Anatomy
2 questionsSensory innervation of the cornea is by which nerve?
Most medial nucleus of cerebellum is:
FMGE 2018 - Anatomy FMGE Practice Questions and MCQs
Question 51: Sensory innervation of the cornea is by which nerve?
- A. 5th (ophthalmic division of the trigeminal nerve) (Correct Answer)
- B. 6th (Abducens nerve)
- C. 3rd (Oculomotor nerve)
- D. 4th (Trochlear nerve)
Explanation: ***5th (ophthalmic division of the trigeminal nerve)*** - The **trigeminal nerve (CN V)** is responsible for sensory innervation of the face, and its **ophthalmic division (V1)** specifically supplies the cornea. - This extensive sensory innervation explains the **extreme sensitivity of the cornea** to touch, temperature, and chemicals, and is crucial for the **corneal reflex**. *6th (Abducens nerve)* - The **abducens nerve (CN VI)** is a **motor nerve** responsible for innervating the **lateral rectus muscle**, which abducts the eye. - It has no role in the sensory innervation of the cornea. *3rd (Oculomotor nerve)* - The **oculomotor nerve (CN III)** is primarily a **motor nerve** responsible for innervating most of the **extraocular muscles** (superior, inferior, medial recti, inferior oblique) and the **levator palpebrae superioris**. - It also carries **parasympathetic fibers** for pupillary constriction and accommodation, but it does not provide sensory innervation to the cornea. *4th (Trochlear nerve)* - The **trochlear nerve (CN IV)** is a **motor nerve** that innervates the **superior oblique muscle**, which depresses and internally rotates the eye. - It has no function in corneal sensation.
Question 52: Most medial nucleus of cerebellum is:
- A. Dentate
- B. Emboliform
- C. Globose
- D. Fastigial (Correct Answer)
Explanation: ***Fastigial*** - The **fastigial nucleus** is located most **medially** within the cerebellum, closest to the midline in the roof of the fourth ventricle [1]. - It is the most medial of the four deep cerebellar nuclei and is primarily associated with the **vestibulocerebellum** (flocculonodular lobe) [1]. - Functions: Maintains **balance, posture, and coordinated eye movements** via connections to vestibular nuclei and reticular formation [1]. *Dentate* - The **dentate nucleus** is the **largest and most lateral** of the cerebellar nuclei, with a characteristic crumpled sac-like appearance (resembling an olive). - Located deep within the **lateral cerebellar hemisphere** white matter [1]. - Associated with the **neocerebellum** (cerebrocerebellum) and involved in **planning and initiating voluntary movements** via the ventrolateral thalamus to motor cortex [1]. *Emboliform* - The **emboliform nucleus** is elongated and located **medial to the dentate** but **lateral to the globose** nucleus. - Together with the globose nucleus, forms the **interposed nuclei**. - Associated with the **spinocerebellum** and involved in **modulating limb movements** and adjusting ongoing motor activity [1]. *Globose* - The **globose nucleus** consists of rounded cell masses located **medial to emboliform** and **lateral to fastigial** nucleus. - Part of the **interposed nuclei** along with emboliform nucleus. - Functions in **fine-tuning and coordinating ongoing movements**, particularly of distal limbs.
Anesthesiology
1 questionsFalse statement about post-dural puncture headache (PDPH):
FMGE 2018 - Anesthesiology FMGE Practice Questions and MCQs
Question 51: False statement about post-dural puncture headache (PDPH):
- A. Commonly occipito-frontal in location
- B. Onset of headache is usually 12-72 hours following procedure
- C. Breach of dura
- D. Headache is relieved in sitting standing position (Correct Answer)
Explanation: ***Headache is relieved in sitting standing position*** - This statement is **false** because a cardinal feature of PDPH is that the headache is **worse in the upright position** (sitting or standing) and **relieved by lying flat**. - The postural nature of the headache is due to the continued leakage of CSF, leading to reduced intracranial pressure, which is exacerbated by gravity when upright. *Commonly occipito-frontal in location* - PDPH typically presents as a headache that can be **holocranial**, **occipital**, or **frontal**, often radiating to the neck. - The location is due to changes in **intracranial pressure** affecting pain-sensitive structures like blood vessels and meninges. *Onset of headache is usually 12-72 hours following procedure* - The onset of PDPH is typically **delayed**, occurring in the vast majority of cases between **12 to 72 hours** after the dural puncture. - Although it can occur immediately or up to five days later, this delayed presentation is characteristic. *Breach of dura* - PDPH is a direct consequence of the intentional or accidental **breach of the dura mater** during procedures like spinal anesthesia or lumbar puncture. - This breach allows for continuous leakage of **cerebrospinal fluid (CSF)**, leading to a reduction in intracranial pressure, which causes the headache.
