FMGE 2018 Practice Questions

Q: Tibial and common peroneal nerves supply which of the following muscles?

Biceps femoris. **Biceps femoris** - The **long head** of the biceps femoris is supplied by the **tibial nerve**. - The **short head** of the biceps femoris is supplied by the **common peroneal nerve**. *Gracilis* - The gracilis muscle is solely innervated by the **obturator nerve**. - It participates in **hip adduction** and **knee flexion**, but its innervation is distinct. *Adductor longus* - The adductor longus muscle is innervated exclusively by the **obturator nerve**. - Its primary function is **adduction of the thigh**. *Adductor magnus* - The adductor magnus has a dual innervation, but not by the tibial and common peroneal nerves. - Its **adductor part** is innervated by the **obturator nerve**, while its **hamstring part** is supplied by the **tibial nerve**.

Q: Which of the following drugs is used for hypotensive anesthesia:

Both Isoflurane and Nitroglycerin. ***Both Isoflurane and Nitroglycerin*** - **Isoflurane** is a volatile anesthetic that can induce **hypotension** by decreasing systemic vascular resistance and myocardial contractility. - **Nitroglycerin** is a potent vasodilator that primarily acts on veins, but also on arteries, to reduce preload and afterload, thereby lowering blood pressure. *Isoflurane* - While **Isoflurane** can be used as part of a hypotensive anesthesia strategy, it is not the sole drug capable of achieving this effect. - Its hypotensive action is dose-dependent and results from **vasodilation** and direct **myocardial depression**. *Nitroglycerin* - **Nitroglycerin** is effective in inducing controlled **hypotension** due to its rapid onset and short duration of action as a vasodilator. - It is frequently used in anesthesia for its ability to reduce blood pressure, particularly in situations requiring a **dry surgical field**. *Dantrolene* - **Dantrolene** is a skeletal muscle relaxant primarily used to treat and prevent **malignant hyperthermia**. - It does not directly induce **hypotension** and is not indicated for hypotensive anesthesia.

Q: Recommended daily dose of Iodine in a school-age child is:-

90-120 ug. ***90-120 ug*** - The recommended daily intake of iodine for **school-age children (6-12 years)** is 90-120 micrograms (µg), which supports normal growth and thyroid function. - According to **WHO/UNICEF/ICCIDD recommendations**, children in this age group require 120 µg/day for optimal thyroid hormone synthesis. - Adequate iodine intake is crucial for the production of **thyroid hormones**, which regulate metabolism and brain development. *120-200 ug* - This range is higher than recommended for school-age children. - **Adolescents (≥12 years) and adults** require 150 µg/day, and **pregnant/lactating women** require 250 µg/day. *30-60 ug* - This range is **insufficient for children** and well below WHO recommendations. - Even **infants and young children (0-5 years)** require 90 µg/day, making this range inadequate for any pediatric age group. - Such low intake could lead to **iodine deficiency** and impaired thyroid function. *500 ug* - This amount is significantly higher than the recommended daily intake for children and could cause **iodine excess** or toxicity. - High doses of iodine can paradoxically inhibit thyroid function and lead to conditions like **iodine-induced hyperthyroidism** or hypothyroidism. - The **tolerable upper intake level** for children is much lower than this amount.

Q: Which of the following is not a component of Jones criteria for diagnosing acute rheumatic fever?

Erythema nodosum. ***Erythema nodosum*** - **Erythema nodosum** is a delayed hypersensitivity reaction characterized by tender, red nodules, typically on the shins, but it is **not a major or minor criterion** in the Jones criteria for acute rheumatic fever. - While it can be associated with various inflammatory conditions, including streptococcal infections, its presence alone does not establish a diagnosis of **acute rheumatic fever (ARF)**. *Sydenham chorea* - **Sydenham chorea** is a major manifestation of ARF, characterized by involuntary, purposeless movements, and it is a key diagnostic criterion [1]. - It results from central nervous system involvement due to **autoimmune reaction** against basal ganglia. *Pancarditis* - **Pancarditis** (inflammation of all layers of the heart) is a major criterion for ARF, often leading to valvular damage, especially mitral stenosis [1]. - It can manifest as **pericarditis**, **myocarditis**, or **endocarditis** [1]. *Migratory polyarthritis* - **Migratory polyarthritis** is a major criterion for ARF, involving painful inflammation that moves from one joint to another. - It typically affects large joints such as the **knees, ankles, elbows, and wrists**.

