In status asthmaticus, which anesthetic agent is used as a bronchodilator?

Ketamine. ***Ketamine*** - Possesses **bronchodilatory** properties due to its sympathomimetic effects, making it useful in severe asthma or **status asthmaticus**. - It can cause **catecholamine release**, leading to relaxation of bronchial smooth muscle and improved airflow. *Morphine* - Can cause **histamine release**, which may lead to **bronchoconstriction** and worsen an asthmatic patient's condition. - It is a respiratory depressant that can further compromise breathing in a patient with severe airway obstruction. *Thiopentone sodium* - May induce **histamine release** and cause **bronchospasm**, which is contraindicated in asthma. - It is a potent depressant of the central nervous system and can cause respiratory depression, worsening the clinical picture of status asthmaticus. *Halothane* - Although it has some **bronchodilatory** properties, its use has largely been replaced by newer inhalational anesthetics due to concerns about myocardial sensitization to catecholamines and potential **hepatotoxicity**. - It is a potent inhalational agent but is less favored in modern anesthesia for asthma due to side effect profiles compared to other agents. [Practice more FMGE 2018 questions on OnCourse]

FMGE 2018 Previous Year Questions with Answers

Q: Muscles cannot release free glucose from glycogen stores because of a deficiency of:

Glucose-6-phosphatase. ***Glucose-6-phosphatase*** - **Glucose-6-phosphatase** is the enzyme that dephosphorylates glucose-6-phosphate to free glucose, allowing its release into the bloodstream. - This enzyme is **physiologically absent in muscle tissue** (present only in liver and kidneys), meaning muscles can break down glycogen for their own energy needs but cannot release free glucose into circulation. - This ensures that muscle glycogen stores are reserved exclusively for muscle's own metabolic needs during contraction. *Glycogen phosphorylase* - **Glycogen phosphorylase** is present in muscle and catalyzes the breakdown of glycogen by cleaving α-1,4 glycosidic bonds to release glucose-1-phosphate. - Muscles have this enzyme and can normally break down glycogen for energy; deficiency causes **McArdle disease** (glycogen storage disease type V) with exercise intolerance. *Hexokinase* - **Hexokinase** is abundant in muscle tissue and phosphorylates free glucose to glucose-6-phosphate for entry into glycolysis. - This enzyme is necessary for utilizing both blood glucose and glycogen-derived glucose-6-phosphate. *Phosphoglucomutase* - **Phosphoglucomutase** is present in muscle and converts glucose-1-phosphate (from glycogen breakdown) to glucose-6-phosphate. - This enzyme is essential for channeling glycogen-derived glucose into glycolysis. [Practice more FMGE 2018 questions on OnCourse]

Q: All of the following are seen in superior laryngeal nerve palsy except:

Stridor. ***Stridor*** - **Superior laryngeal nerve palsy** primarily affects the **cricothyroid muscle** (external branch) and sensation above the vocal cords (internal branch). - Stridor typically results from severe **airway obstruction**, which is not a direct consequence of superior laryngeal nerve palsy as the **vocal cords** are not paralyzed open or closed to cause obstruction. *Aspiration* - The **internal branch of the superior laryngeal nerve** provides sensory innervation to the **supraglottic larynx**. - Loss of sensation in this region can impair the protective **cough reflex**, leading to an increased risk of aspiration. *Bowed vocal cords* - **Palsy of the cricothyroid muscle**, innervated by the **external branch of the superior laryngeal nerve**, causes a loss of tension in the vocal cord. - This lack of tension can result in a characteristically **bowed appearance** of the affected vocal cord during phonation. *Loss of pitch* - The **cricothyroid muscle** is responsible for tensing and elongating the vocal cords, which is crucial for **raising vocal pitch**. - Paralysis of this muscle due to **superior laryngeal nerve palsy** directly impairs the ability to achieve higher pitches, leading to a **monotone voice** or loss of pitch. [Practice more FMGE 2018 questions on OnCourse]

Q: How many blood samples should be drawn in cases of fever of unknown origin to optimize detection of intermittent bacteremia?

