FMGE 2023 Practice Questions

Q: If the division in the zygote occurs between 9-12 days after fertilization, which of the following twins is expected?

Monochorionic monoamniotic. ***Monochorionic monoamniotic*** - Division of the inner cell mass (ICM) occurring between **9 and 12 days** after fertilization results in a twin pregnancy where both fetuses share a single **chorion** and a single **amnion**.- This stage marks division after the amnion has formed (around day 8) but before complete differentiation, leading to high risks like **cord entanglement**. *Dichorionic diamniotic* - This pattern results from division occurring very early, typically within the first **3 days** (2-cell stage to morula stage).- Since separation happens before the differentiation of the trophoblast and inner cell mass, both the **chorion** and the **amnion** are separate. *Conjoint twins* - Conjoint twins (Siamese twins) occur when the separation is delayed beyond the **13th day** after fertilization.- The division is incomplete, as it occurs *after* the formation of the **embryonic disc**. *Monochorionic diamniotic* - This type of twinning arises from division occurring between **4 and 8 days** after fertilization, typically during the blastocyst stage.- It leads to the sharing of the **chorion** but the development of separate **amnions**.

Q: Which of the following is shown in the given image? ![img-35.jpeg](img-35.jpeg)

Linea nigra. ***Linea nigra*** - The image shows a dark, vertical line running down the midline of a pregnant woman's abdomen, which is the classic presentation of **linea nigra**. - This hyperpigmentation of the **linea alba** is a normal physiological change during pregnancy, caused by increased levels of hormones such as **melanocyte-stimulating hormone (MSH)** and **estrogen**. *Striae gravidarum* - **Striae gravidarum**, commonly known as stretch marks, are atrophic linear bands that result from the rapid stretching of the skin. They are not represented by the single, dark vertical line shown. - Initially, they appear as reddish or purplish lines (**striae rubrae**) and later fade to a silvery-white color (**striae albicantes**). *Chloasma* - **Chloasma**, or melasma, is a form of hyperpigmentation that appears on the face, particularly on the cheeks, forehead, and upper lip, often referred to as the "mask of pregnancy". - This condition affects facial skin and does not present as a line on the abdomen. *Linea alba* - The **linea alba** ("white line") is the fibrous connective tissue that runs down the midline of the abdomen in all individuals. It is typically pale and not easily visible. - During pregnancy, the **linea alba** darkens due to hormonal influences, transforming into the **linea nigra**. Therefore, the image shows the pigmented version, not the original linea alba.

Q: The given inclusion bodies are characteristic of which of the following organisms? ![img-30.jpeg](img-30.jpeg)

Cytomegalovirus. ***Cytomegalovirus*** - The image displays cells with marked enlargement (**cytomegaly**) and large, basophilic intranuclear inclusion bodies surrounded by a clear halo, which is the classic **"owl's eye"** appearance pathognomonic for Cytomegalovirus (CMV) infection [1]. - These inclusions are composed of viral particles and are typically seen in various tissues, such as the lungs, kidneys, and gastrointestinal tract, especially in **immunocompromised** patients [1]. *Human papillomavirus* - HPV infection is histologically characterized by **koilocytes**, which are squamous epithelial cells with a non-staining perinuclear halo and a wrinkled, hyperchromatic nucleus. - These changes are typically seen in cervical smears (Pap smears) or skin warts and are distinct from the large intranuclear inclusions of CMV. *Epstein-Barr virus* - EBV infection, particularly in infectious mononucleosis, is identified by the presence of **atypical lymphocytes** (Downey cells) in the peripheral blood, which have abundant cytoplasm and indented nuclei. - EBV does not produce the characteristic "owl's eye" intranuclear inclusions seen in the provided image. *Herpes simplex virus* - HSV infection is characterized by **multinucleated giant cells** with molded nuclei and eosinophilic intranuclear inclusions known as **Cowdry type A bodies**. - While both are herpesviruses, the inclusions in HSV typically give a **"ground-glass"** appearance to the nucleus, which is different from the distinct, haloed "owl's eye" inclusion of CMV. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 367-368.

Q: What type of cell is shown in the image below?

