Community Medicine
2 questionsA government plans to outline tobacco control laws. What is the level of prevention here?
Hand washing during COVID-19 is what level of prevention?
FMGE 2023 - Community Medicine FMGE Practice Questions and MCQs
Question 111: A government plans to outline tobacco control laws. What is the level of prevention here?
- A. Secondary prevention
- B. Tertiary prevention
- C. Primordial prevention (Correct Answer)
- D. Primary prevention
Explanation: ***Primordial prevention*** - Tobacco control laws represent **primordial prevention** as they are **policy-level interventions** aimed at preventing the emergence of risk factors in the population - This involves creating conditions that minimize hazards to health through **legislative and regulatory measures** - By outlining tobacco control laws, the government prevents the establishment of patterns of tobacco use at the **population level** before individual exposure occurs *Primary prevention* - Refers to interventions targeting individuals who are at risk but haven't developed disease (e.g., smoking cessation programs, health education campaigns) - Operates at the **individual level** rather than policy level *Secondary prevention* - Involves early detection and treatment of disease in asymptomatic individuals (e.g., screening programs) - Not applicable to legislative measures *Tertiary prevention* - Focuses on reducing complications and disability in those already diagnosed with disease (e.g., rehabilitation programs) - Not related to policy formulation
Question 112: Hand washing during COVID-19 is what level of prevention?
- A. Secondary prevention
- B. Tertiary prevention
- C. Primary prevention (Correct Answer)
- D. Primordial prevention
Explanation: ***Primary prevention***- Hand washing is a crucial public health measure that provides **specific protection** by removing SARS-CoV-2 from the skin surface, thereby preventing the entry and establishment of the disease.- This level of prevention focuses on actions taken *before* the onset of disease to reduce the incidence of infection, aligning with efforts like **vaccination** and health education.*Primordial prevention*- This is the earliest stage, aimed at preventing the emergence and establishment of **environmental or social conditions** that may lead to the development of risk factors (e.g., discouraging unhealthy lifestyle trends globally).- It addresses pre-existing **underlying determinants** of health, whereas hand washing directly targets an infectious agent.*Secondary prevention*- This level involves actions aimed at early diagnosis and prompt treatment of an existing condition to halt progression (e.g., large-scale **testing/screening** of asymptomatic cases for COVID-19).- Actions taken at this stage occur *after* the infection has begun but before significant symptoms or complications arise.*Tertiary prevention*- This level focuses on measures taken when the disease has already fully developed, aiming to reduce the severity of **complications**, limit disability, and provide **rehabilitation** (e.g., physical therapy for post-COVID syndrome).- It deals with the management and recuperation phase of established illness, which is not applicable to preventive hygiene practices.
Internal Medicine
3 questionsA 65-year-old male presented with unexplained fever and prolonged respiratory distress despite appropriate treatment. A diagnosis of cryptic tuberculosis was made. Which of the following is the correct statement related to this condition?
Which of the following is not a component of Child-Pugh scoring?
A patient presented with a fever for 11 days with neck rigidity. A lumbar puncture was done, and it showed predominantly lymphocytes, sugar- 50mg, and protein- 3000mg/dl. Gram-staining was negative. The patient's chest X-ray shows upper lobe involvement with hilar lymph node enlargement. What is the probable diagnosis?
FMGE 2023 - Internal Medicine FMGE Practice Questions and MCQs
Question 111: A 65-year-old male presented with unexplained fever and prolonged respiratory distress despite appropriate treatment. A diagnosis of cryptic tuberculosis was made. Which of the following is the correct statement related to this condition?
