FMGE 2019 Practice Questions

Q: Visual loss due to cerebral degeneration is related to which artery?

Posterior cerebral artery. ***Posterior cerebral artery*** - The **posterior cerebral artery** supplies the **occipital lobe**, which contains the **primary visual cortex** [1], [2]. - **Infarction** or **degeneration** in this territory can directly lead to **visual field defects** or **cortical blindness** [3]. *Anterior cerebral artery* - The **anterior cerebral artery** supplies the **frontal lobes** and medial aspects of the **parietal lobes**, which are not primarily involved in visual processing [4]. - Occlusion typically causes **contralateral leg weakness** and **sensory loss**, and **behavioral changes**. *Internal carotid artery* - The **internal carotid artery** bifurcates into the **anterior** and **middle cerebral arteries** but does not directly supply the primary visual cortex for central vision [4]. - While it can cause **amaurosis fugax** (transient monocular vision loss) due to retinal ischemia, it is not responsible for cortical visual degeneration. *Middle cerebral artery* - The **middle cerebral artery** supplies the majority of the **lateral surface of the cerebral hemispheres**, including portions of the **temporal** and **parietal lobes** [4]. - While it can cause **homonymous hemianopia** if it affects the **optic radiations** in the temporal or parietal lobes, it does not directly supply the primary visual cortex in the occipital lobe where cerebral degeneration causing visual loss is localized.

Q: In CPR, number of chest compressions per minute in an adult:

100-120 per minute. ***100-120 per minute*** - The **American Heart Association (AHA)** and other international resuscitation guidelines recommend a compression rate of **100 to 120 beats per minute** for adults. - This rate ensures adequate blood flow to vital organs while minimizing rescuer fatigue. *30-50 per minute* - This rate is **too low** and would be ineffective in maintaining adequate cerebral and coronary perfusion during cardiac arrest. - Insufficient compressions per minute significantly **reduce the chances of survival** and positive neurological outcomes. *50-72 per minute* - While better than 30-50, this rate is still **below the recommended range** for effective CPR in adults. - It would likely result in **inadequate blood flow** to the brain and heart, diminishing the effectiveness of resuscitation. *120-200 per minute* - While aiming for higher compression rates might seem beneficial, rates **above 120 per minute** can be counterproductive. - Excessively fast compressions can **reduce chest recoil** and ventricular filling time, actually decreasing cardiac output and perfusion.

Q: Rodent ulcer is

Basal cell carcinoma. ***Basal cell carcinoma*** - The term **"rodent ulcer"** is a historical and descriptive term for a specific type of **basal cell carcinoma (BCC)**, characterized by a **pearly raised border** and a central ulceration. - This appearance, with its rolled edges and sometimes visible telangiectasias, gives the impression of a lesion gnawing away at the tissue, hence the "rodent" description. *Squamous cell carcinoma* - While also a common skin cancer, **squamous cell carcinoma (SCC)** typically presents as a **scaly, crusted nodule or plaque** with irregular borders, or a non-healing ulcer that does not have the classic rolled border of a rodent ulcer. - It is more prone to **metastasis** than BCC. *Rhinophyma* - **Rhinophyma** is a severe form of **rosacea** that causes a bulbous, red, and swollen nose due to hyperplasia of sebaceous glands and connective tissue. - It is a **benign condition** and not a form of skin cancer or ulcer. *Adenocarcinoma (glandular cancer)* - **Adenocarcinoma** is a type of cancer that originates in **glandular tissue**, such as in the breast, prostate, colon, or lung. - It is **not a primary skin cancer** and does not typically present as a "rodent ulcer" on the skin surface.

Q: Raised JVP that does not fall back is a characteristic feature of which condition?

Atrial fibrillation. ***Atrial fibrillation*** - In **atrial fibrillation**, the atria beat chaotically and irregularly, leading to an absence of coordinated atrial contraction [1]. - This results in a lack of measurable 'a' waves in the JVP, and the JVP waveform tends to be **regular without a distinct fall and rise**, reflecting continuous atrial pressure without proper emptying [1]. *Ventricular tachycardia* - While JVP can be elevated due to cardiac decompensation, **ventricular tachycardia** involves rapid, regular ventricular contractions, which would not typically cause a sustained JVP without a clear fall [3]. - The JVP often shows **cannon 'a' waves** in VA dissociation, as the right atrium contracts against a closed tricuspid valve. *Ventricular fibrillation* - **Ventricular fibrillation** is a medical emergency characterized by disorganized ventricular electrical activity, leading to immediate circulatory collapse [3]. - In this state, there is no effective cardiac output, and the patient is typically unconscious, making a JVP assessment less relevant and difficult to interpret in the context of a sustained JVP finding [3]. *Atrial flutter* - **Atrial flutter** typically presents with a regular, characteristic **"sawtooth" pattern** of atrial activity (JVP 'f' waves), and the JVP can show regular, rapid 'a' waves (flutter waves) that are often more prominent than normal [2]. - The JVP usually has a clear, albeit rapid, rise and fall pattern related to the atrial contractions [2].

