FMGE 2023 Practice Questions

Q: Sickness absenteeism of workers in the industry is used to evaluate

Health of the worker. ***Health of the worker*** - Sickness absenteeism refers to the time off work certified due to the worker's own illness, making it a direct and crucial indicator of the **individual worker's health status** - This metric allows occupational health services to evaluate the **morbidity pattern** and effectiveness of health programs within the working population - It is one of the key indicators used in **occupational health surveillance** *Health of the family* - Sickness absenteeism specifically tracks the worker's certified inability to work due to **personal illness**, not the health status of their household or dependents - While caring for sick family members might lead to absence from work, it is not captured under the definition of **sickness absenteeism** *Industrial environment* - Sickness absenteeism is a **health outcome** measure reflecting illness, not a direct measurement of the physical or chemical features of the **industrial environment** itself - To evaluate the industrial environment, specific techniques like **environmental monitoring**, **risk assessment**, or **occupational hazard surveillance** are employed *Community health* - Sickness absenteeism is restricted to the specific, relatively homogeneous population of **employed workers** within that industry - **Community health** is typically evaluated using broader epidemiological indicators covering the entire population, such as **mortality rates**, **disease prevalence**, or **incidence rates** in the general public

Q: The incisors of a child who had white patches on them which later turned brown are due to excessive supplementation of which of the following?

Fluorine. ***Fluorine***- Excessive intake of **fluoride** during the critical period of tooth formation leads to **dental fluorosis**, impairing ameloblast function and mineral deposition.- Fluorosis initially presents as **white patches** (mottling) on the enamel, which eventually become porous and absorb extrinsic stains, leading to the characteristic **brown or black discoloration**.*Vitamin A*- Excessive supplementation results in **hypervitaminosis A**, causing symptoms like **pseudotumor cerebri**, alopecia, and hepatotoxicity, typically not localized dental changes.- Vitamin A is crucial for epithelial differentiation; its deficiency leads to **xerophthalmia** and keratomalacia, not enamel dysgenesis characterized by mottling and brown staining.*Chlorine*- Chlorine, in the form of chloride, is vital for acid-base balance and production of gastric acid; its function is not directly involved in enamel mineralization leading to fluorosis- Excessive chloride intake can contribute to **hyperchloremic metabolic acidosis**, but it is not linked to the specific pattern of dental mottling described.*Riboflavin*- Riboflavin (Vitamin B2) deficiency causes **ariboflavinosis**, manifesting as **cheilosis**, angular stomatitis, and a magenta-colored tongue (glossitis).- Riboflavin supplementation, even in excess, is not associated with **enamel hypoplasia** or the distinctive white-to-brown staining pattern seen in dental fluorosis.

Q: A patient presents with complaints of sudden onset headache, palpitation, and profuse sweating. The patient has had multiple similar episodes in the past. During these episodes, the patient's blood pressure is elevated. A 24-hour urinary metanephrine is elevated. What is the most likely diagnosis?

Pheochromocytoma. ***Pheochromocytoma***- This clinical presentation—paroxysmal episodes of headache, palpitations, and profuse sweating (the classic triad)—coupled with elevated blood pressure strongly suggests a **pheochromocytoma** (a tumor of the adrenal medulla secreting catecholamines). - The definitive biochemical confirmation is the elevated 24-hour urinary **metanephrines** and normetanephrines, which are breakdown products of epinephrine and norepinephrine. *Addison's disease* - This condition involves primary adrenal *insufficiency* (hypocortisolism), which typically presents with **hypotension**, fatigue, weight loss, and **hyperpigmentation**, not hypertensive crises. - It involves decreased production of adrenal hormones, not the episodic overproduction of **catecholamines** seen here. *Renal artery stenosis* - This is a cause of secondary hypertension due to chronic activation of the **Renin-Angiotensin-Aldosterone System (RAAS)**, leading to persistent, non-paroxysmal elevation of blood pressure. - It would not cause the specific triad of episodic symptoms (headache, sweating, palpitations) or lead to elevated **urinary metanephrines**. *Hyperthyroidism* - While it can cause palpitations, tremor, and systolic hypertension, these symptoms are typically chronic and sustained, lacking the sudden paroxysmal nature described. - The primary biochemical abnormality involves elevated **T3/T4 hormones**, not the excessive urinary excretion of **metanephrines** as detailed in this case.

Q: A 45-year-old patient with a history of smoking a pack of cigarettes for the past 15 years presents with hemoptysis. Chest X-ray shows a 3cm upper lobe mass near the apex of the lung. What is the next best step for managing this patient?

