FMGE 2018 Previous Year Questions Practice Questions

Q: In status asthmaticus, which anesthetic agent is used as a bronchodilator?

Ketamine. ***Ketamine*** - Possesses **bronchodilatory** properties due to its sympathomimetic effects, making it useful in severe asthma or **status asthmaticus**. - It can cause **catecholamine release**, leading to relaxation of bronchial smooth muscle and improved airflow. *Morphine* - Can cause **histamine release**, which may lead to **bronchoconstriction** and worsen an asthmatic patient's condition. - It is a respiratory depressant that can further compromise breathing in a patient with severe airway obstruction. *Thiopentone sodium* - May induce **histamine release** and cause **bronchospasm**, which is contraindicated in asthma. - It is a potent depressant of the central nervous system and can cause respiratory depression, worsening the clinical picture of status asthmaticus. *Halothane* - Although it has some **bronchodilatory** properties, its use has largely been replaced by newer inhalational anesthetics due to concerns about myocardial sensitization to catecholamines and potential **hepatotoxicity**. - It is a potent inhalational agent but is less favored in modern anesthesia for asthma due to side effect profiles compared to other agents. [Practice more FMGE 2018 questions on OnCourse]

Q: Muscles cannot release free glucose from glycogen stores because of a deficiency of:

Glucose-6-phosphatase. ***Glucose-6-phosphatase*** - **Glucose-6-phosphatase** is the enzyme that dephosphorylates glucose-6-phosphate to free glucose, allowing its release into the bloodstream. - This enzyme is **physiologically absent in muscle tissue** (present only in liver and kidneys), meaning muscles can break down glycogen for their own energy needs but cannot release free glucose into circulation. - This ensures that muscle glycogen stores are reserved exclusively for muscle's own metabolic needs during contraction. *Glycogen phosphorylase* - **Glycogen phosphorylase** is present in muscle and catalyzes the breakdown of glycogen by cleaving α-1,4 glycosidic bonds to release glucose-1-phosphate. - Muscles have this enzyme and can normally break down glycogen for energy; deficiency causes **McArdle disease** (glycogen storage disease type V) with exercise intolerance. *Hexokinase* - **Hexokinase** is abundant in muscle tissue and phosphorylates free glucose to glucose-6-phosphate for entry into glycolysis. - This enzyme is necessary for utilizing both blood glucose and glycogen-derived glucose-6-phosphate. *Phosphoglucomutase* - **Phosphoglucomutase** is present in muscle and converts glucose-1-phosphate (from glycogen breakdown) to glucose-6-phosphate. - This enzyme is essential for channeling glycogen-derived glucose into glycolysis. [Practice more FMGE 2018 questions on OnCourse]

Q: All of the following are seen in superior laryngeal nerve palsy except:

Stridor. ***Stridor*** - **Superior laryngeal nerve palsy** primarily affects the **cricothyroid muscle** (external branch) and sensation above the vocal cords (internal branch). - Stridor typically results from severe **airway obstruction**, which is not a direct consequence of superior laryngeal nerve palsy as the **vocal cords** are not paralyzed open or closed to cause obstruction. *Aspiration* - The **internal branch of the superior laryngeal nerve** provides sensory innervation to the **supraglottic larynx**. - Loss of sensation in this region can impair the protective **cough reflex**, leading to an increased risk of aspiration. *Bowed vocal cords* - **Palsy of the cricothyroid muscle**, innervated by the **external branch of the superior laryngeal nerve**, causes a loss of tension in the vocal cord. - This lack of tension can result in a characteristically **bowed appearance** of the affected vocal cord during phonation. *Loss of pitch* - The **cricothyroid muscle** is responsible for tensing and elongating the vocal cords, which is crucial for **raising vocal pitch**. - Paralysis of this muscle due to **superior laryngeal nerve palsy** directly impairs the ability to achieve higher pitches, leading to a **monotone voice** or loss of pitch. [Practice more FMGE 2018 questions on OnCourse]

Q: How many blood samples should be drawn in cases of fever of unknown origin to optimize detection of intermittent bacteremia?

