FMGE 2023 Practice Questions

Q: Which of the following airway devices helps maintain Fio2 of 0.25-0.60, irrespective of the patient's breathing effort?

Venturi mask. ***Venturi mask***- This device utilizes the **Bernoulli principle** to mix a specific flow of 100% oxygen with a fixed volume of **room air** via interchangeable jet adapters, achieving a precise FIO2 (0.24-0.60).- Because the total gas flow delivered to the patient (O2 + entrained air) greatly exceeds the patient's peak inspiratory flow, the delivered FIO2 is **independent of the patient's breathing effort** (rate and depth).*Nasal cannula*- The actual FIO2 delivered is highly **variable** and dependent on the patient's **inspiratory flow rate** and pattern, as the device primarily provides supplemental oxygen flow into the pharynx.- It typically provides a maximum FIO2 of about 0.44 at flow rates up to 6 L/min, which is insufficient for predictable FIO2 control in the moderate range.*Simple face mask*- The FIO2 delivered is variable (typically 0.35–0.50) because a significant amount of **room air is entrained** through the ports and the seal around the mask, highly dependent on the patient’s ventilation pattern.- It requires a flow rate of at least 5 L/min to flush out the volume in the mask and prevent the risk of **carbon dioxide ($ ext{CO}_2$) rebreathing** from the mask's dead space.*Non-rebreathing mask*- Offers the **highest FIO2 available** non-invasively (up to 0.90–0.95); however, its primary purpose is maximizing oxygen delivery, not maintaining a precise, lower concentration (0.25-0.60).- While a valve prevents exhaled air from entering the reservoir bag, the exact FIO2 delivered still requires a tight seal and is generally used when high concentrations are needed, making it unsuitable for precise intermediate FIO2.

Q: A family pedigree chart is given below. Identify the mode of inheritance of this condition. ![img-29.jpeg](img-29.jpeg)

Autosomal dominant. ***Autosomal dominant*** - The trait is seen in **every generation** (vertical transmission), and affected parents (individuals 1 and 2) have an unaffected child (individual 7), which is a hallmark of dominant inheritance. - There is **male-to-male transmission** from the affected father (individual 4) to his son (individual 9), which rules out X-linked inheritance. *Autosomal recessive* - This is incorrect because two affected parents (1 and 2) have an unaffected offspring (7). In autosomal recessive inheritance, two affected parents (genotype **aa**) can only produce affected offspring. - The trait does not **skip generations**, which is a typical feature of recessive inheritance patterns. *X-linked recessive* - This is ruled out because an affected mother (2) has an unaffected son (7). In X-linked recessive traits, an affected mother (genotype **X a X a **) must pass the affected allele to all her sons, meaning all her sons would be affected. - Also, an unaffected couple (7 and 8) would need to have an affected child for this pattern to be considered, which is not the case here. *X-linked dominant* - The presence of **male-to-male transmission** (from father 4 to son 9) makes this mode of inheritance impossible. - In X-linked inheritance, a father passes his **Y chromosome** to his sons and his X chromosome to his daughters, so an affected father cannot have an affected son via this mechanism.

Q: A family pedigree chart is given below. Identify the mode of inheritance of this condition.

Autosomal dominant. ***Autosomal dominant*** - The trait is observed in **every generation** (I, II), which is a hallmark of dominant inheritance, as it does not skip generations. - The presence of **male-to-male transmission** (individual 4 to individual 9) definitively rules out X-linked inheritance. Additionally, affected parents (1 and 2) have an unaffected child (7), indicating the parents are likely heterozygous. *Autosomal recessive* - This is ruled out because two affected parents (1 and 2) have an unaffected child (7). If the trait were recessive, all children of two affected parents **must also be affected**. - Typically, autosomal recessive traits **skip generations**, with carriers being phenotypically normal, which is not the pattern seen here. *X-linked recessive* - An affected mother (individual 2) must pass the recessive allele to **all of her sons**. However, her son (individual 7) is unaffected, which contradicts this inheritance pattern. - The presence of **male-to-male transmission** (4 to 9) is impossible in X-linked inheritance, as fathers pass their Y chromosome to sons, not the X chromosome carrying the trait. *X-linked dominant* - An affected father must pass the trait to **all of his daughters**. In this pedigree, the affected father (individual 4) has an unaffected daughter (individual 8), which rules out this mode. - Similarly, another affected father (individual 9) has an unaffected daughter (individual 11), further disproving this pattern.

Q: What is the most common cause of Cushing's disease in a 60-year-old male?

