FMGE 2019 Practice Questions

Q: In a disease with 100% mortality, what is the relationship between incidence and prevalence?

Prevalence is less than incidence (P < I). ***Prevalence is less than incidence (P < I)*** - In a disease with 100% mortality, all affected individuals will eventually die, meaning their contribution to the **prevalent pool is temporary** or non-existent in the long run. - While new cases (incidence) continue to arise, the rapid removal of cases due to death prevents the buildup of prevalent cases, thus keeping prevalence lower than incidence. *Prevalence equals incidence (P = I)* - This scenario would imply that every new case immediately disappears or that the disease has no duration, which contradicts the concept of **disease progression** and death. - **Prevalence** is influenced by both the incidence rate and the duration of the disease; if duration is effectively zero due to immediate death, the relationship still leans towards prevalence being lower. *There is no relationship between prevalence and incidence* - This statement is incorrect as **incidence and prevalence are fundamentally linked**. Prevalence is a function of incidence and disease duration. - Changes in incidence directly affect **prevalence**, although the extent of this effect is modulated by factors like disease duration, recovery, or mortality. *Prevalence is greater than incidence (P > I)* - Prevalence being greater than incidence typically occurs in **chronic diseases** where individuals live with the condition for a long time, allowing prevalent cases to accumulate. - With **100% mortality**, individuals do not survive long enough to contribute significantly to the prevalent pool, making it impossible for prevalence to exceed incidence in this context.

Q: Most prominent and largest air cell of ethmoidal sinus?

Bulla ethmoidalis. ***Bulla ethmoidalis*** - The **bulla ethmoidalis** is universally present and is consistently described as the **largest and most prominent** of the anterior ethmoid air cells. - It forms an anatomical landmark that is consistently superior and posterior to the **hiatus semilunaris**. *Onodi cell* - The **Onodi cell** is a posterior ethmoid air cell that pneumatizes laterally and superiorly into the sphenoid bone, in close proximity to the optic nerve. - While clinically significant due to its relationship with the optic nerve, it is not the largest or most prominent ethmoidal air cell. *Haller cell* - A **Haller cell** is an infraorbital ethmoid cell located along the floor of the orbit, extending into the maxillary sinus. - These cells can contribute to **ostial obstruction** of the maxillary sinus but are typically small compared to the bulla ethmoidalis. *Agger nasi cell* - The **agger nasi cell** is the most anterior ethmoid air cell, located in the lacrimal bone anterior to the frontal recess. - It is often one of the first ethmoid cells to pneumatize but is generally small and not considered the most prominent.

Q: A 20-year-old male presented with fatigue, weakness, and jaundice. What is the most likely diagnosis?

Acute myeloid leukemia. ***Acute myeloid leukemia*** - Presents with **fatigue** and **weakness** due to bone marrow infiltration and resultant cytopenias, typical in this age group [1]. - Often shows **myeloblasts** on peripheral blood smear, confirming the diagnosis [2]. *Chronic myeloid leukemia* - Usually occurs in **older adults** and characterized by **elevated white blood cell counts** with a predominance of mature neutrophils. - Symptoms like fatigue may arise, but there are distinct **Philadelphia chromosome** findings and typically a **longer symptom duration**. *Acute lymphoblastic leukemia* - More common in **younger children** and often associated with **lymphadenopathy** and **thrombocytopenia**, rather than fatigue alone. - Characteristically shows **lymphoblasts** in the blood, which are not mentioned in this patient's presentation. *Chronic lymphocytic leukemia* - Typically presents in adults over **50 years** and is characterized by **lymphocytosis** and often asymptomatic in early stages. - Fatigue may occur but lacks the acute presentation and findings seen in **acute leukemias**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 607-608. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 621-622.

Q: Hemolytic uraemic syndrome is associated with

E. coli 0157. ***E. coli O157*** - **Hemolytic uremic syndrome (HUS)** is most commonly associated with infection by **Shiga toxin-producing E. coli (STEC)**, particularly serotype O157:H7 [2]. - The Shiga toxin damages the **endothelium** of blood vessels, leading to **thrombotic microangiopathy**, which manifests as **hemolytic anemia**, **thrombocytopenia**, and **acute kidney injury** [1], [2]. *Bartonella henselae* - This bacterium is the causative agent of **cat scratch disease**, characterized by **lymphadenopathy** and sometimes systemic symptoms. - It is not typically associated with hemolytic uremic syndrome. *Malaria* - Malaria is a **parasitic infection** transmitted by mosquitoes, causing **fever**, **chills**, and **anemia** due to red blood cell lysis. - While it can cause anemia, it does not directly lead to the thrombotic microangiopathy of HUS. *Parvovirus B19* - **Parvovirus B19** causes **erythema infectiosum (fifth disease)** in children and can cause **aplastic crisis** in individuals with underlying hemolytic disorders. - It primarily targets erythroid precursors in the bone marrow but is not directly linked to HUS.

Q: Which of the following is the earliest finding seen in Diabetic nephropathy?

