FMGE 2023 Practice Questions

Q: Which vitamin deficiency causes xerophthalmia, a condition which causes dry eyes?

Vitamin A. **Vitamin A** - It is critical for the differentiation and maintenance of epithelial tissues, including the **conjunctival** and **corneal** epithelium. - Deficiency impairs the eye's ability to produce necessary mucous and results in **xerophthalmia** (pathological dryness of the conjunctiva and cornea) and **night blindness**. *Vitamin B* - Deficiencies in B vitamins (e.g., B1, B2, B3, B12) primarily affect cellular metabolism, causing conditions like **Beriberi** (B1) or **Pellagra** (B3). - While ocular issues like angular blepharitis can occur with deficiencies like Riboflavin (B2), the primary cause of severe **xerophthalmia** is not Vitamin B deficiency. *Vitamin C* - Vitamin C is essential for **collagen synthesis** and acts as a powerful antioxidant. - Its deficiency leads to **scurvy**, characterized by fragile blood vessels, **gingivitis**, and impaired wound healing, unrelated to primary eye dryness or **xerophthalmia**. *Vitamin D* - This vitamin is primarily involved in maintaining **calcium and phosphate homeostasis** for bone health. - Deficiency causes **rickets** in children and **osteomalacia** in adults, systemic conditions that do not cause **xerophthalmia**.

Q: The shelf life of copper T 380 A is

10 years. ***10 years*** - The **Copper T 380A** is approved for continuous use for up to **10 years** - This is the longest duration among all copper IUDs due to its large copper surface area (380 mm²) - Endorsed by **FDA, WHO, and ICMR** as a highly effective long-acting reversible contraception (LARC) - Most cost-effective IUD due to its prolonged efficacy *5 years* - This duration applies to **Copper T 200B** (lower copper content) - Also the approved duration for hormonal IUDs like **Mirena** (levonorgestrel-releasing) - Not applicable to Copper T 380A which has extended efficacy *3 years* - Associated with lower-dose hormonal IUDs like **Skyla** or **Jaydess** - Much shorter than Copper T 380A due to different mechanism (hormonal vs copper) - Not relevant to copper-based contraception duration *7 years* - Not a standard approved duration for any commonly used IUD - Some clinical studies suggest efficacy beyond labeled duration, but 7 years is not the official approval for Copper T 380A - The standard maximum approved duration remains **10 years**

Q: According to the law, nothing is an offense if a person is of an unsound mind and is not able to understand that the nature and consequences of his/her act are wrong. Which rule of insanity applies in this case?

Mc Naughton's rule. ***Mc Naughton's rule***- This rule is the foundational test for legal insanity in many jurisdictions, which states that a defendant is legally insane if, at the time of the crime, they labored under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act, or if they did know it, that they did not know they were doing what was **wrong**.- The essential criterion focuses on the **cognitive capacity** of the person—whether they understood the difference between right and wrong regarding the specific act.*Durham's rule*- Also known as the **"product test"**, this rule holds that an accused is not criminally responsible if their unlawful act was the **product** of mental disease or defect.- It was criticized for being too broad, focusing on the **causation** (act being a product of illness) rather than the defendant's cognitive capacity to appreciate wrongfulness.*Currens rule*- This option is not a universally recognized independent legal standard for insanity and does not correspond to the cognitive test described in the question.- It is sometimes confused with tests that focus on whether the patient's crime was a consequence of their mental condition, similar to the scope of the **Durham rule** or the ALI Model Penal Code test.*Irresistible impulse rule*- This rule, also called the **"policeman at the elbow"** test, focuses on the **volitional capacity**—the inability to control one's actions, even while knowing the act is wrong.- It differs from the cognitive focus of the M'Naghten rule because the person is aware the act is wrong but feels an overwhelming, **irresistible necessity** to commit it.

Q: In which poisoning is cherry red hypostasis seen on post-mortem examination?