CT-guided biopsy. ***CT-guided biopsy***- This procedure is the preferred method for obtaining a definitive **tissue diagnosis** for a solitary **peripheral lung mass**, especially one highly suspicious of malignancy due to the patient's smoking history and hemoptysis [1].- Since the mass is **3cm** and located peripherally near the **apex**, a percutaneous **CT-guided transthoracic needle aspiration (TTNA)** provides the highest diagnostic yield compared to other non-invasive alternatives [2].*Bronchoscopy*- Bronchoscopy is primarily used to evaluate **central lesions** (proximal to segmental bronchi) or suspicious findings directly within the airway lumen.- It has a low diagnostic yield for discrete, small, or **peripheral masses** like this 3cm apical lesion, as the scope or biopsy instruments cannot reliably reach the target.*Sputum cytology*- Sputum cytology has low overall sensitivity, particularly for **peripheral lung masses** which are unlikely to shed sufficient malignant cells into the central airways.- While non-invasive, it often results in a non-diagnostic result and is therefore not the **next best step** for confirming the diagnosis of a discrete, radiographically apparent mass.*Sputum for AFB*- While an infectious process like tuberculosis (TB) can present as a mass, the patient's robust history of **heavy smoking** and the mass morphology strongly prioritize ruling out **lung carcinoma**.- Obtaining a tissue sample (biopsy) is mandatory due to the high suspicion of malignancy (indicated by hemoptysis and smoking) and takes precedence over attempting an infectious diagnosis first [3].

Q: A 70-year-old patient with a smoking history presents with high-grade fever, cough, confusion, and diarrhea. Chest X-ray shows bilateral infiltrates in bilateral lower lung fields. On sputum gram stain, no organisms were detected. Laboratory results reveal Na: 126mEq/L, AST:62, ALT:56, RBS:112 mg/dl, serum bilirubin of 0.8mg%, and a positive HIV test. Which of the following organisms is responsible?

Legionella. ***Legionella***- This clinical picture, characterized by **high fever**, **atypical pneumonia** (bilateral infiltrates), and systemic symptoms including **confusion** (CNS involvement), **diarrhea** (GI involvement), **hyponatremia** and mildly elevated **LFTs**, is highly suggestive of **Legionella pneumophila** (Legionnaires' disease) [1].- *Legionella* is an **atypical bacterium** that requires specialized culture media and therefore typically results in a Gram stain showing **no organisms detected** through standard methods [1].*Streptococcus*- *Streptococcus pneumoniae* (the most common cause of typical community-acquired pneumonia) typically presents with an abrupt onset, pleurisy, and a consolidation pattern (**lobar pneumonia**) on CXR, differentiating it from this diffuse, atypical presentation.- It is a readily detectable **Gram-positive diplococcus** on sputum Gram stain, which contrasts with the microbiological report of no organisms seen [1].*Pneumocystis jeroveci*- While highly relevant in HIV-positive individuals, **Pneumocystis pneumonia (PJP)** typically presents with subacute onset, severe **hypoxemia**, and diffuse **interstitial infiltrates**, not typically associated with prominent hyponatremia or severe diarrhea [2].- PJP is diagnosed via special staining (e.g., silver stain) on induced sputum or bronchoalveolar lavage, and it does not usually cause the multisystem failure (hyponatremia and transaminitis) characteristic of Legionnaires' disease [2].*Klebsiella*- **Klebsiella pneumoniae** typically causes destruction and necrosis leading to classic **lobar pneumonia** (often in the upper lobes), classically associated with **currant jelly sputum** in immunocompromised individuals, especially alcoholics.- *Klebsiella* is a large encapsulated **Gram-negative rod** that would be easily visible and identifiable on a standard sputum Gram stain.

Q: How much oxygen is given to a term infant with respiratory distress during resuscitation?

21%. ***Correct: 21% (Room Air)*** - **Current NRP and WHO guidelines** recommend starting resuscitation of **term infants with 21% oxygen (room air)** - Evidence shows room air is **equally effective** as 100% oxygen for initial resuscitation - Reduces **oxidative stress and potential harm** from hyperoxia - Oxygen can be **titrated up** if preductal SpO2 targets are not achieved within expected timeframes - This applies specifically to **term infants (≥37 weeks gestation)** *Incorrect: 70%* - Not a standard concentration used in neonatal resuscitation - Would expose infant to unnecessarily high oxygen levels without clear benefit *Incorrect: 100%* - **Outdated practice** - previously used but no longer recommended for term infants - Associated with increased **oxidative stress** and potential harm - May still be considered for **preterm infants <35 weeks** (start with 21-30% and titrate) *Incorrect: 50%* - Not the recommended starting concentration for term infants - May be used as an **intermediate step** when titrating oxygen if initial room air is insufficient **Key Point:** For term infants, always start with room air (21%) during resuscitation and titrate based on SpO2 targets.

