Biochemistry
1 questionsProtein content in cow's milk in comparison to human milk is?
FMGE 2019 - Biochemistry FMGE Practice Questions and MCQs
Question 31: Protein content in cow's milk in comparison to human milk is?
- A. Quadruple
- B. Triple (Correct Answer)
- C. Double
- D. Same
Explanation: ***Triple*** - The protein content in **cow's milk** is approximately **three times higher** than that found in **human milk**. - **Cow's milk** contains approximately **3.3 g/100 mL** of protein, while **human milk** contains about **1.0-1.3 g/100 mL**. - This higher protein load in cow's milk can be challenging for an infant's immature kidneys and digestion. - The predominant protein in cow's milk is **casein (80%)**, while human milk has more **whey proteins (60%)**. *Quadruple* - While cow's milk has significantly more protein than human milk, it is not **four times** the amount. - The exact ratio is closer to **three times (3:1)**, making quadruple an overestimation. *Double* - The protein content of cow's milk is **more than double** that of human milk. - Therefore, stating it is merely double **underestimates** the difference in protein concentration. *Same* - The protein content of **cow's milk and human milk are not the same**. - There are significant differences in both the **quantity** (3:1 ratio) and **type of proteins** (casein vs whey predominance). - These differences make each milk suited for different species' developmental needs.
Internal Medicine
1 questionsAn 85-year-old patient was brought to the ER, BP: 180/100, right hemiparesis was seen. What is the next best step in management?
FMGE 2019 - Internal Medicine FMGE Practice Questions and MCQs
Question 31: An 85-year-old patient was brought to the ER, BP: 180/100, right hemiparesis was seen. What is the next best step in management?
- A. Reduce BP
- B. NCCT (Correct Answer)
- C. MRI
- D. Aspirin 300mg and anticoagulants
Explanation: ***NCCT*** - A **non-contrast CT (NCCT) scan of the brain** is the most crucial initial step to differentiate between **ischemic stroke** and **hemorrhagic stroke** [1]. - This distinction is vital because management, especially the use of thrombolytics or anticoagulants, differs significantly based on stroke type [1]. *Reduce BP* - While blood pressure management is important in stroke, immediate and aggressive lowering of BP in acute ischemic stroke can **worsen cerebral perfusion** and **increase infarct size**. - In hemorrhagic stroke, BP control is often necessary, but the decision to lower BP and by how much depends on the cause and extent of the bleed, and this can only be determined after imaging [1]. *MRI* - **MRI** is more sensitive for detecting acute ischemic changes than CT, especially in the posterior fossa [1]. - However, **MRI is not typically the first-line imaging** in an emergency setting for an acute stroke due to its longer acquisition time and potential contraindications (e.g., pacemakers, metallic implants) [1]. *Aspirin 300mg and anticoagulants* - These medications are indicated for **ischemic stroke** (aspirin is an antiplatelet, anticoagulants may be used in specific cases like cardioembolic stroke). - Administering these agents in the event of a **hemorrhagic stroke** would be contraindicated and could significantly worsen the bleeding, leading to severe neurological damage or death [1].
Obstetrics and Gynecology
2 questionsA 67-year-old female with hypertension and diabetes presents with heavy vaginal bleeding. What is the next step in management?
A 16-year-old girl with acute vaginal bleeding presents to the clinic. What is the immediate management?
FMGE 2019 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 31: A 67-year-old female with hypertension and diabetes presents with heavy vaginal bleeding. What is the next step in management?