CO Poisoning. ***CO Poisoning***- **Cherry red hypostasis** is the hallmark post-mortem finding in fatal **carbon monoxide (CO)** poisoning.- The bright red color is due to the formation of stable **carboxyhemoglobin (COHb)**, which retains this color even when blood pools after death.*Hydrogen sulphide* - Post-mortem findings usually include a **dark, tarry blood** consistency and the characteristic odor of **rotten eggs**.- It primarily acts by inhibiting cellular respiration, leading to asphyxia, but does not produce a bright red compound in the blood.*Yellow phosphorus*- This poisoning primarily causes severe **gastrointestinal irritation**, followed by fatal liver and kidney damage, leading to **jaundice**.- Post-mortem signs may include massive **hepatic necrosis** and luminescence (glowing) of the skin or vomit in the dark.*Hydrogen cyanide*- Cyanide poisoning can sometimes produce a pinkish flush or generalized redness but is typically associated with the odor of **bitter almonds**.- It causes cellular asphyxia by blocking **cytochrome c oxidase**, resulting in highly oxygenated venous blood (arterialization), but not the intense **cherry red** hue of CO poisoning.

Q: An HIV-positive man presents with a high-grade fever. Examination reveals a positive Kernig's sign. CSF shows reduced glucose, increased protein, and increased leukocytes. A diagnosis of cryptococcal meningitis is made. What is the appropriate management for this patient?

Liposomal amphotericin B. ***Liposomal amphotericin B***- **Liposomal amphotericin B** (often combined with **flucytosine**) is the standard of care for the **induction phase** (first 2 weeks) of severe cryptococcal meningitis treatment in HIV-positive patients due to its potent fungicidal activity [1].- The severity of the presentation (high fever, positive **Kernig's sign**, and abnormal CSF findings) necessitates this regimen to rapidly reduce the fungal burden in the central nervous system.*Vancomycin*- **Vancomycin** is an antibiotic used specifically to treat severe infections caused by **Gram-positive bacteria**, notably **MRSA**.- This drug has absolutely no therapeutic efficacy against the fungal pathogen *Cryptococcus neoformans*.*High dose fluconazole with flucytosine*- While fluconazole is an effective antifungal against *Cryptococcus*, this regimen is typically reserved for the **consolidation phase** (post-induction) or for milder disease.- Severe meningitis, indicated by the clinical signs and CSF profile, requires the superior fungicidal activity of **amphotericin B** during the induction phase [1].*Voriconazole*- **Voriconazole** is a broad-spectrum triazole mainly used for treating invasive **Aspergillus** and some *Candida* infections [1], [2].- It has **limited efficacy** against *Cryptococcus neoformans* and is not recommended as primary induction therapy for cryptococcal meningitis.

Q: A chronic alcoholic presents to the emergency room with acute abdominal pain in the epigastric region radiating to the back with nausea, anorexia, and occasional vomiting. Investigations showed elevated amylase levels and total count. Likely diagnosis is

b.Acute pancreatitis. ***Acute pancreatitis*** (Keep the correct option at the top and the incorrect options in the order they are provided in the input) - The clinical presentation of severe **epigastric pain radiating to the back**, associated with nausea and vomiting, is classic for **acute pancreatitis** [1]. - **Alcohol abuse** is a major risk factor, and the diagnosis is supported by findings of significantly elevated serum **amylase and/or lipase** levels [1]. *Acute hepatitis* - Typically presents with **jaundice**, fatigue, dark urine, and right upper quadrant discomfort, not the referred back pain seen here. - Key laboratory findings would include severely elevated **liver transaminases (AST/ALT)**, not primarily amylase. *Acute Cholecystitis* - Characterized by acute pain in the **right upper quadrant** or epigastrium, often radiating to the **right shoulder or scapula**, not the back [2]. - This condition is usually associated with gallstones and is diagnosed via imaging showing gallbladder wall thickening and pericholecystic fluid, though amylase can be mildly elevated secondarily. *Acute appendicitis* - Presents typically with periumbilical pain that migrates to the **right lower quadrant (RLQ)**, often associated with low-grade fever and localized tenderness. - The pain is not classically described as severe epigastric pain radiating to the back, and initial lab markers include leukocytosis but not specific elevation of amylase.

Q: A 28-year-old mother presents with pain in her left breast. Which of the following is the most likely cause of acute mastitis?