ENT
2 questionsRecruitment phenomenon is seen in:
All of the following are seen in Meniere's Disease except:
FMGE 2018 - ENT FMGE Practice Questions and MCQs
Question 51: Recruitment phenomenon is seen in:
- A. Otitis media with effusion
- B. Otosclerosis
- C. Acoustic nerve schwannoma
- D. Meniere's disease (Correct Answer)
Explanation: ***Meniere's disease*** - The recruitment phenomenon, characterized by an abnormal increase in the perception of loudness for a given increase in sound intensity, is a classic finding in **cochlear hearing loss**, often seen in conditions like **Meniere's disease**. - This occurs due to damage to the **outer hair cells** in the cochlea, which normally compress the dynamic range of hearing. *Otitis media with effusion* - This condition involves **conductive hearing loss** due to fluid in the middle ear, and typically does not cause the recruitment phenomenon. - The problem lies in sound transmission, not in the processing of loudness within the cochlea. *Otosclerosis* - This condition causes **conductive hearing loss** due to abnormal bone growth around the stapes footplate, impeding sound transmission to the inner ear. - While it affects hearing, it does not directly lead to altered loudness perception or recruitment, as the cochlea itself is often intact. *Acoustic nerve schwannoma* - This tumor affects the **vestibulocochlear nerve (CN VIII)**, causing **sensorineural hearing loss** that is typically retrocochlear (beyond the cochlea). - While it causes hearing loss, recruitment is usually absent or minimal, as the pathology is neural, not cochlear.
Question 52: All of the following are seen in Meniere's Disease except:
- A. Fullness of ear
- B. Ear Pain (Correct Answer)
- C. Vertigo
- D. Tinnitus
Explanation: ***Ear Pain*** - **Otalgia** (ear pain) is not a typical symptom of **Meniere's disease**. - While patients may experience discomfort due to pressure, sharp or significant pain is generally absent. *Fullness of ear* - A sensation of **aural fullness** or pressure in the affected ear is a characteristic symptom of Meniere's disease, often preceding a vertiginous attack. - This symptom is thought to be due to the buildup of **endolymphatic fluid** within the inner ear. *Vertigo* - **Episodic rotational vertigo** is a hallmark symptom of Meniere's disease, significantly impacting daily activities and often accompanied by nausea and vomiting. - These attacks are typically sudden, severe, and can last from 20 minutes to several hours. *Tinnitus* - **Tinnitus**, often described as a ringing, buzzing, or roaring sound, is a common symptom in patients with Meniere's disease. - It usually fluctuates in intensity and can worsen before or during a vertigo attack.
Internal Medicine
1 questionsA child with diarrhea has deep & rapid respiration. Most likely diagnosis is:
FMGE 2018 - Internal Medicine FMGE Practice Questions and MCQs
Question 51: A child with diarrhea has deep & rapid respiration. Most likely diagnosis is:
- A. Metabolic acidosis (Correct Answer)
- B. Respiratory acidosis
- C. Metabolic alkalosis
- D. Respiratory alkalosis
Explanation: ***Metabolic acidosis*** - Diarrhea leads to a loss of **bicarbonate** from the gastrointestinal tract, causing a decrease in blood pH [1]. - **Deep and rapid respirations** (Kussmaul breathing) are a compensatory mechanism to blow off CO2 and raise the blood pH [1], [2]. *Respiratory acidosis* - This condition results from **hypoventilation**, leading to CO2 retention and a reduced pH [2]. - Deep and rapid breathing would actually improve respiratory acidosis by expelling CO2. *Metabolic alkalosis* - Characterized by an **excess of bicarbonate** and an elevated blood pH [3]. - Compensatory mechanisms would involve decreased respiration to retain CO2, not increased [3]. *Respiratory alkalosis* - This is caused by **hyperventilation**, which leads to excessive CO2 expulsion and an elevated pH [2]. - While hyperventilation causes deep and rapid breathing, it leads to alkalosis, not acidosis (which is indicated by compensatory breathing in this scenario).
Ophthalmology
1 questionsWhat is the true statement about retinoscopy with a plane mirror?
FMGE 2018 - Ophthalmology FMGE Practice Questions and MCQs
Question 51: What is the true statement about retinoscopy with a plane mirror?
- A. In myopia, the red glow moves in the same direction.
- B. Retinoscopy is done at 1 meter away from the patient. (Correct Answer)
- C. In hypermetropia, the red glow moves in the opposite direction.
- D. In emmetropia, the red glow moves in the opposite direction.
Explanation: ***Retinoscopy is done at 1 meter away from the patient.*** - Retinoscopy is typically performed at a **working distance** of 67 cm or 1 meter, to allow for the examiner to observe the reflex and to incorporate a working distance lens in the final calculation. - A 1-meter working distance requires a **-1.00 D sphere correction** to be subtracted from the spherical power found in retinoscopy to find the patient's actual refractive error. *In myopia, the red glow moves in the same direction.* - In **myopia**, using a plane mirror, the retinal reflex appears to move in the **opposite direction** to the movement of the retinoscope. - This "against" movement needs **concave (minus)** lenses to neutralize it. *In hypermetropia, the red glow moves in the opposite direction.* - In **hypermetropia**, using a plane mirror, the retinal reflex appears to move in the **same direction** as the movement of the retinoscope. - This "with" movement needs **convex (plus)** lenses to neutralize it. *In emmetropia, the red glow moves in the opposite direction.* - In **emmetropia**, the light from the retinoscope is focused on the retina, and the reflex also moves in the **same direction** as the retinoscope (when using a plane mirror) until neutralization. - An **emmetropic eye** theoretically requires no corrective lens, other than the working distance correction, to neutralize the reflex.