Q: What is the causative agent for malignant otitis externa?

Pseudomonas. ***Pseudomonas*** - **Malignant otitis externa** is a severe, rapidly progressive infection of the external auditory canal and skull base, primarily caused by **Pseudomonas aeruginosa**. - This opportunistic bacterium thrives in moist environments and commonly affects immunocompromised individuals, such as diabetics or the elderly. *Streptococcus* - While various *Streptococcus* species can cause common ear infections (e.g., **otitis media**), they are not the primary causative agent for malignant otitis externa. - Infections by *Streptococcus* typically present differently and affect other parts of the ear or body more commonly. *Staphylococcus aureus* - **Staphylococcus aureus** is a common cause of skin infections, including localized forms of otitis externa (e.g., furuncles), but it is rarely implicated in the aggressive, invasive form known as malignant otitis externa. - When *Staphylococcus aureus* is involved, it often presents differently and is less likely to cause skull base osteomyelitis. *Influenza* - **Influenza** is a viral infection primarily affecting the **respiratory system** and is not a bacterial pathogen responsible for otitis externa, malignant or otherwise. - Viral infections like influenza can predispose individuals to secondary bacterial infections, but they are not directly causative of this condition.

Q: A 35-year-old female presented with complaints of infertility. She has previous history of PID. Preliminary investigations like USG showed normal organs and hormone levels were also normal. What is the next best investigation?

Hysterosalpingography. ***Hysterosalpingography*** - Given the history of **pelvic inflammatory disease (PID)**, there is a significant risk of **tubal blockage** or damage, which is a common cause of **infertility**. - **Hysterosalpingography (HSG)** is the gold standard investigation to assess the patency and morphology of the **fallopian tubes** and uterine cavity. *Urine culture and sensitivity* - This test is used to detect **urinary tract infections**. While important in general health, it is rarely the primary cause of infertility in the absence of urinary symptoms. - The patient's history of **PID** points towards gynecological causes rather than urinary ones as the likely source of infertility. *Repeat USG* - The initial **ultrasound (USG)** has already shown normal organs, indicating no obvious uterine or ovarian structural abnormalities. - Repeating the same investigation without new symptoms or findings is unlikely to provide additional diagnostic information regarding infertility, especially not **tubal patency**. *Endometrial biopsy* - An **endometrial biopsy** is typically performed to assess the health of the **uterine lining** for conditions like chronic endometritis or abnormal uterine bleeding. - While helpful in specific scenarios, it does not evaluate **fallopian tubal patency**, which is a crucial step in assessing infertility after **PID**.

Q: Least teratogenic antiepileptic drug in pregnancy is:

Levetiracetam. ***Levetiracetam*** - **Levetiracetam** is generally considered one of the **safest antiepileptic drugs (AEDs)** during pregnancy, with a lower risk of major congenital malformations compared to other AEDs. - Studies have shown a **low incidence of neural tube defects** and other severe malformations when used as monotherapy. *Carbamazepine* - **Carbamazepine** is associated with an increased risk of **neural tube defects**, particularly **spina bifida**, during pregnancy. - It can also cause other malformations such as **facial dysmorphism** and developmental delays. *Valproate* - **Valproate** has the **highest teratogenic potential** among common AEDs, linked to a significantly increased risk of **neural tube defects**, **cardiac anomalies**, and **cognitive impairment (fetal valproate syndrome)**. - Due to its high risk, its use is generally **contraindicated in women of childbearing potential** unless no other effective alternative exists. *Phenytoin* - **Phenytoin** is associated with **fetal hydantoin syndrome**, characterized by specific facial features, **growth deficiency**, developmental delay, and increased risk of cleft lip/palate, and **cardiac defects**. - It is known for its **dose-dependent teratogenicity**, making careful monitoring crucial.