Microalbuminuria. ***Microalbuminuria*** - **Microalbuminuria** is defined as the excretion of 30-300 mg of albumin in urine per 24 hours and is the **earliest detectable sign** of diabetic nephropathy, preceding overt proteinuria [1], [3]. - Early detection allows for interventions to slow the progression of kidney damage, such as **strict glycemic control** and **blood pressure management** with ACE inhibitors or ARBs [3]. *Hematuria* - **Hematuria** (blood in the urine) is not typically an early or primary finding in diabetic nephropathy [2]. - While it can occur in some kidney diseases, it is more characteristic of conditions like **glomerulonephritis** or **urinary tract infections** [4]. *Exudates* - **Exudates** refer to leakage of fluid, protein, or cells into tissues, often associated with inflammation or injury, and are not a measure of kidney function. - It's possible this term is being confused with **retinal exudates** (hard exudates) which are a finding in diabetic retinopathy, but not diabetic nephropathy. *Macroalbuminuria* - **Macroalbuminuria** (or overt proteinuria) is the excretion of more than 300 mg of albumin per 24 hours, indicating more advanced kidney damage. - It is a **later finding** than microalbuminuria in the progression of diabetic nephropathy, signifying established kidney disease [3].

Q: Which of the following is not true regarding Wolff-Parkinson-White (WPW) syndrome?

Prolonged PR interval. ***Prolonged PR interval*** - In WPW syndrome, the presence of an **accessory pathway (Bundle of Kent)** allows for **pre-excitation** of the ventricles, bypassing the AV node's normal delay [1]. - This results in a **shortened PR interval** (typically < 0.12 seconds), not a prolonged one [1]. *Delta wave is seen on ECG* - The **delta wave** is a characteristic finding in WPW, representing the slurred upstroke of the QRS complex due to early ventricular activation via the accessory pathway [1]. - It indicates **ventricular pre-excitation** and is a key diagnostic feature [1], [2]. *Bundle of Kent connects atria to ventricles* - The **Bundle of Kent** is an anomalous muscle fiber bundle that forms an **accessory pathway** directly connecting the atria to the ventricles [1]. - This pathway bypasses the AV node, leading to the characteristic ECG findings and potential re-entrant arrhythmias. *Pre-excitation occurs via accessory pathway* - **Pre-excitation** is the hallmark of WPW syndrome, where electrical impulses bypass the normal conduction system (AV node) and activate ventricular tissue prematurely via an **accessory pathway** [1]. - This leads to the characteristic short PR interval and delta wave on the ECG [2].

Q: Which of the following viruses is from the Herpes virus family?

EBV. ***EBV*** - **Epstein-Barr Virus (EBV)** is a member of the **Herpesviridae** family, specifically **Human Herpesvirus 4 (HHV-4)**. - It is a **DNA virus** (double-stranded DNA), which is characteristic of all herpesviruses. - It is known to cause **infectious mononucleosis** and is associated with various malignancies. *Rubella* - **Rubella virus** belongs to the family **Togaviridae** and is the causative agent of **German measles**. - It is an **RNA virus** and is not classified within the Herpesviridae family. *Rabies* - **Rabies virus** is a member of the **Rhabdoviridae** family, specifically the genus **Lyssavirus**. - It is a neurotropic **RNA virus** causing a rapidly progressive, fatal encephalitis. *Measles* - **Measles virus**, also known as **Rubeola**, belongs to the family **Paramyxoviridae**. - It is an **RNA virus** responsible for a highly contagious airborne disease.

Q: A 32-year-old lady with intrauterine fetal death after normal vaginal delivery has continuous passage of urine from the vagina. What is the most probable diagnosis?

Vesicovaginal fistula. ***Vesicovaginal fistula*** - The continuous passage of urine from the vagina following delivery, especially in the context of an intrauterine fetal death where prolonged or difficult labor might occur, is highly suggestive of a **vesicovaginal fistula**. - A fistula creates an abnormal connection between the **bladder** and the **vagina**, leading to continuous urine leakage. *Urge incontinence* - Characterized by an **involuntary loss of urine** associated with a sudden, strong desire to void. - This is typically due to an **overactive detrusor muscle** and would not cause continuous leakage, especially not through the vagina itself after a delivery. *Stress incontinence* - Defined by the leakage of urine with activities that **increase intra-abdominal pressure**, such as coughing, sneezing, or laughing. - It results from weakness of the **pelvic floor muscles** or urethral sphincter, not continuous drainage from the vagina. *Bladder rupture* - While a bladder rupture can cause urinary leakage, it usually presents with **acute abdominal pain**, abdominal distension, and possibly **hematuria**, along with urine accumulating in the peritoneal cavity, rather than continuous passage solely from the vagina. - A rupture would likely be an acute, more severe event with systemic symptoms, distinct from the described continuous vaginal leakage of urine.

Q: Phlyctenular conjunctivitis is primarily associated with hypersensitivity to which of the following?

