Preparing for the DNB CET — Super Speciality? These 10 sample questions mirror the exam's structure — covering clinical reasoning, image interpretation, and applied basic sciences. Each question includes a detailed solution that explains the why, not just the answer. Use them to gauge your readiness and identify weak areas.
Section 1: Clinical Cardiology
Q1. A 55-year-old male presents with acute-onset chest pain and ST-elevation in leads II, III, and aVF. Which artery is most likely occluded?
- A) Left anterior descending
- B) Left circumflex
- C) Right coronary artery
- D) Left main coronary artery
Solution: The correct answer is C. Inferior wall MI (ST-elevation in II, III, aVF) typically involves the right coronary artery (RCA) in 80% of cases. The RCA supplies the inferior wall via the posterior descending artery. Left anterior descending occlusion causes anterior wall changes, while circumflex occlusion leads to lateral wall involvement.
Q2. A patient with dilated cardiomyopathy has a QRS duration of 160 ms and left bundle branch block. Which device therapy is indicated?
- A) Implantable cardioverter-defibrillator (ICD)
- B) Cardiac resynchronization therapy (CRT)
- C) Pacemaker
- D) No device needed
Solution: The correct answer is B. CRT is indicated in symptomatic heart failure patients with LVEF ≤35%, QRS ≥150 ms, and LBBB morphology. This patient meets all criteria. CRT improves ventricular synchrony, ejection fraction, and survival.
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Section 2: Neurology & Neurosurgery
Q3. A 30-year-old woman presents with sudden severe headache and neck stiffness. CT head shows subarachnoid hemorrhage. What is the first-line imaging to identify the cause?
- A) MR angiography
- B) CT angiography
- C) Digital subtraction angiography
- D) Transcranial Doppler
Solution: The correct answer is B. CT angiography is the initial non-invasive test of choice to detect an intracranial aneurysm in suspected SAH. Digital subtraction angiography remains the gold standard but is reserved for cases where CTA is inconclusive or for endovascular planning.
Q4. Which of the following is a characteristic finding in Guillain-Barré syndrome?
- A) Fever at onset
- B) Ascending paralysis with areflexia
- C) Unilateral facial weakness
- D) Sensory level on examination
Solution: The correct answer is B. GBS typically presents with ascending, symmetric weakness and areflexia. Fever is not typical. Unilateral facial weakness suggests Bell's palsy. A sensory level is more indicative of spinal cord pathology.
Section 3: Gastroenterology & Hepatology
Q5. A 45-year-old with cirrhosis and ascites develops fever, abdominal pain, and worsening encephalopathy. What is the most likely diagnosis?
- A) Spontaneous bacterial peritonitis (SBP)
- B) Hepatorenal syndrome
- C) Variceal hemorrhage
- D) Hepatic encephalopathy alone
Solution: The correct answer is A. SBP is a common infection in cirrhotic patients with ascites. The triad of fever, abdominal pain, and altered mental status is classic. Diagnosis is confirmed by ascitic fluid PMN count ≥250 cells/μL. Treatment is empiric third-generation cephalosporins.
Q6. Which of the following is the most sensitive marker for hepatocellular carcinoma?
- A) AFP
- B) Des-gamma-carboxy prothrombin (DCP)
- C) CA 19-9
- D) CEA
Solution: The correct answer is B. DCP (also known as PIVKA-II) has higher sensitivity than AFP for HCC, especially in early stages. AFP can be elevated in benign liver disease. CA 19-9 is used for pancreatic cancer, CEA for colorectal cancer.
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Section 4: Nephrology & Urology
Q7. A patient with nephrotic syndrome develops acute kidney injury after starting an ACE inhibitor. What is the most likely cause?
- A) Acute interstitial nephritis
- B) Prerenal azotemia from hypotension
- C) Bilateral renal artery stenosis
- D) Drug-induced thrombotic microangiopathy
Solution: The correct answer is C. In nephrotic syndrome, ACE inhibitors reduce efferent arteriolar resistance, decreasing glomerular filtration pressure. In bilateral renal artery stenosis, this can precipitate acute renal failure. This is a classic exam pearl.
Q8. Which of the following is the first-line treatment for benign prostatic hyperplasia with moderate symptoms?
- A) Finasteride
- B) Tamsulosin
- C) Transurethral resection of prostate
- D) Watchful waiting
Solution: The correct answer is B. Alpha-blockers like tamsulosin provide rapid symptom relief by relaxing smooth muscle in the prostate and bladder neck. Finasteride is used for larger prostates but takes months. TURP is for refractory cases. Watchful waiting is for mild symptoms.
Section 5: Critical Care & Emergency Medicine
Q9. A 60-year-old with septic shock requires vasopressor support. Which vasopressor is first-line?
- A) Dopamine
- B) Norepinephrine
- C) Epinephrine
- D) Vasopressin
Solution: The correct answer is B. Norepinephrine is the first-line vasopressor in septic shock per Surviving Sepsis Campaign guidelines. It increases mean arterial pressure with less tachycardia than dopamine. Vasopressin is a second-line agent.
Q10. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation. Which lung-protective strategy is recommended?
- A) Tidal volume 10 mL/kg ideal body weight
- B) Tidal volume 6 mL/kg ideal body weight
- C) Plateau pressure >30 cm H2O
- D) High FiO2 to maintain SpO2 >95%
Solution: The correct answer is B. Low tidal volume ventilation (6 mL/kg predicted body weight) reduces ventilator-induced lung injury. Plateau pressure should be kept ≤30 cm H2O. Permissive hypercapnia is often tolerated. High FiO2 can cause oxygen toxicity.