Anatomy
1 questionsVentricles are lined by?
FMGE 2019 - Anatomy FMGE Practice Questions and MCQs
Question 41: Ventricles are lined by?
- A. Schwann cells
- B. Oligodendrocytes
- C. Ependymal cells (Correct Answer)
- D. Astrocytes
Explanation: Ependymal cells - Ependymal cells are a type of glial cell that form the epithelial lining of the ventricles of the brain and the central canal of the spinal cord [3]. - They possess cilia that help circulate the cerebrospinal fluid (CSF) and microvilli involved in CSF absorption. Schwann cells - Schwann cells are responsible for forming the myelin sheath around axons in the peripheral nervous system (PNS) [4]. - They do not line the ventricles, which are part of the central nervous system [2]. Oligodendrocytes - Oligodendrocytes are glial cells that form the myelin sheath around axons in the central nervous system (CNS) [1], [4]. - While they are CNS cells, their primary function is myelination, not lining the ventricular system [1]. Astrocytes - Astrocytes are the most abundant and diverse glial cells in the CNS, providing structural support, metabolic regulation, and forming the blood-brain barrier. - They are found throughout the brain parenchyma but do not directly line the ventricular cavities.
Internal Medicine
2 questionsA farmer with pinpoint pupils, increased secretions and urination. What is the most likely diagnosis?
All of the following are types of Primary headache except:
FMGE 2019 - Internal Medicine FMGE Practice Questions and MCQs
Question 41: A farmer with pinpoint pupils, increased secretions and urination. What is the most likely diagnosis?
- A. Alcohol poisoning
- B. Organophosphate poisoning (Correct Answer)
- C. Opioid poisoning
- D. Atropine poisoning
Explanation: ***Organophosphate poisoning*** - **Pinpoint pupils (miosis)**, **increased secretions** (salivation, lacrimation, bronchial secretions), and **urination** are classic signs of cholinergic crisis caused by organophosphate toxicity [1]. - The patient's profession as a **farmer** increases the likelihood of exposure to pesticides, which often contain organophosphates [1], [2]. *Alcohol poisoning* - While alcohol poisoning can cause CNS depression, it does not typically present with **pinpoint pupils** or **increased secretions** like salivation and urination. - Common signs include **ataxia**, **slurred speech**, **nausea**, and **vomiting**. *Opioid poisoning* - Opioid poisoning also causes **pinpoint pupils** and **CNS depression**, but it typically leads to **decreased secretions** and **urinary retention**, not increased urination [2]. - **Respiratory depression** is a hallmark feature, which is not highlighted here as a primary symptom. *Atropine poisoning* - Atropine is an anticholinergic agent, meaning it would cause the opposite effects of organophosphate poisoning [2]. - Symptoms would include **dilated pupils (mydriasis)**, **dry mouth**, **decreased secretions**, and **urinary retention**.
Question 42: All of the following are types of Primary headache except:
- A. Migraine
- B. Tension
- C. Cluster
- D. Temporal arteritis (Correct Answer)
Explanation: ***Temporal arteritis*** - **Temporal arteritis** is a **secondary headache** caused by inflammation of the **temporal arteries**, not a primary headache type [1]. - It is often associated with symptoms like **jaw claudication**, **scalp tenderness**, and is more common in elderly individuals. *Migraine* - **Migraine** is a common type of **primary headache**, characterized by moderate to severe pain, often unilateral and pulsating [1]. - It can be accompanied by symptoms like **nausea, vomiting**, and sensitivity to light and sound [1]. *Tension* - **Tension-type headache** is the most common type of **primary headache**, typically described as a mild to moderate, bilateral, pressing or tightening pain [1]. - It usually lacks associated symptoms like nausea or vomiting, which differentiates it from migraine. *Cluster* - **Cluster headache** is a severe form of **primary headache**, known for its excruciating unilateral pain, often around the eye or temple [1]. - It is characterized by specific autonomic symptoms on the affected side, such as **lacrimation, rhinorrhea, and ptosis** [1].
Ophthalmology
1 questionsWhich of the following is an advantage of contact lenses over normal glasses?
FMGE 2019 - Ophthalmology FMGE Practice Questions and MCQs
Question 41: Which of the following is an advantage of contact lenses over normal glasses?
- A. Reduced prismatic effect
- B. Improved peripheral vision (Correct Answer)
- C. Decreased risk of infection
- D. UV protection (in specific lenses)
Explanation: ***Improved peripheral vision*** - Contact lenses sit directly on the cornea, moving with the eye and eliminating the **frame obstruction** and **edge distortions** associated with glasses. - This provides a wider and more natural **field of view**, enhancing peripheral vision. *Reduced prismatic effect* - While contact lenses do reduce the **magnification/minification** compared to glasses, the prismatic effect is a specific distortion most pronounced in **strong thick spectacle lenses** and can induce visual discomfort, which contact lenses inherently minimize. - This effect is due to the distance between the spectacle lens and the eye, which contact lenses eliminate. *Decreased risk of infection* - Wearing contact lenses inherently carries a **higher risk of eye infections** if proper hygiene and care are not meticulously followed. - Unlike glasses, contact lenses require regular cleaning, disinfection, and proper storage to prevent bacterial or fungal contamination. *UV protection (in specific lenses)* - While some contact lenses incorporate **UV-blocking agents**, this is not a universal feature of all contact lenses and is also available in many spectacle lenses. - UV protection from contact lenses primarily shields the cornea and iris but does not fully protect the surrounding ocular tissues like glasses (especially wrap-around styles) can.
