FMGE 2019 Practice Questions

Q: Which of the following inhalational anaesthetic agent can cause hepatitis on repeated use?

Halothane. ***Halothane*** - Halothane is known to cause **halothane hepatitis** (also known as halothane-induced liver injury), a rare but severe form of liver damage, particularly on **repeated exposure**. - This is due to the **metabolism of halothane** in the liver, which can produce reactive intermediates that lead to immune-mediated liver cell necrosis. *Sevoflurane* - Sevoflurane is generally considered to have a **low incidence of liver toxicity** and is preferred in patients with pre-existing liver disease. - While it can be metabolized to fluoride ions, the clinical significance of this in terms of liver damage is considered to be minimal compared to halothane. *Ether* - **Diethlyl ether** is an older anesthetic agent that is no longer commonly used due to its flammability and slower induction/recovery times. - While it can cause some hepatic dysfunction, it is not primarily associated with the severe, immune-mediated hepatitis seen with halothane. *Isoflurane* - Isoflurane is an ether-based anesthetic with a much **lower metabolism** rate than halothane. - This reduced metabolism contributes to its **lower potential for liver toxicity** compared to halothane, making it a safer option for patients with liver concerns.

Q: Sustainable Development Goals are designed by:

United Nations. ***United Nations*** - The **Sustainable Development Goals (SDGs)** were developed and adopted by all United Nations Member States in 2015 as a universal call to action to end poverty, protect the planet, and ensure that all people enjoy peace and prosperity by 2030. - They build upon the success of the Millennium Development Goals (MDGs) and address global challenges, including those related to poverty, inequality, climate change, environmental degradation, peace, and justice. *WHO* - The **World Health Organization (WHO)** is a specialized agency of the United Nations responsible for international public health. - While WHO plays a crucial role in implementing health-related SDGs (specifically SDG 3 - Good Health and Well-being), it did not design the entire framework of all 17 SDGs. *UNICEF* - **UNICEF (United Nations Children's Fund)** is a United Nations agency dedicated to providing humanitarian and developmental aid to children worldwide. - UNICEF contributes significantly to achieving several SDGs, particularly those focused on children's well-being, education, and health, but it was not the sole designer of the SDGs. *Government of India* - The **Government of India** is a sovereign government responsible for governing India. - While India is a member state of the United Nations and is committed to achieving the SDGs within its national context, it did not design the global framework of the Sustainable Development Goals.

Q: N95 mask is used for:

aerosol. ***aerosol*** - **N95 masks** are specifically designed to filter out at least 95% of **airborne particles** (aerosols) 0.3 microns or larger. - This level of filtration is crucial for protecting against diseases transmitted via **aerosolized droplets**, such as tuberculosis or COVID-19. *respiratory droplets* - While an N95 mask can filter respiratory droplets, it is primarily designed for smaller **aerosol particles** that can remain suspended in the air. - **Surgical masks** are generally adequate for blocking larger respiratory droplets, preventing splash and splatter. *Dust* - While an N95 mask can filter dust, it is an **overkill** for most common dust exposures. - A simple **dust mask** or even a surgical mask can provide adequate protection against larger dust particles. *in general* - This option is too broad; N95 masks are specifically used when there's a risk of exposure to **aerosolized infectious agents** or **fine particulate matter**. - Their use is typically reserved for settings where **aerosol-generating procedures** are performed or when caring for patients with **airborne diseases**.

Q: A patient after valve replacement will require follow up treatment with

Warfarin. ***Warfarin*** - Patients with **mechanical prosthetic heart valves** require lifelong anticoagulation with **warfarin** to prevent life-threatening thromboembolic complications [1]. - The target **international normalized ratio (INR)** typically ranges from 2.5 to 3.5, depending on the valve type and position. *ACE inhibitors* - **ACE inhibitors** are primarily used for managing **hypertension**, **heart failure**, and **renal protection**, not as routine post-valve replacement prophylaxis [2]. - While they may be used if these co-morbidities exist, they are not a universal requirement after valve surgery. *Beta blockers* - **Beta blockers** are often prescribed to control heart rate, manage **hypertension**, or reduce myocardial oxygen demand, but they are not the primary follow-up treatment for all valve replacement patients. - They do not address the critical need for **anticoagulation** in mechanical valve recipients. *Thiazide* - **Thiazide diuretics** are used to treat **hypertension** and **edema** by increasing salt and water excretion. - They do not play a direct role in preventing **thromboembolism** post-valve replacement and are not generally indicated unless chronic heart failure or hypertension is present.

