FMGE 2019 Practice Questions

Q: The duration of spinal anaesthesia is based directly on:

Dose. ***Dose*** - The **total mass** (dose) of the local anesthetic administered directly influences the number of nerve fibers blocked and the duration of block. - A higher dose of a given local anesthetic generally leads to a **longer duration** of action in spinal anesthesia. *Height* - While patient height can influence the **spread** of spinal anesthesia due to differences in spinal column length, it does not directly determine the **duration** of the block. - The **volume** of the injectate, rather than the patient's height alone, affects the cranial spread of the anesthetic. *Total body fat* - Total body fat has **minimal direct impact** on the duration of spinal anesthesia since local anesthetics are injected directly into the cerebrospinal fluid, largely bypassing systemic fat distribution initially. - **Lipid solubility** of the drug affects its potency and duration within the neuraxis, not external body fat. *Age* - **Age** can influence the **spread** and **onset** of spinal anesthesia due to changes in cerebrospinal fluid volume and spinal cord compliance, but it is not the primary determinant of **duration**. - Older patients may experience a greater spread for a given dose, but the primary factor for duration remains the total drug dose.

Q: Which of the following is used for day care surgery?

Propofol. ***Propofol*** - **Propofol** is favored for **day care surgery** due to its **rapid onset** and **rapid recovery** profile, allowing patients to be discharged quickly. - It produces a **clear-headed recovery** with less postoperative nausea and vomiting compared to other agents. *Thiopentone* - **Thiopentone** has a **longer recovery time** and greater potential for **postoperative sedation** and **nausea**, making it less suitable for day care surgery. - Its use often leads to a **delayed discharge** from the recovery unit. *Ketamine* - **Ketamine** can cause **psychomimetic effects** (e.g., hallucinations, vivid dreams) and **delirium** during emergence, which are undesirable for day care procedures. - It also leads to **increased heart rate** and **blood pressure**, which may prolong recovery and observation time. *Etomidate* - **Etomidate** is known to cause **adrenocortical suppression** and can be associated with **pain on injection** and **myoclonus**, which are not ideal for routine day care use. - While it has a relatively **stable cardiovascular profile**, these side effects limit its widespread use in short procedures where rapid, smooth recovery is paramount.

Q: Synovial fluid contains-

Hyaluronic acid. ***Hyaluronic acid*** - **Hyaluronic acid** is a major component of **synovial fluid**, providing **viscosity** and **lubrication** to joints, which is crucial for reducing friction between articular cartilages. - It's a **glycosaminoglycan** (GAG) responsible for the fluid's unique rheological properties, maintaining joint health and function. *Keratan sulphate* - **Keratan sulphate** is primarily found in **cartilage**, **cornea**, and **bone**, contributing to their structural integrity. - It is not a significant component of **synovial fluid** itself; rather, it is part of the extracellular matrix of surrounding tissues. *Dermatan sulphate* - **Dermatan sulphate** is typically found in **skin**, **blood vessels**, and **heart valves**, where it plays a role in tissue organization and repair. - It is not a characteristic or primary component of **synovial fluid**. *Chondroitin sulphate* - **Chondroitin sulphate** is a GAG abundant in **cartilage**, contributing to its **compressive strength** and elasticity. - While essential for **joint health**, it is found within the cartilage matrix, not freely in high concentrations within the **synovial fluid**.

Q: Frontal headache is due to inflammation of which sinus?

Frontal. ***Frontal*** - Inflammation of the **frontal sinuses** typically causes pain and pressure over the forehead, known as a **frontal headache**. - The pain is often worse in the morning, when bending over, or with changes in **barometric pressure**. *Sphenoid* - **Sphenoid sinusitis** usually causes a headache behind the eyes, at the **vertex of the head**, or in the occipital region. - It is less common than other forms of sinusitis and often presents with more diffuse, deep-seated pain. *Ethmoidal* - **Ethmoidal sinusitis** typically results in pain and pressure between the eyes or over the **bridge of the nose**. - It can also cause eye pain and is sometimes mistaken for a **tension headache**. *Maxillary* - **Maxillary sinusitis** commonly causes pain and pressure in the cheeks, under the eyes, and in the upper teeth, often exacerbated by **chewing or biting**. - This pain can radiate to the temples or ears, but it typically does not manifest as a **frontal headache**.

Q: Most sensitive test for detecting microfilariae?