3. ***3*** - Drawing **three separate blood samples** significantly increases the likelihood of detecting intermittent bacteremia, as bacteria may not always be present in high concentrations in the bloodstream. - This practice maximizes the diagnostic yield while minimizing the risk of false positives from contamination. *1* - A single blood sample has a **low sensitivity** for detecting intermittent bacteremia, as transient presence of bacteria might be missed. - Relying on one sample increases the chance of a **false negative**, delaying appropriate treatment. *2* - While two samples are better than one, they still may not be sufficient to reliably detect **intermittent bacteremia** which can fluctuate. - This quantity might be acceptable for some conditions but is suboptimal for robust exclusion of **bacteremia in FUO** [1]. *4* - While four samples might slightly increase sensitivity over three, the **incremental benefit** in diagnostic yield is often negligible. - This approach adds to the **patient discomfort** and increases resource utilization without substantial additional diagnostic value. [Practice more FMGE 2018 questions on OnCourse]

Q: Which of the following diseases is MOST likely to present with proteinuria?

Diabetic nephropathy. ***Glomerulonephritis*** [1], [2] - It is characterized by **inflammation of the glomeruli**, leading to significant **proteinuria** due to increased permeability [1]. - Commonly associated with **hematuria** and **edema**, which further supports its presence in renal pathology [1], [2]. *Polycystic kidney disease* - Mainly presents with **renal cysts** and may have **hematuria** but does not typically cause significant proteinuria early on. - Proteinuria can occur later due to renal insufficiency, but is not a hallmark feature of the disease. *Pyelonephritis* - This condition primarily causes **inflammatory changes** in the kidney due to infection, leading to **fever** and **flank pain**, rather than proteinuria. - While mild proteinuria may occur, it is usually characterized by **white blood cells** and bacteria in the urine rather than significant protein loss. *Ateriitis* - Typically refers to **inflammation of the arteries**, which does not involve kidney structures directly related to proteinuria [3]. - This condition is associated with other systemic symptoms but rarely presents with notable **urinary protein loss** [3]. [Practice more FMGE 2018 questions on OnCourse]

Biochemistry

1 questions

Q1

Muscles cannot release free glucose from glycogen stores because of a deficiency of:

FMGE 2018 - Biochemistry FMGE Practice Questions and MCQs

Question 1: Muscles cannot release free glucose from glycogen stores because of a deficiency of:

A. Glucose-6-phosphatase (Correct Answer)
B. Hexokinase
C. Phosphoglucomutase
D. Glycogen phosphorylase

Explanation: ***Glucose-6-phosphatase*** - **Glucose-6-phosphatase** is the enzyme that dephosphorylates glucose-6-phosphate to free glucose, allowing its release into the bloodstream. - This enzyme is **physiologically absent in muscle tissue** (present only in liver and kidneys), meaning muscles can break down glycogen for their own energy needs but cannot release free glucose into circulation. - This ensures that muscle glycogen stores are reserved exclusively for muscle's own metabolic needs during contraction. *Glycogen phosphorylase* - **Glycogen phosphorylase** is present in muscle and catalyzes the breakdown of glycogen by cleaving α-1,4 glycosidic bonds to release glucose-1-phosphate. - Muscles have this enzyme and can normally break down glycogen for energy; deficiency causes **McArdle disease** (glycogen storage disease type V) with exercise intolerance. *Hexokinase* - **Hexokinase** is abundant in muscle tissue and phosphorylates free glucose to glucose-6-phosphate for entry into glycolysis. - This enzyme is necessary for utilizing both blood glucose and glycogen-derived glucose-6-phosphate. *Phosphoglucomutase* - **Phosphoglucomutase** is present in muscle and converts glucose-1-phosphate (from glycogen breakdown) to glucose-6-phosphate. - This enzyme is essential for channeling glycogen-derived glucose into glycolysis.

ENT

1 questions

Q1

All of the following are seen in superior laryngeal nerve palsy except:

Internal Medicine

4 questions

Q1

How many blood samples should be drawn in cases of fever of unknown origin to optimize detection of intermittent bacteremia?

Q2

Which of the following diseases is MOST likely to present with proteinuria?

Q3

Which of the following statements is true regarding von Willebrand disease?

