FMGE 2019 Practice Questions

Q: Gluconeogenesis is inhibited by?

Insulin. ***Insulin*** - **Insulin** is a key hormone released in response to high blood glucose, promoting glucose uptake and storage, and **inhibiting hepatic glucose production** through gluconeogenesis and glycogenolysis. - It achieves this by decreasing the transcription and activity of key gluconeogenic enzymes like **phosphoenolpyruvate carboxykinase (PEPCK)** and **glucose-6-phosphatase**. *Cholecystokinin* - **Cholecystokinin (CCK)** is a gastrointestinal hormone primarily involved in digestion, stimulating bile release and pancreatic enzyme secretion. - It does not directly regulate gluconeogenesis; its main role is related to **fat and protein digestion**. *5-alpha reductase* - **5-alpha reductase** is an enzyme involved in steroid metabolism, converting testosterone to the more potent androgen, dihydrotestosterone (DHT). - This enzyme has no direct role in the regulation of **gluconeogenesis**. *Glucagon* - **Glucagon** is a hormone that has the opposite effect of insulin, stimulating gluconeogenesis and glycogenolysis to increase blood glucose levels during fasting or hypoglycemia. - Its primary action is to **promote** hepatic glucose output, not inhibit it.

Q: A 35-year-old woman at 36 weeks of gestation presents with a history of 5 convulsions at home. Her BP is 170/100 mmHg. The diagnosis made by the doctor is eclampsia. What is the next management?

MgSO4 + Labetalol. ***MgSO4 + Labetalol*** - The patient presents with **eclampsia**, characterized by convulsions and severe hypertension (BP 170/100 mmHg) during pregnancy. Magnesium sulfate (**MgSO4**) is the **first-line treatment for preventing and managing eclamptic seizures**. - **Labetalol** is an appropriate antihypertensive for **severe hypertension in pregnancy** (BP ≥160/110 mmHg) and must be used concurrently with MgSO4 to control the high blood pressure and prevent maternal complications like stroke or placental abruption. - Both medications are required for comprehensive management of eclampsia with severe hypertension. *Clonidine* - **Clonidine** is an alpha-2 adrenergic agonist used to treat hypertension but is **not the first-line antihypertensive choice in acute eclampsia** due to potential sedative effects and slower onset compared to other agents like Labetalol, Hydralazine, or Nifedipine. - While it can lower blood pressure, it **does not address the seizure risk** in eclampsia. *Only Labetalol* - While **Labetalol** is crucial for managing severe hypertension, treating eclampsia requires both seizure control and blood pressure management. Administering only Labetalol would **fail to prevent recurrent seizures**, which is the primary life-threatening concern. - It would adequately lower blood pressure but **does not address the underlying seizure pathology** of eclampsia. *Only MgSO4* - **MgSO4** is essential for seizure prophylaxis and treatment in eclampsia. However, in this patient with a blood pressure of **170/100 mmHg (severe hypertension)**, **MgSO4 alone would not adequately control the severe hypertension**, which poses risks of maternal complications like stroke, intracerebral hemorrhage, or placental abruption. - While it prevents seizures effectively, it **does not sufficiently manage severe maternal hypertension**, requiring an additional antihypertensive agent like Labetalol.

Q: hCG is secreted by?

Syncytiotrophoblast. ***Syncytiotrophoblast*** - The **syncytiotrophoblast** is the outer layer of the trophoblast that invades the uterine wall and is responsible for producing human chorionic gonadotropin (**hCG**). - Production of **hCG** by the **syncytiotrophoblast** begins shortly after implantation and is crucial for maintaining the **corpus luteum** and thus **progesterone** secretion during early pregnancy. *Cytotrophoblast* - The **cytotrophoblast** is the inner layer of the trophoblast that proliferates and differentiates into the **syncytiotrophoblast**. - While essential for placental development, the **cytotrophoblast** itself does not directly secrete **hCG**. *Yolk sac* - The **yolk sac** is involved in early nourishment of the embryo and plays a role in the formation of **primitive blood cells** and **germ cells**. - It does not produce **hCG**; its main functions are related to nutrition and hematopoiesis before the placenta is fully functional. *Decidua* - The **decidua** is the modified endometrial lining of the uterus during pregnancy, derived from **maternal tissue**. - It does not produce **hCG** as it is maternal in origin, whereas **hCG** is produced by fetal-derived **trophoblastic cells**.

