Anatomy
1 questionsMost prominent and largest air cell of ethmoidal sinus?
FMGE 2019 - Anatomy FMGE Practice Questions and MCQs
Question 11: Most prominent and largest air cell of ethmoidal sinus?
- A. Onodi cell
- B. Bulla ethmoidalis (Correct Answer)
- C. Haller cell
- D. Agger nasi cell
Explanation: ***Bulla ethmoidalis*** - The **bulla ethmoidalis** is universally present and is consistently described as the **largest and most prominent** of the anterior ethmoid air cells. - It forms an anatomical landmark that is consistently superior and posterior to the **hiatus semilunaris**. *Onodi cell* - The **Onodi cell** is a posterior ethmoid air cell that pneumatizes laterally and superiorly into the sphenoid bone, in close proximity to the optic nerve. - While clinically significant due to its relationship with the optic nerve, it is not the largest or most prominent ethmoidal air cell. *Haller cell* - A **Haller cell** is an infraorbital ethmoid cell located along the floor of the orbit, extending into the maxillary sinus. - These cells can contribute to **ostial obstruction** of the maxillary sinus but are typically small compared to the bulla ethmoidalis. *Agger nasi cell* - The **agger nasi cell** is the most anterior ethmoid air cell, located in the lacrimal bone anterior to the frontal recess. - It is often one of the first ethmoid cells to pneumatize but is generally small and not considered the most prominent.
Community Medicine
1 questionsIn a disease with 100% mortality, what is the relationship between incidence and prevalence?
FMGE 2019 - Community Medicine FMGE Practice Questions and MCQs
Question 11: In a disease with 100% mortality, what is the relationship between incidence and prevalence?
- A. Prevalence is less than incidence (P < I) (Correct Answer)
- B. Prevalence equals incidence (P = I)
- C. There is no relationship between prevalence and incidence
- D. Prevalence is greater than incidence (P > I)
Explanation: ***Prevalence is less than incidence (P < I)*** - In a disease with 100% mortality, all affected individuals will eventually die, meaning their contribution to the **prevalent pool is temporary** or non-existent in the long run. - While new cases (incidence) continue to arise, the rapid removal of cases due to death prevents the buildup of prevalent cases, thus keeping prevalence lower than incidence. *Prevalence equals incidence (P = I)* - This scenario would imply that every new case immediately disappears or that the disease has no duration, which contradicts the concept of **disease progression** and death. - **Prevalence** is influenced by both the incidence rate and the duration of the disease; if duration is effectively zero due to immediate death, the relationship still leans towards prevalence being lower. *There is no relationship between prevalence and incidence* - This statement is incorrect as **incidence and prevalence are fundamentally linked**. Prevalence is a function of incidence and disease duration. - Changes in incidence directly affect **prevalence**, although the extent of this effect is modulated by factors like disease duration, recovery, or mortality. *Prevalence is greater than incidence (P > I)* - Prevalence being greater than incidence typically occurs in **chronic diseases** where individuals live with the condition for a long time, allowing prevalent cases to accumulate. - With **100% mortality**, individuals do not survive long enough to contribute significantly to the prevalent pool, making it impossible for prevalence to exceed incidence in this context.
Internal Medicine
3 questionsHemolytic uraemic syndrome is associated with
Which of the following is the earliest finding seen in Diabetic nephropathy?
Which of the following is not true regarding Wolff-Parkinson-White (WPW) syndrome?
