FMGE 2024 Practice Questions

Q: A 35-year-old patient presents with colicky abdominal pain, joint pain, and palpable purpura. Urinalysis shows only red blood cells with no other significant findings. Which of the following is the likely diagnosis?

IgA vasculitis. ***IgA vasculitis***- The presentation of **palpable purpura**, **colicky abdominal pain**, and **joint pain** (arthralgia/arthritis), along with evidence of renal disease (**hematuria**), is the classic tetrad of **IgA vasculitis** (Henoch-Schönlein purpura) [1]. - This condition involves deposits of **IgA-containing immune complexes** in the walls of small vessels across various organ systems, including the skin, joints, gastrointestinal tract, and kidneys [1]. *Granulomatosis with polyangiitis* - This primarily affects the **upper and lower respiratory tract** (e.g., sinus inflammation, pulmonary nodules/hemorrhage) and the kidneys, often presenting without classic palpable purpura. - It is strongly associated with circulating **c-ANCA** antibodies targeting proteinase 3 (PR3). *Microscopic polyangiitis* - This is a non-necrotizing small-vessel vasculitis [2] typically presenting with **rapidly progressive glomerulonephritis** and often pulmonary capillary involvement causing hemorrhage. - It is usually associated with **p-ANCA** antibodies targeting myeloperoxidase (MPO) and rarely causes the prominent skin and GI symptoms seen here. *Behçet's disease* - The cardinal features of Behçet’s disease are recurrent **oral aphthous ulcers**, **genital ulcers**, and **ocular inflammation** (uveitis). - While it can cause vasculitis, it primarily involves large veins and arteries, and the combination of palpable purpura and colicky pain strongly favors IgA vasculitis over this diagnosis.

Q: What condition is likely in a newborn presenting with dry, rough skin, a big tongue and rough hair?

Congenital hypothyroidism. ***Congenital hypothyroidism*** - This condition is classically associated with signs of **cretinism** in newborns, including developmental delays, **dry/rough skin** (due to **myxedema**), and distinct facial features like **macroglossia** (big tongue). - The presentation of rough hair and generalized skin changes reflect reduced metabolic rate and accumulation of **glycosaminoglycans** in the dermis. *Prader-Willi syndrome* - Characterized by severe **neonatal hypotonia** and feeding difficulties followed by unremitting **hyperphagia** and obesity starting in early childhood. - The key features are related to the deletion of paternal chromosome 15 genes, and it does not typically present with the specific severe **myxedematous skin changes** seen here. *Edward syndrome* - Edward syndrome (**Trisomy 18**) is characterized by severe growth deficiency, **micrognathia**, **rocker-bottom feet**, overlapping fingers, and often severe congenital heart anomalies. - These findings are indicative of severe chromosomal abnormalities that typically result in distinct physical malformations, not primary hypothyroidism features such as **macroglossia** and widespread myxedema. *Galactosemia* - This is an inborn error of metabolism that usually presents after milk feeding starts, leading to poor feeding, **jaundice**, **hepatomegaly**, and subsequent formation of **cataracts**. - The initial clinical picture is dominated by metabolic decompensation, **sepsis (E. coli)**, and liver disease, not the classic physical features of thyroid hormone deficiency.

Q: What is the likely age of a child who can ride a tricycle, walk up stairs with alternate steps, but cannot hop?

3.5 years. ***Correct: 3.5 years*** - At **3.5 years**, a child typically achieves the milestone of **walking up stairs with alternate steps** (reciprocal stair climbing) - The ability to **ride a tricycle** is typically achieved by **3 years** - **Hopping on one foot** is a milestone achieved around **4 years**, so a child at 3.5 years would not yet be able to hop - The combination of these milestones (can ride tricycle, can do alternate steps, cannot hop) places the child at approximately **3.5 years** *Incorrect: 4.5 years and 5.5 years* - By 4.5-5.5 years, children should have already achieved the ability to **hop on one foot** (typically by 4 years) - These ages are too advanced for a child who cannot yet hop *Incorrect: 2.5 years* - At 2.5 years, most children walk up stairs with **both feet on each step** rather than using alternate steps - **Reciprocal stair climbing** (alternate steps) typically develops around **3-3.5 years** - This age is too young for the described skill set

Q: What is the daily fluid requirement for a 3-day-old baby with a birth weight of 1500 grams?

