FMGE 2023 Practice Questions

Q: School health service should include all the following except

Doctor on premises. ***Doctor on premises***- A full-time, dedicated **doctor** is generally not considered an essential or standard component of basic school health services, which are typically managed by a **school health nurse** or auxiliary personnel.- School health services focus on periodic **health screening**, first aid, and referral services, rather than requiring an immediate physician presence for routine needs.*Education of handicapped children*- This falls under the necessary provision of **health promotion** and specialized services to ensure **inclusive education** for all students.- School health services must coordinate resources and adaptive support to facilitate the educational outcomes of children with **special needs**.*Dental and eye health services*- These are crucial components of **health screening** and early detection efforts required in school health services.- Identifying and referring issues like **dental caries** and **visual impairments** prevents academic hindrance and long-term morbidity.*School health records*- Maintaining comprehensive **cumulative health records** is paramount for monitoring the health status of students and ensuring continuity of care throughout their schooling.- These records are essential for tracking **immunization status**, screening results, and medical history, which is critical during emergencies.

Q: How much percent of GNP does WHO recommend being spent on the healthcare sector?

5%. ***5%***- The **World Health Organization (WHO)** recommends that countries aim to spend at least **5%** of their **Gross Domestic Product (GDP)** or **Gross National Product (GNP)** on health.- This minimum threshold is deemed necessary to establish basic **universal health coverage** and ensure robust primary healthcare services.*2.0%*- Spending only **2.0%** of GNP is drastically low and associated with poor health outcomes and high rates of **out-of-pocket expenses** for citizens.- This level of allocation is insufficient to fund essential public health functions or maintain a functional **healthcare system**.*2.5%*- While slightly better than 2.0%, **2.5%** remains well below the recognized international benchmark required for adequate health investment.- This level fails to provide resources for comprehensive care, including preventative services and necessary **infrastructure development**.*3.5%*- Allocating **3.5%** shows some governmental commitment but still falls short of the WHO's target for sustainable and effective health financing.- The shortfall between 3.5% and 5% often represents a gap in funding for critical areas like **health workforce training** and access to specialized care.

Q: Eligible couple registers are maintained at which of the following centres?

Sub-centre. ***Sub-centre (Correct Answer)*** - The **sub-centre** is the most peripheral and first contact point between the primary health care system and the community, typically serving 3,000 to 5,000 population - It is the operational unit responsible for maintaining essential household and community registers, including the **Eligible Couple Register**, used for planning and delivering family planning services - The **Auxiliary Nurse Midwife (ANM)** posted at the sub-centre maintains this register as part of grassroots family planning surveillance *PHC (Incorrect)* - A **Primary Health Centre (PHC)** serves a larger population (20,000 to 30,000) and supervises 4-6 sub-centres - Its role is more administrative and higher-level curative care - While the PHC utilizes the data for planning, the actual maintenance of the **Eligible Couple Register** is done at the sub-centre level *CHC (Incorrect)* - A **Community Health Centre (CHC)** functions as a referral center for 4 PHCs, offering specialized services like obstetrics, surgery, and pediatrics - Typically serves 80,000 to 1,20,000 population - CHCs are higher-level referral units and do not maintain ground-level household/couple-specific registers *District Hospital (Incorrect)* - The **District Hospital** is the highest-level facility in the district, focusing on advanced tertiary care, specialist consultation, and training - It is far removed from the grassroots fieldwork and record-keeping required for community health surveillance - Does not maintain individual **Eligible Couple Registers** for specific villages

Q: Which of the following tests cannot be used to detect blood stains?

