Anesthesiology
2 questionsThe duration of spinal anaesthesia is based directly on:
Which of the following is used for day care surgery?
FMGE 2019 - Anesthesiology FMGE Practice Questions and MCQs
Question 191: The duration of spinal anaesthesia is based directly on:
- A. Height
- B. Total body fat
- C. Dose (Correct Answer)
- D. Age
Explanation: ***Dose*** - The **total mass** (dose) of the local anesthetic administered directly influences the number of nerve fibers blocked and the duration of block. - A higher dose of a given local anesthetic generally leads to a **longer duration** of action in spinal anesthesia. *Height* - While patient height can influence the **spread** of spinal anesthesia due to differences in spinal column length, it does not directly determine the **duration** of the block. - The **volume** of the injectate, rather than the patient's height alone, affects the cranial spread of the anesthetic. *Total body fat* - Total body fat has **minimal direct impact** on the duration of spinal anesthesia since local anesthetics are injected directly into the cerebrospinal fluid, largely bypassing systemic fat distribution initially. - **Lipid solubility** of the drug affects its potency and duration within the neuraxis, not external body fat. *Age* - **Age** can influence the **spread** and **onset** of spinal anesthesia due to changes in cerebrospinal fluid volume and spinal cord compliance, but it is not the primary determinant of **duration**. - Older patients may experience a greater spread for a given dose, but the primary factor for duration remains the total drug dose.
Question 192: Which of the following is used for day care surgery?
- A. Thiopentone
- B. Ketamine
- C. Etomidate
- D. Propofol (Correct Answer)
Explanation: ***Propofol*** - **Propofol** is favored for **day care surgery** due to its **rapid onset** and **rapid recovery** profile, allowing patients to be discharged quickly. - It produces a **clear-headed recovery** with less postoperative nausea and vomiting compared to other agents. *Thiopentone* - **Thiopentone** has a **longer recovery time** and greater potential for **postoperative sedation** and **nausea**, making it less suitable for day care surgery. - Its use often leads to a **delayed discharge** from the recovery unit. *Ketamine* - **Ketamine** can cause **psychomimetic effects** (e.g., hallucinations, vivid dreams) and **delirium** during emergence, which are undesirable for day care procedures. - It also leads to **increased heart rate** and **blood pressure**, which may prolong recovery and observation time. *Etomidate* - **Etomidate** is known to cause **adrenocortical suppression** and can be associated with **pain on injection** and **myoclonus**, which are not ideal for routine day care use. - While it has a relatively **stable cardiovascular profile**, these side effects limit its widespread use in short procedures where rapid, smooth recovery is paramount.
Biochemistry
1 questionsSynovial fluid contains-
FMGE 2019 - Biochemistry FMGE Practice Questions and MCQs
Question 191: Synovial fluid contains-
- A. Keratan sulphate
- B. Hyaluronic acid (Correct Answer)
- C. Dermatan sulphate
- D. Chondroitin sulphate
Explanation: ***Hyaluronic acid*** - **Hyaluronic acid** is a major component of **synovial fluid**, providing **viscosity** and **lubrication** to joints, which is crucial for reducing friction between articular cartilages. - It's a **glycosaminoglycan** (GAG) responsible for the fluid's unique rheological properties, maintaining joint health and function. *Keratan sulphate* - **Keratan sulphate** is primarily found in **cartilage**, **cornea**, and **bone**, contributing to their structural integrity. - It is not a significant component of **synovial fluid** itself; rather, it is part of the extracellular matrix of surrounding tissues. *Dermatan sulphate* - **Dermatan sulphate** is typically found in **skin**, **blood vessels**, and **heart valves**, where it plays a role in tissue organization and repair. - It is not a characteristic or primary component of **synovial fluid**. *Chondroitin sulphate* - **Chondroitin sulphate** is a GAG abundant in **cartilage**, contributing to its **compressive strength** and elasticity. - While essential for **joint health**, it is found within the cartilage matrix, not freely in high concentrations within the **synovial fluid**.
Internal Medicine
1 questionsFrontal headache is due to inflammation of which sinus?
FMGE 2019 - Internal Medicine FMGE Practice Questions and MCQs
Question 191: Frontal headache is due to inflammation of which sinus?