Reed Sternberg cell. ***Reed Sternberg cell*** - This is a classic **Reed-Sternberg cell**, characterized by its large size, bilobed or multinucleated appearance, and prominent eosinophilic nucleoli, which create a pathognomonic "**owl-eye**" look [1], [2]. - These cells are the neoplastic hallmark of **Hodgkin lymphoma** and are crucial for its diagnosis [2]. *Faggot cell* - Faggot cells are malignant promyelocytes containing numerous **Auer rods** that are bundled together, resembling a bundle of sticks. - They are characteristically seen in **Acute Promyelocytic Leukemia (APL)**, a subtype of AML, and are not depicted in the image. *Mott cells* - Mott cells are plasma cells with cytoplasm packed with **Russell bodies**, which are eosinophilic globules of immunoglobulin, giving the cell a "grape-like" appearance. - They are found in conditions with chronic plasma cell stimulation or plasma cell neoplasms like **multiple myeloma**, but their morphology is distinct from the cell shown. *Sézary-Lutzner cells* - These are malignant T-lymphocytes characterized by a highly convoluted, **cerebriform (brain-like) nucleus**. - They are the hallmark cells of cutaneous T-cell lymphomas, such as **Mycosis Fungoides** and **Sézary syndrome**, and lack the "owl-eye" nucleoli seen in the image. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 614-618. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 556-557.

Q: A 40-year-old female presents with frequent headaches. Investigation reveals raised intracranial pressure and the presence of a dural-based tumor. Which of the following histological findings correlate with the diagnosis?

Psammoma bodies with whorling of tumor cells. ***Psammoma bodies with whorling of tumor cells***- The clinical picture of a **dural-based tumor** [2] causing symptoms of **raised intracranial pressure** (headache) is highly suggestive of a **Meningioma**.- **Psammoma bodies** (laminated calcified concretions) formed by the degeneration of the whorled cell clusters [1] are the classic histological hallmark of the transitional and **meningothelial meningioma** subtypes.*Fried egg appearance*- This histological appearance, characterized by clear perinuclear halos, is the classic finding for **Oligodendroglioma**, a type of parenchymal brain tumor.- Oligodendrogliomas typically arise within the cerebral **white matter** and are usually not primarily dural-based.*Flexner - Wintersteiner rosettes*- These are specialized structures representing an attempt at **retinal differentiation** and are the characteristic feature of **Retinoblastoma**.- They are also sometimes seen in highly aggressive midline CNS tumors, such as **Pineoblastoma**.*Homer - Wright rosettes*- These are seen in tumors exhibiting divergent **neuroectodermal differentiation** but lack a true central lumen or fenestration.- They are the characteristic histological finding in **Medulloblastoma** (a cerebellar tumor) and **Neuroblastoma** (a tumor of the adrenal medulla or sympathetic chain). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 727-728. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1316-1317.

Q: A child presents with the findings shown in the image below. What is the true statement regarding this condition?

Kwashiorkor due to protein malnutrition. ***Kwashiorkor due to protein malnutrition*** - The image shows a child with characteristic features of **Kwashiorkor**, including generalized **edema** (swollen legs and feet) and a **distended abdomen** due to hypoalbuminemia and hepatomegaly. - This condition is a form of severe acute malnutrition caused primarily by a dietary **protein deficiency**, often in the setting of adequate or near-adequate calorie intake. *Kwashiorkor due to calorie malnutrition* - The primary cause of **Kwashiorkor** is insufficient **protein** intake, which leads to decreased plasma oncotic pressure and edema; a deficiency in calories is not the defining etiological factor. - Severe **calorie deficiency** is the main feature of **Marasmus**, which presents with severe wasting rather than edema. *Marasmus due to protein malnutrition* - The clinical presentation in the image is **Kwashiorkor**, not **Marasmus**, as evidenced by the presence of significant **edema**. - Marasmus is caused by a combined deficiency of **both protein and calories**, leading to severe wasting and an emaciated appearance. *Marasmus due to calorie malnutrition* - **Marasmus** is characterized by severe **wasting** of subcutaneous fat and muscle, resulting in a 'skin and bones' appearance, which is absent in this child. - The presence of a 'pot belly' and **pitting edema** are the hallmark signs that differentiate **Kwashiorkor** from **Marasmus**.

Q: A 5-year-old girl is brought to the clinic with a fever, cough, red eyes, running nose, and rash. The appearance of the child is shown below. What is the diagnosis? ![img-36.jpeg](img-36.jpeg)

Measles. ***Measles*** - The clinical presentation of fever with the classic triad of **cough, coryza, and conjunctivitis** (the "3 Cs") is highly suggestive of measles (rubeola). - The image shows **Koplik's spots** (small white spots on the buccal mucosa), which are pathognomonic for measles and appear before the characteristic maculopapular rash. *Mumps* - Mumps is primarily characterized by **parotitis**, a painful swelling of the salivary glands, which is not described in this patient. - The classic prodrome of the "3 Cs" and Koplik's spots are absent in mumps. *Chickenpox* - The rash in chickenpox (varicella) is **vesicular**, often described as a "dewdrop on a rose petal," and appears in crops. This is different from the maculopapular rash of measles. - While a fever and malaise can occur, the prominent upper respiratory symptoms and conjunctivitis of measles are not typical of chickenpox. *Erythema infectiosum* - Caused by **Parvovirus B19**, this condition is characterized by a distinctive "**slapped-cheek**" rash on the face. - It is followed by a **lacy, reticular rash** on the trunk and extremities, which is inconsistent with the patient's presentation.

