Anatomy
2 questionsCords of Billroth in spleen are found in
NOT a content of carpal tunnel:-
FMGE 2017 - Anatomy FMGE Practice Questions and MCQs
Question 1: Cords of Billroth in spleen are found in
- A. White pulp
- B. Red pulp (Correct Answer)
- C. Trabecular zone
- D. Mantle zone
Explanation: ***Correct: Red pulp*** - The **cords of Billroth** (or splenic cords) are a distinctive histological feature of the **red pulp** of the spleen. - These cords consist of a meshwork of reticular cells and reticular fibers, packed with macrophages, lymphocytes, plasma cells, and abundant red blood cells. *Incorrect: White pulp* - The **white pulp** is primarily involved in immune functions, containing lymphoid follicles rich in lymphocytes. - It is organized around central arterioles and does not contain the cords of Billroth. *Incorrect: Trabecular zone* - The **trabecular zone** consists of connective tissue septa that extend inward from the splenic capsule, carrying blood vessels and nerves. - It provides structural support to the spleen but is not where the cords of Billroth are located. *Incorrect: Mantle zone* - The **mantle zone** is a region within the **white pulp**, surrounding the germinal centers of lymphoid follicles. - It is composed mainly of naive B lymphocytes and is distinct from the cords of Billroth.
Question 2: NOT a content of carpal tunnel:-
- A. Median nerve
- B. Flexor digitorum profundus
- C. Flexor digitorum superficialis
- D. Ulnar nerve (Correct Answer)
Explanation: ***Ulnar nerve*** - The **ulnar nerve** passes superficial to the **flexor retinaculum**, meaning it is not a direct content of the carpal tunnel [1]. - Instead, it travels through a separate space known as **Guyon's canal**, alongside the ulnar artery [1]. *Median nerve* - The **median nerve** is a primary content of the carpal tunnel and is susceptible to compression within this space, leading to carpal tunnel syndrome [1]. - It provides sensory innervation to the lateral palm and digits, and motor innervation to certain thenar muscles [1]. *Flexor digitorum profundus* - The tendons of the **flexor digitorum profundus** muscles (four of them) pass through the carpal tunnel to insert onto the distal phalanges. - These tendons are responsible for **flexion of the distal interphalangeal (DIP) joints** of the medial four fingers. *Flexor digitorum superficialis* - The tendons of the **flexor digitorum superficialis** muscles (four of them) also pass through the carpal tunnel. - They are responsible for **flexion of the proximal interphalangeal (PIP) joints** of the medial four fingers.
Internal Medicine
4 questionsHeberden's arthropathy affects:
Meningococcal meningitis is seen with which of the following complement deficiency?
Which of the following is not associated with pulmonary arterial hypertension?
Which of these is least effective as first-line treatment for dangerous hyperkalemia?
FMGE 2017 - Internal Medicine FMGE Practice Questions and MCQs
Question 1: Heberden's arthropathy affects:
- A. Distal interphalangeal joint (Correct Answer)
- B. Lumbar spine involvement
- C. Sacroiliac joint involvement
- D. Knee joint involvement
Explanation: ***Distal interphalangeal joint*** - **Heberden's nodes** are pathognomonic bony enlargements that occur on the **distal interphalangeal (DIP) joints** of the fingers [1]. - They are a classic sign of **osteoarthritis**, resulting from cartilage degeneration and new bone formation [1]. *Lumbar spine involvement* - While osteoarthritis can affect the **lumbar spine**, it presents as **back pain** and stiffness, not as nodules on the fingers [1]. - **Heberden's nodes** are specifically associated with peripheral joint involvement, not axial skeleton [1]. *Sacroiliac joint involvement* - **Sacroiliac joint involvement** is characteristic of **spondyloarthropathies** like ankylosing spondylitis, causing inflammatory back pain [1]. - It does not present with bony nodes on the fingers, which are typical of osteoarthritic changes [1]. *Knee joint involvement* - **Knee joint involvement** is common in osteoarthritis, causing pain, swelling, and reduced range of motion [1]. - However, **Heberden's nodes** are distinct from knee symptoms and refer specifically to changes in the DIP joints [1].
Question 2: Meningococcal meningitis is seen with which of the following complement deficiency?
- A. C4
- B. C1q
- C. C5 (Correct Answer)
- D. C2
Explanation: ***C5*** - Deficiencies in terminal complement components (C5-C9) lead to impaired formation of the **membrane attack complex (MAC)**, which is crucial for lysing Neisseria species [1]. - This significantly increases susceptibility to recurrent infections, particularly by **encapsulated bacteria** like *Neisseria meningitidis*, causing diseases such as meningococcal meningitis [2]. *C4* - C4 deficiency is primarily associated with **lupus-like syndromes** and **vasculitis**, due to impaired clearance of immune complexes. - While it can lead to some increased risk of infection, it is not specifically linked to a marked predisposition to meningococcal disease. *C1q* - C1q deficiency also leads to impaired **immune complex clearance** and is strongly associated with **systemic lupus erythematosus (SLE)**. - Like C4 deficiency, it does not typically present with recurrent meningococcal infections as the primary manifestation. *C2* - C2 deficiency is the **most common complement deficiency** and is associated with **lupus-like syndromes** and increased susceptibility to **pyogenic bacterial infections**. - Though it can lead to some increased infection risk, C2 deficiency is not as strongly or specifically linked to recurrent meningococcal meningitis as deficiencies in the terminal complement pathway [2].
