FMGE 2018 Practice Questions

Q: Essential fatty acid:

Linoleic acid. ***Linoleic acid*** - **Linoleic acid** is an **omega-6 fatty acid** that is considered essential because the human body cannot synthesize it and must obtain it through diet. - It is a precursor for other important fatty acids like **arachidonic acid**, which are involved in inflammation and blood clotting. *Citric acid* - **Citric acid** is an organic acid found in citrus fruits and is a key intermediate in the **Krebs cycle** (citric acid cycle), a central metabolic pathway, but it is not a fatty acid. - It is readily synthesized by the body and is therefore not considered an essential nutrient. *Palmitic acid* - **Palmitic acid** is a **saturated fatty acid** with 16 carbon atoms, which is the most common fatty acid in animals and plants. - It can be synthesized by the human body from excess carbohydrates and proteins, hence it is not an essential fatty acid. *Stearic acid* - **Stearic acid** is another common **saturated fatty acid** with 18 carbon atoms, found in various animal and plant fats. - Like palmitic acid, it can be endogenously synthesized by the body and is not considered essential.

Q: 35 years old female presents with tinnitus, vertigo and aural fullness. Likely diagnosis:

Meniere's Disease. ***Meniere's Disease*** - The classic triad of symptoms for Meniere's disease includes **tinnitus**, **vertigo**, and **aural fullness**, along with fluctuating sensorineural hearing loss. - This condition is thought to be caused by an excess of **endolymphatic fluid** within the inner ear. *Ototoxicity* - This condition typically presents with **bilateral, symmetrical hearing loss** and tinnitus, often induced by certain medications (e.g., aminoglycosides, aspirin in high doses). - It usually does not involve episodic vertigo or aural fullness, which are characteristic of Meniere's. *Noise Induced Hearing Loss* - Characterized primarily by **permanent sensorineural hearing loss**, often at specific frequencies (e.g., 4000 Hz notch), and **tinnitus** after prolonged exposure to loud noise. - It does not typically cause the episodic vertigo or sense of aural fullness seen in Meniere's disease. *Otosclerosis* - This condition causes **progressive conductive hearing loss** due to abnormal bone growth around the stapes bone, impairing its movement. - While it can cause tinnitus, it typically does not present with vertigo or aural fullness, and the primary hearing loss is conductive, not sensorineural.

Q: Gastric lavage is contraindicated in?

Hydrocarbons. ***Hydrocarbons*** - Gastric lavage is contraindicated in **hydrocarbon poisoning** due to the high risk of **aspiration** [2]. - Aspiration of hydrocarbons can lead to severe **chemical pneumonitis**, which is often more life-threatening than the systemic toxicity from ingestion [2]. *Bicarbonate* - Ingesting a large amount of bicarbonate can cause **alkalosis** and electrolyte imbalances. - While gastric lavage is not typically the primary treatment for mild bicarbonate overdose, it is not absolutely contraindicated in cases of massive ingestion where there is a clear benefit to removing unabsorbed substance, especially if performed with proper airway protection [1], [3]. *Organo-Phosphosphate poisoning* - Gastric lavage is generally recommended for **organophosphate poisoning** if the patient presents within 1-2 hours of ingestion and is awake with an intact gag reflex, or with a protected airway [2]. - This helps remove unabsorbed poison and can reduce the systemic absorption of these highly toxic compounds. *PCM toxicity* - For **paracetamol (PCM) toxicity**, gastric lavage can be considered if the patient presents within 1-2 hours of ingestion and has ingested a potentially toxic dose, especially when activated charcoal is not immediately available or contraindicated [4]. - The primary treatment for PCM toxicity involves **N-acetylcysteine (NAC)**, but gastric emptying can play a role in reducing initial absorption [4].

Q: Primary osteoarthritis affects all except:

Metacarpophalangeal joint. ***Metacarpophalangeal joint*** - The **metacarpophalangeal (MCP) joints** are typically spared in primary osteoarthritis, making their involvement a less common presentation. - Involvement of the MCP joints, particularly with significant inflammation, might suggest other conditions like **rheumatoid arthritis**. *Hip Joint* - The hip joint is a common site for primary osteoarthritis due to its **weight-bearing function** and susceptibility to mechanical stress. - Patients often experience **groin pain** and reduced range of motion, particularly internal rotation. *Distal interphalangeal joint* - The **distal interphalangeal (DIP) joints** are very commonly affected in primary osteoarthritis, leading to the formation of **Heberden's nodes**. - These nodes are bony enlargements that indicate osteophyte formation and cartilage loss. *Knee joint* - The knee joint is another frequently affected large joint in primary osteoarthritis, often presenting with **pain**, **stiffness**, and **crepitus**. - Its **weight-bearing role** contributes significantly to its vulnerability to degenerative changes.

