FMGE 2017 Practice Questions

Q: Tendons in the 2nd compartment of wrist?

Extensor carpi radialis brevis and longus. ***Extensor carpi radialis brevis and longus*** - The **second dorsal compartment** of the wrist houses the tendons of the **extensor carpi radialis longus (ECRL)** and **extensor carpi radialis brevis (ECRB)** muscles [1]. - These muscles are primarily responsible for **wrist extension** and **radial deviation** of the hand [1]. *Extensor pollicis longus* - The **extensor pollicis longus (EPL)** tendon is located in the **third dorsal compartment** of the wrist [1]. - Its main function is to **extend the thumb's interphalangeal joint** and contributes to extension and adduction of the thumb. *Extensor pollicis brevis* - The **extensor pollicis brevis (EPB)** tendon is found in the **first dorsal compartment** of the wrist [1]. - It works with the abductor pollicis longus to form the **anatomical snuffbox** and primarily **extends the metacarpophalangeal joint** of the thumb [1]. *Abductor pollicis longus* - The **abductor pollicis longus (APL)** tendon is also located in the **first dorsal compartment** of the wrist [1]. - Its primary actions are to **abduct** (move away from the palm) and **extend the thumb** at the carpometacarpal joint [1].

Q: Which of the following conditions should not be considered if JVP rises on deep inspiration?

Atrial fibrillation. The phenomenon of JVP rising on deep inspiration is known as **Kussmaul's sign**, which is indicative of impaired right ventricular filling and is not typically associated with **atrial fibrillation**. In **complete heart block**, there is dissociation between atrial and ventricular contractions. This can lead to **cannon 'a' waves** in the JVP, which are large prominent 'a' waves caused by right atrial contraction against a closed tricuspid valve [1]. **Constrictive pericarditis** is characterized by a rigid pericardium that restricts diastolic filling of the right ventricle. This condition is a classic cause of **Kussmaul's sign**, where the JVP rises paradoxically during inspiration due to increased venous return that cannot be accommodated by the constricted ventricle. **Restrictive cardiomyopathy** involves impaired diastolic filling of the ventricles due to myocardial stiffness. It can also cause a paradoxical rise in JVP during inspiration (**Kussmaul's sign**) because the stiffened right ventricle cannot adequately accommodate the inspiratory increase in venous return.

Q: Initial treatment for management of mild to moderate Crohn's disease is:

Budesonide. ***Budesonide*** - **Budesonide** is a **steroid** with high first-pass metabolism, meaning it works locally in the gastrointestinal tract with minimal systemic effects, making it suitable for mild to moderate Crohn's disease. - It is effective in inducing remission for mild to moderate ileocolonic Crohn's disease, with a better safety profile than systemic corticosteroids. *Mesalamine* - **Mesalamine (5-ASA)** is primarily used for **ulcerative colitis** and has limited efficacy in Crohn's disease, especially for moderate disease. - While it can be considered for very mild Crohn's disease, its role is often debated and not a first-line agent for moderate cases. *Infliximab* - **Infliximab** is a **biologic agent (anti-TNF-α)** used for moderate to severe Crohn's disease or for patients who have failed conventional therapy. - It works by blocking a key inflammatory cytokine and is not typically used as initial treatment for mild disease due to its potency and potential side effects. *Sulfasalazine* - **Sulfasalazine** is more effective in **colonic Crohn's disease** and **ulcerative colitis**, and its efficacy in small bowel Crohn's disease is limited [1]. - Many patients experience side effects such as **nausea**, **headaches**, and **allergic reactions**, limiting its use as a first-line agent.

Q: Which of the following leads to development of SIADH?

CNS disorders. ***CNS disorders*** - Neurological conditions such as **stroke**, hemorrhage, infection, and trauma can cause inappropriate **ADH release** due to damage or irritation of the hypothalamus or posterior pituitary [2]. - This leads to increased water reabsorption and subsequent **hyponatremia** characteristic of SIADH [1]. *Lung cancer* - Certain types of **lung cancer**, particularly **small cell lung carcinoma (SCLC)**, are known to produce ADH ectopically, leading to SIADH. - This represents a **paraneoplastic syndrome**, where the tumor cells independently synthesize and secrete ADH. *Pituitary adenoma* - While pituitary adenomas can cause various endocrine dysfunctions, they are generally **not a direct cause of SIADH**. - **SIADH** typically results from unregulated ADH secretion rather than a primary pituitary tumor's overproduction of ADH itself. *All of the options* - Although **lung cancer** and **CNS disorders** are well-established causes of SIADH, **pituitary adenomas** are not a common or direct cause. - Therefore, choosing "all of the options" would be incorrect due to the inclusion of pituitary adenoma as a direct cause.

Q: Which of the following is the best investigation for acute gout?

