FMGE 2019 Practice Questions

Q: Components of Kuppuswamy scale include:

Income, Occupation, Education. ***Income, Occupation, Education*** - The **Kuppuswamy scale** is a widely used tool in India for classifying the socioeconomic status of families. - It considers **income**, **occupation**, and **education** levels to assign a score. *Income, Housing, Education* - While income and education are components, **housing** is not a primary factor in the original Kuppuswamy scale. - Housing quality and type can be indicators of socioeconomic status, but they are not directly integrated into this specific scale. *Housing, Livestock, land* - None of these are direct components of the **Kuppuswamy scale** for socioeconomic classification. - These factors might be relevant for rural socioeconomic status but are not part of this specific urban-focused scale. *Income, Livestock, Housing* - While income is a component, **livestock** and **housing** are not included in the original Kuppuswamy scale. - This combination of factors would likely be more appropriate for assessing socioeconomic status in agricultural or rural settings.

Q: Anthracosis is caused by:

Coal dust. ***Coal dust*** - **Anthracosis** is a lung condition resulting from the accumulation of **coal dust** particles in the lungs. - It is a common finding in coal miners, hence the term **coal worker's pneumoconiosis**. *Sugar cane waste* - Inhalation of **sugar cane waste** can lead to **bagassosis**, a form of hypersensitivity pneumonitis. - Bagassosis is caused by an immunological reaction to organic dust, not inert particle build-up like anthracosis. *Asbestos* - Exposure to **asbestos** fibers causes **asbestosis**, a severe fibrotic lung disease. - Asbestosis is also linked to an increased risk of lung cancer and **mesothelioma**. *Silica* - Inhalation of **crystalline silica** dust results in **silicosis**, characterized by lung nodule formation and fibrosis. - Occupations involving mining, quarrying, and construction are at high risk for silicosis.

Q: A 32-year-old lady presents with shoulder tip pain. She is diagnosed with Pancoast tumor and presents with miosis. What is the most likely associated diagnosis?

Horner syndrome. Horner syndrome - The presence of miosis (constricted pupil) in a patient with a Pancoast tumor is a classic sign of Horner syndrome. - Pancoast tumors are apical lung tumors that can invade the sympathetic chain, leading to the triad of ptosis, miosis, and anhidrosis. Upper trunk of brachial plexus injury - While Pancoast tumors can involve the brachial plexus, an injury to the upper trunk (C5-C6) typically causes symptoms like weakness in shoulder abduction and external rotation, and sensory loss over the lateral arm. - It does not directly explain miosis unless the sympathetic chain is also involved, which is characteristic of Horner syndrome. Thoracic outlet syndrome - This syndrome involves compression of the neurovascular structures as they exit the thoracic outlet, often causing pain, paresthesias, and weakness in the arm and hand. - It does not directly account for the symptom of miosis, which points to sympathetic nerve involvement. Aberrant right subclavian artery - An aberrant right subclavian artery is a congenital anomaly where the right subclavian artery arises from the distal aortic arch, often causing dysphagia lusoria or being asymptomatic. - It has no direct association with Pancoast tumors or the development of miosis.

Q: A patient presented with some unknown fungal infection. Microscopic examination revealed brown coloured spherical fungi with septate hyphae. Possible condition:

Chromoblastomycosis. ***Chromoblastomycosis*** - This infection is characterized by the presence of **sclerotic bodies** (also known as fumagoid bodies or Medlar bodies), which are **brown-pigmented**, **spherical**, copper-colored cells or muriform cells observed in tissue. - The causative fungi, often dematiaceous molds, exhibit **septate hyphae** in culture. These molds are pigmented due to melanin in their cell walls. *Histoplasmosis* - Caused by *Histoplasma capsulatum*, which appears as **small, oval, intracellular budding yeasts** within macrophages in tissue samples. - It does not typically form sclerotic bodies or prominent septate hyphae in infected tissue. *Candida albicans* - This yeast typically presents as **ovoid budding yeast cells**, pseudohyphae, and true hyphae in tissues. - It is an **achlorophyllous** fungus, meaning it lacks pigmentation and would not appear as "brown coloured" under microscopic examination. *Coccidioidomycosis* - Caused by *Coccidioides immitis* or *C. posadasii*, which are characterized by the formation of **spherules** containing endospores in tissue. - It does not form "brown coloured spherical fungi with septate hyphae" as described; spherules are large, non-pigmented, and contain smaller endospores.

Q: MC cause of atypical pneumonia?

