FMGE 2019 Practice Questions

Q: An injury to the shown area can lead to fracture of which bone

Scaphoid. ***Scaphoid*** - An injury to the **anatomical snuffbox** is a classic presentation for a **scaphoid fracture**. - This bone is particularly vulnerable due to its **limited blood supply**, which can lead to complications such as **avascular necrosis** if untreated. *Lunate* - The lunate is more commonly associated with **dislocations** or **Kienbock's disease** (avascular necrosis of the lunate), rather than fracture from isolated anatomical snuffbox injury. - Pain from a lunate injury often presents more volarly or centrally within the wrist, not specifically the snuffbox. *Hamate* - Fractures of the **hamate** typically occur from direct trauma to the hypothenar eminence, such as from hitting a golf club or tennis racket. - This mechanism of injury and location of pain are distinct from an anatomical snuffbox injury. *Trapezium* - The **trapezium** is more commonly fractured in association with **Bennett's fracture** (fracture at the base of the thumb metacarpal) or from direct trauma to the thumb. - Pain from a trapezium fracture is usually localized to the base of the thumb, rather than the radial aspect of the wrist.

Q: Keshan's disease is due to deficiency of:

Selenium. **Selenium (Correct Answer)** - **Keshan disease** is an endemic cardiomyopathy characterized by multifocal myocyte necrosis, which has been directly linked to a severe dietary deficiency of **selenium**. - Selenium is an essential component of **glutathione peroxidase**, an enzyme critical for protecting cells against oxidative damage. - The disease is named after Keshan County in China where it was first identified in selenium-deficient regions. *Iron (Incorrect)* - **Iron deficiency** primarily leads to **anemia**, characterized by fatigue, pallor, and weakness due to insufficient hemoglobin production. - It does not directly cause the specific cardiomyopathy seen in Keshan disease. *Zinc (Incorrect)* - **Zinc deficiency** can cause a range of symptoms including impaired immune function, skin lesions (acrodermatitis enteropathica), hair loss, and growth retardation. - It is not associated with the cardiac manifestations of Keshan disease. *Copper (Incorrect)* - **Copper deficiency** can result in anemia, neutropenia, impaired immune function, and neurological dysfunction (Menkes disease). - While copper is important for various metalloenzymes, its deficiency does not cause Keshan disease.

Q: Which of the following is a direct health impact of climate change?

Heat-related illnesses. ***Heat-related illnesses*** - Heat-related illnesses such as **heat stroke, heat exhaustion, and heat cramps** are direct health impacts of climate change resulting from increased frequency and intensity of **heat waves**. - Rising global temperatures directly increase the risk of **hyperthermia**, particularly among vulnerable populations including the elderly, children, outdoor workers, and those with chronic diseases. - This is considered a **primary direct health impact** as it results immediately from temperature changes without intermediate pathways. *Increased vector-borne diseases* - While vector-borne diseases (malaria, dengue, chikungunya) do increase with climate change due to expanded geographic range and breeding seasons of vectors, this is considered an **indirect health impact**. - Climate change affects vector ecology through temperature, rainfall, and humidity changes, which then influences disease transmission - involving an intermediate biological pathway. *Food insecurity and malnutrition* - Food insecurity and malnutrition are significant health consequences of climate change but are classified as **indirect impacts**. - They result from climate change effects on **agricultural productivity**, crop yields, food distribution systems, and water availability - multiple intermediate pathways exist between climate change and the health outcome. *Injuries from extreme weather events* - While injuries and deaths from extreme weather events (floods, cyclones, droughts) are important health impacts of climate change, they are often categorized differently from heat-related illnesses. - Heat-related illnesses represent the most **direct physiological response** to the primary manifestation of climate change (rising temperatures), making it the best answer for a "direct" health impact.

Q: McNaughton's rule is related to:

IPC 84. ***IPC 84*** - **McNaughton's rule** (also spelled M'Naghten rule) is a legal test for criminal insanity, stating that a defendant is not guilty if they were unaware of the nature of their actions or that their actions were wrong due to a "disease of the mind." - In India, **IPC 84** (Indian Penal Code Section 84) embodies the principles of McNaughton's rule, providing a defense for persons of unsound mind. *IPC 82* - **IPC 82** deals with the age of criminal responsibility, specifically stating that nothing done by a child under seven years of age is an offense. - This section is focused on the **infancy defense**, not mental illness or insanity. *IPC 87* - **IPC 87** pertains to acts not intended and not known to be likely to cause death or grievous hurt, done by consent. - It relates to the defense of **consent**, often in situations involving minor injuries in sports or medical procedures. *IPC 85* - **IPC 85** provides a defense for acts committed by a person who is incapable of knowing the nature of the act, or that it is wrong or contrary to law, due to **intoxication** caused without their knowledge or against their will. - This section specifically addresses involuntary intoxication, not a general "disease of the mind" as covered by McNaughton's rule.

