Anatomy
1 questionsTrismus is due to spasm of which of the following muscles
FMGE 2018 - Anatomy FMGE Practice Questions and MCQs
Question 71: Trismus is due to spasm of which of the following muscles
- A. Mentalis
- B. Lateral pterygoid
- C. Buccinator
- D. Medial pterygoid (Correct Answer)
Explanation: ***Medial pterygoid*** - **Trismus** is characterized by persistent spasm of the **muscles of mastication**, leading to difficulty opening the mouth. - The **medial pterygoid** is a strong jaw **closer** muscle, and its spasm contributes significantly to trismus along with other masticatory muscles (masseter and temporalis). - Among the given options, medial pterygoid is the muscle of mastication that causes trismus when in spasm. *Mentalis* - The **mentalis muscle** is primarily involved in **pouting** and elevating the lower lip. - While it affects the lower face, it does not directly control jaw opening or closing to cause trismus. - It is **not a muscle of mastication**. *Lateral pterygoid* - The **lateral pterygoid muscle** is primarily responsible for **depressing** (opening) the jaw and is also involved in protrusion and side-to-side movements. - While it is a muscle of mastication, in the context of trismus (jaw closure spasm), the **medial pterygoid** (jaw closer) is more directly implicated than the lateral pterygoid. *Buccinator* - The **buccinator muscle** forms the muscular wall of the cheek and is involved in **chewing**, whistling, and keeping food between the teeth. - It does not directly control jaw opening or closing, and its spasm would not be the primary cause of trismus. - It is **not a muscle of mastication**.
Biochemistry
1 questionsWhich organelle contains its own DNA apart from the nucleus?
FMGE 2018 - Biochemistry FMGE Practice Questions and MCQs
Question 71: Which organelle contains its own DNA apart from the nucleus?
- A. Mitochondria (Correct Answer)
- B. RER
- C. Golgi complex
- D. SER
Explanation: ***Mitochondria*** - Mitochondria contain their own **circular DNA (mtDNA)**, which is inherited maternally, and their own ribosomes. - This DNA encodes for some proteins essential for **cellular respiration** and its own replication, supporting the endosymbiotic theory. *RER* - The **Rough Endoplasmic Reticulum (RER)** is characterized by the presence of **ribosomes** on its surface. - It plays a crucial role in the **synthesis and modification of proteins** designated for secretion or insertion into membranes, but does not contain DNA. *Golgi complex* - The **Golgi complex** is involved in **modifying, sorting, and packaging proteins and lipids** for secretion or delivery to other organelles. - It consists of flattened sacs called cisternae but does not possess DNA. *SER* - The **Smooth Endoplasmic Reticulum (SER)** is involved in **lipid synthesis**, **detoxification** of drugs and poisons, and **calcium ion storage**. - Unlike mitochondria, it does not contain its own genetic material.
ENT
1 questionsMost common cause of sensorineural hearing loss (SNHL)
FMGE 2018 - ENT FMGE Practice Questions and MCQs
Question 71: Most common cause of sensorineural hearing loss (SNHL)
- A. Labyrinthitis
- B. Meniere's disease
- C. Presbycusis (Correct Answer)
- D. Vestibular Schwannoma
Explanation: ***Presbycusis*** - **Presbycusis**, or age-related hearing loss, is the most common cause of **sensorineural hearing loss (SNHL)**, affecting a significant portion of the elderly population. - It typically results from **degenerative changes** in the inner ear, specifically the hair cells and nerve fibers, leading to a gradual, symmetrical, high-frequency SNHL. *Labyrinthitis* - **Labyrinthitis** is an inflammation of the inner ear that can cause sudden SNHL, often accompanied by **vertigo** and **tinnitus**. - While it causes SNHL, it is an acute condition and not the most common overall cause, especially when considering the prevalence of age-related hearing loss. *Meniere's disease* - **Meniere's disease** is characterized by recurrent episodes of **vertigo, fluctuating low-frequency SNHL, tinnitus**, and aural fullness. - It is a specific condition causing SNHL, but its prevalence is much lower than presbycusis, making it a less common overall cause. *Vestibular Schwannoma* - A **vestibular schwannoma** (acoustic neuroma) is a benign tumor that arises from the Schwann cells of the **vestibulocochlear nerve**. - It can cause **progressive unilateral SNHL**, tinnitus, and balance issues, but it is a relatively rare condition compared to presbycusis.
Internal Medicine
1 questionsAll of the following are manifestations of congenital syphilis except:-
FMGE 2018 - Internal Medicine FMGE Practice Questions and MCQs
Question 71: All of the following are manifestations of congenital syphilis except:-
- A. Olympian brow
- B. Gumma (Correct Answer)
- C. Interstitial keratitis
- D. Hutchinson's teeth
Explanation: ***Gumma*** - **Gumma** is a manifestation of **tertiary syphilis** in adults, typically appearing years after the initial infection [1]. - While syphilis can be transmitted congenitally, **gummatous lesions** are not a characteristic finding in congenital syphilis [1]. *Olympian brow* - **Olympian brow** (also known as frontal bossing) is a feature of **congenital syphilis**, characterized by prominent frontal bones [2]. - It results from **periostitis** and abnormal bone development due to chronic infection in utero. *Interstitial keratitis* - **Interstitial keratitis** is a classic manifestation of **late congenital syphilis**, affecting the cornea [2]. - It presents as **bilateral corneal inflammation** leading to vision impairment, often appearing in childhood or adolescence. *Hutchinson's teeth* - **Hutchinson's teeth** are a pathognomonic sign of **congenital syphilis**, characterized by notched, peg-shaped, and widely spaced incisors. - This dental abnormality results from the treponemal infection disrupting the **enamel formation** during tooth development.