Mycoplasma pneumoniae. ***Mycoplasma pneumoniae*** - *M. pneumoniae* is the most common cause of **atypical pneumonia**, often referred to as **"walking pneumonia"** due to milder symptoms compared to typical bacterial pneumonia. - It lacks a **cell wall**, making it resistant to many common antibiotics like penicillin and cephalosporins. *Klebsiella pneumoniae* - *Klebsiella pneumoniae* typically causes **lobar pneumonia**, particularly in individuals with compromised immune systems or alcoholism. - It is associated with **severe symptoms**, such as thick, "currant jelly" sputum, and often forms dense consolidated infiltrates on chest X-rays. [1] *Hemophilus influenzae* - *Haemophilus influenzae* is a common cause of **bacterial pneumonia**, especially in children and adults with underlying lung disease (e.g., COPD). - It usually presents as **typical pneumonia** with more acute and severe symptoms, rather than the milder, atypical presentation. *Chlamydia* - While *Chlamydia pneumoniae* can cause a form of atypical pneumonia, it is **less common** than *Mycoplasma pneumoniae* as the primary cause. [1] - *Chlamydia* infections can also cause other conditions, such as **urethritis** and **cervicitis**, depending on the species involved.

Q: The causative agent for duodenal ulcer is:

H. Pylori. ***H. pylori*** - ***H. pylori*** is a **Gram-negative spiral-shaped bacterium** that colonizes the stomach and duodenum, causing inflammation and increasing the risk of peptic ulcers, including duodenal ulcers. - It produces **urease**, which neutralizes stomach acid by converting urea to ammonia, protecting the bacteria and contributing to mucosal damage. *Lactobacilli* - **Lactobacilli** are **Gram-positive, rod-shaped bacteria** commonly found in the digestive tract and fermented foods. - They are generally considered **beneficial probiotics** and do not cause duodenal ulcers. *E. coli* - ***E. coli*** is a **Gram-negative, rod-shaped bacterium** typically found in the intestines of humans and animals. - While some strains can cause **gastrointestinal infections** (e.g., traveler's diarrhea), *E. coli* is not a known cause of duodenal ulcers. *Shigella* - **Shigella** is a **Gram-negative, rod-shaped bacterium** that causes **shigellosis**, an intestinal infection characterized by severe diarrhea (dysentery). - It primarily affects the **large intestine** and does not cause duodenal ulcers.

Q: Bacillus anthracis is:

Gram positive rods with square ends. ***Gram positive rods with square ends*** - *Bacillus anthracis* is a **gram-positive bacterium**, meaning it retains the crystal violet stain due to its thick peptidoglycan layer. - Microscopically, it appears as **large, rod-shaped bacteria** (bacilli) with characteristic **square-cut ends**, often arranged in chains. *Gram negative cocci in cluster* - This describes organisms like **Neisseria gonorrhoeae** or **meningitidis**, which are spherical (cocci) and appear pink/red after Gram staining. - *Bacillus anthracis* is a **rod-shaped bacterium** that stains Gram-positive. *Gram positive cocci in cluster* - This morphology is characteristic of **Staphylococcus species**, which are spherical bacteria that stain purple and arrange in grape-like clusters. - *Bacillus anthracis* is a **rod-shaped bacterium**, not a coccus. *Gram positive bacilli with spherical ends* - While *Bacillus anthracis* is a **gram-positive bacillus**, its ends are distinctly **square-cut**, not spherical. - Bacteria with spherical or rounded ends would include some other *Bacillus* species or members of the **Clostridium** genus.

Q: Late rupture of tubal pregnancy is seen in?

Interstitial. ***Interstitial*** - The interstitial portion of the fallopian tube is the segment that passes through the **myometrium** of the uterus. This muscular wall provides greater distensibility and support, allowing the pregnancy to grow for a longer period before rupture. - Rupture in the interstitial part typically occurs later (around **8-12 weeks**) and is often more catastrophic due to its proximity to the **uterine blood vessels**, leading to severe hemorrhage. *Fimbriae* - Pregnancies rarely implant in the fimbriae, and if they do, they are more likely to undergo **tubal abortion** rather than rupture. - The fimbriae are finger-like projections at the end of the fallopian tube which is why they cannot hold pregnancy for a longer duration. *Ampulla* - The ampulla is the **widest part** of the fallopian tube and is the most common site of ectopic pregnancy (about 70%). - Rupture in the ampulla typically occurs earlier, around **6-8 weeks**, as its wall is thinner and less distensible compared to the interstitial segment. *Isthmus* - The isthmus is a **narrower, more muscular** segment of the fallopian tube. - Pregnancy in the isthmus tends to rupture early (around **4-6 weeks**) because the lumen is very narrow and the wall is rigid, accommodating very little expansion.

Q: Lady presents with infertility and diagnosed with bilateral cornual block on hysterosalpingography. What is the next step?

