FMGE 2018 Practice Questions

Q: Energy reserve of the body is:

Triglyceride. ***Triglyceride*** - **Triglycerides** are the primary form of **energy storage** in the body, stored predominantly in **adipose tissue**. - They provide a highly concentrated and long-term energy reserve, crucial for periods of fasting or increased energy demand. *Fibres* - **Dietary fibers** are indigestible plant-derived carbohydrates that contribute to digestive health but do not serve as a direct energy reserve for the body. - They are important for maintaining gut motility and regulating blood sugar, but are not metabolized for energy. *Carbohydrate* - **Carbohydrates** (primarily **glycogen**) serve as the **body's most immediate energy source**, stored in the liver and muscles. - However, glycogen stores are limited and are depleted much faster than triglyceride stores during prolonged energy needs. *Proteins* - **Proteins** have numerous structural and functional roles in the body, but are typically used for energy only in cases of **prolonged starvation** when carbohydrate and fat reserves are severely depleted. - Their primary function is not energy storage, and their breakdown for energy can lead to **muscle wasting** and compromise essential body functions.

Q: Ujjawala scheme is for prevention of

Child trafficking. **Child trafficking** - The **Ujjawala scheme** is a comprehensive project of the Ministry of Women and Child Development, Government of India, aimed at **preventing, rescuing, rehabilitating, reintegrating, and repatriating victims of human trafficking**, particularly women and children. - It addresses the severe human rights violation of **trafficking** by providing safe shelter, basic necessities, counseling, and vocational training to survivors. *Child marriage* - While child marriage is a serious issue, the primary focus of the **Ujjawala scheme** is on **combating human trafficking**, not specifically child marriage. - Other schemes like the **Prohibition of Child Marriage Act, 2006**, and various advocacy programs specifically target the prevention of child marriage. *Child abuse* - The **Ujjawala scheme** aims to help victims of trafficking, which often includes elements of abuse, but its direct mandate is focused on **trafficking as a whole**, not all forms of child abuse. - Other legislative frameworks and programs, such as the **Protection of Children from Sexual Offences (POCSO) Act, 2012**, directly address child abuse. *Child labour* - Although children involved in trafficking may be forced into child labor, the **Ujjawala scheme's** overarching objective is to tackle **human trafficking** in its entirety. - Specific efforts to combat child labor are primarily addressed by legislation like the **Child Labour (Prohibition and Regulation) Act, 1986**, and various campaigns against child exploitation.

Q: Mainstay of treatment of glue ear -

Myringotomy + aeration to middle ear. ***Myringotomy + aeration to middle ear*** - **Myringotomy** involves creating a small incision in the eardrum to drain fluid, and inserting a **grommet (ventilation tube)** to aerate the middle ear, which is the primary treatment for persistent glue ear (otitis media with effusion). - This procedure aims to restore ventilation to the middle ear, allowing trapped fluid to drain and preventing recurrent fluid accumulation, which improves hearing. *Temporal bone resection* - This is a major surgical procedure involving the removal of part of the temporal bone, typically reserved for extensive **malignant tumors** or severe infections, and is not indicated for glue ear. - It carries significant risks and is disproportionate to the treatment of a benign condition like glue ear. *Tonsillectomy & adenoidectomy* - While **adenoidectomy** can sometimes be performed in conjunction with grommet insertion if enlarged adenoids contribute to eustachian tube dysfunction, it is not the **primary treatment** for glue ear itself. - **Tonsillectomy** is generally performed for recurrent tonsillitis and has no direct role in treating glue ear. *Radical Mastoidectomy* - This is a highly invasive surgical procedure involving the removal of the mastoid air cells and part of the external auditory canal, typically performed for severe **cholesteatoma** or chronic mastoiditis. - It is an extensive and risky operation that is not appropriate for the management of glue ear, which is a much milder condition.

Q: 'Cafeteria approach' is related with:

Contraception. ***Contraception*** - The **cafeteria approach** in contraception refers to offering a wide variety of **contraceptive methods** to individuals, allowing them to choose the option that best suits their needs, preferences, and circumstances. - This approach promotes **informed choice** and adherence by recognizing that no single contraceptive method is ideal for everyone. *Diet program* - While diet programs involve choices, the term **cafeteria approach** is not specifically or exclusively associated with the methodology of diet selection. - Diet programs typically focus on dietary guidelines or meal plans rather than a broad offering of methods. *National vector borne disease control programme* - This program focuses on managing and preventing **vector-borne diseases** through public health interventions, which does not involve individual "choices" in a cafeteria-style manner. - Its strategies include surveillance, vector control, and case management, without a direct "cafeteria approach" element. *Child and maternal health* - This broad field encompasses various health interventions, but the **cafeteria approach** is not a specific methodology used to describe comprehensive child and maternal health services. - While choices are involved in healthcare, this term is not standard in this context.

Q: Which of the following is true about pterygium?