Barberio's test. ***Barberio's test*** - Barberio's test is used for the **detection of semen stains**, not blood stains - It is a Florence test that detects choline in seminal fluid by forming characteristic brown rhomboid or needle-shaped crystals of choline periodide - This test is specific for forensic identification of seminal stains in sexual assault cases *Incorrect - Spectroscopy* - Spectroscopy is widely used for blood detection by analyzing the absorption spectrum of hemoglobin and its derivatives - Different hemoglobin forms (oxyhemoglobin, reduced hemoglobin, methemoglobin) show characteristic absorption bands *Incorrect - Teichman's test* - Teichman's test is a confirmatory microcrystalline test for blood stains - Forms brownish rhomboid hemin crystals (hematin chloride) when blood is treated with glacial acetic acid and sodium chloride - Highly specific for blood detection in forensic medicine *Incorrect - Takayama's test* - Takayama's test is another confirmatory microcrystalline test for blood - Forms pink feathery hemochromogen crystals when blood is treated with pyridine and glucose in alkaline medium - More sensitive than Teichman's test and works well with old blood stains

Q: Inquest in a case of custodial death is handled by

Executive magistrate. ***Executive magistrate***- In India, an inquest in a case of **custodial death** (death in police lock-up or judicial custody/jail) is mandatory and must be conducted by a **Judicial Magistrate or an Executive Magistrate** under Section 176(1A) of the CrPC.- This requirement ensures the investigation is independent and impartial, reducing potential cover-up by the police or prison authorities.*Police inspector*- The **Police inspector** conducts inquests only for deaths that are suspicious, unnatural, or suicidal (Section 174 CrPC), but not for custodial deaths.- An inquest into a custodial death must be conducted by an authority outside the police establishment to ensure **transparency and accountability**.*Jail superintendent*- The **Jail superintendent** is the administrative head of the prison facility where the death occurred and cannot conduct the inquest due to inherent **conflict of interest**.- Their role is limited to immediately reporting the death to the appropriate Executive Magistrate or Judicial Magistrate, as mandated by law.*Superintendent of Police*- The **Superintendent of Police (SP)** is part of the police hierarchy and therefore not designated to conduct an inquest into a **custodial death**, as the investigation must be external to the involved agency.- The SP's authority is usually related to supervising police investigations, not conducting the specific **magisterial or judicial inquiry** required in these sensitive cases.

Q: Identify the type of homicide caused by smothering and traumatic asphyxia.

Burking. ***Burking***- This term refers to a specific method of **homicide** where death is caused by a combination of **smothering** (covering the mouth and nose) and **traumatic asphyxia** (compression of the chest and abdomen).- This technique prevents both air entry into the lungs and interferes with the respiratory diaphragm, ensuring rapid **asphyxia**.*Mugging*- *Mugging* is primarily defined as a **robbery** or theft involving violence or the threat of violence, not a specific mechanism of lethal asphyxia.- If death occurs during a mugging, the cause (e.g., blunt force trauma, stabbing, or **strangulation**) would define the injury, not the act of mugging itself.*Garrotting*- *Garrotting* specifically refers to a form of **ligature strangulation** often carried out using a specialized instrument or wire tightened around the neck.- Death results from occlusion of the **carotid arteries** and **jugular veins**, causing cerebral ischemia and congestion, or direct compression of the trachea.*Bansdola*- *Bansdola* is a historically recognized method of homicide, particularly in India, involving two people applying pressure to the victim's neck using a **bamboo stick** (*bans*).- This technique is a severe form of localized **strangulation** resulting in rapid mechanical asphyxia and vascular occlusion.

Q: A 26-year-old male with a history of respiratory tract infection 4 weeks ago is unable to stand or walk for the past 2 weeks and the weakness is progressive, ascending, and symmetrical in nature. The lower limbs were involved before and gradually the upper limbs were also affected. On examination you note areflexia. Pain and proprioception are preserved. What is the probable diagnosis?

