FMGE 2018 Practice Questions

Q: Which of the following is a method for on-site disposal of domestic wastewater?

Soakage pit. ***Soakage pit*** - A **soakage pit**, also known as a **seepage pit** or **leach pit**, is an underground chamber that allows treated effluent from a septic tank to seep into the surrounding soil. - It is a common and effective on-site method for the **disposal of domestic wastewater**, particularly in rural or unsewered areas. *Activated sludge process* - The **activated sludge process** is a centralized biological wastewater treatment method used in municipal wastewater treatment plants, not typically for on-site domestic disposal. - It involves aerating wastewater in a tank with suspended microorganisms to consume organic pollutants. *Oxidation pond* - An **oxidation pond**, or **stabilization pond**, is a large, shallow basin where wastewater is treated through natural biological and physical processes. - While it treats wastewater, it is typically a **larger-scale** treatment method for communities or industries, rather than a standalone on-site disposal method for individual domestic units. *All of the options* - This option is incorrect because both the activated sludge process and oxidation ponds are generally larger-scale or centralized treatment methods, not practical for individual on-site domestic disposal. - Only the soakage pit is well-suited for **on-site domestic wastewater disposal**.

Q: Which pattern of inheritance of disease is associated with consanguinity?

Autosomal recessive. ***Autosomal recessive*** - Consanguineous relationships increase the likelihood of offspring inheriting **two copies of a rare deleterious recessive allele**, one from each parent [1]. - This occurs because relatives share a greater proportion of their genes, making it more probable that both parents are **heterozygous carriers** for the same recessive disorder. *Autosomal dominant* - In autosomal dominant disorders, only **one copy of the altered gene** is needed to cause the disease, so expression is not typically influenced by consanguinity. - These conditions often manifest in every generation and are not more prevalent with increased shared genetic material. *X-linked recessive* - X-linked recessive disorders primarily affect males, as they only have one X chromosome, and are transmitted by carrier females. - While consanguinity can theoretically increase the carrier rate within a population, its direct impact on the inheritance pattern of an X-linked trait in a single family is less pronounced compared to autosomal recessive conditions. *X-linked dominant* - X-linked dominant disorders are expressed in heterozygous females and hemizygous males, with affected males often having more severe disease. - The inheritance pattern is not significantly influenced by consanguinity, as only one copy of the affected gene on the X chromosome is sufficient for disease manifestation.

Q: Commonest neurological tumour associated with NF-2:-

Acoustic neuroma. ***Acoustic neuroma*** - **Bilateral acoustic neuromas** (vestibular schwannomas) are the hallmark of **Neurofibromatosis type 2 (NF2)**, virtually diagnostic for the condition [1]. - These tumors arise from the **vestibulocochlear nerve (cranial nerve VIII)** and commonly cause hearing loss and balance problems [1]. *Optic glioma* - **Optic gliomas** are more characteristic of **Neurofibromatosis type 1 (NF1)**, not NF2. - While they can occur in NF2, they are not the most common or diagnostic feature. *Spinal schwannoma* - Spinal schwannomas can occur in NF2, but they are not the *most common* or *defining* neurological tumor associated with the condition. - The presence of multiple schwannomas, especially spinal, is a feature, but **bilateral acoustic neuromas** take precedence for diagnosis. *Meningioma* - Multiple **meningiomas** occur in a significant proportion of NF2 patients, making them common, but they are still secondary to **bilateral acoustic neuromas** in terms of diagnostic significance and prevalence as the *primary* neurological tumor. - These are tumors of the **meninges**, the protective layers surrounding the brain and spinal cord.

Q: Keratometry is done to assess:

Curvature of cornea. ***Curvature of cornea*** - **Keratometry** is specifically designed to measure the **radius of curvature of the anterior surface of the cornea**. - This measurement is essential for detecting and quantifying **astigmatism** and for fitting **contact lenses** and calculating **intraocular lens (IOL) power**. *Corneal thickness* - **Corneal thickness** is measured by **pachymetry**, not keratometry. - Pachymetry is used to assess conditions like **corneal edema** or prior to certain refractive surgeries. *Corneal sensation* - **Corneal sensation** is tested using a fine wisp of cotton or a **corneal aesthesiometer**. - This evaluates the integrity of the **corneal nerves** and blink reflex. *Corneal endothelium* - The **corneal endothelium** is assessed using **specular microscopy** to evaluate cell count, size, and shape. - This is important for surgical planning and monitoring **corneal dystrophies**.

Q: Which of the following infectious diseases is the most likely cause of granuloma formation?