Pituitary microadenoma. ***Pituitary microadenoma*** - Cushing's **Disease** is specifically defined as hypercortisolism caused by an ACTH-secreting tumor of the pituitary gland, which is typically a **microadenoma** (<10 mm) [2]. - Pituitary adenomas are the most common cause of **endogenous** ACTH-dependent hypercortisolism (Cushing's Disease), regardless of the patient's age or sex [1]. *Small-cell lung cancer* - This is the most common cause of **ectopic ACTH syndrome**, which is a form of Cushing's **Syndrome**, not Cushing's Disease [1]. - Ectopic secretion generally leads to rapidly progressive, severe hypercortisolism and is often associated with hypokalemic metabolic alkalosis. *Adrenal tumor* - Adrenal tumors (adenomas or carcinomas) cause **ACTH-independent** Cushing's syndrome by directly overproducing cortisol [1]. - In this etiology, the pituitary gland is suppressed, resulting in very low or undetectable plasma **ACTH levels** [3]. *Ectopic ACTH syndrome* - While ectopic ACTH syndrome (often from bronchial carcinoids or small-cell lung cancer) is a significant cause of Cushing's **Syndrome** in elderly males, it is not the definition of Cushing's **Disease**. [1] - Ectopic sources produce ACTH unresponsive to **high-dose dexamethasone suppression** tests, unlike most cases of Cushing's Disease.

Q: A 50-year-old woman presented with difficulty in activities like climbing stairs, getting up from a chair, and combing hair. Violaceous erythema of the upper eyelids was noted. What is the most probable diagnosis?

Dermatomyositis. ***Dermatomyositis***- The combination of **proximal muscle weakness** (difficulty climbing stairs, rising from a chair, combing hair) and the pathognomonic **Heliotrope sign** (violaceous erythema of the upper eyelids) is highly indicative of **Dermatomyositis** [1], [2].- Dermatomyositis is a type of idiopathic inflammatory **myopathy** that also features characteristic skin findings like **Gottron papules** (over MCPs, PIPs, and elbows) [1], [2].*Inclusion body myositis*- Primarily affects men older than 50 and often involves **distal muscle weakness** (e.g., finger flexors) in addition to proximal muscles, which is not described here [3].- Characterized by early loss of **deep tendon reflexes** and may show **rimmed vacuoles** on muscle biopsy, features distinct from this presentation [3].*Polymyositis*- Presents with similar **proximal muscle weakness** but **lacks the characteristic skin manifestations** like the Heliotrope sign or Gottron papules [1].- Diagnosis is supported by elevated muscle enzymes (CK) and inflammatory changes on muscle biopsy, but the absence of skin findings rules it out in favor of dermatomyositis.*Scleroderma*- Characterized by **skin thickening** and **fibrosis**, often involving the hands and face, and potentially internal organs (lung, GI tract).- Muscle weakness, if present (**Myositis overlap**), is usually less prominent than the distinctive **cutaneous and systemic features** of scleroderma.

Q: Bell's palsy involves

Ipsilateral upper and lower halves of the face.. ***Ipsilateral upper and lower halves of the face.*** - **Bell's palsy** is the most common cause of **idiopathic peripheral (Lower Motor Neuron - LMN)** facial nerve paralysis [1]. - A peripheral (LMN) lesion affects the **entire distribution** of the facial nerve on the affected side, resulting in paralysis of all muscles, including those controlling the forehead and eye closure. - Facial nerve palsies affect the **ipsilateral** side of the face relative to the site of peripheral nerve injury or brainstem nuclear lesion. *Contralateral upper and lower halves of the face.* - This presentation would imply a **bilateral upper and lower facial paralysis**, which is highly unusual for a single lesion like Bell's palsy. - Facial nerve palsies affect the **ipsilateral** side of the face, not contralateral. *Ipsilateral lower half of the face.* - Paralysis limited to the **ipsilateral lower half of the face** while sparing the upper face (forehead) is characteristic of a **Central (Upper Motor Neuron - UMN)** lesion (like a stroke) located in the contralateral cortex [1]. - This does not define Bell's palsy, which is a **peripheral (LMN)** lesion affecting the entire face. *Contralateral lower half of the face.* - This pattern, involving **paralysis of the lower face contralateral** to the lesion while sparing the forehead, is the classic presentation of a **Central (Upper Motor Neuron - UMN)** lesion [1]. - UMN lesions spare the upper face because the **facial nerve nucleus** receives bilateral cortical input for the muscles of the forehead.

Q: Which of the following drugs reduces mortality in a patient with heart failure?

