Biochemistry
1 questionsWhich enzyme level is tested in thiamine deficiency?
FMGE 2019 - Biochemistry FMGE Practice Questions and MCQs
Question 221: Which enzyme level is tested in thiamine deficiency?
- A. Transketolase (Correct Answer)
- B. PDH
- C. Kinase
- D. Pyruvate kinase
Explanation: ***Transketolase*** - The activity of **transketolase** in red blood cells is a reliable biochemical indicator of **thiamine deficiency (vitamin B1)**. - Thiamine pyrophosphate (TPP), the active form of thiamine, is a critical coenzyme for transketolase in the **pentose phosphate pathway**. *PDH* - **Pyruvate dehydrogenase (PDH)** is an enzyme complex that uses thiamine pyrophosphate as a cofactor, but its activity is not typically measured directly for diagnosing thiamine deficiency. - While PDH function is impaired in thiamine deficiency, direct assessment of transketolase activity is the standard diagnostic test. *Kinase* - **Kinase** is a general term for an enzyme that catalyzes the transfer of a phosphate group from a high-energy phosphate-donating molecule (like ATP) to a specific substrate. - This general class of enzymes is not specifically tested for thiamine deficiency. *Pyruvate kinase* - **Pyruvate kinase** is a key enzyme in **glycolysis** that catalyzes the final step of the pathway, converting phosphoenolpyruvate to pyruvate. - Its activity is not directly related to thiamine metabolism or deficiency.
ENT
1 questionsWhat is the most common cause of deafness in a patient with Nasopharyngeal Carcinoma:
FMGE 2019 - ENT FMGE Practice Questions and MCQs
Question 221: What is the most common cause of deafness in a patient with Nasopharyngeal Carcinoma:
- A. Fluid accumulation in the middle ear due to eustachian tube obstruction (Correct Answer)
- B. Middle ear Infection
- C. Metastasis to Temporal Bone
- D. Infiltration of Tumour into middle ear
Explanation: ***Fluid accumulation in the middle ear due to eustachian tube obstruction*** - **Nasopharyngeal carcinoma** often grows in close proximity to the opening of the **eustachian tube**, leading to its obstruction. - Obstruction of the eustachian tube prevents proper ventilation of the middle ear, leading to a build-up of fluid (**serous otitis media**), which causes a **conductive hearing loss**. *Middle ear Infection* - While middle ear infections can cause deafness, they are not the most common cause of hearing loss directly attributable to **nasopharyngeal carcinoma**. - **Fluid accumulation due to Eustachian tube dysfunction** precedes infection and is the primary mechanism linked to the tumor. *Metastasis to Temporal Bone* - **Metastasis to the temporal bone** can occur in advanced stages of nasopharyngeal carcinoma, causing hearing loss. - However, direct **eustachian tube obstruction and serous otitis media** are significantly more common initial presentations of hearing impairment. *Infiltration of Tumour into middle ear* - While direct tumor infiltration into the middle ear can lead to deafness, it is less common than the effect of **eustachian tube obstruction**. - **Tumor infiltration** typically indicates more advanced local disease, whereas **eustachian tube dysfunction** can be an early symptom.
Internal Medicine
1 questionsA long-term diabetic patient with blisters walked barefoot for a few miles on hot sand. He presented with rapidly spreading deep tissue infection with extensive tissue necrosis. What is the most probable diagnosis?
FMGE 2019 - Internal Medicine FMGE Practice Questions and MCQs
Question 221: A long-term diabetic patient with blisters walked barefoot for a few miles on hot sand. He presented with rapidly spreading deep tissue infection with extensive tissue necrosis. What is the most probable diagnosis?
