FMGE 2019 Practice Questions

Q: On republic day, a camp was organized and people were screened for Hypertension by checking BP and for diabetes by checking their BMI and Blood sugar level, which level of prevention is this?

Secondary. ***Secondary*** - This level of prevention focuses on **early detection** and prompt treatment of a disease to halt or slow its progression. - **Screening for hypertension and diabetes** through BP checks, BMI, and blood sugar levels aims to identify these conditions in their early stages before overt symptoms appear. *Tertiary* - This level of prevention involves measures to **reduce the impact** of an established disease, prevent complications, and improve quality of life. - Examples include rehabilitation programs or medications for long-term disease management, which are not described in the scenario. *Primary* - This level of prevention aims to **prevent a disease from occurring** in the first place, typically by addressing risk factors. - Examples include vaccination, health education on healthy eating, or promoting physical activity to prevent the development of hypertension or diabetes. *Primordial* - This is the **earliest level of prevention**, targeting the underlying social, environmental, and economic conditions that contribute to risk factors for disease. - It involves interventions to *prevent the emergence of risk factors* in populations, such as broad public health policies or community-wide initiatives.

Q: A patient who recently got a denture fitted is found to have oral thrush that bleeds on scraping. What is the causative agent for this condition?

Candida. ***Candida*** - **Oral thrush** (candidiasis) is a common opportunistic fungal infection, especially in individuals with **dentures**, which create a warm, moist environment conducive to candidal growth. - The characteristic presentation includes **white patches** on the oral mucosa that, when scraped, reveal an **erythematous** (red) or **bleeding** surface. *Diphtheria* - Diphtheria causes a **pseudomembrane** in the throat that is tough, grayish, and hard to remove, but it's not typically associated with denture use or easy bleeding on scraping. - It is caused by the bacterium *Corynebacterium diphtheriae* and is accompanied by **severe systemic toxicity**, unlike the localized oral thrush. *Staph Aureus* - *Staphylococcus aureus* can cause various infections, but it is not typically associated with the characteristic **white, easily scrapable lesions** of oral thrush. - Oral *Staph aureus* infections might present as **impetigo** periorally or **abscesses**, neither of which fits the clinical description. *Strep Mutans* - *Streptococcus mutans* is primarily known for its role in **dental caries** (cavities) due to acid production from sugar fermentation. - It is not the causative agent for **oral thrush** or the described white, bleeding lesions on scraping.

Q: A young boy came to OPD with complaints of difficulty in breathing. On examination, bilateral polyps were found. On aspiration, bleeding was seen. What will be the initial management?

Topical corticosteroids. ***Topical corticosteroids*** - **Topical corticosteroids** are the **first-line medical management** for **nasal polyps**, helping to reduce inflammation and shrink polyp size. - They work by reducing local inflammation and edema, improving nasal airway patency and breathing. - **Important note**: The presence of **bleeding on aspiration** suggests a **vascular lesion** (such as juvenile nasopharyngeal angiofibroma in young males), which would require **imaging (CT/MRI) before any intervention** and **no biopsy** due to hemorrhage risk. However, if these are inflammatory polyps, topical steroids remain the initial medical management. *Antihistaminic* - **Antihistamines** are not first-line treatment for nasal polyps, as polyps are primarily an **eosinophilic inflammatory condition** rather than a simple IgE-mediated allergic reaction. - While antihistamines may help with associated allergic rhinitis symptoms, they do **not shrink polyps** or address the underlying inflammatory pathology. *Septoplasty* - **Septoplasty** is a surgical procedure to correct a **deviated nasal septum**, not for treating nasal polyps. - This would not address the bilateral polyps causing difficulty in breathing. *I and D* - **Incision and drainage (I&D)** is performed for abscesses or pus collections, which is not the presentation here. - Nasal polyps are benign inflammatory masses, not infectious collections requiring drainage.

Q: Presence of cut injuries in the scrotum is suggestive of?

Homicidal wounds. ***Homicidal wounds*** - Injuries to the **scrotum** are highly unusual in accidental or suicidal contexts due to the protective nature and sensitivity of the area. - The presence of **cut injuries** in such a vulnerable and normally protected area often indicates an intentional act of aggression. *Accidental wounds* - Accidental scrotal injuries are typically due to **blunt trauma** or avulsion, rather than sharp, incised cuts. - They usually occur in situations like sports or industrial accidents, which are not described by "cut injuries." *Suicidal wounds* - Suicidal wounds are typically inflicted in areas like the **wrists**, neck, or chest, aiming for vital structures. - The scrotum is not a common site for self-inflicted injuries, as cutting this area is unlikely to be immediately lethal and is extremely painful. *None of the options* - This option is incorrect because the specific location and type of injury (cut injuries to the scrotum) points strongly towards a specific category of wound. - The other options are considered less likely given the highly sensitive and non-lethal nature of the scrotum for self-harm.

Q: Which of the following is an Autosomal Dominant disease?