Leprosy. ***Leprosy*** - Leprosy is a classic example of a chronic infection that leads to **granuloma formation**, particularly in its tuberculoid and borderline tuberculoid forms [1]. - The immune response to *Mycobacterium leprae* involves the formation of **macrophage-rich granulomas** to contain the infection, often affecting the skin and nerves [2]. *Syphilis* - While syphilis can cause **gummas**, which are granulomatous lesions, these are typically seen in tertiary syphilis and are less characteristic of granuloma formation across all stages compared to leprosy [3]. - Gummas are often **necrotic** and can be widespread, but the primary pathology of syphilis involves vasculitis and inflammation rather than classic granulomatous tissue reaction. *Cat scratch disease* - Caused by *Bartonella henselae*, this infection typically leads to **lymphadenopathy** with **stellate microabscesses** and sometimes epithelioid granulomas, but the granulomas are usually less prominent and distinct than those seen in leprosy. - The histological features are dominated by **suppurative necrosis** within lymphoid tissue rather than well-formed, non-caseating granulomas. *Trench fever* - Trench fever, caused by *Bartonella quintana*, primarily presents with **fever**, **bone pain**, and a **maculopapular rash**. - It does not typically cause **granuloma formation**; the pathology is more related to bacteremia and inflammation of vascular endothelium. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 385-386. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 638-639. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, p. 360.

Q: In Goodpasture syndrome, which organ is involved apart from the lung?

Kidney. ***Kidney*** - Goodpasture syndrome is an **autoimmune disease** that primarily targets the a3 chain of **type IV collagen**, which is found in the **basement membranes** of both the glomeruli in the kidneys and the alveoli in the lungs. [1] - This leads to rapidly progressive **glomerulonephritis** and **pulmonary hemorrhage**, making the kidney a key organ involved alongside the lungs. [1] *Heart* - The heart is generally **not directly involved** in Goodpasture syndrome. - Cardiac symptoms are typically **secondary** to severe anemia from pulmonary hemorrhage or fluid overload from kidney failure. *Spleen* - The spleen is **not a target organ** for the autoantibodies in Goodpasture syndrome. - While it plays a role in immune responses, it is not directly damaged by the disease process itself. *Liver* - The liver is **not affected** by the autoantibodies in Goodpasture syndrome. - **Type IV collagen**, the autoantigen, is not a significant component of the liver basement membranes.

Q: Pheochromocytoma produces all except?

Secretin. Secretin - **Secretin** is a hormone primarily produced by **S cells in the duodenum and jejunum** [3] in response to acidic chyme, stimulating pancreatic bicarbonate secretion. - Pheochromocytomas originate from **chromaffin cells** of the adrenal medulla and are known for producing catecholamines [2], not secretin. *Vasoactive intestinal polypeptide* - **Vasoactive intestinal polypeptide (VIP)** can be produced by some **neuroendocrine tumors** [1], including pheochromocytomas, though it's more commonly associated with VIPomas. - VIP acts as a **vasodilator** and can contribute to symptoms like flushing and diarrhea in rare cases of VIP-producing pheochromocytomas. *Calcitonin* - While calcitonin is primarily associated with **medullary thyroid carcinoma**, it can rarely be produced ectopically by **neuroendocrine tumors**, including some pheochromocytomas. - This ectopic production is part of the broader concept of **paraneoplastic syndromes** seen in various malignancies. *Norepinephrine* - **Norepinephrine** is a major catecholamine produced by pheochromocytomas, leading to classic symptoms such as **hypertension, palpitations, and sweating** [2]. - The tumor cells (chromaffin cells) are specialized to synthesize and release **catecholamines**, including norepinephrine and epinephrine [2].

Q: A 6-year-old child presents with hepatosplenomegaly and generalized lymphadenopathy along with fever. The child developed a rash after being administered ampicillin. What could be the possible diagnosis?

Infectious mononucleosis. ***Infectious mononucleosis*** - The combination of **hepatosplenomegaly**, **generalized lymphadenopathy**, and fever in a child is highly suggestive of infectious mononucleosis, typically caused by the **Epstein-Barr virus (EBV)**. - A characteristic feature is the development of a **maculopapular rash** following the administration of ampicillin or amoxicillin. *Kawasaki disease* - Characterized by **fever**, generalized rash, lymphadenopathy, and mucocutaneous inflammation, but typically does not involve significant **hepatosplenomegaly**. - The rash in Kawasaki disease is not typically triggered by **ampicillin**. *Scarlet fever* - Caused by a **Streptococcus pyogenes** infection and presents with a characteristic **sandpaper-like rash**, **strawberry tongue**, and fever. - It usually does not involve significant **hepatosplenomegaly** or a rash specifically induced by ampicillin. *HIV infection* - While HIV can cause **generalized lymphadenopathy** and **hepatosplenomegaly**, especially in children, the sudden onset of a rash specifically after ampicillin administration is not a hallmark of acute or chronic HIV infection. - Other opportunistic infections and **growth failure** would likely be present in advanced HIV.

