FMGE 2019 Practice Questions

Q: Which is a product of purine metabolism?

Uric acid. ***Uric acid*** - **Uric acid** is the final breakdown product of **purine metabolism** in humans. - It's formed from the oxidation of **xanthine** by the enzyme **xanthine oxidase**. *Xanthine* - **Xanthine** is an intermediate compound in the purine metabolic pathway, but not the final product in humans. - It is converted to **uric acid** via the enzyme **xanthine oxidase**. *Beta alanine* - **Beta-alanine** is a **non-proteogenic amino acid** and is a breakdown product of **pyrimidine metabolism**, not purine. - It is involved in the synthesis of **carnosine**, a buffer in muscle tissue. *Urea* - **Urea** is the primary end product of **protein (amino acid) metabolism** in mammals, representing the main way the body excretes **nitrogen**. - It is produced in the **urea cycle** in the liver and is unrelated to purine breakdown.

Q: Melanin is derived from which amino acid?

Tyrosine. ***Tyrosine*** - **Melanin synthesis** (melanogenesis) begins with the hydroxylation of **tyrosine** to DOPA (dihydroxyphenylalanine), catalyzed by the enzyme **tyrosinase**. - Subsequent steps involve the oxidation of DOPA and its derivatives to form various types of melanin, such as **eumelanin** (black/brown) and **pheomelanin** (red/yellow). *Phenylalanine* - **Phenylalanine** is an essential amino acid that can be converted to tyrosine in the body by the enzyme **phenylalanine hydroxylase**. - While it's a precursor to tyrosine, it's not directly converted to melanin; rather, it must first be hydroxylated to tyrosine. *Alanine* - **Alanine** is a non-essential amino acid involved in glucose metabolism and protein synthesis. - It is not a precursor for melanin synthesis. *Tryptophan* - **Tryptophan** is an essential amino acid that is a precursor for **serotonin**, **melatonin**, and **niacin** (Vitamin B3). - It is not involved in the biosynthesis of melanin.

Q: Main focus of UNICEF is on?

Child health. ***Child health*** - UNICEF's primary mission focuses on advocating for the protection of children's rights, helping to meet their basic needs, and expanding their opportunities to reach their full potential. - This encompasses various aspects of child welfare, with **child health** being a fundamental and overarching priority. *Social health* - While UNICEF's work indirectly contributes to **social health** by fostering community well-being, its direct and explicit focus is not primarily on the broader concept of social health. - Social health is a very broad term that encompasses many aspects not directly and exclusively dealt with by UNICEF. *Mental health* - **Child mental health** is an increasingly recognized area of focus for UNICEF, but it falls under the broader umbrella of child health and well-being, rather than being its sole or main focus. - While important, mental health is a component of overall child health, not the singular main focus. *Nutritional health* - **Nutritional health** is a critical component of child health and a significant area of intervention for UNICEF. - However, it represents one vital aspect within the comprehensive scope of "child health," not the exclusive main focus.

Q: Which of the following is not a measure of dispersion?

Mean. ***Mean*** - The **mean** is a measure of **central tendency**, representing the average value of a dataset. - It describes where the center of the data lies, not how spread out the data points are. *Range* - The **range** is a measure of **dispersion** that indicates the difference between the **maximum** and **minimum** values in a dataset. - It quantifies the overall spread of the data from its lowest to highest points. *Variance* - **Variance** is a measure of **dispersion** that quantifies the **average squared deviation** of each data point from the mean. - It provides insight into how much the individual data points in a distribution deviate from the central tendency. *Standard error* - The **standard error** measures the **precision and sampling variability** of a sample statistic (e.g., sample mean) as an estimate of the population parameter. - While it relates to variability, it specifically quantifies how much a sample statistic varies across different samples, rather than measuring the dispersion of individual observations within a dataset. - In the context of this question, it is considered a measure related to dispersion, though technically it measures sampling variability.

Q: Which of the following is best for diagnosis of pheochromocytoma?