Von Willebrand disease. ***Von Willebrand disease*** - This is an **autosomal dominant** inherited disorder caused by a deficiency or dysfunction of **von Willebrand factor**, crucial for normal hemostasis [1], [2]. - It often presents with **mucocutaneous bleeding** like nosebleeds, easy bruising, and heavy menstrual bleeding [2]. *Wilson's disease* - This is an **autosomal recessive** disorder characterized by defective copper metabolism and accumulation in various organs, most notably the liver and brain. - Clinical features include **hepatic dysfunction**, neurologic symptoms like **tremors**, and **Kayser-Fleischer rings** in the eyes. *Cystic fibrosis* - This is an **autosomal recessive** disorder caused by mutations in the **CFTR gene**, leading to abnormal chloride transport. - It primarily affects the lungs and digestive system, causing **thick mucus production** and recurrent infections. *Friedreich's ataxia* - This is an **autosomal recessive** neurodegenerative disorder typically caused by a **GAA trinucleotide repeat expansion** in the FXN gene. - Key symptoms include progressive **ataxia**, dysarthria, and often heart problems.

Q: Reversible dementia is seen in?

Hypothyroidism. ***Hypothyroidism*** - **Hypothyroidism** can lead to cognitive impairment, including memory loss, slowed thinking, and executive dysfunction, which are reversible with appropriate **thyroid hormone replacement therapy**. - This condition is often characterized by other systemic symptoms like fatigue, weight gain, and cold intolerance, which also improve with treatment. *Pick's disease* - **Pick's disease** is a type of **frontotemporal dementia** caused by progressive degeneration of brain cells, primarily in the frontal and temporal lobes. - It is a **neurodegenerative** disorder, meaning it is progressive and irreversible. *Alzheimer's disease* - **Alzheimer's disease** is the most common cause of dementia, characterized by the accumulation of **amyloid plaques** and **neurofibrillary tangles** in the brain [1]. - It is a **progressive and irreversible neurodegenerative disease** with no cure [2]. *Subacute demyelination of spinal cord* - **Subacute demyelination of the spinal cord** typically refers to conditions like **subacute combined degeneration** due to **vitamin B12 deficiency** [1]. - While this can cause neurological symptoms, including cognitive changes, its primary impact is on the spinal cord and peripheral nerves, and "dementia" in the classic sense is not the primary or defining feature of spinal cord demyelination itself, although B12 deficiency can cause broader cognitive issues [1].

Q: Secretion of prolactin is inhibited by?

Dopamine. ***Dopamine*** - **Dopamine**, produced by the **hypothalamus**, is the primary physiological inhibitor of **prolactin secretion** from the anterior pituitary gland. - It acts on **D2 receptors** on lactotrophs, leading to a decrease in prolactin synthesis and release. *Serotonin* - **Serotonin** generally has a stimulatory effect on **prolactin secretion**, rather than an inhibitory one. - Elevated serotonin levels can lead to **hyperprolactinemia**. *Noradrenaline* - While **noradrenaline** can have complex effects on pituitary hormones, it is not considered the primary direct inhibitor of **prolactin secretion**. - Its influence is often indirect or less potent than that of **dopamine**. *Adrenaline* - **Adrenaline** (epinephrine) is a neurotransmitter and hormone primarily involved in the **"fight or flight" response** and does not directly inhibit **prolactin secretion**. - Its effects on pituitary hormone release are typically less direct compared to **dopamine's** specific action on lactotrophs.

Q: A 24-year-old lady presented with sudden onset chest pain, palpitations lasting for about 20 minutes. She says there were 3 similar episodes in the past. All the investigations were normal. What is the likely diagnosis?

Panic attack. ***Panic attack*** - The sudden onset of **chest pain** and **palpitations** in a young woman, lasting for a brief period (20 minutes), and occurring in recurrent episodes with all investigations being normal, are classic signs of a **panic attack**. - Panic attacks frequently mimic cardiac events, but the absence of organic findings despite recurrent episodes points towards a psychological origin. *Post-traumatic stress disorder* - While PTSD can involve symptoms of anxiety and panic, it is specifically triggered by a **traumatic event** and typically includes re-experiencing the trauma, avoidance, and hyperarousal, none of which are described here. - The patient's presentation primarily focuses on sudden physical symptoms rather than a direct link to past trauma or pervasive fear. *Acute psychosis* - Acute psychosis involves a severe break from reality, characterized by **hallucinations**, **delusions**, or disorganized thought and behavior, which are not present in this scenario. - The symptoms described are more consistent with an anxiety disorder rather than a thought disorder. *Mania* - Mania is a state of elevated mood, increased energy, and often includes symptoms like **reduced need for sleep**, **racing thoughts**, and **impulsive behavior**, which are not described in this patient's presentation. - The core symptoms are acute physical sensations of fear and discomfort, not sustained euphoria or grandiosity.