FMGE 2019 - Internal Medicine FMGE Practice Questions and MCQs
Question 11: Hemolytic uraemic syndrome is associated with
- A. Bartonella henselae
- B. Malaria
- C. E. coli 0157 (Correct Answer)
- D. Parvovirus B19
Explanation: ***E. coli O157*** - **Hemolytic uremic syndrome (HUS)** is most commonly associated with infection by **Shiga toxin-producing E. coli (STEC)**, particularly serotype O157:H7 [2]. - The Shiga toxin damages the **endothelium** of blood vessels, leading to **thrombotic microangiopathy**, which manifests as **hemolytic anemia**, **thrombocytopenia**, and **acute kidney injury** [1], [2]. *Bartonella henselae* - This bacterium is the causative agent of **cat scratch disease**, characterized by **lymphadenopathy** and sometimes systemic symptoms. - It is not typically associated with hemolytic uremic syndrome. *Malaria* - Malaria is a **parasitic infection** transmitted by mosquitoes, causing **fever**, **chills**, and **anemia** due to red blood cell lysis. - While it can cause anemia, it does not directly lead to the thrombotic microangiopathy of HUS. *Parvovirus B19* - **Parvovirus B19** causes **erythema infectiosum (fifth disease)** in children and can cause **aplastic crisis** in individuals with underlying hemolytic disorders. - It primarily targets erythroid precursors in the bone marrow but is not directly linked to HUS.
Question 12: Which of the following is the earliest finding seen in Diabetic nephropathy?
- A. Hematuria
- B. Exudates
- C. Microalbuminuria (Correct Answer)
- D. Macroalbuminuria
Explanation: ***Microalbuminuria*** - **Microalbuminuria** is defined as the excretion of 30-300 mg of albumin in urine per 24 hours and is the **earliest detectable sign** of diabetic nephropathy, preceding overt proteinuria [1], [3]. - Early detection allows for interventions to slow the progression of kidney damage, such as **strict glycemic control** and **blood pressure management** with ACE inhibitors or ARBs [3]. *Hematuria* - **Hematuria** (blood in the urine) is not typically an early or primary finding in diabetic nephropathy [2]. - While it can occur in some kidney diseases, it is more characteristic of conditions like **glomerulonephritis** or **urinary tract infections** [4]. *Exudates* - **Exudates** refer to leakage of fluid, protein, or cells into tissues, often associated with inflammation or injury, and are not a measure of kidney function. - It's possible this term is being confused with **retinal exudates** (hard exudates) which are a finding in diabetic retinopathy, but not diabetic nephropathy. *Macroalbuminuria* - **Macroalbuminuria** (or overt proteinuria) is the excretion of more than 300 mg of albumin per 24 hours, indicating more advanced kidney damage. - It is a **later finding** than microalbuminuria in the progression of diabetic nephropathy, signifying established kidney disease [3].
Question 13: Which of the following is not true regarding Wolff-Parkinson-White (WPW) syndrome?
- A. Delta wave is seen on ECG
- B. Bundle of Kent connects atria to ventricles
- C. Prolonged PR interval (Correct Answer)
- D. Pre-excitation occurs via accessory pathway
Explanation: ***Prolonged PR interval*** - In WPW syndrome, the presence of an **accessory pathway (Bundle of Kent)** allows for **pre-excitation** of the ventricles, bypassing the AV node's normal delay [1]. - This results in a **shortened PR interval** (typically < 0.12 seconds), not a prolonged one [1]. *Delta wave is seen on ECG* - The **delta wave** is a characteristic finding in WPW, representing the slurred upstroke of the QRS complex due to early ventricular activation via the accessory pathway [1]. - It indicates **ventricular pre-excitation** and is a key diagnostic feature [1], [2]. *Bundle of Kent connects atria to ventricles* - The **Bundle of Kent** is an anomalous muscle fiber bundle that forms an **accessory pathway** directly connecting the atria to the ventricles [1]. - This pathway bypasses the AV node, leading to the characteristic ECG findings and potential re-entrant arrhythmias. *Pre-excitation occurs via accessory pathway* - **Pre-excitation** is the hallmark of WPW syndrome, where electrical impulses bypass the normal conduction system (AV node) and activate ventricular tissue prematurely via an **accessory pathway** [1]. - This leads to the characteristic short PR interval and delta wave on the ECG [2].
