FMGE 2019 Practice Questions

Q: Which is not seen in Tumour lysis Syndrome?

Hypophosphatemia. ***Hypophosphatemia*** - **Tumor lysis syndrome (TLS)** is characterized by the rapid breakdown of tumor cells, leading to the release of intracellular components into the bloodstream. - This process typically results in **acute hyperphosphatemia**, not hypophosphatemia, due to the high phosphate content within tumor cells. *Hyperkalemia* - **Hyperkalemia** is a hallmark of TLS because potassium, a major intracellular cation, is released in large quantities as tumor cells lyse. - Excess potassium can lead to potentially life-threatening cardiac arrhythmias. *Hyperuricemia* - **Hyperuricemia** occurs in TLS because nucleic acids (DNA and RNA) released from dying tumor cells are metabolized into purines, which are then converted to uric acid [1]. - High uric acid levels can precipitate in the renal tubules, leading to **acute kidney injury** [1]. *Hypocalcemia* - **Hypocalcemia** develops in TLS secondary to the acute hyperphosphatemia. - The excess phosphate binds with serum calcium to form **calcium-phosphate precipitates**, effectively lowering the concentration of free ionized calcium.

Q: Absolute contraindication of IUCD is?

Acute PID. ***Acute PID*** - **Acute pelvic inflammatory disease (PID)** is an absolute contraindication for IUCD insertion because the device can potentially worsen the existing infection or spread it further into the uterus and fallopian tubes. - Inserting an IUCD in the presence of acute PID significantly increases the risk of serious complications, including **sepsis** and **infertility**. *Previous history of abortion* - A **previous history of abortion** is generally not an absolute contraindication for IUCD insertion; rather, it may be a relative contraindication depending on factors such as the recency of the abortion or presence of infection risks. - IUCDs can be safely inserted after an abortion if there are no signs of infection and the uterus has involuted sufficiently. *Breast cancer* - **Breast cancer** is primarily a contraindication for **hormonal contraceptives** (like hormonal IUCDs) due to the potential estrogen or progestin sensitivity of certain cancers. - However, **copper IUCDs** (which are non-hormonal) are generally safe to use in patients with a history of breast cancer. *PCOD* - **Polycystic ovary syndrome (PCOS)** is not a contraindication for IUCD insertion; in fact, hormonal IUCDs can sometimes be beneficial in managing symptoms like heavy menstrual bleeding associated with PCOS. - IUCDs do not interfere with the underlying pathophysiology of PCOS.

Q: A patient presents with convergent squint in one eye. Vision in the squinting eye is 6/60, and vision in the non-squinting eye is also 6/60. What is the most appropriate next step in management?

Refraction and treat underlying cause of poor vision. ***Refraction and treat underlying cause of poor vision*** - When **both eyes have equally poor vision (6/60)** with a convergent squint, this suggests a **bilateral pathology** affecting visual acuity, not simply a refractive accommodative esotropia. - The **first step** is comprehensive **cycloplegic refraction** to determine if refractive error contributes to the poor vision. - **Equally important** is identifying the **underlying cause** of bilateral vision loss (6/60 in both eyes), which could be: - **Bilateral amblyopia** (though unusual to have equal severity) - **Uncorrected high refractive error** (hypermetropia causing accommodative esotropia) - **Cataracts** (congenital or developmental) - **Retinal pathology** or **optic nerve disorders** - Only after identifying and treating the underlying cause can definitive management of the squint be planned. *Glasses* - While **glasses** may be part of the treatment if refractive error is found, **prescribing glasses alone** without first performing refraction and investigating why both eyes have 6/60 vision is incomplete management. - This option is too narrow and doesn't address the need to identify the underlying pathology causing bilateral poor vision. *Squint surgery* - **Squint surgery** addresses ocular misalignment but does **not improve vision**. - Surgery should only be considered **after** refractive correction, treatment of amblyopia (if present), and management of any underlying pathology. - Operating without addressing the cause of poor vision would be premature. *Botulinum toxin* - **Botulinum toxin** is used for certain types of strabismus as a temporary or alternative to surgery. - Like surgery, it addresses alignment but **not visual acuity**. - The priority is to improve vision and identify the underlying cause before considering alignment procedures.

Q: Which of the following ions is important in irreversible cell injury?

Calcium. ***Calcium*** - An increase in intracellular **calcium** concentration is a critical event in irreversible cell injury, activating various destructive enzymes like **phospholipases**, **proteases**, **endonucleases**, and ATPases [1]. - This influx of calcium can occur due to mitochondrial dysfunction (leading to impaired calcium sequestration) or damage to the plasma membrane [1]. *Sodium* - While important for maintaining **osmotic balance** and cell volume, dysregulation of sodium primarily contributes to **cellular swelling** (hydropic change), which is an early and often reversible sign of cell injury [1]. - Increased intracellular sodium typically leads to water influx, but its direct role in irreversible damage is secondary to calcium. *Chloride* - Changes in chloride ion distribution are often secondary to sodium dysregulation and play a role in maintaining **charge neutrality** and osmotic balance across the cell membrane. - It is not directly implicated as a primary mediator of the **enzyme activation cascade** that leads to irreversible cell damage. *Potassium* - **Potassium** is the major intracellular cation; its leakage out of the cell is a consequence of cell membrane damage, indicating loss of membrane integrity. - While significant **potassium efflux** is a sign of severe injury, it is not the initiator of the irreversible damage pathway, unlike calcium. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 57-62.

Q: In marasmus, which of the following is characteristically seen?

