FMGE 2019 Practice Questions

Q: Keshan's disease is due to deficiency of:

Selenium. **Selenium (Correct Answer)** - **Keshan disease** is an endemic cardiomyopathy characterized by multifocal myocyte necrosis, which has been directly linked to a severe dietary deficiency of **selenium**. - Selenium is an essential component of **glutathione peroxidase**, an enzyme critical for protecting cells against oxidative damage. - The disease is named after Keshan County in China where it was first identified in selenium-deficient regions. *Iron (Incorrect)* - **Iron deficiency** primarily leads to **anemia**, characterized by fatigue, pallor, and weakness due to insufficient hemoglobin production. - It does not directly cause the specific cardiomyopathy seen in Keshan disease. *Zinc (Incorrect)* - **Zinc deficiency** can cause a range of symptoms including impaired immune function, skin lesions (acrodermatitis enteropathica), hair loss, and growth retardation. - It is not associated with the cardiac manifestations of Keshan disease. *Copper (Incorrect)* - **Copper deficiency** can result in anemia, neutropenia, impaired immune function, and neurological dysfunction (Menkes disease). - While copper is important for various metalloenzymes, its deficiency does not cause Keshan disease.

Q: Which of the following is a direct health impact of climate change?

Heat-related illnesses. ***Heat-related illnesses*** - Heat-related illnesses such as **heat stroke, heat exhaustion, and heat cramps** are direct health impacts of climate change resulting from increased frequency and intensity of **heat waves**. - Rising global temperatures directly increase the risk of **hyperthermia**, particularly among vulnerable populations including the elderly, children, outdoor workers, and those with chronic diseases. - This is considered a **primary direct health impact** as it results immediately from temperature changes without intermediate pathways. *Increased vector-borne diseases* - While vector-borne diseases (malaria, dengue, chikungunya) do increase with climate change due to expanded geographic range and breeding seasons of vectors, this is considered an **indirect health impact**. - Climate change affects vector ecology through temperature, rainfall, and humidity changes, which then influences disease transmission - involving an intermediate biological pathway. *Food insecurity and malnutrition* - Food insecurity and malnutrition are significant health consequences of climate change but are classified as **indirect impacts**. - They result from climate change effects on **agricultural productivity**, crop yields, food distribution systems, and water availability - multiple intermediate pathways exist between climate change and the health outcome. *Injuries from extreme weather events* - While injuries and deaths from extreme weather events (floods, cyclones, droughts) are important health impacts of climate change, they are often categorized differently from heat-related illnesses. - Heat-related illnesses represent the most **direct physiological response** to the primary manifestation of climate change (rising temperatures), making it the best answer for a "direct" health impact.

Q: McNaughton's rule is related to:

IPC 84. ***IPC 84*** - **McNaughton's rule** (also spelled M'Naghten rule) is a legal test for criminal insanity, stating that a defendant is not guilty if they were unaware of the nature of their actions or that their actions were wrong due to a "disease of the mind." - In India, **IPC 84** (Indian Penal Code Section 84) embodies the principles of McNaughton's rule, providing a defense for persons of unsound mind. *IPC 82* - **IPC 82** deals with the age of criminal responsibility, specifically stating that nothing done by a child under seven years of age is an offense. - This section is focused on the **infancy defense**, not mental illness or insanity. *IPC 87* - **IPC 87** pertains to acts not intended and not known to be likely to cause death or grievous hurt, done by consent. - It relates to the defense of **consent**, often in situations involving minor injuries in sports or medical procedures. *IPC 85* - **IPC 85** provides a defense for acts committed by a person who is incapable of knowing the nature of the act, or that it is wrong or contrary to law, due to **intoxication** caused without their knowledge or against their will. - This section specifically addresses involuntary intoxication, not a general "disease of the mind" as covered by McNaughton's rule.

Q: Increased susceptibility to N. meningitidis infections is associated with deficiency of which complement component:

C5-C9 deficiency. ***C5-C9 deficiency*** - Deficiencies in **C5-C9 components** impair the formation of the **Membrane Attack Complex (MAC)**, which is crucial for lysing Gram-negative bacteria like **N. meningitidis**. - Patients with MAC deficiencies are at significantly higher risk for recurrent invasive **N. meningitidis** infections. *C1-C4 deficiency* - Deficiencies in **C1-C4 components** primarily affect the **classical complement pathway** and are associated with increased susceptibility to **bacterial infections** and **immune complex diseases** (e.g., SLE). - While these deficiencies compromise opsonization and inflammation, they are not specifically linked to recurrent **N. meningitidis** infections. *C3 deficiency* - **C3 deficiency** is a severe primary immunodeficiency leading to profound defects in complement activation via all pathways, affecting **opsonization** and the formation of the MAC. - This deficiency causes severe recurrent **pyogenic infections** due to encapsulated bacteria but is not as specifically or commonly linked to **N. meningitidis** as deficiencies in the terminal pathway. *C2 deficiency* - **C2 deficiency** is the most common complement deficiency and primarily impacts the **classical pathway**, leading to impaired opsonization and immune complex clearance. - It is often associated with recurrent infections (especially with encapsulated bacteria) and **lupus-like syndromes**, but not specifically increased susceptibility to **N. meningitidis** infections.

