Anatomy
1 questionsWhich lymph node is most commonly involved in prostate cancer?
FMGE 2023 - Anatomy FMGE Practice Questions and MCQs
Question 151: Which lymph node is most commonly involved in prostate cancer?
- A. a.Deep inguinal
- B. b.Pelvic
- C. d.Internal iliac (Correct Answer)
- D. c.Superficial inguinal
Explanation: ***Internal iliac*** - The **internal iliac (hypogastric) lymph nodes** are the **primary and most common** site of lymphatic drainage from the prostate gland. - These nodes, along with the **obturator** and **external iliac** nodes, form the regional pelvic lymph node basin for prostate cancer metastasis. - In prostate cancer staging, metastasis to regional pelvic nodes (N1 disease) most commonly involves the **internal iliac nodes** as the first echelon. - This is the most anatomically specific and clinically relevant answer for the primary lymphatic drainage of the prostate. *Deep inguinal* - **Deep inguinal nodes** drain structures distal to the prostate, such as the lower limb and parts of the external genitalia. - These nodes are not part of the primary drainage pathway for the prostate gland. - Involvement would only occur in very advanced disease with extensive spread. *Pelvic* - While "pelvic lymph nodes" is a correct broad anatomical term encompassing the internal iliac, obturator, and external iliac nodes, it is **too non-specific** for this question. - When asked for the **most common** specific lymph node group involved, the answer should identify the **primary drainage site** (internal iliac) rather than the general region. *Superficial inguinal* - These nodes primarily drain the skin and superficial tissues of the lower abdominal wall, perineum, and lower limbs. - They are not involved in primary prostatic drainage and would only be affected in extremely advanced disease with local invasion.
Community Medicine
2 questionsThe processes in the oxidation pond are _
Which of the following is true regarding the single exposure point source epidemic?
FMGE 2023 - Community Medicine FMGE Practice Questions and MCQs
Question 151: The processes in the oxidation pond are _
- A. Always aerobic
- B. Always anaerobic
- C. Anaerobic during day, aerobic during night
- D. Aerobic during day, anaerobic during night (Correct Answer)
Explanation: ***Aerobic during day, anaerobic during night***- **Oxidation ponds** (or waste stabilization ponds) are shallow ponds where sewage is treated naturally, relying on a synergistic relationship between **algae** and **bacteria**.- During the day, algae perform **photosynthesis**, releasing large amounts of **oxygen** into the water, making the environment **aerobic** and allowing aerobic bacteria to thrive in the epilimnion (surface layer).- At night, photosynthesis ceases, and both algae and bacteria consume oxygen through **respiration**. This consumption, coupled with the settling of sludge (which undergoes anaerobic decomposition at the bottom), makes the environment near the bottom and sometimes throughout the pond **anaerobic**.*Always aerobic*- This is incorrect because, during periods of darkness or high organic load, **oxygen levels drop** significantly due to respiration and decomposition, leading to anaerobic conditions, especially at the bottom.*Always anaerobic*- This is incorrect. While the bottom sludge layer is consistently **anaerobic**, the surface layer (epilimnion) is made **aerobic** during the day by the oxygen produced through **algal photosynthesis**.*Anaerobic during day, aerobic during night*- This is incorrect. The generation of oxygen via **photosynthesis** (driven by sunlight) ensures that the process is **aerobic during the day**, not anaerobic. The oxygen depletion from respiration and lack of photosynthesis causes **anaerobic conditions at night**.
Question 152: Which of the following is true regarding the single exposure point source epidemic?
- A. Has more than one incubation period
- B. Has multiple peaks
- C. Explosive in nature (Correct Answer)
- D. Slow rise and fall
Explanation: ***Correct: Explosive in nature*** - A **single exposure point source epidemic** involves simultaneous exposure of individuals to a common source over a brief timeframe. - This synchronous exposure results in a rapid, steep rise in the number of cases, giving the outbreak an **explosive onset**. *Incorrect: Has more than one incubation period* - Cases usually cluster within one **incubation period** following the single exposure event, as all infections result from the same limited exposure opportunity. - Having cases spread over multiple incubation periods suggests either a **propagated epidemic** or a sustained common source exposure. *Incorrect: Has multiple peaks* - The defining feature of a point source epidemic is a single, sharp peak corresponding to the time when most exposed individuals develop symptoms within the incubation window. - **Multiple peaks** are characteristic of a **propagated epidemic** where secondary and tertiary cases lead to subsequent waves of infection. *Incorrect: Slow rise and fall* - The graph of a single point source epidemic shows a **rapid rise and fall** because the exposure is terminated quickly and all cases appear almost simultaneously. - A **slow rise and fall** is typical of prolonged exposure (continuous common source) or serial transmission (**propagated epidemics**).
