FMGE 2023 Practice Questions

Q: A study was conducted to compare MMR vaccine history in children with autism and children without autism. What kind of study is being done here?

Case-control study. ***Case-control study***- This study design is **retrospective**, comparing the past frequency of an **exposure** (MMR vaccine history) between individuals with the **outcome** (autism - the cases) and individuals without the outcome (controls).- It is commonly used to investigate potential risk factors for rare outcomes, efficiently utilizing known data on disease status.*Cross-sectional study*- Exposure and disease outcome are measured **simultaneously** at a single point in time, assessing disease **prevalence**, not historical exposure differences.- It cannot establish a **temporal relationship** (i.e., whether the vaccine preceded the onset of autism) because exposure and disease are captured at the same time.*Cohort study*- Participants are selected based on their **exposure status** (e.g., vaccinated vs. non-vaccinated) and followed **prospectively** to see who develops the outcome (autism).- This design is inappropriate because the study starts with the outcome already defined (children *with* and *without* autism).*Clinical trial*- This is an **experimental study** where the investigator actively **intervenes** (e.g., assigns a treatment or vaccine) to evaluate its effect, often involving randomization.- The study described is **observational**, merely measuring the past exposure status in existing groups without any active intervention by the researcher.

Q: The urban area of Delhi has 4000 people with different religions. Research is being done to study the dietary habits of the population. Which of the following techniques can be used to obtain a study sample?

Stratified random sampling. ***Stratified random sampling.***- This technique divides the population (Delhi area) into homogeneous subgroups (strata) based on the defining characteristic, which in this case is **religion**, to ensure proportional representation. - Since dietary habits are likely to vary significantly across different religious groups, stratification ensures that the study sample accurately reflects the **dietary heterogeneity** of the urban area. *Cluster random sampling*- **Cluster sampling** is typically used when the population is large and geographically dispersed; the basic unit sampled is a group (cluster), not the individual.- Selecting entire geographical clusters might not capture the full diversity of religious dietary habits, potentially leading to increased **sampling error**. *Simple random sampling*- **Simple random sampling** selects individuals purely randomly, irrespective of their subgroup (religious) membership.- This method risks selecting an inadequate number of individuals from smaller religious groups, thereby failing to accurately represent the **dietary practices** of the entire population. *Systematic random sampling*- **Systematic sampling** involves selecting every 'n'th member from a list and is logistically simple, but it does not account for the intrinsic heterogeneity (religion) of the population.- If the initial list is arranged in a pattern related to religious groups, this method could introduce a **hidden bias**, compromising the representativeness of the sample.

Q: How long should a couple use contraception post-vasectomy?

12-16 weeks. ***12-16 weeks***- Contraception is mandatory post-vasectomy until a follow-up semen analysis confirms **azoospermia** (complete absence of sperm).- The 12-16 week period accounts for the time needed for all existing sperm distal to the occlusion site to be ejaculated and cleared from the system.*4-6 weeks*- This time frame is generally too short to ensure complete clearance of all viable **sperm** stored in the **vas deferens** and related structures.- Relying on this duration significantly increases the risk of early **contraceptive failure** before azoospermia is achieved.*9-11 weeks*- While many men achieve clearance by the 9-week mark, the standard clinical protocol usually mandates waiting until **12 weeks** for the first definitive **semen analysis**.- Stopping contraception prematurely based on an estimated time frame, rather than laboratory confirmation, increases the hazard of unwanted pregnancy.*16-20 weeks*- Although safe, this duration unnecessarily exceeds the typical time required for the successful confirmation of **azoospermia**.- If the semen analysis at 12 weeks confirms **azoospermia**, contraception can typically cease immediately, making further delay unwarranted.

Q: A patient comes to you with increased cough, increased breathlessness, and decreased exercise capacity. Chest X-ray shows pulmonary fibrosis. Which drug can be administered in the given condition?

