INICET Medicine Previous Year Questions (2018–2026)

The correct answer is ST elevation in V3R and V4R.

In acute inferior MI, ST elevation in the right-sided chest leads V3R-V4R indicates right ventricular involvement and points to a proximal RCA occlusion. ST elevation greater than 1 mm in V4R is about 100 percent sensitive for RCA and RV involvement, the most sensitive of the listed criteria. Other features confirm RCA over left circumflex, namely ST elevation greater in lead III than II and reciprocal ST depression in aVL and lead I, each highly specific (about 94 percent) but less sensitive.

The closest distractor is ST elevation in III greater than II. It is a classic RCA pointer and highly SPECIFIC (about 94 percent), but its sensitivity (about 88 percent) is lower than the right-sided leads. Because the question asks for the MOST sensitive criterion, ST elevation in V3R-V4R (about 100 percent) wins over the more specific III over II.

Incorrect Options:

• ST elevation III greater than II: An RCA pointer that is highly specific (about 94 percent) but less sensitive than the right-sided leads.
• ST depression aVL greater than I: A specific reciprocal sign of RCA occlusion (about 94 percent), but with lower sensitivity.
• High S to R ratio aVL: An RCA criterion with only about 76 percent sensitivity.

High-Yield Facts:

• Inferior MI shows ST elevation in II, III, and aVF.
• ST elevation in V4R indicates RV infarction (proximal RCA).
• ST elevation III greater than II favours RCA over circumflex.
• In RV infarct, give IV fluids and avoid nitrates.

Figure: Acute inferior MI - ST elevation in II, III, and aVF. A right-sided lead V4R should be checked for RCA and right ventricular involvement.

The correct answer is 4, 1, 3, 2.

Humoral hypercalcemia of malignancy is driven by tumour PTHrP, which mimics PTH. Management begins by removing aggravating factors - stop exogenous calcium, vitamin D, and thiazides (4). The cornerstone is aggressive IV normal saline (1) to correct hypovolemia and promote calciuresis. A loop diuretic is added only AFTER adequate rehydration (3), to enhance calcium excretion and avoid fluid overload, and it is no longer routine. Finally a bisphosphonate such as zoledronic acid (2) gives sustained control, with onset over 2 to 4 days. Calcitonin can be added for rapid temporary lowering.

The closest distractor is 1, 4, 3, 2 - starting saline before stopping the offending calcium and drugs. Saline is indeed the therapeutic cornerstone, but the first logical step is to remove what is worsening the hypercalcemia (step 4), so 4 precedes 1. Giving a bisphosphonate early (as in 1, 2, 3, 4) is wrong because it acts slowly and follows volume repletion.

Incorrect Options:

• 1, 4, 3, 2: Saline before stopping offending calcium and drugs - the aggravating factors should be removed first.
• 1, 2, 3, 4: Bisphosphonate is too early and the loop diuretic last; bisphosphonate is slow and follows hydration.
• 4, 3, 1, 2: Gives the loop diuretic before saline hydration, which would worsen dehydration.

High-Yield Facts:

• HHM is mediated by PTHrP, which mimics PTH.
• IV normal saline is the cornerstone of acute treatment.
• Give loop diuretics only after volume repletion.
• Bisphosphonates act in 2 to 4 days; calcitonin works within hours.

Figure: Calcium regulation by PTH. In humoral hypercalcemia of malignancy, tumour PTHrP mimics PTH and raises serum calcium by the same pathways.

The correct answer is Air hunger.

The qualitative language of dyspnea helps localize the cause. Air hunger, a suffocating sensation or urge to breathe (cannot get enough air), reflects chemoreceptor stimulation and is characteristic of congestive heart failure and pulmonary edema, and also pulmonary embolism. By contrast, chest tightness points to bronchoconstriction (asthma), wheezing to obstructive airway disease, and an unsatisfying or cannot-take-a-deep-breath sensation to restrictive disease or hyperinflation. So air hunger best fits CHF rather than obstructive lung pathology.

The closest distractor is cannot take a deep breath. It can occur in CHF too, from restrictive physiology due to pulmonary congestion or effusion, but it is the classic descriptor of restrictive disease and COPD hyperinflation. The descriptor most specific to the cardiac and pulmonary-edema mechanism is air hunger, so that is the better answer.

Incorrect Options:

• Chest tightness: The dominant early sensation of asthma (bronchoconstriction), an obstructive airway process.
• Intermittent wheezing: Suggests obstructive airway disease such as asthma or COPD, not heart failure.
• Cannot take a deep breath: An unsatisfied-inspiration sensation typical of restrictive disease or COPD hyperinflation.

High-Yield Facts:

• Air hunger or suffocation suggests CHF, pulmonary edema, or PE.
• Chest tightness suggests asthma (bronchoconstriction).
• Work of breathing is common to COPD, asthma, and neuromuscular disease.
• The descriptor guides but does not replace objective testing.

Figure: Congestive heart failure on chest X-ray - cardiomegaly, vascular cephalization, Kerley B lines, and pleural effusion. Such pulmonary congestion produces air hunger.