Crack in the nipple. ***Crack in the nipple***- This provides a direct portal of entry for bacteria, usually **Staphylococcus aureus**, which are commonly found on the skin or transported from the infant's nasopharynx.- Infective mastitis, characterized by **pain**, **erythema**, and fever, typically follows bacterial invasion through damaged *nipple epithelium*.*Breast engorgement*- This is a non-infectious condition caused by **milk stasis** and increased vascularity, typically occurring early in lactation.- While severe engorgement and incomplete emptying can *predispose* to mastitis by causing ductal blockage, it is not the primary mechanism or the *most likely cause* of the subsequent bacterial infection.*Hormonal influence*- Hormones, primarily **prolactin** and **oxytocin**, regulate milk production and let-down; they do not cause acute bacterial infection.- Changes in estrogen and progesterone levels are associated with breast tenderness (mastalgia) but are not directly causative factors for infective mastitis.*Absence of lactation*- Acute infective mastitis is overwhelmingly a complication of **lactation** (puerperal mastitis) due to milk stasis and nipple trauma.- The absence of lactation drastically *decreases* the typical risk factors for infective mastitis in this demographic (milk stasis, nipple damage from feeding).

Q: Which of the following is not true about CHPS? CHPS - Congenital hypertrophic pyloric stenosis

b.Caused by hypertrophy of longitudinal muscles. ***b.Caused by hypertrophy of longitudinal muscles***- The defining pathology of congenital hypertrophic pyloric stenosis involves hypertrophy and hyperplasia of the **circular muscle layer** of the pylorus, not the longitudinal muscle layer.- This thickening of the circular muscle narrows the pyloric canal lumen, leading to gastric outlet obstruction.*a.Presents with non-bilious vomiting*- This is a true statement; vomiting is typically **non-bilious** because the obstruction is proximal to the **ampulla of Vater** (where bile enters the duodenum).- The vomiting is often projectile, feeding soon after a meal, and progresses from occasional to nearly every feed.*c.USG is very sensitive in diagnosing this condition*- This is a true statement; ultrasonography is the diagnostic modality of choice due to its high sensitivity and specificity, avoiding radiation exposure.- Diagnosis is confirmed when the **pyloric muscle wall thickness** is >4 mm or the **pyloric channel length** is >16 mm.*d.Hypokalemic metabolic alkalosis seen*- This is a true statement; persistent, massive vomiting leads to the loss of gastric **hydrochloric acid (HCl)**.- The resulting primary loss of H+ ions leads to **metabolic alkalosis**, which is compensated by renal excretion of K+ and retention of HCO3- (leading to secondary **hypokalemia**).

Q: All of the following changes occur in chronic starvation except?

Hyperthermia. ***Hyperthermia*** - Chronic starvation triggers a compensatory decrease in the **Basal Metabolic Rate (BMR)**, which is intended to conserve energy and heat production. - The resulting physiological state is typically **hypothermia** (low body temperature) due to both decreased metabolism and loss of insulating subcutaneous fat, meaning hyperthermia does *not* occur. *Exhaustion* - **Profound exhaustion** occurs due to the catabolism of muscle protein and fat reserves, leading to overall muscle wasting and weakness. - Lack of adequate caloric intake also results in states like **anemia** and **hypoglycemia**, which severely limit physical stamina and mental capacity. *Heart atrophy* - The heart, like skeletal muscle, undergoes **autocannibalism** (breakdown of protein) to supply amino acids for essential organ function. - This reduction in myocardial mass (atrophy) severely compromises **cardiac output** and contributes significantly to clinical instability and potential sudden death. *Hypotension* - **Low blood pressure** results from decreased effective circulating volume and reduced **cardiac output** stemming from bradycardia and myocardial atrophy. - Severe fluid and electrolyte shifts, often coupled with volume depletion, further exacerbate the tendency toward **orthostatic hypotension**.