Q: A 20-year-old male complains of repeated changes in glasses prescription. This is most likely caused by:

Keratoconus. ***Keratoconus*** - **Keratoconus** is a progressive disorder where the cornea thins and protrudes into a cone shape, leading to irregular astigmatism and frequent changes in glasses prescription. - This condition commonly presents in young adults and is characterized by **rapid, repeated changes** in both spherical and cylindrical components due to progressive corneal distortion. - The irregular corneal shape makes it difficult to achieve stable, satisfactory vision correction with glasses alone. *Cataract* - A **cataract** is a clouding of the eye's natural lens, which causes blurred vision, glare, and difficulty seeing at night. - While it can cause a "myopic shift" leading to prescription changes, it is more common in older individuals (>50 years) and the changes are typically slower and less frequent than in keratoconus. *Glaucoma* - **Glaucoma** is a group of eye conditions that damage the optic nerve, often due to high intraocular pressure, leading to peripheral vision loss and eventually blindness. - It does not cause changes in refractive error or require frequent updates to glasses prescriptions. - Visual changes are related to field defects, not refractive changes. *Pathological myopia* - **Pathological myopia** is a severe form of nearsightedness where the eye elongates excessively, leading to progressive increases in myopic refractive error. - While it can cause prescription changes in young adults, the progression is typically more **gradual and predictable** (mainly increasing spherical myopia) compared to the **rapid, irregular changes** seen in keratoconus. - Keratoconus is distinguished by frequent changes in astigmatism due to irregular corneal shape, whereas pathological myopia mainly affects spherical power.

Q: A 6-year-old child is suspected with supracondylar fracture of right hand, complaining of pain and swelling. X-ray of right elbow was not significant. What is the next best step in this case?

Compare with X-ray of left hand. ***Compare with X-ray of left hand*** - In pediatric elbow injuries, a seemingly **normal X-ray** in the presence of strong clinical suspicion (pain, swelling, suspected supracondylar fracture) often warrants a comparison view of the contralateral unaffected limb. - This helps identify subtle findings like **epiphyseal separations** or **minimally displaced fractures** that might otherwise be missed due to the developing osseous structures in children. *Cast* - Applying a cast without definitive diagnosis or clear radiographic evidence of a fracture can lead to **unnecessary immobilization** and potential complications if no fracture is present, or inadequate treatment if a specific type of fracture requires reduction. - While immobilization is appropriate for confirmed fractures, it's not the **initial diagnostic step** when X-rays are inconclusive. *Closed reduction with K wire fixation* - This is an **invasive procedure** reserved for **displaced or unstable fractures** after a clear diagnosis has been established. - Performing this without a confirmed and characterized fracture is inappropriate and carries risks of **iatrogenic injury** and complications. *Closed reduction and slab* - Similar to casting, this is a treatment for **confirmed fractures**, typically for acute, stable, or minimally displaced fractures that can be managed non-surgically after a reduction. - It is not a diagnostic step and should not be performed when initial imaging is **inconclusive** and the exact nature of the injury is unknown.

Q: Sixth disease is?

Exanthema subitum. ***Exanthema subitum*** - Exanthema subitum, also known as **Roseola infantum** or **sixth disease**, is a common childhood illness caused by human herpesvirus 6 (HHV-6) or less commonly HHV-7. - It is characterized by **3-5 days of high fever** followed by the abrupt appearance of a **maculopapular rash** once the fever subsides. *Erythema nodosum* - **Erythema nodosum** presents as tender, red nodules, typically on the shins, and is a type of **panniculitis** (inflammation of subcutaneous fat). - It is often associated with systemic diseases, infections (e.g., strep throat, tuberculosis), drugs, or inflammatory bowel disease, rather than being a primary childhood viral exanthem. *Erythema marginatum* - **Erythema marginatum** is a rare, transient, and non-pruritic rash with **serpiginous (snake-like) borders** that is a specific hallmark of **acute rheumatic fever**. - It is not a generalized viral exanthem and does not follow a typical febrile phase like sixth disease. *Erythema Infectiosum* - **Erythema infectiosum**, also known as **fifth disease**, is caused by **parvovirus B19** and is characterized by a "slapped cheek" rash on the face followed by a lacy rash on the trunk and extremities. - While it's a common childhood exanthem, it's distinct from sixth disease in its causative agent and characteristic rash pattern.