Staphylococcus. ***Staphylococcus*** - **Phlyctenular conjunctivitis** is characterized by delayed (Type IV) hypersensitivity reactions to bacterial antigens, most commonly from **Staphylococcus aureus**. - This condition often presents with small, nodular lesions (phlyctenules) on the conjunctiva or cornea, which are essentially collections of inflammatory cells responding to bacterial proteins. - **Important note**: **Mycobacterium tuberculosis** is another well-documented cause of phlyctenular conjunctivitis, particularly in TB-endemic regions, and should be considered in the differential diagnosis. - Other triggers include protein antigens from organisms colonizing the ocular surface. *Chlamydia* - While **Chlamydia trachomatis** can cause chronic conjunctivitis (e.g., trachoma, adult inclusion conjunctivitis), it does not typically lead to the distinct nodular lesions seen in phlyctenular conjunctivitis. - Ocular chlamydial infections are primarily characterized by follicular conjunctivitis and pannus formation. *Pneumococcus* - **Streptococcus pneumoniae** (Pneumococcus) is a common cause of acute bacterial conjunctivitis, characterized by purulent discharge and redness. - However, it is not associated with the specific delayed hypersensitivity reaction that defines phlyctenular conjunctivitis. *Aspergillus* - **Aspergillus** species are fungi and are more commonly implicated in fungal keratitis or allergic bronchopulmonary aspergillosis, particularly in immunocompromised individuals. - Fungal infections of the conjunctiva are rare and do not typically manifest as phlyctenular conjunctivitis.

Q: Which finding is assigned 2 points in the Alvarado scoring system for appendicitis assessment?

Leukocytosis. **Leukocytosis** - An elevated **white blood cell count** (typically greater than 10,000 cells/mm³) is a significant indicator of inflammation, assigned **2 points** in the Alvarado score. - This finding reflects the body's systemic response to the infection and inflammation associated with **appendicitis**. *Low-grade fever* - A low-grade fever (oral temperature of 37.3-38.0°C) is assigned **1 point** in the Alvarado score. - While indicative of inflammation, it is less specific and less weighted than leukocytosis. *Nausea and vomiting* - These gastrointestinal symptoms are common in appendicitis and are assigned **1 point** in the Alvarado score. - They are non-specific and can be present in many other abdominal conditions. *Rebound tenderness* - This clinical sign, indicating **peritoneal irritation**, is assigned **1 point** in the Alvarado score. - It is a physical exam finding, not a laboratory finding, and suggests localized inflammation.

Question 1

In a disease with 100% mortality, what is the relationship between incidence and prevalence?

Accepted Answer

Prevalence is less than incidence (P < I)

Answer

Prevalence equals incidence (P = I)

Answer

There is no relationship between prevalence and incidence

Answer

Prevalence is greater than incidence (P > I)

Question 2

Most prominent and largest air cell of ethmoidal sinus?

Accepted Answer

Bulla ethmoidalis

Answer

Onodi cell

Answer

Haller cell

Answer

Agger nasi cell

Question 3

A 20-year-old male presented with fatigue, weakness, and jaundice. What is the most likely diagnosis?

Accepted Answer

Acute myeloid leukemia

Answer

Acute lymphoblastic leukemia

Answer

Chronic myeloid leukemia

Answer

Chronic lymphocytic leukemia

Question 4

Hemolytic uraemic syndrome is associated with

Accepted Answer

E. coli 0157

Answer

Bartonella henselae

Answer

Malaria

Answer

Parvovirus B19

Question 5

Which of the following is the earliest finding seen in Diabetic nephropathy?

Accepted Answer

Microalbuminuria

Answer

Hematuria

Answer

Exudates

Answer

Macroalbuminuria

Question 6

Which of the following is not true regarding Wolff-Parkinson-White (WPW) syndrome?

Accepted Answer

Prolonged PR interval

Answer

Delta wave is seen on ECG

Answer

Bundle of Kent connects atria to ventricles

Answer

Pre-excitation occurs via accessory pathway

Question 7

Which of the following viruses is from the Herpes virus family?

Accepted Answer

EBV

Answer

Rubella

Answer

Rabies

Answer

Measles

Question 8

A 32-year-old lady with intrauterine fetal death after normal vaginal delivery has continuous passage of urine from the vagina. What is the most probable diagnosis?

Accepted Answer

Vesicovaginal fistula

Answer

Urge incontinence

Answer

Stress incontinence

Answer

Bladder rupture

Question 9

Phlyctenular conjunctivitis is primarily associated with hypersensitivity to which of the following?

Accepted Answer

Staphylococcus

Answer

Chlamydia

Answer

Pneumococcus

Answer

Aspergillus

Question 10

Which finding is assigned 2 points in the Alvarado scoring system for appendicitis assessment?

Accepted Answer

Leukocytosis

Answer

Low-grade fever

Answer

Nausea and vomiting

Answer

Rebound tenderness

FMGE 2019

Community Medicine

ENT

Internal Medicine

Microbiology

Obstetrics and Gynecology

Ophthalmology

Surgery