Biochemistry
1 questionsFluoride, used in the collection of blood samples, inhibits which enzyme?
FMGE 2011 - Biochemistry FMGE Practice Questions and MCQs
Question 1: Fluoride, used in the collection of blood samples, inhibits which enzyme?
- A. Enolase (Correct Answer)
- B. Glucokinase
- C. Glucose-6-phosphatase
- D. Hexokinase
Explanation: ***Enolase*** - Fluoride is a potent inhibitor of **enolase**, an enzyme in the **glycolytic pathway**. - Inhibition of enolase prevents the conversion of **2-phosphoglycerate** to **phosphoenolpyruvate**, thereby halting glycolysis in collected blood samples. *Glucokinase* - Glucokinase is an enzyme primarily found in the **liver** and **pancreatic beta cells** that phosphorylates glucose. - Fluoride does not directly inhibit glucokinase; its primary site of action for preventing glycolysis in blood samples is enolase. *Glucose-6-phosphatase* - This enzyme is crucial for **glucose production** in the liver and kidneys, facilitating the dephosphorylation of **glucose-6-phosphate** to glucose. - Fluoride does not specifically target glucose-6-phosphatase as its mechanism for preventing glycolysis. *Hexokinase* - Hexokinase catalyzes the first step of glycolysis, phosphorylating **glucose to glucose-6-phosphate**. - While essential for glycolysis, hexokinase is not the primary target of fluoride's inhibitory action in blood collection, which specifically aims to stop the entire pathway further downstream at enolase.
Forensic Medicine
2 questionsFracture of hyoid bone is indicative of:
In dry drowning:
FMGE 2011 - Forensic Medicine FMGE Practice Questions and MCQs
Question 1: Fracture of hyoid bone is indicative of:
- A. Manual strangulation (Correct Answer)
- B. Ligature strangulation
- C. Hanging
- D. Bansdola
Explanation: ***Manual strangulation*** - Fracture of the **hyoid bone** is **most indicative** of **manual strangulation** due to direct, localized anteroposterior compression of the neck by fingers and thumbs. - The **greater cornu of hyoid** is most commonly fractured when forceful thumb pressure is applied to the front of the neck during manual throttling. - Among all forms of neck compression, manual strangulation has the **highest incidence** of hyoid fracture (30-50% of cases), especially in victims over 40 years when the hyoid is calcified. - This is considered a **classical sign** in forensic pathology for manual strangulation. *Ligature strangulation* - Involves constriction of the neck by a **ligature** (e.g., rope, cord), which causes more **circumferential compression** rather than localized pressure. - Hyoid fracture occurs in only 10-15% of cases, as the force is distributed around the neck rather than concentrated on the hyoid. - **Ligature marks** are the more characteristic finding. *Hanging* - Involves suspension of the body by a ligature around the neck, typically with an **oblique ligature mark** going upward toward the point of suspension. - Hyoid fracture is relatively **rare in suicidal hanging** (10-20%), but can occur in **judicial hanging with drop** or in elderly individuals with calcified hyoid. - The mechanism is more cervical spine injury and vascular compression rather than direct hyoid trauma. *Bansdola* - **Bansdola** refers to a method involving twisting a stick through a ligature around the neck (garroting). - While it can cause neck injuries, the mechanism is more similar to ligature strangulation with circumferential compression. - **Hyoid fracture** is less characteristic compared to manual strangulation.
Question 2: In dry drowning:
- A. Water does not enter lungs because of laryngeal spasm (Correct Answer)
- B. Seen in alcoholics due to drowning in shallow pool
- C. Death occurs due to sudden immersion in cold water
- D. Death occurs in few days of submersion episode
Explanation: ***Water does not enter lungs because of laryngeal spasm*** - In **dry drowning**, water does not directly enter the lungs but instead causes **laryngospasm**, leading to **suffocation**. - This **reflexive closure of the larynx** prevents water from entering the trachea and bronchial tree during submersion. *Seen in alcoholics due to drowning in shallow pool* - While alcohol consumption can be a factor in drowning incidents, **dry drowning** specifically refers to the mechanism of death due to laryngospasm, not necessarily the circumstances or risk factors. - Drowning in a shallow pool is a circumstance of drowning; it does not define the physiological mechanism of dry drowning. *Death occurs due to sudden immersion in cold water* - Death due to sudden immersion in cold water often leads to **cardiac arrest** (cold shock response) or **hypothermia**, which are different mechanisms from the laryngospasm seen in dry drowning. - Although these can be contributing factors in some drowning deaths, they are not the primary cause of death in dry drowning. *Death occurs in few days of submersion episode* - Death occurring days after a submersion episode is typical of **secondary drowning** (also known as delayed drowning or "wet drowning" with subsequent complications), where inhaled water causes **acute respiratory distress syndrome (ARDS)** or other pulmonary issues. - In **dry drowning**, death occurs rapidly due to **asphyxia** from laryngospasm and not delayed respiratory complications.