Pirfenidone. ***Pirfenidone***- This drug is an **antifibrotic agent** used specifically in the management of **Idiopathic Pulmonary Fibrosis (IPF)** to slow disease progression and decline in lung function [1].- It works by reducing the synthesis of **Transforming Growth Factor-beta (TGF-$\beta$)** and inhibiting collagen deposition, thus limiting fibrotic remodeling.*Bortezomib*- **Bortezomib** is a **proteasome inhibitor** primarily used in the treatment of hematological malignancies, such as **multiple myeloma** and mantle cell lymphoma.- It has no established role in the pathological treatment or management of the underlying lung fibrosis.*Roflumilast*- **Roflumilast** is a selective **phosphodiesterase-4 (PDE-4) inhibitor** used to reduce the risk of exacerbations in patients with severe **COPD** associated with chronic bronchitis [2].- It is an anti-inflammatory maintenance therapy for COPD, but it is not indicated as an antifibrotic treatment for pulmonary fibrosis [2].*Imatinib*- **Imatinib** is a selective **tyrosine kinase inhibitor** effective against the **BCR-ABL fusion protein**, making it the primary treatment for **Chronic Myeloid Leukemia (CML)**.- While tyrosine kinases are sometimes implicated in fibrosis pathways, Imatinib is not an approved or standard treatment for pulmonary fibrosis.

Q: All of the following are true about audit in obstetrics except:

Should be done before analyzing outcomes. ***Should be done before analyzing outcomes*** - An **audit** is defined as a systematic process of reviewing quality of care, which involves comparing current practice (outcomes and processes) against standards. - Therefore, analyzing existing outcomes is an integral **first step** of the audit process, not something that should be done before the audit itself, rendering this statement false. *Improve treatment* - The core objective of any clinical audit in obstetrics is to close the gap between actual performance and best practices, leading directly to the **improvement of patient care and treatment protocols**. - By identifying areas of deviation from established standards, audits enable the implementation of targeted interventions to enhance the quality of **maternal and neonatal outcomes**. *Change in hospital administration and practices* - If an audit reveals systemic failures or resource limitations contributing to poor outcomes, implementing necessary corrections often requires changes in **hospital administrative policies** and practices. - Auditing ensures that institutional resources, documentation, and organizational structures effectively support high standards of **obstetric care**. *Fetal death data is analyzed* - **Perinatal and maternal mortality audits** are essential components of obstetric quality assessment, focusing on severe adverse outcomes. - Analysis of fetal death data (e.g., stillbirths) is crucial for identifying key risk factors, preventable causes, and system weaknesses in **antenatal and intrapartum care**.

Q: An elderly patient with the following deformity was brought to the OPD. What is the most probable diagnosis? ![img-13.jpeg](img-13.jpeg)

Rheumatoid arthritis. ***Rheumatoid arthritis*** - The image displays classic deformities of advanced **rheumatoid arthritis**, including **ulnar deviation** of the fingers at the metacarpophalangeal (MCP) joints and swelling, which are characteristic of this condition. - The presence of a subcutaneous nodule over the olecranon process (elbow) is highly suggestive of a **rheumatoid nodule**, a common extra-articular manifestation of the disease. *Rickets* - Rickets is a disease of **children** caused by defective mineralization of growing bone, typically due to **vitamin D deficiency**. This patient is described as elderly. - It presents with skeletal deformities like **bowed legs (genu varum)** and **rachitic rosary**, not the specific erosive small joint arthritis seen in the image. *Osteomalacia* - Osteomalacia is the adult counterpart of rickets, characterized by softening of bones. It typically causes diffuse **bone pain**, muscle weakness, and fractures rather than joint deformities. - It does not cause the **inflammatory synovitis** and characteristic joint erosions that lead to the deformities seen in rheumatoid arthritis. *Osteoarthritis* - Osteoarthritis is a **degenerative** joint disease that typically affects the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints, leading to **Heberden's** and **Bouchard's nodes**, while characteristically sparing the MCP joints. - It lacks the systemic inflammatory features and does not cause **ulnar deviation** or **rheumatoid nodules**.

Q: A 20-year-old patient presents with painful swelling in the middle finger around the proximal phalanx. An X-ray was done, and it is shown below. What is the most likely diagnosis? ![img-14.jpeg](img-14.jpeg)