Q: Drug of choice for nasal carriers of MRSA is:

Mupirocin. ***Mupirocin*** - **Mupirocin** (Bactroban) is a **topical antibacterial agent** frequently used for the eradication of **nasal colonization with MRSA**. - It is applied directly to the **nares** and works by inhibiting bacterial protein synthesis. *Linezolid* - **Linezolid** is an **oral** or **intravenous antibiotic** used for systemic MRSA infections, not typically for nasal decolonization. - Its use for nasal carriage would be inappropriate due to the risk of systemic side effects and potential for resistance development. *Vancomycin* - **Vancomycin** is a **glycopeptide antibiotic** administered intravenously for severe MRSA infections, not for nasal decolonization. - It has poor oral bioavailability and is not effective as a topical agent for nasal carriage. *Teicoplanin* - **Teicoplanin** is another **glycopeptide antibiotic** similar to vancomycin, used for systemic MRSA infections. - Like vancomycin, it is not used for the topical eradication of nasal MRSA colonization.

Q: A lady comes to OPD after fall from scooty. Her vitals are stable. She is having continuous, clear watery discharge from nose after 2 days. This is most likely a feature of?

CSF rhinorrhoea. ***CSF rhinorrhoea*** - **Clear watery discharge** appearing **two days after head trauma** (fall from scooty) is highly suggestive of **cerebrospinal fluid (CSF) rhinorrhoea**. - This occurs due to a breach in the **skull base**, allowing CSF to leak from the subarachnoid space into the nasal cavity. *Acute respiratory infection* - An acute respiratory infection typically presents with symptoms like **fever, cough**, and **nasal discharge** that is often thicker and discolored, not clear and watery. - The onset of discharge two days after trauma without other signs of infection also makes this less likely. *Rhinitis* - Rhinitis involves inflammation of the nasal mucosa, leading to watery discharge, sneezing, and congestion. - However, the traumatic etiology and the specific timing of the discharge make **CSF leak** a more pertinent diagnosis than simple rhinitis. *Middle cranial fossa fracture* - While a **middle cranial fossa fracture** can cause CSF leakage, the discharge from the nose (rhinorrhoea) typically originates from an **anterior cranial fossa fracture**. - A middle cranial fossa fracture is more commonly associated with **otorrhoea** (CSF leakage from the ear) if the temporal bone is involved.

Question 1

Visual loss due to cerebral degeneration is related to which artery?

Accepted Answer

Posterior cerebral artery

Answer

Anterior cerebral artery

Answer

Internal carotid artery

Answer

Middle cerebral artery

Question 2

In CPR, number of chest compressions per minute in an adult:

Accepted Answer

100-120 per minute

Answer

30-50 per minute

Answer

50-72 per minute

Answer

120-200 per minute

Question 3

Rodent ulcer is

Accepted Answer

Basal cell carcinoma

Answer

Squamous cell carcinoma

Answer

Rhinophyma

Answer

Adenocarcinoma (glandular cancer)

Question 4

Raised JVP that does not fall back is a characteristic feature of which condition?

Accepted Answer

Atrial fibrillation

Answer

Ventricular tachycardia

Answer

Ventricular fibrillation

Answer

Atrial flutter

Question 5

What is the causative agent for malignant otitis externa?

Accepted Answer

Pseudomonas

Answer

Streptococcus

Answer

Staphylococcus aureus

Answer

Influenza

Question 6

A 35-year-old female presented with complaints of infertility. She has previous history of PID. Preliminary investigations like USG showed normal organs and hormone levels were also normal. What is the next best investigation?

Accepted Answer

Hysterosalpingography

Answer

Urine culture and sensitivity

Answer

Repeat USG

Answer

Endometrial biopsy

Question 7

Least teratogenic antiepileptic drug in pregnancy is:

Accepted Answer

Levetiracetam

Answer

Carbamazepine

Answer

Valproate

Answer

Phenytoin

Question 8

Drug of choice for nasal carriers of MRSA is:

Accepted Answer

Mupirocin

Answer

Linezolid

Answer

Vancomycin

Answer

Teicoplanin

Question 9

A lady comes to OPD after fall from scooty. Her vitals are stable. She is having continuous, clear watery discharge from nose after 2 days. This is most likely a feature of?

Accepted Answer

CSF rhinorrhoea

Answer

Acute respiratory infection

Answer

Rhinitis

Answer

Middle cranial fossa fracture

Question 10

A young male patient presents with dyspnea; auscultation reveals absent breath sounds on the right side, and he has hypotension. What is the immediate next step?

Accepted Answer

Needle insertion in 2nd intercostal space, midclavicular line

Answer

Chest X-ray

Answer

Intubate the patient

Answer

Urgent IV fluid administration

FMGE 2019

Anatomy

Anesthesiology

Dermatology

Internal Medicine

Microbiology

Obstetrics and Gynecology

Pharmacology

Surgery