FMGE 2023 Practice Questions

Q: All of the following are superior mediastinal tumors except:

Parathyroid. ***Parathyroid*** - Parathyroid tumors are **not classic superior mediastinal tumors** - Ectopic parathyroid adenomas, when mediastinal, are typically located in the **anterior-inferior mediastinum**, not the superior mediastinum - They descend embryologically with the thymus from the 3rd pharyngeal pouch and are found in the **thymic tongue** or anterior mediastinum at lower levels - **Not part of the classic anterior/superior mediastinal mass differential** (the "4 Ts") *Thymus* - The thymus is the **primary organ** of the anterior and superior mediastinum - **Thymoma, thymic hyperplasia, and thymic carcinoma** are classic superior/anterior mediastinal tumors - Part of the "4 Ts" mnemonic: **Thymus**, Thyroid, Teratoma, Terrible lymphoma *Thyroid* - **Retrosternal (substernal) goiter** represents extension of cervical thyroid into the superior mediastinum - Common cause of superior mediastinal masses, especially in older patients - Can cause tracheal compression and superior vena cava syndrome - Part of the "4 Ts" of anterior mediastinal masses *Lymphoma* - **Lymphoma (especially Hodgkin lymphoma and T-cell lymphoblastic lymphoma)** is one of the most common anterior/superior mediastinal masses - Part of the "4 Ts": Thymus, Thyroid, Teratoma, and **"Terrible lymphoma"** - Typically presents as a large anterior mediastinal mass in young adults - May cause B symptoms (fever, night sweats, weight loss) and superior vena cava syndrome

Q: Confidentiality is maintained in which of the following conditions?

Counselling. ***Counselling***- **Counselling** is a private, one-on-one interaction where the counselor is ethically and legally bound to maintain the client's information as **confidential**.- The foundation of successful **counselling** relies heavily on establishing trust, which is achieved through adherence to strict **confidentiality** rules.*Group discussion*- *Group discussion* involves multiple participants discussing a topic, making the shared information inherently public among the group members, thus negating **confidentiality**.- While privacy among group members might be implied, there is no formal professional obligation or structure ensuring that information remains strictly private outside the *group discussion*.*Panel discussion*- A *panel discussion* is a public forum where a group of experts discusses a subject in front of a larger audience, meaning all information shared is immediately public and not **confidential**.- The primary goal is dissemination of information and expert opinion to a broad audience, conflicting with the concept of **confidentiality**.*Seminar*- A *seminar* is an educational presentation or meeting, usually involving a presenter and an audience, where information is shared publicly.- The format of a *seminar* is designed for open learning and exchange, preventing the maintenance of **confidentiality** for any data or client-specific details presented.

Q: An 8 weeks pregnant woman, working in an industry, consults a doctor. According to the ESI act, what is the duration of maternity leave that she can get?

26 weeks, starting from 8 weeks before delivery. ***26 weeks, starting from 8 weeks before delivery*** - This duration is mandated by the **Maternity Benefit (Amendment) Act, 2017**, which governs the maternity benefits paid through the **ESI scheme** for eligible insured women - This applies for the first two surviving children - The total paid leave entitlement is **26 weeks** (or 182 days), which can be availed for a period not exceeding **8 weeks** immediately preceding the expected date of delivery *4 months* - Four months is approximately **17 weeks**, which is substantially less than the **26 weeks** maximum paid leave guaranteed under the ESI Act and the Maternity Benefit Act - Such a short duration does not comply with current statutory requirements aimed at promoting maternal health and child welfare *28 weeks, starting from 4 weeks after delivery* - The statutory maximum paid maternity leave duration is **26 weeks**, making **28 weeks** an excess entitlement not provided under the current law - The woman is legally entitled to begin her leave up to **8 weeks** prior to the expected delivery date, not just post-delivery, enabling vital pre-natal rest *9 months* - Nine months (approximately **39 weeks**) is significantly longer than the standard paid maternity leave duration of **26 weeks** provided by the ESI Act - While some organizations may offer extended unpaid leave, **9 months** is not the statutory duration for compensated maternity benefit

Q: A public witness of the incident is asked to attend the court and record his evidence. Which type of evidence is provided by the witness to the court?

