Anatomy
1 questionsWhich of the following structures passes through Guyon's canal?
FMGE 2017 - Anatomy FMGE Practice Questions and MCQs
Question 51: Which of the following structures passes through Guyon's canal?
- A. Ulnar nerve (Correct Answer)
- B. Flexor carpi radialis
- C. Radial nerve
- D. Median nerve
Explanation: ### Ulnar nerve - The **ulnar nerve** passes through Guyon's canal, along with the ulnar artery, making it susceptible to compression here [1]. - Compression of the ulnar nerve in Guyon's canal can lead to motor and sensory deficits in its distribution, known as **ulnar tunnel syndrome** [1]. ### Flexor carpi radialis - The **flexor carpi radialis tendon** passes through a separate compartment in the carpal tunnel, distinct from Guyon's canal. - Its primary function is wrist flexion and radial deviation, and it is not associated with Guyon's canal. ### Radial nerve - The **radial nerve** courses along the lateral aspect of the forearm and hand and does not pass through Guyon's canal. - Its injury typically manifests as **wrist drop** and sensory loss over the dorsum of the hand. ### Median nerve - The **median nerve** passes through the carpal tunnel, which is medial to Guyon's canal in the wrist [1]. - Entrapment of the median nerve in the carpal tunnel causes **carpal tunnel syndrome**, characterized by symptoms in the thumb, index, middle, and radial half of the ring finger [1].
Biochemistry
1 questionsWernicke's encephalopathy is due to deficiency of:
FMGE 2017 - Biochemistry FMGE Practice Questions and MCQs
Question 51: Wernicke's encephalopathy is due to deficiency of:
- A. B6
- B. Thiamine (Correct Answer)
- C. B12
- D. Niacin
Explanation: ***Thiamine*** - **Wernicke's encephalopathy** is a serious neurological disorder directly caused by a severe deficiency of **thiamine (vitamin B1)**. - Thiamine is crucial for **glucose metabolism** in the brain; its deficiency impairs energy production, leading to neuronal damage and the characteristic symptoms of confusion, ataxia, and ophthalmoplegia. *B6* - Deficiency of **vitamin B6 (pyridoxine)** can cause peripheral neuropathy, seizures, and microcytic anemia. - It is not the primary cause of the acute neurological syndrome seen in Wernicke's encephalopathy. *B12* - Deficiency of **vitamin B12 (cobalamin)** is associated with megaloblastic anemia and subacute combined degeneration of the spinal cord. - While it can cause neurological symptoms, they differ from the specific triad of Wernicke's encephalopathy. *Niacin* - Deficiency of **niacin (vitamin B3)** causes **pellagra**, characterized by dermatitis, diarrhea, and dementia. - Although it involves neurological symptoms (dementia), the presentation is distinct from Wernicke's encephalopathy.
Internal Medicine
2 questionsPainless burn in hand is seen in:
Which type of anemia is seen in patients of rheumatoid arthritis?
FMGE 2017 - Internal Medicine FMGE Practice Questions and MCQs
Question 51: Painless burn in hand is seen in:
- A. SLE
- B. Mononeuritis multiplex
- C. Diabetes mellitus
- D. Syringomyelia (Correct Answer)
Explanation: ***Syringomyelia*** - Syringomyelia is characterized by a fluid-filled cavity (syrinx) within the **spinal cord**, which can damage nerve fibers responsible for pain and temperature sensation. - This damage leads to a **dissociated sensory loss**, where patients lose the ability to feel pain and temperature but retain touch and vibration, making them susceptible to **painless burns** or injuries. *SLE* - **Systemic lupus erythematosus (SLE)** is an autoimmune disease that can affect various organs, but it does not typically cause a dissociated sensory loss leading to painless burns. - Neurological manifestations in SLE are diverse, ranging from headaches to seizures, but they rarely involve selective loss of pain and temperature sensation in a way that causes painless burns. *Mononeuritis multiplex* - **Mononeuritis multiplex** involves damage to at least two distinct nerve areas, often causing pain, weakness, and sensory loss in a patchy distribution, but usually includes pain. - This condition is not typically characterized by a complete and selective loss of **pain and temperature sensation** in a way that would lead to painless burns without other significant sensory deficits. *Diabetes mellitus* - **Diabetic neuropathy** commonly causes sensory loss, often a "stocking-glove" distribution, which can lead to painless injuries due to reduced pain sensation. - However, diabetic neuropathy primarily affects **small fiber nerves** and is more generalized, unlike the more selective **dissociated sensory loss** seen in syringomyelia that specifically explains painless burns.
Question 52: Which type of anemia is seen in patients of rheumatoid arthritis?
