Forensic Medicine
1 questionsA patient was found to have pink coloured skin and mucosa, bitter almond smell from breath and frothy discharge. Cause of death in this patient;
FMGE 2019 - Forensic Medicine FMGE Practice Questions and MCQs
Question 201: A patient was found to have pink coloured skin and mucosa, bitter almond smell from breath and frothy discharge. Cause of death in this patient;
- A. Cyanide poisoning (Correct Answer)
- B. H2S poisoning
- C. Datura poisoning
- D. CO poisoning
Explanation: ***Cyanide poisoning*** - **Pink/cherry-red skin and mucosa** occur because cyanide **inhibits cytochrome oxidase** in the mitochondrial electron transport chain, preventing cellular oxygen utilization. This results in **high venous oxyhemoglobin levels** as oxygen remains in the blood but cannot be used by tissues. - The characteristic **bitter almond smell** is pathognomonic for cyanide, though only detectable by 40-60% of the population due to genetic variations in odor perception. - **Frothy discharge** indicates pulmonary edema, common in acute cyanide toxicity. *H2S poisoning* - **Hydrogen sulfide** poisoning typically presents with a characteristic **rotten egg smell**, not bitter almonds. - It causes cellular hypoxia by **inhibiting cytochrome oxidase**, similar to cyanide, but the clinical presentation, odor, and skin coloration (may be greenish) differ. *Datura poisoning* - **Datura poisoning** is characterized by an **anticholinergic toxidrome**: hot, dry, red skin (flushed from vasodilation, not hypoxia), dilated pupils, delirium, and urinary retention. - It does not cause a bitter almond smell or the characteristic pink coloration seen in cyanide poisoning. *CO poisoning* - **Carbon monoxide (CO) poisoning** is associated with a **cherry-red skin color** due to **carboxyhemoglobin** formation, where CO binds hemoglobin with 200-250x greater affinity than oxygen. - While it also causes cellular hypoxia, there is **no bitter almond smell**, and the mechanism differs (oxygen cannot bind vs. oxygen cannot be utilized).
Internal Medicine
1 questionsMost common cause of fulminant diabetes is?
FMGE 2019 - Internal Medicine FMGE Practice Questions and MCQs
Question 201: Most common cause of fulminant diabetes is?
- A. Viruses
- B. Non-ketotic hyperosmolar coma
- C. Autoimmunity (Correct Answer)
- D. Diabetic Ketoacidosis
Explanation: ***Autoimmunity*** - **Fulminant diabetes** is a distinct subtype of **Type 1 diabetes** with an acute onset and rapid, severe beta-cell destruction [1]. - This rapid destruction is primarily mediated by an **autoimmune process**, leading to profound insulin deficiency during the initial presentation [2]. *Viruses* - While certain **viral infections** (e.g., Coxsackievirus, enteroviruses) are implicated as potential triggers for **Type 1 diabetes**, they are not considered the direct and most common cause of the fulminant form itself [1]. - Viral infections might initiate or accelerate the **autoimmune process**, but autoimmunity is the direct mechanism of beta-cell destruction. *Non-ketotic hyperosmolar coma* - **Non-ketotic hyperosmolar coma (NKHC)** is a severe complication of **Type 2 diabetes**, characterized by extremely high blood glucose levels without significant ketosis [2]. - It is not a cause of fulminant diabetes but rather a distinct acute diabetic emergency. *Diabetic Ketoacidosis* - **Diabetic ketoacidosis (DKA)** is an acute, life-threatening complication of **Type 1 diabetes** (and sometimes Type 2), characterized by hyperglycemia, ketosis, and metabolic acidosis [3]. - DKA is a **result** of severe insulin deficiency, which can be seen in fulminant diabetes, but it is not the underlying cause of the fulminant condition itself.
Microbiology
2 questionsWhich of the following is the most likely cause in a case of granuloma with positive AFB?
DNA transfer in bacteria by phage is:
FMGE 2019 - Microbiology FMGE Practice Questions and MCQs
Question 201: Which of the following is the most likely cause in a case of granuloma with positive AFB?
- A. Syphilis
- B. Cat scratch disease
- C. Leprosy
- D. Tuberculosis (Correct Answer)
Explanation: ***Tuberculosis*** - **Mycobacterium tuberculosis** is the classic cause of **granulomatous inflammation** with **positive AFB** staining in histopathology. - TB is the most common mycobacterial infection worldwide, and **AFB staining** is routinely positive in tissue specimens, making it the standard association for granuloma + AFB. *Leprosy* - While **Mycobacterium leprae** is acid-fast, **AFB positivity** is variable and often requires special techniques for demonstration. - Leprosy is much less common globally, and AFB demonstration in routine histopathology is less reliable compared to tuberculosis. *Syphilis* - Syphilis is caused by **Treponema pallidum**, a **spirochete** that is not acid-fast. - Although syphilis can cause granulomatous inflammation (**gummas**), **AFB staining** would be negative. *Cat scratch disease* - Cat scratch disease is caused by **Bartonella henselae**, a **Gram-negative bacterium**. - While it causes **granulomatous lymphadenitis**, **Bartonella** is not acid-fast, so **AFB** would be negative.
