FMGE 2024 Practice Questions

Q: Iron absorption is decreased in which of the following?

Tea. ***Tea*** - Contains **tannins and polyphenols** that bind to non-heme iron in the gastrointestinal tract - Forms **insoluble iron complexes** that cannot be absorbed - Can reduce iron absorption by **60-70%** when consumed with meals - Most significant dietary inhibitor of iron absorption *Incorrect: Amla* - Indian gooseberry is rich in **vitamin C (ascorbic acid)** - Vitamin C **enhances iron absorption** by reducing ferric (Fe³⁺) to ferrous (Fe²⁺) form - Also prevents formation of insoluble iron compounds *Incorrect: Lemon* - Rich in **vitamin C and citric acid** - Both compounds **enhance iron absorption** significantly - Citric acid chelates iron, keeping it soluble and bioavailable *Incorrect: Sprouting* - **Reduces phytate content** in grains and legumes - Phytates are iron absorption inhibitors - Sprouting therefore **enhances iron bioavailability**

Q: Rukmini is attending the village health nutrition and sanitation program day. How frequently is this conducted?

Every month. ***Every month***- The **Village Health, Nutrition, and Sanitation (VHNS) Day** is a pivotal platform under the **National Health Mission (NHM)** and is officially required to be conducted **monthly** in every village. - This monthly meeting, often held at the Anganwadi Centre, integrates services such as **immunization**, antenatal and postnatal care, growth monitoring, and sanitation awareness, typically involving the **AWW**, **ANM**, and **ASHA**.*Every week*- Weekly scheduling would place an undue burden on field staff like the **ANM** and Medical Officer, who are responsible for covering multiple Sub-centres and villages.- While specific services or training sessions might occur weekly, the full, integrated delivery of the authorized VHNS program interventions is reserved for the designated **monthly VHNS Day**.*Every 14 days*- The established guidelines for the VHNS Day specify a **monthly** event, ensuring regular but feasible service delivery without overwhelming the rural health structure.- Bi-weekly (every 14 days) is not the prescribed national norm for organizing this comprehensive community mobilization and service delivery day.*Every 3 months*- A quarterly (every 3 months) schedule would be considered inadequate for effective monitoring of children's growth, timely completion of the **immunization schedule**, and addressing immediate maternal health needs.- The high-frequency nature of certain health interventions like nutritional supplementation and growth charting necessitates the established **monthly** meeting to track progress and intervene promptly.

Q: Arrange the order of the Disaster management cycle

Impact-response-rehabilitation-mitigation. ***Impact-response-rehabilitation-mitigation***- The disaster management cycle logically follows the progression from the event itself (**Impact**), immediately followed by addressing the crisis (**Response**), then rebuilding and restoring (**Rehabilitation**), and finally, taking long-term steps to reduce future vulnerability (**Mitigation**).- This sequence captures the critical flow from crisis stabilization (Response) to long-term recovery (Rehabilitation) and future risk reduction (Mitigation).*Rehabilitation-response-impact-mitigation*- This order is incorrect because **rehabilitation** (the recovery phase) must follow the **impact** (the disaster event) and the immediate relief **response**. - The cycle must begin with the occurrence of the event itself (**impact**), which triggers all subsequent management phases.*Response-disaster-rehabilitation-mitigation*- The sequence is flawed because the **response** actions are initiated *after* the **disaster** (or impact) has occurred.- Immediate actions must follow the event, meaning **disaster/impact** must precede the **response** phase.*Impact-mitigation-response-rehabilitation*- This sequence fails because **mitigation** is a long-term strategy for preventing future disasters, which typically occurs before or after the immediate response and recovery, not immediately following the initial **impact**. - The crucial immediate medical and safety interventions (**Response**) must follow the disaster **impact**, before the longer-term **rehabilitation** begins.

Q: The needle with the syringe is disposed of in which container?

White. ***White***- This container is designated specifically for **sharp waste**, including hypodermic needles, fixed-needle syringes, blades, and scalpels, to prevent **needle-stick injuries**.- These containers are required to be **puncture-proof** and tamper-proof to ensure the safe handling of hazardous sharps.*Yellow*- *Yellow* containers are used for **infectious waste**, such as anatomical waste, soiled cotton, dressings, and waste contaminated heavily with blood or body fluids.- Sharps are strictly excluded from yellow bags, which are not designed to withstand **puncture**.*Red*- *Red* containers are designated for **recyclable plastic waste**, including non-sharp items like catheters, tubing, and syringes *without* the needle attached.- If a syringe barrel were being disposed of separately from a detached needle, it would go into the red container, but the combined unit is classified as **sharp waste**.*Blue*- *Blue* containers are designated primarily for **discarded glass items** (like broken bottles or ampules) or sometimes metallic implants.- Although needles are metallic, their primary hazard classification as a 'sharp' mandates disposal in the **puncture-proof White** container.

Q: Which HLA is associated with Reiter syndrome?

