FMGE 2023 Practice Questions

Q: A government plans to outline tobacco control laws. What is the level of prevention here?

Primordial prevention. ***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

Q: Hand washing during COVID-19 is what level of prevention?

Primary prevention. ***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.

Q: 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?

Negative skin tuberculin test and negative chest X-ray. ***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.

Q: Which of the following is not a component of Child-Pugh scoring?

LFT. ***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), 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: 6 sec or INR >2.3 (3 points) [4] - Prolonged PT/elevated INR indicates severely impaired synthesis of vitamin K-dependent clotting factors [3]

Q: 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?

Tuberculous meningitis. ***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].

Q: 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?

Bupropion. ***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**.

Q: The Mental State Examination (100-7) examines which of the following mental functions?

Concentration. ***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.

Q: What is the most common symptom of cannabis intake?

Dream-like state. ***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.

Q: 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?

Schizophrenia. ***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.

Q: Ground-glass appearance on HRCT is seen in which of the following conditions?

Silicosis. ***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.

Question 1

A government plans to outline tobacco control laws. What is the level of prevention here?

Accepted Answer

Primordial prevention

Answer

Secondary prevention

Answer

Tertiary prevention

Answer

Primary prevention

Question 2

Hand washing during COVID-19 is what level of prevention?

Accepted Answer

Primary prevention

Answer

Secondary prevention

Answer

Tertiary prevention

Answer

Primordial prevention

Question 3

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?

Accepted Answer

Negative skin tuberculin test and negative chest X-ray

Answer

Positive skin tuberculin test and negative chest X-ray

Answer

Positive skin tuberculin test and positive chest X-ray

Answer

Negative skin tuberculin test and positive chest X-ray

Question 4

Which of the following is not a component of Child-Pugh scoring?

Accepted Answer

LFT

Answer

Albumin

Answer

Bilirubin

Answer

Prothrombin Time

Question 5

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?

Accepted Answer

Tuberculous meningitis

Answer

Bacterial meningitis

Answer

Fungal meningitis

Answer

Viral meningitis

Question 6

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?

Accepted Answer

Bupropion

Answer

Venlafaxine

Answer

Fluoxetine

Answer

Escitalopram

Question 7

The Mental State Examination (100-7) examines which of the following mental functions?

Accepted Answer

Concentration

Answer

Judgment

Answer

Language

Answer

Orientation

Question 8

What is the most common symptom of cannabis intake?

Accepted Answer

Dream-like state

Answer

Anxiety

Answer

Depressed mood

Answer

Decreased appetite

Question 9

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?

Accepted Answer

Schizophrenia

Answer

Mania

Answer

Delusional disorder

Answer

Brief psychotic disorder

Question 10

Ground-glass appearance on HRCT is seen in which of the following conditions?

Accepted Answer

Silicosis

Answer

Bagassosis

Answer

Anthracosis

Answer

Asbestosis

FMGE 2023

Community Medicine

Internal Medicine

Pharmacology

Psychiatry

Radiology