FMGE 2019 Practice Questions

Q: What is the color of the nitrous oxide cylinder?

Blue. ***Blue*** - According to international color coding for medical gas cylinders, **nitrous oxide (N2O)** cylinders are uniformly colored **blue**. - This color coding helps in distinguishing different medical gases to prevent errors in healthcare settings. *Black* - **Black** is generally the color code for **nitrogen** cylinders in medical gas systems. - This color is distinct from nitrous oxide to avoid confusion during gas administration. *Blue body with white shoulder* - While cylinders have specific body and shoulder colors, a **blue body with a white shoulder** is typically associated with **medical air** in some regions, not nitrous oxide. - Nitrous oxide cylinders are completely blue. *White* - **White** is the color code for **oxygen** cylinders in some international and regional standards, though green is also common, depending on the country. - This color is not used for nitrous oxide cylinders.

Q: Most potent lipid phase antioxidant:

Vitamin E. ***Vitamin E*** - **Vitamin E** (primarily alpha-tocopherol) is a **fat-soluble antioxidant** that is highly effective at neutralizing **lipid peroxyl radicals** within cell membranes and lipoproteins, making it the most potent lipid-phase antioxidant. - It protects against **oxidative damage** to **polyunsaturated fatty acids** in lipid bilayers, which is crucial for maintaining cell membrane integrity. *Vitamin A* - **Vitamin A** (retinol and its derivatives) has antioxidant properties, particularly **beta-carotene**, which can scavenge **single oxygen radicals**. - However, its primary role is not as potent a lipid-phase chain-breaking antioxidant compared to vitamin E. *Vitamin C* - **Vitamin C** (ascorbic acid) is a **water-soluble antioxidant** that works primarily in aqueous environments, such as the cytosol and plasma. - It regenerates expended vitamin E by reducing the **tocopheroxyl radical**, but it doesn't directly act in the lipid phase. *Vitamin K* - **Vitamin K** is essential for **blood coagulation** and **bone metabolism**, serving as a cofactor for gamma-glutamyl carboxylase. - While it has some very limited antioxidant activity in specific contexts, it is not considered a significant or potent antioxidant, especially in the lipid phase.

Q: Posthumous birth is;

Child born after death of father. ***Child born after death of father*** - A **posthumous birth** specifically refers to a child born after the death of their biological father. - The concept is legally significant for **inheritance rights** and lineage, ensuring the child can inherit from their deceased father. - This is the classical and most widely accepted definition in **medico-legal practice**. *After death of both parents* - This scenario would lead to the child being an **orphan**, but the term "posthumous birth" specifically relates to the father's death before the child's birth. - While tragic, it doesn't align with the precise definition of **posthumous birth**. *Child born after death of mother* - While this represents a tragic scenario of **maternal mortality**, it is not the standard definition of posthumous birth. - The term posthumous birth traditionally refers to the **father's death** prior to birth, not the mother's. - This distinguishes it from cases of maternal death during or after delivery. *After death of mother during delivery* - This describes a case of **maternal mortality during childbirth**, not posthumous birth in the traditional sense. - The mother's death occurs during or after the birth process itself, not before the child's birth. - Posthumous birth specifically relates to the **father's death before the child is born**.

Q: The characteristic feature of an entry wound is:

Inversion. ***Inversion*** - An **entry wound** from a projectile, like a bullet, typically creates an **inversion** of the skin edges where it penetrates. - This is due to the **force pushing tissue inward**, causing the wound edges to be depressed below the surrounding skin surface. *Depression* - While it describes a sunken area, "depression" is a general term and does not specifically or accurately describe the **morphology of an entry wound** in forensic pathology. - It lacks the precision of terms like **inversion** when referring to the edge characteristics of a penetrating wound. *Pond's fracture* - **Pond's fracture** is a specific type of skull fracture in infants where a segment of bone is depressed but not completely separated. - This term is **not applicable** to the characteristics of a skin entry wound from a projectile. *Eversion* - **Eversion** refers to the turning outward of edges, which is characteristic of an **exit wound** where tissue is pushed outward by the exiting projectile. - It is the **opposite of what is seen at an entry wound**, where tissue is pushed inward.

Q: Which of the following is included in Celiac sprue diet?