Internal Medicine
1 questionsGastric lavage is contraindicated in the following:
FMGE 2011 - Internal Medicine FMGE Practice Questions and MCQs
Question 1: Gastric lavage is contraindicated in the following:
- A. Barbiturate poisoning
- B. Paracetamol poisoning
- C. Kerosene poisoning (Correct Answer)
- D. Carbolic acid poisoning
Explanation: ***Kerosene poisoning*** - Gastric lavage is contraindicated in **hydrocarbon poisoning** like kerosene due to the high risk of **aspiration pneumonitis**. [1] - Aspiration of hydrocarbons can lead to severe **chemical pneumonitis**, acute respiratory distress syndrome (ARDS), and even death. *Barbiturate poisoning* - Gastric lavage can be useful in **barbiturate poisoning**, especially if presenting within 1-2 hours of ingestion, to remove unabsorbed drug. - It's part of the management strategy to reduce drug absorption and potentially speed up recovery. *Paracetamol poisoning* - **Gastric lavage** may be considered in paracetamol overdose, particularly if performed within 1-2 hours of ingestion, to remove unabsorbed drug. - However, **activated charcoal** is usually the preferred method for gastric decontamination in paracetamol overdose, followed by **N-acetylcysteine**. *Carbolic acid poisoning* - While typically considered a corrosive, gastric lavage might be cautiously used in **carbolic acid (phenol) poisoning** in specific circumstances, such as very early presentation or large ingestions, but it carries risks of esophageal injury. [2] - Dilution with milk or water is often preferred, but lavage should be avoided if there's evidence of significant caustic injury or perforation risk.
Obstetrics and Gynecology
1 questionsRate of uterine involution per day following delivery:
FMGE 2011 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 1: Rate of uterine involution per day following delivery:
- A. 2.5 cm/day
- B. 1.25 cm/day
- C. 1 cm/day (Correct Answer)
- D. 2.25 cm/day
Explanation: ***1 cm/day*** - Following delivery, the uterus typically descends into the pelvis at a rate of **1 cm (or 1 finger breadth) per day**. - This process of **uterine involution** allows the fundus to return to its pre-pregnancy size and location within approximately **6 weeks**. *2.5 cm/day* - This rate of uterine involution is **too rapid** and not consistent with the normal physiological process. - A uterus undergoing such rapid changes might suggest an underlying complication, but it's not the typical rate. *1.25 cm/day* - While closer to the correct rate, **1.25 cm/day** is still slightly faster than the average expected rate of uterine involution. - The standard measurement used in clinical practice and textbooks is generally **1 cm/day**. *2.25 cm/day* - This rate is also **significantly faster** than the normal physiological process of uterine involution. - Such an accelerated rate would not be expected in a healthy postpartum woman.
Pathology
1 questionsDiffuse axonal injury is characterized by lesion at:
FMGE 2011 - Pathology FMGE Practice Questions and MCQs
Question 1: Diffuse axonal injury is characterized by lesion at:
- A. Basal ganglia
- B. Corpus callosum
- C. White matter
- D. Junction of gray and white matter (Correct Answer)
Explanation: ***Junction of gray and white matter*** - Diffuse axonal injury (DAI) is characteristically located at the **gray-white matter junction** (interface between cortex and subcortical white matter) [1] - The differential density and movement between gray and white matter during **rotational acceleration-deceleration injuries** creates maximum shearing forces at this junction [1] - This is the **classic and most characteristic location** of DAI lesions, particularly in the **parasagittal white matter** of cerebral hemispheres - Other common sites include corpus callosum and dorsolateral brainstem, but the gray-white junction is the hallmark location *White matter* - While DAI does involve damage to white matter tracts and axons, simply stating "white matter" is too non-specific [1] - Many other conditions affect white matter (demyelination, ischemia, etc.) - The **distinguishing feature of DAI** is its predilection for the gray-white interface, not white matter in general *Corpus callosum* - The corpus callosum is indeed a common site for **visible macroscopic DAI lesions** and hemorrhages [1] - However, this is just one specific location rather than the characteristic pattern - DAI is more broadly characterized by lesions at gray-white junctions throughout the brain *Basal ganglia* - The basal ganglia are deep gray matter structures not typically involved in classic DAI - These structures may be affected by other traumatic injuries like **contusions** or **deep hemorrhages** - DAI predominantly affects the interface zones and white matter tracts, not deep gray matter nuclei **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1262-1264.