Q: 32 years old lady with twin dichorionic diamniotic pregnancy, first baby breech presentation and second baby cephalic presentation. What is the management?

C - Section. ***C-Section*** - When **twin A is in breech presentation** in a dichorionic diamniotic twin pregnancy, **elective Cesarean section** is the recommended mode of delivery according to ACOG and most international guidelines. - The primary concern is the **increased risk of complications with breech delivery** of the first twin, including **head entrapment**, **cord prolapse**, and **birth trauma**. - While twin B is cephalic (which would be favorable for vaginal delivery if it were the presenting twin), the non-cephalic presentation of twin A dictates the mode of delivery for both twins. *Assisted breech* - While breech extraction may be considered in select cases where **twin A is cephalic and twin B is breech**, attempting vaginal breech delivery when twin A presents as breech is generally not recommended. - The risks of breech delivery for the first twin include **difficulty delivering the aftercoming head**, **cord prolapse**, and **birth asphyxia**, which are unacceptable in an elective situation where cesarean section is readily available. *Instrumental delivery* - Instrumental delivery (forceps or vacuum) is used to assist delivery of a **cephalic presentation** in the second stage of labor. - It cannot be used for **breech presentation** of twin A, making it inappropriate as a primary management strategy in this scenario. *Normal vaginal delivery* - Vaginal delivery with **twin A in non-cephalic (breech) presentation** is contraindicated in most modern obstetric guidelines due to significantly increased perinatal morbidity and mortality. - Even though twin B is cephalic, the presentation of twin A determines the overall delivery approach in twin pregnancies.

Q: Risk of endometrial cancer is least in:

Multipara. ***Multipara*** - **Multiparity** (having multiple successful pregnancies) is associated with a reduced risk of **endometrial cancer**. Each pregnancy provides a period of reduced estrogen exposure and increased progesterone, which is protective against endometrial hyperplasia. - The protective effect is thought to be cumulative, with **higher parity** correlating with a lower risk. *Late menopause* - **Late menopause** prolongs the duration of lifetime exposure to endogenous unopposed estrogen, which significantly increases the risk of **endometrial cancer**. - Estrogen stimulates **endometrial proliferation**, and continued exposure without the counter-regulatory effects of progesterone (as seen in later menopause) can lead to atypical hyperplasia and malignancy. *A positive family history* - A **positive family history** of endometrial cancer suggests a genetic predisposition, which is a significant **risk factor**. - Conditions like **Lynch syndrome** (hereditary non-polyposis colorectal cancer or HNPCC) are strongly associated with an increased risk of endometrial cancer. *Obesity* - **Obesity** is a major risk factor for **endometrial cancer** due to increased peripheral conversion of androgens to estrogens in adipose tissue. - This leads to higher levels of **unopposed estrogen**, promoting endometrial proliferation and increasing cancer risk.

Q: A 40-year-old patient presents with a femur fracture, pulmonary infiltration, and respiratory distress. What is the most likely diagnosis?