Uric acid in synovial fluid. ***Uric acid in synovial fluid*** - The definitive diagnosis of acute gout is established by identifying **negatively birefringent needle-shaped uric acid crystals** within the synovial fluid of the affected joint [1]. - This method directly confirms the presence of **monosodium urate crystals**, which are the hallmark of gout, offering diagnostic certainty [1]. *Uric acid in urine* - While urinary uric acid levels can help assess uric acid excretion, they are not diagnostic for acute gout and do not directly show the presence of **intra-articular crystals**. - This test is more relevant for investigating the **cause of hyperuricemia** (overproduction vs. underexcretion) rather than diagnosing an acute flare. *Anti CCP antibodies* - **Anti-cyclic citrullinated peptide (anti-CCP) antibodies** are markers for **rheumatoid arthritis** and are not relevant for the diagnosis of acute gout. - Their presence indicates an autoimmune inflammatory condition distinct from crystal-induced arthropathy. *Serum uric acid* - Serum uric acid levels are often elevated during an acute gout flare (**hyperuricemia**), but this is not diagnostic, as many individuals with hyperuricemia never develop gout [1]. - Approximately 30% of patients may have **normal serum uric acid levels** during an acute attack, making it an unreliable sole diagnostic criterion.

Q: A 25 year old lady presented with curdy white discharge from the vagina is likely to be suffering from:-

Candida vaginitis. ***Candida vaginitis*** - **Candida vaginitis** is characterized by a **curdy white vaginal discharge**, often described as cottage cheese-like. - This condition is caused by an overgrowth of *Candida* species, typically *Candida albicans*, and is associated with **vaginal itching, burning**, and **dyspareunia**. *Trichomoniasis* - **Trichomoniasis** typically presents with a **frothy, greenish-yellow discharge** and a **foul odor**. - It often causes **severe itching, redness, and irritation**, which differ from the curdy discharge described. *Gonococcal vulvovaginitis* - **Gonococcal vulvovaginitis** in women can cause a **purulent or mucopurulent discharge**, often yellowish. - While it can lead to vaginal irritation, a **curdy white discharge** is not its classic presentation. *Chlamydia trachomatis* - **Chlamydia trachomatis** often causes an **asymptomatic infection**; when symptoms occur, they may include a **mucopurulent discharge**. - A **curdy white discharge** is not a typical symptom of *Chlamydia* infection.

Q: Which of the following breast lesions characteristically shows central necrosis with calcification?

Comedo sub type of DCIS. ***Comedo sub type of DCIS*** - This subtype is characterized by high-grade pleomorphic tumor cells with **central necrosis** within the ducts [1]. - The necrotic debris often calcifies, leading to characteristic **microcalcifications** visible on mammograms [2]. *Cribriform sub type of DCIS* - This subtype features uniform cells forming gland-like spaces within the ducts, but **typically lacks significant central necrosis** and extensive calcification [1]. - It usually presents with a **low nuclear grade** and less aggressive features compared to comedo DCIS [1]. *Lobular carcinoma in situ* - Characterized by small, discohesive cells filling and expanding the acini of the lobules, but it **does not involve ductal necrosis or calcification**. - It is often an **incidental finding** and represents a marker for increased risk of invasive carcinoma in either breast, rather than an obligate precursor lesion visible with calcifications. *Colloid carcinoma* - This is a type of **invasive ductal carcinoma** where tumor cells float in abundant extracellular mucin. - While it is an invasive cancer, it does not typically present with the extensive **ductal necrosis and calcification** seen in comedo DCIS. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1062-1064. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 452-453.

Q: Which of the following local anesthetics is the most common cause of methemoglobinemia?

Benzocaine. ***Benzocaine***- **Benzocaine** is an ester-type local anesthetic that is the **most common cause of methemoglobinemia** among local anesthetics, especially when used in high doses or on mucous membranes due to its rapid absorption.- Its metabolic byproducts, particularly **aniline derivatives**, are potent oxidizers of hemoglobin, converting the ferrous iron (Fe2+) to ferric iron (Fe3+), thus forming methemoglobin which cannot bind oxygen.- **FDA warnings** have been issued regarding benzocaine-induced methemoglobinemia, particularly with topical spray preparations.*Lignocaine*- **Lignocaine** (lidocaine) is an amide-type local anesthetic and is **rarely associated** with methemoglobinemia.- While it can theoretically cause it in very high doses, it is significantly **less potent** in this regard compared to benzocaine.*Chloroprocaine*- **Chloroprocaine** is an ester-type local anesthetic with a very **short duration of action** due to rapid hydrolysis by plasma cholinesterases.- This rapid metabolism typically limits systemic exposure and makes it an **uncommon cause** of methemoglobinemia despite being an ester.*Prilocaine*- **Prilocaine** is an amide-type local anesthetic that can also cause methemoglobinemia, particularly at **higher doses (>600mg)** [1, 2].- It works through its metabolite, **o-toluidine**, which is an oxidizing agent [1].- However, **benzocaine** is more consistently linked to this adverse effect in clinical practice and has more documented case reports.

