Biochemistry
1 questionsEssential fatty acid:
FMGE 2018 - Biochemistry FMGE Practice Questions and MCQs
Question 181: Essential fatty acid:
- A. Citric acid
- B. Palmitic acid
- C. Linoleic acid (Correct Answer)
- D. Stearic acid
Explanation: ***Linoleic acid*** - **Linoleic acid** is an **omega-6 fatty acid** that is considered essential because the human body cannot synthesize it and must obtain it through diet. - It is a precursor for other important fatty acids like **arachidonic acid**, which are involved in inflammation and blood clotting. *Citric acid* - **Citric acid** is an organic acid found in citrus fruits and is a key intermediate in the **Krebs cycle** (citric acid cycle), a central metabolic pathway, but it is not a fatty acid. - It is readily synthesized by the body and is therefore not considered an essential nutrient. *Palmitic acid* - **Palmitic acid** is a **saturated fatty acid** with 16 carbon atoms, which is the most common fatty acid in animals and plants. - It can be synthesized by the human body from excess carbohydrates and proteins, hence it is not an essential fatty acid. *Stearic acid* - **Stearic acid** is another common **saturated fatty acid** with 18 carbon atoms, found in various animal and plant fats. - Like palmitic acid, it can be endogenously synthesized by the body and is not considered essential.
Dental
1 questionsAll are premalignant conditions of oral cavity except:
FMGE 2018 - Dental FMGE Practice Questions and MCQs
Question 181: All are premalignant conditions of oral cavity except:
- A. Oral submucosal fibrosis
- B. Oral lichen planus (Correct Answer)
- C. Leucoplakia
- D. Chronic hyperplastic candidiasis
Explanation: ***Oral lichen planus*** - While certain forms of **oral lichen planus (OLP)**, particularly the erosive type, are considered to have a small potential for malignant transformation, it is generally considered a **potentially malignant disorder** rather than a definitively premalignant condition with high rates of progression. - Its transformation rates are significantly lower and less consistent across studies compared to other conditions listed. *Oral submucosal fibrosis* - This is a well-established **premalignant condition** characterized by chronic, progressive fibrotic changes in the oral mucosa, primarily due to **areca nut chewing**. - It has a high malignant transformation rate, particularly into **oral squamous cell carcinoma**. *Leucoplakia* - This is defined as a white plaque of the oral mucosa that cannot be rubbed off and cannot be characterized as any other diagnosable disease. - It is histologically often associated with **epithelial dysplasia** and has a significant risk of developing into **oral squamous cell carcinoma**, making it a definitive premalignant condition. *Chronic hyperplastic candidiasis* - This is a form of **mucocutaneous candidiasis** that presents as a persistent white plaque that cannot be scraped off. - Unlike other forms of candidiasis, it is considered a **premalignant lesion** with a potential for malignant transformation, especially if associated with epithelial dysplasia.
ENT
2 questionsDip at 4000 Hz in pure tone audiometry indicates:
35 years old female presents with tinnitus, vertigo and aural fullness. Likely diagnosis:
FMGE 2018 - ENT FMGE Practice Questions and MCQs
Question 181: Dip at 4000 Hz in pure tone audiometry indicates:
- A. Meniere's disease
- B. Age related hearing loss
- C. Otosclerosis
- D. Noise induced hearing loss (Correct Answer)
Explanation: ***Noise induced hearing loss*** - A characteristic **"4 kHz Notch"** or dip in the audiogram is a hallmark of **noise-induced hearing loss**, resulting from damage to the **cochlear hair cells** in this frequency range. - This specific frequency is most susceptible to damage from loud noise exposure due to the physical properties of the **basilar membrane**. *Meniere's disease* - Typically presents with **low-frequency hearing loss**, often fluctuating, along with **tinnitus**, **vertigo**, and a feeling of **aural fullness**. - A dip at 4000 Hz is not a characteristic audiometric finding for **Meniere's disease**. *Age related hearing loss* - Also known as **presbycusis**, it is typically a **symmetrical, progressive, sensorineural hearing loss** that primarily affects **higher frequencies**, but it usually presents as a more gradual slope rather than a sharp dip at a specific frequency like 4 kHz. - While high frequencies are affected, the pattern is usually a broader high-frequency loss, not an isolated notch. *Otosclerosis* - This condition is a form of **conductive hearing loss** (though it can have a sensorineural component in advanced stages) due to abnormal bone growth around the **stapes footplate**. - Its classic audiometric finding is a **Carhart notch** around 2000 Hz, with a conductive hearing loss pattern, rather than a sensorineural dip at 4000 Hz.