Q: Which of the following is the chemoprophylaxis of choice in a person who is on a journey to endemic malarial region?

Atovaquone-proguanil. ***Atovaquone-proguanil*** - **First-line choice** for malaria chemoprophylaxis in travelers to endemic regions according to WHO and CDC guidelines - Highly effective against **drug-resistant *P. falciparum***, including chloroquine and mefloquine-resistant strains - **Excellent tolerability** with minimal side effects compared to other antimalarials - **Convenient dosing schedule**: started 1-2 days before travel and continued for only **7 days after** leaving the endemic area (shorter post-travel duration than alternatives) - Well-tolerated with few contraindications, making it suitable for most travelers *Doxycycline* - Effective alternative for malaria prophylaxis as a **tetracycline antibiotic** - Provides additional protection against **leptospirosis** and traveler's diarrhea - However, associated with **photosensitivity reactions** (sunburn risk), **GI upset**, and **esophageal irritation** - Contraindicated in **pregnancy** and **children <8 years** due to effects on teeth and bone - Requires daily dosing starting 1-2 days before until **4 weeks after travel** (longer duration) *Mefloquine* - Once-weekly dosing offers convenience for long-term travelers - Effective against most *P. falciparum* strains - Major limitation: significant **neuropsychiatric side effects** including anxiety, depression, dizziness, and rarely psychosis - Contraindicated in those with **psychiatric history**, seizure disorders, or cardiac conduction abnormalities - Must be started **2-3 weeks before travel** to assess tolerance *Chloroquine* - Historically the first-line agent but now limited by widespread **chloroquine resistance** - Only effective in few remaining areas with **chloroquine-sensitive *P. vivax*** or *P. falciparum* (parts of Central America, Middle East) - Well-tolerated with once-weekly dosing - Not appropriate for most endemic malarial regions in Africa, Southeast Asia, or South America

Q: Therapeutic drug monitoring is done for:

Phenytoin. ***Phenytoin*** - **Phenytoin** has a **narrow therapeutic window**, meaning the difference between an effective and a toxic dose is small, necessitating close monitoring. - Its **variable absorption** and **nonlinear pharmacokinetics** (saturable metabolism) make individual dosing adjustments critical to maintain therapeutic levels and avoid toxicity. *Aspirin* - **Aspirin** is generally not monitored via plasma levels for its analgesic or antiplatelet effects, as its therapeutic effects are often observed at doses where plasma monitoring is not practical or necessary. - Its primary therapeutic use as an **antiplatelet agent** is evaluated by clinical outcomes rather than drug concentration. *Heparin* - **Heparin** is monitored using coagulation tests like **aPTT (activated partial thromboplastin time)** or anti-Xa levels to assess its anticoagulant effect, not direct drug concentration. - Therapeutic drug monitoring for heparin focuses on its **pharmacodynamic effects** on the clotting cascade rather than its absolute plasma concentration. *Metformin* - **Metformin** has a relatively **wide therapeutic index** and its efficacy is primarily measured by reductions in blood glucose and HbA1c, not by plasma drug concentrations. - It is excreted largely unchanged by the kidneys, and dose adjustments are typically made based on **renal function** and glycemic control.

Q: Mechanism of action of allopurinol is

Xanthine oxidase inhibition. ***Xanthine oxidase inhibition*** - **Allopurinol** acts as a **structural analog of hypoxanthine** and competitively inhibits the enzyme **xanthine oxidase**. - By inhibiting **xanthine oxidase**, allopurinol prevents the conversion of hypoxanthine to xanthine and then to uric acid, thereby **decreasing uric acid production**. *Recombinant uricase* - **Recombinant uricase** (e.g., rasburicase, pegloticase) is an enzyme that catalyzes the breakdown of existing uric acid into allantoin, a more soluble compound. - This mechanism is distinct from allopurinol, which **prevents uric acid formation**. *Decrease chemotaxis* - Medications that **decrease chemotaxis**, such as **colchicine**, work by interfering with the migration of neutrophils to sites of inflammation, which is useful in acute gout flares. - This is an **anti-inflammatory mechanism**, not related to uric acid synthesis or excretion. *Increase uric acid excretion* - Drugs that **increase uric acid excretion** are known as **uricosurics** (e.g., probenecid, lesinurad). - These agents act on the renal tubules to **inhibit uric acid reabsorption**, thus promoting its elimination from the body.