Q: A cancer patient undergoing radiotherapy is given a dose of 1.8 to 2 Gy once daily for 5 days per week for a duration of 6 to 8 weeks. What is this type of radiotherapy called?

Regular Fractionated radiotherapy. ***Regular Fractionated radiotherapy***- This schedule uses biologically effective doses typically between **1.8 to 2.0 Gy** delivered once per day, 5 days per week, which is the standard of care for many cancers.- This conventional fractionation regimen allows for optimal **tumor cell kill** while providing sufficient time for normal tissues to repair sublethal damage between fractions (the principle of **Repair**).*Hyper fractionated radiotherapy*- This involves giving smaller doses per fraction (typically **<1.8 Gy**) delivered **more than once a day**.- The goal is often to reduce **late toxicities** to normal tissues while sometimes escalating the total dose delivered.*Accelerated fractionation radiotherapy*- This approach delivers the total treatment dose over a **significantly shorter overall treatment time** than standard fractionation, often involving multiple fractions per day or higher daily doses.- It is primarily used to counteract the effects of **accelerated tumor cell repopulation** during the course of treatment.*Brachytherapy*- This is a type of radiotherapy where the radiation source (sealed isotopes) is placed **inside or next to the tumor** (internal radiation), which is a delivery technique, not an external fractionation schedule.- It can be delivered as **High Dose Rate (HDR)** or **Low Dose Rate (LDR)** therapy.

Question 1

If the division in the zygote occurs between 9-12 days after fertilization, which of the following twins is expected?

Accepted Answer

Monochorionic monoamniotic

Answer

Dichorionic diamniotic

Answer

Monochorionic diamniotic

Answer

Conjoint twins

Question 2

Which of the following is shown in the given image? ![img-35.jpeg](img-35.jpeg)

Accepted Answer

Linea nigra

Answer

Striae gravidarum

Answer

Chloasma

Answer

Linea alba

Question 3

The given inclusion bodies are characteristic of which of the following organisms? ![img-30.jpeg](img-30.jpeg)

Accepted Answer

Cytomegalovirus

Answer

Epstein-Barr virus

Answer

Herpes simplex virus

Answer

Human papillomavirus

Question 4

A 70-year-old male comes with complaints of hip pain. An X-ray of the hip shows lytic lesions and elevated serum calcium levels. Bone marrow plasma cells are 42%, and the cells seen are given in the image below. What is the most likely diagnosis? ![img-31.jpeg](img-31.jpeg)

Accepted Answer

Multiple myeloma

Answer

ALL

Answer

CML

Answer

CLL

Question 5

The following picture shows a lymph node biopsy of a 30-year-old male with cervical lymphadenopathy. The diagnosis is

Accepted Answer

Hodgkin disease

Answer

Chronic lymphocytic leukemia (CLL)

Answer

Human papillomavirus (HPV)

Answer

Acute myeloid leukemia (AML)

Question 6

What type of cell is shown in the image below?

Accepted Answer

Reed Sternberg cell

Answer

Mott cells

Answer

Faggot cell

Answer

Sézary-Lutzner cells

Question 7

A 40-year-old female presents with frequent headaches. Investigation reveals raised intracranial pressure and the presence of a dural-based tumor. Which of the following histological findings correlate with the diagnosis?

Accepted Answer

Psammoma bodies with whorling of tumor cells

Answer

Flexner - Wintersteiner rosettes

Answer

Homer - Wright rosettes

Answer

Fried egg appearance

Question 8

A child presents with the findings shown in the image below. What is the true statement regarding this condition?

Accepted Answer

Kwashiorkor due to protein malnutrition

Answer

Kwashiorkor due to calorie malnutrition

Answer

Marasmus due to calorie malnutrition

Answer

Marasmus due to protein malnutrition

Question 9

A 5-year-old girl is brought to the clinic with a fever, cough, red eyes, running nose, and rash. The appearance of the child is shown below. What is the diagnosis? ![img-36.jpeg](img-36.jpeg)

Accepted Answer

Measles

Answer

Chickenpox

Answer

Mumps

Answer

Erythema infectiosum

Question 10

A cancer patient undergoing radiotherapy is given a dose of 1.8 to 2 Gy once daily for 5 days per week for a duration of 6 to 8 weeks. What is this type of radiotherapy called?

Accepted Answer

Regular Fractionated radiotherapy

Answer

Hyper fractionated radiotherapy

Answer

Brachytherapy

Answer

Accelerated fractionation radiotherapy

FMGE 2023

Obstetrics and Gynecology

Pathology

Pediatrics

Radiology