24-hour urinary Fractionated Metanephrine. ***24-hour urinary Fractionated Metanephrine*** - This test measures the **metabolites of catecholamines** (epinephrine and norepinephrine), which are continuously produced by pheochromocytomas [1]. - As metanephrines are released continuously rather than episodically, their measurement in a 24-hour urine collection provides the **highest sensitivity and specificity** for diagnosing pheochromocytoma. *24-hour Urinary Hydroxy indole acetic acid* - This is a metabolite of **serotonin**, which is relevant to conditions like **carcinoid syndrome**, not pheochromocytoma. - Elevated levels would indicate a serotonin-producing tumor, not a catecholamine-producing tumor. *24-hour urinary Vanillyl Mandelic acid* - While VMA is a metabolite of both epinephrine and norepinephrine, it is a less specific and sensitive marker than fractionated metanephrines for pheochromocytoma. - Its measurement can be affected by various medications and dietary factors, leading to a higher rate of false positives and negatives compared to metanephrines. *24-hour Urinary Hydroxy tryptamine* - This refers to **serotonin**, which is not directly relevant to the diagnosis of pheochromocytoma. - Elevated levels would point towards conditions involving serotonin metabolism, such as carcinoid tumors.

Q: Hyperkalemia means more than

5.5 mEq/l. ***5.5 mEq/l*** - **Hyperkalemia** is defined as a serum potassium level greater than **5.5 mEq/L** [1]. - This elevated level can lead to significant cardiac and neurological complications if not promptly addressed. *4.5 mEq/l* - A potassium level of 4.5 mEq/L falls within the normal physiological range for serum potassium, which is typically **3.5 to 5.0 mEq/L** [1]. - Therefore, this value does not indicate hyperkalemia. *10.5 mEq/l* - While 10.5 mEq/L is indeed an elevated potassium level, it represents **severe hyperkalemia**, far exceeding the general threshold for diagnosis. - The definition of hyperkalemia begins at a lower threshold of **5.5 mEq/L** [1]. *7.5 mEq/l* - A potassium level of 7.5 mEq/L indicates **moderate to severe hyperkalemia** and is a critical finding requiring immediate medical intervention [2]. - However, the initial threshold for defining hyperkalemia is **5.5 mEq/L**, making this option too high for the general definition [1].

Q: A 40-year-old male presents with tachypnea. Examination reveals a respiratory rate of 32/min, pulmonary hypertension, blood pressure of 132/90 mmHg, and elevated JVP. What is the most likely cause of these findings?

Cor pulmonale. ***Cor pulmonale*** - **Cor pulmonale** is right heart failure secondary to pulmonary disease, which perfectly explains the constellation of **tachypnea**, **pulmonary hypertension**, and **elevated JVP**. - The pathophysiology involves underlying lung disease leading to **pulmonary hypertension**, causing **right heart strain** and eventual right heart failure. *Tension pneumothorax* - Characterized by **severe dyspnea**, **hypotension**, and **tracheal deviation**, none of which are explicitly mentioned here. - While it causes tachypnea, it would typically present with **unilateral absent breath sounds** and **hemodynamic instability**, not chronic pulmonary hypertension. *Aortic dissection and rupture* - Typically presents with **sudden onset severe chest pain**, **pulse deficits**, and often **blood pressure differences** between arms. - Does not primarily cause **pulmonary hypertension** or **elevated JVP** as its initial and predominant symptoms. *Right ventricular hypertrophy* - This represents a **structural adaptation** to chronic pressure overload rather than the primary cause of the clinical syndrome. - **RVH** is a consequence and manifestation of **cor pulmonale**, not the underlying diagnosis explaining the patient's presentation.

Q: EBV is most strongly associated with which of the following?

Nasopharyngeal carcinoma. ***Nasopharyngeal carcinoma*** - **Epstein-Barr virus (EBV)** is strongly and consistently associated with the development of **nasopharyngeal carcinoma**, particularly the undifferentiated (endemic) type. - EBV DNA is found in virtually **100% of undifferentiated nasopharyngeal carcinomas**, highlighting its critical role in the pathogenesis of this cancer. - This represents one of the strongest virus-cancer associations in human medicine. *Gastric cancer* - While EBV is linked to a specific subtype of **EBV-associated gastric adenocarcinoma**, it accounts for only about **10% of gastric cancers**. - This makes it a less strong and less prevalent association compared to nasopharyngeal carcinoma. *Esophageal cancer* - **Esophageal cancer** (adenocarcinoma and squamous cell carcinoma) has various risk factors such as GERD, smoking, and alcohol consumption. - **EBV is not a significant etiologic factor** for esophageal cancer. - There is no strong, consistent evidence linking EBV as a primary cause of esophageal malignancy. *Hepatocellular carcinoma* - **Hepatocellular carcinoma** is primarily associated with **hepatitis B virus (HBV)** and **hepatitis C virus (HCV)**, not EBV. - Other risk factors include chronic liver disease, cirrhosis, aflatoxin exposure, and alcohol abuse. - EBV does not play a significant role in hepatocellular carcinoma pathogenesis.

