FMGE 2018 Practice Questions

Q: Which bone connects the sternum to the scapula?

Clavicle. ***Clavicle*** - The **clavicle**, or collarbone, is the only bone that directly connects the **axial skeleton** (via the sternum) to the **appendicular skeleton** (via the scapula). - It articulates medially with the **manubrium** of the sternum at the sternoclavicular joint and laterally with the **acromion** of the scapula at the acromioclavicular joint. *First rib* - The **first rib** articulates with the **manubrium** of the sternum but does not connect directly to the scapula. - Its primary role is to form part of the **thoracic cage**, protecting internal organs. *Manubrium* - The **manubrium** is the superior part of the **sternum** and articulates with the clavicles and the first two ribs. - It does not directly connect to the **scapula**; rather, the clavicle mediates this connection. *Second rib* - The **second rib** articulates with both the **manubrium** and the body of the sternum at the **sternal angle**. - Like the first rib, it is part of the **thoracic cage** and does not directly connect to the scapula.

Q: Masseter is supplied by which nerve?

Mandibular. ***Mandibular*** - The **masseter muscle** is a muscle of mastication, and all muscles of mastication are exclusively innervated by the **mandibular division** (V3) of the trigeminal nerve. - The mandibular nerve carries both **motor and sensory fibers**; its motor branches supply the masseter, temporalis, medial and lateral pterygoids, mylohyoid, anterior belly of digastric, tensor veli palatini, and tensor tympani. *Glossopharyngeal* - The **glossopharyngeal nerve (CN IX)** primarily supplies sensation to the posterior third of the tongue, the pharynx, and the tympanic membrane. - It also has motor functions, innervating the **stylopharyngeus muscle** and providing parasympathetic innervation to the parotid gland. *Facial* - The **facial nerve (CN VII)** is primarily responsible for innervating the **muscles of facial expression**. - It also carries taste sensation from the anterior two-thirds of the tongue and provides parasympathetic innervation to the lacrimal, submandibular, and sublingual glands. *Hypoglossal* - The **hypoglossal nerve (CN XII)** is exclusively a motor nerve. - It innervates all of the **intrinsic and extrinsic muscles of the tongue**, except for the palatoglossus muscle (which is innervated by the vagus nerve).

Q: Which structure connects Broca's area and Wernicke's area?

Arcuate fasciculus. ***Arcuate fasciculus*** - The **arcuate fasciculus** is a bundle of **association fibers** that connects the **Broca's area** (speech production) and **Wernicke's area** (speech comprehension) in the brain [1]. - Damage to this pathway can lead to **conduction aphasia**, where speech comprehension and production are relatively preserved, but repetition is severely impaired. *Fornix* - The **fornix** is a C-shaped bundle of nerve fibers in the brain that acts as the primary efferent (output) pathway of the **hippocampus**, a crucial structure for memory. - It carries signals from the hippocampus to the mammillary bodies and other subcortical structures, playing a key role in **episodic memory** and **spatial navigation**. *Anterior commissure* - The **anterior commissure** is a bundle of nerve fibers, located in front of the columns of the fornix, that connects the two **temporal lobes** and plays a role in pain sensation and memory. - It specifically connects parts of the **pyriform cortex** and **amygdalar nuclei** of the two hemispheres. *Corpus callosum* - The **corpus callosum** is a large, C-shaped nerve fiber bundle found beneath the cerebral cortex in the brain, connecting the **two cerebral hemispheres**. - It facilitates **interhemispheric communication**, allowing for the transfer of motor, sensory, and cognitive information between both sides of the brain [1].

Q: Intellectual disability is seen in?

Phenylketonuria. ***Phenylketonuria*** - **Phenylketonuria (PKU)** is an inherited metabolic disorder where the body cannot process the amino acid **phenylalanine**, leading to its accumulation in the blood and brain. - Untreated PKU results in severe neurological problems, including **intellectual disability**, seizures, and developmental delays. *Von Gierke disease* - **Von Gierke disease** is a type of glycogen storage disease primarily affecting the liver and kidneys, causing **hypoglycemia** and **lactic acidosis**. - It does not typically involve intellectual disability; cognitive development is usually normal if metabolic complications are managed. *Alkaptonuria* - **Alkaptonuria** is an inherited disorder characterized by the accumulation of **homogentisic acid**, leading to dark urine, ochronosis (bluish-black discoloration of cartilage and connective tissue), and arthritis. - It does not cause intellectual disability. *Albinism* - **Albinism** is a group of inherited disorders characterized by a reduced or complete lack of **melanin pigment** in the skin, hair, and eyes. - While it causes vision problems, such as photosensitivity and nystagmus, it is not associated with intellectual disability.