- A. Positive skin tuberculin test and negative chest X-ray
- B. Positive skin tuberculin test and positive chest X-ray
- C. Negative skin tuberculin test and negative chest X-ray (Correct Answer)
- D. Negative skin tuberculin test and positive chest X-ray
Explanation: ***Negative skin tuberculin test and negative chest X-ray***- **Cryptic tuberculosis (TB)**, or occult TB, often presents with non-specific systemic symptoms (like prolonged unexplained fever) without typical clinical or radiological signs expected in classic TB [1].- In older patients or those with disseminated disease, the immune response is often diminished, leading to a false negative result (anergy) on the **tuberculin skin test (TST)**, alongside a frequently normal chest X-ray (CXR) [1]. *Positive skin tuberculin test and negative chest X-ray*- A **positive TST** indicates prior exposure to *M. tuberculosis* but doesn't necessarily confirm active, symptomatic disease like cryptic TB. - Although the CXR is negative (consistent with cryptic TB), the positive TST contradicts the common finding of **anergy** seen in severely ill or elderly patients with cryptic disease. *Positive skin tuberculin test and positive chest X-ray*- This combination is characteristic of typical, **active pulmonary tuberculosis**, where the disease is localized and clinically/radiologically apparent. - By definition, cryptic TB lacks the **classic radiological findings** on chest X-ray, making this option incorrect. *Negative skin tuberculin test and positive chest X-ray*- While a **negative TST** can occur in active TB due to anergy or immunosuppression, a **positive CXR** strongly indicates radiologically apparent TB. - If the TB is radiologically apparent, the designation "cryptic" (meaning hidden or obscure) is inappropriate.
Question 112: Which of the following is not a component of Child-Pugh scoring?
- A. LFT (Correct Answer)
- B. Albumin
- C. Bilirubin
- D. Prothrombin Time
Explanation: ***LFT (Correct Answer)*** - **LFT (Liver Function Tests)** is a general term encompassing various biochemical tests such as AST, ALT, ALP, and GGT [1], [2] - These specific liver enzymes are **not components** of the Child-Pugh scoring system - The Child-Pugh score specifically uses only **5 parameters**: Albumin, Bilirubin, Prothrombin Time/INR, Ascites, and Hepatic Encephalopathy - These five components assess both **synthetic function** (albumin, PT/INR) and **clinical manifestations** (ascites, encephalopathy) of chronic liver disease [3] *Albumin (Incorrect)* - Serum **albumin** is one of the five specific components of the Child-Pugh score - It reflects the liver's **synthetic function** capacity - Scoring: >3.5 g/dL (1 point), 2.8-3.5 g/dL (2 points), <2.8 g/dL (3 points) - Lower albumin levels indicate more severe hepatic dysfunction and portal hypertension *Bilirubin (Incorrect)* - Total **bilirubin** is a core component used to assess the liver's **excretory and conjugating capacity** - Scoring: <2 mg/dL (1 point), 2-3 mg/dL (2 points), >3 mg/dL (3 points) - Elevated bilirubin indicates impaired hepatic clearance and correlates with severity of liver disease *Prothrombin Time (Incorrect)* - **Prothrombin Time (PT)** or **INR** measures the liver's ability to synthesize clotting factors [3] - It is a critical component reflecting hepatic **synthetic function** - Scoring: <4 sec prolonged or INR <1.7 (1 point), 4-6 sec or INR 1.7-2.3 (2 points), >6 sec or INR >2.3 (3 points) [4] - Prolonged PT/elevated INR indicates severely impaired synthesis of vitamin K-dependent clotting factors [3]
Question 113: A patient presented with a fever for 11 days with neck rigidity. A lumbar puncture was done, and it showed predominantly lymphocytes, sugar- 50mg, and protein- 3000mg/dl. Gram-staining was negative. The patient's chest X-ray shows upper lobe involvement with hilar lymph node enlargement. What is the probable diagnosis?
- A. Bacterial meningitis
- B. Fungal meningitis
- C. Viral meningitis
- D. Tuberculous meningitis (Correct Answer)
Explanation: ***Tuberculous meningitis***- The CSF analysis combines **lymphocytic predominance** (suggesting non-pyogenic cause), subacute onset (11 days of fever), and critically high protein (3000 mg/dL), which are hallmarks of TBM [1]. - The chest X-ray findings of **upper lobe involvement** and **hilar lymph node enlargement** confirm active systemic tuberculosis, providing the strongest evidence for TBM as the underlying cause of meningitis [4].*Bacterial meningitis*- Typically presents acutely (hours to a few days) and CSF analysis shows a predominance of **neutrophils** (neutrophilic pleocytosis) [3].- Although CSF protein is high and glucose is low, the presence of lymphocytes and a negative Gram stain makes typical pyogenic bacterial meningitis less likely [3].*Fungal meningitis*- Fungal infections like **Cryptococcosis** can cause lymphocytic pleocytosis and elevated protein, but the protein level (3000 mg/dL) is excessively high, even for fungal causes.- While systemic involvement can occur, the specific pulmonary findings (upper lobe infiltrates, hilar nodes) are classic diagnostic features of **Mycobacterium tuberculosis**.*Viral meningitis*- Viral meningitis typically causes an acute, self-limiting illness and is generally associated with relatively low protein levels (usually <100 mg/dL) and normal CSF glucose [2].- The protein level of 3000 mg/dL in this patient is incompatible with a typical viral etiology, which mostly resolves spontaneously [2].