Q: Increased susceptibility to N. meningitidis infections is associated with deficiency of which complement component:

C5-C9 deficiency. ***C5-C9 deficiency*** - Deficiencies in late complement components (C5-C9) prevent the formation of the **Membrane Attack Complex (MAC)**, which is essential for the lysis of **Neisseria species**. - This specific deficiency leads to an increased risk of recurrent, invasive infections with **Neisseria meningitidis** and **Neisseria gonorrhoeae**. *C1-C4 deficiency* - Deficiencies in early classical pathway components (C1, C2, C4) are most strongly associated with **systemic lupus erythematosus (SLE)** and other **immune complex disorders**. - While they increase the risk of pyogenic infections, they do not carry the same specific predilection for **Neisseria** as terminal pathway defects. *C3 deficiency* - **C3** is the central converging point for all complement pathways; its deficiency results in severe, recurrent infections with **encapsulated bacteria** (e.g., S. pneumoniae). - Deficiency impairs **opsonization** and recruitment of inflammatory cells, leading to a much broader spectrum of infectious susceptibility than MAC deficiency. *C2 deficiency* - **C2 deficiency** is the most common human complement deficiency and is frequently linked to **autoimmune diseases** like SLE due to poor immune complex clearance. - Although it can predispose individuals to infections by **encapsulated organisms**, it is not the classic association for isolated **meningococcal** susceptibility.

Q: A woman comes after 96 hours post coitus. Best contraceptive of choice is?

IUCD. ***IUCD*** - An **intrauterine contraceptive device (IUCD)** can be inserted up to **5 days (120 hours)** after unprotected intercourse or within 5 days of the earliest estimated ovulation. - It is the **most effective form of emergency contraception**, offering approximately **99% efficacy**. - Provides **immediate ongoing contraception** after insertion, making it the optimal choice at 96 hours post-coitus. *Progesterone only pills* - **Progesterone-only emergency contraceptive pills** (e.g., levonorgestrel) are most effective when taken within **72 hours (3 days)** of unprotected intercourse. - At **96 hours**, their efficacy is **significantly reduced**, making them suboptimal compared to IUCD. *OCP* - **Combined oral contraceptive pills (OCPs)** used for emergency contraception (Yuzpe method) are less effective and have more side effects than other emergency contraceptive methods. - Their effectiveness also significantly declines after **72 hours** post-coitus. *Mifepristone* - **Mifepristone** is an **anti-progestin** that can be used for emergency contraception within **120 hours (5 days)** of unprotected intercourse. - While effective within this timeframe at **96 hours**, the **IUCD remains superior** due to its higher efficacy (>99% vs ~98%) and provision of ongoing contraception.

Q: A 34-year-old lady with 4 children, after her 5th normal vaginal delivery, experiences excessive bleeding after the placenta is removed. What is the cause for this?

Uterine atony. ***Uterine atony*** - The most common cause of **postpartum hemorrhage (PPH)**, accounting for 70-80% of cases - **Multiparity** (Grand multipara with 5 deliveries) is a major risk factor, as repeated pregnancies lead to **overdistension and decreased uterine muscle tone** - Uterine atony is the failure of the myometrium to contract adequately after placental delivery, preventing compression of spiral arteries - Part of the **"4 Ts" mnemonic** for PPH causes: **Tone** (atony), Trauma, Tissue, Thrombin *Genital tract trauma* - Second most common cause of PPH (approximately 20% of cases) - Includes cervical lacerations, vaginal tears, or perineal trauma - However, the question specifically mentions **"normal vaginal delivery"** and bleeding **"after placenta removal"**, making trauma less likely - Trauma-related bleeding typically occurs **during or immediately after delivery**, not specifically post-placental *Retained placental tissue* - Accounts for approximately 10% of PPH cases - The question states the placenta **"is removed"**, suggesting complete placental delivery - If placental fragments were retained, bleeding would persist due to inability of the uterus to contract fully - Less likely given the clinical scenario described *Coagulation disorders* - Least common cause of primary PPH (1-2% of cases) - Includes conditions like **DIC, thrombocytopenia, or inherited coagulopathies** - No clinical history suggesting coagulopathy (e.g., no bleeding during pregnancy, no family history) - Would typically present with **oozing from multiple sites**, not just uterine bleeding

Q: Chronic granulomatous inflammation in upper lid (painless swelling) is characteristic of:

Chalazion. ***Chalazion*** - A chalazion is a **chronic**, sterile, **lipogranulomatous** inflammation of the **meibomian glands**. - It presents as a **painless**, firm, round swelling in the eyelid, often in the upper lid due to the larger meibomian glands. *Trachoma* - Trachoma is a **chronic keratoconjunctivitis** caused by *Chlamydia trachomatis*. - It primarily affects the conjunctiva and cornea, leading to scarring, entropion, and eventual blindness, not a painless eyelid swelling. *Internal Hordeolum* - An internal hordeolum is an **acute** bacterial infection of a **meibomian gland**, forming an abscess. - It is typically **painful**, red, and tender, contrasting with the painless nature of the given presentation. *External hordeolum* - An external hordeolum (stye) is an **acute** bacterial infection of the **glands of Zeis or Moll** at the lid margin. - It is usually **painful**, red, and tender, presenting as a small pustule or nodule on the eyelid margin, not a deep-seated painless swelling.