Q4

All of the following are features of Zollinger Ellison syndrome except:

FMGE 2018 - Internal Medicine FMGE Practice Questions and MCQs

Question 1: How many blood samples should be drawn in cases of fever of unknown origin to optimize detection of intermittent bacteremia?

A. 2
B. 3 (Correct Answer)
C. 1
D. 4

Explanation: ***3*** - Drawing **three separate blood samples** significantly increases the likelihood of detecting intermittent bacteremia, as bacteria may not always be present in high concentrations in the bloodstream. - This practice maximizes the diagnostic yield while minimizing the risk of false positives from contamination. *1* - A single blood sample has a **low sensitivity** for detecting intermittent bacteremia, as transient presence of bacteria might be missed. - Relying on one sample increases the chance of a **false negative**, delaying appropriate treatment. *2* - While two samples are better than one, they still may not be sufficient to reliably detect **intermittent bacteremia** which can fluctuate. - This quantity might be acceptable for some conditions but is suboptimal for robust exclusion of **bacteremia in FUO** [1]. *4* - While four samples might slightly increase sensitivity over three, the **incremental benefit** in diagnostic yield is often negligible. - This approach adds to the **patient discomfort** and increases resource utilization without substantial additional diagnostic value.

Question 2: Which of the following diseases is MOST likely to present with proteinuria?

A. Aneurysms
B. Polycystic kidney disease
C. Diabetic nephropathy (Correct Answer)
D. Glomerulonephritis

Explanation: ***Glomerulonephritis*** [1], [2] - It is characterized by **inflammation of the glomeruli**, leading to significant **proteinuria** due to increased permeability [1]. - Commonly associated with **hematuria** and **edema**, which further supports its presence in renal pathology [1], [2]. *Polycystic kidney disease* - Mainly presents with **renal cysts** and may have **hematuria** but does not typically cause significant proteinuria early on. - Proteinuria can occur later due to renal insufficiency, but is not a hallmark feature of the disease. *Pyelonephritis* - This condition primarily causes **inflammatory changes** in the kidney due to infection, leading to **fever** and **flank pain**, rather than proteinuria. - While mild proteinuria may occur, it is usually characterized by **white blood cells** and bacteria in the urine rather than significant protein loss. *Ateriitis* - Typically refers to **inflammation of the arteries**, which does not involve kidney structures directly related to proteinuria [3]. - This condition is associated with other systemic symptoms but rarely presents with notable **urinary protein loss** [3].

Question 3: Which of the following statements is true regarding von Willebrand disease?

A. Factor VIII levels are always normal.
B. Platelet count is consistently decreased.
C. Bleeding time is prolonged due to impaired platelet adhesion. (Correct Answer)
D. Activated partial thromboplastin time (aPTT) is always normal.

Explanation: Normal prothrombin time (PT) - In von Willebrand disease, **PT remains normal**, which indicates that the extrinsic pathway of coagulation is unaffected [1]. - This disorder primarily affects **platelet function** and vWF levels, not prothrombin time. *Platelet count may be decreased in some cases* - While platelet count can be low, it is not a consistent finding in von Willebrand disease; often, **platelet count is normal**. - The disorder primarily involves **qualitative abnormalities** in platelets due to impaired vWF function, rather than quantitative [3]. *Bleeding time is prolonged* - Bleeding time is typically **prolonged** in von Willebrand disease, which reflects platelet dysfunction, but this statement does not correctly state its context. - The disease affects **hemostasis**, leading to increased bleeding tendencies rather than maintaining normal bleeding times. *Normal activated partial thromboplastin time (aPTT)* - In von Willebrand disease, **aPTT may be prolonged** due to the deficiency of factor VIII, which is carried by vWF [2]. - The presence of normal aPTT does not reflect the disease's impact on the intrinsic pathway of coagulation.

