Biochemistry
2 questionsWhich is a product of purine metabolism?
Melanin is derived from which amino acid?
FMGE 2019 - Biochemistry FMGE Practice Questions and MCQs
Question 81: Which is a product of purine metabolism?
- A. Xanthine
- B. Uric acid (Correct Answer)
- C. Beta alanine
- D. Urea
Explanation: ***Uric acid*** - **Uric acid** is the final breakdown product of **purine metabolism** in humans. - It's formed from the oxidation of **xanthine** by the enzyme **xanthine oxidase**. *Xanthine* - **Xanthine** is an intermediate compound in the purine metabolic pathway, but not the final product in humans. - It is converted to **uric acid** via the enzyme **xanthine oxidase**. *Beta alanine* - **Beta-alanine** is a **non-proteogenic amino acid** and is a breakdown product of **pyrimidine metabolism**, not purine. - It is involved in the synthesis of **carnosine**, a buffer in muscle tissue. *Urea* - **Urea** is the primary end product of **protein (amino acid) metabolism** in mammals, representing the main way the body excretes **nitrogen**. - It is produced in the **urea cycle** in the liver and is unrelated to purine breakdown.
Question 82: Melanin is derived from which amino acid?
- A. Tyrosine (Correct Answer)
- B. Phenylalanine
- C. Alanine
- D. Tryptophan
Explanation: ***Tyrosine*** - **Melanin synthesis** (melanogenesis) begins with the hydroxylation of **tyrosine** to DOPA (dihydroxyphenylalanine), catalyzed by the enzyme **tyrosinase**. - Subsequent steps involve the oxidation of DOPA and its derivatives to form various types of melanin, such as **eumelanin** (black/brown) and **pheomelanin** (red/yellow). *Phenylalanine* - **Phenylalanine** is an essential amino acid that can be converted to tyrosine in the body by the enzyme **phenylalanine hydroxylase**. - While it's a precursor to tyrosine, it's not directly converted to melanin; rather, it must first be hydroxylated to tyrosine. *Alanine* - **Alanine** is a non-essential amino acid involved in glucose metabolism and protein synthesis. - It is not a precursor for melanin synthesis. *Tryptophan* - **Tryptophan** is an essential amino acid that is a precursor for **serotonin**, **melatonin**, and **niacin** (Vitamin B3). - It is not involved in the biosynthesis of melanin.
Community Medicine
1 questionsWhat is a target couple?
FMGE 2019 - Community Medicine FMGE Practice Questions and MCQs
Question 81: What is a target couple?
- A. Couple using contraception
- B. Couple with 3 children
- C. Couple that is eligible for practicing family planning
- D. Currently married couple where the wife is in reproductive age (15-49 years) (Correct Answer)
Explanation: ***Currently married couple where the wife is in reproductive age (15-49 years)*** - This is the **official definition** of a target couple according to the **National Family Welfare Programme** of India. - A target couple is specifically defined as a **currently married couple** in which the wife is in the **reproductive age group (15-49 years)**. - This operational definition is used for **planning, monitoring, and evaluation** of family planning services in India. - It forms the basis for calculating **couple protection rate (CPR)** and other family planning indicators. *Couple that is eligible for practicing family planning* - While this is conceptually broad and inclusive, it is **not the standard operational definition** used in Indian public health programs. - The official definition is more specific and includes marital status and age criteria for program planning purposes. *Couple using contraception* - This describes a **protected couple** or **couple currently using contraception**, not a target couple. - Target couples include both those using and not using contraception, as they represent the denominator for family planning coverage. *Couple with 3 children* - The number of children is **not a defining criterion** for a target couple. - Target couples are defined by marital status and reproductive age, regardless of parity (number of children).
Internal Medicine
1 questionsWhich is not seen in Tumour lysis Syndrome?
FMGE 2019 - Internal Medicine FMGE Practice Questions and MCQs
Question 81: Which is not seen in Tumour lysis Syndrome?
- A. Hyperkalemia
- B. Hypophosphatemia (Correct Answer)
- C. Hyperuricemia
- D. Hypocalcemia
Explanation: ***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.
Ophthalmology
1 questionsA 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?
FMGE 2019 - Ophthalmology FMGE Practice Questions and MCQs
Question 81: 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?
- A. Glasses
- B. Refraction and treat underlying cause of poor vision (Correct Answer)
- C. Squint surgery
- D. Botulinum toxin
Explanation: ***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.
Pathology
1 questionsWhich of the following ions is important in irreversible cell injury?
FMGE 2019 - Pathology FMGE Practice Questions and MCQs
Question 81: Which of the following ions is important in irreversible cell injury?