Metoprolol. ***Correct: Metoprolol*** - *Beta-blockers* like **Metoprolol succinate** (extended-release form) reduce mortality in patients with **HFrEF** (Heart Failure with reduced Ejection Fraction) by blocking the deleterious effects of chronic sympathetic nervous system activation on the myocardium [1]. - These drugs prevent ventricular remodeling, reduce **sudden cardiac death** by lowering heart rate and improving oxygen demand/supply balance, and are cornerstone therapies alongside **ACE inhibitors/ARBs/ARNI** [1]. *Incorrect: Furosemide* - Furosemide is a **loop diuretic** used primarily for **symptom relief** (reducing edema, dyspnea) by promoting diuresis and natriuresis to manage volume overload. - It does not modify the underlying disease progression or cardiac remodeling and, thus, has **no demonstrated mortality benefit** in heart failure trials. *Incorrect: Prazosin* - Prazosin is an **alpha-1 adrenergic blocker** used primarily as a vasodilator or for hypertension, but it has not shown benefit and may even increase adverse events in long-term heart failure management. - Unlike approved vasodilator therapies (like hydralazine/nitrate combination in certain populations), Prazosin is **not recommended** for chronic HF therapy due to lack of mortality data and potential for **orthostatic hypotension**. *Incorrect: Torsemide* - Torsemide is a **high-ceiling loop diuretic** similar to Furosemide, typically used to manage symptoms of congestion and fluid retention in heart failure patients. - While some studies suggest better bioavailability than Furosemide, it ultimately functions as a diuretic and **does not confer a mortality benefit** in heart failure.

Q: A 49-year-old male presents with recurrent episodes of watery diarrhoea, dehydration, hypokalemia, and achlorhydria. Which of the following neuroendocrine tumours can be responsible for these symptoms?

VIPoma. A 49-year-old male presents with recurrent episodes of watery diarrhoea, dehydration, hypokalemia, and achlorhydria. Which of the following neuroendocrine tumours can be responsible for these symptoms? ***VIPoma***- The constellation of symptoms—watery diarrhoea, dehydration, hypokalemia, and achlorhydria—is known as **WDHA syndrome** (Watery Diarrhea, Hypokalemia, Achlorhydria), which is pathognomonic for a VIP-secreting tumour. [1] - **Vasoactive Intestinal Peptide (VIP)** acts as an intestinal secretagogue, leading to massive secretion of water and electrolytes, causing profound secretory diarrhea and subsequent life-threatening **hypokalemia** and dehydration. [1] *Insulinoma* - This tumour hypersecretes **insulin**, leading to severe symptoms of **hypoglycemia** (neuroglycopenic symptoms) which are typically worse in the fasting state. [2] - Insulinoma does not cause secretory diarrhea, hypokalemia, or achlorhydria. [2] *Somatostatinoma* - This tumor typically presents with the classic triad of **diabetes mellitus**, **gallstones (cholelithiasis)**, and **steatorrhea** (due to inhibition of pancreatic enzyme secretion). - While diarrhea can occur due to malabsorption, the overwhelming secretory diarrhea and achlorhydria defining this case are not characteristic. *Glucagonoma* - The primary clinical manifestations of glucagonoma include **necrolytic migratory erythema** (a distinctive skin rash), mild **diabetes mellitus**, and often **weight loss**. - It does not cause massive watery diarrhea leading to hypokalemia and achlorhydria.

Q: A 5-year-old child presented with recurrent respiratory infections with thickened sputum. Chest X-ray showed bronchial wall thickening. He has been suffering from steatorrhea since birth. Which of the following is the first differential diagnosis?

Cystic fibrosis. ***Cystic fibrosis*** - This diagnosis is strongly supported by the triad of chronic **recurrent respiratory infections** (due to thick, retained sputum and subsequent bronchiectasis/bronchial wall thickening), and evidence of **pancreatic exocrine insufficiency** presenting as steatorrhea since birth. - It is an autosomal recessive disorder caused by mutations in the **CFTR gene**, leading to defective chloride transport and thick, sticky mucus formation in multiple organs. *Hyaline membrane disease* - Also known as **Respiratory Distress Syndrome (RDS)**, it is a condition primarily affecting **premature infants** due to deficiency of pulmonary surfactant. - It presents acutely within the first few hours of life and is not a cause of chronic, recurrent respiratory infections or steatorrhea in a 5-year-old child. *Alpha 1 anti-trypsin deficiency* - This hereditary condition typically presents with early-onset **panacinar emphysema** and/or liver disease (cirrhosis). - It is not associated with severe **pancreatic exocrine insufficiency** and steatorrhea in childhood, which is a hallmark feature of this patient's presentation. *Malabsorption syndrome* - While the patient exhibits findings consistent with **malabsorption** (steatorrhea), this is a general descriptive term and not a specific primary diagnosis for the entire clinical picture. - Cystic Fibrosis is the most specific primary diagnosis that explains both the **respiratory and gastrointestinal symptoms** (thick sputum, bronchial wall thickening, and steatorrhea).