Question 3: Which of the following is not associated with pulmonary arterial hypertension?
- A. Cor - pulmonale
- B. Left ventricular hypertrophy (Correct Answer)
- C. Mitral Stenosis
- D. Interstitial lung disease
Explanation: ***Left ventricular hypertrophy*** - **Left ventricular hypertrophy** is typically caused by conditions that increase the workload on the left ventricle, such as **systemic hypertension** or **aortic stenosis** [1]. - Pulmonary arterial hypertension directly affects the **pulmonary vasculature**, leading to increased pressure in the pulmonary circuit and ultimately right heart strain, not left ventricular hypertrophy. *Cor pulmonale* - **Cor pulmonale** is defined as **right ventricular enlargement** secondary to lung disease or pulmonary vascular disease. - Pulmonary arterial hypertension increases the afterload on the right ventricle, causing it to dilate and hypertrophy, eventually leading to **right heart failure** (cor pulmonale) [2]. *Mitral Stenosis* - **Mitral stenosis** causes an obstruction to blood flow from the left atrium to the left ventricle, leading to increased pressure in the left atrium and pulmonary veins. - This elevated pressure can be transmitted backward into the pulmonary arteries, leading to **pulmonary arterial hypertension** [3]. *Interstitial lung disease* - **Interstitial lung disease** (ILD) can lead to destruction and remodeling of the pulmonary capillaries, increasing pulmonary vascular resistance [2]. - This increased resistance causes the pulmonary arterial pressure to rise, resulting in **pulmonary arterial hypertension**.
Question 4: Which of these is least effective as first-line treatment for dangerous hyperkalemia?
- A. Calcium chloride injection
- B. Beta-2 agonist (Salbutamol)
- C. Intravenous sodium bicarbonate (Correct Answer)
- D. Dialysis (Hemodialysis)
Explanation: ***Intravenous sodium bicarbonate*** - While it can drive potassium into cells, its effect is often **delayed and unreliable** in acute, dangerous hyperkalemia, especially without concurrent acidosis. - Its efficacy is most pronounced when hyperkalemia is associated with **metabolic acidosis**, which is not always the primary driving factor of dangerous hyperkalemia. *Calcium chloride injection* - This is a **first-line treatment** for dangerous hyperkalemia, as it **stabilizes the cardiac membrane** by antagonizing the direct effects of potassium on myocardial excitability [1]. - It does not lower serum potassium levels but **protects the heart** from life-threatening arrhythmias, buying time for other therapies to reduce potassium [1]. *Beta-2 agonist (Salbutamol)* - **Beta-2 agonists** like salbutamol are effective in shifting potassium **intracellularly**, thereby lowering serum potassium levels. - This effect is mediated by stimulating the **Na+/K+-ATPase pump** on cell membranes. *Dialysis (Hemodialysis)* - **Hemodialysis** is the **most effective and rapid** method for removing excess potassium from the body, especially in cases of severe or refractory hyperkalemia. - It provides definitive treatment by directly **filtering potassium** from the blood, and is often considered when other measures fail or in patients with kidney failure.
Orthopaedics
1 questionsLauge - Hansen classification belongs to:-
FMGE 2017 - Orthopaedics FMGE Practice Questions and MCQs
Question 1: Lauge - Hansen classification belongs to:-
- A. Ankle fracture (Correct Answer)
- B. Femur fracture
- C. Shoulder fracture
- D. Elbow fracture
Explanation: ***Ankle fracture*** - The **Lauge-Hansen classification system** is specifically used to categorize **ankle fractures** based on the position of the foot at the time of injury and the deforming force. - This system describes the mechanism of injury (e.g., supination-adduction, pronation-abduction) and the resulting fracture patterns of the **distal fibula, medial malleolus, and posterior malleolus**. *Femur fracture* - **Femur fractures** are typically classified by other systems, such as the **AO/OTA classification** for long bone fractures or specific patterns like **intertrochanteric** or **subtrochanteric fractures**. - The Lauge-Hansen system is **not applicable** to injuries of the femur. *Shoulder fracture* - **Shoulder fractures** (e.g., proximal humerus fractures) are commonly classified using systems like the **Neer classification**, which describes the number of displaced parts. - The Lauge-Hansen system is **not used** for classifying shoulder injuries. *Elbow fracture* - **Elbow fractures** involve the distal humerus, proximal ulna, or radial head and are classified by various systems depending on the specific bone involved (e.g., **Mason classification for radial head fractures**). - The Lauge-Hansen system is **irrelevant** to elbow an injuries.
