Anatomy
3 questionsFoot eversion is caused by
Bleeding vessel in hemorrhoids is
Which branch of facial nerve supplies muscles of lower lip
FMGE 2018 - Anatomy FMGE Practice Questions and MCQs
Question 91: Foot eversion is caused by
- A. Tibialis anterior
- B. Tibialis posterior
- C. Peroneus longus (Correct Answer)
- D. Extensor digitorum
Explanation: ***Peroneus longus*** - The **peroneus longus** muscle (fibularis longus) is a primary evertor of the foot. - It originates from the head and upper lateral surface of the fibula, inserts into the medial cuneiform and first metatarsal, and its contraction pulls the foot outwards and downwards. *Tibialis anterior* - The **tibialis anterior** is the primary dorsiflexor and invertor of the foot. - It pulls the foot upwards and inwards, which is the opposite action of eversion. *Tibialis posterior* - The **tibialis posterior** is a strong invertor and plantar flexor of the foot. - It contributes to maintaining the arch of the foot and does not cause eversion. *Extensor digitorum* - The **extensor digitorum longus** primarily extends the toes and assists in dorsiflexion of the ankle. - While it may have a slight eversion component, it is not the primary muscle responsible for foot eversion.
Question 92: Bleeding vessel in hemorrhoids is
- A. Superior rectal vein
- B. Middle rectal vein
- C. Middle rectal artery
- D. Superior rectal artery (Correct Answer)
Explanation: Superior rectal artery - Hemorrhoidal bleeding primarily originates from the **terminal branches of the superior rectal artery** within the hemorrhoidal plexus. - The hemorrhoidal cushions contain **arteriovenous anastomoses**, and bleeding occurs from rupture or erosion of the **arterial component**. - This explains why hemorrhoidal bleeding is typically **bright red** (oxygenated arterial blood) and can be brisk. - Modern surgical treatments like **hemorrhoidal artery ligation (HAL)** specifically target these arterial branches, confirming the arterial source of bleeding. Superior rectal vein - While the superior rectal vein drains the hemorrhoidal plexus and is dilated in hemorrhoids, it is **not the primary source of bleeding**. - The venous component contributes to the cushion engorgement but the **actual bleeding is arterial** in nature. - This is an older, outdated concept that has been revised with modern understanding of hemorrhoidal pathophysiology. Middle rectal vein - The middle rectal vein drains the **muscular wall of the rectum** and has minimal involvement in the hemorrhoidal venous plexus. - It is not a significant contributor to hemorrhoidal bleeding. Middle rectal artery - The middle rectal artery provides collateral blood supply to the rectum but plays a **minor role** compared to the superior rectal artery. - The **superior rectal artery** is the dominant arterial supply to the internal hemorrhoidal plexus and is the primary bleeding source.
Question 93: Which branch of facial nerve supplies muscles of lower lip
- A. Marginal mandibular (Correct Answer)
- B. Buccal
- C. Cervical
- D. Temporal
Explanation: ***Marginal mandibular*** - The **marginal mandibular branch** of the facial nerve innervates muscles of the lower lip and chin, including the **depressor labii inferioris**, **depressor anguli oris**, and **mentalis**. - Damage to this nerve causes an inability to depress the lower lip, leading to an **asymmetric smile**. *Buccal* - The **buccal branch** primarily innervates the **buccinator muscle** and the muscles of the upper lip. - It is crucial for **cheek compression** (e.g., blowing or sucking) and expression around the mouth. *Cervical* - The **cervical branch** supplies the **platysma muscle**, a broad sheet of muscle in the neck that helps depress the mandible and draw down the corners of the mouth. - It does not directly innervate the muscles of the lower lip. *Temporal* - The **temporal branch** provides motor innervation to the muscles of the forehead and around the eye, including the **frontalis** and **orbicularis oculi**. - It is responsible for actions like raising the eyebrows and closing the eyelids.
Internal Medicine
1 questionsSyndrome of inappropriate ADH secretion is characterized by all of the following EXCEPT:-
FMGE 2018 - Internal Medicine FMGE Practice Questions and MCQs
Question 91: Syndrome of inappropriate ADH secretion is characterized by all of the following EXCEPT:-
- A. Expanded fluid volume
- B. Hyponatremia
- C. Hypo-osmolar urine (Correct Answer)
- D. Water intoxication
Explanation: ***Hypo-osmolar urine*** - Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is characterized by the secretion of ADH in excess of what is appropriate for the plasma osmolality. This excess ADH causes the kidneys to retain water, leading to **concentrated (hyper-osmolar) urine** [1]. - Therefore, **hypo-osmolar urine** is not a characteristic of SIADH; rather, **hyper-osmolar urine** is expected as the body tries to excrete concentrated urine to compensate for water retention. *Expanded fluid volume* - The excess ADH in SIADH leads to increased **water reabsorption** by the kidneys [1]. - This increased water retention can result in an **expanded extracellular fluid volume**, although usually without significant peripheral edema due to natriuretic peptide release [2]. *Hyponatremia* - The retained water dilutes the plasma sodium concentration, causing **dilutional hyponatremia** [2]. - This is a hallmark feature of SIADH, as the body holds onto too much free water [2]. *Water intoxication* - The characteristic features of SIADH, including **hyponatremia** and **increased total body water**, directly lead to a state of **water intoxication** [1]. - Symptoms can range from mild (nausea, malaise) to severe (seizures, coma) depending on the severity and rapidity of hyponatremia.
