FMGE 2018 Practice Questions

Q: Steps of PCR in sequence are?

Denature DNA, Anneal Primers, Extend DNA. ***Denature DNA, Anneal Primers, Extend DNA*** - This sequence represents the three fundamental steps of each PCR cycle, ensuring accurate and efficient **DNA amplification**. - **Denaturation** separates the double-stranded DNA template, **annealing** allows primers to bind to specific sequences, and **extension** synthesizes new DNA strands. *Denature DNA, Extend DNA, Anneal Primers* - This order is incorrect because **primer annealing** must occur before DNA extension can begin. - Primers provide the necessary starting points for the **DNA polymerase** to synthesize the new strands. *Anneal Primers, Extend DNA, Denature DNA* - This sequence is incorrect as the **template DNA** must first be denatured to separate the strands before primers can anneal to them. - If the DNA is not denatured, the primers cannot access their target sequences. *Extend DNA, Anneal Primers, Denature DNA* - This order is incorrect because **DNA extension** is the final step, occurring only after denaturation and primer annealing. - The polymerase requires both a denatured template and bound primers to initiate synthesis.

Q: All the following are feature of polycystic disease of kidneys except:-

Erythrocytosis. Polycystic kidney disease (PKD) is an autosomal dominant condition where multiple cysts enlarge slowly, compressing and damaging surrounding kidney tissue [1]. ***Erythrocytosis*** - **Polycystic kidney disease (PKD)** typically leads to **anemia** due to reduced erythropoietin production by the damaged kidneys [2]. - **Erythrocytosis** (an abnormally high red blood cell count) is not a common feature of PKD; it is more often associated with conditions like **renal cell carcinoma** or certain chronic hypoxic states. *Renal failure* - **Progressive cyst growth** in PKD eventually destroys functional kidney tissue, leading to a decline in renal function and often culminating in **end-stage renal disease**, which occurs in about 50% of PKD1 patients [1]. - **Renal failure** is a common and serious complication of PKD, necessitating dialysis or kidney transplantation. *Hematuria* - **Cysts in PKD** can rupture into the collecting system, leading to **gross hematuria** (visible blood in urine) or microscopic hematuria [1]. - Trauma to the flank or infection within a cyst can trigger an episode of **hematuria** [1]. *Hypertension* - **Hypertension** is a very common early manifestation of PKD, often preceding any significant decline in glomerular filtration rate. - It results from activation of the **renin-angiotensin-aldosterone system (RAAS)** due to renal ischemia caused by cyst enlargement [1].

Q: In a couple, which of the following investigations are included in the initial work-up for infertility?

Semen analysis, Tubal patency test, Ovulation test. ***Semen analysis, Tubal patency test, Ovulation test*** - This option correctly identifies the **key initial investigations** for both male and female factors in infertility: **semen analysis** for male fertility, **tubal patency test** for assessing fallopian tube function, and **ovulation test** to confirm female ovulatory cycles. - These tests are fundamental in a comprehensive initial infertility work-up as they address the most common causes of infertility. *Testicular biopsy, USG, Sperm penetration test* - While **testicular biopsy** and **sperm penetration test** are relevant, they are typically **second-line investigations** performed if initial tests (like semen analysis) are abnormal. - **Ultrasound (USG)** is a general imaging modality and not a primary, specific infertility test for both partners as listed. *Ovulation, tubal patency, Mantoux test* - **Ovulation** and **tubal patency** are essential, but the **Mantoux test** (for tuberculosis) is generally not part of the *initial routine* infertility work-up unless there is clinical suspicion or prevalence in the region. - The Mantoux test is specific for a particular infection, and not a broad screening test for infertility. *Semen analysis, CXR, Mantoux* - **Semen analysis** is appropriate, but a **Chest X-ray (CXR)** and **Mantoux test** are not routine initial investigations for infertility. - These tests would only be indicated if there were specific clinical signs or a history suggestive of underlying pulmonary or infectious disease.

Q: Optic disc changes of retinitis pigmentosa:

Consecutive optic atrophy. **Consecutive optic atrophy** - In **retinitis pigmentosa**, the progressive degeneration of photoreceptors and retinal pigment epithelium leads to secondary or **consecutive optic atrophy**. - This atrophy is characterized by a **pale, waxy optic disc** due to loss of retinal ganglion cell axons and glia. *Hyperemia of disc* - **Hyperemia of the optic disc** indicates **inflammation** or **swelling** of the optic nerve head, such as in optic neuritis or papilledema. - This is not a typical feature of retinitis pigmentosa, which involves retinal degeneration, not acute inflammation of the optic nerve. *No significant change* - As **retinitis pigmentosa** progresses, significant changes occur in the retina and optic nerve, including **pigmentary deposits**, **vascular attenuation**, and **optic disc pallor**. - Therefore, stating no significant change would be incorrect as the disease significantly alters the fundus appearance. *Blurring of disc margins* - **Blurring of the optic disc margins** is a hallmark sign of **papilledema** (swelling due to increased intracranial pressure) or an acutely inflamed optic nerve head. - This is distinct from the **optic atrophy** seen in retinitis pigmentosa, which typically involves clear but pale disc margins.