Q: Herbert's pits are seen in:

Chlamydial conjunctivitis. ***Chlamydial conjunctivitis*** - **Herbert's pits** are pathognomonic for **trachoma**, a chronic form of chlamydial conjunctivitis caused by *Chlamydia trachomatis* serovars A-C. - They represent healed **follicles** on the superior tarsal conjunctiva, leading to characteristic stellate or linear scarring. *Gonococcal conjunctivitis* - This is an **acute, severe bacterial infection** that typically causes copious purulent discharge and significant edema. - It does not lead to the formation of Herbert's pits, which are sequelae of chronic follicular inflammation. *Vernal conjunctivitis* - A form of chronic allergic conjunctivitis, characterized by **"cobblestone papillae"** on the upper tarsal conjunctiva and **Horner-Trantas dots** at the limbus. - It is not associated with Herbert's pits; its pathophysiology involves mast cell degranulation and allergic inflammation. *Atopic conjunctivitis* - This is often seen in individuals with **atopic dermatitis, asthma, or allergic rhinitis**, presenting with itching, redness, tearing, and sometimes corneal complications. - It does not manifest with follicles or subsequent scarring like Herbert's pits, which are specific to trachoma.

Q: Rosette cataract is seen after:

Blunt trauma to eye. ***Blunt trauma to eye*** - **Rosette cataract** is a classic finding following **blunt ocular trauma**, often due to the concussive force on the lens. - The characteristic **flower-petal or star-shaped opacity** forms in the anterior and/or posterior subcapsular regions of the lens. *Infection* - Ocular infections can lead to various complications like **uveitis** or **endophthalmitis**, but **rosette cataract** is not a typical direct sequela. - While inflammation can cause cataracts, they usually present as **inflammatory cataracts** rather than the specific rosette pattern. *Penetrating injury to eye* - **Penetrating injuries** to the eye often lead to **traumatic cataracts** due to direct lens capsule rupture. - These cataracts are typically focal and can progress rapidly, but the morphology is not usually described as a **rosette pattern** unless secondary to significant blunt force component. *Copper foreign body in eye* - A **copper foreign body** in the eye can cause **chalcosis oculi**, leading to a characteristic greenish-brown discoloration and a **sunflower cataract**. - This type of cataract has a distinct appearance from a **rosette cataract**, with a diffuse radial pattern rather than a focal star shape.

Q: Cornea derives its nutrition chiefly from:

Aqueous humour. ***Aqueous humour*** - The cornea is **avascular**, meaning it lacks its own blood vessels, and thus relies on the **aqueous humor** for metabolic support. - The aqueous humor, located in the anterior chamber, provides **glucose, amino acids, and oxygen** to the posterior surface of the cornea. *Corneal vessels* - The **cornea is avascular** under normal physiological conditions; the presence of corneal vessels (neovascularization) is typically a sign of pathology. - This avascularity is crucial for maintaining corneal transparency and optimal vision. *Perilimbal vessels* - Perilimbal vessels (at the limbus, the junction between cornea and sclera) primarily supply the **periphery of the cornea** and the limbal stem cell niche, not the entire cornea's main nutritional needs. - While they contribute some oxygen and nutrients, the **aqueous humor** is the predominant source for the central and posterior cornea. *Mucous layer* - The mucous layer, part of the tear film, primarily functions in **lubrication and adhesion** of the tear film to the corneal surface. - While it contains some dissolved oxygen from the atmosphere to supply the anterior cornea, its role in nutrient supply (glucose, amino acids) is **minimal** compared to the aqueous humor.

Q: Blount Disease is involvement of

Proximal tibia. ***Proximal tibia*** - Blount disease, also known as **tibia vara**, is a growth disorder affecting the **tibia** (shin bone) in children. - It specifically involves the **medial physis of the proximal tibia**, leading to abnormal growth in this area and resulting in a **bow-legged** deformity. *Distal femur* - Malformations or growth disturbances of the **distal femur** are typically associated with conditions like genu valgum (**knock-knees**) or other angular deformities originating higher up in the leg. - Blount disease's primary pathology does not originate from the distal femur. *Distal tibia* - Conditions affecting the **distal tibia** can lead to ankle deformities or foot problems. - Blount disease is distinctly a problem of the knee region, not the ankle. *Proximal femur* - Problems in the **proximal femur** are commonly associated with conditions like Legg-Calvé-Perthes disease or developmental dysplasia of the hip. - While these can also cause gait abnormalities, Blount disease's characteristic bowing deformity originates from the tibia.

Q: A 6-year-old child is brought with high fever with rigors for 5 days with pain in right hypochondrium. On examination, the patient is anicteric and tenderness is noted in right upper quadrant. What is the best investigation for this case?