- A. Burn
- B. Cellulitis
- C. Diabetic foot
- D. Necrotizing fasciitis (Correct Answer)
Explanation: ***Necrotizing fasciitis*** - The rapid spread of deep tissue infection with extensive necrosis, especially in an immunocompromised patient like a diabetic, is highly characteristic of **necrotizing fasciitis**. [1] - **Diabetic peripheral neuropathy** can lead to unnoticed injury (walking barefoot on hot sand) and impaired wound healing, further predisposing to severe infections. [2] *Burn* - While walking on hot sand can cause burns, this patient's presentation of "rapidly spreading deep tissue infection" and "extensive tissue necrosis" goes beyond a typical burn injury, suggesting an overwhelming infection. - Burns primarily involve direct tissue damage from heat, whereas the described pathology is indicative of a **bacterial infection** escalating rapidly. *Cellulitis* - **Cellulitis** is a superficial skin infection that typically presents as localized redness, warmth, and swelling, but it usually does not involve deep tissue necrosis or such rapid, extensive spread. - It lacks the hallmark sign of rapid progression to **necrosis** and involvement of deep fascial planes that necessitate urgent surgical debridement. *Diabetic foot* - **Diabetic foot** is a broad term encompassing various foot complications in diabetes, including ulcers, infections, and Charcot arthropathy. While this patient has a diabetic foot, the specific presentation of **rapidly spreading infection** with **extensive necrosis** points to a particular, severe diagnosis within the diabetic foot spectrum, rather than the general term. [2] - The context describes a specific acute, life-threatening infectious process rather than the chronic complications typically associated with the general term "diabetic foot."
Orthopaedics
1 questionsThe shown apparatus is used for
FMGE 2019 - Orthopaedics FMGE Practice Questions and MCQs
Question 221: The shown apparatus is used for
- A. Ankle knee stabilizer
- B. Thomas splint
- C. Knee brace
- D. Patella tendon bearing brace (Correct Answer)
Explanation: ***Patella tendon bearing brace*** - This orthotic device is designed to **transfer weight-bearing load through the patella tendon**, reducing stress on the lower extremity during ambulation. - It features a **molded cuff** that fits snugly below the patella and distributes weight through the **patellar tendon bearing area**, commonly used in **prosthetic applications** and **below-knee amputees**. *Ankle knee stabilizer* - This device provides **combined support to both ankle and knee joints** simultaneously, typically used for **multi-joint injuries** or instability. - It features **dual bracing systems** with straps and supports extending from ankle to knee, unlike the focused patellar tendon bearing design. *Thomas splint* - A **rigid metal-framed splint** used primarily for **femur fracture stabilization** and maintaining **skeletal traction** in emergency situations. - It consists of a **ring that fits around the upper thigh** with extending metal bars, designed for **fracture immobilization** rather than weight distribution. *Knee brace* - A general **knee joint support device** used for **ligament injuries**, **post-surgical recovery**, or **osteoarthritis management**. - Available in various forms (**sleeve, hinged, or wraparound designs**) but lacks the specific **weight-bearing transfer mechanism** of a patella tendon bearing brace.
Pharmacology
1 questionsWhich anti-asthma drug is avoided with erythromycin?
FMGE 2019 - Pharmacology FMGE Practice Questions and MCQs
Question 221: Which anti-asthma drug is avoided with erythromycin?
- A. Ipratropium
- B. Salbutamol
- C. Theophylline (Correct Answer)
- D. Terbutaline
Explanation: ***Theophylline*** - **Erythromycin** inhibits the **cytochrome P450 (CYP) enzymes** responsible for theophylline metabolism, leading to increased theophylline levels and potential toxicity. - Elevated theophylline can cause adverse effects such as **nausea**, **vomiting**, **arrhythmias**, and **seizures**. *Ipratropium* - **Ipratropium** is largely eliminated unchanged in urine, with minimal hepatic metabolism. - It does not interact significantly with **erythromycin** as its metabolism is not dependent on the CYP enzyme system. *Salbutamol* - **Salbutamol** is primarily metabolized by **sulfotransferase enzymes** in the liver and gut, not primarily by CYP enzymes. - Therefore, **erythromycin** has a negligible impact on salbutamol's metabolism and plasma levels. *Terbutaline* - **Terbutaline** is mainly metabolized by **conjugation reactions** (glucuronidation and sulfation) and excreted renally. - It also has limited interaction potential with **erythromycin** due to its distinct metabolic pathways.
