FMGE 2019 Practice Questions

Q: Ammonia formed in the brain is converted into

Glutamine. ***Glutamine*** - **Ammonia** is detoxified in the brain by combining with **glutamate** to form **glutamine** via the enzyme **glutamine synthetase**. - This conversion is crucial because **glutamine** is non-toxic and can be safely transported out of the brain to the liver for further processing. *Glycine* - **Glycine** is an amino acid that can function as a neurotransmitter, but it is not the primary product of ammonia detoxification in the brain. - While it can be synthesized in the brain, it does not serve as the molecule to which toxic ammonia is directly converted for transport. *Urea* - **Urea** is the primary end-product of ammonia detoxification in the **liver** through the **urea cycle**. - The brain lacks the complete set of enzymes required for the **urea cycle**, so it cannot convert ammonia into urea. *Cysteine* - **Cysteine** is a sulfur-containing amino acid involved in protein synthesis and antioxidant defense, but it is not directly involved in the detoxification pathway of ammonia in the brain. - Its synthesis and metabolism are distinct from the process of ammonia sequestration.

Q: Which is not a contraindication for OPV?

Diarrhoea. ***Diarrhoea*** - **Diarrhoea** is not considered a contraindication for OPV; while it may reduce vaccine efficacy, the vaccine should still be administered. - Minor illnesses, including mild **gastrointestinal upset**, are not reasons to defer vaccination. *Leukemia* - **Leukemia** is a **malignancy** of the blood cells, leading to an **immunocompromised state**. - Live vaccines like OPV are generally **contraindicated** in individuals with leukemia due to the risk of vaccine-associated paralytic poliomyelitis (VAPP). *Malignancy* - Children with **malignancies**, especially those undergoing treatment like **chemotherapy** or **radiation**, are often **immunocompromised**. - Live oral vaccines are typically **contraindicated** in these patients to prevent serious infections from the live attenuated virus. *Immunocompromised* - Being **immunocompromised**, whether due to disease (e.g., HIV, primary immunodeficiency) or medication (e.g., high-dose corticosteroids), is a **contraindication** for live attenuated vaccines like OPV. - The weakened immune system cannot effectively clear the vaccine virus, leading to a higher risk of **serious infection** or **vaccine-associated paralysis**.

Q: A lady, when exposed to cold, experiences extremities turning blue. Which of the following antibodies is associated with this condition?

Anti-SCL-70. Anti-SCL-70 - The symptom of extremities turning blue, especially upon cold exposure, describes **Raynaud's phenomenon**, a common feature of **systemic sclerosis (scleroderma)** [1]. - **Anti-SCL-70 antibodies** (topoisomerase 1 antibodies) are highly specific for **diffuse cutaneous systemic sclerosis**, a severe form of the disease often associated with Raynaud's. *Anti-RO* - **Anti-RO (SSA) antibodies** are primarily associated with **Sjögren's syndrome** and **subacute cutaneous lupus erythematosus**, conditions not typically characterized by prominent Raynaud's as the presenting symptom [2]. - While Sjögren's syndrome can have Raynaud's, it's not the defining feature and other symptoms like **dry eyes** and **dry mouth** would likely be present. *Anti-SS-B* - **Anti-SS-B (La) antibodies** are also associated with **Sjögren's syndrome**, often appearing alongside anti-RO antibodies [2]. - Their presence does not directly point to diffuse systemic sclerosis or severe Raynaud's as the primary condition. *Anti-SS-A* - **Anti-SS-A (RO) antibodies** are primarily linked to **Sjögren's syndrome** and **neonatal lupus**, and can also be seen in **systemic lupus erythematosus** [2]. - While Raynaud's can occur in lupus, the presence of isolated cold-induced blue extremities points more strongly towards systemic sclerosis given the provided options.

Q: True about Crohn's disease except

Rectum is involved. ***Rectum is involved*** - While Crohn's disease can affect any part of the gastrointestinal tract from mouth to anus, **rectal involvement is much less common** and often spares the rectum in typical cases, especially when compared to ulcerative colitis. [1] - The disease typically exhibits **skip lesions**, meaning there are healthy segments of the bowel between affected areas, and the rectum is frequently one of these spared regions. [1] *Transmural* - Crohn's disease is characterized by **transmural inflammation**, meaning the inflammation extends through all layers of the bowel wall, from the mucosa to the serosa. [1] - This transmural involvement can lead to complications such as **fistulas, strictures, and abscesses**. *Recurrence is more common* - **Recurrence after surgery is very common** in Crohn's disease, with many patients experiencing disease relapse within a few years post-operation. - This high recurrence rate often necessitates ongoing medical management and sometimes further surgical interventions. *Fissures are formed* - Due to the **transmural inflammation** and chronic nature of Crohn's disease, patients often develop **fissures**, which are deep cracks or excoriations, particularly in the perianal area. - These fissures can be quite painful and complicated by **fistula formation** or abscesses.