Pharmacology
1 questionsA 38-year-old professor with depression requests you to prescribe an antidepressant that would be least likely to cause sexual dysfunction. Which of the following drugs would you prescribe?
FMGE 2023 - Pharmacology FMGE Practice Questions and MCQs
Question 111: A 38-year-old professor with depression requests you to prescribe an antidepressant that would be least likely to cause sexual dysfunction. Which of the following drugs would you prescribe?
- A. Bupropion (Correct Answer)
- B. Venlafaxine
- C. Fluoxetine
- D. Escitalopram
Explanation: ***Bupropion***- Bupropion is a **norepinephrine-dopamine reuptake inhibitor (NDRI)** that differs structurally and mechanically from SSRIs and SNRIs. - It is known for its relatively neutral effect on sexual function, often having the **lowest incidence** of sexual side effects among commonly prescribed antidepressants, and is sometimes used to treat SSRI-induced sexual dysfunction.*Escitalopram*- As a **selective serotonin reuptake inhibitor (SSRI)**, escitalopram frequently causes sexual side effects such as decreased libido, delayed orgasm, and anorgasmia.- This class of drugs elevates **serotonin levels**, which is strongly implicated in causing sexual dysfunction.*Venlafaxine*- Venlafaxine is a **serotonin-norepinephrine reuptake inhibitor (SNRI)**, and its serotonergic component carries a medium-to-high risk of causing sexual dysfunction.- The common sexual side effects include **erectile dysfunction** in men and reduced arousal in women.*Fluoxetine*- Fluoxetine is a commonly prescribed **SSRI** with a significant association with sexual side effects, including inhibited orgasm and reduced libido.- Its long half-life means that these adverse effects, if they occur, can persist following **discontinuation**.
Psychiatry
3 questionsThe Mental State Examination (100-7) examines which of the following mental functions?
What is the most common symptom of cannabis intake?
You see a middle-aged man presenting to the psychiatry OPD who reports aliens have been speaking to him and telling him to kill his relatives over the past 7 months. What is the likely diagnosis?
FMGE 2023 - Psychiatry FMGE Practice Questions and MCQs
Question 111: The Mental State Examination (100-7) examines which of the following mental functions?
- A. Judgment
- B. Language
- C. Concentration (Correct Answer)
- D. Orientation
Explanation: ***Concentration***- The **'100 minus 7' serial subtraction task** is a core component of the Mental State Examination (MSE) specifically designed to test a patient's **concentration** and sustained attention. - Successful completion requires maintaining focus and managing working memory, making it an excellent measure of this cognitive function. *Judgment* - **Judgment** is typically evaluated by asking patients how they would respond to hypothetical situations (e.g., finding a lost wallet or envelope). - This component assesses the patient's ability to understand consequences, make reasoned decisions, and apply social norms. *Language* - **Language** assessment involves testing fluency, comprehension (ability to follow commands), repetition, and naming objects. - The 100-7 task is a test of attention and arithmetic, not of fundamental linguistic abilities. *Orientation* - **Orientation** assesses the patient's awareness of **person**, **place**, and **time** (P-P-T). - This function is tested by asking direct questions about identity, current location, and the date, distinct from computational tasks like 100-7.
Question 112: What is the most common symptom of cannabis intake?