Q: Disulfiram is a type of:-

Aversion therapy. **Aversion therapy** - **Disulfiram** works by inhibiting aldehyde dehydrogenase, leading to the accumulation of acetaldehyde when alcohol is consumed, which causes unpleasant symptoms like flushing, nausea, and vomiting. - This creates an **aversive reaction** to alcohol, which discourages further drinking, making it a form of aversion therapy. *Anticraving therapy* - While disulfiram can indirectly reduce cravings by making alcohol consumption unpleasant, its primary mechanism is not to directly modulate craving pathways in the brain. - Drugs like **naltrexone** or **acamprosate** are more commonly categorized as specific anticraving agents for alcohol dependence. *Detoxification* - **Detoxification** refers to the supervised withdrawal from a substance to manage acute withdrawal symptoms and stabilize the patient. - Disulfiram is used after detoxification to help maintain abstinence, not during the acute withdrawal phase. *Opioid management therapy* - **Opioid management therapy** involves medications like **methadone** or **buprenorphine** used to treat opioid dependence. - Disulfiram is specifically used for **alcohol use disorder** and has no role in managing opioid dependence.

Q: Venlafaxine comes under which class of drugs?

Serotonin-norepinephrine reuptake inhibitor (SNRI). ***Serotonergic noradrenergic reuptake inhibitor*** - **Venlafaxine** is an antidepressant that works by inhibiting the reuptake of both **serotonin** and **norepinephrine**, making it a **Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)**. - This dual mechanism contributes to its efficacy in treating **major depressive disorder**, **anxiety disorders**, and **neuropathic pain**. *Monoamine oxidase inhibitors* - **MAOIs** inhibit the enzyme **monoamine oxidase**, which metabolizes neurotransmitters like **serotonin**, **norepinephrine**, and **dopamine**. - They are associated with significant **food and drug interactions**, unlike venlafaxine. *Serotonin receptor antagonist* - These drugs *block* **serotonin receptors**, often used as **antiemetics** (e.g., ondansetron) or in some **antipsychotics**. - They do not primarily increase serotonin or norepinephrine levels via reuptake inhibition. *Selective serotonin reuptake inhibitor* - **SSRIs** (e.g., fluoxetine, sertraline) primarily inhibit the reuptake of **serotonin**, with minimal effect on other neurotransmitters. - While venlafaxine affects serotonin, it also significantly impacts norepinephrine, distinguishing it from SSRIs.

Question 1

Tendons in the 2nd compartment of wrist?

Accepted Answer

Extensor carpi radialis brevis and longus

Answer

Extensor pollicis longus

Answer

Extensor pollicis brevis

Answer

Abductor pollicis longus

Question 2

Which of the following conditions should not be considered if JVP rises on deep inspiration?

Accepted Answer

Atrial fibrillation

Answer

Complete heart block

Answer

Constrictive pericarditis

Answer

Restrictive cardiomyopathy

Question 3

Initial treatment for management of mild to moderate Crohn's disease is:

Accepted Answer

Budesonide

Answer

Mesalamine

Answer

Infliximab

Answer

Sulfasalazine

Question 4

Which of the following leads to development of SIADH?

Accepted Answer

CNS disorders

Answer

Lung cancer

Answer

Pituitary adenoma

Answer

All of the options

Question 5

Which of the following is the best investigation for acute gout?

Accepted Answer

Uric acid in synovial fluid

Answer

Uric acid in urine

Answer

Anti CCP antibodies

Answer

Serum uric acid

Question 6

A 25 year old lady presented with curdy white discharge from the vagina is likely to be suffering from:-

Accepted Answer

Candida vaginitis

Answer

Trichomoniasis

Answer

Gonococcal vulvovaginitis

Answer

Chlamydia trachomatis

Question 7

Which of the following breast lesions characteristically shows central necrosis with calcification?

Accepted Answer

Comedo sub type of DCIS

Answer

Cribriform sub type of DCIS

Answer

Lobular carcinoma in situ

Answer

Colloid carcinoma

Question 8

Which of the following local anesthetics is the most common cause of methemoglobinemia?

Accepted Answer

Benzocaine

Answer

Lignocaine

Answer

Chloroprocaine

Answer

EMLA Cream (Lignocaine + Prilocaine)

Answer

Prilocaine

Answer

Dibucaine

Question 9

Disulfiram is a type of:-

Accepted Answer

Aversion therapy

Answer

Anticraving therapy

Answer

Detoxification

Answer

Opioid management therapy

Question 10

Venlafaxine comes under which class of drugs?

Accepted Answer

Serotonin-norepinephrine reuptake inhibitor (SNRI)

Answer

Monoamine oxidase inhibitors

Answer

Serotonin receptor antagonist

Answer

Selective serotonin reuptake inhibitor

FMGE 2017

Anatomy

Internal Medicine

Obstetrics and Gynecology

Pathology

Pharmacology