FMGE 2018 Practice Questions

Q: Cold water is not used for ear cleaning because

Caloric stimulation caused by cold water. ***Caloric stimulation caused by cold water*** - Irrigating the ear canal with **cold water** causes significant **caloric stimulation** of the vestibular system. - This can induce **vertigo**, **nausea**, and **vomiting** due to the temperature difference stimulating the semicircular canals. *Damage to tympanic membrane* - While excessive pressure from irrigation can potentially damage the **tympanic membrane**, the temperature of the water itself is not the primary factor for this risk. - Damage is more related to the **force of irrigation** and pre-existing membrane integrity, not cold temperature. *It will cause infection* - The temperature of the water used for irrigation does not directly determine the risk of infection. - **Infection risk** is primarily associated with using unsterile water or introducing bacteria into a compromised ear canal, regardless of water temperature. *It will make the wax hard* - Earwax, or **cerumen**, is softened by water irrigation, not hardened. - **Warm water** is typically preferred because it aids in softening the wax more effectively and comfortably than cold water.

Q: Most common cause of sensorineural hearing loss (SNHL)

Presbycusis. ***Presbycusis*** - **Presbycusis**, or age-related hearing loss, is the most common cause of **sensorineural hearing loss (SNHL)**, affecting a significant portion of the elderly population. - It typically results from **degenerative changes** in the inner ear, specifically the hair cells and nerve fibers, leading to a gradual, symmetrical, high-frequency SNHL. *Labyrinthitis* - **Labyrinthitis** is an inflammation of the inner ear that can cause sudden SNHL, often accompanied by **vertigo** and **tinnitus**. - While it causes SNHL, it is an acute condition and not the most common overall cause, especially when considering the prevalence of age-related hearing loss. *Meniere's disease* - **Meniere's disease** is characterized by recurrent episodes of **vertigo, fluctuating low-frequency SNHL, tinnitus**, and aural fullness. - It is a specific condition causing SNHL, but its prevalence is much lower than presbycusis, making it a less common overall cause. *Vestibular Schwannoma* - A **vestibular schwannoma** (acoustic neuroma) is a benign tumor that arises from the Schwann cells of the **vestibulocochlear nerve**. - It can cause **progressive unilateral SNHL**, tinnitus, and balance issues, but it is a relatively rare condition compared to presbycusis.

Q: Mark the false statement regarding testing of COVID-19.

First line screening assay: N gene assay.. ***First line screening assay: N gene assay.*** * While the **nucleocapsid (N) gene** is a common target for COVID-19 PCR assays, the statement that it is the *first-line screening assay* is often a simplification or outdated, as many assays target multiple genes (e.g., N, E, RdRp) for increased sensitivity and specificity from the outset. * Different health organizations and diagnostic kits have varied recommendations for initial screening targets, but there isn't a universal consensus that the N gene alone is the specific 'first-line screening assay' in all contexts when considering the breadth of available PCR tests. *Confirmatory assay: RdRp gene assay.* * The **RdRp (RNA-dependent RNA polymerase) gene** is a highly specific and conserved target for SARS-CoV-2 detection and is often used in **confirmatory PCR assays**. * Detection of the RdRp gene, sometimes alongside other targets like the E (envelope) gene, helps in confirming the presence of the virus. *Peripheral ground glass opacities on CT is the hallmark feature.* * **Peripheral ground glass opacities (GGOs)** are indeed a **hallmark radiological finding** in COVID-19 pneumonia, seen on CT scans. * These opacities reflect alveolar inflammation and fluid accumulation, especially in the early and moderate stages of the disease. *Most predominant method of diagnosis of COVID-19 is PCR.* * **Reverse transcription-polymerase chain reaction (RT-PCR)** remains the **gold standard and most predominant method** for diagnosing active COVID-19 infection. * PCR tests directly detect viral genetic material, offering high sensitivity and specificity in symptomatic and asymptomatic individuals.

Q: Which of these types of fibroid may be removed at the time of a cesarean section?