Laparoscopy and hysteroscopy. ***Laparoscopy and hysteroscopy*** - A **laparoscopy** allows for direct visualization of the fallopian tubes to confirm the tubal obstruction and assess for other pelvic pathology like **endometriosis** or **adhesions**. - A **hysteroscopy** can be performed concurrently to inspect the uterine cavity and the tubal ostia for any intracavitary abnormalities or to attempt **canalization of the cornual block**. *Tuboplasty* - **Tuboplasty** is a corrective surgical procedure for tubal obstruction, but it is typically considered *after* a definitive diagnosis and assessment of the block's extent have been made via diagnostic procedures. - Its success rate varies depending on the location and nature of the block, and it is not the immediate next step for diagnosis. *USG* - **Transvaginal ultrasonography (USG)** is a useful tool for evaluating uterine and ovarian morphology but is generally *not definitive* for diagnosing tubal patency or specific locations of tubal blockage. - While it can identify some pathologies, it cannot visualize the fallopian tubes with sufficient clarity to determine cornual obstruction. *IVF* - **In vitro fertilization (IVF)** is an *assisted reproductive technology* used to bypass tubal factor infertility, but it is a treatment option, not a diagnostic step. - It would be considered *after* a full diagnostic workup has confirmed the tubal blockage and other fertility factors, and after counseling regarding prognosis and success rates.

Q: Which of the following is an oral direct thrombin inhibitor?

Dabigatran. ***Dabigatran*** - **Dabigatran** is the correct answer because it is an **oral direct thrombin inhibitor (DTI)**, meaning it directly inhibits thrombin (factor IIa) to prevent clot formation. - It is one of the **novel oral anticoagulants (NOACs)**, used for conditions like atrial fibrillation and venous thromboembolism. *Lepirudin* - **Lepirudin** is a **direct thrombin inhibitor**, but it is administered **intravenously**, not orally. - It is typically used for **heparin-induced thrombocytopenia (HIT)** when heparin is contraindicated. *Rivaroxaban* - **Rivaroxaban** is an **oral anticoagulant**, but it is a **direct factor Xa inhibitor**, not a direct thrombin inhibitor. - This drug prevents the conversion of prothrombin to thrombin by inhibiting factor Xa. *Warfarin* - **Warfarin** is an **oral anticoagulant**, but it acts as a **vitamin K antagonist (VKA)**, inhibiting the synthesis of coagulation factors II, VII, IX, and X. - It does not directly inhibit thrombin, but rather reduces the production of thrombin precursors.

Question 1

Components of Kuppuswamy scale include:

Accepted Answer

Income, Occupation, Education

Answer

Income, Housing, Education

Answer

Housing, Livestock, land

Answer

Income, Livestock, Housing

Question 2

Anthracosis is caused by:

Accepted Answer

Coal dust

Answer

Sugar cane waste

Answer

Asbestos

Answer

Silica

Question 3

A 32-year-old lady presents with shoulder tip pain. She is diagnosed with Pancoast tumor and presents with miosis. What is the most likely associated diagnosis?

Accepted Answer

Horner syndrome

Answer

Upper trunk of brachial plexus injury

Answer

Thoracic outlet syndrome

Answer

Aberrant right subclavian artery

Question 4

A patient presented with some unknown fungal infection. Microscopic examination revealed brown coloured spherical fungi with septate hyphae. Possible condition:

Accepted Answer

Chromoblastomycosis

Answer

Histoplasmosis

Answer

Candida albicans

Answer

Coccidioidomycosis

Question 5

MC cause of atypical pneumonia?

Accepted Answer

Mycoplasma pneumoniae

Answer

Klebsiella pneumoniae

Answer

Hemophilus influenzae

Answer

Chlamydia

Question 6

The causative agent for duodenal ulcer is:

Accepted Answer

H. Pylori

Answer

Lactobacilli

Answer

E. coli

Answer

Shigella

Question 7

Bacillus anthracis is:

Accepted Answer

Gram positive rods with square ends

Answer

Gram negative cocci in cluster

Answer

Gram positive cocci in cluster

Answer

Gram positive bacilli with spherical ends

Question 8

Late rupture of tubal pregnancy is seen in?

Accepted Answer

Interstitial

Answer

Fimbriae

Answer

Ampulla

Answer

Isthmus

Question 9

Lady presents with infertility and diagnosed with bilateral cornual block on hysterosalpingography. What is the next step?

Accepted Answer

Laparoscopy and hysteroscopy

Answer

Tuboplasty

Answer

USG

Answer

IVF

Question 10

Which of the following is an oral direct thrombin inhibitor?

Accepted Answer

Dabigatran

Answer

Lepirudin

Answer

Rivaroxaban

Answer

Warfarin

FMGE 2019

Community Medicine

Internal Medicine

Microbiology

Obstetrics and Gynecology

Pharmacology