HLA-B27. ***HLA-B27*** - **HLA-B27** is the major histocompatibility complex (MHC) class I allele strongly associated with **Reiter syndrome** (now termed **Reactive Arthritis**) a component of the **seronegative spondyloarthropathies** [1]. - Approximately 60-80% of patients with Reactive Arthritis who present with the classic triad (urethritis, conjunctivitis, arthritis) are positive for **HLA-B27** [1]. *HLA-DR3* - **HLA-DR3** is primarily associated with several autoimmune disorders, including **Celiac Disease**, **Graves' Disease**, and **Systemic Lupus Erythematosus** (SLE). - It is an MHC class II allele, distinguishing it from the MHC class I linkage observed in Reactive Arthritis. *HLA-DQ8* - **HLA-DQ8** (often with HLA-DQ2) is a key genetic risk factor for **Celiac Disease**, playing a role in presenting gliadin peptides to T cells. - This allele is also associated with **Type 1 Diabetes Mellitus** but lacks a significant established association with the pathogenesis of the spondyloarthropathies. *HLA-DR4* - **HLA-DR4** carries the strongest genetic risk for **Rheumatoid Arthritis** (RA), particularly in individuals prone to developing severe, erosive disease. - While associated with generalized autoimmunity, **HLA-DR4** is not the primary marker for the seronegative spondyloarthropathies like Reactive Arthritis [2].

Q: A patient experienced a fall onto an outstretched hand, and an X-ray revealed a fracture of the base of the first metacarpal with accompanying subluxation at the carpometacarpal (CMC) joint. Define this type of fracture.

A. Bennett’s fracture. ***Bennett’s fracture***- This is a characteristic **intra-articular fracture** at the base of the **first metacarpal**, which extends into the carpometacarpal (CMC) joint.- The main metacarpal shaft is typically pulled proximally and radially by the **Abductor Pollicis Longus** tendon, leading to the obligatory **subluxation** described.*Scaphoid fracture*- This injury involves one of the **carpal bones** (the scaphoid) in the wrist, not the metacarpal bases or MCP/CMC joints.- Although commonly caused by a fall onto an outstretched hand (FOOSH), its primary presentation is tenderness in the **anatomical snuffbox**.*Reverse Colle’s fracture*- This fracture, also known as **Smith’s fracture**, affects the **distal radius** in the forearm.- It is defined by the **volar** (palmar) displacement of the distal radial fragment, opposite to the displacement seen in a typical Colle's fracture.*Colle’s fracture*- This common FOOSH injury affects the **distal radius** bones in the forearm, not the hand joints.- It is defined by the characteristic **dorsal** (posterior) displacement of the distal radial fragment, often creating a 'dinner fork' deformity.

Q: Identify the type of fracture in a patient who sustained a road traffic accident resulting in fractures of both the tibia and fibula.

Bumper Fracture. ***Bumper Fracture*** - A **bumper fracture** refers to fractures of the **tibia and fibula** sustained when a pedestrian is struck by a vehicle bumper during a **road traffic accident**. - The term typically describes **mid-shaft or proximal shaft fractures** of both bones caused by direct lateral impact from a car bumper. - This matches the clinical scenario of **both tibia and fibula fractures** following RTA, making it the correct answer. - Note: The term can also refer specifically to lateral tibial plateau fractures, but in the context of "both bones" being fractured, it refers to the shaft fracture pattern. *Patella sleeve fracture* - This is a rare **avulsion fracture** seen almost exclusively in **children and adolescents**, involving the superior or inferior pole of the patella. - It results from forceful contraction of the **quadriceps** or sudden loading, causing avulsion of the cartilaginous sleeve. - This does not involve both tibia and fibula, making it incorrect for this scenario. *Depressed skull fracture* - This fracture involves the **calvarium (skull)** where bone fragments are pushed inward toward the brain. - While RTAs can cause head injuries, the question specifically describes fractures of the **tibia and fibula** (lower limb bones), not skull injury. *Cervical fracture* - Refers to fractures involving the **cervical vertebrae** in the neck region. - Although cervical spine injuries occur in RTAs, this does not match the clinical scenario of **lower limb long bone fractures** (tibia and fibula).

Q: Which of the following is the investigation of choice for CML?

Karyotyping. ***Karyotyping (Conventional Cytogenetics)*** - **Gold standard** and investigation of choice for CML diagnosis - Detects the **Philadelphia chromosome t(9;22)** present in 95% of CML cases [2] - WHO diagnostic criterion for CML - Can identify additional chromosomal abnormalities with prognostic significance - Provides complete chromosomal analysis *FISH (Fluorescence In Situ Hybridization)* - Used as **complementary technique** when karyotyping fails or metaphases are inadequate - More sensitive than karyotyping but NOT the first-line investigation [2] - Useful for monitoring minimal residual disease - Cannot detect additional chromosomal abnormalities *Molecular testing (BCR-ABL PCR)* - Used for **monitoring treatment response** and detecting minimal residual disease [1] - Highly sensitive and quantitative [1] - Not the initial investigation of choice for diagnosis *LAP score (Leukocyte Alkaline Phosphatase)* - Used to differentiate CML from leukemoid reaction - Low in CML, high in leukemoid reaction - Older diagnostic tool, now largely replaced by molecular methods - Not the investigation of choice **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 185-187. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 225-226.