Oral evidence. ***Oral evidence***- This is testimony given verbally by a witness under **oath or affirmation** in court, based on their personal knowledge and direct observation of the facts of the case.- As the individual is a direct public witness of the incident, their statement recorded in court constitutes direct or **oral evidence**.*Hearsay evidence*- This refers to evidence based on what the witness heard from someone else, rather than what they personally observed, making it generally **inadmissible** in court proceedings.- Since the witness directly observed the incident, their evidence is a primary account, not a secondary or **hearsay** report.*Subpoena*- A **subpoena** is a legal document or writ issued by the court ordering a witness to appear in court or produce specific documents.- It is an **instrument of summons** compelling the attendance of the witness, not the actual type of evidence delivered by them.*Circumstantial evidence*- This is indirect evidence that requires the court to draw inferences from facts to establish the conclusion (e.g., establishing **motive or opportunity**).- The witness is providing a statement based on what they *saw*, which is direct evidence, not evidence relying on secondary inference or **circumstantial facts**.

Q: A 50-year-old factory worker was brought to the emergency room with complaints of headache, vomiting, and blurring of vision after he consumed local spirit. Which of the following is used for the treatment of his condition?

Fomepizole. ***Fomepizole***- Fomepizole is the preferred antidote for **methanol** and **ethylene glycol** poisoning because it competitively inhibits the enzyme **alcohol dehydrogenase** (ADH).- By inhibiting ADH, it prevents the metabolism of methanol into its toxic metabolite, **formic acid**, which is responsible for the characteristic **ocular toxicity** (blurring of vision) and **metabolic acidosis** seen in this patient.*Flumazenil*- Flumazenil is a competitive antagonist used to reverse the effects of **benzodiazepines**, primarily in cases of overdose or to reverse procedural sedation.- It has no role in the treatment of **methanol poisoning**, which causes toxicity via the accumulation of **formic acid**.*N-acetyl cysteine*- **N-acetyl cysteine (NAC)** is the specific antidote for **acetaminophen** (paracetamol) overdose, as it replenishes **glutathione** stores in the liver.- It is ineffective in the treatment of **methanol poisoning**, which requires ADH inhibition or **hemodialysis** to remove the toxins.*Naloxone*- **Naloxone** is an opioid antagonist used specifically to rapidly reverse the effects of **opioid overdose** by competing for the opioid receptors.- The patient's symptoms (headache, vomiting, blurring of vision) are classic for **methanol toxicity** and are not indicative of opioid overdose.

Q: Which of the following is NOT a symptom associated with chronic cocaine abuse?

Dilated pupils, rapid pulse and sweating.. ***Dilated pupils, rapid pulse and sweating.***- These manifestations (mydriasis, tachycardia, and diaphoresis) are classic signs of **acute cocaine intoxication** resulting from massive sympathetic nervous system overstimulation.- While they occur every time the drug is used, they reflect the transient state of acute drug action rather than structural, neurological, or hygienic **long-term complications** of chronic abuse.*Nasal/palatal perforation.*- Chronic intranasal cocaine abuse leads to severe **vasoconstriction** and subsequent **ischemic necrosis** of the cartilaginous and bony structures in the septum and palate.- This structural destruction is a definitive **long-term consequence** that may lead to chronic sinusitis, dysphonia, and septal perforation.*Black tongue and teeth.*- This presentation is a characteristic finding in individuals who chronically smoke **crack cocaine**, often referred to as "crack mouth."- It is caused by a combination of extreme heat exposure, chemical irritation from the smoke, and severe neglect of **oral hygiene** associated with addiction.*Hallucination of insects crawling on the skin (formication).*- This severe **tactile hallucination**, often colloquially termed "cocaine bugs," is a known psychiatric consequence of **chronic, high-dose stimulant abuse**.- It results from neurotoxicity and is a marker of severe dopaminergic system dysregulation due to long-term substance use.

Q: A patient who was diagnosed with prostate cancer is being investigated. The bone scan is reported as a super scan with increased uptake in the bones and reduced activity in the spleen. What is the reason for this super scan appearance?