80-90 ml/kg/day. ***80-90 ml/kg/day***- This range represents the typical fluid requirement for a very low birth weight (**VLBW**) infant on the second or third day of life (DOL 2-3).- It allows for a safe transition from the restricted fluids (60-80 ml/kg/day) of DOL 1 towards higher maintenance needs, minimizing the risk of conditions like **patent ductus arteriosus (PDA)**.*100-110 ml/kg/day*- This rate is usually required later in the first week (around **DOL 4 to DOL 7**) as the infant's renal function matures and catabolism increases.- Providing this high volume prematurely to a 3-day-old **VLBW** infant increases the risk of **fluid overload** and associated neonatal morbidities.*120-130 ml/kg/day*- This represents a standard high maintenance fluid rate, typically achieved by **DOL 7** or later, especially for infants utilizing **phototherapy**.- It is significantly above the required baseline for a **3-day-old** baby and would lead to potential hyponatremia and **pulmonary edema**.*130-150 ml/kg/day*- This is the usual **full maintenance** or "maximal" fluid requirement often seen after the first week of life (DOL 7+) or in situations requiring high replacement.- Administration of this rate on DOL 3 is strongly discouraged due to the extreme risk of **cardiovascular and pulmonary complications**.

Q: What could be the possible diagnosis for a newborn exhibiting weak lower limb pulses and strong upper limb pulses?

COA. ***COA*** (Coarctation of the Aorta) - The classic presentation of **Coarctation of the Aorta** involves a narrowing of the aorta, usually distal to the left subclavian artery, leading to increased pressure proximal to the coarctation (strong upper limb pulses) and decreased pressure distal to it (weak lower limb pulses). - This severe pressure gradient is manifested as **differential pulses** and potential **blood pressure discrepancy** between the arms and legs, making this the most likely diagnosis. *TGA* - **Transposition of the Great Arteries** is characterized by severe **cyanosis** presenting shortly after birth due to two parallel circulations (aorta from RV, pulmonary artery from LV). - It does not typically cause a significant differential in pulse strength between the upper and lower limbs unless complicated by underlying aortic arch anomalies. *TOF* - **Tetralogy of Fallot** typically presents with cyanosis and **hypercyanotic spells** (**tet spells**) due to severe right ventricular outflow tract obstruction and a large VSD. - While it is a common cyanotic heart disease, it primarily affects flow to the pulmonary circulation and does not cause obstruction in the systemic aorta leading to differential pulses. *Ebstein anomaly* - This condition involves the apical displacement of the **tricuspid valve** leaflets into the **right ventricle**, leading to tricuspid regurgitation and large right atrium. - Clinical features usually include varying degrees of cyanosis and signs of right heart failure but do not typically involve a differential in systemic arterial pulses.

Q: At what age does the transfer of one object to another hand happen?

7 months. ***7 months***- The transfer of an object from one hand to the other is a significant **fine motor milestone**, typically achieved between **6 and 8 months** of age, averaging around 7 months.- This milestone requires improved **bilateral coordination** and the ability to recognize that the object can be held by either hand, often coinciding with independent sitting.*4 months*- At **4 months**, infants generally begin reaching for objects deliberately and bringing them to their mouth using a primitive **palmar grasp**.- Transfer is not yet possible as the release mechanism and coordination between the two upper limbs are insufficiently developed.*9 months*- By **9 months**, infants are generally developing the **pincer grasp** (using the index finger and thumb) and possess well-established object transfer skills.- They move on to more complex manipulations, like banging two objects together or voluntarily releasing objects into a container.*12 months*- At **12 months**, fine motor skills are highly refined, allowing for precise actions such as stacking two blocks and using a mature **pincer grip** to pick up small crumbs.- Object transfer is fully developed and consolidated by this age, which is far beyond the initial stage of acquisition.

Q: What is the mechanism of action of Ethosuximide?

Inhibits calcium channels in thalamic neurons. ***Inhibits calcium channels in thalamic neurons***- Ethosuximide selectively blocks **T-type calcium channels** (**transient type**) primarily found on **thalamic neurons**.- This blockade reduces the **low-threshold burst firing** responsible for the characteristic **3-Hz spike-and-wave discharge** seen in absence seizures.*Enhances GABAergic inhibition*- This mechanism is characteristic of **Benzodiazepines** and **Barbiturates**, which increase the frequency or duration of GABA-A channel opening.- While some broad-spectrum AEDs like **Valproate** also increase GABA levels, this is not the primary mechanism of action for Ethosuximide.*Blocks sodium channels*- Drugs that block neuronal sodium channels, such as **Phenytoin** and **Carbamazepine**, are effective against tonic-clonic and partial seizures.- This mechanism prevents the rapid, sustained firing of action potentials but is largely ineffective against the burst firing characteristic of absence seizures.*Increases serotonin levels*- This is the primary mechanism associated with **Selective Serotonin Reuptake Inhibitors (SSRIs)** and other antidepressants.- It is not relevant to the function of Ethosuximide, which is specific to modulating neuronal excitability through calcium channels.