Microbiology
1 questionsWhich of the following viruses is from the Herpes virus family?
FMGE 2019 - Microbiology FMGE Practice Questions and MCQs
Question 11: Which of the following viruses is from the Herpes virus family?
- A. Rubella
- B. EBV (Correct Answer)
- C. Rabies
- D. Measles
Explanation: ***EBV*** - **Epstein-Barr Virus (EBV)** is a member of the **Herpesviridae** family, specifically **Human Herpesvirus 4 (HHV-4)**. - It is a **DNA virus** (double-stranded DNA), which is characteristic of all herpesviruses. - It is known to cause **infectious mononucleosis** and is associated with various malignancies. *Rubella* - **Rubella virus** belongs to the family **Togaviridae** and is the causative agent of **German measles**. - It is an **RNA virus** and is not classified within the Herpesviridae family. *Rabies* - **Rabies virus** is a member of the **Rhabdoviridae** family, specifically the genus **Lyssavirus**. - It is a neurotropic **RNA virus** causing a rapidly progressive, fatal encephalitis. *Measles* - **Measles virus**, also known as **Rubeola**, belongs to the family **Paramyxoviridae**. - It is an **RNA virus** responsible for a highly contagious airborne disease.
Obstetrics and Gynecology
2 questionsA 32-year-old lady with intrauterine fetal death after normal vaginal delivery has continuous passage of urine from the vagina. What is the most probable diagnosis?
A woman comes after 96 hours post coitus. Best contraceptive of choice is?
FMGE 2019 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 11: A 32-year-old lady with intrauterine fetal death after normal vaginal delivery has continuous passage of urine from the vagina. What is the most probable diagnosis?
- A. Urge incontinence
- B. Stress incontinence
- C. Bladder rupture
- D. Vesicovaginal fistula (Correct Answer)
Explanation: ***Vesicovaginal fistula*** - The continuous passage of urine from the vagina following delivery, especially in the context of an intrauterine fetal death where prolonged or difficult labor might occur, is highly suggestive of a **vesicovaginal fistula**. - A fistula creates an abnormal connection between the **bladder** and the **vagina**, leading to continuous urine leakage. *Urge incontinence* - Characterized by an **involuntary loss of urine** associated with a sudden, strong desire to void. - This is typically due to an **overactive detrusor muscle** and would not cause continuous leakage, especially not through the vagina itself after a delivery. *Stress incontinence* - Defined by the leakage of urine with activities that **increase intra-abdominal pressure**, such as coughing, sneezing, or laughing. - It results from weakness of the **pelvic floor muscles** or urethral sphincter, not continuous drainage from the vagina. *Bladder rupture* - While a bladder rupture can cause urinary leakage, it usually presents with **acute abdominal pain**, abdominal distension, and possibly **hematuria**, along with urine accumulating in the peritoneal cavity, rather than continuous passage solely from the vagina. - A rupture would likely be an acute, more severe event with systemic symptoms, distinct from the described continuous vaginal leakage of urine.
Question 12: A woman comes after 96 hours post coitus. Best contraceptive of choice is?
- A. Progesterone only pills
- B. OCP
- C. IUCD (Correct Answer)
- D. Mifepristone
Explanation: ***IUCD*** - An **intrauterine contraceptive device (IUCD)** can be inserted up to **5 days (120 hours)** after unprotected intercourse or within 5 days of the earliest estimated ovulation. - It is the **most effective form of emergency contraception**, offering approximately **99% efficacy**. - Provides **immediate ongoing contraception** after insertion, making it the optimal choice at 96 hours post-coitus. *Progesterone only pills* - **Progesterone-only emergency contraceptive pills** (e.g., levonorgestrel) are most effective when taken within **72 hours (3 days)** of unprotected intercourse. - At **96 hours**, their efficacy is **significantly reduced**, making them suboptimal compared to IUCD. *OCP* - **Combined oral contraceptive pills (OCPs)** used for emergency contraception (Yuzpe method) are less effective and have more side effects than other emergency contraceptive methods. - Their effectiveness also significantly declines after **72 hours** post-coitus. *Mifepristone* - **Mifepristone** is an **anti-progestin** that can be used for emergency contraception within **120 hours (5 days)** of unprotected intercourse. - While effective within this timeframe at **96 hours**, the **IUCD remains superior** due to its higher efficacy (>99% vs ~98%) and provision of ongoing contraception.
