FMGE 2023 Practice Questions

Q: Which of the following is not a component of the RCH program?

Women education and empowerment. ***Women education and empowerment*** - This component addresses **social determinants of health** and is a broader outcome or goal of improving health indicators, not a listed, direct service pillar of the RCH (Reproductive and Child Health) program. - RCH focuses on integrated delivery of specific health services like **Safe Motherhood**, Child Health, Family Planning, and RTI/STD management. *Safe motherhood* - This is a core component, encompassing services like **Antenatal Care (ANC)**, skilled birth attendance, and **Postnatal Care (PNC)** to reduce maternal mortality and morbidity. - It emphasizes ensuring access to quality institutional delivery and emergency obstetric care (EOC). *Children and new-born care* - This is a critical component covering essential services such as **immunization**, management of neonatal and childhood illnesses (e.g., through **IMNCI**), and nutrition. - The goal is to reduce infant and child morbidity and mortality rates. *Screening and treatment of STD/RTI* - This element is integral to reproductive health, focusing on **prevention, diagnosis, and treatment** of Reproductive Tract Infections (RTI) and **Sexually Transmitted Diseases (STD)**. - It helps prevent complications like infertility and adverse pregnancy outcomes, particularly important for ensuring safe motherhood.

Q: A surveyor visits a household consisting of a 35-year-old man, his wife who is 6 weeks pregnant and a 3-year-old child. The man's brother along with his wife is currently visiting them for a month owing to winter vacation. What type of family would the surveyor classify the household?

Nuclear family. ***Nuclear family***- A **nuclear family** consists of a couple and their unmarried children living together, which includes the man, his wife, and their 3-year-old child. - The presence of the man's brother and his wife is **temporary** (only for a month for vacation) and does not change the classification of the permanent household unit. *Joint family*- A **joint family** is created when two or more nuclear families live together (e.g., married sons living with their parents) and share possessions and usually a common kitchen. - Since the brother and his wife are only temporary guests and not permanent members of the household, the definition of a joint family is not met. *Extended family*- An **extended family** is a nuclear family plus one or more non-immediate relatives who live under the same roof permanently (e.g., a grandparent or an unmarried aunt/uncle). - The visiting brother and his wife are not permanent residents, thus failing to meet the criteria for an extended family. *Third generation family*- A **third generation family** (or three-generation family) requires members from three distinct generations to be living together (e.g., grandparents, parents, and children). - This household only contains two generations (the parents and their child); the brother belongs to the same generation as the man.

Q: What is the denominator in infant mortality rate?

1000. ***Correct: 1000*** - The **Infant Mortality Rate (IMR)** is standardly calculated as the number of deaths of infants under one year of age per **1000 live births** in a given population and time period - This denominator (per **1000 live births**) is the international standard adopted by organizations like the **WHO** for standardized calculation and comparison of vital rates - IMR is expressed as deaths per 1000 live births, making it directly comparable across different populations and time periods *Incorrect: 100* - A denominator of **100** is used when expressing a rate as a **percentage**, which is not the conventional methodology for reporting IMR - Using 100 as the denominator would convert the IMR into a percentage, which is not conducive to reliable international comparisons - Standard vital statistics use 1000 as the base denominator *Incorrect: 10,000* - A denominator of **10,000** is occasionally used for reporting rates of very specific, **less common** public health events or diseases - It is **not** the traditional choice for IMR; standard indices of mortality (like Crude Death Rate, Birth Rate, IMR) rely on a base of **1000** *Incorrect: 1,00,000* - A denominator of **1,00,000** (one lakh) is primarily used when calculating incidence or prevalence of extremely **rare diseases** or specific morbidity rates in large populations - While it provides larger whole numbers, it violates the conventional rule that major vital statistics rates (like IMR) use **1000** as the denominator

Q: A 6-month-old baby presents with a bright red, raised, soft nodule measuring 2 cm in diameter on the forehead. The lesion has well-defined borders, appeared 2 weeks after birth as a small red spot, and has been growing rapidly over the past few months. The surface has a characteristic strawberry-like appearance with a lobulated texture. What is the most likely diagnosis?