Q: A patient presented with sudden onset of thunderclap headache & dilated pupils. Findings are consistent with:

Acute aneurismal hemorrhage. ***Acute aneurismal hemorrhage*** - **Thunderclap headache** is the hallmark symptom, often described as the "worst headache of life," due to sudden elevation of intracranial pressure [2]. - **Dilated pupils**, especially unilateral, can indicate compression of the **oculomotor nerve (CN III)** by an expanding aneurysm in the posterior communicating artery region, a direct effect of subarachnoid hemorrhage [1]. *Brain stem encephalitis* - This condition involves inflammation of the brainstem, which typically presents with a range of neurological deficits such as **ataxia**, **cranial nerve palsies**, and **altered consciousness**. - While headaches can occur, a characteristic **thunderclap headache** is not a typical feature, and pupillary abnormalities would be more varied depending on the extent of brainstem involvement. *Acute ischemia of midbrain* - **Midbrain ischemia** would present with brainstem symptoms like **vertigo**, **diplopia**, **hemiparesis**, or **oculomotor nerve palsy** [3]. - Although it could lead to pupillary changes if the oculomotor nucleus is affected, it typically does not cause a sudden, severe **thunderclap headache**. *Meningitis* - **Meningitis** presents with headache, fever, **neck stiffness**, and altered mental status [2]. - While headache is common, a sudden **thunderclap headache** is less typical, and **dilated pupils** are not a primary diagnostic feature unless there is severe herniation or other complications.

Q: True about Mooren's ulcer:

Affects cornea. ***Affects cornea*** - **Mooren's ulcer** is a rare, severe, and idiopathic chronic **ulcerative keratitis** that primarily affects the cornea. - It involves a progressive **peripheral corneal stromal thinning** and ulceration, often extending circumferentially and centrally. *Bilateral in majority of cases* - Mooren's ulcer is **unilateral in approximately 60-80%** of cases, making bilateral presentation less common. - While it can be bilateral, especially in a more severe form, it's not the majority presentation. *Sudden loss of vision* - The vision loss associated with Mooren's ulcer is typically **gradual and progressive**, due to increasing corneal thinning, scarring, and astigmatism. - **Sudden vision loss** is not a characteristic feature of this condition and would suggest other acute pathologies. *Painless* - Mooren's ulcer is often associated with **significant pain**, **photophobia**, and **lacrimation**. - The pain can be severe and debilitating, stemming from the inflammatory process and corneal nerve involvement.

Q: 79 yrs old lady had fall, the following X-ray was taken. Which of the following is treatment?

Hemiahroplasty. ***Hemiarthroplasty*** - The X-ray shows a **displaced femoral neck fracture** in an elderly patient, which typically has a high risk of **avascular necrosis** of the femoral head due to disruption of blood supply. - Hemiarthroplasty involves replacing only the **femoral head and neck** with a prosthetic component, leaving the acetabulum intact, which is suitable for elderly patients with good acetabular cartilage and less active lifestyles. *Hip spica* - A hip spica cast is primarily used for **pediatric femur fractures** or certain types of hip dislocations in children, not for displaced femoral neck fractures in elderly adults. - This method would not provide stable fixation or address the high risk of **avascular necrosis** associated with these fractures in older patients. *Nailing* - Nailing (intramedullary nailing) is typically used for **intertrochanteric fractures** or subtrochanteric fractures, where the fracture line is distal to the femoral neck. - For displaced femoral neck fractures, nailing alone may not provide adequate stability and carries a higher risk of **non-union** or **avascular necrosis** compared to arthroplasty in elderly patients. *Total Hip Replacement* - Total hip replacement involves replacing both the **femoral head and the acetabulum** with prosthetic components. - While an option for femoral neck fractures, it is generally reserved for younger, more active patients or those with pre-existing **acetabular pathology** like arthritis, as it is a more extensive and complex procedure than hemiarthroplasty.

Q: A newborn loses maximum heat from:

Head. ***Head*** - Newborns have a **relatively large head surface area** compared to their total body surface area. - The head also has a rich **blood supply** and lacks subcutaneous fat for insulation, contributing to significant heat loss through **convection and radiation**. *Abdomen* - While the abdomen contributes to heat loss, it is covered by clothing and has a more proportionate surface area to mass ratio compared to the head, making it a **less significant site for maximal heat loss**. - Heat loss from the abdomen is not as pronounced as from the head due to its **central location** and typically greater insulation. *Neck* - The neck's surface area is comparably small, and it is often covered or in close proximity to the body, which helps to **reduce heat loss**. - It does not possess the same combination of large surface area and lack of insulating fat as the head. *Palms & soles* - While palms and soles have a high density of **sweat glands** and can contribute to heat loss through evaporation, their **total surface area is relatively small** in a newborn. - These areas are less significant for overall maximal heat loss compared to the head due to their limited size.