Q: A patient presented with 2 days history of fever. On examination there was a swelling in the neck and one side tonsil was pushed to midline. What is the most likely diagnosis:-

Quinsy. ***Quinsy (Peritonsillar abscess)*** - **Quinsy** is a **peritonsillar abscess** that presents with fever, severe throat pain, and the pathognomonic sign of **unilateral tonsil pushed toward the midline**. - The abscess forms in the **peritonsillar space** (between the tonsillar capsule and superior constrictor muscle), causing **medial displacement of the tonsil** and **bulging of the soft palate**. - Patients typically have **trismus, dysphagia, "hot potato voice"** and may have visible neck swelling. - This clinical presentation exactly matches the description: tonsil pushed to midline is the **classic finding for peritonsillar abscess**. *Parapharyngeal abscess* - A **parapharyngeal abscess** involves the deep parapharyngeal space lateral to the pharynx. - While it can cause neck swelling and fever, it typically causes **fullness and induration of the lateral pharyngeal wall** rather than prominent medial displacement of the tonsil itself. - The **tonsil is usually NOT pushed to the midline** in parapharyngeal abscess; instead, there is lateral pharyngeal wall bulging. - Often presents with more prominent external neck swelling below the angle of mandible. *Retropharyngeal abscess* - A **retropharyngeal abscess** occurs in the retropharyngeal space behind the posterior pharyngeal wall. - Presents with **posterior pharyngeal wall bulge**, neck stiffness, and dysphagia. - Does **NOT cause medial displacement of the tonsil** as the abscess is posterior, not lateral to the tonsil. *Tonsillitis* - **Acute tonsillitis** causes bilateral tonsillar inflammation with erythema and exudates. - While both tonsils may be enlarged, there is **no unilateral medial displacement** of one tonsil. - Less likely to cause significant neck swelling compared to deep space infections.

Q: Which is the primary organ involved in Goodpasture syndrome?

Kidney. Kidney - Goodpasture syndrome is an autoimmune disease primarily characterized by the production of antibodies against the alpha-3 chain of type IV collagen in the glomerular basement membrane (GBM) and alveolar basement membrane [1]. - This leads to rapidly progressive glomerulonephritis and pulmonary hemorrhage, making the kidneys and lungs the main affected organs, with the kidneys being the primary and universally involved organ [1]. Adrenals - The adrenal glands are not directly involved in the pathogenesis or primary pathology of Goodpasture syndrome. - Conditions like Addison's disease or Cushing's syndrome affect the adrenals, which are distinct from Goodpasture syndrome. Liver - The liver is not a target organ for the antibodies involved in Goodpasture syndrome. - Diseases like autoimmune hepatitis or primary biliary cholangitis primarily affect the liver. Brain - The brain is not affected by the specific autoantibodies targeting type IV collagen in Goodpasture syndrome. - Neurological conditions such as vasculitis of the central nervous system or multiple sclerosis involve the brain.

Q: Which of the following drugs is a direct inhibitor of clotting factor Xa?

Apixaban. ***Apixaban*** - Apixaban is an **oral direct factor Xa inhibitor**, which means it directly binds to and inactivates factor Xa. - This inhibition prevents the conversion of **prothrombin to thrombin**, thereby disrupting the coagulation cascade. *Argatroban* - Argatroban is a **direct thrombin inhibitor** (DTI), meaning it selectively binds to and inhibits thrombin (factor IIa). - It is often used in cases of **heparin-induced thrombocytopenia (HIT)** due to its non-heparin-based mechanism of action. *Fondaparinux* - Fondaparinux is an **indirect factor Xa inhibitor** that binds to antithrombin, thereby enhancing antithrombin's ability to inactivate factor Xa. - It does not directly bind to factor Xa itself, but rather potentiates the action of a natural anticoagulant. *Aspirin* - Aspirin is an **antiplatelet agent** that inhibits cyclooxygenase (COX-1), thereby reducing the production of thromboxane A2. - This mechanism primarily inhibits **platelet aggregation** and adhesion, rather than directly inhibiting a clotting factor in the coagulation cascade.

Q: The primary dopaminergic reward center in the brain is?