Capillary hemangioma. ***Capillary hemangioma*** - Also known as a **strawberry hemangioma**, this is the most common benign vascular tumor of infancy, appearing as a bright red, raised, soft plaque or nodule with sharply defined borders. - These lesions are characterized by an initial rapid **proliferative phase** typically occurring in the first year of life, followed by a slow, eventual **spontaneous involution**. *Portwine stain* - This is a vascular **capillary malformation**, characterized by a flat (**macular**) pink, red, or purple patch that is present at birth. - Unlike hemangiomas, portwine stains **do not involute** spontaneously and persist throughout life; they may thicken and darken over time. *Cavernous hemangioma* - This term is often used for hemangiomas that are **deeper** (involving the reticular dermis and subcutaneous tissue), resulting in a blue, soft, or ill-defined mass. - While they also undergo spontaneous involution, they lack the characteristic superficial, bright red, **raised** appearance seen in typical capillary (strawberry) hemangiomas. *Naevus simplex* - Also known as a **salmon patch** or **stork bite**, this is a common, faint, macular pink-to-red vascular mark typically found on the nape of the neck, eyelids, or glabella. - These lesions are transient and usually **fade completely** before 18 months of age, unlike capillary hemangiomas which are raised and generally take longer to involute.

Q: A patient presents with a violaceous rash on the upper back and shoulders (img-16.jpeg) and Gottron's papules on hands (img-17.jpeg). What is the likely diagnosis?

Dermatomyositis. ***Dermatomyositis*** - The presence of a **heliotrope rash** (violaceous eruption on the upper eyelids) and **Gottron's papules** (violaceous papules over the knuckles) are pathognomonic for this inflammatory myopathy. - Other characteristic skin findings include the **shawl sign** (a photosensitive rash on the upper back, shoulders, and posterior neck, as seen in the image), the **V-sign**, and associated proximal muscle weakness. *Systemic lupus erythematosus* - SLE is classically associated with a **malar rash** (butterfly rash) over the bridge of the nose and cheeks, which spares the nasolabial folds. - While photosensitivity is a common feature, the specific findings of a heliotrope rash and Gottron's papules are not typical for SLE. *Systemic sclerosis* - This condition is characterized by progressive **skin thickening** and fibrosis, particularly **sclerodactyly** (tightening of the skin on the fingers). - Key differentiating features include **Raynaud phenomenon** and internal organ involvement, which are absent in this presentation. *Cushing syndrome* - This endocrine disorder is caused by excess **cortisol** and presents with distinct features like a **moon face**, **buffalo hump**, and purple **striae**. - It does not cause the inflammatory, photosensitive rashes that are characteristic of dermatomyositis.

Q: An 18-year-old female patient comes with the following findings. Which of the following is pathognomonic of the primary stage of this disease?

Comedone. ***Comedone*** - The **comedo** is the primary, pathognomonic lesion of **acne vulgaris**. It is a non-inflammatory lesion formed by a blocked **pilosebaceous unit** with sebum and keratinocytes. - Comedones can be open (**blackheads**) or closed (**whiteheads**) and are the precursor to all inflammatory acne lesions like papules and pustules. *Papule* - A **papule** is a small, solid, raised inflammatory lesion that develops when a comedo ruptures, leading to an inflammatory response. - It represents a progression from the non-inflammatory primary stage to **inflammatory acne** and is therefore not the initial lesion. *Pustule* - A **pustule** is a superficial inflammatory lesion containing visible purulent material (pus), which typically evolves from a papule. - The presence of pus signifies a more advanced inflammatory process involving **Propionibacterium acnes** and neutrophils, not the primary stage. *Abscess* - An **abscess** is a deep, painful, pus-filled lesion that is characteristic of severe **nodulocystic acne**, a more advanced form of the disease. - This represents a severe inflammatory response and is not the primary lesion, which is much smaller and non-inflammatory.