- A. Sphenoid
- B. Ethmoidal
- C. Frontal (Correct Answer)
- D. Maxillary
Explanation: ***Frontal*** - Inflammation of the **frontal sinuses** typically causes pain and pressure over the forehead, known as a **frontal headache**. - The pain is often worse in the morning, when bending over, or with changes in **barometric pressure**. *Sphenoid* - **Sphenoid sinusitis** usually causes a headache behind the eyes, at the **vertex of the head**, or in the occipital region. - It is less common than other forms of sinusitis and often presents with more diffuse, deep-seated pain. *Ethmoidal* - **Ethmoidal sinusitis** typically results in pain and pressure between the eyes or over the **bridge of the nose**. - It can also cause eye pain and is sometimes mistaken for a **tension headache**. *Maxillary* - **Maxillary sinusitis** commonly causes pain and pressure in the cheeks, under the eyes, and in the upper teeth, often exacerbated by **chewing or biting**. - This pain can radiate to the temples or ears, but it typically does not manifest as a **frontal headache**.
Microbiology
2 questionsMost sensitive test for detecting microfilariae?
A patient presents with suspected diphtheria. What media will be used to diagnose this condition?
FMGE 2019 - Microbiology FMGE Practice Questions and MCQs
Question 191: Most sensitive test for detecting microfilariae?
- A. Membrane filtration technique (Correct Answer)
- B. Diethylcarbamazine (DEC) challenge test
- C. Fluorescence-based immunoassay
- D. Thick blood smear
Explanation: ***Membrane filtration technique*** - The **membrane filtration technique** is considered the most sensitive test for detecting **microfilariae** because it concentrates microfilariae from a larger volume of blood (typically 1 mL or more) onto a filter membrane, increasing detection rates, especially in low-parasite density infections. - This method physically traps the microfilariae, allowing for microscopic examination of the concentrated sample after staining, which enhances visualization. *Diethylcarbamazine (DEC) challenge test* - The **DEC challenge test** uses **diethylcarbamazine** to provoke the release of microfilariae into the peripheral blood, especially in cases of occult filariasis or when microfilaria numbers are low. - While it can be useful in certain diagnostic situations, it is **less sensitive** than membrane filtration for directly detecting circulating microfilariae and carries the risk of inducing severe adverse reactions due to rapid parasite killing. *Fluorescence-based immunoassay* - **Fluorescence-based immunoassays** detect **antigens** or **antibodies** related to filarial infection, providing evidence of exposure or active infection. - While valuable for diagnosis, especially in antibody detection for chronic or occult infections, they do not directly detect live microfilariae and thus are not the most sensitive method for *detecting microfilariae themselves*. *Thick blood smear* - A **thick blood smear** is a common and quick method for detecting microfilariae by examining a drop of blood for their presence. - However, it is **less sensitive** than the membrane filtration technique, particularly in persons with low microfilaremia, as it examines a much smaller volume of blood.
Question 192: A patient presents with suspected diphtheria. What media will be used to diagnose this condition?
- A. Chocolate agar
- B. Cary-Blair
- C. Loffler's serum slope (Correct Answer)
- D. Lowenstein-Jensen
Explanation: ***Loffler's serum slope*** - **Löffler's serum slope** is a specific enrichment medium used for the isolation and identification of *Corynebacterium diphtheriae*, the causative agent of diphtheria. - It enhances the characteristic **metachromatic granules** (Babes-Ernst bodies) within the bacteria, aiding in microscopic identification. *Chocolate agar* - **Chocolate agar** is a non-selective enrichment medium often used for fastidious organisms like *Haemophilus influenzae* and *Neisseria* species. - While it supports the growth of many bacteria, it is not specifically optimized for the isolation or enhanced identification of *Corynebacterium diphtheriae*. *Cary-Blair* - **Cary-Blair transport medium** is designed to preserve enteric pathogens like *Salmonella* and *Shigella* in fecal samples during transport. - It is not a primary culture medium for *Corynebacterium diphtheriae* and would not be used for diagnosis of diphtheria. *Lowenstein-Jensen* - **Lowenstein-Jensen (LJ) medium** is a specialized egg-based medium primarily used for the isolation and culture of *Mycobacterium tuberculosis*. - It contains malachite green to inhibit the growth of other bacteria and is not suitable for the growth of *Corynebacterium diphtheriae*.
Obstetrics and Gynecology
1 questionsAmsel's criteria are used for?
FMGE 2019 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 191: Amsel's criteria are used for?
- A. Candidiasis
- B. Trichomoniasis
- C. Chlamydia infection
- D. Bacterial vaginosis (Correct Answer)
Explanation: ***Bacterial vaginosis*** - **Amsel's criteria** are a set of four clinical signs used to diagnose **bacterial vaginosis**, a common vaginal infection. - At least three of the four criteria must be present for a positive diagnosis: **thin, white, homogeneous discharge**, **clue cells** on microscopy, vaginal pH >4.5, and a **fishy odor** before or after adding 10% KOH (whiff test). *Candidiasis* - Diagnosed based on clinical symptoms such as **pruritus** and thick, white, **"cottage cheese-like" discharge**, along with identification of yeast (hyphae/pseudohyphae) on microscopy. - **Amsel's criteria** are not used for its diagnosis. *Trichomoniasis* - Typically diagnosed by microscopic observation of **motile trichomonads** in a wet mount, or by nucleic acid amplification tests (NAATs). - It presents with a **foamy, yellow-green discharge** and sometimes a **"strawberry cervix"**, none of which are part of Amsel's criteria. *Chlamydia infection* - Primarily diagnosed using **nucleic acid amplification tests (NAATs)** from urine or swab samples. - It is often **asymptomatic** or presents with non-specific symptoms like discharge or dysuria, and **Amsel's criteria** are not applicable.