Internal Medicine
2 questionsGenetic testing for BRCA 1/BRCA 2 is indicated for all of the following except:
A patient is diagnosed with acromegaly. Transsphenoidal surgery is not feasible. Which of the following drugs is preferred for the medical management of this patient?
FMGE 2023 - Internal Medicine FMGE Practice Questions and MCQs
Question 151: Genetic testing for BRCA 1/BRCA 2 is indicated for all of the following except:
- A. Breast and ovarian cancer
- B. Breast cancer diagnosed in a postmenopausal female >50 years of age (Correct Answer)
- C. Male breast cancer
- D. Bilateral breast cancer
Explanation: ***Breast cancer diagnosed in a postmenopausal female >50 years of age***- Genetic testing for **BRCA1/BRCA2** is typically focused on younger onset (<50 years), those with **triple-negative tumors**, or individuals with a significant family history, irrespective of age [1].- For individuals diagnosed at age **50 or older**, testing is generally not indicated *solely* based on age unless other high-risk factors like specific tumor pathology or **Ashkenazi Jewish ancestry** are present.*Male breast cancer*- **Male breast cancer** is a strong indication for **BRCA** testing, irrespective of age of onset, as approximately 10–20% of cases are linked to **BRCA mutations**, primarily **BRCA2**.- **BRCA2** mutations confer a significantly elevated lifetime risk of breast cancer in men, establishing genetic screening as standard practice.*Bilateral breast cancer*- A personal history of **bilateral breast cancer** (cancer occurring in both breasts) is a major criterion for **BRCA** testing because it suggests a strong underlying systemic risk or genetic predisposition [1].- Developing two separate primary breast cancers is highly characteristic of inherited cancer predisposition syndromes involving **BRCA1/BRCA2** mutations [2].*Breast and ovarian cancer*- A personal history of both **breast cancer** and **ovarian cancer** (or a strong family history involving both) is a near-absolute indication for genetic testing.- These two cancers are the hallmark cancers strongly associated with **BRCA1/BRCA2** mutations [2], especially **BRCA1**, which increases the risk of high-grade serous **ovarian cancer** substantially.
Question 152: A patient is diagnosed with acromegaly. Transsphenoidal surgery is not feasible. Which of the following drugs is preferred for the medical management of this patient?
- A. Terlipressin
- B. Ketoconazole
- C. Leuprolide
- D. Lanreotide depot formulation (Correct Answer)
Explanation: ***Lanreotide depot formulation***- It is a **somatostatin analog** (SSA) and a first-line medical therapy for acromegaly, particularly when surgery fails or is contraindicated [1].- SSAs normalize **GH (Growth Hormone)** and **IGF-1 (Insulin-like Growth Factor-1)** levels by inhibiting pituitary GH secretion [1].*Terlipressin*- It is primarily an analog of **vasopressin** used to treat **esophageal variceal bleeding** and hepatorenal syndrome.- It has no role in reducing pituitary growth hormone hypersecretion characteristic of acromegaly.*Ketoconazole*- It is an **antifungal agent** that also inhibits **steroidogenesis** (glucocorticoids, androgens).- Its primary hormonal use is in treating **Cushing's syndrome** (due to cortisol inhibition), not acromegaly.*Leuprolide*- This is a **GnRH agonist** used primarily to treat conditions like **prostate cancer**, **endometriosis**, and **precocious puberty**.- It acts on the hypothalamic-pituitary-gonadal axis and does not directly target GH-secreting tumors.
Pharmacology
2 questionsA 29-year-old male patient presents to the OPD with a 10-year history of coarse facial features and progressive enlargement of the hands and feet. Laboratory evaluation revealed elevated IGF-1 and non-suppressible growth hormone levels after the 75 g glucose challenge test. A diagnosis of acromegaly is made. Which of the following drugs is preferred for the management of this patient?
Which of the following is a first-line antitubercular drug prescribed in the initial 2 months of treatment?