- A. Endometrial biopsy (Correct Answer)
- B. Pelvic ultrasound
- C. Detailed history and physical examination
- D. Complete blood count and coagulation studies
Explanation: ***Endometrial biopsy*** - **Postmenopausal bleeding is endometrial cancer until proven otherwise** - this is a fundamental principle in gynecology requiring immediate tissue diagnosis. - **Endometrial biopsy is the first-line investigation** for any postmenopausal woman presenting with vaginal bleeding, as per **ACOG, RCOG, and WHO guidelines**. - An office endometrial biopsy (using **Pipelle sampler**) can be performed quickly and has **90-97% sensitivity** for detecting endometrial cancer and hyperplasia. - In this 67-year-old patient with risk factors (hypertension, diabetes), direct tissue sampling is mandatory to rule out **endometrial carcinoma**, which is the most concerning etiology. - If office biopsy is inadequate or negative but bleeding persists, proceed to **hysteroscopy with directed biopsy** or **dilatation and curettage (D&C)**. *Pelvic ultrasound* - While transvaginal ultrasound can assess **endometrial thickness** (cancer unlikely if <4-5mm in postmenopausal women), it **cannot replace histological diagnosis**. - Ultrasound may be used as an **adjunct** or for **triage in resource-limited settings**, but in established postmenopausal bleeding, **tissue diagnosis takes priority**. - Some protocols use ultrasound first, but the definitive diagnostic step remains biopsy, and many guidelines recommend proceeding directly to biopsy in postmenopausal bleeding. *Detailed history and physical examination* - History and examination are **always performed initially** when a patient presents, but the question asks for the "next step in management" after the presentation is established. - These would have already been completed to confirm postmenopausal status, exclude obvious causes (trauma, atrophic vaginitis), and assess hemodynamic stability. - The "next step" implies the specific diagnostic or therapeutic intervention to identify the cause. *Complete blood count and coagulation studies* - **CBC** helps assess the degree of anemia from blood loss and guides need for transfusion. - **Coagulation studies** may identify bleeding disorders but are not routinely indicated unless clinical suspicion exists. - These investigations are **supportive** but do not identify the **anatomical source** or **histological cause** of bleeding, which is essential for management of postmenopausal bleeding.
Question 32: A 16-year-old girl with acute vaginal bleeding presents to the clinic. What is the immediate management?
- A. Administer high-dose estrogen
- B. Perform dilation and curettage
- C. Start tranexamic acid
- D. Stabilize the patient and investigate the cause of bleeding (Correct Answer)
Explanation: ***Stabilize the patient and investigate the cause of bleeding*** - In a patient with acute bleeding, the **immediate priority** is to stabilize their hemodynamic status, which may involve intravenous fluids or blood transfusion, followed by a thorough investigation to identify the underlying cause of bleeding. - A 16-year-old presenting with acute vaginal bleeding requires a **comprehensive medical evaluation** to rule out trauma, pregnancy-related complications, coagulation disorders, or structural abnormalities before specific treatments are initiated. *Administer high-dose estrogen* - High-dose estrogen can be used to **acutely stop uterine bleeding** by promoting rapid endometrial proliferation, but it is not the *immediate* management without patient stabilization and identifying the cause, especially in an acute setting. - While effective for some types of dysfunctional uterine bleeding, it is a **therapeutic intervention**, not the primary step for initial stabilization or diagnosis. *Perform dilation and curettage* - Dilation and curettage (D&C) is a **surgical procedure** used to remove tissue from the uterus and is typically performed for diagnostic or therapeutic reasons after initial assessment and stabilization, or if medical management fails. - It carries risks and is not the first-line immediate management for acute vaginal bleeding in an adolescent without a clear indication, such as severe, uncontrolled bleeding resistant to medical therapy or suspected retained products of conception. *Start tranexamic acid* - Tranexamic acid is an **antifibrinolytic** that helps reduce bleeding by inhibiting fibrinolysis, making it useful for managing menstrual bleeding or other bleeding disorders. - While it can be part of medical management once the patient is stabilized, it is not the *immediate* initial step before hemodynamic stabilization or diagnostic workup to determine the cause of bleeding.
Ophthalmology
1 questionsWhich of the following is seen in retinitis pigmentosa?
FMGE 2019 - Ophthalmology FMGE Practice Questions and MCQs
Question 31: Which of the following is seen in retinitis pigmentosa?
