FMGE 2019 Practice Questions

Q: What is the most common oral cancer?

Squamous cell ca. ***Squamous cell ca*** - **Squamous cell carcinoma (SCC)** accounts for over **90% of all oral cancers**, making it the most prevalent type. - It arises from the **stratified squamous epithelium** lining the oral cavity. *Transition cell ca* - This term is more commonly associated with tumors of the **urinary tract**, such as transitional cell carcinoma of the bladder. - **Transitional cell carcinomas** are not typically found in the oral cavity. *Mucoepidermoid* - **Mucoepidermoid carcinoma** is the most common primary malignant tumor of **salivary glands**, not the oral cavity lining. - While salivary glands are in the oral region, this type of cancer originates specifically from these glands. *Adenocarcinoma* - **Adenocarcinoma** originates from **glandular tissue** and represents a small percentage of oral cancers. - It is much **less common** than squamous cell carcinoma in the oral cavity.

Q: Chronic viral hepatitis is seen with all of the following viruses, except?

HEV. ***HEV*** - While HEV can cause acute hepatitis, it **rarely progresses to chronic infection** in immunocompetent individuals. - Chronic HEV infection is primarily seen in **immunocompromised patients**, such as organ transplant recipients. *HCV* - **Hepatitis C virus** is well-known for its high propensity to establish chronic infection, with about 75-85% of acutely infected individuals developing **chronic hepatitis** [1]. - Chronic HCV infection can lead to **cirrhosis**, liver failure, and hepatocellular carcinoma [1]. *HBV* - **Hepatitis B virus** is a major cause of chronic hepatitis worldwide, especially when acquired perinatally or in early childhood [1]. - Approximately 5-10% of immunocompetent adults who acquire acute HBV infection progress to **chronic hepatitis** [1]. *HDV* - **Hepatitis D virus** is a defective virus that requires co-infection with HBV to replicate; therefore, chronic HDV infection only occurs in individuals with chronic HBV. - Co-infection or superinfection with HDV often **accelerates the progression of liver disease** to cirrhosis and liver failure.

Q: Which type of gout is seen in a patient who is on treatment of CML?

Secondary gout. ***Secondary gout*** - **Secondary gout** occurs when a high uric acid level is a consequence of another medical condition or its treatment, such as **chronic myelogenous leukemia (CML)** [1]. - The increased cell turnover in CML, especially during treatment, leads to a significant release of **purines**, which are then metabolized into **uric acid**, causing hyperuricemia and gout [1]. *Pseudogout* - **Pseudogout** is caused by the deposition of **calcium pyrophosphate dihydrate (CPPD)** crystals, not uric acid crystals, in the joints [2]. - While it can mimic gout attacks, it has a different underlying pathophysiology and is not directly linked to CML or its treatment. *Acute gout* - **Acute gout** describes the sudden onset of severe pain, swelling, and redness in a joint, which is a common presentation of any type of gout, whether primary or secondary. - This term refers to a **gout flare** rather than the underlying cause of the hyperuricemia. *Primary gout* - **Primary gout** occurs due to an intrinsic metabolic defect in purine metabolism or renal excretion of uric acid, without an identifiable underlying disease [1]. - In this scenario, the gout is secondary to CML and its treatment, making **primary gout** an incorrect classification [1].

Q: A 32-year-old lady presents with shoulder tip pain. She is diagnosed with Pancoast tumor and presents with miosis. What is the most likely associated diagnosis?

Horner syndrome. Horner syndrome - The presence of miosis (constricted pupil) in a patient with a Pancoast tumor is a classic sign of Horner syndrome. - Pancoast tumors are apical lung tumors that can invade the sympathetic chain, leading to the triad of ptosis, miosis, and anhidrosis. Upper trunk of brachial plexus injury - While Pancoast tumors can involve the brachial plexus, an injury to the upper trunk (C5-C6) typically causes symptoms like weakness in shoulder abduction and external rotation, and sensory loss over the lateral arm. - It does not directly explain miosis unless the sympathetic chain is also involved, which is characteristic of Horner syndrome. Thoracic outlet syndrome - This syndrome involves compression of the neurovascular structures as they exit the thoracic outlet, often causing pain, paresthesias, and weakness in the arm and hand. - It does not directly account for the symptom of miosis, which points to sympathetic nerve involvement. Aberrant right subclavian artery - An aberrant right subclavian artery is a congenital anomaly where the right subclavian artery arises from the distal aortic arch, often causing dysphagia lusoria or being asymptomatic. - It has no direct association with Pancoast tumors or the development of miosis.

Q: MC cause of atypical pneumonia?