Q: Which antibody is seen in recent infection?

IgM. ***IgM*** - **IgM** is the first antibody produced during a **primary immune response** to a new infection. - Its presence indicates a **recent or ongoing acute infection**. *IgE* - **IgE** is primarily associated with **allergic reactions** and defense against parasites. - It is not typically an indicator of a recent bacterial or viral infection. *IgD* - **IgD** is mostly found on the surface of **B cells** and plays a role in B cell activation. - Its function in circulating blood is not well understood, and it is not used to diagnose recent infection. *IgG* - **IgG** is the most abundant antibody in serum and represents a **secondary, more delayed immune response**. - Its presence indicates **past exposure or chronic infection**, as it provides long-term immunity.

Q: Internal hordeolum is due to inflammation of-

Meibomian glands. ***Meibomian glands (Correct)*** - An **internal hordeolum** results from acute **bacterial infection** (usually *Staphylococcus aureus*) and inflammation of a **Meibomian gland**, which are modified sebaceous glands located within the tarsal plate of the eyelid. - These glands produce the **lipid layer** of the tear film, and their blockage and infection lead to a painful, red lump on the **inner surface of the eyelid**. *Moll's gland (Incorrect)* - **Moll's glands** are modified apocrine sweat glands located near the base of the eyelashes. - Inflammation or infection of a Moll's gland would more commonly contribute to an **external hordeolum (stye)**, not an internal one. *Lacrimal gland (Incorrect)* - The **lacrimal gland** produces the watery component of tears and is located in the superotemporal orbit. - Inflammation of the lacrimal gland is called **dacryoadenitis**, which presents with swelling in the outer part of the upper eyelid and is distinct from a hordeolum. *Zeis gland (Incorrect)* - **Zeis glands** are sebaceous glands associated with the hair follicles of the eyelashes. - Similar to Moll's glands, infection of a Zeis gland is a common cause of an **external hordeolum (stye)**, which appears on the eyelid margin.

Q: Fleischer's ring is seen in?

Keratoconus. ***Keratoconus*** - **Fleischer's ring** is a brownish-yellow to greenish-brown ring of **iron deposition** (hemosiderin) in the **corneal epithelium** around the base of the cone in patients with **keratoconus**. - It is a specific sign of **keratoconus**, which is a progressive thinning and steepening of the cornea, causing it to bulge into a cone shape. *Keratoglobus* - **Keratoglobus** is a rare, non-inflammatory condition where the **entire cornea** becomes thin and globularly protrudes, unlike the localized cone in keratoconus. - It typically does not present with an isolated Fleischer's ring; other corneal findings may be present. *Keratomalacia* - **Keratomalacia** is corneal softening and necrosis caused by severe **vitamin A deficiency**. - It presents with xerosis (dryness), night blindness, and eventual corneal melting and perforation. - It does not involve iron deposition in the form of a Fleischer's ring. *Trachoma* - **Trachoma** is a chronic infectious disease of the eye caused by *Chlamydia trachomatis*, leading to scarring of the conjunctiva and cornea. - It is a leading cause of preventable blindness worldwide and is not associated with Fleischer's ring.

Q: Acute graft rejection occurs within?

< 6 months. ***< 6 months*** - **Acute graft rejection** typically occurs within the first few **weeks to months** after transplantation due to a T-cell mediated immune response against the donor organ [1]. - While it can manifest at any time, the majority of cases occur within the **first 6 months** post-transplant, making this the most appropriate time frame [1]. *Few minutes* - Rejection presenting within minutes of transplantation is characteristic of **hyperacute rejection**, which is caused by pre-existing **donor-specific antibodies** [1]. - This rapid form of rejection is mediated by **complement activation** and leads to immediate graft failure [1]. *6-12 months* - Rejection occurring in this timeframe might still be acute, but the peak incidence is generally earlier. - Rejection presenting after 6 months is often categorized as **late acute rejection** or may start to transition towards signs of chronic rejection, which occurs over a longer period. *Few hours* - Rejection within a few hours could be a very early form of **acute rejection** or a delayed presentation of **hyperacute rejection** [1]. - However, the classic presentation of acute rejection is more prolonged than a few hours, usually developing over days to weeks. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 241-242.

