FMGE 2019 Practice Questions

Q: Which of the following is present in skeletal muscle?

GLUT 4. ***GLUT 4*** - **GLUT 4** is the primary glucose transporter found in **skeletal muscle** and adipose tissue. - Its translocation to the cell membrane is **insulin-dependent** and also stimulated by muscle contraction, allowing increased glucose uptake. *GLUT 2* - **GLUT 2** is predominantly found in the liver, pancreas (beta cells), intestine, and kidney. - It has a **low affinity (high Km)** for glucose, allowing it to transport glucose efficiently only at high blood glucose concentrations. *GLUT 7* - **GLUT 7** is a glucose transporter located in the **endoplasmic reticulum** membrane of the liver and other gluconeogenic tissues. - It plays a role in the flux of glucose within the ER lumen, particularly in **hepatic glucose production**. *GLUT 5* - **GLUT 5** is primarily responsible for **fructose transport** in the small intestine, testes, and kidneys. - It does not transport glucose and has a specific affinity for fructose.

Q: Which of the following is cardio protective?

HDL. ***HDL*** - **High-density lipoprotein (HDL)** is known as "good cholesterol" because it helps remove **excess cholesterol** from the body and transport it back to the liver for excretion. - This process, called **reverse cholesterol transport**, helps prevent the buildup of plaque in arteries, thereby reducing the risk of **atherosclerosis** and cardiovascular disease. *CHYLOMICRON* - **Chylomicrons** are responsible for transporting **dietary triglycerides** from the intestines to various tissues. - While essential for nutrient absorption, elevated chylomicron levels can contribute to **hypertriglyceridemia**, which is a risk factor for cardiovascular disease and pancreatitis. *VLDL* - **Very low-density lipoprotein (VLDL)** primarily transports **endogenously synthesized triglycerides** from the liver to peripheral tissues. - High levels of VLDL are considered a **risk factor for atherosclerosis** as they can be metabolized into LDL, contributing to plaque formation. *LDL* - **Low-density lipoprotein (LDL)** is often referred to as "bad cholesterol" because it deposits cholesterol in the walls of arteries. - This deposition leads to the formation of **atherosclerotic plaque**, which can narrow arteries and increase the risk of heart attacks and strokes.

Q: In autopsy, which organ is removed with liver?

Spleen. ***Spleen*** - In autopsy, the **spleen is routinely removed along with the liver** as part of standard dissection protocols (Virchow's method and variations). - This is done to examine the **portal venous system**, assess the **hepatosplenic circulation**, and evaluate pathologies affecting both organs such as **portal hypertension**, **congestive splenomegaly**, or **hepatic cirrhosis**. - The anatomical proximity and shared vascular connections make their removal together both practical and diagnostically valuable. *Kidney* - The **kidneys** are typically removed separately or as part of the **posterior abdominal block** after the liver and spleen have been removed. - While kidneys may be examined in relation to the abdominal vasculature, they are not removed in direct continuity with the liver block in standard autopsy technique. - Their retroperitoneal location makes separate dissection more appropriate. *Stomach* - The **stomach** is removed as part of the **gastrointestinal tract block**, which includes the esophagus, duodenum, and often the pancreas. - Though anatomically adjacent to the liver, it is not part of the hepatosplenic block. - Its examination focuses on mucosal pathology, ulcers, tumors, and gastric contents rather than hepatic circulation. *Brain* - The **brain** is removed as a completely separate organ through **craniotomy** after reflection of the scalp. - It is housed within the cranium and has no anatomical or dissection relationship with abdominal organs. - Brain removal follows examination of the cranial cavity, meninges, and cerebral vessels.

Q: Diagnosis of Gout is confirmed by which test?

Synovial fluid analysis. ***Synovial fluid analysis*** - Diagnosis of gout is definitively confirmed by the presence of **negatively birefringent, needle-shaped urate crystals** within neutrophils in the synovial fluid [1]. - This direct visualization of crystals confirms the diagnosis and differentiates gout from other forms of arthritis [1]. *X-ray changes* - While X-rays can show characteristic changes in chronic gout, such as **punched-out erosions with overhanging edges** (rat-bite erosions), these are not diagnostic of acute gout and may appear late in the disease course. - X-ray findings are less specific and do not confirm the presence of urate crystals. *Urine uric acid levels* - Urine uric acid levels help to distinguish between **overproducers and underexcreters** of uric acid, which can guide long-term management strategies [1]. - However, they do not directly confirm the diagnosis of an acute gouty attack. *Serum Uric acid level* - Elevated serum uric acid (hyperuricemia) is a prerequisite for gout, but many individuals with hyperuricemia never develop gout [1]. - Therefore, a **high serum uric acid level alone is not sufficient** to diagnose gout, especially during an acute attack when levels can sometimes be normal [1].