Psychiatry
1 questionsA 6 year old child who does not interact with other children of his age group and prefers playing alone with repetitive behaviors, is likely to be suffering from:
FMGE 2017 - Psychiatry FMGE Practice Questions and MCQs
Question 1: A 6 year old child who does not interact with other children of his age group and prefers playing alone with repetitive behaviors, is likely to be suffering from:
- A. ADHD
- B. Autism (Correct Answer)
- C. Depression
- D. Bipolar disorder
Explanation: ***Autism*** - Difficulties in **social interaction** and **communication**, along with **repetitive behaviors** and restricted interests, are core diagnostic features of **Autism Spectrum Disorder (ASD)**. - The child's preference for playing alone and lack of interaction with peers are hallmark signs of **social deficits** in ASD. *ADHD* - **Attention-Deficit/Hyperactivity Disorder (ADHD)** primarily involves difficulties with **inattention**, **hyperactivity**, and **impulsivity**. - While children with ADHD may struggle socially, repetitive behaviors and a complete lack of interest in peer interaction are not typical primary symptoms. *Depression* - **Depression** in children often presents with **sadness**, **loss of interest** in previously enjoyed activities, changes in sleep or appetite, and irritability. - Social withdrawal in depression is usually due to low mood or anhedonia, rather than a fundamental difficulty in social understanding or a preference for repetitive play. *Bipolar disorder* - **Bipolar disorder** in children involves distinct episodes of **mania** (elevated mood, increased energy, decreased need for sleep) and **depression**. - The symptoms described do not align with the characteristic mood swings and episodic nature of bipolar disorder.
Surgery
2 questionsWhich of the following is the best management for radiation induced occlusive disease of carotid artery?
A 50 kg patient has 40 % burn of the body surface area. Calculate the ringer lactate solution to be given for first 8 hours of fluid:
FMGE 2017 - Surgery FMGE Practice Questions and MCQs
Question 1: Which of the following is the best management for radiation induced occlusive disease of carotid artery?
- A. Carotid endarterectomy
- B. Low dose aspirin
- C. Carotid bypass procedure
- D. Carotid angioplasty and stenting (Correct Answer)
Explanation: ***Carotid angioplasty and stenting*** - **Radiation-induced carotid artery disease** often involves the distal part of the carotid artery, making it less amenable to surgical endarterectomy. - **Angioplasty and stenting** offer a less invasive approach with good technical success in these challenging cases, especially given the increased fragility and fibrosis of radiated tissues. *Carotid endarterectomy* - **Carotid endarterectomy** in previously radiated fields is associated with a significantly higher risk of complications, including **cranial nerve injury**, **wound infection**, and **carotid artery rupture**, due to tissue fibrosis and scarring. - The disease often extends beyond the easily accessible segment for endarterectomy in radiation-induced cases. *Low dose aspirin* - **Low-dose aspirin** is an important component of medical therapy for **atherosclerotic disease** and **stroke prevention**, but it is insufficient as a sole treatment for symptomatic or high-grade occlusive disease of the carotid artery. - It helps manage the underlying **atherosclerotic process** but does not directly address the severe stenosis or occlusion. *Carotid bypass procedure* - **Carotid bypass procedures** are complex surgical interventions usually reserved for cases of **carotid artery occlusion** or **recurrent stenosis** after previous interventions where endarterectomy or stenting is not feasible. - While an option, it is more invasive and technically demanding than angioplasty and stenting, particularly in already radiated tissues with compromised vascular integrity.
Question 2: A 50 kg patient has 40 % burn of the body surface area. Calculate the ringer lactate solution to be given for first 8 hours of fluid:
- A. 8 Litres
- B. 2 Litres
- C. 4 Litres (Correct Answer)
- D. 1 Litre
Explanation: ***4 Litres*** - The **Parkland formula** for fluid resuscitation in burn patients is **4 mL x body weight (kg) x % total body surface area (TBSA) burned**. - For this patient: 4 mL x 50 kg x 40% = 8000 mL or **8 Litres** of Ringer's Lactate in the first 24 hours. Half of this volume ([8 Litres / 2] = **4 Litres**) is given in the first 8 hours. *8 Litres* - This amount represents the **total fluid requirement** for the entire first 24 hours, not just the first 8 hours. - Only **half of the total calculated fluid** is administered in the initial 8-hour period. *2 Litres* - This volume is generally **too low** for a patient with 40% TBSA burns, which is considered a significant burn. - Insufficient fluid resuscitation can lead to **burn shock** and organ hypoperfusion. *1 Litre* - This amount is **grossly inadequate** for a patient with 40% TBSA burns. - Administering such a small volume would likely result in **severe hypovolemic shock** and clinical deterioration.