Fat embolism. ***Fat embolism*** - A **femur fracture** significantly increases the risk of **fat embolism**, where fat globules from the bone marrow enter the bloodstream and lodge in the pulmonary capillaries. - The classic triad of **fat embolism syndrome** includes respiratory distress, neurological symptoms, and a petechial rash, but respiratory symptoms (pulmonary infiltration and distress) are usually the first to appear. *Obstruction* - While an obstruction could cause respiratory distress, it typically wouldn't be associated with diffuse **pulmonary infiltrates** following a long bone fracture. - **Airway obstruction** would present with stridor or wheezing, and is usually localized rather than systemic. *Pulmonary embolism* - A **pulmonary embolism** (PE) can cause respiratory distress and infiltrates, but given the context of a recent femur fracture, fat embolism is a more specific and likely diagnosis. - PE is usually due to a **venous thromboembolism** and can be suspected in immobilized patients, but the question points more strongly to fat release. *Air embolism* - **Air embolism** usually results from iatrogenic causes (e.g., central line insertion, surgery) or trauma to large veins, allowing a significant amount of air into the circulation. - While it can cause respiratory distress, it doesn't typically cause the diffuse **pulmonary infiltrates** described, which are characteristic of fat embolism.

Q: Which of the following has prolonged inspiratory spasms that resemble breath holding?

Apneustic breathing. ***Apneustic breathing*** - This pattern is characterized by **prolonged inspiratory pauses**, resembling breath-holding, followed by a short, insufficient expiratory phase. - It is caused by damage to the **pons** in the brainstem, often due to stroke or trauma, which disrupts the normal rhythm of breathing. *Kussmaul breathing* - Characterized by **deep**, **rapid**, and labored breathing, typically seen in metabolic acidosis like **diabetic ketoacidosis**. - It is a compensatory mechanism to increase CO2 elimination and raise blood pH. *Biot's breathing* - Involves irregular breathing with **periods of apnea** interspersed with shallow breaths. - This pattern is associated with damage to the **medulla oblongata** or severe intracranial pressure. *Cheyne-Stokes breathing* - Characterized by a **crescendo-decrescendo pattern** of respiration, where breathing gradually increases in depth and rate, then decreases, followed by a period of **apnea**. - It is often observed in **heart failure**, stroke, or severe neurological conditions, indicating brainstem or cerebral dysfunction.

Question 1

Which of the following inhalational anaesthetic agent can cause hepatitis on repeated use?

Accepted Answer

Halothane

Answer

Sevoflurane

Answer

Ether

Answer

Isoflurane

Question 2

Sustainable Development Goals are designed by:

Accepted Answer

United Nations

Answer

WHO

Answer

UNICEF

Answer

Government of India

Question 3

N95 mask is used for:

Accepted Answer

aerosol

Answer

respiratory droplets

Answer

Dust

Answer

in general

Question 4

A patient after valve replacement will require follow up treatment with

Accepted Answer

Warfarin

Answer

ACE inhibitors

Answer

Beta blockers

Answer

Thiazide

Question 5

Gynecomastia is seen in all except;

Accepted Answer

Leprosy

Answer

Kidney failure

Answer

Liver failure

Answer

Stilbestrol therapy for prostate cancer

Answer

Teratoma of the testis

Answer

Hormonal

Answer

Idiopathic

Answer

Anorchism and After castration

Answer

Klinefelter's syndrome

Question 6

32 years old lady with twin dichorionic diamniotic pregnancy, first baby breech presentation and second baby cephalic presentation. What is the management?

Accepted Answer

C - Section

Answer

Assisted breech

Answer

Instrumental delivery

Answer

Normal vaginal delivery

Question 7

Risk of endometrial cancer is least in:

Accepted Answer

Multipara

Answer

Late menopause

Answer

A positive family history

Answer

Obesity

Question 8

A 40-year-old patient presents with a femur fracture, pulmonary infiltration, and respiratory distress. What is the most likely diagnosis?

Accepted Answer

Fat embolism

Answer

Obstruction

Answer

Pulmonary embolism

Answer

Air embolism

Question 9

Which of the following has Autosomal Recessive inheritance?

Accepted Answer

Sickle cell anaemia

Answer

Osteogenesis imperfecta

Answer

Hereditary spherocytosis

Answer

von Willebrand Disease Type 1

Question 10

Which of the following has prolonged inspiratory spasms that resemble breath holding?

Accepted Answer

Apneustic breathing

Answer

Kussmaul breathing

Answer

Biot breathing

Answer

Cheyne-Stokes breathing

FMGE 2019

Anesthesiology

Community Medicine

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pathology

Physiology