Q: Which of the following is an absolute contraindication for breastfeeding?

Galactosemia in infant. ***Galactosemia in infant***- **Galactosemia** is an absolute contraindication as the infant lacks the enzyme needed to metabolize **galactose** found in breast milk (**lactose**).- Ingestion of breast milk leads to the accumulation of toxic metabolites, potentially causing **liver failure**, **cataracts**, and **developmental delay**.*HIV positive mother*- In resource-rich settings, **HIV** is generally considered a contraindication, but it is not universally absolute; in low-resource settings, exclusive breastfeeding might be recommended if formula feeding is unsafe.- Effective maternal **Antiretroviral Therapy (ART)** significantly reduces the risk of transmission via breast milk, making it a relative risk based on local context and ART adherence.*Hepatitis C in mother*- **Hepatitis C virus (HCV)** is generally **not transmitted** through breast milk, and breastfeeding is usually considered safe.- Breastfeeding is only cautioned against if the mother has **bleeding or fissured nipples**, which could theoretically allow blood-borne virus transmission.*Tuberculosis in mother*- Mothers with routine, **active pulmonary TB** can breastfeed if they are on appropriate treatment and wear a mask, as the bacteria is rarely excreted in milk.- If the mother has newly diagnosed, **untreated active TB**, temporary separation and feeding expressed milk may be necessary until she is non-infectious, but breastfeeding is not permanently contraindicated.

Q: An 8-year-old child presented with a sudden onset of high-grade fever, seizures, and loss of consciousness. On examination, the child had anemia, hypoglycemia, and no focal neurological deficits. What is the probable diagnosis?

Cerebral malaria. ***Cerebral malaria***- This diagnosis is strongly suggested by the sudden onset of high-grade fever, seizures, and loss of consciousness in a child, coupled with systemic complications like **anemia** and significant **hypoglycemia**.- Cerebral malaria, caused by *Plasmodium falciparum*, is a medical emergency where **hypoglycemia** results from high glucose consumption by parasites and impaired hepatic gluconeogenesis; **anemia** is also a key feature. *Tubercular meningitis*- Tuberculous meningitis typically presents with an **insidious, subacute onset** (over weeks) of fever, headache, and altered sensorium, not the sudden, explosive presentation described.- While it can cause neurological deficits, it is less commonly associated with the acute, severe systemic triad of high fever, profound **hypoglycemia**, and **anemia** seen here.*Viral meningitis*- Viral meningitis is usually associated with a milder clinical course and typically lacks the profound systemic complications like severe **anemia** and significant **hypoglycemia** that often precipitate seizures and coma in this age group.- Though high fever and seizures can occur, the presence of severe systemic features points away from typical viral etiologies and towards a systemic parasitic infection.*Fungal meningitis*- Fungal meningitis (e.g., *Cryptococcus*) is typically an **indolent or chronic infection** developing over weeks to months, primarily affecting **immunocompromised patients** (e.g., HIV/AIDS), which is unlikely in an otherwise healthy 8-year-old.- It rarely presents as an acute febrile illness with subsequent rapid onset of **anemia** and severe **hypoglycemia** leading to loss of consciousness.

Q: Gonadal growth corresponds with _____.

Skeletal system. ***Skeletal system*** - **Gonadal growth** follows the Genital growth curve (Scammon's curves), characterized by minimal pre-pubertal growth and dramatic acceleration during **puberty** (ages 12-18). - The **skeletal system** follows the General growth curve, which similarly exhibits a significant **pubertal growth spurt** coinciding with the surge in sex hormones. - Both gonadal maturation and skeletal growth during puberty are driven by **sex steroids** (estrogen and testosterone), making their growth patterns temporally aligned and hormonally interdependent. - The timing of peak skeletal growth velocity (PHV) corresponds closely with the rapid gonadal development during **adolescence**. *Brain* - The **brain** follows the Neural growth curve, which shows rapid growth in **early childhood** (reaching ~90% of adult size by age 6 years) and then plateaus. - This pattern is **opposite** to gonadal growth, which remains relatively dormant in childhood and accelerates only during puberty. - Neural and Genital curves are the most divergent among Scammon's four growth curves. *Lymphoid growth* - **Lymphoid tissue** (thymus, lymph nodes, tonsils) follows a unique curve with rapid early growth, reaching peak size (>100% adult size) by age **10-12 years**, then involuting during puberty. - This pattern of early hypertrophy and pubertal regression is **inverse** to gonadal development. *Dental growth* - **Dental eruption** follows a predictable, age-specific schedule related to the General growth pattern and craniofacial bone development. - While influenced by overall maturation, dental development does not exhibit the characteristic hormone-dependent **pubertal acceleration** seen in gonadal growth.