Pediatrics
1 questionsIn males, first pubertal sign is:
FMGE 2011 - Pediatrics FMGE Practice Questions and MCQs
Question 1: In males, first pubertal sign is:
- A. Pubic hair development
- B. Hoarseness of voice
- C. Penis enlargement
- D. Testicular enlargement (Correct Answer)
Explanation: ***Testicular enlargement*** - The first noticeable sign of puberty in males is typically **testicular enlargement**, followed by other changes. - This enlargement is due to the increase in the size of the **seminiferous tubules** and the production of sperm. *Pubic hair development* - While pubic hair development is an important pubertal sign, it usually follows **testicular enlargement**, appearing as the second or third sign. - It is driven by the increase in **adrenal androgens** and **testosterone**. *Hoarseness of voice* - The voice change or **deepening (hoarseness)** usually occurs later in puberty, as the larynx grows and vocal cords lengthen. - This is a secondary sexual characteristic mediated by **testosterone**. *Penis enlargement* - **Penis enlargement** typically begins after testicular enlargement has been established, usually around a Tanner stage 3. - This growth is also directly stimulated by increasing levels of **testosterone**.
Pharmacology
1 questionsAll are true about atropine poisoning, except
FMGE 2011 - Pharmacology FMGE Practice Questions and MCQs
Question 1: All are true about atropine poisoning, except
- A. Decreased temperature (Correct Answer)
- B. Dysarthria
- C. Dysphagia
- D. Dilated pupils
Explanation: ***Decreased temperature*** - Atropine is an **anticholinergic** agent that blocks muscarinic receptors, leading to decreased sweating and **hyperthermia** (increased temperature) in poisoning. - The phrase **"hot as a hare"** is a classic mnemonic for atropine poisoning, referring to this elevated body temperature. *Dysarthria* - **Dysarthria** (slurred or difficult speech) can be a symptom of atropine poisoning due to the **CNS effects** of anticholinergic toxicity. - Atropine crosses the blood-brain barrier and can cause a range of neurological symptoms including agitation, delirium, and impaired speech. *Dysphagia* - **Dysphagia** (difficulty swallowing) is a common symptom in atropine poisoning, related to the **drying of oral and pharyngeal secretions** due to anticholinergic effects. - The mouth becomes very dry, making it difficult to form a food bolus and swallow effectively. *Dilated pupils* - **Dilated pupils (mydriasis)** unresponsive to light are a hallmark sign of atropine poisoning, as atropine blocks parasympathetic innervation to the iris sphincter muscle. - This symptom is often described in the mnemonic as **"blind as a bat"** due to the associated blurred vision and photophobia.
Psychiatry
1 questionsAll are true about delirium tremens, except:
FMGE 2011 - Psychiatry FMGE Practice Questions and MCQs
Question 1: All are true about delirium tremens, except:
- A. Clouding of consciousness
- B. Visual hallucinations
- C. Normal sleep-wake cycle (Correct Answer)
- D. Coarse tremors
Explanation: ***Normal sleep wake cycle*** - Delirium tremens is characterized by a **disrupted sleep-wake cycle**, often with **insomnia** and **nocturnal exacerbation** of symptoms, making a normal sleep-wake cycle an incorrect statement. - The brain's regulatory mechanisms for sleep are significantly impaired due to the withdrawal of alcohol's suppressive effects. *Clouding of consciousness* - **Clouding of consciousness** is a hallmark feature of delirium tremens, representing a reduced awareness of the environment and impaired attention. - Patients often present with **disorientation** regarding time, place, and person. *Visual hallucinations* - **Visual hallucinations** are very common in delirium tremens, often described as vivid, frightening, and involving small animals or insects. - These hallucinations contribute to the patient's **agitation** and fear. *Coarse tremors* - **Coarse tremors**, particularly of the hands and face, are a classic physical sign of alcohol withdrawal and an integral part of delirium tremens. - These tremors are due to the **overactivity of the sympathetic nervous system** as the inhibitory effects of alcohol wear off.
Surgery
1 questionsSecondary hemorrhage is seen:
FMGE 2011 - Surgery FMGE Practice Questions and MCQs
Question 1: Secondary hemorrhage is seen:
- A. 6 h after surgery
- B. 24 h after surgery
- C. 7-14 days after surgery (Correct Answer)
- D. During anesthesia
Explanation: ***7-14 days after surgery*** - **Secondary hemorrhage** is typically caused by **infection** leading to erosion of blood vessels, which takes several days to develop. - This type of bleeding is characterized by onset more than 24 hours after surgery, commonly occurring between **7 to 14 days post-operatively**. *6 h after surgery* - Hemorrhage occurring within the first 24 hours (or particularly within the first few hours) is usually classified as **primary hemorrhage**. - **Primary hemorrhage** is often due to inadequate hemostasis during the initial surgical procedure. *24 h after surgery* - Bleeding at 24 hours post-surgery still falls under the definition of **primary or reactionary hemorrhage**. - **Reactionary hemorrhage** occurs within the first 24 hours due to dislodgement of clots or changes in blood pressure. *During anesthesia* - Hemorrhage during anesthesia is by definition **primary hemorrhage**, occurring contemporaneously with the surgical procedure. - This is directly related to surgical technique or patient factors during the operation itself.