- A. Sodium
- B. Chloride
- C. Calcium (Correct Answer)
- D. Potassium
Explanation: ***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.
Pediatrics
1 questionsIn marasmus, which of the following is characteristically seen?
FMGE 2019 - Pediatrics FMGE Practice Questions and MCQs
Question 81: In marasmus, which of the following is characteristically seen?
- A. Hepatomegaly
- B. Edema
- C. Voracious appetite
- D. Severe muscle wasting (Correct Answer)
Explanation: ***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.
Surgery
3 questionsWhat is the most common anterior mediastinal tumor?
In an accident case, after the arrival of medical team, all should be done in early management except;
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?
FMGE 2019 - Surgery FMGE Practice Questions and MCQs
Question 81: What is the most common anterior mediastinal tumor?
- A. Bronchogenic cyst
- B. Neurofibroma
- C. Pericardial cyst
- D. Thymoma (Correct Answer)
Explanation: ***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 82: In an accident case, after the arrival of medical team, all should be done in early management except;
- A. Glasgow coma scale
- B. Check BP (Correct Answer)
- C. Stabilization of cervical vertebrae
- D. Check Respiration
Explanation: ***Check BP*** - In the **immediate/early management** of trauma (primary survey), while circulation assessment is crucial, the **initial assessment of circulation** focuses on: - **Pulse rate and quality** (radial, carotid) - **Capillary refill time** - **Skin color and temperature** - **Active hemorrhage control** - **Formal blood pressure measurement** with a cuff, while important, is typically recorded during or after these rapid initial assessments, as it takes more time to obtain an accurate reading. - In the context of this question, among the four options listed, BP measurement is relatively less immediate compared to the other life-saving priorities (airway protection, breathing assessment, C-spine stabilization, and GCS). - **Note:** This is a nuanced distinction - BP is assessed during primary survey, but the other three options have more immediate life-threatening implications if not addressed. *Glasgow coma scale* - **GCS assessment** is part of the **"D" (Disability)** step in the ATLS primary survey. - It is performed early to assess neurological status and level of consciousness. - GCS <8 indicates need for **definitive airway protection** (intubation). - This is a critical early assessment that guides immediate management decisions. *Stabilization of cervical vertebrae* - **C-spine immobilization** is part of the **"A" (Airway)** step - "Airway with cervical spine protection." - It is performed **simultaneously** with airway assessment using a **rigid cervical collar**. - This is the **first priority** in trauma management to prevent secondary spinal cord injury. - All trauma patients should be assumed to have C-spine injury until proven otherwise. *Check Respiration* - **Respiratory assessment** is part of the **"B" (Breathing)** step in the ATLS primary survey. - This involves checking: - **Respiratory rate and pattern** - **Chest wall movement** - **Air entry bilaterally** - **Signs of tension pneumothorax or flail chest** - This is an immediate life-saving priority and must be assessed early.
Question 83: 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?
- A. Ludwig's angina
- B. Peritonsillar abscess (Correct Answer)
- C. Retropharyngeal abscess
- D. Parapharyngeal abscess
Explanation: ***Peritonsillar abscess*** - A **peritonsillar abscess** (quinsy) is the most common deep neck space infection and characteristically causes **medial displacement of the tonsil**, which is the key clinical finding in this case. - The patient presents with classic features: severe unilateral sore throat, difficulty swallowing, and the hallmark sign of **tonsillar displacement medially**. - The swelling in the **upper lateral neck** can occur with peritonsillar abscess, especially when there is significant inflammation extending into the surrounding tissues. - Other typical features include trismus, "hot potato voice," and uvular deviation (though not mentioned here). *Parapharyngeal abscess* - A **parapharyngeal abscess** can develop as an extension of a peritonsillar abscess, but the primary finding would be **bulging of the lateral pharyngeal wall** rather than medial displacement of the tonsil itself. - While neck swelling is prominent in parapharyngeal abscess, the specific finding of **medial tonsillar displacement** is more characteristic of peritonsillar abscess. - Parapharyngeal abscess typically presents with more systemic toxicity and can involve cranial nerve complications. *Retropharyngeal abscess* - A **retropharyngeal abscess** typically causes severe dysphagia and odynophagia with posterior pharyngeal wall bulging. - It does not cause **medial displacement of the tonsil**, which is the key finding in this case. - Neck swelling would be more posterior and midline, and patients often present with neck hyperextension and respiratory distress. *Ludwig's angina* - **Ludwig's angina** is a severe bilateral cellulitis of the floor of the mouth involving the submandibular, sublingual, and submental spaces. - It characteristically causes painful swelling and **elevation of the tongue**, creating a "bull neck" appearance. - It does not cause **tonsillar displacement** or localized unilateral upper neck swelling as described in this case.