Severe muscle wasting. ***Severe muscle wasting*** - **Severe muscle wasting** and **loss of subcutaneous fat** are hallmark features of marasmus, giving the child a characteristic **"skin and bones"** appearance. - Children present with **visible ribs**, **sunken cheeks**, and **prominent bony landmarks** due to depletion of both fat and muscle stores from chronic energy deficiency. *Hepatomegaly* - **Hepatomegaly** is a characteristic feature of **kwashiorkor**, not marasmus, caused by **fatty infiltration** of the liver due to impaired lipoprotein synthesis. - In marasmus, the liver is typically **normal or reduced in size** as fat stores are mobilized and utilized for energy needs. *Edema* - **Pitting edema** is a hallmark feature of **kwashiorkor**, resulting from severe protein deficiency causing **hypoalbuminemia** and reduced plasma oncotic pressure. - Marasmus is characterized by **absence of edema** because the protein deficiency is proportionally less severe compared to the overall caloric deficiency. *Voracious appetite* - Children with marasmus typically have **poor appetite** and **feeding difficulties**, not increased hunger, due to severe weakness and apathy. - The **energy depletion** and **muscle wasting** significantly reduce the child's interest in food and ability to consume adequate amounts.

Q: Hydrochlorothiazide works by inhibiting

Na+ Cl pump in early DCT. ***Na+ Cl pump in early DCT*** - **Hydrochlorothiazide** is a **thiazide diuretic** that acts primarily on the **early distal convoluted tubule (DCT)**. - It inhibits the **sodium-chloride cotransporter (NCC)**, leading to increased excretion of sodium, chloride, and water. *Na+ Cl pump in late DCT* - The **late DCT** and collecting duct are primarily involved in fine-tuning sodium reabsorption, influenced by **aldosterone**, not the primary site of action for thiazides. - The **epithelial sodium channel (ENaC)** and Na+/K+-ATPase are more prominent here. *Na+ K+ 2Cl pump in descending limb of loop of Henle* - The **descending limb of the loop of Henle** is primarily permeable to water, with no active ion pumps like **Na+ K+ 2Cl pump**. - Its main function is to concentrate the urine by allowing water to move out. *Na+ K+ 2Cl pump in ascending limb of loop of Henle* - **Furosemide** and other **loop diuretics** act on the **Na+ K+ 2Cl cotransporter (NKCC2)** in the **thick ascending limb of the loop of Henle**, not hydrochlorothiazide. - Inhibition here prevents significant reabsorption of sodium, potassium, and chloride, leading to potent diuresis.

Q: What is the most common anterior mediastinal tumor?

Thymoma. ***Thymoma*** - **Thymomas** are the most common primary tumor of the **anterior mediastinum** in adults. - They originate from the epithelial cells of the **thymus gland**, which is located in the anterior mediastinum. *Bronchogenic cyst* - **Bronchogenic cysts** are typically found in the **middle mediastinum**, although they can occasionally occur in the anterior or posterior mediastinum. - They are congenital anomalies resulting from abnormal budding of the **tracheobronchial tree**. *Neurofibroma* - **Neurofibromas** are nerve sheath tumors that typically occur in the **posterior mediastinum**, arising from spinal nerves. - They are often associated with **neurofibromatosis type 1**. *Pericardial cyst* - **Pericardial cysts** are benign, fluid-filled sacs most commonly found in the **middle mediastinum**, specifically in the cardiophrenic angle. - They are usually asymptomatic and are often discovered incidentally.

Question 1

What is a target couple?

Accepted Answer

Currently married couple where the wife is in reproductive age (15-49 years)

Answer

Couple using contraception

Answer

Couple with 3 children

Answer

Couple that is eligible for practicing family planning

Question 2

A 6-year-old boy came to the hospital with complaints of sore throat and difficulty in swallowing. His left tonsil was pushed medially and had swelling over the left side upper part of neck. What will be the diagnosis?

Accepted Answer

Peritonsillar abscess

Answer

Ludwig's angina

Answer

Retropharyngeal abscess

Answer

Parapharyngeal abscess

Question 3

Which is not seen in Tumour lysis Syndrome?

Accepted Answer

Hypophosphatemia

Answer

Hyperkalemia

Answer

Hyperuricemia

Answer

Hypocalcemia

Question 4

Absolute contraindication of IUCD is?

Accepted Answer

Acute PID

Answer

Previous history of abortion

Answer

Breast cancer

Answer

PCOD

Question 5

A patient presents with convergent squint in one eye. Vision in the squinting eye is 6/60, and vision in the non-squinting eye is also 6/60. What is the most appropriate next step in management?

Accepted Answer

Refraction and treat underlying cause of poor vision

Answer

Glasses

Answer

Squint surgery

Answer

Botulinum toxin

Question 6

Which of the following ions is important in irreversible cell injury?

Accepted Answer

Calcium

Answer

Sodium

Answer

Chloride

Answer

Potassium

Question 7

In marasmus, which of the following is characteristically seen?

Accepted Answer

Severe muscle wasting

Answer

Hepatomegaly

Answer

Edema

Answer

Voracious appetite

Question 8

Hydrochlorothiazide works by inhibiting

Accepted Answer

Na+ Cl pump in early DCT

Answer

Na+ Cl pump in late DCT

Answer

Na+ K+ 2Cl pump in descending limb of loop of Henle

Answer

Na+ K+ 2Cl pump in ascending limb of loop of Henle

Question 9

What is the most common anterior mediastinal tumor?

Accepted Answer

Thymoma

Answer

Bronchogenic cyst

Answer

Neurofibroma

Answer

Pericardial cyst

Question 10

In an accident case, after the arrival of medical team, all should be done in early management except;

Accepted Answer

Check BP

Answer

Glasgow coma scale

Answer

Stabilization of cervical vertebrae

Answer

Check Respiration

FMGE 2019

Community Medicine

ENT

Internal Medicine

Obstetrics and Gynecology

Ophthalmology

Pathology

Pediatrics

Pharmacology

Surgery