FMGE 2019 Practice Questions

Q: Which enzyme level is tested in thiamine deficiency?

Transketolase. ***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.

Q: What is the most common presentation of nasopharyngeal carcinoma?

Neck lymph node. ***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.

Q: 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?

Necrotizing fasciitis. ***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."

Q: The shown apparatus is used for

Patella tendon bearing brace. ***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.

Q: Which anti-asthma drug is avoided with erythromycin?

Theophylline. ***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.

Q: To diagnose post-traumatic stress disorder, the symptoms should persist for more than ______

1 month. ***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.

Q: 32-year-old man presented with fever and pain in upper right hypochondrium after food intake. Investigation of choice?

Ultrasound. ***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.

Q: The complication which will not occur after PCNL surgery:

Urethral stricture. ***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.

Q: A lady with 50% TBSA burn with involvement of dermis and subcutaneous tissue came to the emergency department. The burns will be classified as:

3rd degree burn. ***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 1

Which enzyme level is tested in thiamine deficiency?

Accepted Answer

Transketolase

Answer

PDH

Answer

Kinase

Answer

Pyruvate kinase

Question 2

What is the most common presentation of nasopharyngeal carcinoma?

Accepted Answer

Neck lymph node

Answer

Loss of smell

Answer

Blockage of nose

Answer

Blood tinged discharge

Question 3

What is the most common cause of deafness in a patient with Nasopharyngeal Carcinoma:

Accepted Answer

Fluid accumulation in the middle ear due to eustachian tube obstruction

Answer

Middle ear Infection

Answer

Metastasis to Temporal Bone

Answer

Infiltration of Tumour into middle ear

Question 4

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?

Accepted Answer

Necrotizing fasciitis

Answer

Burn

Answer

Cellulitis

Answer

Diabetic foot

Question 5

The shown apparatus is used for

Accepted Answer

Patella tendon bearing brace

Answer

Ankle knee stabilizer

Answer

Thomas splint

Answer

Knee brace

Question 6

Which anti-asthma drug is avoided with erythromycin?

Accepted Answer

Theophylline

Answer

Ipratropium

Answer

Salbutamol

Answer

Terbutaline

Question 7

To diagnose post-traumatic stress disorder, the symptoms should persist for more than ______

Accepted Answer

1 month

Answer

2 days

Answer

3 months

Answer

6 months

Question 8

32-year-old man presented with fever and pain in upper right hypochondrium after food intake. Investigation of choice?

Accepted Answer

Ultrasound

Answer

CT scan

Answer

ERCP (Endoscopic Retrograde Cholangiopancreatography)

Answer

MRCP (Magnetic Resonance Cholangiopancreatography)

Question 9

The complication which will not occur after PCNL surgery:

Accepted Answer

Urethral stricture

Answer

Organ injury

Answer

Bleeding

Answer

Sepsis

Question 10

A lady with 50% TBSA burn with involvement of dermis and subcutaneous tissue came to the emergency department. The burns will be classified as:

Accepted Answer

3rd degree burn

Answer

2nd degree superficial

Answer

2nd degree deep

Answer

1st degree

FMGE 2019

Biochemistry

ENT

Internal Medicine

Orthopaedics

Pharmacology

Psychiatry

Surgery