Increased uptake due to diffuse metastasis. ***Increased uptake due to diffuse metastasis***- The **super scan** appearance is pathognomonic for **widespread skeletal metastasis**, particularly common in advanced prostate cancer, where nearly all the tracer is utilized by diffuse bony lesions.- The reduced or absent visualization of soft tissues (like the **spleen**, **kidneys**, and **bladder**) results from the extremely high proportion of the radiotracer being extracted by the vast surface area of the metastatic bone lesions.*Increased uptake by carcinoma prostate*- Bone scans (using Tc-99m MDP) primarily reflect **osteoblastic activity** in bone, not the direct uptake by the primary non-osseous tumor tissue in the prostate.- While uptake might occasionally be seen in the primary tumor due to adjacent bony involvement or calcification, this is not the cause of the diffuse **super scan** pattern across the entire skeleton.*Increased uptake by the bone*- While the super scan is characterized by increased uptake in the bone, this statement fails to detail the underlying pathological *reason*, which is the widespread **diffuse skeletal metastasis**.- Normal physiological uptake by bone would not lead to the non-visualization of the **kidneys** and **spleen**, which is a crucial defining feature of the super scan.*Decreased uptake by adrenal glands and kidney*- The non-visualization (or decreased uptake) in soft tissue organs, including the **kidneys**, is a *consequence* of the super scan pattern, not the underlying cause of the appearance.- The primary mechanism is the massive tracer uptake in the skeleton due to **diffuse pathological activity**, leaving insufficient free tracer for normal soft tissue background and excretion.

Q: A 55-year-old male patient presents with hematuria and a mass in the left kidney on a CT scan, as shown below. What is the diagnosis?

Renal angiomyolipoma. ***Renal angiomyolipoma*** - This is a benign renal tumor composed of three tissue types: blood vessels (**angio**), smooth muscle (**myo**), and fat (**lipoma**). The presence of macroscopic fat on a CT scan is a key diagnostic feature. - Patients can be asymptomatic or present with **hematuria** or flank pain, particularly if the tumor is large. There is a strong association with **tuberous sclerosis**. *Renal cell carcinoma* - This is the most common malignant kidney tumor in adults, often presenting with **hematuria**, flank pain, and a palpable mass (the classic triad). - On imaging, it typically appears as a heterogeneously enhancing solid mass and crucially, **lacks macroscopic fat**, which helps differentiate it from an angiomyolipoma. *Renal oncocytoma* - This is a benign epithelial tumor that can be difficult to distinguish from renal cell carcinoma on imaging alone. - It may show a characteristic **central stellate scar** on contrast-enhanced CT, but it does not contain significant fat tissue. *Renal cyst* - A simple renal cyst appears on CT as a well-defined, thin-walled, non-enhancing lesion filled with fluid of **water density**. - The image and description indicate a solid, **neovascular mass**, which is inconsistent with the avascular nature of a simple cyst.

Q: A 73 year old male smoker with a past history of coronary artery disease presents with blackening of the toes. An image of the foot is shown below. What is the most likely diagnosis?

Atherosclerosis. ***Atherosclerosis*** - The patient's advanced age (73), history of **smoking**, and **coronary artery disease** are all major risk factors for atherosclerosis, the most common cause of peripheral arterial disease (PAD). - The blackening of the toes is indicative of **dry gangrene**, a form of tissue necrosis resulting from severe, chronic ischemia due to atherosclerotic occlusion of the arteries supplying the foot. *Buerger's disease* - This condition, also known as **thromboangiitis obliterans**, is a non-atherosclerotic vasculitis that typically affects **young male smokers**, usually under the age of 45. - The patient's advanced age makes Buerger's disease a much less likely diagnosis compared to atherosclerosis. *Raynaud's disease* - Raynaud's disease is characterized by episodic **vasospasm** of digital arteries, usually triggered by cold or stress, leading to distinct color changes (white, blue, and red), which is not the primary presentation here. - While severe secondary Raynaud's phenomenon can lead to gangrene, it is not the most probable cause in an elderly patient with multiple risk factors for atherosclerosis. *Giant cell arteritis* - This is a **large-vessel vasculitis** that typically affects patients over 50 and presents with symptoms like headache, jaw claudication, and visual disturbances. - While it can cause limb claudication, isolated digital gangrene is a very uncommon manifestation, and the patient's presentation is classic for atherosclerotic PAD.

Q: A 50-year-old woman after thyroidectomy comes to you for a 2nd opinion for further treatment of papillary thyroid cancer. What would you recommend for this patient?