Microbiology
1 questionsQuellung reaction is seen with:
FMGE 2018 - Microbiology FMGE Practice Questions and MCQs
Question 91: Quellung reaction is seen with:
- A. Pneumococcus (Correct Answer)
- B. Gonococcus
- C. Staphylococcus
- D. Streptococcus
Explanation: ***Pneumococcus*** - The Quellung reaction, also known as the **Neufeld reaction**, is a classic immunological test used to identify bacteria based on their **capsular polysaccharides**. - In the presence of specific antisera, the capsule of **_Streptococcus pneumoniae_** (Pneumococcus) swells visibly when viewed under a microscope, appearing larger and more refractile. - **Pneumococcus is the CLASSIC organism** associated with the Quellung reaction in clinical microbiology and is the standard answer in medical examinations. - While other encapsulated bacteria (_Haemophilus influenzae_, _Klebsiella pneumoniae_, _N. meningitidis_) can theoretically show capsular swelling, the test is primarily used for and associated with pneumococcal identification. *Gonococcus* - **_Neisseria gonorrhoeae_** (Gonococcus) is a Gram-negative diplococcus that causes sexually transmitted infections. - It does not possess a prominent polysaccharide capsule that exhibits the Quellung reaction in routine clinical practice. *Staphylococcus* - **_Staphylococcus_** species are Gram-positive cocci that form grape-like clusters. - While some staphylococci produce capsules or slime layers, these are not characterized using the Quellung reaction. *Streptococcus* - While _S. pneumoniae_ is technically a species of Streptococcus, in clinical terminology **"Pneumococcus" is the specific term** that denotes this particular organism. - When asked about the Quellung reaction, **"Pneumococcus" is the preferred and correct answer** rather than the broader genus term "Streptococcus." - The Quellung test is not routinely used for other Streptococcus species (like _S. pyogenes_, _S. agalactiae_) in standard clinical practice, making "Pneumococcus" the most accurate answer.
Ophthalmology
2 questionsCause of sudden loss of vision in a diabetic is due to:
Obstacles in concomitant squint are:
FMGE 2018 - Ophthalmology FMGE Practice Questions and MCQs
Question 91: Cause of sudden loss of vision in a diabetic is due to:
- A. Central retinal vein occlusion
- B. Neovascular glaucoma
- C. Vitreous hemorrhage (Correct Answer)
- D. Central retinal artery occlusion
Explanation: ***Vitreous hemorrhage*** - **Vitreous hemorrhage** is the **most common cause** of sudden, painless vision loss in individuals with **proliferative diabetic retinopathy** - New, fragile blood vessels (neovascularization) on the retina in diabetes can rupture, leading to bleeding into the **vitreous gel** - Patients describe sudden onset of floaters, cobwebs, or a red haze obscuring vision *Central retinal vein occlusion* - **CRVO** causes sudden, painless vision loss with **retinal hemorrhages in all four quadrants** (blood and thunder appearance) - While diabetic patients are at increased risk, vision loss is typically less profound than vitreous hemorrhage - Fundoscopy shows widespread retinal hemorrhages, dilated tortuous veins, and cotton-wool spots *Neovascular glaucoma* - **Neovascular glaucoma** causes **painful** vision loss and elevated intraocular pressure due to new vessel growth on the iris and trabecular meshwork - While associated with diabetes, it usually presents with more **gradual onset** and pain, rather than sudden, painless vision loss - Characterized by rubeosis iridis and elevated IOP *Central retinal artery occlusion* - **CRAO** causes sudden, profound, painless monocular vision loss, often described as a "curtain coming down" - While diabetic patients are at higher risk for CRAO due to generalized atherosclerosis, it typically results in a **cherry-red spot** on the macula - This is usually embolic in nature and less specifically related to diabetic retinopathy itself
Question 92: Obstacles in concomitant squint are:
- A. Sensory obstacles
- B. Motor obstacles
- C. Central obstacles
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Concomitant squint** involves **sensory obstacles** (e.g., amblyopia, eccentric fixation), **motor obstacles** (e.g., muscle imbalance, inadequate fusional vergence), and **central obstacles** (e.g., defective brain processing of visual information). - All these factors interact to cause and maintain the misalignment of the eyes. *Sensory obstacles* - These include conditions like **amblyopia** (lazy eye) due to suppression of the deviated eye's image, and **eccentric fixation**, where the fovea is not used for central vision. - While significant, sensory obstacles alone do not fully explain concomitant squint, as motor and central components are also crucial. *Motor obstacles* - These involve issues with the **extraocular muscles**, such as imbalance in muscle tone, or problems with the **neural control** of eye movements, leading to a deviation that is relatively constant in all gaze positions. - Motor obstacles are a key component but are often influenced by central and sensory factors. *Central obstacles* - These refer to problems within the brain's visual pathways and centers responsible for **fusion**, **vergence**, and maintaining **ocular alignment**. - Defective processing of visual input or an inability to maintain binocular vision can directly contribute to squint, highlighting the brain's role in coordinating eye movements.