Question 202: DNA transfer in bacteria by phage is:
- A. Transformation
- B. Conjugation
- C. Translation
- D. Transduction (Correct Answer)
Explanation: ***Transduction*** - **Transduction** is the process by which foreign DNA is introduced into a cell by a virus or viral vector, specifically a **bacteriophage** in bacteria. - During transduction, the phage infects a bacterial cell, and its genetic material becomes incorporated into the host cell's DNA, or it may package bacterial DNA into new phage particles, which then infect other bacteria. *Transformation* - **Transformation** is the process where bacteria take up **naked DNA** from their environment. - This process does not involve a bacteriophage or any other viral vector. *Conjugation* - **Conjugation** is a process of genetic transfer between bacterial cells involving direct cell-to-cell contact through a **pilus**. - It typically involves the transfer of plasmids or other genetic elements, not mediated by a bacteriophage. *Translation* - **Translation** is the process by which messenger RNA (mRNA) is decoded to produce a specific **amino acid sequence** (protein). - This is a fundamental step in gene expression and does not involve the transfer of DNA between bacteria via a phage.
Obstetrics and Gynecology
2 questionsA grand multipara is defined as a woman who has had how many viable pregnancies (≥20 weeks):
A 26-week pregnant female presents with hypertension for the first time. There is no proteinuria. What is the most likely diagnosis?
FMGE 2019 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 201: A grand multipara is defined as a woman who has had how many viable pregnancies (≥20 weeks):
- A. >2
- B. >=5 (Correct Answer)
- C. >3
- D. >4
Explanation: ***>=5*** - A **grand multipara** is defined as a woman who has delivered **five or more** viable fetuses (live births or stillbirths after 20 weeks of gestation). - This classification is important clinically due to the increased risks associated with grand multiparity, such as **postpartum hemorrhage** and complications during labor. *>2* - This definition is too broad, as a woman with 3 or 4 live births is considered a **multipara**, but not specifically a grand multipara. - The term **multipara** generally applies to women who have had two or more live births. *>3* - This definition includes women with 4 live births, who are considered **multipara** but do not meet the stricter criteria for **grand multipara**. - The term **grand multipara** specifically denotes a higher number of deliveries with associated increased obstetric risks. *>4* - While close, this definition would include a woman with 5 live births, but it does not specify "five or more." - The precise definition of a **grand multipara** is five or more, which carries specific clinical implications for pregnancy management.
Question 202: A 26-week pregnant female presents with hypertension for the first time. There is no proteinuria. What is the most likely diagnosis?
- A. Hypertension diagnosed before 20 weeks of gestation
- B. Hypertension diagnosed after 20 weeks of gestation without proteinuria (Correct Answer)
- C. Hypertension with proteinuria or end-organ damage
- D. Hypertension with seizures
Explanation: ***Hypertension diagnosed after 20 weeks of gestation without proteinuria*** - This scenario describes **gestational hypertension**, defined as new-onset hypertension (≥140/90 mmHg) presenting *after* 20 weeks of gestation, without associated proteinuria or other signs of preeclampsia. - The patient's presentation at **26 weeks** with **no proteinuria** directly aligns with the diagnostic criteria for gestational hypertension. *Hypertension diagnosed before 20 weeks of gestation* - This description corresponds to **chronic hypertension**, meaning the hypertension was present *before* pregnancy or diagnosed *before* 20 weeks of gestation. - The question explicitly states the hypertension is presenting for the **first time** and the gestational age is **26 weeks**, ruling out chronic hypertension. *Hypertension with proteinuria or end-organ damage* - This definition describes **preeclampsia**, which involves new-onset hypertension *after* 20 weeks accompanied by significant **proteinuria** or signs of **end-organ damage** like renal insufficiency, liver dysfunction, or thrombocytopenia. - The patient specifically has **no proteinuria**, making preeclampsia an unlikely diagnosis based on the provided information. *Hypertension with seizures* - This refers to **eclampsia**, a severe complication of preeclampsia characterized by the development of **generalized tonic-clonic seizures** in a pregnant patient with preeclampsia, unrelated to other brain conditions. - The patient in this case is not experiencing seizures; therefore, eclampsia is not the correct diagnosis.
Ophthalmology
1 questionsEvisceration is removal of which layer of eyeball?
FMGE 2019 - Ophthalmology FMGE Practice Questions and MCQs
Question 201: Evisceration is removal of which layer of eyeball?
- A. Middle and inner (Correct Answer)
- B. All the layers of eyeball
- C. Outer and inner
- D. Outer and middle
Explanation: ***Middle and inner*** - **Evisceration** involves the surgical removal of the internal contents of the eyeball, which include components derived from the **middle (uveal) and inner (retinal) layers**. - The **sclera** (outermost layer) and **extraocular muscles** are preserved, allowing for a more natural prosthetic eye fit. *All the layers of eyeball* - This describes **enucleation**, where the entire eyeball is removed including all three layers (sclera, choroid/ciliary body/iris, and retina). - Enucleation is a more extensive procedure than evisceration, typically performed for intraocular tumors or severe trauma where preservation of the sclera isn't possible. *Outer and inner* - This option is incorrect because the **outer layer (sclera)** is specifically preserved in evisceration. - Removing the outer layer would lead to a more destructive procedure, inconsistent with the definition of evisceration. *Outer and middle* - This option is incorrect because the **outer layer (sclera)** is preserved during evisceration, while the entire **inner layer (retina)** is removed. - The middle layer (uvea) is removed, but this option inaccurately states the fate of the outer and inner layers.