- A. Arteriolar attenuation (Correct Answer)
- B. Neovascularization
- C. Papilledema
- D. Retinal artery thrombosis
Explanation: ***Arteriolar attenuation*** - **Arteriolar attenuation** is a classic finding in retinitis pigmentosa, reflecting the progressive loss of retinal tissue and the associated reduction in metabolic demand, leading to narrowing of the retinal arterioles. - This sign indicates the ongoing degeneration of photoreceptors and the underlying retinal layers, which is characteristic of the disease. *Neovascularization* - **Neovascularization** (abnormal new blood vessel growth) is typically associated with conditions like proliferative diabetic retinopathy or age-related macular degeneration. - It is not a primary feature of retinitis pigmentosa, which is a degenerative disease rather than an ischemic or proliferative one. *Papilledema* - **Papilledema** is swelling of the optic disc due to increased intracranial pressure. - It is not a feature of retinitis pigmentosa; rather, the optic disc in retinitis pigmentosa often appears waxy pale due to optic atrophy. *Retinal artery thrombosis* - **Retinal artery thrombosis** involves the sudden blockage of a retinal artery, leading to acute vision loss and often presenting with a 'cherry-red spot' on the macula. - This is an acute vascular event and is not characteristic of the chronic, progressive degeneration seen in retinitis pigmentosa.
Pharmacology
3 questionsAll of the following can result in gynecomastia except:
Mechanism of action of atropine in treatment of organophosphate poisoning is?
Which of the following is the shortest-acting corticosteroid?
FMGE 2019 - Pharmacology FMGE Practice Questions and MCQs
Question 31: All of the following can result in gynecomastia except:
- A. Spironolactone
- B. Digoxin
- C. Aromatase inhibitors (Correct Answer)
- D. Sulphonamides
Explanation: ***Aromatase inhibitors*** - **Aromatase inhibitors** block the conversion of androgens to estrogens, thereby **decreasing estrogen levels** which would prevent rather than cause gynecomastia. - They are used in estrogen-sensitive breast cancers to reduce estrogen-dependent growth. *Spironolactone* - **Spironolactone** is an aldosterone antagonist that also possesses anti-androgenic effects and can inhibit androgen synthesis, leading to an **increased estrogen-to-androgen ratio** and gynecomastia. - It can also directly stimulate the estrogen receptor in male breast tissue. *Sulphonamides* - Certain **sulphonamides**, particularly sulfasalazine, have been associated with gynecomastia, possibly due to direct toxic effects on testicular function leading to a **relative increase in estrogen activity**. - While less common than with some other drugs, it can alter the estrogen-androgen balance. *Digoxin* - **Digoxin** can cause gynecomastia by mimicking estrogen physiologically or by inhibiting androgen production, leading to an **alteration in the estrogen-to-androgen ratio**. - The risk of gynecomastia is especially noted with prolonged use and higher doses of digoxin.
Question 32: Mechanism of action of atropine in treatment of organophosphate poisoning is?
- A. It inhibits secretion of acetylcholine
- B. It has antimuscarinic activity (Correct Answer)
- C. It is reactivator of acetylcholine esterase enzyme
- D. It is agonist of acetylcholine receptors
Explanation: ***It has antimuscarinic activity*** - **Organophosphate poisoning** leads to **excessive acetylcholine** at muscarinic receptors, causing symptoms like miosis, bradycardia, and increased secretions. - **Atropine** is a **competitive antagonist** at these muscarinic receptors, thereby blocking the effects of excess acetylcholine. *It inhibits secretion of acetylcholine* - Atropine does not directly inhibit the secretion of **acetylcholine** from nerve terminals. - Its action is postsynaptic, specifically at the **receptor level**. *It is reactivator of acetylcholine esterase enzyme* - **Pralidoxime (2-PAM)** and other **oximes** are the drugs that reactivate **acetylcholinesterase**. - Atropine does not reactivate the enzyme; it only blocks the effects of acetylcholine. *It is agonist of acetylcholine receptors* - An **agonist** would mimic the effects of acetylcholine, which would worsen the symptoms of organophosphate poisoning. - Atropine is an **antagonist**, meaning it blocks the receptors.