Q: Whipple's disease is caused by:

Bacteria. **Bacteria** - Whipple's disease is caused by the bacterium **_Tropheryma whipplei_**, a rod-shaped, gram-positive actinobacterium. - This bacterium causes a chronic, systemic infection affecting various organ systems, most commonly the gastrointestinal tract. *Virus* - Viruses are intracellular parasites that reproduce inside living cells, and they are not the causative agent of Whipple's disease. - While viral infections can cause gastrointestinal symptoms, they do not lead to the distinct histopathological findings of Whipple's disease, such as **PAS-positive macrophages**. *Helminths* - Helminths are parasitic worms (e.g., tapeworms, roundworms) that can cause intestinal and systemic infections. - These organisms are multicellular eukaryotes and are distinct from the bacterial etiology of Whipple's disease. *Protozoa* - Protozoa are single-celled eukaryotic organisms that can cause a range of infections, often gastrointestinal (e.g., Giardia, Entamoeba). - While parasitic infections can cause malabsorption, the specific **PAS-positive macrophage infiltrates** seen in Whipple's disease are characteristic of bacterial infection, not protozoan.

Q: A lady with 36-week pregnancy with previous C-section comes with low BP, tachycardia, and on USG fluid present in peritoneum. What is the diagnosis and next management?

Uterine scar rupture with Laparotomy. ***Uterine scar rupture with Laparotomy*** - The presentation of **low blood pressure**, **tachycardia**, and **free fluid in the peritoneum** in a 36-week pregnant woman with a **previous C-section** is highly indicative of uterine scar rupture given the signs of **hemorrhagic shock**. - **Laparotomy** (emergency abdominal surgery) is the immediate and definitive management to repair the ruptured uterus, control bleeding, and deliver the fetus. *Abruptio and C-section* - **Placental abruption** typically presents with painful vaginal bleeding, uterine tenderness, and fetal distress, which are not explicitly mentioned as the primary symptoms here. - While a **C-section** would be indicated for abruption, the presence of free fluid in the peritoneum and hemodynamic instability in a woman with a prior C-section points more towards rupture. *Ectopic pregnancy and abortion* - An **ectopic pregnancy** is ruled out by the 36-week gestational age; these occur much earlier in pregnancy. - An **abortion** refers to the termination of pregnancy and does not cause these specific signs and symptoms at 36 weeks. *Impending dehiscence and Laparoscopy* - **Impending dehiscence** (separation of the uterine scar without complete rupture) would likely cause localized pain but typically not the severe signs of **hypovolemic shock** and free peritoneal fluid seen here. - **Laparoscopy** is a minimally invasive procedure and would not be appropriate for the emergency management of a potentially life-threatening hemorrhage from uterine rupture.

Q: A newly married couple, the woman is having irregular menstruation. What is the contraceptive of choice?

OCP. ***OCP*** - **Oral Contraceptive Pills (OCPs)** are a highly effective method that also help regulate **menstrual cycles** due to their hormonal content. - They provide effective contraception while simultaneously addressing the symptom of **irregular menstruation** in a newly married woman. *Barrier method* - **Barrier methods** like condoms are effective for contraception but do not address or regulate irregular menstrual cycles. - Their effectiveness depends heavily on consistent and correct use with each act of intercourse. *Calendar method* - The **calendar method** relies on tracking the menstrual cycle to predict fertile windows and is unreliable with **irregular menstruation**. - It would be ineffective as a contraceptive for a woman with unpredictable cycle lengths, leading to a high risk of unintended pregnancy. *Progesterone only pills* - **Progesterone-only pills** (POPs) can be used for contraception, but they may cause or exacerbate **menstrual irregularities**. - While effective in preventing pregnancy, they do not offer the cycle-regulating benefits that combination OCPs do for women with irregular periods.

Q: Which tumor arises from embryonic neural cells?

Medulloblastoma. ***Medulloblastoma*** - This tumor arises from **embryonic neural cells** in the **cerebellum**. - It is a highly malignant **brain tumor** most commonly found in children [1]. *Fibrous astrocytoma* - This is a type of **glioma** that arises from **mature astrocytes**, not embryonic neural cells. - It typically occurs in adults and can be found in various locations within the brain. *Neuroglioma* - This is a broad term that refers to **tumors of neuroglial origin**, meaning they arise from glial cells. - It does not specifically refer to a tumor originating from embryonic neural cells. *Ependymoma* - This tumor arises from **ependymal cells**, which line the **ventricles** and **spinal canal**. - While these are technically neural cells, they are more differentiated than the embryonic neural cells that give rise to medulloblastoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1314-1315.

