Subacute Sclerosing Panencephalitis is a rare and dangerous complication of;
A lady presents with amenorrhea and galactorrhea. What is the most likely cause?
Which of the following is included in Celiac sprue diet?
All are risk factors of esophageal squamous cell carcinoma except:
A lady, when exposed to cold, experiences extremities turning blue. Which of the following antibodies is associated with this condition?
True about Crohn's disease except
FMGE 2019 - Internal Medicine FMGE Practice Questions and MCQs
Question 41: Subacute Sclerosing Panencephalitis is a rare and dangerous complication of;
- A. Rubella
- B. Varicella
- C. Mumps
- D. Measles (Correct Answer)
Explanation: ***Measles*** - **Subacute sclerosing panencephalitis (SSPE)** is a rare, fatal degenerative disease of the central nervous system caused by persistent infection with a defective **measles virus**. [1] - It typically develops **years after the initial measles infection**, affecting children and young adults, leading to cognitive decline, seizures, and motor dysfunction. [1], [2] *Rubella* - While rubella can cause congenital rubella syndrome, it is **not associated with SSPE**. - Complications of rubella usually involve birth defects, such as **cardiac malformations**, **deafness**, and **cataracts**, when acquired during pregnancy. *Varicella* - **Varicella-zoster virus (VZV)** causes chickenpox and shingles, but it is **not a known cause of SSPE**. - Neurological complications of VZV can include **cerebellar ataxia** or **encephalitis** acutely, or **postherpetic neuralgia** in later life. *Mumps* - Mumps virus can cause **parotitis**, **orchitis**, and **meningitis/encephalitis**, but it is **not implicated in the development of SSPE**. - The encephalitis associated with mumps typically occurs during the acute infection and generally has a good prognosis.
Question 42: A lady presents with amenorrhea and galactorrhea. What is the most likely cause?
- A. None of the options
- B. Pituitary adenoma (Correct Answer)
- C. Adrenal hyperplasia
- D. 7α-hydroxylase deficiency
Explanation: ### Pituitary adenoma - A **prolactin-secreting pituitary adenoma** (prolactinoma) is the most common cause of sustained **hyperprolactinemia**, leading to both **amenorrhea** and **galactorrhea** [1]. - **Elevated prolactin levels** inhibit gonadotropin-releasing hormone (GnRH) pulsatility, leading to reduced LH and FSH, causing anovulation and amenorrhea, alongside direct stimulation of breast tissue for galactorrhea [1], [2]. ### *None of the options* - This option is incorrect as **pituitary adenoma** is a highly plausible cause for the presented symptoms. - The combination of **amenorrhea** and **galactorrhea** is a classic presentation of hyperprolactinemia, often due to a pituitary adenoma [1]. ### *Adrenal hyperplasia* - **Adrenal hyperplasia** typically involves overproduction of androgens or cortisol, leading to symptoms like **hirsutism**, **virilization**, or **Cushing's syndrome**, rather than galactorrhea [3]. - While it can cause menstrual irregularities, it does not directly cause **galactorrhea**, which is primarily linked to prolactin excess [1], [3]. ### *7α-hydroxylase deficiency* - **7α-hydroxylase deficiency** is a rare genetic disorder affecting **bile acid synthesis**, not directly related to reproductive hormones or prolactin regulation. - Its clinical manifestations are primarily related to **liver disease** due to abnormal bile acid metabolism and would not present with amenorrhea and galactorrhea.
Question 43: Which of the following is included in Celiac sprue diet?
- A. Wheat
- B. Quinoa (Correct Answer)
- C. Barley
- D. Rye
Explanation: ***Quinoa*** - Quinoa is a **naturally gluten-free grain** and is therefore safe for individuals with Celiac disease. - It serves as an excellent source of **protein, fiber, and essential nutrients**, making it a healthy and suitable staple in a gluten-free diet. *Wheat* - Wheat contains **gluten**, a protein that triggers an autoimmune response in individuals with Celiac disease [1]. - Consumption of wheat leads to damage of the **small intestinal villi**, causing malabsorption and various symptoms [2]. *Barley* - Barley also contains **gluten**, making it unsuitable for a Celiac sprue diet [1]. - It is often found in various food products, including malt, and must be strictly avoided to prevent **intestinal damage** [1]. *Rye* - Rye is another grain that contains **gluten** and is thus prohibited for individuals with Celiac disease [1]. - Similar to wheat and barley, consuming rye can provoke an **immune reaction** that damages the small intestine [2].
