NIMSET: Medical Superspeciality (DM/MCh) Examples

Each question is followed by 4 alternatives. Answer represents the one that is most appropriate among the alternatives

Cardiology

Ques Given below is the schematic representation of Doppler echocardiographic evaluation of aortic stenosis.

Which one of the following is the correct formula for calculating the aortic valve area (A2)

(A) A1 x V1 x V2

(B) (V1 x V2) / A1

(D) (A1 x V1) / V2

Ques A 15 day old child is admitted with congestive heart failure. Physical examination reveals no visible cyanosis. Cardiac examination reveals a single S2, a constant ejection click, grade II/VI ejection systolic muumur in the left parasternal area and a mid diastolic murmur in the apex. Which of the following conditions is the most likely diagnosis.

(A) a large perimembranous ventricular septal defect

(B) common AV canal defect

(D) truncus arteriosus

Ref Moss & Adarns, Heart Disease in Infants Children &Adolescents,5th ed,1995, Pg1030

Ans D

Cardiothoracic Surgery

Ques Given below is the schematic representation of chest wall movement in a patient who is in respiratory distress after sustaining polytrauma in a road traffic accident.

The condition is most likely to result from which one of the following conditions

(A) diaphragmatic rupture

(B) hemopneumothorax

(D) fat embolism.

Ques A 50-year old man who underwent coronary artery bypass surgery was found to have excess blood in the chest drain in the first hour after surgery. Activated clotting time (ACT) was 300 seconds (normal 120-150 seconds). The most appropriate initial treatment is

(A) incremental protamine administration

(B) aprotonin (trasylol)

(D) vitamin K administration

Clinical Pharmacology and Therapeutics

Ques Given below is the dose-plasma drug concentration curve for a particular drug.

The curve is typical for a drug

(A) which has concentration independent metabolism (e.g. lidocaine or lignocaine)

(B) which has very short half life (e.g. esmolol)

(D) for which therapeutic drug monitoring is essential (e.g. phenytoin)

Ques A young girl with history of upper respiratory tract infection was given a common sulfonamide antibiotic (septran). Soon after she complained of abdominal pain and cramps with restlessness. On re-examination the next day she was found to have motor weakness (proximal greater than distal) and normal reflexes. Which of the following is the most likely diagnosis

(A) Gullain Barre syndrome

(B) polymyositis

(D) acute intermittent porphyria

Nephrology

Ques A 30-year old man presented with fever, epistaxis, cough, and oliguria. Relevant investigations showed nodular infiltrates in the lung, active urine sediment, and advanced renal failure. Biopsy from lung lesions showed necrotizing granulomatous inflammation. The serological marker most specific for the suspected disease is

(A) p-ANCA

(B) anti Sm

(D) anti U1 RNP

Ques A child aged 4 years presented with edema and a bland urine sediment. Twenty-four hour protein excretion in the urine was 3.6 gm. The most appropriate next step in the management is

(A) kidney biopsy

(B) intravenous pyelogram

(D) trial of steroid therapy

Neurosciences

Ques An 60-year old hypertensive and diabetic man presented with loss of both superficial (pain and temperature) and deep (touch and proprioception) sensation on one half of body and later had severe agonizing pain on affected area. The most probable site of lesion is in the distribution of

(A) posterior inferior cerebellar artery

(B) middle cerebral artery

(D) posterior cerebral artery

Ques Given below is the diagram of circle of Willis with various sites indicated by numbers. An expanding aneurysm at which site typically causes ptosis as the presenting manifestation

(A) site 1

(B) site 2

(D) site 4

Plastic Surgery

Ques In the diagram shown below, the individual is attempting to pinch a paper between the thumb and the fingers. Weakness of a muscle "A" in the right thumb results in flexion due to the overaction of a muscle "B". The muscles "A" and "B" respectively are

(A) flexor pollicis longus and flexor pollicis brevis

(B) abductor pollicis longus and flexor pollicis longus

(D) extensor digitorum and flex
Urology

Ques A 52-year old man presented with urinary frequency and urgency. The American Urological Association (AUA) symptom score was 10. His prostate specific antigen (PSA) was 3.9 ng/ml. In the previous year, his PSA was 2.5 ng/ml detected in a screening programme. The digital rectal examination was normal. The most appropriate management modality is

(A) watchful waiting and followup with repeat yearly PSA estimation

(B) transurethral resection (TUR) biopsy

(D) cystourethroscopy