Pharmacology
1 questionsWhich of the following is a monoclonal antibody used in cancer treatment?
FMGE 2019 - Pharmacology FMGE Practice Questions and MCQs
Question 41: Which of the following is a monoclonal antibody used in cancer treatment?
- A. Cisplatin
- B. Rituximab (Correct Answer)
- C. 5-fluorouracil
- D. Methotrexate
Explanation: ***Rituximab*** - **Rituximab** is a **chimeric monoclonal antibody** that targets the **CD20 protein** found on the surface of normal and malignant **B lymphocytes**. - It is widely used in the treatment of various **lymphomas** and **leukemias**, as well as autoimmune diseases, by inducing the death of CD20-positive B cells. *Cisplatin* - **Cisplatin** is a **platinum-based chemotherapy drug** that works by forming **DNA adducts**, leading to DNA damage and apoptosis of cancer cells. - It is used in various solid tumors but is not a monoclonal antibody; it's a **cytotoxic agent**. *5-fluorouracil* - **5-fluorouracil (5-FU)** is an **antimetabolite chemotherapy drug** that interferes with DNA and RNA synthesis, thereby inhibiting cell division. - It is a **pyrimidine analog** and not a monoclonal antibody. *Methotrexate* - **Methotrexate** is a **folate analog antimetabolite** that inhibits **dihydrofolate reductase**, interfering with DNA synthesis and cell proliferation. - It's a conventional chemotherapy agent and immunosuppressant, not a monoclonal antibody.
Physiology
2 questionsNaCl symporter is present in which part of the nephron?
Which of the following causes hypoxic hypoxia?
FMGE 2019 - Physiology FMGE Practice Questions and MCQs
Question 41: NaCl symporter is present in which part of the nephron?
- A. PCT
- B. DCT (Correct Answer)
- C. Loop of Henle
- D. Collecting duct
Explanation: ***DCT*** - The **NaCl symporter** (also known as the **Na-Cl co-transporter** or NCC) is located in the **luminal membrane** of cells in the **distal convoluted tubule (DCT)**. - This transporter is responsible for reabsorbing approximately 5-10% of filtered sodium and chloride, and it is the target of **thiazide diuretics**. *PCT* - The **proximal convoluted tubule (PCT)** is responsible for bulk reabsorption of Na+ through various mechanisms, including Na+/H+ exchangers and Na+-glucose co-transporters, but not the specific NaCl symporter found in the DCT. - While significant NaCl reabsorption occurs here, it is primarily driven by different transport proteins. *Loop of Henle* - The **thick ascending limb of the loop of Henle** uses the **Na-K-2Cl co-transporter (NKCC2)** for Na+ reabsorption, which is distinct from the NaCl symporter. - This segment is the target for **loop diuretics**. *Collecting duct* - The **collecting duct** reabsorbs Na+ primarily through the **epithelial sodium channel (ENaC)**, which is regulated by aldosterone. - While reabsorption of sodium occurs, the specific NaCl symporter is not present in this segment.
Question 42: Which of the following causes hypoxic hypoxia?
- A. Pneumonia (Correct Answer)
- B. HCN poisoning
- C. CO poisoning
- D. Circulatory shock
Explanation: ***Pneumonia*** - Pneumonia causes **hypoxic hypoxia** by impairing **gas exchange** in the lungs due to inflammation and fluid accumulation in the alveoli, leading to reduced oxygen uptake. - This results in a **low partial pressure of oxygen (PaO2)** in the arterial blood, even with normal oxygen-carrying capacity and tissue perfusion. *HCN poisoning* - **Hydrogen cyanide (HCN) poisoning** causes **histotoxic hypoxia**, where cells are unable to utilize oxygen despite adequate delivery, by inhibiting **cytochrome c oxidase** in the electron transport chain. - It does not directly reduce the amount of oxygen in the blood or its delivery to tissues. *CO poisoning* - **Carbon monoxide (CO) poisoning** causes **anemic hypoxia** by binding to hemoglobin with a much higher affinity than oxygen, forming **carboxyhemoglobin (COHb)**. - This reduces the **oxygen-carrying capacity** of the blood and shifts the oxygen-hemoglobin dissociation curve to the left, but it is not a direct problem with alveolar gas exchange or oxygen partial pressure. *Circulatory shock* - **Circulatory shock** causes **stagnant or ischemic hypoxia**, characterized by reduced blood flow and oxygen delivery to tissues due to systemic circulatory failure. - While it results in tissue oxygen deprivation, the primary issue is impaired perfusion rather than a defect in the initial oxygenation of blood in the lungs or the blood's capacity to carry oxygen.
