FMGE 2018 Practice Questions

Q: Adam's apple seen in boys is because of:

Thyroid cartilage. Thyroid cartilage - The "Adam's apple" is a common term for the laryngeal prominence, which is formed by the anterior projection of the thyroid cartilage. - During puberty in males, the thyroid cartilage grows significantly, leading to a more prominent protrusion and deepening of the voice [1]. Tracheal rings - The tracheal rings are C-shaped cartilages that provide structural support to the trachea, preventing its collapse. - They are located inferior to the larynx and are not visible externally as a distinct prominence like the Adam's apple. Hyoid bone - The hyoid bone is a U-shaped bone located in the anterior neck between the chin and the thyroid cartilage. - It is unique because it is the only bone in the human body that does not articulate with any other bone; it serves as an anchor for muscles of the tongue and floor of the mouth. Cricoid cartilage - The cricoid cartilage is a ring-shaped cartilage located inferior to the thyroid cartilage, forming the base of the larynx. - While it is a part of the larynx, its anterior projection is not as prominent as that of the thyroid cartilage, and it does not form the "Adam's apple."

Q: Winging of scapula is due to paralysis of

Serratus anterior. ***Serratus anterior*** - The **serratus anterior muscle** is responsible for **protraction and rotation of the scapula**, holding it close to the thoracic wall. - Paralysis of this muscle, often due to injury to the **long thoracic nerve**, causes the **medial border of the scapula** to protrude posteriorly, a condition known as **medial scapular winging**. - This is the **classic and most common cause** of scapular winging. *Rhomboid major* - The rhomboid major muscle primarily performs **retraction and downward rotation of the scapula**. - Paralysis of this muscle would lead to the scapula being displaced laterally and superiorly, not winging. *Trapezius* - The trapezius muscle has multiple actions, including **elevating, depressing, retracting, and rotating the scapula**. - Paralysis of the trapezius (e.g., due to **accessory nerve damage**) can cause **lateral scapular winging** where the inferior angle protrudes, along with shoulder drooping and difficulty shrugging. - However, **serratus anterior paralysis** is the classic answer for scapular winging in exam contexts. *Levator scapulae* - The levator scapulae muscle is primarily involved in **elevating and downwardly rotating the scapula**. - Dysfunction of this muscle would impair shoulder elevation but would not be the direct cause of scapular winging.

Q: Irreversible obstructive lung function is seen in which of the following conditions?

COPD. ***COPD*** - **Chronic Obstructive Pulmonary Disease** (COPD) is characterized by **persistent airflow limitation** that is not fully reversible [3]. - This irreversibility is due to structural changes in the airways and parenchyma, including **emphysema** and **chronic bronchitis** [2]. *Asthma* - Asthma is characterized by **reversible airway obstruction** and hyperresponsiveness, often triggered by allergens or irritants [4]. - While it can be severe, the key distinguishing feature is that the airway limitation can be significantly reversed with bronchodilator treatment [1]. *Pleural effusion* - A pleural effusion involves the **accumulation of fluid in the pleural space**, which is outside the lung tissue. - This condition causes **restrictive lung disease** by compressing the lung, rather than obstructing the airways from within, and is usually treatable by drainage. *Kyphoscoliosis* - **Kyphoscoliosis** is a skeletal deformity of the spine that restricts lung expansion, leading to **restrictive lung disease**. - It does not directly cause an obstructive pattern within the airways, but rather impairs the mechanical ability of the lungs to inflate.

Q: True about endometriosis:

Presence of endometrium at ectopic locations. ***Presence of endometrium at ectopic locations*** - **Endometriosis** is defined as the presence of endometrial glands and stroma outside of the uterine cavity. - These ectopic endometrial implants respond to hormonal changes, leading to cyclical pain and inflammation. *Presence of endometrial gland in deep myometrium* - This describes **adenomyosis**, a condition where endometrial tissue invades the muscular wall of the uterus (myometrium). - While both can cause pelvic pain, endometriosis specifically refers to endometrial tissue *outside* the uterus. *Treated preferably with hysterectomy* - Hysterectomy is a definitive treatment option, especially for severe cases or when fertility is not desired, but it is not the *preferred* initial treatment for all patients. - Initial management often includes **pain relievers**, **hormonal therapy**, or **laparoscopic excision** of endometriotic implants. *Seen in multiparous women* - Endometriosis is more commonly diagnosed in **nulliparous (never given birth)** or women who delay childbearing. - While it can occur in multiparous women, it is not a characteristic association.

Q: A G4P2 lady presented with history of two abortions at 16 weeks and 20 weeks POG. Which of the following could be the most likely reason for these abortions?