Conjunctival invasion making a flap over cornea. ***Conjunctival invasion making a flap over cornea*** - A **pterygium** is characterized by the growth of **fibrovascular tissue** from the conjunctiva onto the cornea. - This growth typically forms a **triangular flap**, with its apex extending towards the center of the corneal surface. *Fatty deposition of sclera* - This description is more indicative of **pinguecula**, which is a **yellowish, fatty deposit** on the conjunctiva, usually on the nasal side, but it does not invade the cornea. - Unlike pterygium, a **pinguecula** remains confined to the conjunctiva and does not grow across the limbus onto the cornea. *Inflammation of cornea* - While a pterygium can sometimes cause irritation or inflammation, its primary characteristic is a **degenerative growth of tissue**, not primarily an inflammatory condition of the cornea itself. - **Keratitis** refers to inflammation of the cornea, which can have various causes, but it is not the defining feature of pterygium. *Dead epithelial debris accumulation* - The accumulation of dead epithelial debris is not the principal histological feature of a pterygium. - Pterygium involves **hyperplasia of conjunctival epithelium** and **subepithelial fibrovascular tissue growth**, not merely dead cell accumulation.

Q: Blow out fracture can be due to:

Tennis ball injury. ***Tennis ball injury*** - A tennis ball injury to the orbit can cause a **blowout fracture** due to either direct impact compressing the globe or hydraulic pressure from the ball transmission of force, leading to a fracture of the orbital floor or medial wall. - The impact forces the orbital contents posteriorly, increasing intraorbital pressure which in turn causes the weakest bony walls (usually the floor or medial wall) to fracture outwards into the maxillary or ethmoid sinuses, respectively. *Punch at the chin from below* - A punch to the chin from below typically results in fractures of the **mandible**, particularly the condyles or angle. - This mechanism does not directly transmit force to the orbital rim or globe in a way that would cause a classic blowout fracture. *Sudden fall* - A sudden fall can cause various types of fractures depending on the impact site, but it is not a specific or common mechanism for a **blowout fracture**. - Falls usually lead to fractures of the extremities, hips, or skull other than the orbit, depending on how the body impacts the ground. *Chisel and hammer injury* - A chisel and hammer injury would more likely cause a **localized, penetrating injury** or a focal fracture at the point of impact on the face or skull. - This type of injury does not typically generate the diffuse hydraulic pressure within the orbit needed to cause a **blowout fracture** of the orbital floor or medial wall.

Q: Which nerve is commonly damaged in fracture of neck of fibula?

Common peroneal. ***Common peroneal*** - The **common peroneal nerve** (also known as the **common fibular nerve**) wraps superficially around the **neck of the fibula**, making it highly vulnerable to injury in fractures of this region. - Damage to this nerve typically results in **foot drop** and sensory loss over the dorsum of the foot and lateral leg, due to impaired dorsiflexion and eversion. *Tibial* - The **tibial nerve** lies in the posterior compartment of the leg and is generally well-protected, making it less susceptible to injury from a fibular neck fracture. - Injury to the tibial nerve would primarily affect plantarflexion of the foot and sensation to the sole. *Superficial peroneal* - The **superficial peroneal nerve** is a branch of the common peroneal nerve that descends along the lateral compartment of the leg. - While it originates from the common peroneal, a direct fracture of the fibular neck is more likely to injure the main common peroneal trunk rather than just this specific branch, leading to a broader deficit. *Deep peroneal* - The **deep peroneal nerve** is another branch of the common peroneal nerve that runs through the anterior compartment of the leg. - Similar to the superficial peroneal nerve, a fracture at the fibular neck is more likely to affect the main **common peroneal nerve** directly.

Q: Heart failure cells are:-

Pigmented alveolar macrophages. ***Pigmented alveolar macrophages*** - **Heart failure cells** are **alveolar macrophages** that have phagocytosed **hemosiderin** [1], which is derived from extravasated red blood cells. - This occurs in conditions causing **pulmonary congestion** and **hemorrhage**, most notably in chronic left-sided heart failure [2]. *Lipofuscin granules in cardiac cells* - **Lipofuscin** is a "wear-and-tear" pigment that accumulates in various aging cells, including **cardiac myocytes** [3]. - While present in heart cells, **lipofuscin granules** do not represent the classic "heart failure cells" which are found in the lung [3]. *Pigmented cells in pancreas* - **Pigmented cells in the pancreas** are not a recognized pathological entity described as "heart failure cells." - This option is medically irrelevant in the context of heart failure pathophysiology. *Pigmented hepatocytes* - **Pigmented hepatocytes** can be seen in various conditions, such as **hemochromatosis** (iron overload) or certain drug-induced liver injuries. - However, they are not referred to as "heart failure cells," which specifically refers to hemosiderin-laden macrophages in the lungs. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 75-76. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 536-537. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, p. 75.

Q: What is needed for prothrombin to thrombin conversion?