Q: A 6-year-old child is brought for complaints of short stature. His height is comparable with his parent's height and his bone age corresponds to his chronological age. What is the likely diagnosis?

Familial short stature. ***Familial short stature***- The short stature is proportional, and the growth velocity is usually normal, with the child tracking below the 3rd percentile but parallel to the normal curve.- Crucially, the **bone age corresponds to the chronological age**, meaning the skeletal maturation rate is normal, and they have an adult height potential consistent with their genetic background.*Constitutional delay*- This condition is characterized by a **delayed bone age** (e.g., bone age is 4 years in a 6-year-old child), which contradicts the case findings.- These children often have delayed puberty but will eventually reach a normal adult height, simply having a late **growth spurt**.*Undernutrition*- Chronic severe undernutrition causes short stature, often presenting with features like **wasting or stunting** and usually **delayed bone maturation**.- While it is a cause of growth failure, the history of height correlating with parents and normal bone age makes primary undernutrition less likely.*Growth hormone deficiency*- GH deficiency typically results in a **severely reduced growth velocity** and often significantly **delayed bone age**.- The pattern of growth velocity and height is typically inconsistent with the mid-parental height, unlike in familial short stature.

Question 1

Sickness absenteeism of workers in the industry is used to evaluate

Accepted Answer

Health of the worker

Answer

Community health

Answer

Industrial environment

Answer

Health of the family

Question 2

The incisors of a child who had white patches on them which later turned brown are due to excessive supplementation of which of the following?

Accepted Answer

Fluorine

Answer

Riboflavin

Answer

Vitamin A

Answer

Chlorine

Question 3

A patient presents with complaints of sudden onset headache, palpitation, and profuse sweating. The patient has had multiple similar episodes in the past. During these episodes, the patient's blood pressure is elevated. A 24-hour urinary metanephrine is elevated. What is the most likely diagnosis?

Accepted Answer

Pheochromocytoma

Answer

Renal artery stenosis

Answer

Hyperthyroidism

Answer

Addison's disease

Question 4

A 45-year-old patient with a history of smoking a pack of cigarettes for the past 15 years presents with hemoptysis. Chest X-ray shows a 3cm upper lobe mass near the apex of the lung. What is the next best step for managing this patient?

Accepted Answer

CT-guided biopsy

Answer

Bronchoscopy

Answer

Sputum cytology

Answer

Sputum for AFB

Question 5

A 70-year-old patient with a smoking history presents with high-grade fever, cough, confusion, and diarrhea. Chest X-ray shows bilateral infiltrates in bilateral lower lung fields. On sputum gram stain, no organisms were detected. Laboratory results reveal Na: 126mEq/L, AST:62, ALT:56, RBS:112 mg/dl, serum bilirubin of 0.8mg%, and a positive HIV test. Which of the following organisms is responsible?

Accepted Answer

Legionella

Answer

Klebsiella

Answer

Streptococcus

Answer

Pneumocystis jeroveci

Question 6

How much oxygen is given to a term infant with respiratory distress during resuscitation?

Accepted Answer

21%

Answer

70%

Answer

100%

Answer

50%

Question 7

Which of the following is an absolute contraindication for breastfeeding?

Accepted Answer

Galactosemia in infant

Answer

HIV positive mother

Answer

Tuberculosis in mother

Answer

Hepatitis C in mother

Question 8

An 8-year-old child presented with a sudden onset of high-grade fever, seizures, and loss of consciousness. On examination, the child had anemia, hypoglycemia, and no focal neurological deficits. What is the probable diagnosis?

Accepted Answer

Cerebral malaria

Answer

Tubercular meningitis

Answer

Viral meningitis

Answer

Fungal meningitis

Question 9

Gonadal growth corresponds with _____.

Accepted Answer

Skeletal system

Answer

Dental growth

Answer

Lymphoid growth

Answer

Brain

Question 10

A 6-year-old child is brought for complaints of short stature. His height is comparable with his parent's height and his bone age corresponds to his chronological age. What is the likely diagnosis?

Accepted Answer

Familial short stature

Answer

Constitutional delay

Answer

Undernutrition

Answer

Growth hormone deficiency

FMGE 2023

Community Medicine

Internal Medicine

Microbiology

Pediatrics