Radiology
1 questionsA man presents to the emergency department with a head injury following a vehicular accident. What is the investigation of choice?
FMGE 2019 - Radiology FMGE Practice Questions and MCQs
Question 41: A man presents to the emergency department with a head injury following a vehicular accident. What is the investigation of choice?
- A. MRI
- B. CECT
- C. NCCT (Correct Answer)
- D. X-ray
Explanation: ***NCCT*** - **Non-contrast Computed Tomography (NCCT)** of the head is the **investigation of choice** for acute head trauma due to its rapid acquisition, wide availability, and excellent sensitivity for detecting acute hemorrhage, fractures, and mass effects. - It rapidly identifies life-threatening conditions such as **epidural, subdural, and intracerebral hemorrhages**, which require immediate intervention. *MRI* - **MRI** is superior for detecting subtle brain tissue injuries, diffuse axonal injury, and non-hemorrhagic lesions but is generally **not the first-line investigation** in acute trauma due to longer scan times, limited availability in the emergency setting, and inability to detect acute hemorrhage as clearly as CT. - Its use is typically reserved for follow-up studies or when CT findings are inconclusive or specific soft tissue detail is required. *CECT* - **Contrast-enhanced CT (CECT)** of the head is reserved for specific indications like evaluating vascular lesions (e.g., aneurysms, arteriovenous malformations) or tumors, which are generally **not the primary concern** in the initial assessment of acute head trauma. - Administering contrast agents can delay imaging, may pose risks to patients with renal impairment or allergies, and does not significantly improve the detection of acute traumatic hemorrhage compared to NCCT. *X-ray* - **X-rays** of the skull are useful for detecting **skull fractures**, but they provide **limited information** regarding intracranial injuries or soft tissue damage, which are critical in head trauma. - They have largely been superseded by CT scans, which offer a more comprehensive view of both bony structures and intracranial contents.
Surgery
2 questionsInvestigations used for CSF rhinorrhea are all except:
A patient who underwent gastrectomy develops sweating and diarrhea within 20 minutes after eating. What could be the cause?
FMGE 2019 - Surgery FMGE Practice Questions and MCQs
Question 41: Investigations used for CSF rhinorrhea are all except:
- A. Skull X-ray (Correct Answer)
- B. CT cisternogram
- C. Beta-2 transferrin
- D. Nasal endoscopy
Explanation: ***Skull X-ray*** - A **skull X-ray** is generally not useful for diagnosing **CSF rhinorrhea** as it lacks the detailed soft tissue resolution needed to identify CSF leaks. - It cannot visualize small defects in the skull base or detect the presence of CSF distinct from other nasal secretions. *CT cisternogram* - A **CT cisternogram** is a highly effective imaging modality for localizing **CSF leaks**, involving an intrathecal injection of contrast followed by CT scanning. - It can pinpoint the exact site of the leak in the skull base, which is crucial for surgical planning. *Beta-2 transferrin* - **Beta-2 transferrin** is a protein found almost exclusively in **cerebrospinal fluid (CSF)**, making its detection in nasal discharge diagnostic of CSF rhinorrhea. - This biochemical test offers high specificity for confirming the presence of CSF. *Nasal endoscopy* - **Nasal endoscopy** allows direct visualization of the nasal cavity and can help identify the source of the leak, especially if active dripping is observed. - During the procedure, the Valsalva maneuver or changes in head position can sometimes provoke or increase the flow of CSF, aiding in localization.
Question 42: A patient who underwent gastrectomy develops sweating and diarrhea within 20 minutes after eating. What could be the cause?
- A. Late dumping syndrome
- B. Hyperglycemia
- C. Early dumping syndrome (Correct Answer)
- D. Hypoglycemia
Explanation: ***Early dumping syndrome*** - Occurs **15-30 minutes after eating** in patients who have undergone **gastric surgery**, such as gastrectomy, due to rapid emptying of hyperosmolar chyme into the small intestine. - Symptoms include **sweating**, **diarrhea**, **nausea**, **cramping**, and **tachycardia** due to fluid shifts and hormonal responses. *Late dumping syndrome* - Typically occurs **1-3 hours after eating**, not within 20 minutes. - It is characterized by **hypoglycemia** due to an exaggerated insulin response to the rapid absorption of glucose, leading to symptoms like weakness, confusion, and tremor. *Hyperglycemia* - While a rapid influx of glucose can initially cause hyperglycemia, the symptoms described (sweating, diarrhea) are more indicative of the systemic effects of rapid gastric emptying rather than simple hyperglycemia itself. - Hyperglycemia post-meal is a normal physiological response, and the constellation of symptoms points to a post-surgical complication. *Hypoglycemia* - Hypoglycemia is characteristic of **late dumping syndrome**, occurring hours after a meal, not within 20 minutes. - The symptoms of early dumping syndrome are primarily driven by fluid shifts and neurovascular responses, not low blood glucose.