Biochemistry
1 questionsSteps of PCR in sequence are?
FMGE 2018 - Biochemistry FMGE Practice Questions and MCQs
Question 141: Steps of PCR in sequence are?
- A. Denature DNA, Extend DNA, Anneal Primers
- B. Anneal Primers, Extend DNA, Denature DNA
- C. Extend DNA, Anneal Primers, Denature DNA
- D. Denature DNA, Anneal Primers, Extend DNA (Correct Answer)
Explanation: ***Denature DNA, Anneal Primers, Extend DNA*** - This sequence represents the three fundamental steps of each PCR cycle, ensuring accurate and efficient **DNA amplification**. - **Denaturation** separates the double-stranded DNA template, **annealing** allows primers to bind to specific sequences, and **extension** synthesizes new DNA strands. *Denature DNA, Extend DNA, Anneal Primers* - This order is incorrect because **primer annealing** must occur before DNA extension can begin. - Primers provide the necessary starting points for the **DNA polymerase** to synthesize the new strands. *Anneal Primers, Extend DNA, Denature DNA* - This sequence is incorrect as the **template DNA** must first be denatured to separate the strands before primers can anneal to them. - If the DNA is not denatured, the primers cannot access their target sequences. *Extend DNA, Anneal Primers, Denature DNA* - This order is incorrect because **DNA extension** is the final step, occurring only after denaturation and primer annealing. - The polymerase requires both a denatured template and bound primers to initiate synthesis.
Internal Medicine
1 questionsAll the following are feature of polycystic disease of kidneys except:-
FMGE 2018 - Internal Medicine FMGE Practice Questions and MCQs
Question 141: All the following are feature of polycystic disease of kidneys except:-
- A. Renal failure
- B. Erythrocytosis (Correct Answer)
- C. Hematuria
- D. Hypertension
Explanation: Polycystic kidney disease (PKD) is an autosomal dominant condition where multiple cysts enlarge slowly, compressing and damaging surrounding kidney tissue [1]. ***Erythrocytosis*** - **Polycystic kidney disease (PKD)** typically leads to **anemia** due to reduced erythropoietin production by the damaged kidneys [2]. - **Erythrocytosis** (an abnormally high red blood cell count) is not a common feature of PKD; it is more often associated with conditions like **renal cell carcinoma** or certain chronic hypoxic states. *Renal failure* - **Progressive cyst growth** in PKD eventually destroys functional kidney tissue, leading to a decline in renal function and often culminating in **end-stage renal disease**, which occurs in about 50% of PKD1 patients [1]. - **Renal failure** is a common and serious complication of PKD, necessitating dialysis or kidney transplantation. *Hematuria* - **Cysts in PKD** can rupture into the collecting system, leading to **gross hematuria** (visible blood in urine) or microscopic hematuria [1]. - Trauma to the flank or infection within a cyst can trigger an episode of **hematuria** [1]. *Hypertension* - **Hypertension** is a very common early manifestation of PKD, often preceding any significant decline in glomerular filtration rate. - It results from activation of the **renin-angiotensin-aldosterone system (RAAS)** due to renal ischemia caused by cyst enlargement [1].
Obstetrics and Gynecology
1 questionsIn a couple, which of the following investigations are included in the initial work-up for infertility?
FMGE 2018 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 141: In a couple, which of the following investigations are included in the initial work-up for infertility?
- A. Testicular biopsy, USG, Sperm penetration test
- B. Ovulation, tubal patency, Mantoux test
- C. Semen analysis, CXR, Mantoux
- D. Semen analysis, Tubal patency test, Ovulation test (Correct Answer)
Explanation: ***Semen analysis, Tubal patency test, Ovulation test*** - This option correctly identifies the **key initial investigations** for both male and female factors in infertility: **semen analysis** for male fertility, **tubal patency test** for assessing fallopian tube function, and **ovulation test** to confirm female ovulatory cycles. - These tests are fundamental in a comprehensive initial infertility work-up as they address the most common causes of infertility. *Testicular biopsy, USG, Sperm penetration test* - While **testicular biopsy** and **sperm penetration test** are relevant, they are typically **second-line investigations** performed if initial tests (like semen analysis) are abnormal. - **Ultrasound (USG)** is a general imaging modality and not a primary, specific infertility test for both partners as listed. *Ovulation, tubal patency, Mantoux test* - **Ovulation** and **tubal patency** are essential, but the **Mantoux test** (for tuberculosis) is generally not part of the *initial routine* infertility work-up unless there is clinical suspicion or prevalence in the region. - The Mantoux test is specific for a particular infection, and not a broad screening test for infertility. *Semen analysis, CXR, Mantoux* - **Semen analysis** is appropriate, but a **Chest X-ray (CXR)** and **Mantoux test** are not routine initial investigations for infertility. - These tests would only be indicated if there were specific clinical signs or a history suggestive of underlying pulmonary or infectious disease.