Q: A 50-year-old female patient with a known case of ovarian cancer presents with difficulty in activities like climbing stairs, getting up from a chair, combing hair, etc. The following characteristic sign was found on examination. The most probable diagnosis is:

Dermatomyositis. ***Dermatomyositis*** - This diagnosis is strongly suggested by the combination of **symmetric proximal muscle weakness** (difficulty climbing stairs, combing hair) and the characteristic **Shawl sign**, an erythematous rash over the shoulders, neck, and upper back as shown in the image. - Dermatomyositis is a well-known **paraneoplastic syndrome**, frequently associated with underlying malignancies, particularly **ovarian cancer** in women, which aligns perfectly with the patient's history. *Systemic lupus erythematosus* - The classic cutaneous feature of SLE is a **malar rash** (butterfly rash) on the face; while other photosensitive rashes can occur, the Shawl sign is more specific to dermatomyositis. - Although SLE can present with myositis, the strong association with an underlying ovarian cancer makes dermatomyositis a more probable diagnosis. *Systemic sclerosis* - The primary feature of systemic sclerosis is **widespread fibrosis** and thickening of the skin (**scleroderma**), typically starting in the fingers (**sclerodactyly**), which is not described. - Muscle weakness in systemic sclerosis is usually due to disuse atrophy or fibrosis rather than a primary inflammatory myopathy, and it does not present with the rash seen. *Cushing syndrome* - While Cushing syndrome can cause **proximal muscle weakness** due to steroid myopathy, its characteristic skin findings include **violaceous striae**, easy bruising, and plethora, not a Shawl sign. - The inflammatory nature of the rash seen in the image is inconsistent with the endocrine and metabolic changes of Cushing syndrome.

Q: A young male patient presents with ptosis and muscle weakness, which reportedly worsens in the evening and improves in the morning. This is relieved by neostigmine. What is the likely diagnosis?

Myasthenia gravis. ***Myasthenia gravis***- The presentation of muscle weakness, specifically **ptosis**, that worsens with fatigue (evening) or activity and improves with rest (morning), is the classic hallmark of the autoimmune condition **Myasthenia Gravis (MG)**.- The dramatic improvement upon administration of **neostigmine** (an acetylcholinesterase inhibitor) is diagnostic, confirming impaired transmission at the **neuromuscular junction** due to autoantibodies against **acetylcholine receptors (AChR)** [1].*Huntington chorea*- This is a progressive, inherited neurodegenerative disorder primarily characterized by involuntary, jerky movements (**chorea**) and cognitive decline. - It is related to excessive CAG trinucleotide repeats on chromosome 4, leading to neuronal loss in the **caudate nucleus**, and does not respond to neostigmine.*Amyotrophic lateral sclerosis*- ALS is a motor neuron disease characterized by progressive and unrelenting weakness due to the loss of both **upper and lower motor neurons**.- The weakness in ALS is permanent, not fluctuating diurnally, and does not improve with acetylcholinesterase inhibitors like neostigmine.*External ophthalmoplegia*- This is a descriptive term referring to weakness or paralysis of the external eye muscles; while it is often seen in MG (where it is often called ocular MG), it is a symptom, not the overall diagnosis.- This term does not explain the generalized muscle weakness, the pattern of **fatigability**, or the characteristic response to **neostigmine**.

Q: In a primigravida what is a satisfactory dilation rate?

1.2 cm/hr. ***1.2 cm/hr***- This rate is the classical minimum acceptable cervical dilation velocity during the **active phase of labor** in a **primigravida**, according to the Friedmann curve.- A dilation rate falling below **1.2 cm/hr** in a primigravida is generally treated as an abnormally slow progression, or a **protraction disorder**.*0.5 cm/hr*- A dilation rate of **0.5 cm/hr** is significantly protracted and would be indicative of a high-risk labor pattern requiring re-evaluation and typically intervention, such as **oxytocin augmentation**.- Even the modern, slower labor curves (Zhang curve) do not support such a slow rate as satisfactory for the entire active phase.*0.75 cm/hr*- This rate is below the recognized minimum benchmark of **1.2 cm/hr** for a primigravida during the active phase of labor.- Persistence at this slow rate would likely lead to a diagnosis of **protracted active phase** and increase the risk of maternal and fetal complications.*1.5 cm/hr*- While **1.5 cm/hr** represents rapid and favorable cervical progression, the classical standard for the *minimum satisfactory* rate in a primigravida is established as **1.2 cm/hr**.- **1.5 cm/hr** is often cited as the minimum satisfactory rate for a **multigravida**, who generally progresses faster than a primigravida.

Q: A patient on anti-cancer therapy developed an infection. Blood analysis revealed neutropenia. Which of the following drugs is likely to be effective in this patient?