Cervical incompetence. ***Cervical incompetence*** - **Recurrent second-trimester pregnancy losses** (16 and 20 weeks) with a history of two previous abortions are highly suggestive of cervical incompetence, where the cervix dilates prematurely. - This condition is characterized by painless, progressive cervical dilation leading to **fetal expulsion** without contractions, which aligns with the presentation of repeated mid-trimester abortions. *Thyroid abnormality* - While **untreated hypothyroidism** or **hyperthyroidism** can increase the risk of miscarriage, these typically lead to **earlier first-trimester losses** or other obstetric complications, not recurrent mid-trimester abortions. - Abortion due to thyroid dysfunction is often associated with other signs and symptoms of thyroid disease, which are not mentioned. *Chromosomal abnormality* - **Chromosomal abnormalities** are the most common cause of **first-trimester miscarriages**, accounting for about 50% of them. - While they can cause later losses, recurrent mid-trimester abortions are less commonly attributed solely to chromosomal issues, especially in the absence of other malformations. *Placenta previa* - **Placenta previa** is a condition where the placenta partially or totally covers the cervix, causing painless vaginal bleeding in the **late second or third trimester**. - It increases the risk of preterm birth but is not a direct cause of recurrent fetal loss at 16 and 20 weeks gestation in the manner described.

Q: After a normal delivery, when can combined oral contraceptives be started for a non-breastfeeding mother?

6 weeks. ***6 weeks*** - For **non-breastfeeding mothers**, combined oral contraceptives (COCs) are most safely initiated at **6 weeks postpartum** according to WHO Medical Eligibility Criteria. - At 6 weeks postpartum, the risk of **venous thromboembolism (VTE)** has returned to baseline, making this the safest timing (WHO MEC Category 1 - no restriction). - This timing balances both safety and effective contraception for mothers not breastfeeding. *Immediately after delivery* - Starting COCs immediately postpartum significantly increases the risk of **venous thromboembolism (VTE)** due to the hypercoagulable state after delivery. - This timing is contraindicated for combined hormonal methods (WHO MEC Category 3-4). *2 weeks* - At 2 weeks (14 days) postpartum, the VTE risk remains elevated in the early postpartum period. - Combined hormonal contraceptives are generally not recommended before 3 weeks (21 days) postpartum for non-breastfeeding women. - This timing does not meet standard safety guidelines. *12 weeks* - While 12 weeks postpartum is medically safe for initiating COCs, it is unnecessarily delayed. - This extended waiting period increases the risk of unintended pregnancy when effective contraception could be safely provided earlier at 6 weeks.

Q: EDD ( Expected Date of Delivery) is calculated by:

Naegele's formula. ***Naegele's formula*** - **Naegele's formula** is the most common and widely accepted method for calculating the estimated date of delivery (EDD). - It involves adding one year, subtracting three months, and adding seven days to the **first day of the last menstrual period (LMP)**. *Cardiff Formula* - The **Cardiff Formula** is a method used for assessing fetal movements, particularly for monitoring fetal well-being, not for calculating EDD. - It establishes a baseline of fetal movements over a specific period to detect any significant decrease. *McDonald's rule* - **McDonald's rule** is a clinical method used to estimate the gestational age based on fundal height measurements. - While it helps in estimating gestational age, it is not primarily used for calculating the precise EDD. *Hadlock Formula* - The **Hadlock Formula** refers to a set of widely used ultrasound-based formulas for estimating fetal weight and gestational age, typically involving biometry measurements like BPD, HC, AC, and FL. - While accurate for gestational age estimation, it's an imaging-based method, not a direct calculation of EDD from the LMP like Naegele's.

Q: Tennis player can spontaneously reduce a shoulder dislocation. He can do it again and again himself. He is suffering from?

Recurrent shoulder dislocation. ***Recurrent shoulder dislocation*** - The ability to **spontaneously reduce** a shoulder dislocation, and the history of it happening "again and again" strongly indicate **recurrent shoulder dislocation**. - This condition often results from **ligamentous laxity** or damage to the **labrum** (Bankart lesion) that fails to stabilize the shoulder joint after an initial dislocation. *Inferior shoulder dislocation* - This is a **specific type of shoulder dislocation** (luxatio erecta) where the humeral head is displaced inferiorly, but "inferior" alone does not explain the recurrent nature. - While possible in an individual, the key element here is the **recurrence** and self-reduction, not just the direction of a single dislocation. *Fracture upper end humerus* - A fracture of the upper end of the humerus is a **bony injury** and would typically present with severe pain, swelling, and inability to move the arm, not spontaneous reduction. - This injury would usually **prevent** the patient from repeatedly dislocating and reducing their shoulder. *Acute shoulder dislocation* - An acute shoulder dislocation refers to a **single, recent episode** of dislocation. - The patient's repeated ability to self-reduce the shoulder indicates a chronic problem rather than an initial, isolated event.

