FMGE 2023 Practice Questions

Q: Highest birth rate is seen in which stage of the demographic cycle?

Stage I. ***Stage I***- This stage, also known as the **High Stationary** phase, is characterized by a **high birth rate** and a high death rate.- The high birth rate is maintained due to factors like **traditional societal norms**, lack of family planning, and high infant mortality necessitating more children for survival.*Stage II*- In this stage (**Early Expanding**), the **death rate begins to fall sharply** due to improvements in sanitation, nutrition, and healthcare.- While the birth rate remains high, leading to the maximum population growth, it is typically equivalent to or slightly lower than the birth rate seen in Stage I.*Stage III*- This stage (**Late Expanding**) is defined by a **sharp decrease** in the **birth rate** due to urbanization, increased education, and adoption of family planning measures.- Both the birth rate and death rate are falling, meaning the birth rate is significantly lower than that observed in Stage I.*Stage IV*- This stage (**Low Stationary**) is characterized by both a **low birth rate** and a **low death rate**, resulting in very slow or zero population growth.- This stage reflects fully developed countries where fertility rates are close to or below the replacement level.

Q: During a vaccination drive, a male patient asks the presiding doctor if the recommended vaccine can lead to impotency. What type of barrier will the doctor be addressing?

Cultural barrier. ***Cultural barrier***- The patient's concern that a vaccine might cause **impotency** is deeply rooted in **cultural norms**, fears, and misinformation that link health interventions to changes in fertility or masculinity.- This type of barrier involves addressing deeply held social beliefs, values, or **rumors** within a community that create hesitancy towards medical interventions.*Physical barrier*- A physical barrier involves logistical issues that prevent access to services, such as **long distances** to the vaccination site or inadequate infrastructure.- It concerns tangible, external obstacles rather than internalized beliefs or fears about the vaccine's effect on the body.*Environmental barrier*- Environmental barriers include external factors like adverse **weather conditions**, geographical challenges, or **poor sanitation** affecting the viability or accessibility of the drive.- This does not account for the patient's specific belief about the vaccine's physiological consequences rooted in societal context.*Physiological barrier*- Physiological barriers relate to the patient's **biological state**, such as existing allergies, concurrent illness, or immunodeficiency, that might alter the body's reaction to the vaccine.- The concern about potential impotency is a fear disseminated through **social means**, not an immediate medical contraindication related to the patient's current physiology.

Q: A pregnant woman with a 2-year-old child gives a history of completing required antenatal vaccinations during her previous pregnancy. Which of the following would you recommend for her current pregnancy?

Give a booster dose of TT. ***Give a booster dose of TT*** - The woman completed her required antenatal vaccination (TT2 or more) **2 years ago** during her previous pregnancy - Since the interval is **less than 3 years**, she only requires **one booster dose of TT** to maintain protective immunity against tetanus - According to **Indian National Immunization Program** guidelines, **Tetanus Toxoid (TT)** remains the standard vaccine for antenatal immunization in India - If the last dose was given 10 years: **2 doses** *Give a booster dose of Td* - While **Td (Tetanus-Diphtheria)** or Tdap is recommended in some international guidelines (WHO, US CDC) to provide dual protection against tetanus and diphtheria, it is **not the standard practice in India's national immunization program** - For **FMGE and Indian Medical PG exams**, the focus is on **TT as per Indian protocols**, not Td/Tdap *Give 2 doses of TT* - Giving **two doses** is unnecessary because she completed her vaccination series just 2 years ago, and her baseline immunity is adequate - Two doses during pregnancy are indicated only for women with **unknown or incomplete immunization status** or when >10 years have elapsed since the last dose - As per Indian guidelines, she requires only **one booster dose**, not a full series *Give 2 doses of Td* - This is incorrect because she doesn't require a **primary series** - she only needs a single booster - Additionally, **Td is not the standard antenatal vaccine in India's national program**; TT is used - Two doses of Td would be considered only if the woman had no prior tetanus immunization history

Q: A patient comes with a history of category 3 dog bites. He received prophylaxis for a monkey bite 6 months back. What is the next step in management?