Question 182: 35 years old female presents with tinnitus, vertigo and aural fullness. Likely diagnosis:
- A. Ototoxicity
- B. Noise Induced Hearing Loss
- C. Meniere's Disease (Correct Answer)
- D. Otosclerosis
Explanation: ***Meniere's Disease*** - The classic triad of symptoms for Meniere's disease includes **tinnitus**, **vertigo**, and **aural fullness**, along with fluctuating sensorineural hearing loss. - This condition is thought to be caused by an excess of **endolymphatic fluid** within the inner ear. *Ototoxicity* - This condition typically presents with **bilateral, symmetrical hearing loss** and tinnitus, often induced by certain medications (e.g., aminoglycosides, aspirin in high doses). - It usually does not involve episodic vertigo or aural fullness, which are characteristic of Meniere's. *Noise Induced Hearing Loss* - Characterized primarily by **permanent sensorineural hearing loss**, often at specific frequencies (e.g., 4000 Hz notch), and **tinnitus** after prolonged exposure to loud noise. - It does not typically cause the episodic vertigo or sense of aural fullness seen in Meniere's disease. *Otosclerosis* - This condition causes **progressive conductive hearing loss** due to abnormal bone growth around the stapes bone, impairing its movement. - While it can cause tinnitus, it typically does not present with vertigo or aural fullness, and the primary hearing loss is conductive, not sensorineural.
Ophthalmology
1 questionsTrue about Mooren's ulcer:
FMGE 2018 - Ophthalmology FMGE Practice Questions and MCQs
Question 181: True about Mooren's ulcer:
- A. Bilateral in majority of cases
- B. Affects cornea (Correct Answer)
- C. Sudden loss of vision
- D. Painless
Explanation: ***Affects cornea*** - **Mooren's ulcer** is a rare, severe, and idiopathic chronic **ulcerative keratitis** that primarily affects the cornea. - It involves a progressive **peripheral corneal stromal thinning** and ulceration, often extending circumferentially and centrally. *Bilateral in majority of cases* - Mooren's ulcer is **unilateral in approximately 60-80%** of cases, making bilateral presentation less common. - While it can be bilateral, especially in a more severe form, it's not the majority presentation. *Sudden loss of vision* - The vision loss associated with Mooren's ulcer is typically **gradual and progressive**, due to increasing corneal thinning, scarring, and astigmatism. - **Sudden vision loss** is not a characteristic feature of this condition and would suggest other acute pathologies. *Painless* - Mooren's ulcer is often associated with **significant pain**, **photophobia**, and **lacrimation**. - The pain can be severe and debilitating, stemming from the inflammatory process and corneal nerve involvement.
Pathology
1 questionsWhat is the mechanism of secondary healing?
FMGE 2018 - Pathology FMGE Practice Questions and MCQs
Question 181: What is the mechanism of secondary healing?
- A. Neovascularization
- B. Scab formation
- C. Granuloma formation
- D. Granulation tissue (Correct Answer)
Explanation: ***Granulation tissue*** - **Secondary intention healing** involves the formation of abundant **granulation tissue** to fill the tissue defect [1]. - Granulation tissue consists of new **capillaries**, **fibroblasts**, and inflammatory cells, which lay the groundwork for wound closure [2]. *Neovascularization* - **Neovascularization** is the specific process of forming new blood vessels within the wound, which is a component of granulation tissue formation, but not the overall healing mechanism [2]. - While essential for delivering nutrients and oxygen, it's a sub-process rather than the primary mechanism for secondary healing itself. *Scab formation* - **Scab formation** is an initial protective mechanism, primarily associated with superficial wounds and not the intrinsic mechanism of tissue repair and closure in secondary healing. - A scab primarily protects the underlying wound from infection and desiccation while healing occurs beneath it. *Granuloma formation* - **Granuloma formation** is a specific type of chronic inflammatory response characterized by collections of macrophages, often seen in persistent infections or foreign body reactions, not typical secondary wound healing [2]. - It indicates a **cell-mediated immune response** to a non-degradable stimulus, aiming to wall off the offending agent. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 117-119. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 105-107.
Pharmacology
1 questionsTrue for lithium:
FMGE 2018 - Pharmacology FMGE Practice Questions and MCQs
Question 181: True for lithium:
- A. Can be given safely in renal dysfunction
- B. Protein bound
- C. Narrow therapeutic index (Correct Answer)
- D. Delayed absorption
Explanation: ***Narrow therapeutic index*** - Lithium has a **narrow therapeutic index**, meaning the difference between its effective and toxic doses is small. - This necessitates **close monitoring of serum lithium levels** to ensure efficacy and prevent toxicity. *Can be given safely in renal dysfunction* - Lithium is **primarily excreted renally**, and its clearance is directly proportional to creatinine clearance. - Therefore, it **should be used with caution** (or avoided) in patients with renal dysfunction due to increased risk of toxicity. *Protein bound* - Lithium is **not protein-bound**; it exists as a free ion in the blood. - This characteristic contributes to its rapid distribution and excretion. *Delayed absorption* - Lithium is **rapidly and almost completely absorbed** from the gastrointestinal tract. - Peak plasma concentrations are usually reached within 1-2 hours for immediate-release preparations.