Q: Initial radiological finding seen in knee TB

Increase in joint space. ***Increase in joint space*** - Early **tuberculous synovitis** leads to synovial hypertrophy and effusion, causing an **increase in joint space** due to fluid accumulation on imaging. - This is the **initial radiological finding** before significant cartilage destruction or bone erosion occurs. - Part of **Phemister's triad** (juxta-articular osteoporosis, peripheral erosions, and gradual joint space reduction in later stages). *Reduction of joint space* - **Joint space narrowing** typically occurs later in the disease as the **cartilage is destroyed**. - This finding is more characteristic of advanced tuberculous arthritis, not the initial stages of knee TB. *Bone resorption* - **Bone resorption (osteolysis)** is a later manifestation of knee TB, often seen with **caseous necrosis** and subchondral bone involvement. - It does not represent the very initial radiological changes, which are primarily synovial-based. *Degeneration of cartilage* - While cartilage is eventually affected by knee TB, **cartilage degeneration** leading to significant changes visualized on imaging is a later event. - The initial presentation is more about synovial inflammation and fluid buildup causing increased joint space.

Q: Distal ileum was removed in a 20-year-old girl. Which absorption deficiency will be seen?

Bile salts. ***Bile salts*** - The **distal ileum** is the primary site for the active reabsorption of **bile salts** back into the enterohepatic circulation. - Their malabsorption leads to **fat malabsorption** and steatorrhea, and can lead to gallstones due to changes in bile composition. *Iron* - The majority of **iron absorption** primarily occurs in the **duodenum** and proximal jejunum, not the distal ileum. - Iron deficiency would typically result from issues higher up in the small intestine or from chronic blood loss. *Copper* - **Copper absorption** mainly occurs in the **stomach** and **duodenum**. - Deficiency typically arises from dietary inadequacy or specific genetic disorders, not distal ileal resection. *Zinc* - **Zinc absorption** occurs throughout the **small intestine**, with significant absorption in the **jejunum**. - While some zinc is absorbed in the ileum, its primary absorption site is not limited to or predominantly in the distal ileum, making malabsorption less likely with isolated distal ileum removal.

Question 1

Which of the following is present in skeletal muscle?

Accepted Answer

GLUT 4

Answer

GLUT 2

Answer

GLUT 7

Answer

GLUT 5

Question 2

Which of the following is cardio protective?

Accepted Answer

HDL

Answer

Chylomicron

Answer

VLDL

Answer

LDL

Question 3

In autopsy, which organ is removed with liver?

Accepted Answer

Spleen

Answer

Stomach

Answer

Kidney

Answer

Brain

Question 4

Diagnosis of Gout is confirmed by which test?

Accepted Answer

Synovial fluid analysis

Answer

X- ray changes

Answer

Urine uric acid levels

Answer

Serum Uric acid level

Question 5

Whipple's disease is caused by:

Accepted Answer

Bacteria

Answer

Virus

Answer

Helminths

Answer

Protozoa

Question 6

A lady with 36-week pregnancy with previous C-section comes with low BP, tachycardia, and on USG fluid present in peritoneum. What is the diagnosis and next management?

Accepted Answer

Uterine scar rupture with Laparotomy

Answer

Abruptio and C-section

Answer

Ectopic pregnancy and abortion

Answer

Impending dehiscence and Laparoscopy

Question 7

A newly married couple, the woman is having irregular menstruation. What is the contraceptive of choice?

Accepted Answer

OCP

Answer

Barrier method

Answer

Calendar method

Answer

Progesterone only pills

Question 8

Which tumor arises from embryonic neural cells?

Accepted Answer

Medulloblastoma

Answer

Fibrous astrocytoma

Answer

Neuroglioma

Answer

Ependymoma

Question 9

Initial radiological finding seen in knee TB

Accepted Answer

Increase in joint space

Answer

Reduction of joint space

Answer

Bone resorption

Answer

Degeneration of cartilage

Question 10

Distal ileum was removed in a 20-year-old girl. Which absorption deficiency will be seen?

Accepted Answer

Bile salts

Answer

Iron

Answer

Copper

Answer

Zinc

FMGE 2019

Biochemistry

Forensic Medicine

Internal Medicine

Microbiology

Obstetrics and Gynecology

Pathology

Radiology

Surgery