Q: A 5-year-old child presents with a lesion in the right eye. Histopathology reveals the presence of Flexner-Wintersteiner rosettes. What is the likely diagnosis?

Retinoblastoma. ***Retinoblastoma*** - The presence of **Flexner-Wintersteiner rosettes**, which are characteristic arrangements of columnar cells around a central lumen, is the pathognomonic histological feature of well-differentiated **retinoblastoma** [1].- This tumor is the most common **intraocular malignancy** of childhood, typically presenting as **leukocoria** (white pupillary reflex) in children under the age of 5. *Optic nerve glioma*- These tumors are typically low-grade astrocytomas, most frequently **pilocytic astrocytomas**, characterized by glial cells, not neuronal-like rosettes.- They involve the **optic nerve** itself and are strongly associated with **Neurofibromatosis type 1 (NF1)**. *Rhabdomyosarcoma*- This is the most common **pediatric orbital malignancy** (outside the globe), typically presenting with rapid onset of **proptosis** (exophthalmos) and eyelid swelling.- Histologically, it is a small round blue cell tumor derived from mesenchymal cells, showing **rhabdomyoblasts**, and does not form Flexner-Wintersteiner rosettes. *Ocular melanoma*- This malignancy is extremely rare in the pediatric population and is overwhelmingly a disease of **adults**.- Histopathology shows malignant cells derived from **melanocytes** (spindle or epithelioid cells) containing melanin, lacking photoreceptor differentiation structures like rosettes. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Eye, p. 1342.

Q: Which among the following is the least radiosensitive cell?

Platelets. ***Platelets*** - Platelets are **anuclear cell fragments** derived from megakaryocytes, lacking a nucleus and DNA, which makes them highly resistant to the direct cytotoxic effects of radiation. - They are one of the **least radiosensitive** circulating components; platelet counts typically require very high radiation doses to fall significantly. *Monocytes* - Monocytes are generally considered **moderately radiosensitive**, more susceptible to radiation-induced death than mature neutrophils or platelets. - They exhibit susceptibility to **interphase death** upon irradiation, although less sensitive than lymphocytes. *Lymphocytes* - Lymphocytes are the **most radiosensitive** mature circulating blood cells, undergoing rapid apoptosis (programmed cell death) even at low radiation doses (sub-2 Gy). - Their high sensitivity relates to their dependence on DNA integrity for survival and their prompt initiation of the **apoptotic pathway** following damage. *Neutrophils* - Mature neutrophils are considered relatively radiosensitive, but significantly **less sensitive than lymphocytes** and moderately less sensitive than monocytes. - Their numbers drop less rapidly than lymphocytes primarily because of a large pre-formed **reserve pool** in the bone marrow, providing temporary protection.

Question 1

Iron absorption is decreased in which of the following?

Accepted Answer

Tea

Answer

Amla

Answer

Lemon

Answer

Sprouting

Question 2

Rukmini is attending the village health nutrition and sanitation program day. How frequently is this conducted?

Accepted Answer

Every month

Answer

Every 3 months

Answer

Every 14 days

Answer

Every week

Question 3

Arrange the order of the Disaster management cycle

Accepted Answer

Impact-response-rehabilitation-mitigation

Answer

Rehabilitation-response-impact-mitigation

Answer

Impact-mitigation-response-rehabilitation

Answer

Response-disaster-rehabilitation-mitigation

Question 4

The needle with the syringe is disposed of in which container?

Accepted Answer

White

Answer

Red

Answer

Blue

Answer

Yellow

Question 5

Which HLA is associated with Reiter syndrome?

Accepted Answer

HLA-B27

Answer

HLA-DQ8

Answer

HLA-DR3

Answer

HLA-DR4

Question 6

A patient experienced a fall onto an outstretched hand, and an X-ray revealed a fracture of the base of the first metacarpal with accompanying subluxation at the carpometacarpal (CMC) joint. Define this type of fracture.

Accepted Answer

A. Bennett’s fracture

Answer

B. Scaphoid fracture

Answer

C. Reverse Colle’s fracture

Answer

D. Colle’s fracture

Question 7

Identify the type of fracture in a patient who sustained a road traffic accident resulting in fractures of both the tibia and fibula.

Accepted Answer

Bumper Fracture

Answer

Depressed skull fracture

Answer

Patella sleeve fracture

Answer

Cervical fracture

Question 8

Which of the following is the investigation of choice for CML?

Accepted Answer

Karyotyping

Answer

LAP score

Answer

FISH

Answer

Molecular testing (BCR-ABL PCR)

Question 9

A 5-year-old child presents with a lesion in the right eye. Histopathology reveals the presence of Flexner-Wintersteiner rosettes. What is the likely diagnosis?

Accepted Answer

Retinoblastoma

Answer

Optic nerve glioma

Answer

Rhabdomyosarcoma

Answer

Ocular melanoma

Question 10

Which among the following is the least radiosensitive cell?

Accepted Answer

Platelets

Answer

Lymphocytes

Answer

Neutrophils

Answer

Monocytes

FMGE 2024

Biochemistry

Community Medicine

Internal Medicine

Orthopaedics

Pathology

Radiology