Q: A 34-year-old lady with 4 children, after her 5th normal vaginal delivery, experiences excessive bleeding after the placenta is removed. What is the cause for this?

Uterine atony. ***Uterine atony*** - The most common cause of **postpartum hemorrhage (PPH)**, accounting for 70-80% of cases - **Multiparity** (Grand multipara with 5 deliveries) is a major risk factor, as repeated pregnancies lead to **overdistension and decreased uterine muscle tone** - Uterine atony is the failure of the myometrium to contract adequately after placental delivery, preventing compression of spiral arteries - Part of the **"4 Ts" mnemonic** for PPH causes: **Tone** (atony), Trauma, Tissue, Thrombin *Genital tract trauma* - Second most common cause of PPH (approximately 20% of cases) - Includes cervical lacerations, vaginal tears, or perineal trauma - However, the question specifically mentions **"normal vaginal delivery"** and bleeding **"after placenta removal"**, making trauma less likely - Trauma-related bleeding typically occurs **during or immediately after delivery**, not specifically post-placental *Retained placental tissue* - Accounts for approximately 10% of PPH cases - The question states the placenta **"is removed"**, suggesting complete placental delivery - If placental fragments were retained, bleeding would persist due to inability of the uterus to contract fully - Less likely given the clinical scenario described *Coagulation disorders* - Least common cause of primary PPH (1-2% of cases) - Includes conditions like **DIC, thrombocytopenia, or inherited coagulopathies** - No clinical history suggesting coagulopathy (e.g., no bleeding during pregnancy, no family history) - Would typically present with **oozing from multiple sites**, not just uterine bleeding

Q: Chronic granulomatous inflammation in upper lid (painless swelling) is characteristic of:

Chalazion. ***Chalazion*** - A chalazion is a **chronic**, sterile, **lipogranulomatous** inflammation of the **meibomian glands**. - It presents as a **painless**, firm, round swelling in the eyelid, often in the upper lid due to the larger meibomian glands. *Trachoma* - Trachoma is a **chronic keratoconjunctivitis** caused by *Chlamydia trachomatis*. - It primarily affects the conjunctiva and cornea, leading to scarring, entropion, and eventual blindness, not a painless eyelid swelling. *Internal Hordeolum* - An internal hordeolum is an **acute** bacterial infection of a **meibomian gland**, forming an abscess. - It is typically **painful**, red, and tender, contrasting with the painless nature of the given presentation. *External hordeolum* - An external hordeolum (stye) is an **acute** bacterial infection of the **glands of Zeis or Moll** at the lid margin. - It is usually **painful**, red, and tender, presenting as a small pustule or nodule on the eyelid margin, not a deep-seated painless swelling.

Q: Bell clapper deformity (abnormal testicular fixation) predisposes to which of the following conditions?

Testicular torsion. ***Testicular torsion*** - The **bell clapper deformity** describes an abnormally high attachment of the tunica vaginalis, leaving the testis and epididymis free to rotate within the scrotal sac. - This anatomical variation allows the spermatic cord to twist, cutting off blood supply to the testis, which is the mechanism of **testicular torsion**. *Hydrocele* - A **hydrocele** is a collection of fluid in the tunica vaginalis, resulting from an imbalance in fluid production and absorption, or a patent processus vaginalis. - It is not directly caused by abnormal testicular fixation. *Testicular atrophy* - **Testicular atrophy** is a reduction in testicular size, often due to conditions like cryptorchidism, mumps orchitis, or prolonged testicular torsion, but not predisposed by the bell clapper deformity itself unless torsion occurs. - While torsion can lead to atrophy if not promptly treated, the deformity directly predisposes to the torsion event, rather than atrophy itself. *Varicocele* - A **varicocele** is an abnormal dilation of the veins of the pampiniform plexus within the scrotum, usually due to incompetent valves or venous obstruction. - This condition is not associated with testicular fixation abnormalities.

Q: A 62-year-old female had a kidney stone and was treated with PCNL. After 2 days, she comes to the OPD with chills and fever. What is the complication?