Wound cleaning+ rabies vaccine on day 0 & 3. ***Wound cleaning+ rabies vaccine on day 0 & 3***- Since the patient received prophylaxis 6 months ago, they are considered **previously immunized**, meaning **Rabies Immunoglobulin (RIG)** is *not* required, even for a **Category 3 bite**.- For a previously immunized individual with a Category III exposure, the required management is a **booster regimen** consisting of the rabies vaccine given on **Day 0** and **Day 3** (two doses). *Wound cleaning only*- This action is inadequate for managing a **Category 3 bite**, which involves severe exposure like deep puncture wounds or mucosal contamination.- Even in previously vaccinated individuals, a **booster dose** is necessary to ensure adequate and rapid protective antibody levels against the high viral load typical of a severe animal bite. *Wound cleaning+rabies vaccine on day 0,3 & 7*- While this 3-dose schedule is sometimes used, the **standard recommended booster regimen** for previously immunized individuals with a new Category III exposure is the **2-dose schedule** (Day 0 and Day 3) as per WHO and IAPSM guidelines.- The 2-dose booster is sufficient to rapidly achieve protective antibody titers in individuals who have received complete prior vaccination. *Wound cleaning+IM vaccine +RIG*- The administration of **Rabies Immunoglobulin (RIG)** is unnecessary and contraindicated in patients who have been **previously immunized** with a full course of the rabies vaccine.- RIG is reserved for **unvaccinated** patients with Category II or III exposures to provide immediate passive immunity before the active immune response develops.

Q: A 26-year-old male presented with erythematous plaques covered with silvery scales over the extensor surfaces of both arms. Punctate pitting was noted on examining the nails. What is the most likely diagnosis?

Psoriasis. ***Psoriasis*** - The clinical presentation of **well-demarcated, erythematous plaques** covered with **silvery scales** on **extensor surfaces** is the hallmark of plaque psoriasis. - **Nail pitting**, as shown in the image, along with other nail changes like **onycholysis** (separation of the nail from the nail bed) and the **oil drop sign**, are highly characteristic findings in psoriasis. *Lichen planus* - Lichen planus is characterized by the "6 P's": **Pruritic, Purple, Polygonal, Planar Papules, and Plaques**, which differ significantly from the silvery-scaled lesions of psoriasis. - It commonly appears on **flexor surfaces**, such as the wrists, and is often associated with **Wickham's striae** (fine white lines on the lesions or oral mucosa). *Eczema* - Eczema (atopic dermatitis) typically presents with **poorly-demarcated, erythematous patches** with intense **pruritus**, leading to **lichenification** and **excoriations**, rather than well-defined plaques with silvery scales. - In adults, eczema classically involves the **flexor surfaces**, such as the antecubital and popliteal fossae, contrasting with the extensor distribution seen in this case. *Pityriasis rosea* - Pityriasis rosea typically begins with a solitary, larger lesion known as a **herald patch**, which is absent in this presentation. - This is followed by a generalized eruption of smaller, oval, pink papules with fine scale in a **"Christmas tree" distribution** on the trunk, which is inconsistent with the described findings.

Q: A patient presented with itchy lesions, as shown below. What is the diagnosis?

Lichen planus. ***Lichen planus*** - The image displays classic features of lichen planus, which are often described by the **'5 P's'**: **P**ruritic (itchy), **P**olygonal, **P**lanar (flat-topped), **P**urple **P**apules and plaques. - A characteristic sign, though not always clearly visible, is the presence of fine white lines on the surface of the lesions, known as **Wickham's striae**. It is also associated with **Hepatitis C** infection. *Scabies* - Scabies presents with intensely pruritic small papules, vesicles, and pathognomonic **burrows**, which are not seen in the image. The lesions shown are large plaques, not typical for a mite infestation. - The distribution of scabies is characteristic, favoring **finger web spaces**, wrists, axillae, and the genital area, whereas the lesions shown are on a broader surface. *Psoriasis* - Psoriasis typically appears as well-demarcated, erythematous plaques covered with a thick, **silvery-white scale**. The lesions in the image are violaceous and lack the prominent silvery scale. - A key clinical sign in psoriasis is the **Auspitz sign**, where pinpoint bleeding occurs after the scale is removed. Lesions are commonly found on **extensor surfaces** like the elbows and knees. *Warts* - Warts (verruca vulgaris) are caused by the **Human Papillomavirus (HPV)** and present as hyperkeratotic, exophytic papules with a rough, papillomatous surface, unlike the flat-topped lesions in the image. - On close inspection, warts often show thrombosed capillaries appearing as **black dots** (pepper pot sign), which are absent in these lesions.