Pharmacology
1 questionsShortest-acting muscle relaxant is:
FMGE 2018 - Pharmacology FMGE Practice Questions and MCQs
Question 51: Shortest-acting muscle relaxant is:
- A. Atracurium
- B. Tubocurarine
- C. Succinylcholine (Correct Answer)
- D. Pancuronium
Explanation: ***Correct: Succinylcholine*** - **Succinylcholine** is a depolarizing neuromuscular blocker with a rapid onset and a very short duration of action, typically **5-10 minutes**, due to its rapid hydrolysis by **plasma pseudocholinesterase**. - Its ultrashort action makes it ideal for **rapid sequence intubation** and other procedures requiring brief muscle relaxation. *Incorrect: Atracurium* - **Atracurium** is an intermediate-acting nondepolarizing muscle relaxant with a duration of action of approximately **20-35 minutes**. - Its metabolism occurs via Hoffman elimination and ester hydrolysis, making it suitable for patients with **renal or hepatic dysfunction**. *Incorrect: Tubocurarine* - **Tubocurarine** is a long-acting nondepolarizing muscle relaxant that is now rarely used due to its significant adverse effects, including **histamine release** and ganglion blockade. - Its duration of action can be **60-120 minutes**. *Incorrect: Pancuronium* - **Pancuronium** is a long-acting nondepolarizing muscle relaxant with a duration of action of **60-90 minutes**. - It is eliminated primarily by the **kidneys**, making its duration prolonged in patients with **renal impairment**.
Surgery
2 questionsIn gastric outlet obstruction in a peptic ulcer patient, the site of obstruction is most likely to be:
Which of the following is FALSE regarding deep second-degree burns?
FMGE 2018 - Surgery FMGE Practice Questions and MCQs
Question 51: In gastric outlet obstruction in a peptic ulcer patient, the site of obstruction is most likely to be:
- A. Pylorus (Correct Answer)
- B. Duodenum
- C. Antrum
- D. Fundus
Explanation: ***Pylorus*** - The **pylorus** is the most common site of obstruction in gastric outlet obstruction caused by **peptic ulcer disease**. This is due to **scarring** and **inflammation** from chronic ulcers in or near this region. - Obstruction at the pylorus impedes the normal flow of digested food from the stomach into the **duodenum**. *Duodenum* - While ulcers can occur in the **duodenum** (specifically the duodenal bulb), they are less likely to cause a complete obstruction of the gastric outlet. - **Duodenal ulcers** are more common than gastric ulcers, but rarely lead to severe narrowing causing outlet obstruction. *Antrum* - The **gastric antrum** is part of the stomach leading up to the pylorus. Although ulcers can occur here, obstruction is less common compared to the **pylorus** itself. - Obstruction due to antral pathology typically occurs closer to the **pyloric sphincter**. *Fundus* - The **fundus** is the upper, dome-shaped part of the stomach. It is very rarely the site of obstruction in the context of gastric outlet obstruction from peptic ulcer disease. - Obstructions in the fundus are usually associated with other pathologies, such as **tumors** or **gastric volvulus**, not peptic ulcers causing outlet obstruction.
Question 52: Which of the following is FALSE regarding deep second-degree burns?
- A. Heal by scar deposition
- B. Painless
- C. Show blanching response (Correct Answer)
- D. Damage to deeper dermis
Explanation: ***Show blanching response (FALSE - Correct Answer)*** - This is the **FALSE statement**. Deep second-degree burns typically show **absent or diminished blanching response**, not a positive blanching response. - A **blanching response** indicates intact blood flow to the capillaries, which is typical of **superficial partial-thickness burns** only. - In **deep second-degree burns**, the damage extends deeper into the reticular dermis, involving the **dermal capillary plexus**, leading to loss of the blanching response. *Heal by scar deposition (TRUE)* - **Deep second-degree burns** damage the dermal elements responsible for regeneration, necessitating significant **scar deposition** for healing. - Due to destruction of many **dermal appendages** (hair follicles, sebaceous glands), complete regeneration without scarring is unlikely. *Painless (TRUE)* - While superficial burns are very painful, **deep second-degree burns** can be relatively **painless** due to destruction of **nerve endings** in the deeper dermis. - The variable destruction of **nociceptors** means patients may experience both painful areas and areas of reduced sensation or numbness. *Damage to deeper dermis (TRUE)* - **Deep second-degree burns** are characterized by injury extending into the **reticular dermis** (deeper layer), which lies beneath the papillary dermis. - This level of damage affects significant **dermal structures** including hair follicles, sweat glands, and nerve endings.