Bacterial sepsis. ***Bacterial sepsis*** - **Chills and fever** two days after a **Percutaneous Nephrolithotomy (PCNL)** are highly suggestive of a systemic infection, specifically **bacterial sepsis**, as this procedure carries a risk of introducing bacteria into the bloodstream. - Urinary tract manipulation, especially in a patient with a potentially *infected kidney stone*, can lead to bacteremia and subsequent **sepsis** if not properly managed. *Acute pancreatitis* - **Acute pancreatitis** is not a common complication of PCNL. It typically presents with severe **epigastric pain** radiating to the back, often with nausea and vomiting, and is usually associated with gallstones or alcohol abuse. - While it can cause fever, the clinical presentation and context do not strongly support **pancreatitis** as the primary issue following a PCNL. *Ureteric stricture* - A **ureteric stricture** is a *late complication* of kidney stone treatment and typically leads to symptoms of **urinary obstruction**, such as flank pain, rather than acute fever and chills two days post-procedure. - It would not cause acute systemic signs like **chills and fever** within such a short timeframe after PCNL. *Splenic injury* - **Splenic injury** is a rare but possible complication of procedures around the left kidney; however, it would typically present with **abdominal pain**, signs of **hemorrhage** (e.g., hypotension), and sometimes shoulder pain, not primarily with fever and chills as the immediate post-operative concern. - While fever can occur with internal injuries, the primary and most immediate concern with fever and chills after a urological procedure is **infection**.

Q: What is the most common tumor of the mediastinum?

Neurogenic tumor. ***Neurogenic tumor*** - **Neurogenic tumors** are the **most common primary tumors of the mediastinum** overall, accounting for approximately **35-40%** of all mediastinal masses. - They are the most common tumors of the **posterior mediastinum** and arise from nerve sheaths (e.g., **schwannomas, neurofibromas**) or sympathetic ganglia. - These tumors occur across all age groups, with higher prevalence when including both pediatric and adult populations. *Thymoma* - **Thymomas** are the most common primary tumor of the **anterior mediastinum** in adults, accounting for about **40-50%** of anterior mediastinal masses. - However, they represent only about **20-25%** of all mediastinal tumors overall. - Often associated with paraneoplastic syndromes like **myasthenia gravis** (30-50% of cases). *Lymphoma* - **Lymphoma** is a common mediastinal tumor, particularly **Hodgkin lymphoma** in young adults, accounting for approximately **15-20%** of mediastinal masses. - It often presents with bulky mediastinal masses and symptoms like **dyspnea, cough, or superior vena cava syndrome**. - While very common, it ranks second or third overall after neurogenic tumors. *Neuroblastic tumor* - **Neuroblastic tumors** (e.g., neuroblastoma, ganglioneuroblastoma) are a subset of neurogenic tumors more common in **children**. - They arise from the sympathetic nervous system and typically occur in the posterior mediastinum. - While important in pediatric populations, they are less common than all neurogenic tumors combined.

Question 1

Keshan's disease is due to deficiency of:

Accepted Answer

Selenium

Answer

Iron

Answer

Zinc

Answer

Copper

Question 2

Which of the following is a direct health impact of climate change?

Accepted Answer

Heat-related illnesses

Answer

Food insecurity and malnutrition

Answer

Injuries from extreme weather events

Answer

Increased vector-borne diseases

Question 3

McNaughton's rule is related to:

Accepted Answer

IPC 84

Answer

IPC 82

Answer

IPC 87

Answer

IPC 85

Question 4

Increased susceptibility to N. meningitidis infections is associated with deficiency of which complement component:

Accepted Answer

C5-C9 deficiency

Answer

C1-C4 deficiency

Answer

C3 deficiency

Answer

C2 deficiency

Question 5

A 34-year-old lady with 4 children, after her 5th normal vaginal delivery, experiences excessive bleeding after the placenta is removed. What is the cause for this?

Accepted Answer

Uterine atony

Answer

Genital tract trauma

Answer

Retained placental tissue

Answer

Coagulation disorders

Question 6

Chronic granulomatous inflammation in upper lid (painless swelling) is characteristic of:

Accepted Answer

Chalazion

Answer

Trachoma

Answer

Internal Hordeolum

Answer

External Hordeolum

Question 7

Bell clapper deformity (abnormal testicular fixation) predisposes to which of the following conditions?

Accepted Answer

Testicular torsion

Answer

Hydrocele

Answer

Testicular atrophy

Answer

Varicocele

Question 8

A 62-year-old female had a kidney stone and was treated with PCNL. After 2 days, she comes to the OPD with chills and fever. What is the complication?

Accepted Answer

Bacterial sepsis

Answer

Acute pancreatitis

Answer

Ureteric stricture

Answer

Splenic injury

Question 9

A 6-month-old child presents with an umbilical hernia measuring 3 cm in diameter. What is the management protocol?

Accepted Answer

Observation until 2 years of age, then surgery if unresolved

Answer

Immediate surgical repair

Answer

Elective surgery at 5 years of age

Answer

Hernioplasty for repair

Question 10

What is the most common tumor of the mediastinum?

Accepted Answer

Neurogenic tumor

Answer

Thymoma

Answer

Lymphoma

Answer

Neuroblastic tumor

FMGE 2019

Biochemistry

Community Medicine

Forensic Medicine

Microbiology

Obstetrics and Gynecology

Ophthalmology

Surgery