FMGE 2023 - Pharmacology FMGE Practice Questions and MCQs
Question 151: A 29-year-old male patient presents to the OPD with a 10-year history of coarse facial features and progressive enlargement of the hands and feet. Laboratory evaluation revealed elevated IGF-1 and non-suppressible growth hormone levels after the 75 g glucose challenge test. A diagnosis of acromegaly is made. Which of the following drugs is preferred for the management of this patient?
- A. Leuprolide
- B. Ketoconazole
- C. Lanreotide depot formulation (Correct Answer)
- D. Terlipressin
Explanation: ***Lanreotide depot formulation***- This is a long-acting **somatostatin analog (SSA)** that binds to somatostatin receptors on the pituitary adenoma, effectively inhibiting the secretion of **growth hormone (GH)**.- SSAs, including lanreotide and **octreotide**, are considered the first-line medical therapy for acromegaly, especially when surgery fails or is contraindicated, as they control both GH and **IGF-1** levels.*Terlipressin*- *Terlipressin* is primarily used for the treatment of **bleeding esophageal varices** in patients with portal hypertension, as it acts as a **vasopressin analog** causing splanchnic vasoconstriction.- It has no therapeutic role in controlling sustained GH hypersecretion or managing the pituitary tumor responsible for **acromegaly**.*Ketoconazole*- *Ketoconazole* is primarily an **antifungal agent** but is occasionally used to inhibit **steroid biosynthesis** in conditions like **Cushing's syndrome** due to its effect on P450 enzymes.- It does not affect the production or secretion of **growth hormone** from the somatotropes and is therefore ineffective in treating **acromegaly**.*Leuprolide*- *Leuprolide* is a **Gonadotropin-Releasing Hormone (GnRH) agonist** used for conditions responsive to chemical castration, such as **prostate cancer** or **endometriosis**.- This agent targets the hypothalamic-pituitary-gonadal axis, having no clinical utility in directly suppressing the hypersecretion of **GH** in **acromegaly**.
Question 152: Which of the following is a first-line antitubercular drug prescribed in the initial 2 months of treatment?
- A. Streptomycin
- B. Linezolid
- C. Levofloxacin
- D. Ethambutol (Correct Answer)
Explanation: **Ethambutol** - **Ethambutol (E)** is a crucial component of the standard **four-drug regimen (RIPE)** used during the intensive initial phase (first 2 months) of active TB treatment. - Its primary function is to prevent emerging **rifampicin** or **isoniazid resistance**, although its main adverse effect is dose-related **optic neuritis**. *Streptomycin* - Streptomycin is an **aminoglycoside** and was historically used, but it is currently classified as a **second-line injectable agent** due to its toxicity and need for parenteral administration. - It is typically reserved for treating **multidrug-resistant TB (MDR-TB)** or in situations where oral first-line drugs cannot be used. *Linezolid* - Linezolid is an **oxazolidinone** antibiotic primarily reserved for treating highly resistant forms of TB, specifically **MDR-TB** or **XDR-TB**. - It is not included in the standard first-line regimen due to concerns regarding side effects like **myelosuppression** and **peripheral neuropathy**. *Levofloxacin* - Levofloxacin is a **fluoroquinolone** antibiotic, which is classified as a **second-line antitubercular agent**. - It is generally used in alternative regimens or for treating **drug-resistant TB** when standard first-line drugs are ineffective or contraindicated.
Radiology
1 questionsWhich of the following is the best imaging modality to diagnose neuroendocrine tumors (NETs)?
FMGE 2023 - Radiology FMGE Practice Questions and MCQs
Question 151: Which of the following is the best imaging modality to diagnose neuroendocrine tumors (NETs)?
- A. MRI
- B. PET (Correct Answer)
- C. CT
- D. USG
Explanation: ***PET***- **PET** imaging, particularly using tracers like **Gallium-68 DOTATATE** or **DOTATOC**, is the best modality because it targets the **somatostatin receptors (SSTr)** highly expressed on most well-differentiated neuroendocrine tumors (NETs).- This molecular imaging technique offers the highest **sensitivity and specificity** for identifying the primary tumor, effectively staging the disease, detecting occult metastases, and assessing therapeutic response.*USG*- **Ultrasound (USG)** is often limited to screening the abdominal organs (like the liver or pancreas) but lacks the anatomical comprehensiveness and sensitivity required for definitive staging of systemic NET disease.- Its performance is highly **operator-dependent**, and it is generally poor for evaluating deeply located tumors or detecting **pulmonary** or **osseous** involvement.*CT*- **CT scans** provide excellent anatomical information, are essential for tumor size measurement (using **RECIST criteria**), and are often used as the anatomical backbone to complement functional imaging like PET/CT.- However, CT relies on structural changes (size and density) and is significantly **less sensitive** than somatostatin receptor PET for finding small primary tumors or widespread, metabolically active metastases.*MRI*- **MRI** offers superior soft tissue contrast compared to CT, making it highly valuable, especially for evaluating complex areas like the **liver parenchyma** for metastatic disease or specific NETs (e.g., pancreatic NETs).- Like CT, MRI is a structural modality and fails to provide the **functional information** that PET offers regarding the presence and density of **somatostatin receptors**, limiting its use for overall tumor burden assessment and staging compared to PET.