Q: True for lithium:

Narrow therapeutic index. ***Narrow therapeutic index*** - Lithium has a **narrow therapeutic index**, meaning the difference between its effective and toxic doses is small. - This necessitates **close monitoring of serum lithium levels** to ensure efficacy and prevent toxicity. *Can be given safely in renal dysfunction* - Lithium is **primarily excreted renally**, and its clearance is directly proportional to creatinine clearance. - Therefore, it **should be used with caution** (or avoided) in patients with renal dysfunction due to increased risk of toxicity. *Protein bound* - Lithium is **not protein-bound**; it exists as a free ion in the blood. - This characteristic contributes to its rapid distribution and excretion. *Delayed absorption* - Lithium is **rapidly and almost completely absorbed** from the gastrointestinal tract. - Peak plasma concentrations are usually reached within 1-2 hours for immediate-release preparations.

Q: Which of the following is not done in carcinoma esophagus?

pH - metry/monitoring. ***pH - metry/monitoring*** - **pH metry/monitoring** is primarily used to diagnose **gastroesophageal reflux disease (GERD)**, which is not a direct diagnostic tool for esophageal carcinoma itself. - While GERD is a risk factor for **Barrett's esophagus** and subsequently adenocarcinoma of the esophagus, pH monitoring does not directly identify or stage the cancer. *CT chest* - **CT (Computed Tomography) chest** is routinely performed in esophageal carcinoma to assess the **local extent** of the tumor and identify potential **lymph node involvement** or **metastasis** to other organs. - It is crucial for **staging** the disease and guiding treatment decisions such as resectability. *PET scan* - A **PET (Positron Emission Tomography) scan** is highly useful for detecting **distant metastases** and identifying **occult disease** not visible on CT, especially in cases of suspected advanced esophageal carcinoma. - It helps in **accurate staging** and avoiding futile surgery in patients with metastatic disease. *Biopsy* - **Biopsy**, typically performed during endoscopy, is the **gold standard** for confirming the diagnosis of esophageal carcinoma by obtaining tissue for **histopathological examination**. - It identifies the cell type (e.g., adenocarcinoma, squamous cell carcinoma) and grade of the tumor, which is essential for treatment planning.

Question 1

Essential fatty acid:

Accepted Answer

Linoleic acid

Answer

Citric acid

Answer

Palmitic acid

Answer

Stearic acid

Question 2

35 years old female presents with tinnitus, vertigo and aural fullness. Likely diagnosis:

Accepted Answer

Meniere's Disease

Answer

Ototoxicity

Answer

Noise Induced Hearing Loss

Answer

Otosclerosis

Question 3

Gastric lavage is contraindicated in?

Accepted Answer

Hydrocarbons

Answer

Bicarbonate

Answer

Organo-Phosphosphate poisoning

Answer

PCM toxicity

Question 4

Primary osteoarthritis affects all except:

Accepted Answer

Metacarpophalangeal joint

Answer

Hip Joint

Answer

Distal interphalangeal joint

Answer

Knee joint

Question 5

A patient presented with sudden onset of thunderclap headache & dilated pupils. Findings are consistent with:

Accepted Answer

Acute aneurismal hemorrhage

Answer

Brain stem encephalitis

Answer

Acute ischemia of midbrain

Answer

Meningitis

Question 6

True about Mooren's ulcer:

Accepted Answer

Affects cornea

Answer

Bilateral in majority of cases

Answer

Sudden loss of vision

Answer

Painless

Question 7

79 yrs old lady had fall, the following X-ray was taken. Which of the following is treatment?

Accepted Answer

Hemiahroplasty

Answer

Hip spica

Answer

Nailing

Answer

Total Hip Replacement

Question 8

A newborn loses maximum heat from:

Accepted Answer

Head

Answer

Abdomen

Answer

Neck

Answer

Palms & soles

Question 9

True for lithium:

Accepted Answer

Narrow therapeutic index

Answer

Can be given safely in renal dysfunction

Answer

Protein bound

Answer

Delayed absorption

Question 10

Which of the following is not done in carcinoma esophagus?

Accepted Answer

pH - metry/monitoring

Answer

CT chest

Answer

PET scan

Answer

Biopsy

FMGE 2018

Biochemistry

ENT

Forensic Medicine

Internal Medicine

Ophthalmology

Orthopaedics

Pediatrics

Pharmacology

Surgery