Ophthalmology
1 questionsOptic disc changes of retinitis pigmentosa:
FMGE 2018 - Ophthalmology FMGE Practice Questions and MCQs
Question 141: Optic disc changes of retinitis pigmentosa:
- A. Hyperemia of disc
- B. Consecutive optic atrophy (Correct Answer)
- C. No significant change
- D. Blurring of disc margins
Explanation: **Consecutive optic atrophy** - In **retinitis pigmentosa**, the progressive degeneration of photoreceptors and retinal pigment epithelium leads to secondary or **consecutive optic atrophy**. - This atrophy is characterized by a **pale, waxy optic disc** due to loss of retinal ganglion cell axons and glia. *Hyperemia of disc* - **Hyperemia of the optic disc** indicates **inflammation** or **swelling** of the optic nerve head, such as in optic neuritis or papilledema. - This is not a typical feature of retinitis pigmentosa, which involves retinal degeneration, not acute inflammation of the optic nerve. *No significant change* - As **retinitis pigmentosa** progresses, significant changes occur in the retina and optic nerve, including **pigmentary deposits**, **vascular attenuation**, and **optic disc pallor**. - Therefore, stating no significant change would be incorrect as the disease significantly alters the fundus appearance. *Blurring of disc margins* - **Blurring of the optic disc margins** is a hallmark sign of **papilledema** (swelling due to increased intracranial pressure) or an acutely inflamed optic nerve head. - This is distinct from the **optic atrophy** seen in retinitis pigmentosa, which typically involves clear but pale disc margins.
Orthopaedics
1 questionsIn fracture of upper 1/3 of forearm, it is immobilized in:
FMGE 2018 - Orthopaedics FMGE Practice Questions and MCQs
Question 141: In fracture of upper 1/3 of forearm, it is immobilized in:
- A. Supination (Correct Answer)
- B. Pronation
- C. Any position
- D. Mid prone
Explanation: ***Supination*** - In a fracture of the **proximal third of the forearm**, the **biceps brachii** and **supinator muscles**, which are still attached to the proximal fragment, will cause it to **supinate**. - To align the distal fragment with the proximal fragment and ensure proper healing, the forearm must be immobilized in **full supination**. *Pronation* - **Pronation** would cause malalignment of the fracture fragments, as the proximal fragment would remain supinated while the distal fragment is pronated. - This position is only used for fractures of the **distal third of the forearm** where the **pronator quadratus** and **pronator teres** dominate. *Any position* - Immobilizing in **any position** would risk **malunion** or nonunion due to the unopposed muscle forces acting on the proximal and distal fragments. - Correct anatomical alignment is crucial for restoring function and preventing long-term complications. *Mid prone* - The **mid-prone** position is typically used for fractures of the **middle third of the forearm**, where the pronator and supinator muscle forces are more balanced. - In a proximal third fracture, the stronger supinator muscles would still pull the proximal fragment into supination, causing misalignment in the mid-prone position.
Pathology
1 questionsWhich of the following is true about Anaplasia?
FMGE 2018 - Pathology FMGE Practice Questions and MCQs
Question 141: Which of the following is true about Anaplasia?
- A. Benign and fully reversible
- B. Loss of cohesion between cells
- C. Change of epithelium type
- D. Loss of differentiation (Correct Answer)
Explanation: ***Loss of differentiation*** - **Anaplasia** is defined as the loss of structural and functional differentiation in cells, indicating a reversal to a more primitive state [1]. - It is a hallmark feature of **malignancy** and is associated with increased proliferative capacity and aggressiveness of tumors [1]. *Benign and fully reversible* - **Anaplasia** is a characteristic of **malignant tumors** and is generally not reversible without treatment [1]. - Benign cellular changes are typically reversible and maintain their differentiation features [1]. *Loss of cohesion between cells* - While loss of cohesion can occur in some aggressive tumors, it is more specifically related to changes in cell adhesion molecules and is not the primary definition of **anaplasia**. - **Anaplasia** refers to the loss of differentiation, not solely the physical separation of cells [1]. *Change of epithelium type* - This description refers to **metaplasia**, which is the reversible change of one differentiated cell type to another differentiated cell type [1]. - **Anaplasia** involves a loss of differentiation, not merely a change to a different, still differentiated, cell type [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 276-280.