Surgery
2 questionsA 51-year-old lady presents with complaints of a mass in the right breast. On examination, the mass was larger than 5 cm and ipsilateral mobile axillary lymph nodes were present. What is the staging, considering the mass is malignant?
Which of the following procedures has the highest risk of causing the recurrence of duodenal ulcers?
FMGE 2023 - Surgery FMGE Practice Questions and MCQs
Question 151: A 51-year-old lady presents with complaints of a mass in the right breast. On examination, the mass was larger than 5 cm and ipsilateral mobile axillary lymph nodes were present. What is the staging, considering the mass is malignant?
- A. pT4N1M0
- B. cT4N1M0
- C. pT3N1M0
- D. cT3N1M0 (Correct Answer)
Explanation: ***cT3N1M0*** **Correct answer based on TNM staging for breast cancer:** **T (Tumor) - T3:** - Tumor **>5 cm** in greatest dimension = T3 - The patient has a mass **larger than 5 cm**, meeting T3 criteria **N (Nodes) - N1:** - **Ipsilateral mobile axillary lymph nodes** = N1 - Mobile nodes without fixation to surrounding structures **M (Metastasis) - M0:** - **No mention of distant metastasis** = M0 **Clinical vs Pathological Staging:** - **"c" prefix** = clinical staging (based on physical examination, imaging) - **"p" prefix** = pathological staging (after surgery, histopathological examination) - This case uses **clinical examination findings**, so "c" prefix is appropriate *pT4N1M0* - Incorrect because: - Uses pathological prefix "p" without surgical specimen - T4 indicates chest wall/skin involvement, not present here *cT4N1M0* - Incorrect because: - T4 requires tumor extension to chest wall or skin ulceration/nodules - This tumor is only >5 cm without local extension *pT3N1M0* - Incorrect because: - Uses pathological staging prefix "p" when only clinical examination performed - Correct T and N staging but wrong staging type
Question 152: Which of the following procedures has the highest risk of causing the recurrence of duodenal ulcers?
- A. Highly selective vagotomy (Correct Answer)
- B. Gastro-jejunostomy
- C. Gastrectomy
- D. Truncal vagotomy
Explanation: ***Highly selective vagotomy***- ***Highly selective vagotomy*** (or parietal cell vagotomy) denervates only the acid-producing parietal cell mass, reducing basal and maximal acid output less intensely than other procedures. This procedure preserves the innervation of the **gastric antrum** and **pylorus**, maintaining physiological motility but resulting in the highest reported **ulcer recurrence rate** (historically 10-20%).*Gastrectomy*- A subtotal **gastrectomy** involves physically removing the portion of the stomach (body and/or antrum) responsible for acid or gastrin production, leading to a drastic reduction in acid load and a very low recurrence rate. This procedure is generally associated with the highest rates of **post-gastrectomy syndromes** (e.g., afferent loop syndrome, dumping syndrome) compared to vagotomy alone.*Truncal vagotomy*- **Truncal vagotomy** divides the main vagus trunks, causing near-maximal reduction of cephalic-phase acid secretion but requires mandatory **drainage procedures** (**pyloroplasty** or gastrojejunostomy) due to resulting gastric atony. The profound reduction in acid output achieved by this method gives it a significantly lower recurrence rate than highly selective vagotomy.*Gastro-jejunostomy*- **Gastro-jejunostomy** (often referring to the creation of a stoma between the stomach and jejunum) is typically performed as the **drainage procedure** necessary after truncal vagotomy, allowing food egress when the pylorus is dysfunctional. While effective in preventing stasis, a gastro-jejunostomy carries a specific risk of **marginal ulceration** (anastomotic ulceration) but the overall rate of recurrence for the combined operation is low.