Q: Shortest acting local anaesthetic

Chloroprocaine. ***Chloroprocaine*** - **Chloroprocaine** is known for its rapid onset and very **short duration of action**, typically lasting 30-60 minutes, due to its **rapid hydrolysis** by plasma and liver esterases. - Its quick metabolism makes it suitable for short procedures where a brief blockade is desired, minimizing the risk of systemic toxicity. *Dibucaine* - **Dibucaine** is a local anesthetic with a **long duration of action**, typically 2 to 4 hours, which is much longer than chloroprocaine. - It is used topically and in spinal anesthesia, but its prolonged effect makes it unsuitable as the shortest-acting option. *Procaine* - **Procaine** is an ester-type local anesthetic with a relatively **short duration of action** (approximately 30-60 minutes), but it is generally longer than that of chloroprocaine. - It was one of the first synthetic local anesthetics and is less potent and shorter-acting than many modern agents. *Cocaine* - **Cocaine** has a moderate duration of action as a local anesthetic, typically lasting 60-90 minutes, which is longer than chloroprocaine. - While it is a potent local anesthetic and vasoconstrictor, its high abuse potential and systemic side effects limit its clinical use, mainly to topical application in otolaryngology.

Q: Negative symptoms of schizophrenia are all except:-

Over activity. ***Over activity*** - **Overactivity** is a manifestation of disorganized or positive symptoms in schizophrenia, such as **agitation** or purposeless movements, rather than a deficiency. - While it can occur in schizophrenia, it represents an excess or distortion of normal function, distinguishing it from **negative symptoms** which reflect a reduction or absence of typical behaviors. *Apathy* - **Apathy**, or avolition, is a core negative symptom characterized by a **lack of motivation** and an inability to initiate or persist in goal-directed activities. - Patients with apathy often show diminished interest in daily activities and personal care. *Anhedonia* - **Anhedonia** is a negative symptom defined by the **inability to experience pleasure** from activities that are usually enjoyable. - This can include a loss of interest in social interactions, hobbies, and other rewarding experiences. *Alogia* - **Alogia**, or poverty of speech, is a negative symptom characterized by a **reduction in the quantity and fluency of speech**. - Individuals with alogia may provide brief, empty responses and exhibit long pauses during conversation.

Question 1

Adam's apple seen in boys is because of:

Accepted Answer

Thyroid cartilage

Answer

Tracheal rings

Answer

Hyoid bone

Answer

Cricoid cartilage

Question 2

Winging of scapula is due to paralysis of

Accepted Answer

Serratus anterior

Answer

Rhomboid major

Answer

Trapezius

Answer

Levator scapulae

Question 3

Irreversible obstructive lung function is seen in which of the following conditions?

Accepted Answer

COPD

Answer

Asthma

Answer

Pleural effusion

Answer

Kyphoscoliosis

Question 4

True about endometriosis:

Accepted Answer

Presence of endometrium at ectopic locations

Answer

Presence of endometrial gland in deep myometrium

Answer

Treated preferably with hysterectomy

Answer

Seen in multiparous women

Question 5

A G4P2 lady presented with history of two abortions at 16 weeks and 20 weeks POG. Which of the following could be the most likely reason for these abortions?

Accepted Answer

Cervical incompetence

Answer

Thyroid abnormality

Answer

Chromosomal abnormality

Answer

Placenta previa

Question 6

After a normal delivery, when can combined oral contraceptives be started for a non-breastfeeding mother?

Accepted Answer

6 weeks

Answer

Immediately after delivery

Answer

2 weeks

Answer

12 weeks

Question 7

EDD ( Expected Date of Delivery) is calculated by:

Accepted Answer

Naegele's formula

Answer

Cardiff Formula

Answer

McDonald's rule

Answer

Hadlock Formula

Question 8

Tennis player can spontaneously reduce a shoulder dislocation. He can do it again and again himself. He is suffering from?

Accepted Answer

Recurrent shoulder dislocation

Answer

Inferior shoulder dislocation

Answer

Fracture upper end humerus

Answer

Acute shoulder dislocation

Question 9

Shortest acting local anaesthetic

Accepted Answer

Chloroprocaine

Answer

Dibucaine

Answer

Procaine

Answer

Cocaine

Question 10

Negative symptoms of schizophrenia are all except:-

Accepted Answer

Over activity

Answer

Apathy

Answer

Anhedonia

Answer

Alogia

FMGE 2018

Anatomy

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pharmacology

Psychiatry