Question 33: Which of the following is the shortest-acting corticosteroid?
- A. Dexamethasone
- B. Hydrocortisone (Correct Answer)
- C. Triamcinolone
- D. Deflazacort
Explanation: ***Hydrocortisone***- **Hydrocortisone** is considered a **short-acting corticosteroid** with a biological half-life of 8-12 hours [1].- It is a naturally occurring glucocorticoid, acting as a direct replacement for cortisol.- Among the given options, it has the shortest duration of action.*Dexamethasone*- **Dexamethasone** is a **long-acting corticosteroid** with a biological half-life of 36-72 hours.- Its potent and prolonged action makes it suitable for conditions requiring sustained anti-inflammatory or immunosuppressive effects.*Triamcinolone*- **Triamcinolone** is an **intermediate-acting corticosteroid** with a biological half-life typically ranging from 18-36 hours.- It is commonly used for its anti-inflammatory effects in conditions like allergies, asthma, and skin disorders.*Deflazacort*- **Deflazacort** is an **intermediate-acting corticosteroid** with a duration of action of approximately 12-18 hours.- It is a prodrug that is metabolized to 21-desacetyl deflazacort, the active form, often used in conditions like Duchenne muscular dystrophy and inflammatory disorders.
Physiology
1 questionsWhat is the principal stimulus for vasopressin secretion?
FMGE 2019 - Physiology FMGE Practice Questions and MCQs
Question 31: What is the principal stimulus for vasopressin secretion?
- A. Hyperosmolality (Correct Answer)
- B. Hypovolemia
- C. Hypoosmolality
- D. Hypervolemia
Explanation: ***Hyperosmolality*** - An increase in **plasma osmolality**, even by a small percentage (1-2%), is the **most potent and PRINCIPAL stimulus** for ADH (vasopressin) release. - This is detected by **osmoreceptors** in the hypothalamus (particularly in the organum vasculosum of the lamina terminalis), which are extremely sensitive and respond rapidly. - This response is the primary mechanism for day-to-day regulation of water balance. *Hypovolemia* - A significant decrease in **blood volume** (typically >10%) also stimulates vasopressin release, but it is **much less sensitive** than hyperosmolality and serves as a secondary/backup mechanism. - This response is mediated by **baroreceptors** in the carotid sinuses and aortic arch. - Only activated during substantial volume loss (hemorrhage, severe dehydration). *Hypoosmolality* - **Decreased plasma osmolality** actively **inhibits** vasopressin secretion as the body aims to excrete excess water. - This helps to prevent overhydration and maintain proper fluid balance. *Hypervolemia* - **Increased blood volume** (hypervolemia) **inhibits** vasopressin secretion, as the body needs to excrete excess fluid. - This contributes to diuresis and the lowering of blood pressure.
Psychiatry
1 questionsFear of "places from where escape is difficult" is called ______
FMGE 2019 - Psychiatry FMGE Practice Questions and MCQs
Question 31: Fear of "places from where escape is difficult" is called ______
- A. Claustrophobia
- B. Aerophobia
- C. Agoraphobia (Correct Answer)
- D. Ailurophobia
Explanation: ***Agoraphobia*** - **Agoraphobia** is the intense fear and anxiety of situations or places that might be difficult to escape from or where help might not be available, such as open spaces, crowds, or public transportation. - Individuals with agoraphobia often avoid these situations or endure them with extreme distress, sometimes resulting in being housebound. *Claustrophobia* - **Claustrophobia** is the intense fear of tight, enclosed spaces, such as elevators, small rooms, or MRI machines. - This phobia is distinct from agoraphobia, which centers around difficulty escaping rather than the space itself. *Aerophobia* - **Aerophobia** is the fear of flying, specifically involving airplanes or other forms of air travel. - It is a specific phobia related to a particular situation, not a generalized fear of inescapable places. *Ailurophobia* - **Ailurophobia** is the irrational fear of cats. - This is a specific animal phobia and has no relation to the fear of open spaces or situations from which escape might be difficult.