FMGE 2019 Practice Questions

Q: In the shown lateral view, the structure marked with arrowhead is?

Trachea. ***Trachea*** - This is a lateral view of the thorax, and the **trachea** is the most anterior conduit in the superior mediastinum, visible as an **air-filled structure** anterior to the esophagus. - The arrowhead points to a vertical air column in the anterior aspect, consistent with the expected anatomical location and appearance of the **trachea**. *Pulmonary artery* - The **pulmonary artery** lies anterior to the main bronchi and usually branches before this level, and it is a vascular structure, not an air-filled lumen. - It would appear as a soft tissue density, not a radiolucent (dark) air-filled structure on an X-ray. *Left atrium* - The **left atrium** is located posteriorly to the ascending aorta and pulmonary artery, and it is a cardiac chamber, not an air-filled tubular structure. - It is also a soft tissue density and would not be visible as a distinct air-filled lumen on a lateral chest X-ray in this position. *Esophagus* - The **esophagus** is located posterior to the trachea, running behind it in the mediastinum. - While it is a tubular structure, it is usually not air-filled unless there is swallowed air or a pathology (e.g., hiatus hernia), and it would be located *behind* the structure indicated by the arrowhead.

Q: Diseases spread by the shown vector are all except

Chagas disease. ***Chagas disease*** - Chagas disease is caused by *Trypanosoma cruzi* and is transmitted by the **reduviid bug** (kissing bug), not the **sandfly** shown in the image. - Its transmission involves the bug's feces, which contain trypomastigotes, entering the bite wound or mucous membranes. *Oriental sore* - This is a localized form of **cutaneous leishmaniasis**, caused by *Leishmania tropica* or *L. major*, and is transmitted by the **sandfly**. - It presents as chronic skin ulcers, primarily in the Middle East and Asia. *Cutaneous leishmaniasis* - This is a general term for various skin manifestations of leishmaniasis, including Oriental sore, which are all transmitted by the bite of an infected female **sandfly**. - It results in skin lesions ranging from nodules to ulcers. *Kala-azar* - Also known as **visceral leishmaniasis**, it is caused by *Leishmania donovani* and is transmitted by the bite of an infected female **sandfly**. - This severe form affects internal organs like the spleen, liver, and bone marrow, leading to fever, weight loss, and anemia.

Q: All of the following are the causes for hypercalcemia Except?

Acute pancreatitis. ***Acute pancreatitis*** - **Acute pancreatitis** is most commonly associated with **hypocalcemia**, not hypercalcemia [1]. - The likely mechanism for hypocalcemia in pancreatitis is the **saponification of calcium in necrotic fat** by free fatty acids released from local lipase activity [1]. *Thiazides* - **Thiazide diuretics** can cause a mild increase in calcium levels by **increasing calcium reabsorption in the distal renal tubule** [2]. - This effect is generally not severe enough to cause symptomatic hypercalcemia unless other underlying conditions are present. *Hyperparathyroidism* - **Primary hyperparathyroidism** is a common cause of hypercalcemia, due to the **overproduction of parathyroid hormone (PTH)** [2]. - PTH increases serum calcium by increasing **bone resorption**, renal calcium reabsorption, and intestinal calcium absorption [2]. *Hypervitaminosis of Vitamin D* - Excessive intake or production of **Vitamin D** leads to hypercalcemia by increasing **intestinal absorption of calcium** [2]. - It also enhances **bone resorption**, contributing to elevated serum calcium levels.

Q: Central obesity is seen in;

Cushing's disease. ***Cushing's disease*** - **Cushing's disease** is characterized by **excessive cortisol production**, leading to fat redistribution, including **central obesity** with a 'buffalo hump' and 'moon face' [1]. - **Cortisol's metabolic effects** promote increased visceral fat accumulation and breakdown of peripheral fat [1]. *Crohn's disease* - **Crohn's disease** is an **inflammatory bowel disease** that typically causes **weight loss**, abdominal pain, and diarrhea due to malabsorption and inflammation. - While patients can develop complications like **fistulas** and **abscesses**, central obesity is not a primary feature. *Celiac disease* - **Celiac disease** is an **autoimmune disorder** triggered by gluten, leading to **malabsorption** and usually presenting with **weight loss**, diarrhea, and nutrient deficiencies. - Central obesity is **not a typical presentation** and would be contradictory to the malabsorptive state. *Conn's disease* - **Conn's disease**, or primary aldosteronism, involves **excessive aldosterone** production, primarily causing **hypertension** and hypokalemia. - It **does not directly cause central obesity**; its metabolic effects are unrelated to fat distribution.

