FMGE 2023 Practice Questions

Q: Which of the following is a sensitive and specific marker of intestinal inflammation?

Fecal lactoferrin. ***Fecal lactoferrin***- This is an excellent proxy marker for active intestinal inflammation because **lactoferrin** is a highly concentrated protein released by **activated neutrophils** migrating into the gut lumen [1].- Elevated fecal levels often correlate well with endoscopic and histological evidence of mucosal inflammation [2], making it a sensitive and specific non-invasive test for conditions like **Inflammatory Bowel Disease (IBD)**.*Procalcitonin*- Primarily serves as a highly specific marker for diagnosing and monitoring **sepsis** and severe **systemic bacterial infection**.- It generally reflects systemic inflammatory responses and is not specific for inflammation localized to the **intestinal mucosa**.*Tissue transglutaminase IgA*- This is an autoantibody primarily used for screening and diagnosing **Celiac disease**, an autoimmune condition triggered by **gluten**.- It indicates underlying autoimmunity causing villous atrophy but is not used as a general marker of acute or chronic **intestinal inflammation** (like IBD).*High-sensitivity C-reactive protein*- It is a widely used, but **non-specific**, acute-phase reactant indicating **systemic inflammation** originating from any part of the body [1].- While elevated in IBD, its sensitivity and specificity for identifying isolated or localized intestinal inflammation are inferior to non-invasive **fecal markers** like lactoferrin or calprotectin.

Q: Ovarian drilling is done in which of the following conditions?

Polycystic ovarian syndrome. ***Polycystic ovarian syndrome (PCOS)*** - **Ovarian drilling (laparoscopic ovarian diathermy)** is a surgical treatment specifically indicated for **clomiphene-resistant PCOS** - The procedure involves creating multiple small perforations in the ovarian capsule using diathermy or laser - **Mechanism:** Destroys androgen-producing ovarian stroma, reduces serum LH and androgens, restores ovulation in 50-70% of cases - **Indications:** Failed medical management with clomiphene citrate, as an alternative to gonadotropin therapy - Advantages include lower multiple pregnancy risk compared to gonadotropins *Incorrect: Endometriosis* - Treated with laparoscopic excision/ablation of endometriotic deposits, not ovarian drilling - May involve ovarian cystectomy for endometriomas *Incorrect: Ovarian tumor* - Requires surgical excision (cystectomy or oophorectomy) based on pathology - Drilling would be inadequate and inappropriate for tumor management *Incorrect: Ovarian hyperstimulation syndrome (OHSS)* - Iatrogenic complication of ovulation induction with gonadotropins or IVF - Managed conservatively with fluid management, monitoring, and supportive care - Not a surgical condition requiring ovarian drilling

Q: Which type of hysterectomy is done in a case of carcinoma cervix stage IB?

Type 3 hysterectomy. ***Type 3 hysterectomy***- This procedure represents the **classic radical hysterectomy** (Wertheim-Meigs operation) and is the standard surgical treatment for primary carcinoma of the cervix, specifically **FIGO Stage IB** and early Stage IIA- It requires the complete excision of the uterus, cervix, upper third of the vagina, and the removal of the *entire* **parametria** and uterosacral ligaments up to the pelvic sidewall, alongside meticulous **pelvic lymphadenectomy**.*Type 1 hysterectomy*- This is a **simple (extra-fascial) hysterectomy** that removes the uterus while preserving the deep pelvic fascia; it removes minimal to no parametrial tissue- It is inadequate for Stage IB disease and is typically reserved for benign indications or **FIGO Stage IA1** microinvasive carcinoma.*Type 2 hysterectomy*- Known as a **modified radical hysterectomy**, this procedure involves the resection of the uterus along with the medial half of the parametrium, providing less radical resection than Type 3.- It is usually reserved for smaller, low-risk lesions like **FIGO Stage IA2** or very small Stage IB1 tumors, depending on institutional protocol and tumor characteristics.*Type 4 hysterectomy*- This procedure is an **extended radical hysterectomy**, involving extensive removal of adjacent structures beyond Type 3, often including parts of the bladder or ureters (approaching pelvic exenteration).- It is generally reserved for critically advanced local cancers, those involving neighboring organs, or specific cases of local **recurrence**.