Membrane filtration technique. ***Membrane filtration technique*** - The **membrane filtration technique** is considered the most sensitive test for detecting **microfilariae** because it concentrates microfilariae from a larger volume of blood (typically 1 mL or more) onto a filter membrane, increasing detection rates, especially in low-parasite density infections. - This method physically traps the microfilariae, allowing for microscopic examination of the concentrated sample after staining, which enhances visualization. *Diethylcarbamazine (DEC) challenge test* - The **DEC challenge test** uses **diethylcarbamazine** to provoke the release of microfilariae into the peripheral blood, especially in cases of occult filariasis or when microfilaria numbers are low. - While it can be useful in certain diagnostic situations, it is **less sensitive** than membrane filtration for directly detecting circulating microfilariae and carries the risk of inducing severe adverse reactions due to rapid parasite killing. *Fluorescence-based immunoassay* - **Fluorescence-based immunoassays** detect **antigens** or **antibodies** related to filarial infection, providing evidence of exposure or active infection. - While valuable for diagnosis, especially in antibody detection for chronic or occult infections, they do not directly detect live microfilariae and thus are not the most sensitive method for *detecting microfilariae themselves*. *Thick blood smear* - A **thick blood smear** is a common and quick method for detecting microfilariae by examining a drop of blood for their presence. - However, it is **less sensitive** than the membrane filtration technique, particularly in persons with low microfilaremia, as it examines a much smaller volume of blood.

Q: A patient presents with suspected diphtheria. What media will be used to diagnose this condition?

Loffler's serum slope. ***Loffler's serum slope*** - **Löffler's serum slope** is a specific enrichment medium used for the isolation and identification of *Corynebacterium diphtheriae*, the causative agent of diphtheria. - It enhances the characteristic **metachromatic granules** (Babes-Ernst bodies) within the bacteria, aiding in microscopic identification. *Chocolate agar* - **Chocolate agar** is a non-selective enrichment medium often used for fastidious organisms like *Haemophilus influenzae* and *Neisseria* species. - While it supports the growth of many bacteria, it is not specifically optimized for the isolation or enhanced identification of *Corynebacterium diphtheriae*. *Cary-Blair* - **Cary-Blair transport medium** is designed to preserve enteric pathogens like *Salmonella* and *Shigella* in fecal samples during transport. - It is not a primary culture medium for *Corynebacterium diphtheriae* and would not be used for diagnosis of diphtheria. *Lowenstein-Jensen* - **Lowenstein-Jensen (LJ) medium** is a specialized egg-based medium primarily used for the isolation and culture of *Mycobacterium tuberculosis*. - It contains malachite green to inhibit the growth of other bacteria and is not suitable for the growth of *Corynebacterium diphtheriae*.

Q: Amsel's criteria are used for?

Bacterial vaginosis. ***Bacterial vaginosis*** - **Amsel's criteria** are a set of four clinical signs used to diagnose **bacterial vaginosis**, a common vaginal infection. - At least three of the four criteria must be present for a positive diagnosis: **thin, white, homogeneous discharge**, **clue cells** on microscopy, vaginal pH >4.5, and a **fishy odor** before or after adding 10% KOH (whiff test). *Candidiasis* - Diagnosed based on clinical symptoms such as **pruritus** and thick, white, **"cottage cheese-like" discharge**, along with identification of yeast (hyphae/pseudohyphae) on microscopy. - **Amsel's criteria** are not used for its diagnosis. *Trichomoniasis* - Typically diagnosed by microscopic observation of **motile trichomonads** in a wet mount, or by nucleic acid amplification tests (NAATs). - It presents with a **foamy, yellow-green discharge** and sometimes a **"strawberry cervix"**, none of which are part of Amsel's criteria. *Chlamydia infection* - Primarily diagnosed using **nucleic acid amplification tests (NAATs)** from urine or swab samples. - It is often **asymptomatic** or presents with non-specific symptoms like discharge or dysuria, and **Amsel's criteria** are not applicable.

Q: A boy was riding bicycle, he fell down forward and injury to his shoulder was seen, which nerve injury will be seen in the condition as given in X-ray?

Axillary. ***Axillary*** - A fall forward onto the shoulder often results in an **anterior shoulder dislocation**, which commonly injures the **axillary nerve** due to its close proximity to the humeral head. - Injury to the axillary nerve would manifest as **deltoid muscle weakness** (impaired shoulder abduction) and **sensory loss over the lateral shoulder**. *Radial* - The radial nerve is more commonly injured in **midshaft humeral fractures** or compression injuries in the axilla (e.g., "crutch palsy"), not typically from a direct shoulder dislocation. - Radial nerve injury leads to **wrist drop** and difficulty extending the fingers and thumb. *Median* - The median nerve is generally protected in shoulder dislocations but can be affected by more severe trauma or **distal humeral fractures**, specifically around the elbow or wrist. - Injury to the median nerve affects **flexion of the wrist and fingers** and **thumb opposition**, along with sensory deficits in the first 3.5 digits. *Ulnar* - The ulnar nerve is most vulnerable at the **medial epicondyle of the humerus** (funny bone) or in compression injuries at the wrist (Guyon's canal). - Ulnar nerve injury results in **weakness of intrinsic hand muscles** (e.g., abducting/adducting fingers) and sensory loss to the little finger and half of the ring finger.

