Answer

B, C and D

Question 9

Which of the following structures is NOT part of the trabecular outflow pathway?

Accepted Answer

Uveoscleral pathway

Answer

Schlemm's canal

Answer

Collector vessels

Answer

Trabecular meshwork

Question 10

Which features help distinguish central nystagmus from peripheral nystagmus?

Accepted Answer

All of the above

Answer

Direction and duration

Answer

Latency

Answer

Fatigue

INI-CET 2026

Community Medicine

ENT

Ophthalmology