Ophthalmology
1 questionsPhlyctenular conjunctivitis is primarily associated with hypersensitivity to which of the following?
FMGE 2019 - Ophthalmology FMGE Practice Questions and MCQs
Question 11: Phlyctenular conjunctivitis is primarily associated with hypersensitivity to which of the following?
- A. Staphylococcus (Correct Answer)
- B. Chlamydia
- C. Pneumococcus
- D. Aspergillus
Explanation: ***Staphylococcus*** - **Phlyctenular conjunctivitis** is characterized by delayed (Type IV) hypersensitivity reactions to bacterial antigens, most commonly from **Staphylococcus aureus**. - This condition often presents with small, nodular lesions (phlyctenules) on the conjunctiva or cornea, which are essentially collections of inflammatory cells responding to bacterial proteins. - **Important note**: **Mycobacterium tuberculosis** is another well-documented cause of phlyctenular conjunctivitis, particularly in TB-endemic regions, and should be considered in the differential diagnosis. - Other triggers include protein antigens from organisms colonizing the ocular surface. *Chlamydia* - While **Chlamydia trachomatis** can cause chronic conjunctivitis (e.g., trachoma, adult inclusion conjunctivitis), it does not typically lead to the distinct nodular lesions seen in phlyctenular conjunctivitis. - Ocular chlamydial infections are primarily characterized by follicular conjunctivitis and pannus formation. *Pneumococcus* - **Streptococcus pneumoniae** (Pneumococcus) is a common cause of acute bacterial conjunctivitis, characterized by purulent discharge and redness. - However, it is not associated with the specific delayed hypersensitivity reaction that defines phlyctenular conjunctivitis. *Aspergillus* - **Aspergillus** species are fungi and are more commonly implicated in fungal keratitis or allergic bronchopulmonary aspergillosis, particularly in immunocompromised individuals. - Fungal infections of the conjunctiva are rare and do not typically manifest as phlyctenular conjunctivitis.
Pharmacology
1 questionsAllopurinol inhibits which enzyme?
FMGE 2019 - Pharmacology FMGE Practice Questions and MCQs
Question 11: Allopurinol inhibits which enzyme?
- A. Lysyl oxidase
- B. Xanthine oxidase (Correct Answer)
- C. Cyclooxygenase
- D. Kinase
Explanation: ***Xanthine oxidase*** - Allopurinol is a **purine analog** that acts as a **competitive inhibitor** of the enzyme **xanthine oxidase**. - By inhibiting xanthine oxidase, allopurinol prevents the conversion of **hypoxanthine to xanthine** and subsequently to **uric acid**, thereby lowering serum uric acid levels. *Lysyl oxidase* - **Lysyl oxidase** is an enzyme involved in the **cross-linking of collagen and elastin**, crucial for the stability of connective tissues. - Its inhibition would not directly affect **uric acid metabolism** or be a mechanism of allopurinol's action. *Cyclooxygenase* - **Cyclooxygenase (COX)** is a key enzyme in the synthesis of **prostaglandins and thromboxanes** from arachidonic acid, mediating inflammation and pain. - **NSAIDs** are inhibitors of cyclooxygenase, not allopurinol. *Kinase* - **Kinases** are a broad class of enzymes that **catalyze the transfer of phosphate groups** from high-energy molecules (like ATP) to specific substrates. - While essential for many cellular processes, kinases are not the specific target of **allopurinol** in uric acid reduction.