- A. Normocytic and normochromic anemia (Correct Answer)
- B. Normocytic and hypochromic anemia
- C. Sideroblastic anemia
- D. Macrocytic anemia
Explanation: The anemia seen in **rheumatoid arthritis (RA)** is typically **anemia of chronic disease**, characterized by **normal-sized red blood cells (normocytic)** and **normal hemoglobin content (normochromic)**. This type of anemia is caused by **chronic inflammation** leading to impaired iron utilization and reduced erythropoiesis [1], [2]. This type of anemia is associated with inflammation-mediated upregulation of hepcidin [1]. Although iron deficiency can coexist in RA patients, the primary anemia of chronic disease mechanism generally results in normochromic cells [2].
Obstetrics and Gynecology
1 questionsWhich of the following is the most sensitive and specific test during antenatal check-up for a pregnant lady with family history of Thalassemia?
FMGE 2017 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 51: Which of the following is the most sensitive and specific test during antenatal check-up for a pregnant lady with family history of Thalassemia?
- A. P. smear and reticulocyte count
- B. Hemoglobin electrophoresis
- C. High performance liquid chromatography (Correct Answer)
- D. NESTROFT
Explanation: ***High performance liquid chromatography*** - **HPLC** is considered the most sensitive and specific test for diagnosing thalassemia and other hemoglobinopathies due to its ability to accurately quantify different hemoglobin fractions. - It provides a detailed **hemoglobin profile**, allowing for precise identification of abnormal hemoglobins and accurate assessment of thalassemia carrier status. *P. smear and reticulocyte count* - A **peripheral smear** can show microcytic, hypochromic red blood cells, which are characteristic of thalassemia, but this finding is not specific. - A **reticulocyte count** can indicate increased red blood cell production, but it is a general indicator of hemolysis or bone marrow activity and not specific for thalassemia. *Hemoglobin electrophoresis* - **Hemoglobin electrophoresis** separates different hemoglobin types based on their electrical charge, which is useful for identifying hemoglobinopathies. - While it can detect abnormal hemoglobins, its resolution and quantitative accuracy are generally lower than that of HPLC, making it less sensitive for detecting subtle variations or quantifying small amounts of abnormal hemoglobin. *NESTROFT* - **NESTROFT** (Naked eye single tube red cell osmotic fragility test) is a screening test used to detect beta-thalassemia carriers by assessing red cell osmotic fragility. - It is a good, inexpensive screening tool but lacks the sensitivity and specificity of definitive diagnostic tests like HPLC, and positive results require confirmation with other methods.
Pharmacology
4 questionsAtorvastatin is used as an anti-dyslipidemic drug. These drugs inhibit their target enzyme by:-
The shortest acting opioid is:-
Which of the following anti-diabetic drugs is associated with weight gain?
All of the following are actions produced by mu receptors of morphine except:-
FMGE 2017 - Pharmacology FMGE Practice Questions and MCQs
Question 51: Atorvastatin is used as an anti-dyslipidemic drug. These drugs inhibit their target enzyme by:-
- A. Noncompetitive inhibition
- B. Competitive inhibition (Correct Answer)
- C. Irreversible inhibition
- D. Uncompetitive inhibition
Explanation: ***Competitive inhibition*** - Atorvastatin is a **statin**, which acts as a **competitive inhibitor** of **HMG-CoA reductase**, the rate-limiting enzyme in cholesterol synthesis. - It competes with the natural substrate, HMG-CoA, for binding to the **active site of the enzyme**, thereby reducing cholesterol production. *Uncompetitive* - **Uncompetitive inhibitors** bind only to the **enzyme-substrate complex**, not to the free enzyme. - This type of inhibition is characterized by a decrease in both **apparent Vmax** and **apparent Km**. *Noncompetitive inhibition* - **Noncompetitive inhibitors** bind to an allosteric site on the enzyme, distinct from the active site, and can bind to either the **free enzyme or the enzyme-substrate complex**. - This leads to a decrease in the **apparent Vmax** but does not affect Km. *Irreversible inhibition* - **Irreversible inhibitors** form a **strong covalent bond** with the enzyme, permanently inactivating it. - Statins do not form covalent bonds with HMG-CoA reductase; their inhibition is **reversible** upon drug discontinuation.