Q: 20 yr old female diagnosed previously with adenocarcinoma stomach and on examination following is seen;

Sister Mary joseph nodule. ***Sister Mary Joseph nodule*** - A **Sister Mary Joseph nodule** is a **metastatic lesion** to the umbilicus, often originating from an intra-abdominal malignancy such as **gastric adenocarcinoma**. - Its presence in a patient with a known history of **adenocarcinoma of the stomach** strongly suggests metastatic spread. *Infected umbilical hernia* - An **infected umbilical hernia** would typically present with signs of local infection such as **erythema**, **pain**, **tenderness**, and possibly **purulent discharge**. - While it might cause a lump, it does not explain the association with a prior diagnosis of gastric adenocarcinoma. *Umbilical granuloma* - An **umbilical granuloma** is a benign, inflamed overgrowth of tissue that presents as a **red, moist lump** at the umbilicus, often seen in infants. - It is not associated with malignancy and would not typically be found in a 20-year-old female in the context of gastric cancer. *Irish node* - An **Irish node** refers to a **left axillary lymph node metastasis** from gastric cancer. - While it signifies metastatic gastric cancer, it is distinct from an umbilical metastasis.

Question 1

Gluconeogenesis is inhibited by?

Accepted Answer

Insulin

Answer

Cholecystokinin

Answer

5-alpha reductase

Answer

Glucagon

Question 2

A 35-year-old woman at 36 weeks of gestation presents with a history of 5 convulsions at home. Her BP is 170/100 mmHg. The diagnosis made by the doctor is eclampsia. What is the next management?

Accepted Answer

MgSO4 + Labetalol

Answer

Clonidine

Answer

Only Labetalol

Answer

Only MgSO4

Question 3

hCG is secreted by?

Accepted Answer

Syncytiotrophoblast

Answer

Cytotrophoblast

Answer

Yolk sac

Answer

Decidua

Question 4

A 20-year-old male complains of repeated changes in glasses prescription. This is most likely caused by:

Accepted Answer

Keratoconus

Answer

Cataract

Answer

Glaucoma

Answer

Pathological myopia

Question 5

A 6-year-old child is suspected with supracondylar fracture of right hand, complaining of pain and swelling. X-ray of right elbow was not significant. What is the next best step in this case?

Accepted Answer

Compare with X-ray of left hand

Answer

Cast

Answer

Closed reduction with K wire fixation

Answer

Closed reduction and slab

Question 6

Sixth disease is?

Accepted Answer

Exanthema subitum

Answer

Erythema nodosum

Answer

Erythema marginatum

Answer

Erythema Infectiosum

Question 7

Which of the following is the chemoprophylaxis of choice in a person who is on a journey to endemic malarial region?

Accepted Answer

Atovaquone-proguanil

Answer

Doxycycline

Answer

Mefloquine

Answer

Chloroquine

Question 8

Therapeutic drug monitoring is done for:

Accepted Answer

Phenytoin

Answer

Aspirin

Answer

Heparin

Answer

Metformin

Question 9

Mechanism of action of allopurinol is

Accepted Answer

Xanthine oxidase inhibition

Answer

Recombinant uricase

Answer

Decrease chemotaxis

Answer

Increase uric acid excretion

Question 10

20 yr old female diagnosed previously with adenocarcinoma stomach and on examination following is seen;

Accepted Answer

Sister Mary joseph nodule

Answer

Infected umbilical hernia

Answer

Umbilical granuloma

Answer

Irish node

FMGE 2019

Biochemistry

Obstetrics and Gynecology

Ophthalmology

Orthopaedics

Pediatrics

Pharmacology

Surgery