Filgrastim. ***Filgrastim***- It is a recombinant form of **granulocyte colony-stimulating factor (G-CSF)**, which stimulates the proliferation and differentiation of neutrophil precursors in the bone marrow.- It is the standard treatment for **chemotherapy-induced neutropenia** (as seen in patients on anti-cancer therapy) to raise neutrophil counts and reduce infection risk.*Romiplostim*- This drug is a **thrombopoietin (TPO) receptor agonist** used to stimulate platelet production.- It is indicated for conditions like **immune thrombocytopenia** and would not be effective in stimulating neutrophil recovery in neutropenia.*Oprelvekin*- It is a recombinant form of **interleukin-11 (IL-11)**, indicated specifically for the prevention of severe **thrombocytopenia** following myelosuppressive chemotherapy.- While it has some broad hematopoietic effects, its primary clinical use is platelet restoration, making it ineffective for acute **neutropenia** in this context.*Epoetin alfa*- This drug is a recombinant form of **erythropoietin (EPO)**, primarily used to stimulate red blood cell production to treat **anemia**.- It specifically targets the erythroid lineage and has no clinical utility in increasing **neutrophil** counts.

Question 1

Which of the following is not a component of the RCH program?

Accepted Answer

Women education and empowerment

Answer

Children and new-born care

Answer

Screening and treatment of STD/RTI

Answer

Safe motherhood

Question 2

A surveyor visits a household consisting of a 35-year-old man, his wife who is 6 weeks pregnant and a 3-year-old child. The man's brother along with his wife is currently visiting them for a month owing to winter vacation. What type of family would the surveyor classify the household?

Accepted Answer

Nuclear family

Answer

Third generation family

Answer

Joint family

Answer

Extended family

Question 3

What is the denominator in infant mortality rate?

Accepted Answer

1000

Answer

100

Answer

10,000

Answer

1,00,000

Question 4

A 6-month-old baby presents with a bright red, raised, soft nodule measuring 2 cm in diameter on the forehead. The lesion has well-defined borders, appeared 2 weeks after birth as a small red spot, and has been growing rapidly over the past few months. The surface has a characteristic strawberry-like appearance with a lobulated texture. What is the most likely diagnosis?

Accepted Answer

Capillary hemangioma

Answer

Portwine stain

Answer

Naevus simplex

Answer

Cavernous hemangioma

Question 5

A patient presents with a violaceous rash on the upper back and shoulders (img-16.jpeg) and Gottron's papules on hands (img-17.jpeg). What is the likely diagnosis?

Accepted Answer

Dermatomyositis

Answer

Systemic lupus erythematosus

Answer

Systemic sclerosis

Answer

Cushing syndrome

Question 6

An 18-year-old female patient comes with the following findings. Which of the following is pathognomonic of the primary stage of this disease?

Accepted Answer

Comedone

Answer

Pustule

Answer

Abscess

Answer

Papule

Question 7

A 50-year-old female patient with a known case of ovarian cancer presents with difficulty in activities like climbing stairs, getting up from a chair, combing hair, etc. The following characteristic sign was found on examination. The most probable diagnosis is:

Accepted Answer

Dermatomyositis

Answer

Systemic lupus erythematosus

Answer

Systemic sclerosis

Answer

Cushing syndrome

Question 8

A young male patient presents with ptosis and muscle weakness, which reportedly worsens in the evening and improves in the morning. This is relieved by neostigmine. What is the likely diagnosis?

Accepted Answer

Myasthenia gravis

Answer

Huntington chorea

Answer

Amyotrophic lateral sclerosis

Answer

External ophthalmoplegia

Question 9

In a primigravida what is a satisfactory dilation rate?

Accepted Answer

1.2 cm/hr

Answer

1.5 cm/hr

Answer

0.5 cm/hr

Answer

0.75 cm/hr

Question 10

A patient on anti-cancer therapy developed an infection. Blood analysis revealed neutropenia. Which of the following drugs is likely to be effective in this patient?

Accepted Answer

Filgrastim

Answer

Epoetin alfa

Answer

Oprelvekin

Answer

Romiplostim

FMGE 2023

Community Medicine

Dermatology

Internal Medicine

Obstetrics and Gynecology

Pharmacology