Question 52: The shortest acting opioid is:-
- A. Remifentanil (Correct Answer)
- B. Fentanyl
- C. Alfentanil
- D. Sufentanil
Explanation: ***Remifentanil*** - **Remifentanil** is an **ultra-short-acting opioid** due to its unique metabolism by **non-specific plasma and tissue esterases**. - Its rapid metabolism results in a very short context-sensitive half-time, meaning its effects **terminate quickly** regardless of infusion duration. *Alfentanil* - **Alfentanil** is a **short-acting opioid** but its duration of action is longer than remifentanil. - It is eliminated primarily by **hepatic metabolism**, which is slower than esterase-based metabolism. *Fentanyl* - **Fentanyl** is a **potent synthetic opioid** with an intermediate duration of action. - Its elimination is dependent on **hepatic metabolism**, and it has a longer context-sensitive half-time compared to remifentanil. *Sufentanil* - **Sufentanil** is a **very potent opioid** with a longer duration of action than fentanyl and alfentanil. - Its metabolism is hepatic, leading to a **longer elimination half-life** and thus a more prolonged effect.
Question 53: Which of the following anti-diabetic drugs is associated with weight gain?
- A. Pioglitazone (Correct Answer)
- B. Acarbose
- C. Metformin
- D. Sitagliptin
Explanation: ***Pioglitazone*** - **Pioglitazone**, a **thiazolidinedione**, primarily works by improving insulin sensitivity in peripheral tissues. - Its mechanism of action can lead to **fluid retention** and **increased subcutaneous fat storage**, both contributing to weight gain. *Acarbose* - **Acarbose** is an **alpha-glucosidase inhibitor** that delays carbohydrate absorption in the gut. - This mechanism typically leads to a **neutral effect or slight weight loss**, as fewer calories are rapidly absorbed. *Metformin* - **Metformin**, a **biguanide**, reduces hepatic glucose production and improves insulin sensitivity. - It is often associated with **weight neutrality or modest weight loss**, and is not known to cause weight gain. *Sitagliptin* - **Sitagliptin** is a **dipeptidyl peptidase-4 (DPP-4) inhibitor** that enhances incretin effects. - This class of drugs is generally considered **weight-neutral** and rarely causes weight gain.
Question 54: All of the following are actions produced by mu receptors of morphine except:-
- A. Respiratory depression
- B. Hyperalgesia (Correct Answer)
- C. Miosis
- D. Decreased GI motility
Explanation: ***Hyperalgesia***- **Hyperalgesia** is not a direct effect of **μ-opioid receptor activation**; in fact, μ-receptor activation causes **analgesia**.- While chronic opioid use can lead to **opioid-induced hyperalgesia**, this is a complex phenomenon involving adaptations to long-term exposure, not an acute action of the receptor itself.*Respiratory depression*- Activation of **μ-opioid receptors** in the **brainstem** leads to a dose-dependent decrease in respiratory rate and depth [1].- This effect is mediated by reduced sensitivity of respiratory centers to **CO2 levels**, making it a major concern in opioid overdose [1].*Miosis*- **Miosis** (pinpoint pupils) is a classic sign of **opioid intoxication** and results from excitatory actions of μ-opioid receptor activation on the **Edinger-Westphal nucleus** of the oculomotor nerve [1, 3].- This effect is mediated through inhibition of **GABAergic neurons**, leading to increased parasympathetic outflow to the iris sphincter.*Decreased GI motility*- Activation of **μ-opioid receptors** in the **gastrointestinal tract** reduces peristalsis, increases water reabsorption, and decreases secretions [1, 2].- This leads to **constipation**, a very common and persistent side effect of opioid use [1, 2].
Radiology
1 questionsWhich of the following is a gold standard investigation for diagnosis of renal stone?
FMGE 2017 - Radiology FMGE Practice Questions and MCQs
Question 51: Which of the following is a gold standard investigation for diagnosis of renal stone?
- A. Helical CT with Non-contrast (Correct Answer)
- B. USG
- C. Helical CT with contrast
- D. MRI
Explanation: ***Helical CT with Non-contrast*** - **Non-contrast helical CT** (also known as CT KUB) is considered the **gold standard** due to its high sensitivity and specificity for detecting all types of urinary tract calculi, regardless of their composition. - It rapidly identifies stones, their location, size, and associated complications like **hydronephrosis**, without the need for IV contrast. *USG* - **Ultrasound** is a good initial screening tool and can detect larger stones and hydronephrosis, but its sensitivity is lower than CT, especially for smaller stones or those in the ureters. - Its diagnostic accuracy is highly **operator-dependent**, and it may miss stones obscured by bowel gas or bone. *Helical CT with contrast* - While helical CT is excellent, the use of **IV contrast** is generally avoided for routine stone detection as it can obscure the highly dense stones from the contrast-enhanced renal collecting system. - Contrast is primarily useful for evaluating **renal masses**, infection, or vascular abnormalities, not for primary stone diagnosis. *MRI* - **MRI** has limited utility in detecting typical renal stones because most calculi are not well-visualized on standard MRI sequences due to their lack of free water and low signal intensity. - It may be considered in specific populations, such as **pregnant women** or children, to avoid radiation exposure, but it is not the gold standard for stone detection.