Q: Praziquantel is used for the treatment of

Schistosomiasis. ***Schistosomiasis*** - **Praziquantel** is the primary drug for treating all species of **schistosomiasis**, effectively killing adult worms [1], [2]. - It works by increasing the **calcium permeability** of the worm's cells, leading to muscle contraction and paralysis [2]. *Rhinosporidiosis* - **Rhinosporidiosis** is a fungal infection, and its treatment typically involves **surgical excision** of the lesions. - Antifungal agents like **dapsone** may be used as an adjuvant therapy, but praziquantel is not indicated. *Strongyloidiasis* - **Strongyloidiasis** is caused by the nematode *Strongyloides stercoralis*, and the preferred treatment is **ivermectin** [3]. - **Albendazole** is an alternative treatment option, but praziquantel is ineffective against this parasite [2], [3]. *Trichomoniasis* - **Trichomoniasis** is a sexually transmitted infection caused by the protozoan *Trichomonas vaginalis*. - It is effectively treated with **metronidazole** or **tinidazole**, while praziquantel has no activity against this protozoan.

Q: A lady has taken medication for amoebiasis infection. She drank alcohol on the same day. She has nausea, vomiting, and dizziness. Which anti-amoebic drug could have led to interaction with alcohol to produce these symptoms?

Metronidazole. ***Metronidazole*** - **Metronidazole** is well-known for causing a **disulfiram-like reaction** when consumed with alcohol. - This reaction leads to a rapid accumulation of **acetaldehyde**, manifesting as nausea, vomiting, flushing, headache, and dizziness. *Nitazoxanide* - **Nitazoxanide** is an oral anti-infective agent used for protozoal infections, but it is **not associated with a disulfiram-like reaction** with alcohol. - Its mechanism of action involves interfering with the **pyridoxine ferredoxin oxidoreductase enzyme**, which is distinct from alcohol metabolism. *Paromomycin* - **Paromomycin** is an aminoglycoside antibiotic primarily used for luminal amoebiasis and is **poorly absorbed from the GI tract**. - It does **not typically interact with alcohol** or cause disulfiram-like reactions. *Diloxanide* - **Diloxanide furoate** is a luminal amoebicide primarily used for asymptomatic cyst passers. - It is **not known to cause a disulfiram-like reaction** or significant interactions with alcohol.

Question 1

The duration of spinal anaesthesia is based directly on:

Accepted Answer

Dose

Answer

Height

Answer

Total body fat

Answer

Age

Question 2

Which of the following is used for day care surgery?

Accepted Answer

Propofol

Answer

Thiopentone

Answer

Ketamine

Answer

Etomidate

Question 3

Synovial fluid contains-

Accepted Answer

Hyaluronic acid

Answer

Keratan sulphate

Answer

Dermatan sulphate

Answer

Chondroitin sulphate

Question 4

Frontal headache is due to inflammation of which sinus?

Accepted Answer

Frontal

Answer

Sphenoid

Answer

Ethmoidal

Answer

Maxillary

Question 5

Most sensitive test for detecting microfilariae?

Accepted Answer

Membrane filtration technique

Answer

Diethylcarbamazine (DEC) challenge test

Answer

Fluorescence-based immunoassay

Answer

Thick blood smear

Question 6

A patient presents with suspected diphtheria. What media will be used to diagnose this condition?

Accepted Answer

Loffler's serum slope

Answer

Chocolate agar

Answer

Cary-Blair

Answer

Lowenstein-Jensen

Question 7

Amsel's criteria are used for?

Accepted Answer

Bacterial vaginosis

Answer

Candidiasis

Answer

Trichomoniasis

Answer

Chlamydia infection

Question 8

A boy was riding bicycle, he fell down forward and injury to his shoulder was seen, which nerve injury will be seen in the condition as given in X-ray?

Accepted Answer

Axillary

Answer

Radial

Answer

Median

Answer

Ulnar

Question 9

Praziquantel is used for the treatment of

Accepted Answer

Schistosomiasis

Answer

Rhinosporidiosis

Answer

Strongyloidiasis

Answer

Trichomoniasis

Question 10

A lady has taken medication for amoebiasis infection. She drank alcohol on the same day. She has nausea, vomiting, and dizziness. Which anti-amoebic drug could have led to interaction with alcohol to produce these symptoms?

Accepted Answer

Metronidazole

Answer

Nitazoxanide

Answer

Paromomycin

Answer

Diloxanide

FMGE 2019

Anesthesiology

Biochemistry

ENT

Microbiology

Obstetrics and Gynecology

Orthopaedics

Pharmacology