FMGE 2018 Practice Questions

Q: Secondary ossification centre appears before birth at

Lower end of femur. Lower end of femur - The distal femur is one of the very few secondary ossification centers that appears before birth, specifically during the 9th month of gestation. - Its presence is an important indicator of fetal maturity and can be seen on prenatal imaging. Upper end of femur - The proximal femoral epiphysis typically develops its secondary ossification center after birth, usually between 3-6 months of age. - This timing is considerably later than the distal femur. Lower end of tibia - The secondary ossification center for the distal tibia appears after birth, generally around 1-2 years of age. - This is a common timeline for many secondary ossification centers. Lower end of fibula - The secondary ossification center for the distal fibula also appears after birth, typically between 6 months and 1 year of age. - This timing is later than the distal femur but earlier than the distal tibia.

Q: Gold standard method of diagnosing celiac disease is

Small bowel biopsy. ***Small bowel biopsy*** - A **small bowel biopsy** is considered the **gold standard** for diagnosing celiac disease as it directly visualizes the characteristic damage to the intestinal lining. - The biopsy reveals histologic changes like **villous atrophy**, crypt hyperplasia, and increased intraepithelial lymphocytes, which are pathognomonic for celiac disease [1]. *Blood picture* - A blood picture (complete blood count) might show **anemia** (often iron-deficiency anemia) due to malabsorption, but this is a non-specific finding and not diagnostic for celiac disease [1]. - It does not provide direct evidence of intestinal damage caused by gluten. *Anti-endomysial antibodies* - **Anti-endomysial antibodies (EMA)** are highly specific for celiac disease, but they are still a serological test, not the definitive diagnostic method. - Serological tests like EMA and **tissue transglutaminase (tTG) antibodies** are used for screening and monitoring but require biopsy confirmation. *Biochemical test* - Biochemical tests might show abnormalities related to **malabsorption**, such as low iron, calcium, or vitamin D levels, but these are secondary effects and not diagnostic of celiac disease itself [1]. - These tests indicate nutritional deficiencies but do not identify the underlying cause.

Q: Most common cause of bacterial meningitis in post-neonatal period:

Streptococcus pneumoniae. ***Streptococcus pneumoniae*** - *S. pneumoniae* is the most common cause of **bacterial meningitis** in the post-neonatal period (1 month to 1 year of age), particularly in regions with high vaccination rates against Hib. - Its polysaccharide capsule and ability to evade the immune system contribute to its virulence in causing **central nervous system infections**. - Accounts for approximately 40-50% of bacterial meningitis cases in this age group. *Mycobacterium tuberculosis* - While it can cause **tuberculous meningitis**, this is a less common form of meningitis, typically with a more **insidious onset** and often associated with immunosuppression or endemic areas. - Represents a chronic form of meningitis rather than acute bacterial meningitis. *Staphylococcus aureus* - *S. aureus* meningitis typically occurs in specific contexts such as **post-neurosurgery**, following head trauma, or in patients with indwelling catheters or bacteremia. - It is not the most frequent pathogen in community-acquired meningitis in infants. *Klebsiella* - **Klebsiella pneumoniae** can cause meningitis, especially in **neonates** (first 28 days of life), immunocompromised individuals, or patients with healthcare-associated infections. - However, it is not the most common cause of meningitis in the post-neonatal period.

Q: Which of the following statements about tubercular osteomyelitis is NOT true?