Mycoplasma pneumoniae. ***Mycoplasma pneumoniae*** - *M. pneumoniae* is the most common cause of **atypical pneumonia**, often referred to as **"walking pneumonia"** due to milder symptoms compared to typical bacterial pneumonia. - It lacks a **cell wall**, making it resistant to many common antibiotics like penicillin and cephalosporins. *Klebsiella pneumoniae* - *Klebsiella pneumoniae* typically causes **lobar pneumonia**, particularly in individuals with compromised immune systems or alcoholism. - It is associated with **severe symptoms**, such as thick, "currant jelly" sputum, and often forms dense consolidated infiltrates on chest X-rays. [1] *Hemophilus influenzae* - *Haemophilus influenzae* is a common cause of **bacterial pneumonia**, especially in children and adults with underlying lung disease (e.g., COPD). - It usually presents as **typical pneumonia** with more acute and severe symptoms, rather than the milder, atypical presentation. *Chlamydia* - While *Chlamydia pneumoniae* can cause a form of atypical pneumonia, it is **less common** than *Mycoplasma pneumoniae* as the primary cause. [1] - *Chlamydia* infections can also cause other conditions, such as **urethritis** and **cervicitis**, depending on the species involved.

Q: What is the mode of transmission of genetic material to bacteria through bacteriophage?

Transduction. ***Transduction*** - **Transduction** is the process by which foreign DNA is introduced into a bacterium by a **bacteriophage** (a virus that infects bacteria). - This occurs when a bacteriophage carries bacterial DNA from one bacterium to another, often as a result of errors during viral replication. *Transformation* - **Transformation** involves the uptake of **naked DNA** from the environment by a bacterial cell. - This process does not involve a bacteriophage as an intermediary for genetic transfer. *Conjugation* - **Conjugation** is the transfer of genetic material between bacterial cells by direct cell-to-cell contact through a **pilus**. - This process requires physical contact between two bacteria and does not involve bacteriophages. *Translation* - **Translation** is the process by which messenger RNA (mRNA) is decoded to produce a specific protein. - This is a fundamental step in gene expression and is distinctly different from genetic material transmission between organisms.

Q: A patient presented with some unknown fungal infection. Microscopic examination revealed brown coloured spherical fungi with septate hyphae. Possible condition:

Chromoblastomycosis. ***Chromoblastomycosis*** - This infection is characterized by the presence of **sclerotic bodies** (also known as fumagoid bodies or Medlar bodies), which are **brown-pigmented**, **spherical**, copper-colored cells or muriform cells observed in tissue. - The causative fungi, often dematiaceous molds, exhibit **septate hyphae** in culture. These molds are pigmented due to melanin in their cell walls. *Histoplasmosis* - Caused by *Histoplasma capsulatum*, which appears as **small, oval, intracellular budding yeasts** within macrophages in tissue samples. - It does not typically form sclerotic bodies or prominent septate hyphae in infected tissue. *Candida albicans* - This yeast typically presents as **ovoid budding yeast cells**, pseudohyphae, and true hyphae in tissues. - It is an **achlorophyllous** fungus, meaning it lacks pigmentation and would not appear as "brown coloured" under microscopic examination. *Coccidioidomycosis* - Caused by *Coccidioides immitis* or *C. posadasii*, which are characterized by the formation of **spherules** containing endospores in tissue. - It does not form "brown coloured spherical fungi with septate hyphae" as described; spherules are large, non-pigmented, and contain smaller endospores.

Q: Late rupture of tubal pregnancy is seen in?

Interstitial. ***Interstitial*** - The interstitial portion of the fallopian tube is the segment that passes through the **myometrium** of the uterus. This muscular wall provides greater distensibility and support, allowing the pregnancy to grow for a longer period before rupture. - Rupture in the interstitial part typically occurs later (around **8-12 weeks**) and is often more catastrophic due to its proximity to the **uterine blood vessels**, leading to severe hemorrhage. *Fimbriae* - Pregnancies rarely implant in the fimbriae, and if they do, they are more likely to undergo **tubal abortion** rather than rupture. - The fimbriae are finger-like projections at the end of the fallopian tube which is why they cannot hold pregnancy for a longer duration. *Ampulla* - The ampulla is the **widest part** of the fallopian tube and is the most common site of ectopic pregnancy (about 70%). - Rupture in the ampulla typically occurs earlier, around **6-8 weeks**, as its wall is thinner and less distensible compared to the interstitial segment. *Isthmus* - The isthmus is a **narrower, more muscular** segment of the fallopian tube. - Pregnancy in the isthmus tends to rupture early (around **4-6 weeks**) because the lumen is very narrow and the wall is rigid, accommodating very little expansion.

Q: Football player with knee injury diagnosed as medial collateral ligament injury. Which structure is most commonly associated with this type of injury?