Psychiatry
1 questionsTo diagnose post-traumatic stress disorder, the symptoms should persist for more than ______
FMGE 2019 - Psychiatry FMGE Practice Questions and MCQs
Question 221: To diagnose post-traumatic stress disorder, the symptoms should persist for more than ______
- A. 1 month (Correct Answer)
- B. 2 days
- C. 3 months
- D. 6 months
Explanation: ***1 month*** - According to the **DSM-5 criteria**, for a diagnosis of **Post-Traumatic Stress Disorder (PTSD)**, the symptoms must persist for **more than one month**. - If symptoms last for less than one month, but meet other criteria, the diagnosis is typically **Acute Stress Disorder**. *2 days* - Symptoms lasting only **2 days** following a traumatic event are too short for a diagnosis of PTSD. - Such a brief duration may align with an **acute stress reaction**, which is a normal response to trauma and usually resolves quickly. *3 months* - While symptoms lasting **3 months** would certainly qualify for PTSD in terms of duration, this is not the minimum duration required. - The **minimum duration** for PTSD diagnosis is specifically defined as more than one month. *6 months* - Symptoms persisting for **6 months** or longer clearly meet the duration criteria for PTSD, but this is not the minimal period. - Setting the minimum at 6 months would lead to **underdiagnosis** of PTSD in individuals whose symptoms are significant and disabling after one month but before six months.
Surgery
4 questions32-year-old man presented with fever and pain in upper right hypochondrium after food intake. Investigation of choice?
The complication which will not occur after PCNL surgery:
A lady with 50% TBSA burn with involvement of dermis and subcutaneous tissue came to the emergency department. The burns will be classified as:
What is the most common presentation of nasopharyngeal carcinoma?
FMGE 2019 - Surgery FMGE Practice Questions and MCQs
Question 221: 32-year-old man presented with fever and pain in upper right hypochondrium after food intake. Investigation of choice?
- A. Ultrasound (Correct Answer)
- B. CT scan
- C. ERCP (Endoscopic Retrograde Cholangiopancreatography)
- D. MRCP (Magnetic Resonance Cholangiopancreatography)
Explanation: ***Ultrasound*** - **Ultrasound** is the initial and often definitive investigation for suspected **gallbladder pathology** like cholecystitis, especially given the symptoms of fever and **right upper quadrant pain post-meals**. - It effectively visualizes **gallstones**, gallbladder wall thickening, and **pericholecystic fluid**, which are key indicators of cholecystitis. *CT scan* - A **CT scan** is generally not the first-line investigation for acute cholecystitis due to **radiation exposure** and its **lower sensitivity** for gallstones compared to ultrasound. - While it can identify complications like abscesses or perforations, it is usually reserved for **ambiguous ultrasound findings** or suspected complications. *ERCP (Endoscopic Retrograde Cholangiopancreatography)* - **ERCP** is an **invasive procedure** primarily used therapeutically for the removal of **bile duct stones** or for stent placement in cases of obstruction. - It carries risks of **pancreatitis** and perforation, making it unsuitable as an initial diagnostic tool for simple cholecystitis. *MRCP (Magnetic Resonance Cholangiopancreatography)* - **MRCP** is a **non-invasive imaging technique** that provides detailed images of the **biliary and pancreatic ducts** without radiation, primarily useful for confirming suspected bile duct stones or strictures. - While excellent for ductal anatomy, it is **not typically the first choice** for acute cholecystitis, as ultrasound is quicker, cheaper, and sufficient for initial diagnosis.