Periosteal reaction is characteristic. ***Periosteal reaction is characteristic*** - This statement is **NOT true** for tubercular osteomyelitis; periosteal reaction is generally **minimal or absent** due to the insidious and less florid inflammatory response. - Unlike pyogenic osteomyelitis, which causes significant periosteal new bone formation, tuberculosis typically results in **slow bone destruction** without marked reactive bone changes. *Sequestrum is uncommon* - This statement is **true** because **sequestrum** (a piece of dead bone separated from healthy bone) is less frequently observed in tubercular osteomyelitis compared to pyogenic osteomyelitis. - The **granulomatous inflammation** of tuberculosis tends to cause slow bone necrosis rather than the rapid, liquefactive necrosis that leads to large sequestra. *It is a type of secondary osteomyelitis* - This statement is **true** as tubercular osteomyelitis is almost always secondary to a **primary focus of tuberculosis** elsewhere in the body, typically the lungs [1]. - The infection spreads **hematogenously** to the bone, making it a manifestation of disseminated tuberculosis rather than a primary bone infection [1]. *Inflammation is minimal* - This statement is **true** in the sense that the **acute inflammatory response** in tubercular osteomyelitis is often less pronounced than in pyogenic infections. - While it is a chronic infectious process, the characteristic **granulomatous inflammation** develops over time, and the initial or acute inflammatory signs might be subtle or "minimal" compared to bacterial osteomyelitis [1].

Q: What is the histopathological finding 12 hours after ischemic injury to heart?

Hyper-eosinophilia of myocytes. ***Hyper-eosinophilia of myocytes*** - Within **4-12 hours** of myocardial ischemia, the most characteristic histological finding is the development of **hypereosinophilia** in the sarcoplasm of myocardial cells [1]. - This is due to the loss of **glycogen** and an increase in **cytoplasmic protein binding** to eosin, indicating early irreversible cell injury [1], [2]. *Neocapillary invasion of myocytes* - **Neocapillary invasion** is a feature of **healing** and **repair** processes, usually observed much later, typically days to weeks after the initial injury, to facilitate scar formation [1]. - This process involves the growth of **new blood vessels** into the damaged tissue. *Karyorrhexis of myocytes* - **Karyorrhexis**, the fragmentation of the cell nucleus, is a later stage of necrosis, usually becoming apparent **12-24 hours post-infarction** [1]. - In the initial 12 hours, nuclear changes like **pyknosis** (nuclear shrinkage and increased basophilia) might be observed, but karyorrhexis is not prominent [1]. *Coagulation necrosis of myocytes* - While myocardial infarction is characterized by **coagulation necrosis**, the classic histological signs of full-blown coagulation necrosis, such as loss of striations and nuclear changes, become prominent at **12-24 hours and beyond** [1]. - In the first 12 hours, **hypereosinophilia** is the primary early indicator of this necrotic process, preceding the more overt classical features [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 552. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 548-550.

Q: For a child 3-5 months of age with H1N1, treatment Oseltamivir dose is

20 mg BD X 5 days. ***20 mg BD X 5 days*** - For infants aged **3-5 months** with H1N1 influenza, the recommended dose of **Oseltamivir** is **20 mg twice daily** (BD) for **5 days**. This dosage is based on weight-based recommendations to ensure appropriate antiviral activity. - This treatment regimen is crucial for reducing the severity and duration of influenza symptoms in this vulnerable age group and should be initiated as early as possible. *12 mg BD X 5 days* - This dosage is typically recommended for younger infants, specifically those aged **less than 1 month up to 2 months** (up to 3 kg body weight). - It is **underdosing** for a child in the 3-5 months age range, which could lead to suboptimal antiviral effect. *25 mg BD X 5 days* - This dosage is generally used for children weighing **between 15 kg and 23 kg**, which is significantly higher than the average weight for an infant aged 3-5 months. - Administering this dose to a 3-5 month old would constitute an **overdose**, potentially leading to increased side effects such as nausea, vomiting, or other adverse reactions. *20 mg OD X 5 days* - While 20 mg is the correct single dose, giving it **once daily (OD)** is incorrect for treating H1N1 influenza in infants. - Oseltamivir requires a **twice-daily (BD)** regimen to maintain therapeutic drug levels and effectively inhibit viral replication over the 24-hour period.

