Internal Medicine
1 questionsWhich of the following is a sensitive and specific marker of intestinal inflammation?
FMGE 2023 - Internal Medicine FMGE Practice Questions and MCQs
Question 51: Which of the following is a sensitive and specific marker of intestinal inflammation?
- A. Procalcitonin
- B. Fecal lactoferrin (Correct Answer)
- C. High-sensitivity C-reactive protein
- D. Tissue transglutaminase IgA
Explanation: ***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.
Obstetrics and Gynecology
2 questionsOvarian drilling is done in which of the following conditions?
Which type of hysterectomy is done in a case of carcinoma cervix stage IB?
FMGE 2023 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 51: Ovarian drilling is done in which of the following conditions?
- A. Endometriosis
- B. Ovarian tumor
- C. Polycystic ovarian syndrome (Correct Answer)
- D. Ovarian hyperstimulation syndrome
Explanation: ***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
Question 52: Which type of hysterectomy is done in a case of carcinoma cervix stage IB?
- A. Type 2 hysterectomy
- B. Type 3 hysterectomy (Correct Answer)
- C. Type 4 hysterectomy
- D. Type 1 hysterectomy
Explanation: ***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**.
Ophthalmology
2 questionsA 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?
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?
FMGE 2023 - Ophthalmology FMGE Practice Questions and MCQs
Question 51: 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?
- A. Eosinophils
- B. Mast cells (Correct Answer)
- C. Neutrophils
- D. Lymphocyte
Explanation: ***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.
Question 52: 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?
- A. Argon
- B. Argon fluoride
- C. Femto laser
- D. Nd YAG laser (Correct Answer)
Explanation: ***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.
Pathology
4 questionsA 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?
Which of the following is implicated in the pathogenesis of rheumatoid arthritis?
Asbestos exposure may be associated with which of the following malignancies?
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?
FMGE 2023 - Pathology FMGE Practice Questions and MCQs
Question 51: 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?
- A. Oil red O
- B. Triphenyl tetrazolium chloride (Correct Answer)
- C. Sudan black B
- D. Masson trichrome
Explanation: ***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.
Question 52: Which of the following is implicated in the pathogenesis of rheumatoid arthritis?
- A. Defective cellular and humoral immunity
- B. Autoimmunity (Correct Answer)
- C. Chronic microbial infections
- D. IgE mediated
Explanation: ***Autoimmunity*** - **Rheumatoid arthritis (RA)** is fundamentally a chronic, systemic **autoimmune disease** where the immune system attacks the synovium and joint structures [1].- The pathogenesis involves the loss of **self-tolerance**, leading to the production of autoantibodies (like **RF** and **Anti-CCP**) and T-cell mediated chronic inflammation [2]. *IgE mediated*- **IgE mediated** reactions define Type I (Immediate) Hypersensitivity, which is the mechanism behind allergic reactions like **anaphylaxis** and asthma.- RA is primarily driven by Type III (immune complex) and Type IV (T-cell mediated) hypersensitivity mechanisms, not IgE-mediated mast cell degranulation.*Defective cellular and humoral immunity*- RA is characterized by an **overactive and misdirected** immune response against self-antigens, not a broad deficiency in the immune system.- Conditions resulting from defective immunity are classified as **immunodeficiency syndromes**, typically leading to recurrent, severe opportunistic infections.*Chronic microbial infections*- While certain infections may act as an environmental trigger in genetically susceptible individuals (**molecular mimicry**), the persistence of RA is due to established **autoimmunity**, not ongoing microbial proliferation.- Diseases caused by chronic microbial infections, such as **tuberculosis** or **leprosy**, resolve upon successful eradication of the pathogen, unlike RA which requires continuous immunosuppression. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 175-176. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1212.
Question 53: Asbestos exposure may be associated with which of the following malignancies?
- A. Hepatic angiosarcoma
- B. Skin carcinoma
- C. Acute myeloid leukemia
- D. Mesothelioma (Correct Answer)
Explanation: ***Mesothelioma***- The definitive and most recognized malignancy strongly linked to inhalation of **asbestos fibers** is **malignant mesothelioma**, primarily affecting the pleura or less commonly the peritoneum [1], [2].- Exposure typically involves a long latent period, often 20 to 50 years, after the initial exposure to asbestos minerals like **chrysotile** or **amphibole** [3].*Acute myeloid leukemia*- **Acute myeloid leukemia (AML)** is often linked to exposure to **benzene** or therapeutic **alkylating agents**, but not typically associated with asbestos inhalation [2].- AML is a malignancy of the **bone marrow** affecting myeloid precursors, distinct from the fibrotic and solid tumors caused by asbestos.*Hepatic angiosarcoma*- **Hepatic angiosarcoma** is a rare vascular tumor of the liver typically associated with chemical carcinogens such as **vinyl chloride monomer**, **arsenic**, or **thorium dioxide (Thorotrast)**.- There is no established primary association between asbestos exposure and the development of hepatic angiosarcoma.*Skin carcinoma*- **Skin carcinoma** (e.g., basal or squamous cell carcinoma) is overwhelmingly linked to chronic exposure to **ultraviolet (UV) radiation**.- While asbestos is a potent carcinogen associated with lung and pleural malignancies, it is not a recognized major risk factor for typical cutaneous carcinomas. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 221-222. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 286. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 339-340.
Question 54: 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?
- A. Defective fibrillin
- B. Abnormal collagen
- C. Absent dystrophin (Correct Answer)
- D. Expansions of CTG triplet repeats
Explanation: ***Absent dystrophin***- Duchenne Muscular Dystrophy (DMD) is caused by mutations in the *DMD* gene located on the X-chromosome, leading to the complete or near-complete absence of the muscle stabilizing protein, **dystrophin** [1].- The resulting muscle fiber instability and necrosis cause the progressive weakness and **pseudohypertrophy** (replacement of muscle tissue with fat and connective tissue) observed in this young boy [1].*Abnormal collagen*- Abnormalities in collagen, such as Type I or V defects, are typically associated with disorders like **Osteogenesis Imperfecta** (brittle bone disease) or **Ehlers-Danlos Syndrome**, which involves skin and joint hyperlaxity [2].- Connective tissue disorders usually do not present with the characteristic **calf pseudohypertrophy** seen in DMD.*Expansions of CTG triplet repeats*- This genetic abnormality is the underlying cause of **Myotonic Dystrophy Type 1 (DM1)**, not DMD [3].- DM1 symptoms include **myotonia** (inability to quickly relax muscles), cataracts, frontal balding, and typically have a later or more variable onset pattern [4].*Defective fibrillin*- Defective **fibrillin-1** is the causative factor in **Marfan Syndrome**, an autosomal dominant disorder of connective tissue.- Marfan Syndrome primarily involves the skeletal, ocular (**ectopia lentis**), and cardiovascular systems (**aortic root dilation**), which is distinct from the primary myopathy seen in DMD. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1244-1245. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 154-155. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 732-733. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1245-1246.
Physiology
1 questionsWhich of the following cells is responsible for destroying bacterial foreign bodies in liver sinusoids?
FMGE 2023 - Physiology FMGE Practice Questions and MCQs
Question 51: Which of the following cells is responsible for destroying bacterial foreign bodies in liver sinusoids?
- A. Hepatocytes
- B. Sinusoidal endothelial cells
- C. Kupffer cells (Correct Answer)
- D. Ito cells
Explanation: ***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**.