Pharmacology
3 questionsWhich drug is used as a spermicidal cream in contraceptives?
Which is the most cardiotoxic anti-cancer drug among the following?
Mechanism of action of exenatide in diabetes mellitus is
FMGE 2019 - Pharmacology FMGE Practice Questions and MCQs
Question 201: Which drug is used as a spermicidal cream in contraceptives?
- A. Gossypol
- B. Clomiphene
- C. Nonoxynol-9 (Correct Answer)
- D. Centchroman
Explanation: **Nonoxynol-9** - **Nonoxynol-9** is a common **spermicide** used in many contraceptive products like creams, foams, and gels. - It works by damaging the **sperm cell membrane**, effectively immobilizing and killing sperm. *Gossypol* - **Gossypol** is a natural compound found in cotton plants that has been studied for its potential as a **male contraceptive**. - It works by inhibiting **spermatogenesis** but has not been approved for widespread use due to toxicity concerns like **hypokalemia**. *Clomiphene* - **Clomiphene** is a **selective estrogen receptor modulator (SERM)** used to induce ovulation in women who are infertile due to anovulation. - It stimulates the release of **gonadotropins** (FSH and LH) from the pituitary gland, leading to follicular development. *Centchroman* - **Centchroman** (also known as Ormeloxifene) is a **non-steroidal oral contraceptive** used in India. - It acts as a **selective estrogen receptor modulator** in the uterus, disrupting the implantation process.
Question 202: Which is the most cardiotoxic anti-cancer drug among the following?
- A. Cyclophosphamide
- B. Tamoxifen
- C. Imatinib
- D. Anthracyclines (Correct Answer)
Explanation: ***Anthracyclines*** - **Anthracyclines** (e.g., doxorubicin, daunorubicin) are notorious for causing **dose-dependent cardiotoxicity**, leading to **irreversible dilated cardiomyopathy** and **heart failure**. - Their cardiotoxic effect is primarily due to the generation of **reactive oxygen species** and interference with cardiac topoisomerase IIβ. *Cyclophosphamide* - Cyclophosphamide can cause cardiotoxicity, particularly at **high doses**, manifesting as **hemorrhagic myocardial necrosis** or **pericarditis**. - However, its cardiotoxicity is generally considered **less frequent and severe** than that of anthracyclines. *Tamoxifen* - Tamoxifen is primarily associated with an **increased risk of thromboembolic events** and **endometrial cancer**. - While some cardiac effects like **QT prolongation** can occur, it is not considered a primary cardiotoxic agent leading to cardiomyopathy. *Imatinib* - Imatinib, a **tyrosine kinase inhibitor**, has been linked to **cardiac dysfunction** including heart failure in some patients. - However, the incidence and severity of cardiotoxicity with imatinib are **lower** compared to anthracyclines, which are broadly cardiotoxic.
Question 203: Mechanism of action of exenatide in diabetes mellitus is
- A. It is DPP-4 inhibitor and results in decreased breakdown of GLP
- B. It is amylin analogue and decreases glucagon
- C. It is analogue of GLP released from gut and increases glucose dependent insulin secretion (Correct Answer)
- D. It inhibits SGLT-2 and causes glucosuria
Explanation: ***It is analogue of GLP released from gut and increase glucose dependant insulin secretion*** - **Exenatide** is a **glucagon-like peptide-1 (GLP-1) receptor agonist**, mimicking the action of naturally occurring GLP-1 [1]. - It stimulates **glucose-dependent insulin secretion**, suppresses glucagon release, slows gastric emptying, and promotes satiety, all contributing to improved glycemic control [2]. *It inhibits SGLT-2 and cause glucosuria* - This describes the mechanism of **sodium-glucose co-transporter 2 (SGLT-2) inhibitors**, such as empagliflozin or canagliflozin, which promote glucose excretion in urine. - **Exenatide** does not directly affect renal glucose reabsorption. *It is DPP-4 inhibitor and result in decreased breakdown of GLP* - This mechanism belongs to **dipeptidyl peptidase-4 (DPP-4) inhibitors** (e.g., sitagliptin, saxagliptin), which prevent the rapid degradation of endogenous GLP-1, thus prolonging its action [1]. - **Exenatide** directly activates GLP-1 receptors rather than modulating the enzyme that breaks down endogenous GLP-1 [1]. *It is amylin analogue and decrease glucagon* - This describes **pramlintide**, an amylin analogue used in diabetes management, which primarily suppresses postprandial glucagon secretion, slows gastric emptying, and promotes satiety. - While **exenatide** also decreases glucagon, its primary mechanism is via GLP-1 receptor agonism [2].