Calcium. ***Calcium*** - **Calcium ions (Ca2+)** are absolutely essential cofactors for the conversion of **prothrombin to thrombin** in the coagulation cascade. - They are required for the formation and function of the **prothrombinase complex** (Factor Xa + Factor Va + Ca2+ + phospholipid surface). - Calcium binds to **γ-carboxyglutamic acid (Gla) residues** on prothrombin and Factor Xa, enabling them to anchor to phospholipid surfaces where the conversion occurs. - This is why **EDTA and citrate** (calcium chelators) are used as anticoagulants in blood collection tubes. *Magnesium* - **Magnesium** is an important cofactor for numerous enzymatic reactions (e.g., ATP-dependent enzymes, DNA/RNA polymerases). - However, it is **not directly involved** in the prothrombin to thrombin conversion step of the coagulation cascade. - Its primary roles are in DNA synthesis, muscle function, and nerve transmission. *Sodium* - **Sodium** is vital for maintaining fluid balance, osmotic pressure, nerve impulses, and muscle contractions. - It does **not play a direct role** as a cofactor in the prothrombinase complex or prothrombin to thrombin conversion. *Potassium* - **Potassium** is essential for maintaining cell membrane potential, nerve impulses, cardiac function, and muscle contraction. - It is **not a cofactor** for the enzymatic reactions involved in the coagulation cascade.

Q: Which is NOT a feature of pleural effusion?

Muffled heart sound. ***Muffled heart sound*** - This is **NOT a feature of pleural effusion** and is the correct answer to this negation question. - Muffled heart sounds are characteristic of **pericardial effusion** or **cardiac tamponade**, where fluid accumulates in the pericardial sac around the heart itself. - Pleural effusion involves fluid in the pleural space surrounding the lungs, not the heart. - While massive pleural effusions can displace mediastinal structures, they do not typically cause muffled heart sounds. *Horizontal fluid level* - This **IS a feature** when air is also present in the pleural space (**hydropneumothorax**). - In **simple pleural effusion** (fluid only), the fluid typically forms a **meniscus-shaped curve** with blunting of the costophrenic angles on upright chest X-ray, not a horizontal level. - However, when both air and fluid are present, a distinct horizontal air-fluid level is visible on upright imaging. - Since the question asks about pleural effusion broadly, and effusions can be associated with air (empyema with gas-forming organisms, post-thoracentesis), this can be considered a radiological feature in certain contexts. *Low lung volume* - This **IS a feature** of pleural effusion. - The accumulating pleural fluid causes **compression atelectasis** of the adjacent lung parenchyma. - This results in **reduced functional lung volume** on the affected side, visible on chest imaging. *Decreased chest movements* - This **IS a feature** of pleural effusion. - Fluid in the pleural space restricts normal lung expansion and chest wall movement. - On physical examination, there are **diminished respiratory excursions** on the affected side. - This is one of the classic clinical signs of pleural effusion.

Question 1

Energy reserve of the body is:

Accepted Answer

Triglyceride

Answer

Fibres

Answer

Carbohydrate

Answer

Proteins

Question 2

Ujjawala scheme is for prevention of

Accepted Answer

Child trafficking

Answer

Child marriage

Answer

Child abuse

Answer

Child labour

Question 3

Mainstay of treatment of glue ear -

Accepted Answer

Myringotomy + aeration to middle ear

Answer

Temporal bone resection

Answer

Tonsillectomy & adenoidectomy

Answer

Radical Mastoidectomy

Question 4

'Cafeteria approach' is related with:

Accepted Answer

Contraception

Answer

Diet program

Answer

National vector borne disease control programme

Answer

Child and maternal health

Question 5

Which of the following is true about pterygium?

Accepted Answer

Conjunctival invasion making a flap over cornea

Answer

Fatty deposition of sclera

Answer

Inflammation of cornea

Answer

Dead epithelial debris accumulation

Question 6

Blow out fracture can be due to:

Accepted Answer

Tennis ball injury

Answer

Punch at the chin from below

Answer

Sudden fall

Answer

Chisel and hammer injury

Question 7

Which nerve is commonly damaged in fracture of neck of fibula?

Accepted Answer

Common peroneal

Answer

Tibial

Answer

Superficial peroneal

Answer

Deep peroneal

Question 8

Heart failure cells are:-

Accepted Answer

Pigmented alveolar macrophages

Answer

Lipofuscin granules in cardiac cells

Answer

Pigmented cells in pancreas

Answer

Pigmented hepatocytes

Question 9

What is needed for prothrombin to thrombin conversion?

Accepted Answer

Calcium

Answer

Magnesium

Answer

Sodium

Answer

Potassium

Question 10

Which is NOT a feature of pleural effusion?

Accepted Answer

Muffled heart sound

Answer

Horizontal fluid level

Answer

Low lung volume

Answer

Decreased chest movements

FMGE 2018

Biochemistry

Community Medicine

ENT

Obstetrics and Gynecology

Ophthalmology

Orthopaedics

Pathology

Physiology

Radiology