Q: A 30-year-old woman presented with complaints of bone pain and abdominal cramps. Her family says she has a history of abnormal behavior. The consultant doctor arrived at a provisional diagnosis based on the clinical features. Which of the following would be the best investigation to arrive at a definitive diagnosis?

Sestamibi scan. ***Sestamibi scan*** - The clinical features (bone pain, abdominal cramps, abnormal behavior being "bones, groans, and psychic moans") strongly suggest **primary hyperparathyroidism** due to hypercalcemia, which requires definitive localization of the culprit adenoma. - The **Technetium-99m Sestamibi scan** is the best definitive investigation because it is a functional imaging study that specifically identifies hyperactive parathyroid tissue, showing increased, persistent uptake relative to the thyroid gland. *MRI* - MRI is primarily a **structural imaging** modality and is usually reserved for cases where initial localization studies (like Sestamibi and Ultrasound) are equivocal or to assess for **ectopic parathyroid tissue** located deep in the neck or mediastinum. - It lacks the high **functional specificity** of the Sestamibi scan required to definitively confirm that the identified mass is the hyperfunctioning parathyroid adenoma. *Ultrasonogram* - Ultrasound is often the **initial screening tool** for identifying parathyroid adenomas in the neck, being easily accessible and inexpensive, but it is **operator-dependent**. - It is not considered the single best definitive test because it often fails to localize small, posterior, or **ectopic adenomas** and provides only structural, not functional, information about the gland. *CT scan* - CT scans provide excellent **anatomical detail** and are helpful in complex cases or for locating mediastinal/ectopic glands, especially when planning highly focused surgery. - Like MRI, CT is a structural study that identifies masses but does not definitively prove the **hyperfunctionality** specific to parathyroid adenomas, making Sestamibi superior for definitive diagnosis.

Question 1

Which of the following airway devices helps maintain Fio2 of 0.25-0.60, irrespective of the patient's breathing effort?

Accepted Answer

Venturi mask

Answer

Simple face mask

Answer

Non-rebreathing mask

Answer

Nasal cannula

Question 2

A family pedigree chart is given below. Identify the mode of inheritance of this condition. ![img-29.jpeg](img-29.jpeg)

Accepted Answer

Autosomal dominant

Answer

Autosomal recessive

Answer

X-linked recessive

Answer

X-linked dominant

Question 3

A family pedigree chart is given below. Identify the mode of inheritance of this condition.

Accepted Answer

Autosomal dominant

Answer

X-linked dominant

Answer

Autosomal recessive

Answer

X-linked recessive

Question 4

What is the most common cause of Cushing's disease in a 60-year-old male?

Accepted Answer

Pituitary microadenoma

Answer

Small-cell lung cancer

Answer

Adrenal tumor

Answer

Ectopic ACTH syndrome

Question 5

A 50-year-old woman presented with difficulty in activities like climbing stairs, getting up from a chair, and combing hair. Violaceous erythema of the upper eyelids was noted. What is the most probable diagnosis?

Accepted Answer

Dermatomyositis

Answer

Inclusion body myositis

Answer

Polymyositis

Answer

Scleroderma

Question 6

Bell's palsy involves

Accepted Answer

Ipsilateral upper and lower halves of the face.

Answer

Contralateral upper and lower halves of the face.

Answer

Ipsilateral lower half of the face.

Answer

Contralateral lower half of the face.

Question 7

Which of the following drugs reduces mortality in a patient with heart failure?

Accepted Answer

Metoprolol

Answer

Prazosin

Answer

Torsemide

Answer

Furosemide

Question 8

A 49-year-old male presents with recurrent episodes of watery diarrhoea, dehydration, hypokalemia, and achlorhydria. Which of the following neuroendocrine tumours can be responsible for these symptoms?

Accepted Answer

VIPoma

Answer

Glucagonoma

Answer

Insulinoma

Answer

Somatostatinoma

Question 9

A 5-year-old child presented with recurrent respiratory infections with thickened sputum. Chest X-ray showed bronchial wall thickening. He has been suffering from steatorrhea since birth. Which of the following is the first differential diagnosis?

Accepted Answer

Cystic fibrosis

Answer

Hyaline membrane disease

Answer

Alpha 1 anti-trypsin deficiency

Answer

Malabsorption syndrome

Question 10

A 30-year-old woman presented with complaints of bone pain and abdominal cramps. Her family says she has a history of abnormal behavior. The consultant doctor arrived at a provisional diagnosis based on the clinical features. Which of the following would be the best investigation to arrive at a definitive diagnosis?

Accepted Answer

Sestamibi scan

Answer

MRI

Answer

Ultrasonogram

Answer

CT scan

FMGE 2023

Anesthesiology

Biochemistry

Internal Medicine

Pediatrics

Radiology