Question 222: The complication which will not occur after PCNL surgery:
- A. Organ injury
- B. Urethral stricture (Correct Answer)
- C. Bleeding
- D. Sepsis
Explanation: ***Urethral stricture*** - **Urethral stricture** is a complication typically associated with transurethral procedures involving instrumentation through the urethra, such as a **Transurethral Resection of the Prostate (TURP)** or repeated urethral catheterisation. - **PCNL (Percutaneous Nephrolithotomy)** involves direct access to the kidney through the skin in the flank, bypassing the urethra entirely, therefore, making urethral stricture not a direct complication of this procedure. *Organ injury* - **Organ injury**, particularly to adjacent organs like the **colon**, **pleura**, or **spleen/liver**, can occur during PCNL if the access tract is misdirected or during instrumentation. - This is a well-recognised but infrequent complication requiring careful pre-operative planning and imaging guidance. *Bleeding* - **Bleeding** is a common complication of PCNL due to the invasive nature of the procedure, involving puncture of the kidney and fragmentation of stones. - It can range from minor self-limiting bleeding to significant haemorrhage requiring transfusion or further intervention such as **angiography** and **embolization**. *Sepsis* - **Sepsis** is a serious potential complication, particularly if the patient has pre-existing urinary tract infection or if bacteria are dislodged during stone fragmentation. - **Infection** can disseminate into the bloodstream, leading to severe systemic inflammatory response syndrome and septic shock.
Question 223: A lady with 50% TBSA burn with involvement of dermis and subcutaneous tissue came to the emergency department. The burns will be classified as:
- A. 3rd degree burn (Correct Answer)
- B. 2nd degree superficial
- C. 2nd degree deep
- D. 1st degree
Explanation: ***3rd degree burn*** - **Third-degree burns** involve the entire thickness of the skin (dermis and epidermis) and often extend into the **subcutaneous tissue**, muscle, or bone. - These burns typically appear dry, leathery, and often lack pain sensation due to nerve destruction. *2nd degree superficial* - **Superficial second-degree burns** involve the epidermis and the superficial part of the dermis, often presenting with **blisters** and painful, red, moist skin. - They do not extend to the subcutaneous tissue, which is a key feature of the burn described. *2nd degree deep* - **Deep second-degree burns** involve the epidermis and deeper layers of the dermis, but not the entire dermis or subcutaneous tissue. - While they can be less painful and appear dry, the involvement of **subcutaneous tissue** pushes the classification to third-degree. *1st degree* - **First-degree burns** only affect the epidermis, causing redness and pain but **no blistering** or damage to deeper layers. - These are typically sunburns or minor scalds and do not involve the dermis or subcutaneous tissue.
Question 224: What is the most common presentation of nasopharyngeal carcinoma?
- A. Loss of smell
- B. Blockage of nose
- C. Neck lymph node (Correct Answer)
- D. Blood tinged discharge
Explanation: ***Neck lymph node*** - The most common initial symptom of nasopharyngeal carcinoma is a **painless neck mass** due to metastasis to cervical lymph nodes. - This occurs in a significant percentage of patients, often even before local symptoms from the primary tumor are prominent. *Loss of smell* - While possible in advanced stages if the tumor invades the **olfactory nerves** or directly obstructs the nasal cavity, it is not typically the initial or most common presentation. - This symptom is more indicative of conditions directly affecting the **olfactory epithelium** or nerves, not early nasopharyngeal carcinoma. *Blockage of nose* - **Nasal obstruction** or stuffiness can occur as the tumor grows and localizes within the nasopharynx, but it is less common as an initial symptom than a palpable neck mass. - This symptom might also be attributed to other common conditions like sinusitis or allergies, delaying diagnosis. *Blood tinged discharge* - **Epistaxis (nosebleeds)** or blood-tinged sputum/discharge can be a symptom, especially with later-stage tumors that are ulcerating or bleeding. - However, it is reported less frequently as the presenting symptom compared to cervical lymphadenopathy.