FMGE 2018 Practice Questions

Q: Which of the following drugs is used for hypotensive anesthesia:

Both Isoflurane and Nitroglycerin. ***Both Isoflurane and Nitroglycerin*** - **Isoflurane** is a volatile anesthetic that can induce **hypotension** by decreasing systemic vascular resistance and myocardial contractility. - **Nitroglycerin** is a potent vasodilator that primarily acts on veins, but also on arteries, to reduce preload and afterload, thereby lowering blood pressure. *Isoflurane* - While **Isoflurane** can be used as part of a hypotensive anesthesia strategy, it is not the sole drug capable of achieving this effect. - Its hypotensive action is dose-dependent and results from **vasodilation** and direct **myocardial depression**. *Nitroglycerin* - **Nitroglycerin** is effective in inducing controlled **hypotension** due to its rapid onset and short duration of action as a vasodilator. - It is frequently used in anesthesia for its ability to reduce blood pressure, particularly in situations requiring a **dry surgical field**. *Dantrolene* - **Dantrolene** is a skeletal muscle relaxant primarily used to treat and prevent **malignant hyperthermia**. - It does not directly induce **hypotension** and is not indicated for hypotensive anesthesia.

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: Recommended daily dose of Iodine in a school-age child is:-

90-120 ug. ***90-120 ug*** - The recommended daily intake of iodine for **school-age children (6-12 years)** is 90-120 micrograms (µg), which supports normal growth and thyroid function. - According to **WHO/UNICEF/ICCIDD recommendations**, children in this age group require 120 µg/day for optimal thyroid hormone synthesis. - Adequate iodine intake is crucial for the production of **thyroid hormones**, which regulate metabolism and brain development. *120-200 ug* - This range is higher than recommended for school-age children. - **Adolescents (≥12 years) and adults** require 150 µg/day, and **pregnant/lactating women** require 250 µg/day. *30-60 ug* - This range is **insufficient for children** and well below WHO recommendations. - Even **infants and young children (0-5 years)** require 90 µg/day, making this range inadequate for any pediatric age group. - Such low intake could lead to **iodine deficiency** and impaired thyroid function. *500 ug* - This amount is significantly higher than the recommended daily intake for children and could cause **iodine excess** or toxicity. - High doses of iodine can paradoxically inhibit thyroid function and lead to conditions like **iodine-induced hyperthyroidism** or hypothyroidism. - The **tolerable upper intake level** for children is much lower than this amount.

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: Herbert's pits are seen in:

Chlamydial conjunctivitis. ***Chlamydial conjunctivitis*** - **Herbert's pits** are pathognomonic for **trachoma**, a chronic form of chlamydial conjunctivitis caused by *Chlamydia trachomatis* serovars A-C. - They represent healed **follicles** on the superior tarsal conjunctiva, leading to characteristic stellate or linear scarring. *Gonococcal conjunctivitis* - This is an **acute, severe bacterial infection** that typically causes copious purulent discharge and significant edema. - It does not lead to the formation of Herbert's pits, which are sequelae of chronic follicular inflammation. *Vernal conjunctivitis* - A form of chronic allergic conjunctivitis, characterized by **"cobblestone papillae"** on the upper tarsal conjunctiva and **Horner-Trantas dots** at the limbus. - It is not associated with Herbert's pits; its pathophysiology involves mast cell degranulation and allergic inflammation. *Atopic conjunctivitis* - This is often seen in individuals with **atopic dermatitis, asthma, or allergic rhinitis**, presenting with itching, redness, tearing, and sometimes corneal complications. - It does not manifest with follicles or subsequent scarring like Herbert's pits, which are specific to trachoma.

Q: Rosette cataract is seen after:

Blunt trauma to eye. ***Blunt trauma to eye*** - **Rosette cataract** is a classic finding following **blunt ocular trauma**, often due to the concussive force on the lens. - The characteristic **flower-petal or star-shaped opacity** forms in the anterior and/or posterior subcapsular regions of the lens. *Infection* - Ocular infections can lead to various complications like **uveitis** or **endophthalmitis**, but **rosette cataract** is not a typical direct sequela. - While inflammation can cause cataracts, they usually present as **inflammatory cataracts** rather than the specific rosette pattern. *Penetrating injury to eye* - **Penetrating injuries** to the eye often lead to **traumatic cataracts** due to direct lens capsule rupture. - These cataracts are typically focal and can progress rapidly, but the morphology is not usually described as a **rosette pattern** unless secondary to significant blunt force component. *Copper foreign body in eye* - A **copper foreign body** in the eye can cause **chalcosis oculi**, leading to a characteristic greenish-brown discoloration and a **sunflower cataract**. - This type of cataract has a distinct appearance from a **rosette cataract**, with a diffuse radial pattern rather than a focal star shape.

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: 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: A 6-year-old child is brought with high fever with rigors for 5 days with pain in right hypochondrium. On examination, the patient is anicteric and tenderness is noted in right upper quadrant. What is the best investigation for this case?

USG. ***USG*** - A **ultrasound** is the preferred initial investigation, especially in children, for evaluating abdominal pain in the **right hypochondrium** with fever. - It can effectively identify common causes like **cholecystitis**, **hepatitis**, or **liver abscess**, which fit the clinical presentation. *SGOT/LFT* - **Liver function tests (LFTs)** like SGOT/AST and SGPT/ALT provide information about liver inflammation or damage but do not help localize the pathology. - They are useful for assessing liver function but are not the primary diagnostic tool to identify the cause of the pain or fever. *CECT* - **Contrast-enhanced computed tomography (CECT)** is a more advanced imaging technique, often used after initial screening or when ultrasound findings are inconclusive. - It involves radiation exposure and contrast risks, making it less suitable as a first-line investigation for a child with these symptoms. *Serology* - **Serological tests** detect antibodies or antigens related to specific infections (e.g., viral hepatitis) but do not provide immediate anatomical information. - While they can confirm an infectious cause, they cannot identify the source of the pain or rule out other non-infectious pathologies immediately.

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.

Question 1

Which of the following drugs is used for hypotensive anesthesia:

Accepted Answer

Both Isoflurane and Nitroglycerin

Answer

Isoflurane

Answer

Nitroglycerin

Answer

Dantrolene

Question 2

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 3

Recommended daily dose of Iodine in a school-age child is:-

Accepted Answer

90-120 ug

Answer

120-200 ug

Answer

30-60 ug

Answer

500 ug

Question 4

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 5

Herbert's pits are seen in:

Accepted Answer

Chlamydial conjunctivitis

Answer

Gonococcal conjunctivitis

Answer

Vernal conjunctivitis

Answer

Atopic conjunctivitis

Question 6

Rosette cataract is seen after:

Accepted Answer

Blunt trauma to eye

Answer

Infection

Answer

Penetrating injury to eye

Answer

Copper foreign body in eye

Question 7

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

Accepted Answer

Supination

Answer

Pronation

Answer

Any position

Answer

Mid prone

Question 8

Most common cause of cholestatic jaundice in newborn is

Accepted Answer

Biliary atresia

Answer

Neonatal hepatitis

Answer

Physiological

Answer

Choledochal cyst

Question 9

A 6-year-old child is brought with high fever with rigors for 5 days with pain in right hypochondrium. On examination, the patient is anicteric and tenderness is noted in right upper quadrant. What is the best investigation for this case?

Accepted Answer

USG

Answer

SGOT/LFT

Answer

CECT

Answer

Serology

Question 10

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

FMGE 2018

Anesthesiology

Biochemistry

Community Medicine

Obstetrics and Gynecology

Ophthalmology

Orthopaedics

Pediatrics

Pharmacology