Q: Which of the following organs is a primary lymphoid organ?

Thymus. ***Thymus***- **Primary lymphoid organs** are the sites where lymphocytes are generated and mature into immunocompetent cells.- The **thymus** is essential for the maturation, selection, and central tolerance of **T lymphocytes**.*Lymph node*- Lymph nodes are classified as **secondary lymphoid organs** where matured lymphocytes activate and proliferate upon encountering specific antigens.- They serve as critical filters for **lymph**, organizing immune responses against pathogens draining from local tissues.*Spleen*- The spleen is a major **secondary lymphoid organ** responsible for filtering **blood** and mounting immune responses to systemic infections.- The **white pulp** contains T and B cell zones that are crucial for activating adaptive immunity against blood-borne pathogens.*MALT*- MALT (Mucosa-Associated Lymphoid Tissue) represents **secondary lymphoid tissues** found beneath epithelial surfaces.- It is responsible for initiating local immune responses at mucosal sites (e.g., **Peyer's patches** in the intestine).

Question 1

The Anemia Mukt Bharat program aims to address anemia across India through targeted interventions. Which statement accurately describes its administration of Iron and Folic Acid (IFA) supplementation?

Accepted Answer

IFA is provided during the 2nd trimester of pregnancy and continues during lactation for up to 6 months

Answer

IFA supplementation is administered solely during pregnancy

Answer

Administering IFA during the 1st trimester is adequate.

Answer

A 100-day course of IFA supplementation is sufficient

Question 2

A 35-year-old patient presents with colicky abdominal pain, joint pain, and palpable purpura. Urinalysis shows only red blood cells with no other significant findings. Which of the following is the likely diagnosis?

Accepted Answer

IgA vasculitis

Answer

Behçet's disease

Answer

Granulomatosis with polyangiitis

Answer

Microscopic polyangiitis

Question 3

What condition is likely in a newborn presenting with dry, rough skin, a big tongue and rough hair?

Accepted Answer

Congenital hypothyroidism

Answer

Prader-Willi syndrome

Answer

Edward syndrome

Answer

Galactosemia

Question 4

What is the likely age of a child who can ride a tricycle, walk up stairs with alternate steps, but cannot hop?

Accepted Answer

3.5 years

Answer

4.5 years

Answer

5.5 years

Answer

2.5 years

Question 5

What is the daily fluid requirement for a 3-day-old baby with a birth weight of 1500 grams?

Accepted Answer

80-90 ml/kg/day

Answer

100-110 ml/kg/day

Answer

130-150 ml/kg/day

Answer

120-130 ml/kg/day

Question 6

What could be the possible diagnosis for a newborn exhibiting weak lower limb pulses and strong upper limb pulses?

Accepted Answer

COA

Answer

TOF

Answer

Ebstein anomaly

Answer

TGA

Question 7

At what age does the transfer of one object to another hand happen?

Accepted Answer

7 months

Answer

4 months

Answer

12 months

Answer

9 months

Question 8

What is the mechanism of action of Ethosuximide?

Accepted Answer

Inhibits calcium channels in thalamic neurons

Answer

Enhances GABAergic inhibition

Answer

Blocks sodium channels

Answer

Increases serotonin levels

Question 9

What is the primary mechanism of action of methotrexate?

Accepted Answer

Inhibits dihydrofolate reductase, leading to decreased DNA synthesis

Answer

Inhibits RNA synthesis by blocking RNA polymerase

Answer

Interferes with microtubule formation during cell division

Answer

Inhibits DNA synthesis by blocking thymidylate synthase

Question 10

Which of the following organs is a primary lymphoid organ?

Accepted Answer

Thymus

Answer

Lymph node

Answer

MALT

Answer

Spleen

FMGE 2024

Community Medicine

Internal Medicine

Pediatrics

Pharmacology

Physiology