Q: In which of the following conditions there is an increase in lung diffusion capacity?

Alveolar haemorrhage. ***Alveolar haemorrhage*** - The presence of **red blood cells within the alveoli** provides an additional source of **hemoglobin**, which can bind to carbon monoxide (CO) and therefore **increase the measured CO diffusion capacity (DLCO)**. - This is often seen in conditions like **Goodpasture's syndrome** or **pulmonary capillaritis**. *Pulmonary oedema* - Characterized by an **accumulation of fluid in the interstitial and alveolar spaces**, which **increases the diffusion barrier** for gases. - This fluid buildup **impairs gas exchange**, leading to a **decrease in DLCO**. *Idiopathic pulmonary fibrosis* - This condition involves **thickening and scarring of the alveolar-capillary membrane**, which significantly **increases the diffusion distance** for gases. - The resultant **fibrosis and destruction of capillaries** lead to a **marked decrease in DLCO**. *Emphysema* - Emphysema causes **destruction of alveolar walls** and the **pulmonary capillary bed**, leading to a **reduction in the surface area available for gas exchange**. - This loss of functional alveolar-capillary units results in a **decreased DLCO**.

Q: Best treatment strategy for carcinoma of the anal canal:

Chemoradiation. ***Chemoradiation*** - Carcinoma of the anal canal is primarily treated with **chemoradiation** (combinations of chemotherapy and radiation therapy) as the standard of care to achieve **organ preservation**. - This combined approach improves local control and survival rates compared to either modality alone, making it the **primary curative strategy** for most localized anal canal cancers. *Radiation* - While radiation therapy is a crucial component of anal canal cancer treatment, using it alone (**monotherapy**) is generally less effective than chemoradiation. - **Local recurrence rates** are higher with radiation alone compared to combined modality treatment. *Surgery* - Surgery, specifically **abdominoperineal resection (APR)**, is typically reserved for **recurrent disease** or cases where chemoradiation fails. - Initial radical surgery for anal canal cancer leads to significant morbidity (e.g., permanent colostomy) and is generally avoided as a primary treatment due to the success of chemoradiation. *Chemotherapy* - Chemotherapy alone is **not curative** for localized anal canal carcinoma. - It is primarily used in combination with radiation (chemoradiation) to sensitize the tumor to radiation and improve local control, or as treatment for **metastatic disease**.

Question 1

Which of the following is a method for on-site disposal of domestic wastewater?

Accepted Answer

Soakage pit

Answer

Activated sludge process

Answer

Oxidation pond

Answer

All of the options

Question 2

Which pattern of inheritance of disease is associated with consanguinity?

Accepted Answer

Autosomal recessive

Answer

Autosomal dominant

Answer

X linked recessive

Answer

X linked dominant

Question 3

Commonest neurological tumour associated with NF-2:-

Accepted Answer

Acoustic neuroma

Answer

Optic glioma

Answer

Meningioma

Answer

Spinal schwannoma

Question 4

Keratometry is done to assess:

Accepted Answer

Curvature of cornea

Answer

Corneal thickness

Answer

Corneal sensation

Answer

Corneal endothelium

Question 5

Which of the following infectious diseases is the most likely cause of granuloma formation?

Accepted Answer

Leprosy

Answer

Syphilis

Answer

Cat scratch disease

Answer

Trench fever

Question 6

In Goodpasture syndrome, which organ is involved apart from the lung?

Accepted Answer

Kidney

Answer

Heart

Answer

Spleen

Answer

Liver

Question 7

Pheochromocytoma produces all except?

Accepted Answer

Secretin

Answer

Vasoactive intestinal polypeptide

Answer

Norepinephrine

Answer

Calcitonin

Question 8

A 6-year-old child presents with hepatosplenomegaly and generalized lymphadenopathy along with fever. The child developed a rash after being administered ampicillin. What could be the possible diagnosis?

Accepted Answer

Infectious mononucleosis

Answer

Kawasaki disease

Answer

Scarlet fever

Answer

HIV infection

Question 9

In which of the following conditions there is an increase in lung diffusion capacity?

Accepted Answer

Alveolar haemorrhage

Answer

Pulmonary oedema

Answer

Idiopathic pulmonary fibrosis

Answer

Emphysema

Question 10

Best treatment strategy for carcinoma of the anal canal:

Accepted Answer

Chemoradiation

Answer

Radiation

Answer

Surgery

Answer

Chemotherapy

FMGE 2018

Community Medicine

Internal Medicine

Ophthalmology

Pathology

Pediatrics

Physiology

Surgery