Enchondroma. ***Enchondroma*** - This is the most common primary bone tumor of the hand, typically found in the **phalanges** and **metacarpals** in patients aged 10-40, consistent with this case. - The X-ray shows a classic well-defined, centrally located, **lytic lesion** causing **endosteal scalloping** (thinning of the inner cortex) and expansile remodeling, which are characteristic features of an **enchondroma**. *Osteosarcoma* - **Osteosarcoma** typically arises in the **metaphysis** of long bones like the femur and tibia, and is very rare in the small bones of the hand. - Radiographically, it presents with aggressive features like **cortical destruction**, a soft tissue mass, and a **sunburst** or **Codman's triangle** periosteal reaction, which are absent in this image. *Ewing's sarcoma* - This is a highly malignant tumor that most commonly affects the **diaphysis** (shaft) of long bones and the pelvis; its occurrence in the hand is extremely rare. - It classically shows an aggressive, permeative or **moth-eaten** lytic lesion with a large soft tissue component and a characteristic **onion-skin** periosteal reaction. *Osteoclastoma* - Also known as a Giant Cell Tumor (GCT), it characteristically occurs in the **epiphysis** of long bones in skeletally mature individuals, most commonly around the knee. - The typical radiographic appearance is an eccentric, lytic lesion extending to the subarticular bone, often described as having a **"soap bubble"** appearance, which differs from the findings here.

Q: An 80-year-old female patient with a history of slip and fall in the bathroom was brought to the casualty. She is having pain in the left hip and is unable to walk. She has no history of osteoarthritis. On examination, the left lower limb is shortened and externally rotated. X-ray findings are shown below. How will you manage this patient?

Hemiarthroplasty. ***Hemiarthroplasty*** - This is the treatment of choice for a **displaced intracapsular femoral neck fracture** in an elderly patient (typically >75 years) due to the high risk of **avascular necrosis (AVN)** and **non-union** if treated with internal fixation. - It involves replacing the femoral head with a prosthesis, which allows for **early mobilization** and weight-bearing, significantly reducing the risk of complications associated with immobility in geriatric patients, such as DVT and pneumonia. *Internal fixation with cancellous screws* - This approach is reserved for **undisplaced femoral neck fractures** or for displaced fractures in younger, more physiologically fit patients (<65 years) where preserving the native femoral head is a priority. - In an 80-year-old with a displaced fracture and likely poor bone quality, the risk of fixation failure, **non-union**, or subsequent **AVN** is unacceptably high, often requiring a second surgery. *Meyer's operation* - This is a **muscle-pedicle bone graft** procedure, typically using the quadratus femoris, designed to improve the blood supply to the femoral head. - It is not a primary treatment for an acute fracture but is sometimes used as an adjunct to internal fixation in younger patients to prevent AVN, or as a treatment for early-stage AVN itself. *McMurray's osteotomy* - This is a type of **intertrochanteric osteotomy** historically used to treat **non-union** of femoral neck fractures by converting shear forces at the fracture site into compressive forces. - It is not indicated for the primary management of an acute femoral neck fracture in an elderly patient and has been largely superseded by modern arthroplasty techniques.

Q: Which drug is most appropriate for treating diarrhea in a patient treated for colorectal carcinoma with 5-fluorouracil?

Loperamide. ***Loperamide*** - **Loperamide** is the standard, first-line agent used for controlling **chemotherapy-induced diarrhea (CID)**, especially that caused by 5-fluorouracil (5-FU). - High doses of loperamide are often required in a fixed, scheduled regimen (e.g., 2 mg every 2 hours) until diarrhea resolves, to decrease gut motility and intestinal fluid secretion. *Ciprofloxacin* - **Ciprofloxacin** is an antibiotic used when diarrhea is suspected to be infectious or for prophylaxis against **neutropenic fever**, but it is not the symptomatic treatment for 5-FU toxicity. - It does not address the underlying pathology of 5-FU induced enteritis, which involves mucosal damage and malabsorption. *Atropine* - **Atropine** is primarily used to treat acute **cholinergic syndrome** (early diarrhea, sweating, lacrimation) which is a major toxicity associated with the chemotherapy drug **Irinotecan**, not 5-FU. - As an anticholinergic, it is not the preferred or protocol-driven agent for managing severe, non-infectious 5-FU-induced diarrhea. *Ornidazole* - This is an **antibiotic/antiprotozoal** medication, mainly effective against organisms like *Giardia* or *Amoeba*. - It is not indicated for symptomatic management of non-infectious **chemotherapy-induced toxicity** resulting from the direct mucosal damage inflicted by 5-FU.

Q: Which of the following drugs are used to treat chemotherapy-induced nausea and vomiting?