Pedunculated fibroid. ***Pedunculated fibroid*** - **Pedunculated subserosal fibroids** are the safest type to remove during cesarean section, particularly those on a **narrow stalk** - They can be easily accessed through the abdominal incision without disrupting the uterine wall integrity - The stalk can be **clamped, ligated, and divided** with minimal risk of hemorrhage if proper hemostatic technique is used - Removal does not compromise the **hysterotomy closure** or future uterine integrity - This is the **only type of fibroid** routinely considered safe for removal during C-section if clinically indicated *Intramural fibroid* - **Intramural fibroids** are embedded within the myometrial wall and their removal is **generally contraindicated** during cesarean section - Myomectomy during C-section carries significant risk of **severe hemorrhage** from the highly vascular pregnant uterus - Removal can compromise **uterine wall integrity** and interfere with proper hysterotomy closure - May increase risk of **uterine rupture** in subsequent pregnancies - Standard obstetric practice is to **avoid myomectomy at cesarean** unless the fibroid is directly obstructing delivery *Broad ligament fibroid* - **Broad ligament fibroids** are located between the layers of the broad ligament, often in close proximity to the **ureter** and **uterine vessels** - Removal carries extremely high risk of **ureteral injury** and **massive hemorrhage** from pedicle vessels - Their excision is **absolutely contraindicated** during cesarean section *Cervical fibroid* - **Cervical fibroids** are located in the cervix with its **rich vascular supply** from cervical branches of uterine arteries - Removal during C-section risks **uncontrollable hemorrhage** and can cause **cervical incompetence** - Excision is **contraindicated** during cesarean section and should be managed separately if needed

Q: In dacryocystorhinostomy (DCR), Lacrimal sac opens into:

Middle meatus. ***Middle meatus*** - In **dacryocystorhinostomy (DCR)**, a new connection is created between the lacrimal sac and the **nasal cavity**, specifically directing tears into the middle meatus. - This surgical procedure aims to bypass an obstruction in the **nasolacrimal duct**, allowing tears to drain directly into the nasal passage through this newly formed opening. *Supreme meatus* - The supreme meatus is a **rare anatomical variation**, located superior to the superior meatus, and is not the standard site for lacrimal drainage. - Surgical intervention in DCR does not target this region for tear evacuation. *Inferior meatus* - The **nasolacrimal duct** normally drains into the inferior meatus, but DCR is performed when this duct is **obstructed**. - Connecting the lacrimal sac directly to the inferior meatus is not the typical surgical approach for DCR. *Superior meatus* - The superior meatus receives drainage from the **posterior ethmoid cells** and the **sphenoid sinus**. - It is not the anatomical location for the lacrimal drainage system, nor is it the target for DCR.

Q: Pharmacodynamics deals with:-

Mechanism of action of a drug. Detailed study of the **Mechanism of action of a drug** [1][2] - **Pharmacodynamics** describes what the **drug does to the body**, including its **molecular targets** and biochemical effects [3]. - This involves the study of the drug's mechanisms to produce its therapeutic or toxic effects [2]. *Latency of onset* - **Latency of onset** refers to the time it takes for a drug to start producing its effects, which is a pharmacokinetic rather than a pharmacodynamic parameter. - It deals with the drug's absorption and distribution rather than its interaction with the body once it reaches its site of action. *Transport of drug across the biological membranes* - The **transport of drugs across biological membranes** is a key aspect of **pharmacokinetics**, specifically absorption and distribution [1]. - This process determines how much drug reaches its target site, not how it interacts with the target. *Mode of excretion of a drug* - The **mode of excretion** of a drug (e.g., renal, hepatic) falls under **pharmacokinetics**, addressing how the body gets rid of the drug. - This process influences the drug's duration of action and elimination half-life, not its mechanism of action.

Q: Therapeutic index of a drug is an indicator of:-

Safety. ***Safety*** - The **therapeutic index (TI)** is a ratio comparing the **toxic dose (TD50)** to the **effective dose (ED50)**: TI = TD50/ED50. - It indicates the **margin of safety** of a drug—the wider the margin between therapeutic and toxic doses, the safer the drug. - A **high therapeutic index** means greater safety; a **low therapeutic index** means the drug has a narrow safety margin. *Potency* - **Potency** refers to the amount of drug needed to produce a given effect, represented by the **ED50**. - The therapeutic index is a **ratio**, not a measure of potency alone. - A highly potent drug can still have a narrow therapeutic index if its toxic dose is close to its effective dose. *Efficacy* - **Efficacy** describes the **maximum therapeutic effect** a drug can produce, irrespective of dose. - The therapeutic index does not quantify maximum effect but rather the **safety margin** within which therapeutic effects can be achieved. *All of these* - While potency and efficacy are important drug properties, the therapeutic index **specifically indicates safety**. - TI is not a composite measure of all drug properties—it is exclusively a safety parameter.

Q: Which of the following investigations work on the same principle?