Obstetrics and Gynecology
1 questionsWhich of these types of fibroid may be removed at the time of a cesarean section?
FMGE 2018 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 71: Which of these types of fibroid may be removed at the time of a cesarean section?
- A. Pedunculated fibroid (Correct Answer)
- B. Broad ligament fibroid
- C. Cervical fibroid
- D. Intramural
Explanation: ***Pedunculated fibroid*** - **Pedunculated subserosal fibroids** are the safest type to remove during cesarean section, particularly those on a **narrow stalk** - They can be easily accessed through the abdominal incision without disrupting the uterine wall integrity - The stalk can be **clamped, ligated, and divided** with minimal risk of hemorrhage if proper hemostatic technique is used - Removal does not compromise the **hysterotomy closure** or future uterine integrity - This is the **only type of fibroid** routinely considered safe for removal during C-section if clinically indicated *Intramural fibroid* - **Intramural fibroids** are embedded within the myometrial wall and their removal is **generally contraindicated** during cesarean section - Myomectomy during C-section carries significant risk of **severe hemorrhage** from the highly vascular pregnant uterus - Removal can compromise **uterine wall integrity** and interfere with proper hysterotomy closure - May increase risk of **uterine rupture** in subsequent pregnancies - Standard obstetric practice is to **avoid myomectomy at cesarean** unless the fibroid is directly obstructing delivery *Broad ligament fibroid* - **Broad ligament fibroids** are located between the layers of the broad ligament, often in close proximity to the **ureter** and **uterine vessels** - Removal carries extremely high risk of **ureteral injury** and **massive hemorrhage** from pedicle vessels - Their excision is **absolutely contraindicated** during cesarean section *Cervical fibroid* - **Cervical fibroids** are located in the cervix with its **rich vascular supply** from cervical branches of uterine arteries - Removal during C-section risks **uncontrollable hemorrhage** and can cause **cervical incompetence** - Excision is **contraindicated** during cesarean section and should be managed separately if needed
Ophthalmology
1 questionsIn dacryocystorhinostomy (DCR), Lacrimal sac opens into:
FMGE 2018 - Ophthalmology FMGE Practice Questions and MCQs
Question 71: In dacryocystorhinostomy (DCR), Lacrimal sac opens into:
- A. Supreme meatus
- B. Middle meatus (Correct Answer)
- C. Inferior meatus
- D. Superior meatus
Explanation: ***Middle meatus*** - In **dacryocystorhinostomy (DCR)**, a new connection is created between the lacrimal sac and the **nasal cavity**, specifically directing tears into the middle meatus. - This surgical procedure aims to bypass an obstruction in the **nasolacrimal duct**, allowing tears to drain directly into the nasal passage through this newly formed opening. *Supreme meatus* - The supreme meatus is a **rare anatomical variation**, located superior to the superior meatus, and is not the standard site for lacrimal drainage. - Surgical intervention in DCR does not target this region for tear evacuation. *Inferior meatus* - The **nasolacrimal duct** normally drains into the inferior meatus, but DCR is performed when this duct is **obstructed**. - Connecting the lacrimal sac directly to the inferior meatus is not the typical surgical approach for DCR. *Superior meatus* - The superior meatus receives drainage from the **posterior ethmoid cells** and the **sphenoid sinus**. - It is not the anatomical location for the lacrimal drainage system, nor is it the target for DCR.
Pathology
1 questionsEarliest feature of TB:
FMGE 2018 - Pathology FMGE Practice Questions and MCQs
Question 71: Earliest feature of TB:
- A. Caseation
- B. Lymphocytosis (Correct Answer)
- C. Granuloma
- D. Langerhans' Giant cells
Explanation: ***Lymphocytosis*** - While the very earliest response to *Mycobacterium tuberculosis* involves neutrophils (acute inflammation), among the given options, **lymphocytosis is the earliest feature** [1]. - Within 2-3 weeks of initial infection, the immune system mounts a cellular response with increased **lymphocytes** (particularly CD4+ T cells) and macrophages attempting to contain the bacteria [2]. - This lymphocytic infiltration precedes the organized granuloma formation and represents the early cell-mediated immune response to TB [3]. *Granuloma* - **Granuloma formation** is a hallmark of tuberculosis, where epithelioid macrophages organize into structured aggregates to wall off the infection. - This organized structure typically develops around 3-4 weeks after infection, following the initial lymphocytic response [4]. *Caseation* - **Caseous necrosis** is the characteristic cheese-like necrosis seen in the center of TB granulomas. - This represents tissue death and is a later feature (4+ weeks), developing as granulomas mature and central hypoxia leads to cell death [4]. *Langerhans' Giant cells* - **Langhans giant cells** (not Langerhans cells of skin) are multinucleated giant cells formed by fusion of epithelioid macrophages within established granulomas [5]. - These appear in mature granulomas and represent a late organized response, not an early feature. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 195-196. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 379-380. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, p. 380. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 380-381. [5] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 109.