Pediatrics
1 questionsMost common cause of cholestatic jaundice in newborn is
FMGE 2018 - Pediatrics FMGE Practice Questions and MCQs
Question 141: Most common cause of cholestatic jaundice in newborn is
- A. Neonatal hepatitis
- B. Physiological
- C. Choledochal cyst
- D. Biliary atresia (Correct Answer)
Explanation: ***Biliary atresia*** - This is the **most common cause of cholestatic jaundice** requiring surgical intervention in otherwise healthy full-term newborns. - It involves the **progressive obliteration or absence of extrahepatic bile ducts**, leading to bile flow obstruction, conjugated hyperbilirubinemia, and ultimately liver damage if untreated. - Incidence is approximately **1 in 10,000-15,000 live births**, and early diagnosis (before 60 days of age) is critical for optimal surgical outcomes with Kasai portoenterostomy. *Neonatal hepatitis* - While it can cause **cholestatic jaundice** in newborns, biliary atresia remains the leading **surgical cause** requiring urgent intervention. - It describes a diverse group of conditions leading to inflammation of the liver, which can be **idiopathic** or caused by infections (TORCH), metabolic disorders, or genetic conditions. - Unlike biliary atresia, neonatal hepatitis may improve with supportive care and treatment of underlying causes. *Physiological* - **Physiological jaundice** is characterized by **unconjugated hyperbilirubinemia** and is typically transient, resolving without intervention. - It does not cause cholestatic jaundice, which involves **conjugated hyperbilirubinemia** and indicates an underlying pathological process. *Choledochal cyst* - A **choledochal cyst** is a congenital dilation of the bile ducts and can cause cholestatic jaundice, but it is a **rarer cause** compared to biliary atresia. - Symptoms often include an **abdominal mass**, pain, and recurrent cholangitis, which may differ from the typical presentation of early biliary atresia.
Pharmacology
2 questionsIn the management of diabetes mellitus, lactic acidosis is caused by which of the following?
Prophylactic dose of Oseltamivir for infants (3-11 months) is?
FMGE 2018 - Pharmacology FMGE Practice Questions and MCQs
Question 141: In the management of diabetes mellitus, lactic acidosis is caused by which of the following?
- A. Pioglitazone
- B. Metformin (Correct Answer)
- C. Glipizide
- D. Tolbutamide
Explanation: ***Metformin*** - Metformin can cause **lactic acidosis**, especially in patients with **renal impairment**, as it inhibits hepatic gluconeogenesis and lactate clearance [1]. - The risk is increased in conditions leading to **tissue hypoperfusion** or **hypoxemia**, where lactate production is elevated. *Pioglitazone* - **Pioglitazone** is a thiazolidinedione that improves insulin sensitivity but is not associated with lactic acidosis [1]. - Its main risks include **fluid retention**, **heart failure**, and increased risk of **bladder cancer**. *Glipizide* - **Glipizide** is a sulfonylurea that stimulates insulin secretion from beta cells but does not cause lactic acidosis [2]. - The primary adverse effect is **hypoglycemia** [2]. *Tolbutamide* - **Tolbutamide** is an older generation sulfonylurea, similar to glipizide, and also acts by stimulating insulin release [2]. - Its main risk is **hypoglycemia**, and it is not associated with lactic acidosis [2].
Question 142: Prophylactic dose of Oseltamivir for infants (3-11 months) is?
- A. 3 mg/kg/day (Correct Answer)
- B. 5 mg/kg/day
- C. 1 mg/kg/day
- D. 7 mg/kg/day
Explanation: ***3 mg/kg/day*** - The recommended **prophylactic dose of oseltamivir** for infants aged 3 to 11 months is **3 mg/kg once daily** for 10 days. - This dosage is essential for preventing **influenza** in this vulnerable age group when exposure is known or highly suspected. *5 mg/kg/day* - A dose of **5 mg/kg** is generally used for **treatment** of influenza in infants and children, not for prophylaxis. - This higher dose is administered twice daily for 5 days when a child is already symptomatic. *1 mg/kg/day* - This dosage is **too low** for either prophylactic or treatment use in infants and would likely be ineffective against influenza. - Sub-optimal dosing can lead to **treatment failure** and a higher risk of complications. *7 mg/kg/day* - This dosage is **higher than recommended** for prophylaxis and could potentially lead to increased adverse effects without offering additional benefit. - Higher doses are usually reserved for **severely immunocompromised** patients or specific treatment regimens, not standard prophylaxis.
Physiology
1 questionsWhat is the best stimulus for release of vasopressin?
FMGE 2018 - Physiology FMGE Practice Questions and MCQs
Question 141: What is the best stimulus for release of vasopressin?
- A. Hypotension
- B. Hypertension
- C. Hyperosmolality of extracellular fluid (Correct Answer)
- D. Decreased plasma volume
Explanation: ***Hyperosmolality of extracellular fluid*** - **Hyperosmolality** is sensed by **osmoreceptors** in the hypothalamus, which then stimulate the release of vasopressin (ADH). - This response is crucial for **water conservation** to dilute the extracellular fluid and restore normal osmolality. *Hypotension* - While hypotension does stimulate vasopressin release, its effect is less potent than that of hyperosmolality in terms of triggering release. - Baroreceptors sense a decrease in blood pressure, leading to an increase in **ADH** to help maintain blood volume and pressure. *Hypertension* - **Hypertension** would typically inhibit vasopressin release, as the body would attempt to excrete more water to lower blood volume and pressure. - Increased blood pressure signals stretch receptors, leading to a decrease in **ADH** secretion. *Decreased plasma volume* - A decrease in **plasma volume** (hypovolemia) also stimulates ADH release, but this is often accompanied by changes in osmolality. - The primary stimulus for ADH is usually the resulting **increase in plasma osmolality** due to water loss, or significant drops in blood pressure detected by baroreceptors.