Q: Resting membrane potential of nerve fibre is close to isoelectric potential of:

Potassium ions. ***Potassium ions*** - The **resting membrane potential** is primarily determined by the **equilibrium potential of potassium ions** because the membrane is far more permeable to potassium than to other ions at rest. - Due to the high **permeability to K+**, a significant outward flow of potassium ions occurs, making the inside of the cell negative relative to the outside, approaching the **Nernst potential for K+**. *Sodium ions* - The membrane has very low permeability to **sodium ions** at rest, so **Na+ influx** only slightly affects the resting potential. - The **Nernst potential for Na+** is positive, which is opposite to the negative resting membrane potential. *Chloride ions* - While chloride ions contribute to the **resting membrane potential**, their contribution is typically less significant than potassium due to varying membrane permeability in different neurons. - In many cells, chloride ions follow the electrical gradient set by other ions and do not actively determine the resting potential. *Magnesium ions* - **Magnesium ions** play crucial roles as cofactors for enzymes and in neurotransmission but have minimal direct influence on establishing the **resting membrane potential**. - The membrane is largely **impermeable to Mg2+** at rest, and their concentration gradients do not establish the baseline voltage.

Q: Best way to localize extra-adrenal pheochromocytoma:

Nuclear medicine scan (MIBG scan). ***Nuclear medicine scan (MIBG scan)*** - **Iodine-131-metaiodobenzylguanidine (MIBG) scan** is the imaging modality of choice for localizing extra-adrenal pheochromocytomas due to its high specificity for **neuroendocrine tumors** like pheochromocytomas and paragangliomas. - MIBG is structurally similar to **norepinephrine** and is actively taken up by adrenergic neurons, allowing visualization of hypersecreting chromaffin cells wherever they are located in the body. *X-ray* - **X-rays** provide limited soft tissue detail and are generally not useful for localizing pheochromocytomas, especially extra-adrenal ones. - They may show calcifications in some tumors but lack the sensitivity and specificity needed for definitive localization. *Clinical examination* - A **clinical examination** can identify signs and symptoms suggestive of pheochromocytoma (e.g., hypertension, palpitations, sweating) but cannot localize the tumor itself. - Localization requires **imaging studies** due to the variable and often deep-seated location of these tumors. *VMA excretion* - **Vanillylmandelic acid (VMA) excretion** is a biochemical test used to diagnose pheochromocytoma by measuring catecholamine metabolites in urine. - While it confirms the presence of a catecholamine-secreting tumor, it provides **no information about the tumor's location**.

Q: Which of these is the best for management of a 3 cm stone in renal pelvis without evidence of hydronephrosis?

PCNL. ***PCNL*** - **Percutaneous nephrolithotomy (PCNL)** is the gold standard treatment for large renal stones (>2 cm) due to its high stone-free rates in a single procedure. - For a 3 cm renal pelvis stone, PCNL provides the best clearance rate (~95%) with minimal need for repeat procedures. - It involves direct percutaneous access to the kidney, allowing fragmentation and removal of large stone burden efficiently. *ESWL* - **Extracorporeal shock wave lithotripsy (ESWL)** has limited efficacy for stones >2 cm, with stone-free rates dropping to 50-60% for 3 cm stones. - Multiple sessions are typically required, with increased risk of steinstrasse (stone street) formation and residual fragments. - While non-invasive, ESWL is not the optimal choice for this stone size. *Retrograde pyeloplasty* - This option appears to reference **retrograde endoscopic approaches** (such as retrograde intrarenal surgery - RIRS or ureteroscopy). - While retrograde ureteroscopy can treat renal stones, it is generally reserved for stones <2 cm due to longer operative time and lower stone-free rates for larger stones. - True "pyeloplasty" is a reconstructive procedure for ureteropelvic junction obstruction, not a stone removal technique. *Antegrade pyeloplasty* - This option likely refers to **antegrade endoscopic access** to the renal pelvis. - While antegrade access is used in PCNL, "pyeloplasty" specifically means surgical reconstruction of the UPJ for obstruction, not stone treatment. - Antegrade ureteroscopy alone (without nephroscopy) would be less effective than PCNL for a 3 cm stone.