Q: A diabetic patient developed DVT with a necrolytic migratory rash. What is the most likely diagnosis?

Glucagonoma. ***Glucagonoma***- This paraneoplastic syndrome, caused by excessive glucagon secretion, is classically associated with the triad of **diabetes mellitus** (due to glucagon's counter-regulatory effect), **necrolytic migratory erythema (NME)**, and a high incidence of **venous thrombosis** (DVT/PE).- The classic rash, **NME**, is an erythematous, scaling rash that begins peripherally and migrates, often causing eroded, painful lesions [1].*Insulinoma*- The primary manifestation is **hypoglycemia** (Whipple's triad), leading to neuroglycopenic symptoms like confusion and seizures.- This tumor does not cause the characteristic **necrolytic migratory rash** or have a strong association with DVT.*Gastrinoma*- Gastrinomas cause **Zollinger-Ellison syndrome**, characterized by severe, refractory **peptic ulcer disease** (PUD) and chronic diarrhea.- The clinical presentation lacks the key features of hyperglycemia, DVT, and **necrolytic migratory erythema (NME)**.*VIPoma*- VIPomas cause the **WDHA syndrome** (**W**atery **D**iarrhea, **H**ypokalemia, **A**chlorhydria), leading to profound dehydration and electrolyte imbalances.- This tumor is not associated with the pathogenesis of **necrolytic migratory erythema** or the hypercoagulable state responsible for DVT.

Q: A primigravida delivers a healthy baby via normal delivery. After how many hours should she initiate breastfeeding?

Within 1 hour. ***Within 1 hour***- The World Health Organization (WHO) and UNICEF strongly recommend initiating breastfeeding within the **first hour** of birth, often termed **early initiation**.- This practice stimulates early **suckling reflexes**, encourages bonding, and ensures the baby receives **colostrum**, which is rich in antibodies.*After 1 hour*- While better than waiting several hours, delaying beyond the first hour can miss the infant's period of **quiet alertness** immediately post-delivery, when they are most receptive to suckling.- The first hour is critical for the establishment of a successful maternal-infant bond and **optimal milk production signaling**.*After 4-6 hours*- Delaying breastfeeding significantly reduces the likelihood of successful **exclusive breastfeeding** later on, as the infant may become sleepy or less keen to latch.- Waiting this long deprives the newborn of the crucial **colostrum** and its protective immunological and nutritional benefits during a vulnerable period.*After 24 hours*- This is considered a significant and unnecessary delay, which greatly increases the risk of **neonatal hypothermia, hypoglycemia**, and poor feeding outcomes.- It is strictly against standard guidelines and often necessitates artificial formula supplementation, undermining the goal of achieving **exclusive breastfeeding**.

Q: A 44-year-old lady presents to the hospital with a ballotable flank mass. On CT imaging, the mass measures 4cm. Urine examination shows malignant cells. What is the most appropriate management for her condition?

Partial nephrectomy. ***Partial nephrectomy*** - For localized renal tumors measuring **≤ 4 cm (T1a)**, such as the one described, partial nephrectomy is the gold standard treatment, aiming to preserve renal function. - This approach, also known as **nephron-sparing surgery**, offers equivalent cancer control to radical nephrectomy for small tumors but with a lower risk of long-term **chronic kidney disease (CKD)** and associated cardiovascular morbidity. *Partial nephrectomy + neoadjuvant chemotherapy* - **Renal cell carcinoma (RCC)**, the most common type of kidney cancer, is notoriously resistant to conventional chemotherapy, so neoadjuvant chemotherapy is not a standard treatment for localized disease. - Neoadjuvant approaches for RCC, when used, typically involve **targeted therapy** or **immunotherapy** in the context of clinical trials for larger or more advanced tumors, not for a small 4cm mass. *Radical nephrectomy* - **Radical nephrectomy**, the removal of the entire kidney, is considered overtreatment for a small 4cm mass and is generally reserved for larger tumors (**>7 cm**) or when a partial nephrectomy is not technically feasible. - Performing a radical nephrectomy when a partial is possible unnecessarily sacrifices nephrons, increasing the patient's risk of developing **CKD** in the future. *Radical nephrectomy + postoperative radiotherapy* - RCC is largely **radioresistant**, and adjuvant radiotherapy after surgery has not been shown to improve survival or prevent recurrence for non-metastatic disease. - Radiotherapy is typically reserved for palliative care in cases of metastatic RCC, for example, to control symptoms from **bone** or **brain metastases**.