Q: Allopurinol inhibits which enzyme?

Xanthine oxidase. ***Xanthine oxidase*** - Allopurinol is a **purine analog** that acts as a **competitive inhibitor** of the enzyme **xanthine oxidase**. - By inhibiting xanthine oxidase, allopurinol prevents the conversion of **hypoxanthine to xanthine** and subsequently to **uric acid**, thereby lowering serum uric acid levels. *Lysyl oxidase* - **Lysyl oxidase** is an enzyme involved in the **cross-linking of collagen and elastin**, crucial for the stability of connective tissues. - Its inhibition would not directly affect **uric acid metabolism** or be a mechanism of allopurinol's action. *Cyclooxygenase* - **Cyclooxygenase (COX)** is a key enzyme in the synthesis of **prostaglandins and thromboxanes** from arachidonic acid, mediating inflammation and pain. - **NSAIDs** are inhibitors of cyclooxygenase, not allopurinol. *Kinase* - **Kinases** are a broad class of enzymes that **catalyze the transfer of phosphate groups** from high-energy molecules (like ATP) to specific substrates. - While essential for many cellular processes, kinases are not the specific target of **allopurinol** in uric acid reduction.

Q: Bell clapper deformity (abnormal testicular fixation) predisposes to which of the following conditions?

Testicular torsion. ***Testicular torsion*** - The **bell clapper deformity** describes an abnormally high attachment of the tunica vaginalis, leaving the testis and epididymis free to rotate within the scrotal sac. - This anatomical variation allows the spermatic cord to twist, cutting off blood supply to the testis, which is the mechanism of **testicular torsion**. *Hydrocele* - A **hydrocele** is a collection of fluid in the tunica vaginalis, resulting from an imbalance in fluid production and absorption, or a patent processus vaginalis. - It is not directly caused by abnormal testicular fixation. *Testicular atrophy* - **Testicular atrophy** is a reduction in testicular size, often due to conditions like cryptorchidism, mumps orchitis, or prolonged testicular torsion, but not predisposed by the bell clapper deformity itself unless torsion occurs. - While torsion can lead to atrophy if not promptly treated, the deformity directly predisposes to the torsion event, rather than atrophy itself. *Varicocele* - A **varicocele** is an abnormal dilation of the veins of the pampiniform plexus within the scrotum, usually due to incompetent valves or venous obstruction. - This condition is not associated with testicular fixation abnormalities.

Question 1

An injury to the shown area can lead to fracture of which bone

Accepted Answer

Scaphoid

Answer

Lunate

Answer

Hamate

Answer

Trapezium

Question 2

Keshan's disease is due to deficiency of:

Accepted Answer

Selenium

Answer

Iron

Answer

Zinc

Answer

Copper

Question 3

Which of the following is a direct health impact of climate change?

Accepted Answer

Heat-related illnesses

Answer

Food insecurity and malnutrition

Answer

Injuries from extreme weather events

Answer

Increased vector-borne diseases

Question 4

McNaughton's rule is related to:

Accepted Answer

IPC 84

Answer

IPC 82

Answer

IPC 87

Answer

IPC 85

Question 5

Increased susceptibility to N. meningitidis infections is associated with deficiency of which complement component:

Accepted Answer

C5-C9 deficiency

Answer

C1-C4 deficiency

Answer

C3 deficiency

Answer

C2 deficiency

Question 6

A woman comes after 96 hours post coitus. Best contraceptive of choice is?

Accepted Answer

IUCD

Answer

Progesterone only pills

Answer

OCP

Answer

Mifepristone

Question 7

A 34-year-old lady with 4 children, after her 5th normal vaginal delivery, experiences excessive bleeding after the placenta is removed. What is the cause for this?

Accepted Answer

Uterine atony

Answer

Genital tract trauma

Answer

Retained placental tissue

Answer

Coagulation disorders

Question 8

Chronic granulomatous inflammation in upper lid (painless swelling) is characteristic of:

Accepted Answer

Chalazion

Answer

Trachoma

Answer

Internal Hordeolum

Answer

External Hordeolum

Question 9

Allopurinol inhibits which enzyme?

Accepted Answer

Xanthine oxidase

Answer

Lysyl oxidase

Answer

Cyclooxygenase

Answer

Kinase

Question 10

Bell clapper deformity (abnormal testicular fixation) predisposes to which of the following conditions?

Accepted Answer

Testicular torsion

Answer

Hydrocele

Answer

Testicular atrophy

Answer

Varicocele

FMGE 2019

Anatomy

Biochemistry

Community Medicine

Forensic Medicine

Microbiology

Obstetrics and Gynecology

Ophthalmology

Pharmacology

Surgery