Quinoa. ***Quinoa*** - Quinoa is a **naturally gluten-free grain** and is therefore safe for individuals with Celiac disease. - It serves as an excellent source of **protein, fiber, and essential nutrients**, making it a healthy and suitable staple in a gluten-free diet. *Wheat* - Wheat contains **gluten**, a protein that triggers an autoimmune response in individuals with Celiac disease [1]. - Consumption of wheat leads to damage of the **small intestinal villi**, causing malabsorption and various symptoms [2]. *Barley* - Barley also contains **gluten**, making it unsuitable for a Celiac sprue diet [1]. - It is often found in various food products, including malt, and must be strictly avoided to prevent **intestinal damage** [1]. *Rye* - Rye is another grain that contains **gluten** and is thus prohibited for individuals with Celiac disease [1]. - Similar to wheat and barley, consuming rye can provoke an **immune reaction** that damages the small intestine [2].

Q: All are risk factors of esophageal squamous cell carcinoma except:

GERD. ***GERD*** - **Gastroesophageal reflux disease (GERD)** is strongly associated with **esophageal adenocarcinoma**, not esophageal squamous cell carcinoma. - Chronic acid reflux can lead to **Barrett's esophagus**, which is a precursor to adenocarcinoma [1]. *Smoking* - **Smoking** is a significant and well-documented risk factor for **esophageal squamous cell carcinoma**, increasing the risk in a dose-dependent manner. - Carcinogens in tobacco smoke directly damage esophageal epithelial cells, promoting malignant transformation. *Achalasia cardia* - **Achalasia cardia** involves impaired relaxation of the lower esophageal sphincter and loss of peristalsis, leading to food stasis and chronic inflammation [2]. - This chronic irritation and inflammation significantly increase the risk of developing **esophageal squamous cell carcinoma**. *Alcohol* - **Alcohol consumption**, especially heavy drinking, is a major risk factor for **esophageal squamous cell carcinoma**. - Alcohol metabolizes into acetaldehyde, a known carcinogen, which directly damages DNA in esophageal cells.

Q: Double decidual sign is seen in?

Uterine gestational sac. ***Uterine gestational sac*** - The **double decidual sign** is a normal sonographic finding in early **intrauterine pregnancies**, representing the interface between the decidua capsularis and the decidua parietalis/vera. - It indicates a **viable intrauterine pregnancy** and helps differentiate it from a pseudogestational sac or ectopic pregnancy. *Pseudo gestational sac* - A pseudogestational sac is a collection of fluid within the **endometrial cavity** associated with an ectopic pregnancy. - It typically lacks the **double decidual sign** and may show internal echoes or irregular shape. *Threatened Abortion* - While it involves an intrauterine pregnancy, a threatened abortion is characterized by **vaginal bleeding** and/or mild cramping, with a closed cervix. - The presence of a **double decidual sign** confirms an intrauterine gestation but does not rule out the threat of abortion, as the viability is assessed by the presence of a fetal pole and heart activity. *Ectopic pregnancy* - An ectopic pregnancy occurs when the fertilized egg implants outside the uterus, most commonly in the **fallopian tubes**. - It will **not show a double decidual sign** within the uterus, although a pseudogestational sac might be present.

Q: Preferred drug for the treatment of ventricular tachycardia is

Lignocaine. ***Lignocaine*** *(Historical Answer for FMGE-2019)* - **Lignocaine** (also known as **lidocaine**) is a **Class IB antiarrhythmic** drug that was historically the preferred treatment for **ventricular tachycardia (VT)**, especially in patients with **ischemic heart disease**. - It works by **blocking sodium channels** in the heart, specifically targeting depolarized or partially depolarized cells, which helps to stabilize the ventricular rhythm. - **⚠️ IMPORTANT UPDATE:** Current guidelines (AHA/ACC 2015 onwards) now recommend **amiodarone as the first-line antiarrhythmic** for hemodynamically stable VT, with lignocaine as a **second-line alternative**. This question reflects the teaching prevalent at the time of FMGE-2019. *Digoxin* - **Digoxin** is a **cardiac glycoside** primarily used for **atrial fibrillation** with rapid ventricular response and **heart failure**. - It is **not the preferred drug** for ventricular tachycardia and can even precipitate arrhythmias in some cases. *Propranolol* - **Propranolol** is a **beta-blocker** (Class II antiarrhythmic) typically used to treat **supraventricular tachycardias**, **hypertension**, and **angina**. - While beta-blockers can have some role in preventing recurrent VT, they are **not the first-line treatment** for acute VT. *Diltiazem* - **Diltiazem** is a **calcium channel blocker** (Class IV antiarrhythmic) primarily used for **supraventricular tachycardias** and to control ventricular rate in **atrial fibrillation**. - It is **not effective** for ventricular tachycardia and may worsen the condition in some cases.

