INI SS Memory Based Question Paper with Solutions for January 2027 Session

INI SS Memory Based Question Paper with Solutions 2027

Stage I exam is now over. The candidates can use this page to see questions which have been recalled, understand the answers and revise the concepts tested during the January 2027 admission period.

Memory-based questions and their solutions will be listed according to specialities. The questions will be updated as per availability, and the answers will be marked according to their verification status.

1. Which form of calcium supplement is preferred in a patient with achlorhydria?
    Answer: Calcium citrate. It is absorbed independently of gastric acid, unlike calcium carbonate.

2. After starting an ARB, an increase in serum creatinine of more than what percentage from baseline should prompt evaluation for AKI and consideration of stopping the drug?
    Answer: More than 30%. Check for renal artery stenosis or volume depletion.

3. Which bone turnover marker is least affected by renal excretion, making it most reliable in CKD?
    Answer: Bone-specific alkaline phosphatase. It is cleared by the liver, not the kidney.

4. A child with McCune-Albright syndrome has peripheral precocious puberty. Which drug is used for treatment?
    Answer: Letrozole, an aromatase inhibitor (tamoxifen and fulvestrant are alternatives).

5. A patient has hypophosphatemic rickets with hypercalciuria, a defect in the NaPi cotransporter, and normal vitamin D and PTH. What is the diagnosis?
    Answer: Hereditary hypophosphatemic rickets with hypercalciuria (SLC34A3, NaPi-IIc defect).

6. Which transcription factor determines differentiation of the corticotroph (ACTH-producing) lineage?
    Answer: T-Pit (TBX19). Related points: Pit-1 drives GH, PRL and TSH cells, and Prop-1 is needed for Pit-1 and for the gonadotrophs (LH, FSH).

7. A patient with a non-functioning pituitary adenoma (NFPA) has a small, stable residual tumor after surgery. What is the best management?
    Answer: Surveillance with serial MRI.

8. Which of the following is associated with a better response to cabergoline in prolactinoma?
    Answer: Younger age, as per the recall. This is the item I’m least sure of, so please check it against your key. Many sources link young age and male sex with more aggressive or resistant disease.

9. What is the approximate percentage of the adrenal cortex occupied by the zona fasciculata?
    Answer: About 75%.

10. During adrenal vein sampling (AVS) for primary aldosteronism, if cortisol is also co-secreted, which alternative marker is used to calculate the lateralization index?
     Answer: Plasma metanephrines.

11. Which two glucocorticoids have equal potency?
     Answer: Prednisone and prednisolone.

12. Arrange the following in descending order of anti-inflammatory activity: hydrocortisone, prednisone, methylprednisolone, fludrocortisone, dexamethasone.
     Answer: Dexamethasone > fludrocortisone > methylprednisolone > prednisone > hydrocortisone.

13. Adrenarche is characterised by an increase in which hormones?
     Answer: DHEA and DHEAS, from the zona reticularis.

14. What is the intratesticular testosterone concentration compared to serum testosterone?
     Answer: 50 to 100 times higher.

15. Excess zinc intake causes anaemia by inducing deficiency of which mineral?
     Answer: Copper. Zinc induces enterocyte metallothionein, which traps copper and reduces its absorption.

16. Which hormonal changes are seen in anorexia nervosa?
     Answer: Raised cortisol and low T3 (low T3 syndrome). Also low LH, FSH and estrogen.

17. Which statement about amiodarone-induced thyrotoxicosis (AIT) type 2 is correct?
     Answer: It is a destructive thyroiditis, so remission is more likely than in type 1, and it responds to glucocorticoids.

18. A patient on levothyroxine for hypothyroidism is started on carbamazepine. What is the effect on thyroid hormone requirement?
     Answer: Requirement increases because carbamazepine induces hepatic enzymes and increases thyroid hormone clearance.

19. Which are the important adverse effects of propylthiouracil (PTU)?
     Answer: Hepatotoxicity (fulminant liver failure, boxed warning) is the key one. Agranulocytosis and ANCA-positive vasculitis also occur.

20. How is the water deficit calculated in hypernatremia?
     Answer: Water deficit = TBW × (serum Na / 140 − 1), where TBW = 0.6 × body weight in kg for men (0.5 for women).

21. A patient has metabolic acidosis and envelope-shaped crystals in the urine. What is the diagnosis?
     Answer: Ethylene glycol poisoning (calcium oxalate dihydrate crystals).

22. What is the treatment of ethylene glycol poisoning?
     Answer: Fomepizole and early hemodialysis.

23. What type of acidosis is seen in ethylene glycol poisoning?
     Answer: High anion gap metabolic acidosis

INI SS January 2027 Exam Analysis: Initial Candidate Feedback

From the initial post-paper reactions, it is apparent that the level of perceived difficulty seemed to vary with each of the specialities examined. While some candidates found Urology and Neurosurgery difficult, the feedback given for Cardiology was varied in nature. Others felt Plastic Surgery to be moderately tough, whereas Surgical Oncology was relatively easier. 

These are personal opinions given by the candidates and cannot be considered officially as INI SS subject-wise difficulty. One candidate’s opinion need not be representative of the entire exam paper.

Candidates can also check INI SS exam analysis for more clarity.

How the Questions and Solutions Get Compiled

The process is simple. Candidates share what they remember. Those recalls get compared with each other, then checked against standard textbooks and current guidelines. Answers go in only after that. If a question can't be verified, it won't be shown as confirmed. 

What to Do Right After the Exam

• Write down what you remember in the first hour. Recall fades fast. Don't wait till tomorrow.

• Note the topic, not just the question. A one-line note on the concept is enough.

• Check your answers later. Use the verified set once it's up, not a random group chat.

• Keep an eye on the result. It's expected around October 31. Details will be on official site.