Pharmacology
3 questionsInsulin of choice for the treatment of diabetic ketoacidosis is:
Praziquantel is used for the treatment of
A lady has taken medication for amoebiasis infection. She drank alcohol on the same day. She has nausea, vomiting, and dizziness. Which anti-amoebic drug could have led to interaction with alcohol to produce these symptoms?
FMGE 2019 - Pharmacology FMGE Practice Questions and MCQs
Question 191: Insulin of choice for the treatment of diabetic ketoacidosis is:
- A. Insulin lispro
- B. Insulin glargine
- C. NPH insulin
- D. Regular Insulin (Correct Answer)
Explanation: ***Regular Insulin*** - **Regular insulin** is the insulin of choice for treating **diabetic ketoacidosis (DKA)** because it can be administered intravenously. - Its **short onset of action** and predictable duration allow for rapid and precise titration in a critical care setting. *Insulin lispro* - **Insulin lispro** is a **rapid-acting insulin analog** typically used for mealtime coverage, which has a very quick onset and short duration. - While it acts quickly, its primary use is not for the continuous intravenous infusion required in DKA management. *Insulin glargine* - **Insulin glargine** is a **long-acting insulin analog** designed to provide basal insulin replacement. - It has a prolonged duration of action and a slow, sustained release profile, making it unsuitable for the rapid correction needed in DKA. *NPH insulin* - **NPH insulin** is an **intermediate-acting insulin** that has a delayed onset and peak effect. - Its insoluble nature and variable absorption make it inappropriate for the acute, immediate intravenous insulin therapy required in DKA.
Question 192: Praziquantel is used for the treatment of
- A. Schistosomiasis (Correct Answer)
- B. Rhinosporidiosis
- C. Strongyloidiasis
- D. Trichomoniasis
Explanation: ***Schistosomiasis*** - **Praziquantel** is the primary drug for treating all species of **schistosomiasis**, effectively killing adult worms [1], [2]. - It works by increasing the **calcium permeability** of the worm's cells, leading to muscle contraction and paralysis [2]. *Rhinosporidiosis* - **Rhinosporidiosis** is a fungal infection, and its treatment typically involves **surgical excision** of the lesions. - Antifungal agents like **dapsone** may be used as an adjuvant therapy, but praziquantel is not indicated. *Strongyloidiasis* - **Strongyloidiasis** is caused by the nematode *Strongyloides stercoralis*, and the preferred treatment is **ivermectin** [3]. - **Albendazole** is an alternative treatment option, but praziquantel is ineffective against this parasite [2], [3]. *Trichomoniasis* - **Trichomoniasis** is a sexually transmitted infection caused by the protozoan *Trichomonas vaginalis*. - It is effectively treated with **metronidazole** or **tinidazole**, while praziquantel has no activity against this protozoan.
Question 193: A lady has taken medication for amoebiasis infection. She drank alcohol on the same day. She has nausea, vomiting, and dizziness. Which anti-amoebic drug could have led to interaction with alcohol to produce these symptoms?
- A. Nitazoxanide
- B. Paromomycin
- C. Metronidazole (Correct Answer)
- D. Diloxanide
Explanation: ***Metronidazole*** - **Metronidazole** is well-known for causing a **disulfiram-like reaction** when consumed with alcohol. - This reaction leads to a rapid accumulation of **acetaldehyde**, manifesting as nausea, vomiting, flushing, headache, and dizziness. *Nitazoxanide* - **Nitazoxanide** is an oral anti-infective agent used for protozoal infections, but it is **not associated with a disulfiram-like reaction** with alcohol. - Its mechanism of action involves interfering with the **pyridoxine ferredoxin oxidoreductase enzyme**, which is distinct from alcohol metabolism. *Paromomycin* - **Paromomycin** is an aminoglycoside antibiotic primarily used for luminal amoebiasis and is **poorly absorbed from the GI tract**. - It does **not typically interact with alcohol** or cause disulfiram-like reactions. *Diloxanide* - **Diloxanide furoate** is a luminal amoebicide primarily used for asymptomatic cyst passers. - It is **not known to cause a disulfiram-like reaction** or significant interactions with alcohol.