3. ***3*** - Drawing **three separate blood samples** significantly increases the likelihood of detecting intermittent bacteremia, as bacteria may not always be present in high concentrations in the bloodstream. - This practice maximizes the diagnostic yield while minimizing the risk of false positives from contamination. *1* - A single blood sample has a **low sensitivity** for detecting intermittent bacteremia, as transient presence of bacteria might be missed. - Relying on one sample increases the chance of a **false negative**, delaying appropriate treatment. *2* - While two samples are better than one, they still may not be sufficient to reliably detect **intermittent bacteremia** which can fluctuate. - This quantity might be acceptable for some conditions but is suboptimal for robust exclusion of **bacteremia in FUO** [1]. *4* - While four samples might slightly increase sensitivity over three, the **incremental benefit** in diagnostic yield is often negligible. - This approach adds to the **patient discomfort** and increases resource utilization without substantial additional diagnostic value. [Practice more FMGE 2018 questions on OnCourse]

Q: Which of the following diseases is MOST likely to present with proteinuria?

Diabetic nephropathy. ***Glomerulonephritis*** [1], [2] - It is characterized by **inflammation of the glomeruli**, leading to significant **proteinuria** due to increased permeability [1]. - Commonly associated with **hematuria** and **edema**, which further supports its presence in renal pathology [1], [2]. *Polycystic kidney disease* - Mainly presents with **renal cysts** and may have **hematuria** but does not typically cause significant proteinuria early on. - Proteinuria can occur later due to renal insufficiency, but is not a hallmark feature of the disease. *Pyelonephritis* - This condition primarily causes **inflammatory changes** in the kidney due to infection, leading to **fever** and **flank pain**, rather than proteinuria. - While mild proteinuria may occur, it is usually characterized by **white blood cells** and bacteria in the urine rather than significant protein loss. *Ateriitis* - Typically refers to **inflammation of the arteries**, which does not involve kidney structures directly related to proteinuria [3]. - This condition is associated with other systemic symptoms but rarely presents with notable **urinary protein loss** [3]. [Practice more FMGE 2018 questions on OnCourse]

Question 1

In status asthmaticus, which anesthetic agent is used as a bronchodilator?

Accepted Answer

Ketamine

Answer

Morphine

Answer

Thiopentone sodium

Answer

Halothane

Question 2

Muscles cannot release free glucose from glycogen stores because of a deficiency of:

Accepted Answer

Glucose-6-phosphatase

Answer

Hexokinase

Answer

Phosphoglucomutase

Answer

Glycogen phosphorylase

Question 3

All of the following are seen in superior laryngeal nerve palsy except:

Accepted Answer

Stridor

Answer

Bowed vocal cords

Answer

Loss of pitch

Answer

Aspiration

Question 4

How many blood samples should be drawn in cases of fever of unknown origin to optimize detection of intermittent bacteremia?

Accepted Answer

3

Answer

2

Answer

1

Answer

4

Question 5

Which of the following diseases is MOST likely to present with proteinuria?

Accepted Answer

Diabetic nephropathy

Answer

Aneurysms

Answer

Polycystic kidney disease

Answer

Glomerulonephritis

Question 6

Which of the following statements is true regarding von Willebrand disease?

Accepted Answer

Bleeding time is prolonged due to impaired platelet adhesion.

Answer

Factor VIII levels are always normal.

Answer

Platelet count is consistently decreased.

Answer

Activated partial thromboplastin time (aPTT) is always normal.

Question 7

All of the following are features of Zollinger Ellison syndrome except:

Accepted Answer

Beta cell tumours of the pancreas

Answer

Severe diarrhoea

Answer

Very high acid output

Answer

Intractable peptic ulcers

Question 8

Hydrops fetalis in a fetus can be due to:

Accepted Answer

Parvovirus B19

Answer

Human papilloma virus

Answer

Influenza Virus

Answer

Epstein-Barr virus

Question 9

Which one of the following is NOT a characteristic feature of bacterial vaginosis?

Accepted Answer

Thick white discharge

Answer

Vaginal pH >4.5

Answer

Fishy odour

Answer

Presence of clue cells

Question 10

From which part of the gastrointestinal tract is glucose absorbed?

Accepted Answer

Duodenum and jejunum

Answer

Stomach

Answer

Colon

Answer

Ileum

FMGE 2018

Anesthesiology

Biochemistry

ENT

Internal Medicine

Obstetrics and Gynecology

Physiology

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