Medial meniscus. ***Medial meniscus*** - The **medial meniscus** is commonly injured in conjunction with the **medial collateral ligament** due to their anatomical proximity and shared role in knee stability. - The MCL is a primary restraint to **valgus stress**, and strong valgus forces that injure the MCL can also transmit stress to the medial meniscus, leading to tears. *Lateral meniscus* - The **lateral meniscus** is less frequently injured alongside the MCL because it is typically more mobile and not directly attached to the MCL. - Injuries to the lateral meniscus are more often associated with **anterior cruciate ligament (ACL) tears** or significant *rotational forces*. *Anterior cruciate ligament* - The **anterior cruciate ligament** is primarily injured by **non-contact pivoting** or **hyperextension injuries**, and while it can be part of the "unhappy triad" (along with MCL and medial meniscus tears), an isolated MCL injury does not most commonly implicate it. - ACL tears lead to **anterior instability** of the tibia relative to the femur, which is a different biomechanical mechanism than an isolated MCL injury. *Posterior Cruciate Ligament* - The **posterior cruciate ligament** is injured by a direct blow to the anterior tibia while the knee is flexed or during a dashboard injury, leading to **posterior instability**. - Its injury mechanism is distinct from that of the MCL, which is primarily due to **valgus stress**.

Q: A patient has MCV <80, MCH <23. Which type of anaemia shall be classified?

Microcytic hypochromic. ***Microcytic hypochromic*** - A **Mean Corpuscular Volume (MCV)** less than **80 fL** indicates **microcytosis** (small red blood cells) [1]. - A **Mean Corpuscular Hemoglobin (MCH)** less than **23 pg** indicates **hypochromia** (pale red blood cells due to reduced hemoglobin content) [1]. *Normocytic normochromic* - This classification refers to red blood cells with **normal MCV (80-100 fL)** and **normal MCH (27-32 pg)**. - Examples include anemia of chronic disease or acute blood loss, which do not fit the given lab values. *Normocytic hypochromic* - While **hypochromia (MCH 100 fL**, which is the opposite of the given MCV of <80. - The term "hyperchromic" is generally not used for anemia classification because red blood cells have a maximal hemoglobin concentration and cannot be truly hyperchromic. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Question 1

What is the most common oral cancer?

Accepted Answer

Squamous cell ca

Answer

Transition cell ca

Answer

Mucoepidermoid

Answer

Adenocarcinoma

Question 2

Chronic viral hepatitis is seen with all of the following viruses, except?

Accepted Answer

HEV

Answer

HCV

Answer

HBV

Answer

HDV

Question 3

Which type of gout is seen in a patient who is on treatment of CML?

Accepted Answer

Secondary gout

Answer

Pseudogout

Answer

Acute gout

Answer

Primary gout

Question 4

A 32-year-old lady presents with shoulder tip pain. She is diagnosed with Pancoast tumor and presents with miosis. What is the most likely associated diagnosis?

Accepted Answer

Horner syndrome

Answer

Upper trunk of brachial plexus injury

Answer

Thoracic outlet syndrome

Answer

Aberrant right subclavian artery

Question 5

MC cause of atypical pneumonia?

Accepted Answer

Mycoplasma pneumoniae

Answer

Klebsiella pneumoniae

Answer

Hemophilus influenzae

Answer

Chlamydia

Question 6

What is the mode of transmission of genetic material to bacteria through bacteriophage?

Accepted Answer

Transduction

Answer

Transformation

Answer

Conjugation

Answer

Translation

Question 7

A patient presented with some unknown fungal infection. Microscopic examination revealed brown coloured spherical fungi with septate hyphae. Possible condition:

Accepted Answer

Chromoblastomycosis

Answer

Histoplasmosis

Answer

Candida albicans

Answer

Coccidioidomycosis

Question 8

Late rupture of tubal pregnancy is seen in?

Accepted Answer

Interstitial

Answer

Fimbriae

Answer

Ampulla

Answer

Isthmus

Question 9

Football player with knee injury diagnosed as medial collateral ligament injury. Which structure is most commonly associated with this type of injury?

Accepted Answer

Medial meniscus

Answer

Lateral meniscus

Answer

Anterior cruciate ligament

Answer

Posterior Cruciate Ligament

Question 10

A patient has MCV <80, MCH <23. Which type of anaemia shall be classified?

Accepted Answer

Microcytic hypochromic

Answer

Normocytic normochromic

Answer

Normocytic hypochromic

Answer

Hyperchromic macrocytic

FMGE 2019

Dental

Internal Medicine

Microbiology

Obstetrics and Gynecology

Orthopaedics

Pathology