Q: Which muscle tendon is stretched in patellar tendon reflex?

Quadriceps femoris. ***Quadriceps femoris*** - The patellar tendon reflex is an example of a **stretch reflex**, where striking the patellar tendon directly stretches the quadriceps femoris muscle. - This stretch activates **muscle spindles** within the quadriceps, leading to its contraction and subsequent leg extension. *Biceps femoris* - The biceps femoris is part of the **hamstring muscle group**, located on the posterior aspect of the thigh. - Its primary action is **knee flexion** and hip extension, and it is not directly stretched during the patellar tendon reflex. *Semitendinosus* - The semitendinosus is also a **hamstring muscle** and functions in knee flexion and hip extension. - It is located medially on the posterior thigh and is not involved in the patellar tendon reflex arc. *Adductor magnus* - The adductor magnus is a large muscle on the **medial side of the thigh**, primarily responsible for **hip adduction**. - It is not directly stretched by tapping the patellar tendon and does not participate in the patellar reflex.

Q: A woman has mild depressive symptoms a few days after delivery that disappear within 2 weeks postpartum. The most likely cause is ______

Postpartum blues. ***Postpartum blues*** - **Mild depressive symptoms** that onset a few days after delivery and resolve within **two weeks postpartum** are characteristic of postpartum blues. - This condition is very common, affecting 50-80% of new mothers, and is thought to be due to **hormonal shifts** and **sleep deprivation**. *Major depression* - **Major depression** involves more severe and persistent symptoms that last for **at least two weeks** and significantly impair functioning, often requiring intervention. - While it can occur postpartum (postpartum depression), the **mild nature** and rapid resolution of symptoms in this case make it less likely. *Mania* - **Mania** is characterized by elevated mood, increased energy, racing thoughts, and decreased need for sleep, which are not described here. - This condition is typically associated with **bipolar disorder** and represents a distinct mood disturbance from the mild depressive symptoms described. *Postpartum psychosis* - **Postpartum psychosis** is a severe and rare psychiatric emergency characterized by **hallucinations, delusions, and disorganized behavior**. - Its rapid onset, severe symptoms, and high risk of harm to mother and baby are distinct from the mild, self-resolving symptoms presented.

Question 1

Ammonia formed in the brain is converted into

Accepted Answer

Glutamine

Answer

Glycine

Answer

Urea

Answer

Cysteine

Question 2

Which is not a contraindication for OPV?

Accepted Answer

Diarrhoea

Answer

Leukemia

Answer

Malignancy

Answer

Immunocompromised

Question 3

A lady, when exposed to cold, experiences extremities turning blue. Which of the following antibodies is associated with this condition?

Accepted Answer

Anti-SCL-70

Answer

Anti-RO

Answer

Anti-SS-B

Answer

Anti-SS-A

Question 4

True about Crohn's disease except

Accepted Answer

Rectum is involved

Answer

Transmural

Answer

Recurrence is more common

Answer

Fissures are formed

Question 5

Which antibody is seen in recent infection?

Accepted Answer

IgM

Answer

IgE

Answer

IgD

Answer

IgG

Question 6

Internal hordeolum is due to inflammation of-

Accepted Answer

Meibomian glands

Answer

Moll's gland

Answer

Lacrimal gland

Answer

Zeis gland

Question 7

Fleischer's ring is seen in?

Accepted Answer

Keratoconus

Answer

Keratoglobus

Answer

Keratomalacia

Answer

Trachoma

Question 8

Acute graft rejection occurs within?

Accepted Answer

< 6 months

Answer

Few minutes

Answer

6-12 months

Answer

Few hours

Question 9

Which muscle tendon is stretched in patellar tendon reflex?

Accepted Answer

Quadriceps femoris

Answer

Biceps femoris

Answer

Semitendinosus

Answer

Adductor magnus

Question 10

A woman has mild depressive symptoms a few days after delivery that disappear within 2 weeks postpartum. The most likely cause is ______

Accepted Answer

Postpartum blues

Answer

Major depression

Answer

Mania

Answer

Postpartum psychosis

FMGE 2019

Biochemistry

Community Medicine

Internal Medicine

Microbiology

Ophthalmology

Pathology

Physiology

Psychiatry