Q: All are stages of grief, except:

Agitation. ***Agitation*** - **Agitation** is not one of the five stages of grief described by Elisabeth Kübler-Ross. Instead, it can be a symptom experienced during many of the stages, but is not a stage itself. - The Kübler-Ross model specifically outlines **Denial**, **Anger**, **Bargaining**, **Depression**, and **Acceptance**. *Bargaining* - **Bargaining** is a recognized stage of grief where individuals try to negotiate or make deals in an attempt to postpone the inevitable or reduce suffering. - This stage often involves thoughts like "If only I had..." or "I promise I'll do X if Y happens." *Anger* - **Anger** is a well-established stage of grief, where the individual may feel rage, resentment, or frustration directed at themselves, others, or higher powers. - This stage reflects the intense emotional response to loss and the perceived unfairness of the situation. *Denial* - **Denial** is the initial stage of grief, characterized by disbelief and a difficulty accepting the reality of the impending death or loss. - This stage serves as a temporary defense mechanism, allowing the individual to cope with overwhelming emotions by refusing to acknowledge the truth.

Q: Which of the following is best assessed by FAST USG?

Pericardium. ***Pericardium*** - FAST USG is **most clinically significant** for detecting **pericardial effusions** and **cardiac tamponade** in trauma patients. - The **subxiphoid view** provides **excellent direct visualization** of the heart and pericardial space with minimal interference. - **Small volumes** of pericardial fluid (as little as 50-100 mL) are **clinically significant** and potentially life-threatening, requiring immediate intervention. - Cardiac tamponade is an **immediately reversible cause of shock** that demands urgent diagnosis and pericardiocentesis. - **Sensitivity >90%** for clinically significant pericardial effusions in the trauma setting. *Liver* - FAST assesses the **hepatorenal space (Morison's pouch)** for free fluid, not the liver parenchyma itself. - Requires **larger volumes of free fluid** (>200-500 mL) to be reliably detected in the peritoneal cavity. - Detailed assessment of actual liver injury requires **contrast-enhanced CT imaging**. *Spleen* - FAST evaluates the **splenorenal recess** for free fluid surrounding the spleen, not splenic parenchymal injury. - Detection depends on adequate volume of free fluid being present. - **CT scanning** is superior for defining splenic lacerations, hematomas, and grading injury severity. *Pleural cavity* - While Extended FAST (eFAST) can assess **pleural spaces** for effusion or pneumothorax, this is an **extension** of the standard 4-view FAST protocol. - Standard FAST focuses on the **four primary windows**: pericardial, perihepatic, perisplenic, and pelvic. - **Chest X-ray** and **CT** remain primary modalities for comprehensive thoracic assessment.

Question 1

On republic day, a camp was organized and people were screened for Hypertension by checking BP and for diabetes by checking their BMI and Blood sugar level, which level of prevention is this?

Accepted Answer

Secondary

Answer

Tertiary

Answer

Primary

Answer

Primordial

Question 2

A patient who recently got a denture fitted is found to have oral thrush that bleeds on scraping. What is the causative agent for this condition?

Accepted Answer

Candida

Answer

Diphtheria

Answer

Staph Aureus

Answer

Strep Mutans

Question 3

A young boy came to OPD with complaints of difficulty in breathing. On examination, bilateral polyps were found. On aspiration, bleeding was seen. What will be the initial management?

Accepted Answer

Topical corticosteroids

Answer

Septoplasty

Answer

I and D

Answer

Antihistaminic

Question 4

Presence of cut injuries in the scrotum is suggestive of?

Accepted Answer

Homicidal wounds

Answer

Accidental wounds

Answer

Suicidal wounds

Answer

None of the options

Question 5

Which of the following is an Autosomal Dominant disease?

Accepted Answer

Von Willebrand disease

Answer

Wilson's disease

Answer

Cystic fibrosis

Answer

Friedreich's ataxia

Question 6

Reversible dementia is seen in?

Accepted Answer

Hypothyroidism

Answer

Pick's disease

Answer

Alzheimer's disease

Answer

Subacute demyelination of spinal cord

Question 7

Secretion of prolactin is inhibited by?

Accepted Answer

Dopamine

Answer

Serotonin

Answer

Noradrenaline

Answer

Adrenaline

Question 8

A 24-year-old lady presented with sudden onset chest pain, palpitations lasting for about 20 minutes. She says there were 3 similar episodes in the past. All the investigations were normal. What is the likely diagnosis?

Accepted Answer

Panic attack

Answer

Post-traumatic stress disorder

Answer

Acute psychosis

Answer

Mania

Question 9

All are stages of grief, except:

Accepted Answer

Agitation

Answer

Bargaining

Answer

Anger

Answer

Denial

Question 10

Which of the following is best assessed by FAST USG?

Accepted Answer

Pericardium

Answer

Liver

Answer

Spleen

Answer

Pleural cavity

FMGE 2019

Community Medicine

Dental

ENT

Forensic Medicine

Internal Medicine

Physiology

Psychiatry

Radiology