Pharmacology
1 questionsTherapeutic index of a drug is an indicator of:-
FMGE 2018 - Pharmacology FMGE Practice Questions and MCQs
Question 71: Therapeutic index of a drug is an indicator of:-
- A. All of these
- B. Potency
- C. Safety (Correct Answer)
- D. Efficacy
Explanation: ***Safety*** - The **therapeutic index (TI)** is a ratio comparing the **toxic dose (TD50)** to the **effective dose (ED50)**: TI = TD50/ED50. - It indicates the **margin of safety** of a drug—the wider the margin between therapeutic and toxic doses, the safer the drug. - A **high therapeutic index** means greater safety; a **low therapeutic index** means the drug has a narrow safety margin. *Potency* - **Potency** refers to the amount of drug needed to produce a given effect, represented by the **ED50**. - The therapeutic index is a **ratio**, not a measure of potency alone. - A highly potent drug can still have a narrow therapeutic index if its toxic dose is close to its effective dose. *Efficacy* - **Efficacy** describes the **maximum therapeutic effect** a drug can produce, irrespective of dose. - The therapeutic index does not quantify maximum effect but rather the **safety margin** within which therapeutic effects can be achieved. *All of these* - While potency and efficacy are important drug properties, the therapeutic index **specifically indicates safety**. - TI is not a composite measure of all drug properties—it is exclusively a safety parameter.
Radiology
2 questionsMark the false statement regarding testing of COVID-19.
Which of the following investigations work on the same principle?
FMGE 2018 - Radiology FMGE Practice Questions and MCQs
Question 71: Mark the false statement regarding testing of COVID-19.
- A. First line screening assay: N gene assay. (Correct Answer)
- B. Confirmatory assay: RdRp gene assay.
- C. Peripheral ground glass opacities on CT is the hallmark feature.
- D. Most predominant method of diagnosis of COVID-19 is PCR.
Explanation: ***First line screening assay: N gene assay.*** * While the **nucleocapsid (N) gene** is a common target for COVID-19 PCR assays, the statement that it is the *first-line screening assay* is often a simplification or outdated, as many assays target multiple genes (e.g., N, E, RdRp) for increased sensitivity and specificity from the outset. * Different health organizations and diagnostic kits have varied recommendations for initial screening targets, but there isn't a universal consensus that the N gene alone is the specific 'first-line screening assay' in all contexts when considering the breadth of available PCR tests. *Confirmatory assay: RdRp gene assay.* * The **RdRp (RNA-dependent RNA polymerase) gene** is a highly specific and conserved target for SARS-CoV-2 detection and is often used in **confirmatory PCR assays**. * Detection of the RdRp gene, sometimes alongside other targets like the E (envelope) gene, helps in confirming the presence of the virus. *Peripheral ground glass opacities on CT is the hallmark feature.* * **Peripheral ground glass opacities (GGOs)** are indeed a **hallmark radiological finding** in COVID-19 pneumonia, seen on CT scans. * These opacities reflect alveolar inflammation and fluid accumulation, especially in the early and moderate stages of the disease. *Most predominant method of diagnosis of COVID-19 is PCR.* * **Reverse transcription-polymerase chain reaction (RT-PCR)** remains the **gold standard and most predominant method** for diagnosing active COVID-19 infection. * PCR tests directly detect viral genetic material, offering high sensitivity and specificity in symptomatic and asymptomatic individuals.
Question 72: Which of the following investigations work on the same principle?
- A. MRI and PET Scan
- B. CT and MRI
- C. CT and X-ray (Correct Answer)
- D. USG and HIDA Scan
Explanation: ***CT and X-ray*** - Both **Computed Tomography (CT)** and **X-ray** imaging utilize **ionizing radiation** to generate images of the body's internal structures. - They work by passing X-ray beams through the patient, with different tissues absorbing the radiation to varying degrees, which is then detected to create an image. *MRI and PET Scan* - **Magnetic Resonance Imaging (MRI)** uses **strong magnetic fields and radio waves** to create detailed images of soft tissues, based on water content. - **Positron Emission Tomography (PET) scans** use **radioactive tracers** to visualize metabolic activity and blood flow, detecting gamma rays emitted from the patient. *CT and MRI* - **CT scans** use **ionizing radiation** (X-rays) to produce cross-sectional images. - **MRI scans** use **magnetic fields and radio waves** and do not involve ionizing radiation. *USG and HIDA Scan* - **Ultrasound (USG)** uses **high-frequency sound waves** to create real-time images of organs and structures. - **Hepatobiliary Iminodiacetic Acid (HIDA) scans** are a type of nuclear medicine study that uses a **radioactive tracer** to evaluate liver and gallbladder function.