Ventral tegmental area. ***Ventral tegmental area*** - The **ventral tegmental area (VTA)** is a key component of the mesolimbic dopamine system, often referred to as the **reward pathway** in the brain. - It projects dopamine neurons to various areas, including the **nucleus accumbens** and prefrontal cortex, mediating feelings of pleasure and reward. *Hippocampus* - The **hippocampus** is primarily involved in **memory formation** and spatial navigation. - While it interacts with reward pathways, it is not the primary dopaminergic reward center itself. *Amygdala* - The **amygdala** is critical for processing **emotions**, particularly fear and aggression, and plays a role in emotional memory. - It modulates reward responses but is not the primary source of dopaminergic reward signaling. *Thalamus* - The **thalamus** acts as a **relay station** for sensory information, directing it to appropriate cortical areas. - It has diverse functions but is not recognized as the central dopaminergic reward area.

Q: Inverse stretch reflex is mediated :

Golgi tendon organ. ***Golgi tendon*** - The **Golgi tendon organ (GTO)** is a **proprioceptor** located at the junction of muscle fibers and tendons, sensitive to changes in muscle tension. - When muscle tension becomes excessive, the GTO is activated, inhibiting the alpha motor neurons innervating that muscle, leading to muscle relaxation, which is the **inverse stretch reflex**. *Unmyelinated C fibres* - These fibers are primarily involved in transmitting **slow, dull pain** and **temperature sensations**, but not proprioceptive reflexes. - Their conduction velocity is much slower than that required for rapid protective reflexes. *Dorsal Column* - The dorsal column-medial lemniscus pathway is responsible for transmitting **fine touch, vibration, and proprioception** to the brain, but it is an ascending sensory pathway and does not directly mediate spinal reflexes. - This pathway is involved in conscious perception, not the direct arc of a reflex. *Muscle spindle* - The **muscle spindle** is responsible for the **stretch reflex** (myotatic reflex), which causes muscle contraction in response to stretch. - It detects changes in **muscle length and rate of change of length**, which is distinct from the inverse stretch reflex mediated by the GTO.

Question 1

Which bone connects the sternum to the scapula?

Accepted Answer

Clavicle

Answer

First rib

Answer

Manubrium

Answer

Second rib

Question 2

Masseter is supplied by which nerve?

Accepted Answer

Mandibular

Answer

Glossopharyngeal

Answer

Facial

Answer

Hypoglossal

Question 3

Which structure connects Broca's area and Wernicke's area?

Accepted Answer

Arcuate fasciculus

Answer

Fornix

Answer

Anterior commissure

Answer

Corpus callosum

Question 4

Intellectual disability is seen in?

Accepted Answer

Phenylketonuria

Answer

Von Gierke disease

Answer

Alkaptonuria

Answer

Albinism

Question 5

A patient presented with 2 days history of fever. On examination there was a swelling in the neck and one side tonsil was pushed to midline. What is the most likely diagnosis:-

Accepted Answer

Quinsy

Answer

Retropharyngeal abscess

Answer

Parapharyngeal abscess

Answer

Tonsillitis

Question 6

Which is the primary organ involved in Goodpasture syndrome?

Accepted Answer

Kidney

Answer

Adrenals

Answer

Liver

Answer

Brain

Question 7

A 32 year old pregnant woman presents with 36 week pregnancy with complaints of pain abdomen and decreased fetal movements. Upon examination PR= 96/min, BP = 156/100 mm Hg, FHR = 128 bpm. On per-vaginum examination there is altered blood seen and cervix is soft 1 cm dilated. What is the preferred management?

Accepted Answer

Perform cesarean section

Answer

Observation and monitoring

Answer

Initiate labor induction

Answer

Administer medications to delay labor

Question 8

Which of the following drugs is a direct inhibitor of clotting factor Xa?

Accepted Answer

Apixaban

Answer

Argatroban

Answer

Fondaparinux

Answer

Aspirin

Question 9

The primary dopaminergic reward center in the brain is?

Accepted Answer

Ventral tegmental area

Answer

Hippocampus

Answer

Amygdala

Answer

Thalamus

Question 10

Inverse stretch reflex is mediated :

Accepted Answer

Golgi tendon organ

Answer

Unmyelinated C fibres

Answer

Dorsal Column

Answer

Muscle spindle

FMGE 2018

Anatomy

Biochemistry

ENT

Internal Medicine

Obstetrics and Gynecology

Pharmacology

Physiology