Guillain Barre syndrome. ***Guillain Barre syndrome*** - **Acute inflammatory demyelinating polyradiculoneuropathy (AIDP)** - most common GBS variant [1] - Classic presentation: **progressive, ascending, symmetrical weakness** starting in lower limbs [1] - **Areflexia** is a hallmark feature due to peripheral nerve involvement [1] - **Preceding infection** (respiratory or gastrointestinal) occurs in 60-70% of cases, typically 1-4 weeks prior [1] - **Preserved sensory examination** for pain and proprioception (though may have paresthesias) [1] - **Motor weakness predominates** over sensory symptoms [1] - Diagnosis confirmed by: CSF showing albuminocytologic dissociation, nerve conduction studies showing demyelination - Treatment: **IV immunoglobulin (IVIG)** or **plasmapheresis** *Myasthenia gravis* - Presents with **fatigable weakness**, worsens with activity - **Ocular and bulbar muscles** typically affected first (ptosis, diplopia, dysphagia) - **Reflexes are preserved** (not areflexia) - No ascending pattern of weakness - Positive acetylcholine receptor antibodies, abnormal repetitive nerve stimulation *Polymyositis* - **Proximal muscle weakness** (shoulder and hip girdle), not ascending pattern - **Subacute onset** over weeks to months (not acute 2 weeks) - **Elevated creatine kinase (CK)** levels - Reflexes typically preserved initially - Muscle biopsy shows inflammatory infiltrates *Multiple sclerosis* - **Relapsing-remitting pattern** with episodes separated in time and space - **Sensory symptoms prominent** (numbness, tingling, vision changes) - **Hyperreflexia** with upper motor neuron signs (not areflexia) - Does not present with acute ascending paralysis - MRI shows demyelinating plaques in CNS

Q: An 8-month-old infant is being treated with vitamin A supplementation over 2 consecutive days for Vitamin A deficiency. What is the recommended dose to be given each day?

100,000 IU. ***100,000 IU*** - This is the correct **single dose per day** of Vitamin A for infants aged 6 to 11 months in the therapeutic regimen for Vitamin A deficiency or measles. - According to **WHO guidelines**, the therapeutic protocol for this age group involves administering **100,000 IU on Day 1** and **100,000 IU on Day 2** (and a third dose on Day 14 for severe deficiency). - This dose is both safe and effective for treating deficiency in this specific age group. *25,000 IU* - This dose is significantly lower than the recommended therapeutic level for infants 6-11 months and would be **ineffective** for treating Vitamin A deficiency. - Doses of this magnitude are not part of standardized WHO supplementation protocols for this age group. *50,000 IU* - This is the standard single dose recommended for **infants under 6 months** of age (1-5 months) for both prophylactic and therapeutic purposes. - For an 8-month-old infant (6–11 months age group), 50,000 IU is **insufficient** for effective therapeutic intervention. *200,000 IU* - This is the standard single dose for **children aged 12 months to 5 years** for routine supplementation. - Giving 200,000 IU as a single dose to an 8-month-old infant carries significant risk of **acute hypervitaminosis A toxicity** including symptoms such as bulging fontanelle, nausea, vomiting, and headache.

Q: A 60-year-old patient presents with painless hematuria. He is diagnosed with bladder cancer involving the muscle layer. What is the next best step in the treatment of this patient?

Radical cystectomy. ***Radical cystectomy***- Because this tumor involves the **muscle layer**, it is classified as **muscle-invasive bladder cancer (MIBC)** (T2 stage or higher), for which radical cystectomy is the gold standard treatment for patients who are surgical candidates.- This procedure involves complete removal of the bladder and adjacent pelvic lymph nodes, followed by urinary diversion, offering the best survival and curative rates for localized MIBC.*Intravesical administration of BCG*- This immunotherapy is used primarily for **high-risk non-muscle-invasive bladder cancer (NMIBC)**, particularly carcinoma in situ (CIS) or high-grade T1 tumors, to reduce recurrence.- It cannot achieve adequate penetration or tumor clearance in tumors that have already invaded the **detrusor muscle**.*Radiotherapy*- Radiotherapy is typically used as part of a **bladder-preserving trimodality therapy** (TMT) when the patient is unable or unwilling to undergo surgery.- For fit patients with MIBC, **radical cystectomy** generally provides superior long-term survival rates compared to radiotherapy alone.*Neoadjuvant chemotherapy with Mitomycin C*- **Mitomycin C** is an agent used *intravesically* for NMIBC, similar to BCG, to prevent recurrence after TURBT.- Standard **neoadjuvant chemotherapy** for MIBC (given before cystectomy) consists of **systemic platinum-based regimens** (like Gemcitabine/Cisplatin) and not local Mitomycin C.