USG. ***USG*** - A **ultrasound** is the preferred initial investigation, especially in children, for evaluating abdominal pain in the **right hypochondrium** with fever. - It can effectively identify common causes like **cholecystitis**, **hepatitis**, or **liver abscess**, which fit the clinical presentation. *SGOT/LFT* - **Liver function tests (LFTs)** like SGOT/AST and SGPT/ALT provide information about liver inflammation or damage but do not help localize the pathology. - They are useful for assessing liver function but are not the primary diagnostic tool to identify the cause of the pain or fever. *CECT* - **Contrast-enhanced computed tomography (CECT)** is a more advanced imaging technique, often used after initial screening or when ultrasound findings are inconclusive. - It involves radiation exposure and contrast risks, making it less suitable as a first-line investigation for a child with these symptoms. *Serology* - **Serological tests** detect antibodies or antigens related to specific infections (e.g., viral hepatitis) but do not provide immediate anatomical information. - While they can confirm an infectious cause, they cannot identify the source of the pain or rule out other non-infectious pathologies immediately.

Q: Which of the following hormones regulates blood levels of 1,25-OH-cholecalciferol positively?

Parathormone. ***Parathormone*** - **Parathormone (PTH)** directly stimulates the **renal 1-alpha-hydroxylase** enzyme, which converts 25-hydroxycholecalciferol to its active form, **1,25-dihydroxycholecalciferol (calcitriol)**. - This activation is crucial for increasing **calcium absorption** from the gut and maintaining calcium homeostasis. *Thyroxine* - **Thyroxine** (thyroid hormone) primarily regulates **metabolism**, growth, and development. - It does not have a direct positive regulatory effect on the synthesis or blood levels of **1,25-OH-cholecalciferol**. *Calcitonin* - **Calcitonin** is a hormone that **lowers blood calcium levels** by inhibiting osteoclast activity and decreasing renal calcium reabsorption. - It does not positively regulate the production of **1,25-OH-cholecalciferol**; in fact, its actions are generally antagonistic to those influenced by active vitamin D. *Insulin* - **Insulin** is a key hormone in **glucose metabolism**, facilitating glucose uptake by cells and promoting glycogen synthesis. - It plays no direct role in the regulation or synthesis of **1,25-OH-cholecalciferol**.

Question 1

Tibial and common peroneal nerves supply which of the following muscles?

Accepted Answer

Biceps femoris

Answer

Gracilis

Answer

Adductor longus

Answer

Adductor magnus

Question 2

Which of the following drugs is used for hypotensive anesthesia:

Accepted Answer

Both Isoflurane and Nitroglycerin

Answer

Isoflurane

Answer

Nitroglycerin

Answer

Dantrolene

Question 3

Recommended daily dose of Iodine in a school-age child is:-

Accepted Answer

90-120 ug

Answer

120-200 ug

Answer

30-60 ug

Answer

500 ug

Question 4

Which of the following is not a component of Jones criteria for diagnosing acute rheumatic fever?

Accepted Answer

Erythema nodosum

Answer

Sydenham chorea

Answer

Pancarditis

Answer

Migratory polyarthritis

Question 5

Herbert's pits are seen in:

Accepted Answer

Chlamydial conjunctivitis

Answer

Gonococcal conjunctivitis

Answer

Vernal conjunctivitis

Answer

Atopic conjunctivitis

Question 6

Rosette cataract is seen after:

Accepted Answer

Blunt trauma to eye

Answer

Infection

Answer

Penetrating injury to eye

Answer

Copper foreign body in eye

Question 7

Cornea derives its nutrition chiefly from:

Accepted Answer

Aqueous humour

Answer

Corneal vessels

Answer

Perilimbal vessels

Answer

Mucous layer

Question 8

Blount Disease is involvement of

Accepted Answer

Proximal tibia

Answer

Distal femur

Answer

Distal tibia

Answer

Proximal femur

Question 9

A 6-year-old child is brought with high fever with rigors for 5 days with pain in right hypochondrium. On examination, the patient is anicteric and tenderness is noted in right upper quadrant. What is the best investigation for this case?

Accepted Answer

USG

Answer

SGOT/LFT

Answer

CECT

Answer

Serology

Question 10

Which of the following hormones regulates blood levels of 1,25-OH-cholecalciferol positively?

Accepted Answer

Parathormone

Answer

Thyroxine

Answer

Calcitonin

Answer

Insulin

FMGE 2018

Anatomy

Anesthesiology

Community Medicine

Internal Medicine

Ophthalmology

Orthopaedics

Pediatrics

Physiology