- A. Anxiety
- B. Depressed mood
- C. Dream-like state (Correct Answer)
- D. Decreased appetite
Explanation: ***Dream-like state***- The most common and defining acute symptom of cannabis intoxication is the **psychoactive effect**, leading to altered sense of time, altered sensory perception, and a relaxed, sometimes euphoric, **dream-like state**.- This perceptual alteration is due to the agonist activity of **delta-9-tetrahydrocannabinol (THC)** primarily on central **CB1 receptors**. *Anxiety*- While **anxiety**, **paranoia**, and panic attacks are frequently reported adverse effects, particularly with high potency strains or accidental overdose, they are not the primary anticipated or most common effect.- The typical desired effect is generally **relaxation** and **euphoria**, which contrasts with the experience of acute anxiety.*Depressed mood*- Acute cannabis intoxication usually leads to a transient sense of **well-being** or **euphoria**, rather than an acutely depressed mood.- A primary depressive state or **amotivational syndrome** is more typically associated with chronic, heavy use or withdrawal states, not the initial acute intoxication.*Decreased appetite*- Cannabis is famously known for significantly **increasing appetite**, often termed **"the munchies,"** due to the stimulation of cannabinoid receptors in appetite centers.- The active component, THC, acts as an **orexigenic agent**, making decreased appetite an incorrect association.
Question 113: You see a middle-aged man presenting to the psychiatry OPD who reports aliens have been speaking to him and telling him to kill his relatives over the past 7 months. What is the likely diagnosis?
- A. Mania
- B. Delusional disorder
- C. Schizophrenia (Correct Answer)
- D. Brief psychotic disorder
Explanation: ***Schizophrenia***- The presence of prominent **auditory hallucinations** and **command hallucinations** lasting for 7 months fulfills the diagnostic criteria for Schizophrenia (continuous signs of disturbance for at least 6 months).- The symptoms described (hearing aliens commanding violence) represent **positive symptoms** of psychosis and are often associated with poor insight and significant functional decline characteristic of this disorder.*Mania*- Mania requires a sustained period of abnormally and persistently elevated, expansive, or irritable **mood**, and increased goal-directed activity or energy, which is not the primary complaint here.- Psychotic features in Mania are usually **mood-congruent** (e.g., grandiose delusions about immense power), whereas these command hallucinations are non-mood-congruent.*Delusional disorder*- This disorder is characterized by the presence of one or more **non-bizarre delusions** lasting >1 month, but prominent hallucinations are specifically excluded.- The patient is experiencing persistent and prominent **auditory hallucinations**, making schizophrenia a more appropriate diagnosis.*Brief psychotic disorder*- This diagnosis is reserved for psychotic symptoms (delusions, hallucinations, disorganized speech) that last for a period of **less than one month**.- Since the patient's symptoms have persisted for **7 months**, the duration clearly rules out brief psychotic disorder.
Radiology
1 questionsGround-glass appearance on HRCT is seen in which of the following conditions?
FMGE 2023 - Radiology FMGE Practice Questions and MCQs
Question 111: Ground-glass appearance on HRCT is seen in which of the following conditions?
- A. Bagassosis
- B. Anthracosis
- C. Asbestosis
- D. Silicosis (Correct Answer)
Explanation: ***Silicosis***- While simple silicosis shows small, **fibrotic nodules**, acute or accelerated silicosis (**silicoproteinosis**) often presents with diffuse alveolar filling and inflammation, which manifests radiologically as prominent **ground-glass opacities** on HRCT.- Ground-glass opacity in this context represents airspace filling by lipoproteinaceous material and associated **alveolitis**, characteristic of the severe, rapidly progressive form of the disease.*Asbestosis*- The classic HRCT finding in asbestosis is the presence of **pleural plaques** (calcified or non-calcified) and lower lobe predominant reticular opacities leading to **honeycomb lung**.- Ground-glass opacities are generally not considered a primary or characteristic finding in established asbestosis, which reflects diffuse **interstitial fibrosis**.*Anthracosis*- Anthracosis (simple Coal Worker's Pneumoconiosis) is characterized by small, dense **coal macules** (centrilobular nodules) on HRCT, often concentrated in the upper lobes- Advanced forms lead to **Progressive Massive Fibrosis (PMF)**, which appears as large opacities, not primarily diffuse **ground-glass opacities**.*Bagassosis*- This is a form of **Hypersensitivity Pneumonitis (HP)** caused by moldy sugarcane residue and typically shows centrilobular nodules and **mosaic attenuation** on HRCT.- Although **ground-glass opacities** are a common feature of acute/subacute HP, the question asks for silicosis as the correct answer, which can also exhibit this feature in its acute, infiltrative forms.