Q: A child presents with complaints of bed wetting. What is the first line of treatment?

Bed alarm technique. ***Bed alarm technique*** - The **bed alarm technique** is considered the most effective first-line treatment for **nocturnal enuresis** in children. - It works through **classical conditioning**, training the child to wake up in response to bladder fullness. *Motivational therapy* - **Motivational therapy** can be a useful adjunct to other treatments, but it is not typically the sole **first-line therapy** due to varying effectiveness. - It focuses on building the child's confidence and encouraging dryness but does not directly address the physiological aspects of bedwetting. *Oxybutynin* - **Oxybutynin** is an anticholinergic medication that can reduce bladder contractions and increase bladder capacity. - It is usually reserved for cases where **bedwetting alarms** and **desmopressin** have been ineffective, or when there is an identifiable **overactive bladder component**. *Desmopressin* - **Desmopressin** is an antidiuretic hormone analogue that reduces urine production during the night. - While effective, it is often considered a **second-line treatment** after behavioral interventions like the bed alarm, or when rapid but temporary improvement is desired.

Question 1

Which is a product of purine metabolism?

Accepted Answer

Uric acid

Answer

Xanthine

Answer

Beta alanine

Answer

Urea

Question 2

Melanin is derived from which amino acid?

Accepted Answer

Tyrosine

Answer

Phenylalanine

Answer

Alanine

Answer

Tryptophan

Question 3

Main focus of UNICEF is on?

Accepted Answer

Child health

Answer

Social health

Answer

Mental health

Answer

Nutritional health

Question 4

Which of the following is not a measure of dispersion?

Accepted Answer

Mean

Answer

Range

Answer

Variance

Answer

Standard error

Question 5

A 6-year-old boy came to the hospital with complaints of sore throat and difficulty in swallowing. His left tonsil was pushed medially and had swelling over the left side upper part of neck. What will be the diagnosis?

Accepted Answer

Peritonsillar abscess

Answer

Ludwig's angina

Answer

Retropharyngeal abscess

Answer

Parapharyngeal abscess

Question 6

Which of the following is best for diagnosis of pheochromocytoma?

Accepted Answer

24-hour urinary Fractionated Metanephrine

Answer

24-hour Urinary Hydroxy indole acetic acid

Answer

24-hour urinary Vanillyl Mandelic acid

Answer

24-hour Urinary Hydroxy tryptamine

Question 7

Hyperkalemia means more than

Accepted Answer

5.5 mEq/l

Answer

4.5 mEq/l

Answer

10.5 mEq/l

Answer

7.5 mEq/l

Question 8

A 40-year-old male presents with tachypnea. Examination reveals a respiratory rate of 32/min, pulmonary hypertension, blood pressure of 132/90 mmHg, and elevated JVP. What is the most likely cause of these findings?

Accepted Answer

Cor pulmonale

Answer

Tension pneumothorax

Answer

Aortic dissection and rupture

Answer

Right ventricular hypertrophy

Question 9

EBV is most strongly associated with which of the following?

Accepted Answer

Nasopharyngeal carcinoma

Answer

Gastric cancer

Answer

Esophageal cancer

Answer

Hepatocellular carcinoma

Question 10

A child presents with complaints of bed wetting. What is the first line of treatment?

Accepted Answer

Bed alarm technique

Answer

Motivational therapy

Answer

Oxybutynin

Answer

Desmopressin

FMGE 2019

Biochemistry

Community Medicine

ENT

Internal Medicine

Microbiology

Pediatrics