Q: A 60-year-old male presents with claudication and blackening of the toes. An image of the foot is shown below. What is the most likely diagnosis? ![img-25.jpeg](img-25.jpeg)

Atherosclerosis. ***Atherosclerosis*** - Atherosclerosis is the most common cause of **peripheral artery disease (PAD)** in patients over 50, leading to stenosis of arteries and causing symptoms like **claudication** (pain on exertion). - Severe, progressive disease results in **critical limb ischemia**, characterized by insufficient blood flow to meet metabolic demands at rest, which can lead to tissue necrosis and **gangrene** (blackening of the toes) as seen in the image. *Buerger's disease* - This condition, also known as **thromboangiitis obliterans**, is a non-atherosclerotic inflammatory vasculitis that typically affects **young male smokers** (usually under 45 years old). - It characteristically involves small-to-medium-sized arteries and veins and is often associated with superficial thrombophlebitis, which is not typical for this patient's demographic. *Raynaud's disease* - This is a functional vascular disorder characterized by episodic **vasospasm** of digital arteries, usually triggered by cold or stress, leading to well-demarcated color changes (white, blue, and red). - It does not cause claudication, which is a symptom of fixed arterial obstruction, and rarely results in the extensive, progressive gangrene seen in this case. *Giant cell arteritis* - This is a vasculitis of large and medium-sized arteries, primarily affecting branches of the **carotid artery** (e.g., temporal artery), leading to headache, jaw claudication, and visual loss. - While it can involve limb arteries, isolated severe lower limb ischemia with gangrene is an uncommon presentation; **atherosclerosis** is a far more frequent cause in this age group.

Question 1

Which vitamin deficiency causes xerophthalmia, a condition which causes dry eyes?

Accepted Answer

Vitamin A

Answer

Vitamin C

Answer

Vitamin D

Answer

Vitamin B

Question 2

The shelf life of copper T 380 A is

Accepted Answer

10 years

Answer

5 years

Answer

7 years

Answer

3 years

Question 3

According to the law, nothing is an offense if a person is of an unsound mind and is not able to understand that the nature and consequences of his/her act are wrong. Which rule of insanity applies in this case?

Accepted Answer

Mc Naughton's rule

Answer

Irresistible impulse rule

Answer

Durham's rule

Answer

Currens rule

Question 4

In which poisoning is cherry red hypostasis seen on post-mortem examination?

Accepted Answer

CO Poisoning

Answer

Hydrogen sulphide

Answer

Yellow phosphorus

Answer

Hydrogen cyanide

Question 5

An HIV-positive man presents with a high-grade fever. Examination reveals a positive Kernig's sign. CSF shows reduced glucose, increased protein, and increased leukocytes. A diagnosis of cryptococcal meningitis is made. What is the appropriate management for this patient?

Accepted Answer

Liposomal amphotericin B

Answer

High dose fluconazole with flucytosine

Answer

Voriconazole

Answer

Vancomycin

Question 6

A chronic alcoholic presents to the emergency room with acute abdominal pain in the epigastric region radiating to the back with nausea, anorexia, and occasional vomiting. Investigations showed elevated amylase levels and total count. Likely diagnosis is

Accepted Answer

b.Acute pancreatitis

Answer

a.Acute hepatitis

Answer

d.Acute appendicitis

Answer

c.Acute Cholecystitis

Question 7

A 28-year-old mother presents with pain in her left breast. Which of the following is the most likely cause of acute mastitis?

Accepted Answer

Crack in the nipple

Answer

Absence of lactation

Answer

Breast engorgement

Answer

Hormonal influence

Question 8

Which of the following is not true about CHPS? CHPS - Congenital hypertrophic pyloric stenosis

Accepted Answer

b.Caused by hypertrophy of longitudinal muscles

Answer

a.Presents with non-bilious vomiting

Answer

c.USG is very sensitive in diagnosing this condition

Answer

d.Hypokalemic metabolic alkalosis seen

Question 9

All of the following changes occur in chronic starvation except?

Accepted Answer

Hyperthermia

Answer

Exhaustion

Answer

Heart atrophy

Answer

Hypotension

Question 10

A 60-year-old male presents with claudication and blackening of the toes. An image of the foot is shown below. What is the most likely diagnosis? ![img-25.jpeg](img-25.jpeg)

Accepted Answer

Atherosclerosis

Answer

Buerger's disease

Answer

Raynaud's disease

Answer

Giant cell arteritis

FMGE 2023

Biochemistry

Community Medicine

Forensic Medicine

Internal Medicine

Obstetrics and Gynecology

Pediatrics

Physiology

Surgery