Q: After a normal delivery in a 27-year-old female, placenta is still attached to the uterus. Most common complication which can occur due to forceful traction of cord?

Uterine inversion. ***Uterine inversion*** - Forceful traction on the umbilical cord when the placenta is still firmly attached can pull the **fundus of the uterus inside out**, leading to uterine inversion. - This is a rare obstetric emergency associated with significant **hemorrhage** and shock. *Hemorrhage* - While hemorrhage is a common complication of retained placenta and uterine inversion, it is a *consequence* of these conditions, not the direct complication of forceful cord traction itself in the same way uterine inversion is. - The direct mechanical complication from forceful traction is the pulling out of the uterus, which then *causes* the significant hemorrhage. *Uterine rupture* - Uterine rupture during the third stage of labor is exceptionally rare and usually associated with a **previously scarred uterus** or excessive uterine overdistension, not typically caused by forceful cord traction. - Forceful cord traction is more likely to cause inversion or avulsion of the cord, rather than a tear in the uterine wall. *Placental abruption* - Placental abruption involves the **premature separation of a normally implanted placenta** *before* the delivery of the fetus. - This event occurs during pregnancy or labor before birth, not after delivery when the placenta is simply retained.

Q: A lady with 12-week pregnancy presents with bleeding. On examination, vagina is normal, internal os is closed, and USG shows fetal viability with fundal height of 13 weeks. What is the diagnosis?

Threatened abortion. ***Threatened abortion*** - This diagnosis is characterized by **vaginal bleeding** in the first half of pregnancy with a **closed internal os** and evidence of fetal viability on ultrasound. - The fundal height being consistent with gestational age also indicates ongoing pregnancy, despite the bleeding. *Inevitable abortion* - This condition is indicated by vaginal bleeding accompanied by a **dilated cervix (open internal os)**, suggesting that the pregnancy cannot be salvaged. - While bleeding is present, the **closed internal os** in the given scenario rules out inevitable abortion. *Incomplete abortion* - This involves vaginal bleeding, an **open internal os**, and the **partial expulsion of pregnancy tissue**, with some products of conception remaining in the uterus. - The presentation does not include an open os or retained products of conception, as the fetus is viable and the os is closed. *Complete abortion* - This occurs when **all products of conception have been expelled** from the uterus, characterized by an initially open os that subsequently closes, and often a decrease in bleeding. - The presence of a **viable fetus** and a closed os clearly rules out a complete abortion.

Q: A person is not able to count fingers from a distance of 6 meters. He shall be categorized into which type of blindness?

Severe visual impairment. ***Severe visual impairment*** - Severe visual impairment is defined as visual acuity **less than 6/60 to 3/60** (presenting visual acuity). - The key clinical threshold is the **inability to count fingers at 6 meters**, which corresponds to VA < 6/60. - This category represents a significant functional vision loss where the person can typically still count fingers at 3 meters but not at 6 meters. - According to **WHO ICD-10 classification**, this falls under **Category H1** (severe visual impairment). *Moderate visual impairment* - Moderate visual impairment is characterized by visual acuity of **less than 6/18 to 6/60**. - A person with moderate visual impairment would **still be able to count fingers at 6 meters**. - This does not match the clinical presentation described in the question. *Profound visual impairment* - Profound visual impairment (also called **Blindness Category 1**) is defined as visual acuity **less than 3/60 to 1/60**. - The key threshold here is the **inability to count fingers at 3 meters** (but can count at 1 meter). - This is more severe than what is described in the question, as the question only specifies inability at 6 meters. *Near-total blindness* - Near-total blindness (**Blindness Category 2**) refers to visual acuity **less than 1/60 to light perception only**. - This represents the ability to perceive hand movements close to the face or only light perception. - This is far more severe than the presentation described in the question.