Q: All of the following drugs are used for prophylaxis of migraine except;

Flutamide. ***Flutamide*** - **Flutamide** is an **antiandrogen** used in the treatment of prostate cancer, not for migraine prophylaxis. - Its mechanism of action involves blocking androgen receptors, which is irrelevant to migraine pathophysiology. *Flunarizine* - **Flunarizine** is a **calcium channel blocker** commonly used for migraine prophylaxis due to its vascular effects. - It helps stabilize neuronal membranes and reduce cerebral vasospasm, preventing migraine attacks. *Imipramine* - **Imipramine** is a **tricyclic antidepressant (TCA)** that can be used off-label for migraine prevention due to its neuromodulatory effects. - It works by affecting neurotransmitter levels, particularly serotonin and norepinephrine, which play a role in migraine pathways. *Propranolol* - **Propranolol** is a **beta-blocker** widely used for migraine prophylaxis, especially in patients with coexisting hypertension or anxiety. - Its mechanism involves modulating adrenergic activity and potentially stabilizing cortical excitability.

Q: A 45-year-old policeman presents with pain in the right leg after duty. On examination, the pulse in the right popliteal fossa is absent, and there is pain in the right buttock. The left side is normal. At which level is the blockage?

Iliac. ***Iliac*** - Pain in the **right buttock** suggests a blockage in the **internal iliac artery** or its branches, which supply the gluteal muscles. - The absence of a pulse in the right **popliteal fossa** indicates significant arterial obstruction proximal to this level, consistent with an iliac artery lesion. *Popliteal* - A popliteal blockage would primarily cause symptoms below the knee, and would not explain **buttock pain**. - A popliteal pulse would be absent, but pulses proximal to the popliteal artery (like femoral) would generally be present. *Aortoiliac* - A blockage at the **aortoiliac** level might affect both legs or cause more widespread symptoms, but the description specifies the right leg. - While buttock pain can occur in aortoiliac occlusion, it often presents with bilateral claudication or erectile dysfunction (Leriche syndrome), which are not mentioned here. *Femoral* - A femoral blockage would cause symptoms in the thigh and calf, and would not explain **buttock pain** due to the collateral circulation. - The **femoral pulse** would be absent, but the pain distribution doesn't directly point to an isolated femoral lesion as the primary cause of buttock pain.

Question 1

What is the color of the nitrous oxide cylinder?

Accepted Answer

Blue

Answer

Black

Answer

Blue body with white shoulder

Answer

White

Question 2

Most potent lipid phase antioxidant:

Accepted Answer

Vitamin E

Answer

Vitamin A

Answer

Vitamin C

Answer

Vitamin K

Question 3

Posthumous birth is;

Accepted Answer

Child born after death of father

Answer

After death of both parents

Answer

Child born after death of mother

Answer

After death of mother during delivery

Question 4

The characteristic feature of an entry wound is:

Accepted Answer

Inversion

Answer

Depression

Answer

Pond's fracture

Answer

Eversion

Question 5

Which of the following is included in Celiac sprue diet?

Accepted Answer

Quinoa

Answer

Wheat

Answer

Barley

Answer

Rye

Question 6

All are risk factors of esophageal squamous cell carcinoma except:

Accepted Answer

GERD

Answer

Smoking

Answer

Achalasia cardia

Answer

Alcohol

Question 7

Double decidual sign is seen in?

Accepted Answer

Uterine gestational sac

Answer

Pseudo gestational sac

Answer

Threatened Abortion

Answer

Ectopic pregnancy

Question 8

Preferred drug for the treatment of ventricular tachycardia is

Accepted Answer

Lignocaine

Answer

Digoxin

Answer

Propranolol

Answer

Diltiazem

Question 9

All of the following drugs are used for prophylaxis of migraine except;

Accepted Answer

Flutamide

Answer

Flunarizine

Answer

Imipramine

Answer

Propranolol

Question 10

A 45-year-old policeman presents with pain in the right leg after duty. On examination, the pulse in the right popliteal fossa is absent, and there is pain in the right buttock. The left side is normal. At which level is the blockage?

Accepted Answer

Iliac

Answer

Popliteal

Answer

Aortoiliac

Answer

Femoral

FMGE 2019

Anesthesiology

Biochemistry

Forensic Medicine

Internal Medicine

Obstetrics and Gynecology

Pharmacology

Surgery