Q: In fracture of upper 1/3 of forearm, it is immobilized in:

Supination. ***Supination*** - In a fracture of the **proximal third of the forearm**, the **biceps brachii** and **supinator muscles**, which are still attached to the proximal fragment, will cause it to **supinate**. - To align the distal fragment with the proximal fragment and ensure proper healing, the forearm must be immobilized in **full supination**. *Pronation* - **Pronation** would cause malalignment of the fracture fragments, as the proximal fragment would remain supinated while the distal fragment is pronated. - This position is only used for fractures of the **distal third of the forearm** where the **pronator quadratus** and **pronator teres** dominate. *Any position* - Immobilizing in **any position** would risk **malunion** or nonunion due to the unopposed muscle forces acting on the proximal and distal fragments. - Correct anatomical alignment is crucial for restoring function and preventing long-term complications. *Mid prone* - The **mid-prone** position is typically used for fractures of the **middle third of the forearm**, where the pronator and supinator muscle forces are more balanced. - In a proximal third fracture, the stronger supinator muscles would still pull the proximal fragment into supination, causing misalignment in the mid-prone position.

Q: Which of the following is true about Anaplasia?

Loss of differentiation. ***Loss of differentiation*** - **Anaplasia** is defined as the loss of structural and functional differentiation in cells, indicating a reversal to a more primitive state [1]. - It is a hallmark feature of **malignancy** and is associated with increased proliferative capacity and aggressiveness of tumors [1]. *Benign and fully reversible* - **Anaplasia** is a characteristic of **malignant tumors** and is generally not reversible without treatment [1]. - Benign cellular changes are typically reversible and maintain their differentiation features [1]. *Loss of cohesion between cells* - While loss of cohesion can occur in some aggressive tumors, it is more specifically related to changes in cell adhesion molecules and is not the primary definition of **anaplasia**. - **Anaplasia** refers to the loss of differentiation, not solely the physical separation of cells [1]. *Change of epithelium type* - This description refers to **metaplasia**, which is the reversible change of one differentiated cell type to another differentiated cell type [1]. - **Anaplasia** involves a loss of differentiation, not merely a change to a different, still differentiated, cell type [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 276-280.

Q: Most common cause of cholestatic jaundice in newborn is

Biliary atresia. ***Biliary atresia*** - This is the **most common cause of cholestatic jaundice** requiring surgical intervention in otherwise healthy full-term newborns. - It involves the **progressive obliteration or absence of extrahepatic bile ducts**, leading to bile flow obstruction, conjugated hyperbilirubinemia, and ultimately liver damage if untreated. - Incidence is approximately **1 in 10,000-15,000 live births**, and early diagnosis (before 60 days of age) is critical for optimal surgical outcomes with Kasai portoenterostomy. *Neonatal hepatitis* - While it can cause **cholestatic jaundice** in newborns, biliary atresia remains the leading **surgical cause** requiring urgent intervention. - It describes a diverse group of conditions leading to inflammation of the liver, which can be **idiopathic** or caused by infections (TORCH), metabolic disorders, or genetic conditions. - Unlike biliary atresia, neonatal hepatitis may improve with supportive care and treatment of underlying causes. *Physiological* - **Physiological jaundice** is characterized by **unconjugated hyperbilirubinemia** and is typically transient, resolving without intervention. - It does not cause cholestatic jaundice, which involves **conjugated hyperbilirubinemia** and indicates an underlying pathological process. *Choledochal cyst* - A **choledochal cyst** is a congenital dilation of the bile ducts and can cause cholestatic jaundice, but it is a **rarer cause** compared to biliary atresia. - Symptoms often include an **abdominal mass**, pain, and recurrent cholangitis, which may differ from the typical presentation of early biliary atresia.

Q: In the management of diabetes mellitus, lactic acidosis is caused by which of the following?

Metformin. ***Metformin*** - Metformin can cause **lactic acidosis**, especially in patients with **renal impairment**, as it inhibits hepatic gluconeogenesis and lactate clearance [1]. - The risk is increased in conditions leading to **tissue hypoperfusion** or **hypoxemia**, where lactate production is elevated. *Pioglitazone* - **Pioglitazone** is a thiazolidinedione that improves insulin sensitivity but is not associated with lactic acidosis [1]. - Its main risks include **fluid retention**, **heart failure**, and increased risk of **bladder cancer**. *Glipizide* - **Glipizide** is a sulfonylurea that stimulates insulin secretion from beta cells but does not cause lactic acidosis [2]. - The primary adverse effect is **hypoglycemia** [2]. *Tolbutamide* - **Tolbutamide** is an older generation sulfonylurea, similar to glipizide, and also acts by stimulating insulin release [2]. - Its main risk is **hypoglycemia**, and it is not associated with lactic acidosis [2].