Pathology
1 questionsAlbers-Schönberg disease is:
FMGE 2018 - Pathology FMGE Practice Questions and MCQs
Question 91: Albers-Schönberg disease is:
- A. Osteoporosis
- B. Paget
- C. Osteogenesis imperfecta
- D. Osteopetrosis (Correct Answer)
Explanation: ***Osteopetrosis*** - **Albers-Schönberg disease** is another name for **osteopetrosis**, also known as **marble bone disease** [1]. - It is a group of rare genetic disorders characterized by abnormally **dense bones** due to a defect in **osteoclast** function, leading to impaired bone resorption [1]. *Osteoporosis* - **Osteoporosis** is characterized by decreased bone density and structural deterioration of bone tissue, leading to an increased risk of fractures. - It results from an imbalance where **bone resorption outpaces bone formation**, the opposite of osteopetrosis. *Paget* (Paget's disease of bone) - **Paget's disease of bone** involves localized areas of increased bone turnover, leading to disorganized bone remodeling and weakened, enlarged bones. - It is distinct from osteopetrosis, which involves a generalized increase in bone density. *Osteogenesis imperfecta* - **Osteogenesis imperfecta** (OI), or brittle bone disease, is a genetic disorder causing extremely fragile bones prone to fractures, often due to defects in **collagen production** [1]. - This condition presents with bone fragility and often blue sclera, which is the opposite of the increased bone density seen in osteopetrosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1188-1189.
Physiology
1 questionsInhibin is secreted by:
FMGE 2018 - Physiology FMGE Practice Questions and MCQs
Question 91: Inhibin is secreted by:
- A. Peg cells
- B. Leydig cells
- C. Sertoli cells (Correct Answer)
- D. Interstitial cells
Explanation: ***Sertoli cells*** - **Sertoli cells** are located in the seminiferous tubules of the testes and play a crucial role in spermatogenesis. - They secrete **inhibin**, a hormone that selectively inhibits the secretion of follicle-stimulating hormone (FSH) from the anterior pituitary gland. *Peg cells* - **Peg cells** (non-ciliated secretory cells) are found in the lining of the fallopian tubes, not the testes. - They produce **tubal fluid** which nourishes the ovum and spermatozoa, and aids in sperm capacitation. *Leydig cells* - **Leydig cells** are found in the interstitial tissue between the seminiferous tubules of the testes. - Their primary function is to produce and secrete **androgens**, such as testosterone, in response to luteinizing hormone (LH). *Interstitial cells* - This term is a general descriptor for cells located in the spaces between functional tissues or organs. - In the context of the testes, **Leydig cells** are the primary interstitial cells responsible for hormone production, while **Sertoli cells** are part of the seminiferous tubules.
Surgery
1 questionsPatient with history of blunt trauma to face presents with enophthalmos, diplopia on upward gaze and loss of sensitivity over cheek. True statement about this is:
FMGE 2018 - Surgery FMGE Practice Questions and MCQs
Question 91: Patient with history of blunt trauma to face presents with enophthalmos, diplopia on upward gaze and loss of sensitivity over cheek. True statement about this is:
- A. Maxillary fracture
- B. Zygomatic bone is most likely injured
- C. It is a blow out fracture (Correct Answer)
- D. Frontal bone fracture
Explanation: ***It is a blow out fracture*** - The combination of **enophthalmos** (sunken eye), **diplopia on upward gaze** (due to **inferior rectus muscle entrapment**), and **loss of sensitivity over the cheek** (indicating infraorbital nerve involvement) are classic signs of an **orbital blowout fracture**. - These fractures typically involve the **orbital floor** or medial wall, caused by a direct impact to the orbit, which transmits force to the thin bony walls causing them to fracture while the orbital rim remains intact. *Maxillary fracture* - While the **infraorbital nerve** passes through the maxilla, a general maxillary fracture typically presents with broader symptoms such as **midfacial pain**, **swelling**, and **malocclusion**, which are not specified here. - Maxillary fractures often involve the **zygomaticomaxillary complex** or Le Fort patterns, which usually lead to more extensive facial abnormalities. *Zygomatic bone is most likely injured* - A **zygomatic arch fracture** would primarily cause **flattening of the cheek** and pain upon opening the mouth, not enophthalmos or diplopia on upward gaze. - While the zygoma forms part of the orbit, isolated zygomatic fractures rarely cause these specific orbital findings. *Frontal bone fracture* - **Frontal bone fractures** typically result from **high-impact trauma** and can involve the **frontal sinus**, leading to **forehead swelling**, **CSF rhinorrhea**, or **periorbital ecchymosis** (raccoon eyes). - The symptoms described are not characteristic of a frontal bone fracture.