Q: A young person with recurrent seasonal conjunctivitis presents with itchiness and eye-watering. What is the most likely cell involved in the immediate phase of this condition?

Mast cells. ***Mast cells*** - Seasonal allergic conjunctivitis is a classic Type I **hypersensitivity** reaction (IgE-mediated). The immediate phase is mediated by the degranulation of **mast cells** resident in the conjunctiva. - Upon allergen exposure, cross-linking of surface-bound IgE causes mast cells to release potent preformed mediators, notably **histamine**, which directly causes the immediate onset of **pruritus** (itchiness) and vascular leakage (watering).*Eosinophils* - Eosinophils are primarily associated with the **late-phase** allergic response, recruited to the site hours after the initial reaction. - They contribute to chronic inflammation and tissue damage by releasing major basic protein and other toxic mediators.*Neutrophils* - Neutrophils are the hallmark of **acute inflammation** and are typically abundant in **bacterial infections**, which is not the primary mechanism of this seasonal condition. - While present in some inflammatory states, they are not the primary effector cell governing the immediate symptoms of Type I hypersensitivity.*Lymphocyte* - Lymphocytes, particularly T helper type 2 (Th2) cells, are crucial for promoting the B cell synthesis of **IgE** (sensitization phase). - They drive the overall adaptive immune response but do not mediate the rapid, immediate release of mediators responsible for the acute symptoms.

Q: Following cataract surgery, a patient comes with complaints of decreased visual acuity. On examination, posterior capsular opacification is seen. What type of laser can be used to treat this condition?

Nd YAG laser. ***Nd YAG laser*** - The **Nd YAG laser** (Neodymium-doped Yttrium Aluminum Garnet) is the gold standard for treating **Posterior Capsular Opacification (PCO)**, which causes secondary visual decline after cataract extraction. - It employs **photodisruption** (a non-thermal process creating plasma) to precisely cut an opening in the opacified posterior capsule, restoring the visual axis (YAG capsulotomy). *Femto laser* - The **Femtosecond laser** is commonly used for creating the corneal flap in **LASIK** or performing certain steps (**capsulotomy**, lens fragmentation) during primary cataract surgery. - It is not typically used for the treatment of *established* PCO as the **Nd YAG** laser procedure is faster, more efficient, and specifically designed for posterior capsule cutting. *Argon fluoride* - **Argon fluoride** is the emission medium for the **Excimer laser**, which operates in the ultraviolet spectrum. - The primary application of the Excimer laser in ophthalmology is **photoablation** of corneal tissue for refractive surgery (e.g., **PRK** and **LASIK**). *Argon* - The **Argon laser** is a thermal laser used primarily for **photocoagulation** in retinal conditions, such as treating **diabetic retinopathy** or performing peripheral iridotomy. - It is unsuitable for PCO treatment because its thermal mechanism would cause unnecessary heat damage to surrounding structures, unlike the non-thermal **photodisruption** of the Nd YAG laser.

Q: A 65-year-old man dies due to myocardial infarction. Which stains can be used to see the infarct in the heart while conducting an autopsy?

Triphenyl tetrazolium chloride. ***Triphenyl tetrazolium chloride***- This stain is used to macroscopically identify **acute myocardial infarction** during autopsy, typically within the first few hours up to 2 weeks post-infarct [1].- It detects the activity of **dehydrogenase enzymes** (like LDH); viable myocardium reacts with TTC to form a **brick red** color, while the necrotic (infarcted) tissue lacks these enzymes and remains **pale** or *gray-yellow* [1].*Oil red O*- **Oil red O** is a lipid stain primarily used to demonstrate neutral lipids and **triglycerides**, often used for conditions like steatosis or fat emboli.- It is not specific for the cellular necrosis defining an acute infarct and is generally used on frozen sections.*Sudan black B*- **Sudan black B** is a lipid stain used to visualize phospholipids, neutral lipids, and lipoproteins.- It is more commonly employed in hematopathology (e.g., staining **myeloblasts**) or for demonstrating specific lipid storage, not for defining the boundaries of an acute myocardial infarct in gross pathology examination.*Masson trichrome*- This is a differential stain used to distinguish between muscle (red) and **collagen** (blue or green), used to highlight **fibrosis**.- While crucial for identifying **old, healed myocardial infarcts** (scar tissue), it is ineffective for rapid visualization of a fresh, acute infarct where significant collagen deposition has not yet taken place [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 552-554.