Q: Prophylactic dose of Oseltamivir for infants (3-11 months) is?

3 mg/kg/day. ***3 mg/kg/day*** - The recommended **prophylactic dose of oseltamivir** for infants aged 3 to 11 months is **3 mg/kg once daily** for 10 days. - This dosage is essential for preventing **influenza** in this vulnerable age group when exposure is known or highly suspected. *5 mg/kg/day* - A dose of **5 mg/kg** is generally used for **treatment** of influenza in infants and children, not for prophylaxis. - This higher dose is administered twice daily for 5 days when a child is already symptomatic. *1 mg/kg/day* - This dosage is **too low** for either prophylactic or treatment use in infants and would likely be ineffective against influenza. - Sub-optimal dosing can lead to **treatment failure** and a higher risk of complications. *7 mg/kg/day* - This dosage is **higher than recommended** for prophylaxis and could potentially lead to increased adverse effects without offering additional benefit. - Higher doses are usually reserved for **severely immunocompromised** patients or specific treatment regimens, not standard prophylaxis.

Q: What is the best stimulus for release of vasopressin?

Hyperosmolality of extracellular fluid. ***Hyperosmolality of extracellular fluid*** - **Hyperosmolality** is sensed by **osmoreceptors** in the hypothalamus, which then stimulate the release of vasopressin (ADH). - This response is crucial for **water conservation** to dilute the extracellular fluid and restore normal osmolality. *Hypotension* - While hypotension does stimulate vasopressin release, its effect is less potent than that of hyperosmolality in terms of triggering release. - Baroreceptors sense a decrease in blood pressure, leading to an increase in **ADH** to help maintain blood volume and pressure. *Hypertension* - **Hypertension** would typically inhibit vasopressin release, as the body would attempt to excrete more water to lower blood volume and pressure. - Increased blood pressure signals stretch receptors, leading to a decrease in **ADH** secretion. *Decreased plasma volume* - A decrease in **plasma volume** (hypovolemia) also stimulates ADH release, but this is often accompanied by changes in osmolality. - The primary stimulus for ADH is usually the resulting **increase in plasma osmolality** due to water loss, or significant drops in blood pressure detected by baroreceptors.

Question 1

Steps of PCR in sequence are?

Accepted Answer

Denature DNA, Anneal Primers, Extend DNA

Answer

Denature DNA, Extend DNA, Anneal Primers

Answer

Anneal Primers, Extend DNA, Denature DNA

Answer

Extend DNA, Anneal Primers, Denature DNA

Question 2

All the following are feature of polycystic disease of kidneys except:-

Accepted Answer

Erythrocytosis

Answer

Renal failure

Answer

Hematuria

Answer

Hypertension

Question 3

In a couple, which of the following investigations are included in the initial work-up for infertility?

Accepted Answer

Semen analysis, Tubal patency test, Ovulation test

Answer

Testicular biopsy, USG, Sperm penetration test

Answer

Ovulation, tubal patency, Mantoux test

Answer

Semen analysis, CXR, Mantoux

Question 4

Optic disc changes of retinitis pigmentosa:

Accepted Answer

Consecutive optic atrophy

Answer

Hyperemia of disc

Answer

No significant change

Answer

Blurring of disc margins

Question 5

In fracture of upper 1/3 of forearm, it is immobilized in:

Accepted Answer

Supination

Answer

Pronation

Answer

Any position

Answer

Mid prone

Question 6

Which of the following is true about Anaplasia?

Accepted Answer

Loss of differentiation

Answer

Benign and fully reversible

Answer

Loss of cohesion between cells

Answer

Change of epithelium type

Question 7

Most common cause of cholestatic jaundice in newborn is

Accepted Answer

Biliary atresia

Answer

Neonatal hepatitis

Answer

Physiological

Answer

Choledochal cyst

Question 8

In the management of diabetes mellitus, lactic acidosis is caused by which of the following?

Accepted Answer

Metformin

Answer

Pioglitazone

Answer

Glipizide

Answer

Tolbutamide

Question 9

Prophylactic dose of Oseltamivir for infants (3-11 months) is?

Accepted Answer

3 mg/kg/day

Answer

5 mg/kg/day

Answer

1 mg/kg/day

Answer

7 mg/kg/day

Question 10

What is the best stimulus for release of vasopressin?

Accepted Answer

Hyperosmolality of extracellular fluid

Answer

Hypotension

Answer

Hypertension

Answer

Decreased plasma volume

FMGE 2018

Biochemistry

Internal Medicine

Obstetrics and Gynecology

Ophthalmology

Orthopaedics

Pathology

Pediatrics

Pharmacology

Physiology