Question 4: All of the following are features of Zollinger Ellison syndrome except:

A. Severe diarrhoea
B. Beta cell tumours of the pancreas (Correct Answer)
C. Very high acid output
D. Intractable peptic ulcers

Explanation: ***Beta cell tumours of the pancreas*** - Zollinger-Ellison syndrome (ZES) is caused by **gastrinomas**, which are **neuroendocrine tumors** that typically arise from the **gastrin-producing G cells**, not the insulin-producing beta cells, of the pancreas or duodenum. - While pancreatic tumors are common in ZES, they are specifically **gastrinomas**, leading to excessive gastrin secretion. *Severe diarrhoea* - This is a common feature of ZES resulting from the **high acid output** reaching the small intestine. - The excessive acid inactivates pancreatic lipase, leading to **maldigestion** and stimulates fluid and electrolyte secretion, causing secretory diarrhea. *Very high acid output* - ZES is characterized by the **overproduction of gastrin**, which stimulates the parietal cells of the stomach to secrete large amounts of **hydrochloric acid**. - This leads to a significantly **increased basal and maximal acid output** in the stomach. *Intractable peptic ulcers* - The extremely high gastric acid secretion in ZES causes **multiple, recurrent, and often refractory peptic ulcers**, which can be located in atypical sites such as the jejunum. - These ulcers are typically difficult to treat with standard anti-ulcer medications due to the persistent gastric hypersecretion.

Obstetrics and Gynecology

2 questions

Q1

Hydrops fetalis in a fetus can be due to:

Q2

Which one of the following is NOT a characteristic feature of bacterial vaginosis?

FMGE 2018 - Obstetrics and Gynecology FMGE Practice Questions and MCQs

Question 1: Hydrops fetalis in a fetus can be due to:

A. Human papilloma virus
B. Parvovirus B19 (Correct Answer)
C. Influenza Virus
D. Epstein-Barr virus

Explanation: ***Parvovirus B19*** - **Parvovirus B19** infection in a fetus can lead to severe **anemia** and **hydrops fetalis** because the virus targets **erythroid progenitor cells**, impairing red blood cell production. - The resulting severe anemia causes **high-output cardiac failure**, leading to widespread edema, ascites, pleural effusions, and pericardial effusions, which characterize hydrops fetalis. *Epstein-Barr virus* - While **Epstein-Barr virus (EBV)** can infect the fetus, it is more commonly associated with conditions like **lymphoproliferative disorders** or **hepatosplenomegaly**, not typically hydrops fetalis as a primary manifestation. - EBV infection in pregnancy is often asymptomatic or causes mild illness and is not a common cause of severe fetal anemia or hydrops. *Human papilloma virus* - **Human papilloma virus (HPV)** is known to cause **genital warts** and is associated with **cervical cancer**, but it does not cause hydrops fetalis. - Vertical transmission of HPV can occur, leading to conditions like **recurrent respiratory papillomatosis** in the infant, but it does not affect red blood cell production or fluid balance in the fetus in a way that would cause hydrops. *Influenza Virus* - **Influenza virus** infection during pregnancy can lead to complications such as **preterm delivery** or **low birth weight**, but it is not a direct cause of hydrops fetalis. - The influenza virus primarily affects the respiratory system and does not directly target fetal erythroid cells or cause the severe anemia necessary for hydrops.

Question 2: Which one of the following is NOT a characteristic feature of bacterial vaginosis?

A. Vaginal pH >4.5
B. Fishy odour
C. Presence of clue cells
D. Thick white discharge (Correct Answer)

Explanation: ***Thick white discharge*** - Bacterial vaginosis is characterized by a **thin, grayish-white, homogeneous discharge**, not a thick white one. - A thick, white, "cottage cheese-like" discharge is more typical of **vulvovaginal candidiasis (yeast infection)**. *Presence of clue cells* - **Clue cells** are epithelial cells covered with bacteria, which are a hallmark microscopic finding in bacterial vaginosis. - Their presence is a key diagnostic criterion (Amsel criteria) for the condition. *Vaginal pH >4.5* - Bacterial vaginosis is associated with an **elevated vaginal pH, typically greater than 4.5**, due to the shift in vaginal flora. - This alkaline pH is a critical diagnostic indicator. *Fishy odour* - A **distinctive fishy odor**, particularly after intercourse or douching, is a classic symptom of bacterial vaginosis. - This odor is due to the production of **volatile amines** by anaerobic bacteria.

Physiology

1 questions

Q1

From which part of the gastrointestinal tract is glucose absorbed?

FMGE 2018

Anesthesiology

Biochemistry

ENT

Internal Medicine

Obstetrics and Gynecology

Physiology

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