Q: Which of the following will have unilateral hydronephrosis?

Retrocaval ureter. ***Retrocaval ureter*** - This is a rare congenital anomaly where the **right ureter** passes behind the inferior vena cava (IVC), causing extrinsic compression and obstruction. - Since only the right ureter is involved in this pathway abnormality, it inherently results in **unilateral hydronephrosis** of the right kidney. *Phimosis* - Phimosis is the inability to retract the foreskin; severe cases can cause distal urinary outflow obstruction. - If obstruction is severe enough to cause hydronephrosis, the resulting high intravesical pressure would be transmitted equally to both kidneys, usually causing **bilateral hydronephrosis**. *Posterior urethral valves* - **Posterior urethral valves (PUV)** are congenital folds in the posterior urethra, causing obstruction distal to the bladder neck. - This obstruction leads to high intravesical pressure, which impairs drainage from both kidneys, inevitably resulting in **bilateral hydronephrosis**. *Urethral strictures* - Urethral strictures are narrowings of the urethra, usually acquired, which obstruct urine flow distal to the bladder. - Significant obstruction at this level causes increased back pressure in the bladder and ureters, usually leading to pressure effects and subsequent **bilateral hydronephrosis**.

Question 1

Highest birth rate is seen in which stage of the demographic cycle?

Accepted Answer

Stage I

Answer

Stage II

Answer

Stage III

Answer

Stage IV

Question 2

During a vaccination drive, a male patient asks the presiding doctor if the recommended vaccine can lead to impotency. What type of barrier will the doctor be addressing?

Accepted Answer

Cultural barrier

Answer

Physiological barrier

Answer

Environmental barrier

Answer

Physical barrier

Question 3

A pregnant woman with a 2-year-old child gives a history of completing required antenatal vaccinations during her previous pregnancy. Which of the following would you recommend for her current pregnancy?

Accepted Answer

Give a booster dose of TT

Answer

Give a booster dose of Td

Answer

Give 2 doses of TT

Answer

Give 2 doses of Td

Question 4

A patient comes with a history of category 3 dog bites. He received prophylaxis for a monkey bite 6 months back. What is the next step in management?

Accepted Answer

Wound cleaning+ rabies vaccine on day 0 & 3

Answer

Wound cleaning only

Answer

Wound cleaning+IM vaccine +RIG

Answer

Wound cleaning+rabies vaccine on day 0,3 & 7

Question 5

A 26-year-old male presented with erythematous plaques covered with silvery scales over the extensor surfaces of both arms. Punctate pitting was noted on examining the nails. What is the most likely diagnosis?

Accepted Answer

Psoriasis

Answer

Eczema

Answer

Pityriasis rosea

Answer

Lichen planus

Question 6

A patient presented with itchy lesions, as shown below. What is the diagnosis?

Accepted Answer

Lichen planus

Answer

Scabies

Answer

Psoriasis

Answer

Warts

Question 7

A diabetic patient developed DVT with a necrolytic migratory rash. What is the most likely diagnosis?

Accepted Answer

Glucagonoma

Answer

VIPoma

Answer

Insulinoma

Answer

Gastrinoma

Question 8

A primigravida delivers a healthy baby via normal delivery. After how many hours should she initiate breastfeeding?

Accepted Answer

Within 1 hour

Answer

After 24 hours

Answer

After 4-6 hours

Answer

After 1 hour

Question 9

A 44-year-old lady presents to the hospital with a ballotable flank mass. On CT imaging, the mass measures 4cm. Urine examination shows malignant cells. What is the most appropriate management for her condition?

Accepted Answer

Partial nephrectomy

Answer

Partial nephrectomy + neoadjuvant chemotherapy

Answer

Radical nephrectomy + postoperative radiotherapy

Answer

Radical nephrectomy

Question 10

Which of the following will have unilateral hydronephrosis?

Accepted Answer

Retrocaval ureter

Answer

Phimosis

Answer

Posterior urethral valves

Answer

Urethral strictures

FMGE 2023

Community Medicine

Dermatology

Internal Medicine

Obstetrics and Gynecology

Surgery