Q: Which of the following is the class of shock where urine output is first decreased?

b. Moderate. Detailed assessment of shock states involves monitoring vital signs and organ perfusion metrics like urine output. In **moderate shock** (Class II hemorrhagic shock, ~15-30% blood loss), strong **sympathetic stimulation** leads to significant renal vasoconstriction to preserve perfusion to vital organs [1]. This causes a substantial reduction in glomerular filtration rate (**GFR**), resulting in the **first clinically significant decrease** in urine output (typically 20-30 mL/hr or **oliguria**) [1]. This is the earliest stage where urine output becomes measurably decreased. *Compensated/Mild* - In **compensated or mild shock** (Class I, 30 mL/hr) as the minimal volume deficit does not yet necessitate severe renal vasoconstriction. - Baroreceptor reflexes and mild tachycardia are sufficient to maintain renal perfusion. *Severe* - In **severe shock** (Class III-IV, >30% blood loss), there is dramatic reduction in cardiac output and marked hypotension, leading to profound oliguria or complete **anuria**. - While urine output is lowest here, the **initial measurable decrease** occurs earlier in moderate shock (Class II), before progression to cardiovascular collapse. - By this stage, multiple organ dysfunction is evident.

Question 1

School health service should include all the following except

Accepted Answer

Doctor on premises

Answer

Dental and eye health services

Answer

School health records

Answer

Education of handicapped children

Question 2

How much percent of GNP does WHO recommend being spent on the healthcare sector?

Accepted Answer

5%

Answer

3.5%

Answer

2.5%

Answer

2.0%

Question 3

Eligible couple registers are maintained at which of the following centres?

Accepted Answer

Sub-centre

Answer

District hospital

Answer

PHC

Answer

CHC

Question 4

Which of the following tests cannot be used to detect blood stains?

Accepted Answer

Barberio's test

Answer

Spectroscopy

Answer

Teichman's test

Answer

Takayama's test

Question 5

Inquest in a case of custodial death is handled by

Accepted Answer

Executive magistrate

Answer

Police inspector

Answer

Superintendent of Police

Answer

Jail superintendent

Question 6

Identify the type of homicide caused by smothering and traumatic asphyxia.

Accepted Answer

Burking

Answer

Garrotting

Answer

Bansdola

Answer

Mugging

Question 7

A 26-year-old male with a history of respiratory tract infection 4 weeks ago is unable to stand or walk for the past 2 weeks and the weakness is progressive, ascending, and symmetrical in nature. The lower limbs were involved before and gradually the upper limbs were also affected. On examination you note areflexia. Pain and proprioception are preserved. What is the probable diagnosis?

Accepted Answer

Guillain Barre syndrome

Answer

Myasthenia gravis

Answer

Polymyositis

Answer

Multiple sclerosis

Question 8

An 8-month-old infant is being treated with vitamin A supplementation over 2 consecutive days for Vitamin A deficiency. What is the recommended dose to be given each day?

Accepted Answer

100,000 IU

Answer

25,000 IU

Answer

50,000 IU

Answer

200,000 IU

Question 9

A 60-year-old patient presents with painless hematuria. He is diagnosed with bladder cancer involving the muscle layer. What is the next best step in the treatment of this patient?

Accepted Answer

Radical cystectomy

Answer

Radiotherapy

Answer

Neoadjuvant chemotherapy with Mitomycin C

Answer

Intravesical administration of BCG

Question 10

Which of the following is the class of shock where urine output is first decreased?

Accepted Answer

b. Moderate

Answer

a. Compensated

Answer

c. Mild

Answer

d. Severe

FMGE 2023

Community Medicine

Forensic Medicine

Internal Medicine

Pediatrics

Surgery