CT and X-ray. ***CT and X-ray*** - Both **Computed Tomography (CT)** and **X-ray** imaging utilize **ionizing radiation** to generate images of the body's internal structures. - They work by passing X-ray beams through the patient, with different tissues absorbing the radiation to varying degrees, which is then detected to create an image. *MRI and PET Scan* - **Magnetic Resonance Imaging (MRI)** uses **strong magnetic fields and radio waves** to create detailed images of soft tissues, based on water content. - **Positron Emission Tomography (PET) scans** use **radioactive tracers** to visualize metabolic activity and blood flow, detecting gamma rays emitted from the patient. *CT and MRI* - **CT scans** use **ionizing radiation** (X-rays) to produce cross-sectional images. - **MRI scans** use **magnetic fields and radio waves** and do not involve ionizing radiation. *USG and HIDA Scan* - **Ultrasound (USG)** uses **high-frequency sound waves** to create real-time images of organs and structures. - **Hepatobiliary Iminodiacetic Acid (HIDA) scans** are a type of nuclear medicine study that uses a **radioactive tracer** to evaluate liver and gallbladder function.

Q: What is the most likely diagnosis for this 60-year-old man with the lesion shown in the image?

SCC of lip. ***SCC of lip*** - The image displays a **chronic, ulcerated, crusted lesion** on the **lower lip** of an older male, which is highly characteristic of **squamous cell carcinoma (SCC) of the lip**, particularly with a history of sun exposure. - SCC of the lip often affects the lower lip due to greater sun exposure and presents as a **non-healing ulcer** or **crusted lesion** that can be indurated at the base. *Plunging Ranula* - A plunging ranula is typically a **cystic lesion** appearing in the **neck** or **submandibular space**, originating from the **sublingual gland**. - It is a **mucous extravasation cyst** and does not present as an ulcerated, crusted lesion on the lip itself. *Basal cell carcinoma* - While **basal cell carcinoma (BCC)** can occur on the face, it is **rare on the lip mucosa** and typically presents as a **pearly nodule with telangiectasias**, often with rolled borders. - The lesion in the image appears more infiltrative and ulcerative than a typical BCC, and its location on the lip with sun exposure points more towards SCC. *Epulis* - An **epulis** is a **gingival growth** or **tumor-like lesion** that arises from the gum tissue, typically caused by chronic irritation or inflammation. - It is usually a **benign, localized fibrous or granulomatous lesion** and does not present as a malignant ulceration on the lip like the one shown.

Question 1

Cold water is not used for ear cleaning because

Accepted Answer

Caloric stimulation caused by cold water

Answer

Damage to tympanic membrane

Answer

It will cause infection

Answer

It will make the wax hard

Question 2

Most common cause of sensorineural hearing loss (SNHL)

Accepted Answer

Presbycusis

Answer

Labyrinthitis

Answer

Meniere's disease

Answer

Vestibular Schwannoma

Question 3

Mark the false statement regarding testing of COVID-19.

Accepted Answer

First line screening assay: N gene assay.

Answer

Confirmatory assay: RdRp gene assay.

Answer

Peripheral ground glass opacities on CT is the hallmark feature.

Answer

Most predominant method of diagnosis of COVID-19 is PCR.

Question 4

Which of these types of fibroid may be removed at the time of a cesarean section?

Accepted Answer

Pedunculated fibroid

Answer

Broad ligament fibroid

Answer

Cervical fibroid

Answer

Intramural

Question 5

In dacryocystorhinostomy (DCR), Lacrimal sac opens into:

Accepted Answer

Middle meatus

Answer

Supreme meatus

Answer

Inferior meatus

Answer

Superior meatus

Question 6

Earliest feature of TB:

Accepted Answer

Lymphocytosis

Answer

Caseation

Answer

Granuloma

Answer

Langerhans' Giant cells

Question 7

Pharmacodynamics deals with:-

Accepted Answer

Mechanism of action of a drug

Answer

Latency of onset

Answer

Transport of drug across the biological membranes

Answer

Mode of excretion of a drug

Question 8

Therapeutic index of a drug is an indicator of:-

Accepted Answer

Safety

Answer

All of these

Answer

Potency

Answer

Efficacy

Question 9

Which of the following investigations work on the same principle?

Accepted Answer

CT and X-ray

Answer

MRI and PET Scan

Answer

CT and MRI

Answer

USG and HIDA Scan

Question 10

What is the most likely diagnosis for this 60-year-old man with the lesion shown in the image?

Accepted Answer

SCC of lip

Answer

Plunging Ranula

Answer

Basal cell carcinoma

Answer

Epulis

FMGE 2018

ENT

Microbiology

Obstetrics and Gynecology

Ophthalmology

Pathology

Pharmacology

Radiology

Surgery