Q: Cellulitis is characterized as:

Nonsuppurative and invasive. ***Nonsuppurative and invasive*** - Cellulitis is considered **nonsuppurative** as it typically lacks macroscopic pus formation, distinguishing it from abscesses. - It is **invasive** because it involves the dermal and subcutaneous tissues, spreading through fascial planes. *Suppurative and invasive* - This description is more indicative of conditions like an **abscess**, which involves localized collections of pus. - While abscesses are invasive, cellulitis characteristically lacks the discrete pus collection. *Nonsuppurative and non-invasive* - Conditions that are nonsuppurative and non-invasive might include self-limiting skin rashes or superficial inflammatory processes. - Cellulitis involves deeper tissue infection, which inherently makes it invasive. *Suppurative and non-invasive* - A condition that is suppurative but non-invasive would be rare and contradictory, as pus formation often indicates a tissue response that is at least locally invasive. - Superficial pustules might be considered suppurative and relatively non-invasive, but cellulitis clearly extends beyond such superficial lesions.

Q: A 3-month-old baby presents with fever and respiratory rate of 60/min. The baby is irritable but feeding well. There is no stridor, no chest indrawing, and no convulsions. What is the diagnosis?

Pneumonia. ***Pneumonia*** - A respiratory rate of 60 breaths per minute in a 3-month-old infant meets the **WHO criteria for fast breathing**, which is the primary indicator for diagnosing **pneumonia** in this age group. - The absence of chest indrawing, stridor, or convulsions means this falls under **pneumonia**, not **severe** or **very severe pneumonia**. *Very severe pneumonia* - This would be diagnosed if there were **danger signs** such as inability to feed, lethargy, or convulsions, which are explicitly stated as absent. - Presence of **stridor** in a calm child or **severe malnutrition** would also suggest very severe pneumonia, none of which are mentioned. *Severe pneumonia* - This classification requires the presence of **chest indrawing** or **stridor** in a child, which are noted as absent in the clinical presentation. - While the child has fast breathing, the lack of additional severe signs distinguishes it from severe pneumonia. *No Pneumonia* - The presence of **fast breathing** (respiratory rate of 60 in a 3-month-old) is a clear sign of respiratory distress indicating **pneumonia**, according to WHO guidelines. - If the child had a normal respiratory rate and no other signs of respiratory illness, this option might be considered.

Question 1

In the shown lateral view, the structure marked with arrowhead is?

Accepted Answer

Trachea

Answer

Pulmonary artery

Answer

Left atrium

Answer

Esophagus

Question 2

According to WHO International Health Regulations, which disease requires immediate notification due to its epidemic potential and international spread risk?

Accepted Answer

Yellow fever

Answer

Malaria

Answer

HIV

Answer

Polio

Question 3

Diseases spread by the shown vector are all except

Accepted Answer

Chagas disease

Answer

Oriental sore

Answer

Kala azar

Answer

Cutaneous leishmaniasis

Question 4

All of the following are the causes for hypercalcemia Except?

Accepted Answer

Acute pancreatitis

Answer

Thiazides

Answer

Hyperparathyroidism

Answer

Hypervitaminosis of Vitamin D

Question 5

Central obesity is seen in;

Accepted Answer

Cushing's disease

Answer

Crohn's disease

Answer

Celiac disease

Answer

Conn's disease

Question 6

After a normal delivery in a 27-year-old female, placenta is still attached to the uterus. Most common complication which can occur due to forceful traction of cord?

Accepted Answer

Uterine inversion

Answer

Hemorrhage

Answer

Uterine rupture

Answer

Placental abruption

Question 7

A lady with 12-week pregnancy presents with bleeding. On examination, vagina is normal, internal os is closed, and USG shows fetal viability with fundal height of 13 weeks. What is the diagnosis?

Accepted Answer

Threatened abortion

Answer

Incomplete abortion

Answer

Complete abortion

Answer

Inevitable abortion

Question 8

A person is not able to count fingers from a distance of 6 meters. He shall be categorized into which type of blindness?

Accepted Answer

Severe visual impairment

Answer

Moderate visual impairment

Answer

Near-total blindness

Answer

Profound visual impairment

Question 9

Cellulitis is characterized as:

Accepted Answer

Nonsuppurative and invasive

Answer

Suppurative and invasive

Answer

Nonsuppurative and non-invasive

Answer

Suppurative and non-invasive

Question 10

A 3-month-old baby presents with fever and respiratory rate of 60/min. The baby is irritable but feeding well. There is no stridor, no chest indrawing, and no convulsions. What is the diagnosis?

Accepted Answer

Pneumonia

Answer

Very severe pneumonia

Answer

Severe pneumonia

Answer

No Pneumonia

FMGE 2019

Anatomy

Community Medicine

Internal Medicine

Obstetrics and Gynecology

Ophthalmology

Pathology

Pediatrics