Granisetron + dexamethasone + aprepitant. ***Granisetron + dexamethasone + aprepitant***- This triple-therapy combination represents the gold standard for preventing and treating highly emetogenic chemotherapy (HEC)-induced nausea and vomiting (CINV).- **Granisetron** (a **5-HT3 receptor antagonist**) blocks acute CINV, **dexamethasone** (a corticosteroid) enhances the antiemetic effect, and **aprepitant** (an **NK-1 receptor antagonist**) covers the delayed phase of CINV.*Doxylamine + domperidone + aprepitant*- **Doxylamine** is primarily used for nausea in pregnancy (mixed with pyridoxine) and is not a standard first-line agent for CINV prophylaxis.- **Domperidone** (a D2 antagonist) is infrequently used for CINV due to concerns over QT prolongation and is significantly less effective than 5-HT3 antagonists.*Prochlorperazine + metoclopramide + domperidone*- This combination consists primarily of **dopamine D2 receptor antagonists** and is insufficient for prophylaxis against moderately or highly emetogenic chemotherapy.- It lacks both a **5-HT3 inhibitor** (crucial for acute CINV) and an **NK-1 inhibitor** (crucial for delayed CINV and highly emetogenic regimens).*Dexamethasone + metoclopramide + domperidone*- This regimen is missing the key highly potent antiemetics: the **5-HT3 receptor antagonist** (like granisetron or ondansetron) and the **NK-1 receptor antagonist** (like aprepitant), which are indispensable for highly emetogenic chemotherapy.- While **dexamethasone** is standard, relying solely on **metoclopramide** and **domperidone** (D2 antagonists) is an inadequate primary strategy against severe CINV.

Question 1

A study was conducted to compare MMR vaccine history in children with autism and children without autism. What kind of study is being done here?

Accepted Answer

Case-control study

Answer

Clinical trial

Answer

Cross-sectional study

Answer

Cohort study

Question 2

The urban area of Delhi has 4000 people with different religions. Research is being done to study the dietary habits of the population. Which of the following techniques can be used to obtain a study sample?

Accepted Answer

Stratified random sampling

Answer

Simple random sampling

Answer

Systematic random sampling

Answer

Cluster random sampling

Question 3

How long should a couple use contraception post-vasectomy?

Accepted Answer

12-16 weeks

Answer

4-6 weeks

Answer

9-11 weeks

Answer

16-20 weeks

Question 4

A patient comes to you with increased cough, increased breathlessness, and decreased exercise capacity. Chest X-ray shows pulmonary fibrosis. Which drug can be administered in the given condition?

Accepted Answer

Pirfenidone

Answer

Imatinib

Answer

Bortezomib

Answer

Roflumilast

Question 5

All of the following are true about audit in obstetrics except:

Accepted Answer

Should be done before analyzing outcomes

Answer

Improve treatment

Answer

Change in hospital administration and practices

Answer

Fetal death data is analyzed

Question 6

An elderly patient with the following deformity was brought to the OPD. What is the most probable diagnosis? ![img-13.jpeg](img-13.jpeg)

Accepted Answer

Rheumatoid arthritis

Answer

Rickets

Answer

Osteomalacia

Answer

Osteoarthritis

Question 7

A 20-year-old patient presents with painful swelling in the middle finger around the proximal phalanx. An X-ray was done, and it is shown below. What is the most likely diagnosis? ![img-14.jpeg](img-14.jpeg)

Accepted Answer

Enchondroma

Answer

Osteosarcoma

Answer

Ewing's sarcoma

Answer

Osteoclastoma

Question 8

An 80-year-old female patient with a history of slip and fall in the bathroom was brought to the casualty. She is having pain in the left hip and is unable to walk. She has no history of osteoarthritis. On examination, the left lower limb is shortened and externally rotated. X-ray findings are shown below. How will you manage this patient?

Accepted Answer

Hemiarthroplasty

Answer

Meyer's operation

Answer

McMurray's osteotomy

Answer

Internal fixation with cancellous screws

Question 9

Which drug is most appropriate for treating diarrhea in a patient treated for colorectal carcinoma with 5-fluorouracil?

Accepted Answer

Loperamide

Answer

Ciprofloxacin

Answer

Atropine

Answer

Ornidazole

Question 10

Which of the following drugs are used to treat chemotherapy-induced nausea and vomiting?

Accepted Answer

Granisetron + dexamethasone + aprepitant

Answer

Doxylamine + domperidone + aprepitant

Answer

Prochlorperazine + metoclopramide + domperidone

Answer

Dexamethasone + metoclopramide + domperidone

FMGE 2023

Community Medicine

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pharmacology