FMGE 2019 Practice Questions

Q: 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;

Cyanide poisoning. ***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).

Q: Most common cause of fulminant diabetes is?

Autoimmunity. ***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.

Q: Which of the following is the most likely cause in a case of granuloma with positive AFB?

Tuberculosis. ***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.

Q: DNA transfer in bacteria by phage is:

Transduction. ***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.

Q: A grand multipara is defined as a woman who has had how many viable pregnancies (≥20 weeks):

>=5. ***>=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.

Q: Evisceration is removal of which layer of eyeball?

Middle and inner. ***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.

Q: Which drug is used as a spermicidal cream in contraceptives?

Nonoxynol-9. **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.

Q: Which is the most cardiotoxic anti-cancer drug among the following?

Anthracyclines. ***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 1

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;

Accepted Answer

Cyanide poisoning

Answer

H2S poisoning

Answer

Datura poisoning

Answer

CO poisoning

Question 2

Most common cause of fulminant diabetes is?

Accepted Answer

Autoimmunity

Answer

Viruses

Answer

Non-ketotic hyperosmolar coma

Answer

Diabetic Ketoacidosis

Question 3

Which of the following is the most likely cause in a case of granuloma with positive AFB?

Accepted Answer

Tuberculosis

Answer

Syphilis

Answer

Cat scratch disease

Answer

Leprosy

Question 4

DNA transfer in bacteria by phage is:

Accepted Answer

Transduction

Answer

Transformation

Answer

Conjugation

Answer

Translation

Question 5

A grand multipara is defined as a woman who has had how many viable pregnancies (≥20 weeks):

Accepted Answer

>=5

Answer

>2

Answer

>3

Answer

>4

Question 6

A 26-week pregnant female presents with hypertension for the first time. There is no proteinuria. What is the most likely diagnosis?

Accepted Answer

Hypertension diagnosed after 20 weeks of gestation without proteinuria

Answer

Hypertension diagnosed before 20 weeks of gestation

Answer

Hypertension with proteinuria or end-organ damage

Answer

Hypertension with seizures

Question 7

Evisceration is removal of which layer of eyeball?

Accepted Answer

Middle and inner

Answer

All the layers of eyeball

Answer

Outer and inner

Answer

Outer and middle

Question 8

Which drug is used as a spermicidal cream in contraceptives?

Accepted Answer

Nonoxynol-9

Answer

Gossypol

Answer

Clomiphene

Answer

Centchroman

Question 9

Which is the most cardiotoxic anti-cancer drug among the following?

Accepted Answer

Anthracyclines

Answer

Cyclophosphamide

Answer

Tamoxifen

Answer

Imatinib

Question 10

Mechanism of action of exenatide in diabetes mellitus is

Accepted Answer

It is analogue of GLP released from gut and increases glucose dependent insulin secretion

Answer

It is DPP-4 inhibitor and results in decreased breakdown of GLP

Answer

It is amylin analogue and decreases glucagon

Answer

It inhibits SGLT-2 and causes glucosuria

FMGE 2019

Forensic Medicine

Internal Medicine

Microbiology

Obstetrics and Gynecology

Ophthalmology

Pharmacology