Q: Which of the following cells is responsible for destroying bacterial foreign bodies in liver sinusoids?

Kupffer cells. ***Kupffer cells***- These are resident **macrophages** specifically located within the **liver sinusoids**.- Their primary role is **phagocytosis**, enabling them to clear the blood of **bacteria**, old red blood cells, and other foreign particulate matter entering the liver via the portal vein.*Hepatocytes*- These are the main parenchymal cells of the liver, primarily responsible for metabolic functions such as **bile production**, **protein synthesis**, and **detoxification**.- They lack the specialized migratory and high-volume **phagocytic capacity** needed to clear circulating bacteria.*Ito cells*- Also known as **hepatic stellate cells**, they reside in the **Space of Dissé** and are specialized for storing **Vitamin A**.- Upon activation (e.g., due to injury), they differentiate into myofibroblasts and are central to **liver fibrosis**.*Sinusoidal endothelial cells*- These cells line the vascular space of the sinusoid and are characterized by numerous **fenestrations** (pores) that allow fluid exchange with the Space of Dissé.- Although they form the barrier, they are generally less active in high-capacity microbial clearance compared to the dedicated **Kupffer cell macrophages**.

Question 1

Which of the following is a sensitive and specific marker of intestinal inflammation?

Accepted Answer

Fecal lactoferrin

Answer

Procalcitonin

Answer

High-sensitivity C-reactive protein

Answer

Tissue transglutaminase IgA

Question 2

Ovarian drilling is done in which of the following conditions?

Accepted Answer

Polycystic ovarian syndrome

Answer

Endometriosis

Answer

Ovarian tumor

Answer

Ovarian hyperstimulation syndrome

Question 3

Which type of hysterectomy is done in a case of carcinoma cervix stage IB?

Accepted Answer

Type 3 hysterectomy

Answer

Type 2 hysterectomy

Answer

Type 4 hysterectomy

Answer

Type 1 hysterectomy

Question 4

A young person with recurrent seasonal conjunctivitis presents with itchiness and eye-watering. What is the most likely cell involved in the immediate phase of this condition?

Accepted Answer

Mast cells

Answer

Eosinophils

Answer

Neutrophils

Answer

Lymphocyte

Question 5

Following cataract surgery, a patient comes with complaints of decreased visual acuity. On examination, posterior capsular opacification is seen. What type of laser can be used to treat this condition?

Accepted Answer

Nd YAG laser

Answer

Argon

Answer

Argon fluoride

Answer

Femto laser

Question 6

A 65-year-old man dies due to myocardial infarction. Which stains can be used to see the infarct in the heart while conducting an autopsy?

Accepted Answer

Triphenyl tetrazolium chloride

Answer

Oil red O

Answer

Sudan black B

Answer

Masson trichrome

Question 7

Which of the following is implicated in the pathogenesis of rheumatoid arthritis?

Accepted Answer

Autoimmunity

Answer

Defective cellular and humoral immunity

Answer

Chronic microbial infections

Answer

IgE mediated

Question 8

Asbestos exposure may be associated with which of the following malignancies?

Accepted Answer

Mesothelioma

Answer

Hepatic angiosarcoma

Answer

Skin carcinoma

Answer

Acute myeloid leukemia

Question 9

An 8-year-old boy presents with progressive muscle weakness and walking difficulties. On examination, pseudohypertrophy of calf muscles was noted. Which of the following is true regarding this condition?

Accepted Answer

Absent dystrophin

Answer

Defective fibrillin

Answer

Abnormal collagen

Answer

Expansions of CTG triplet repeats

Question 10

Which of the following cells is responsible for destroying bacterial foreign bodies in liver sinusoids?

Accepted Answer

Kupffer cells

Answer

Hepatocytes

Answer

Sinusoidal endothelial cells

Answer

Ito cells

FMGE 2023

Internal Medicine

Obstetrics and Gynecology

Ophthalmology

Pathology

Physiology