Question 44: All are risk factors of esophageal squamous cell carcinoma except:
- A. Smoking
- B. Achalasia cardia
- C. GERD (Correct Answer)
- D. Alcohol
Explanation: ***GERD*** - **Gastroesophageal reflux disease (GERD)** is strongly associated with **esophageal adenocarcinoma**, not esophageal squamous cell carcinoma. - Chronic acid reflux can lead to **Barrett's esophagus**, which is a precursor to adenocarcinoma [1]. *Smoking* - **Smoking** is a significant and well-documented risk factor for **esophageal squamous cell carcinoma**, increasing the risk in a dose-dependent manner. - Carcinogens in tobacco smoke directly damage esophageal epithelial cells, promoting malignant transformation. *Achalasia cardia* - **Achalasia cardia** involves impaired relaxation of the lower esophageal sphincter and loss of peristalsis, leading to food stasis and chronic inflammation [2]. - This chronic irritation and inflammation significantly increase the risk of developing **esophageal squamous cell carcinoma**. *Alcohol* - **Alcohol consumption**, especially heavy drinking, is a major risk factor for **esophageal squamous cell carcinoma**. - Alcohol metabolizes into acetaldehyde, a known carcinogen, which directly damages DNA in esophageal cells.
Question 45: A lady, when exposed to cold, experiences extremities turning blue. Which of the following antibodies is associated with this condition?
- A. Anti-RO
- B. Anti-SS-B
- C. Anti-SS-A
- D. Anti-SCL-70 (Correct Answer)
Explanation: Anti-SCL-70 - The symptom of extremities turning blue, especially upon cold exposure, describes **Raynaud's phenomenon**, a common feature of **systemic sclerosis (scleroderma)** [1]. - **Anti-SCL-70 antibodies** (topoisomerase 1 antibodies) are highly specific for **diffuse cutaneous systemic sclerosis**, a severe form of the disease often associated with Raynaud's. *Anti-RO* - **Anti-RO (SSA) antibodies** are primarily associated with **Sjögren's syndrome** and **subacute cutaneous lupus erythematosus**, conditions not typically characterized by prominent Raynaud's as the presenting symptom [2]. - While Sjögren's syndrome can have Raynaud's, it's not the defining feature and other symptoms like **dry eyes** and **dry mouth** would likely be present. *Anti-SS-B* - **Anti-SS-B (La) antibodies** are also associated with **Sjögren's syndrome**, often appearing alongside anti-RO antibodies [2]. - Their presence does not directly point to diffuse systemic sclerosis or severe Raynaud's as the primary condition. *Anti-SS-A* - **Anti-SS-A (RO) antibodies** are primarily linked to **Sjögren's syndrome** and **neonatal lupus**, and can also be seen in **systemic lupus erythematosus** [2]. - While Raynaud's can occur in lupus, the presence of isolated cold-induced blue extremities points more strongly towards systemic sclerosis given the provided options.
Question 46: True about Crohn's disease except
- A. Transmural
- B. Recurrence is more common
- C. Rectum is involved (Correct Answer)
- D. Fissures are formed
Explanation: ***Rectum is involved*** - While Crohn's disease can affect any part of the gastrointestinal tract from mouth to anus, **rectal involvement is much less common** and often spares the rectum in typical cases, especially when compared to ulcerative colitis. [1] - The disease typically exhibits **skip lesions**, meaning there are healthy segments of the bowel between affected areas, and the rectum is frequently one of these spared regions. [1] *Transmural* - Crohn's disease is characterized by **transmural inflammation**, meaning the inflammation extends through all layers of the bowel wall, from the mucosa to the serosa. [1] - This transmural involvement can lead to complications such as **fistulas, strictures, and abscesses**. *Recurrence is more common* - **Recurrence after surgery is very common** in Crohn's disease, with many patients experiencing disease relapse within a few years post-operation. - This high recurrence rate often necessitates ongoing medical management and sometimes further surgical interventions. *Fissures are formed* - Due to the **transmural inflammation** and chronic nature of Crohn's disease, patients often develop **fissures**, which are deep cracks or excoriations, particularly in the perianal area. - These fissures can be quite painful and complicated by **fistula formation** or abscesses.