Q: Marjolin's ulcer is:-

Squamous cell carcinoma from scar. ***Squamous cell carcinoma from scar*** - A Marjolin's ulcer is a rare but aggressive form of squamous cell carcinoma (SCC) that arises in areas of previously traumatized, chronically inflamed, or scarred skin. - Common sites include burn scars, chronic osteomyelitis tracts, pressure ulcers, and venous ulcers. - Typically has a long latency period (average 30-35 years after initial injury). - Characterized by higher rates of local recurrence and metastasis compared to conventional SCC. *Adenoma of scar* - An adenoma is a benign tumor of glandular origin and is not typically associated with scar tissue or malignant transformation in this context. - The malignancy arising in a scar is usually carcinoma, not adenoma. *Amoebic ulcer* - An amoebic ulcer is caused by the parasite *Entamoeba histolytica* and typically affects the colon, presenting as dysentery. - It is not a type of malignant transformation within a pre-existing scar. *Tubercular ulcer* - A tubercular ulcer is a manifestation of tuberculosis, often affecting the skin or mucous membranes and caused by *Mycobacterium tuberculosis*. - This is an infectious process and not a malignant transformation of scar tissue.

Question 1

Secondary ossification centre appears before birth at

Accepted Answer

Lower end of femur

Answer

Upper end of femur

Answer

Lower end of tibia

Answer

Lower end of fibula

Question 2

Gold standard method of diagnosing celiac disease is

Accepted Answer

Small bowel biopsy

Answer

Blood picture

Answer

Anti-endomysial antibodies

Answer

Biochemical test

Question 3

Most common cause of bacterial meningitis in post-neonatal period:

Accepted Answer

Streptococcus pneumoniae

Answer

Mycobacterium tuberculosis

Answer

Staphylococcus aureus

Answer

Klebsiella

Question 4

Which of the following statements about tubercular osteomyelitis is NOT true?

Accepted Answer

Periosteal reaction is characteristic

Answer

Sequestrum is uncommon

Answer

It is a type of secondary osteomyelitis

Answer

Inflammation is minimal

Question 5

What is the histopathological finding 12 hours after ischemic injury to heart?

Accepted Answer

Hyper-eosinophilia of myocytes

Answer

Neocapillary invasion of myocytes

Answer

Karyorrhexis of myocytes

Answer

Coagulation necrosis of myocytes

Question 6

For a child 3-5 months of age with H1N1, treatment Oseltamivir dose is

Accepted Answer

20 mg BD X 5 days

Answer

12 mg BD X 5 days

Answer

25 mg BD X 5 days

Answer

20 mg OD X 5 days

Question 7

Resting membrane potential of nerve fibre is close to isoelectric potential of:

Accepted Answer

Potassium ions

Answer

Sodium ions

Answer

Chloride ions

Answer

Magnesium ions

Question 8

Best way to localize extra-adrenal pheochromocytoma:

Accepted Answer

Nuclear medicine scan (MIBG scan)

Answer

X-ray

Answer

Clinical examination

Answer

VMA excretion

Question 9

Which of these is the best for management of a 3 cm stone in renal pelvis without evidence of hydronephrosis?

Accepted Answer

PCNL

Answer

Retrograde pyeloplasty

Answer

ESWL

Answer

Antegrade pyeloplasty

Question 10

Marjolin's ulcer is:-

Accepted Answer

Squamous cell carcinoma from scar

Answer

Adenoma of scar

Answer

Amoebic ulcer

Answer

Tubercular ulcer

FMGE 2018

Anatomy

Internal Medicine

Microbiology

Orthopaedics

Pathology

Pediatrics

Physiology

Radiology

Surgery