Radioactive iodine (RAI) ablation. ***Radioactive iodine (RAI) ablation*** - After total thyroidectomy for papillary thyroid cancer, **radioactive iodine (I-131) ablation** is the standard next step for most patients - **Indications for RAI ablation:** tumor >1 cm, lymph node metastases, extrathyroidal extension, vascular invasion, or unfavorable histology - RAI ablation serves dual purpose: destroys residual thyroid tissue and micro-metastases, and enables follow-up with thyroglobulin levels - A **post-therapy whole body scan** is typically performed 5-7 days after RAI ablation to assess uptake - TSH stimulation (either by thyroid hormone withdrawal or recombinant TSH) is required before RAI therapy *Wait and watch* - Only appropriate for **very low-risk papillary microcarcinomas** (<1 cm, no extrathyroidal extension, no nodal metastases) in carefully selected patients - Not the standard recommendation after thyroidectomy for papillary cancer without risk stratification details *Radiotherapy (External beam)* - **Not first-line** post-operative treatment for differentiated thyroid cancer - Reserved for: RAI-refractory disease, tumors that don't take up iodine, gross residual disease not amenable to surgery, or palliative care - May be considered in elderly patients with aggressive local disease *Chemotherapy* - **No role** in the routine management of differentiated thyroid cancer (papillary or follicular) - Only considered in advanced, progressive, RAI-refractory disease with targeted agents (lenvatinib, sorafenib) - Conventional cytotoxic chemotherapy is ineffective in thyroid cancer

Question 1

All of the following are superior mediastinal tumors except:

Accepted Answer

Parathyroid

Answer

Thyroid

Answer

Thymus

Answer

Lymphoma

Question 2

Confidentiality is maintained in which of the following conditions?

Accepted Answer

Counselling

Answer

Group discussion

Answer

Panel discussion

Answer

Seminar

Question 3

An 8 weeks pregnant woman, working in an industry, consults a doctor. According to the ESI act, what is the duration of maternity leave that she can get?

Accepted Answer

26 weeks, starting from 8 weeks before delivery

Answer

4 months

Answer

28 weeks, starting from 4 weeks after delivery

Answer

9 months

Question 4

A public witness of the incident is asked to attend the court and record his evidence. Which type of evidence is provided by the witness to the court?

Accepted Answer

Oral evidence

Answer

Circumstantial evidence

Answer

Subpoena

Answer

Hearsay evidence

Question 5

A 50-year-old factory worker was brought to the emergency room with complaints of headache, vomiting, and blurring of vision after he consumed local spirit. Which of the following is used for the treatment of his condition?

Accepted Answer

Fomepizole

Answer

Flumazenil

Answer

N-acetyl cysteine

Answer

Naloxone

Question 6

Which of the following is NOT a symptom associated with chronic cocaine abuse?

Accepted Answer

Dilated pupils, rapid pulse and sweating.

Answer

Black tongue and teeth.

Answer

Hallucination of insects crawling on the skin (formication).

Answer

Nasal/palatal perforation.

Question 7

A patient who was diagnosed with prostate cancer is being investigated. The bone scan is reported as a super scan with increased uptake in the bones and reduced activity in the spleen. What is the reason for this super scan appearance?

Accepted Answer

Increased uptake due to diffuse metastasis

Answer

Increased uptake by carcinoma prostate

Answer

Decreased uptake by adrenal glands and kidney

Answer

Increased uptake by the bone

Question 8

A 55-year-old male patient presents with hematuria and a mass in the left kidney on a CT scan, as shown below. What is the diagnosis?

Accepted Answer

Renal angiomyolipoma

Answer

Renal cell carcinoma

Answer

Renal oncocytoma

Answer

Renal cyst

Question 9

A 73 year old male smoker with a past history of coronary artery disease presents with blackening of the toes. An image of the foot is shown below. What is the most likely diagnosis?

Accepted Answer

Atherosclerosis

Answer

Giant cell arteritis

Answer

Buerger's disease

Answer

Raynaud's disease

Question 10

A 50-year-old woman after thyroidectomy comes to you for a 2nd opinion for further treatment of papillary thyroid cancer. What would you recommend for this patient?

Accepted Answer

Radioactive iodine (RAI) ablation

Answer

Wait and watch.

Answer

Radiotherapy

Answer

Chemotherapy

FMGE 2023

Anatomy

Community Medicine

Forensic Medicine

Pharmacology

Psychiatry

Radiology

Surgery