Physiology
1 questionsAn exaggerated pain response to a normally painful stimulus is called:
FMGE 2018 - Physiology FMGE Practice Questions and MCQs
Question 181: An exaggerated pain response to a normally painful stimulus is called:
- A. Causalgia
- B. Allodynia
- C. Hypersensitivity
- D. Hyperalgesia (Correct Answer)
Explanation: ***Hyperalgesia*** - This term describes an **increased sensitivity to pain** where a stimulus that is normally painful is perceived as even more painful than usual. - It often results from **damage to nociceptive afferent pathways** or central sensitization. *Causalgia* - This is an older term now largely replaced by complex regional pain syndrome type II (**CRPS II**), characterized by severe, burning pain following a **nerve injury**. - Unlike hyperalgesia, it specifically refers to a **syndrome of severe pain** after nerve trauma, not just an increased response to noxious stimuli. *Allodynia* - This refers to pain caused by a stimulus that **does not normally provoke pain**, such as light touch or brushing of the skin. - It differs from hyperalgesia, which is an exaggerated response to a **normally painful stimulus**. *Hypersensitivity* - This is a **general term** meaning an increased physical or allergic sensitivity to a substance or condition. - It is a **broader concept** and not as specific to pain perception as hyperalgesia or allodynia.
Surgery
2 questionsDye for Sentinel Lymph Node Biopsy is injected in which of the following sites?
Which of the following is not done in carcinoma esophagus?
FMGE 2018 - Surgery FMGE Practice Questions and MCQs
Question 181: Dye for Sentinel Lymph Node Biopsy is injected in which of the following sites?
- A. Nipple
- B. Axilla
- C. Areola (Correct Answer)
- D. Tail of spence
Explanation: ***Areola*** - The **areola** is the primary site for injecting dye in sentinel lymph node biopsy because it is rich in **lymphatic vessels** that directly drain into the regional lymph nodes. - This method ensures the dye follows the natural lymphatic drainage pathway, accurately identifying the **first lymph node** to receive drainage from the tumor. *Nipple* - While the nipple is part of the breast, it has a less dense network of **lymphatic vessels** compared to the areola. - Injection directly into the nipple may not consistently identify the sentinel lymph node as effectively as periareolar or intratumoral injections. *Axilla* - The **axilla** contains the regional lymph nodes that are the *target* for identification, not the site of dye injection. - Injecting dye directly into the axilla would bypass the lymphatic drainage from the tumor, making the biopsy ineffective. *Tail of spence* - The **tail of Spence** is an extension of breast tissue into the axilla, and while it contains breast tissue, it is not the most optimal or primary site for dye injection. - The lymphatic drainage from the tail of Spence would still rely on the broader lymphatic network, which is best accessed via the central breast regions like the areola.
Question 182: Which of the following is not done in carcinoma esophagus?
- A. pH - metry/monitoring (Correct Answer)
- B. CT chest
- C. PET scan
- D. Biopsy
Explanation: ***pH - metry/monitoring*** - **pH metry/monitoring** is primarily used to diagnose **gastroesophageal reflux disease (GERD)**, which is not a direct diagnostic tool for esophageal carcinoma itself. - While GERD is a risk factor for **Barrett's esophagus** and subsequently adenocarcinoma of the esophagus, pH monitoring does not directly identify or stage the cancer. *CT chest* - **CT (Computed Tomography) chest** is routinely performed in esophageal carcinoma to assess the **local extent** of the tumor and identify potential **lymph node involvement** or **metastasis** to other organs. - It is crucial for **staging** the disease and guiding treatment decisions such as resectability. *PET scan* - A **PET (Positron Emission Tomography) scan** is highly useful for detecting **distant metastases** and identifying **occult disease** not visible on CT, especially in cases of suspected advanced esophageal carcinoma. - It helps in **accurate staging** and avoiding futile surgery in patients with metastatic disease. *Biopsy* - **Biopsy**, typically performed during endoscopy, is the **gold standard** for confirming the diagnosis of esophageal carcinoma by obtaining tissue for **histopathological examination**. - It identifies the cell type (e.g., adenocarcinoma, squamous cell carcinoma) and grade of the tumor, which is essential for treatment planning.