FMGE 2023

Q: Identify the histological image below.

Transitional epithelium. ***Transitional epithelium***- This is also known as **urothelium** and is specialized to line the urinary tract (ureters, bladder, proximal urethra) due to its unique structure.- It is characterized by large, bulbous surface cells called **dome cells** or **umbrella cells**, which protect subepithelial layers from urine. *Pseudostratified columnar epithelium*- This epithelium appears layered because the nuclei are at different levels, but all cells rest on the **basement membrane**.- It is commonly found lining the respiratory tract (**trachea** and bronchi) where it typically features **cilia** and goblet cells. *Non-keratinized squamous epithelium*- This tissue consists of multiple layers of cells (stratified) where the surface cells are flattened and **nucleated**.- Locations include the lining of the **vagina**, esophagus, and oral cavity, where protection from abrasion is needed. *Stratified squamous epithelium*- This general category includes both keratinized and non-keratinized types, but it lacks the characteristic **dome cells** of urothelium.- Its main function is providing robust protection from **mechanical stress**, and it does not exhibit the high degree of stretchability seen in the bladder lining. [Practice more FMGE 2023 questions on OnCourse]

Q: A patient presents cyst on the neck with anterior to the sternocleidomastoid at the junction of the upper and middle third of the muscle. This cyst is due to the persistence of which of the following embryological clefts?

2nd cleft. ***2nd cleft***- A cyst appearing anterior to the **sternocleidomastoid muscle (SCM)**, especially at the junction of the upper and middle third, is the classical presentation of a second branchial cleft cyst (BCC) [1].- Persistence of the **cervical sinus**, which is formed by the rapid growth of the second arch covering the 2nd, 3rd, and 4th clefts, results in the most common type of BCC (over 90%).*1st cleft*- First branchial cleft cysts are rare and typically manifest near the **external auditory canal**, the angle of the mandible, or within the parotid gland [1].- These defects are often associated with the structures of the first arch, such as the **facial nerve** or parotid gland parenchyma.*3rd cleft*- Cysts derived from the third cleft are uncommon and usually present lower in the neck, often close to or piercing the **thyrohyoid membrane**.- A third cleft fistula would course **posterior to the carotid arteries** and anterior to the vagus nerve before ending in the pyriform sinus.*4th cleft*- Remnants of the fourth cleft are extremely rare and typically involve a fistula that tracks inferiorly to the great vessels (e.g., the **aortic arch** on the left side).- Fourth arch defects are often associated with recurrent **thyroiditis** or infection originating from the pyriform sinus. [Practice more FMGE 2023 questions on OnCourse]

Q: A patient presented to the OPD with an abnormal gait. On examination, a right-sided hip drop was observed when the patient was asked to stand on the left foot. Which of the following muscles are paralyzed in this patient?

Left gluteus medius and gluteus minimus. ***Left gluteus medius and gluteus minimus*** - The Trendelenburg sign is positive when the pelvis drops on the side opposite the one being stood on (the unsupported side). - This indicates paralysis or weakness of the **hip abductors** on the **standing leg** (left side in this case), which are the gluteus medius and gluteus minimus, responsible for stabilizing the pelvis. - These muscles are innervated by the **superior gluteal nerve**. *Right gluteus maximus and gluteus medius* - Paralysis of muscles on the right side would typically manifest as a deficit when bearing weight on the **right leg** (causing the left hip to drop). - The **gluteus maximus** is mainly a powerful hip extensor (needed for climbing stairs, running, and rising from a seated position) and does not play the primary role in stabilizing the pelvis during single-leg stance. *Right gluteus medius and gluteus minimus* - If these muscles on the right side were paralyzed, the pelvis would drop on the **left side** when the patient attempts to stand on the right foot. - The finding of a right hip drop while standing on the left foot confirms the deficit is on the ipsilateral side of the standing limb (the **left side**). *Left gluteus maximus and gluteus medius* - While the **left gluteus medius** is correctly identified as being paralyzed, the inclusion of the gluteus maximus is inaccurate. - The **gluteus maximus** is innervated by the **inferior gluteal nerve** (not the superior gluteal nerve), and its paralysis causes difficulty with activities requiring hip extension, such as climbing stairs or rising from a chair (gluteus maximus lurch). - The Trendelenburg sign specifically tests the **superior gluteal nerve** and the hip abductors (gluteus medius and minimus), not the gluteus maximus. [Practice more FMGE 2023 questions on OnCourse]

Q: The framework of the external nose:

Upper 1/3rd bony and lower 2/3rd cartilaginous. ***Upper 1/3rd bony and lower 2/3rd cartilaginous*** - The superior portion (root and bridge) of the external nose is supported by the **nasal bones** and the **frontal process of the maxilla**, constituting the bony framework (approximately the upper third). - The inferior portion (apex and alae) is primarily supported by the **hyaline cartilages** (septal, lateral, and alar cartilages), which comprise the remaining two-thirds, ensuring flexibility. *Upper 1/2 is bony, and lower 1/2 is cartilaginous* - The anatomical ratio is not 1:1; the **cartilaginous component** provides the majority of the structure and length of the external nose, extending past the halfway point. - The **bony framework** includes the nasal bridge and is significantly shorter than the soft cartilaginous portion below it. *Upper 2/3rd is bony and the lower 1/3rd is cartilaginous* - This ratio is anatomically reversed and medically inaccurate, as it implies a dominant bony structure, which would make the nose **rigid**. - The **cartilaginous elements** are necessary for the mobility and shape of the nasal tip and alae, comprising the bulk (two-thirds) of the external framework. *None of the above* - Since the description "upper 1/3rd bony and lower 2/3rd cartilaginous" is anatomically accurate, this option is incorrect. - The correct anatomical framework is well-established in standard anatomy references and medical literature. [Practice more FMGE 2023 questions on OnCourse]

Q: A 55-year-old man is diagnosed with left testicular carcinoma. Which of the following lymph nodes is the first to be involved?

Para-aortic lymph nodes. ***Para-aortic lymph nodes***- The testes originate in the retroperitoneum, and their lymphatic drainage follows the **gonadal vessels**, primarily draining to the **paraaortic** (L1/L2 level) nodes, irrespective of descent into the scrotum.- For the **left testis**, the primary landing site for metastatic cancer is the **para-aortic chain** due to its drainage pathway along the left gonadal vein into the left renal vein [1].*Inguinal lymph nodes*- These nodes drain the **scrotal skin**, coverings, and structures superficial to the **tunica vaginalis**, not the testis itself [1].- Involvement of inguinal nodes only occurs late in the disease if the tumor has invaded the scrotal wall, or post-scrotal trauma/surgery [1].*Iliac lymph nodes*- These nodes (internal and external) primarily drain the **pelvic structures** (e.g., bladder, prostate, lower limb).- They are considered second-echelon nodes for testicular cancer, typically involved only after spread to the primary retroperitoneal (para-aortic/paracaval) chains.*Pre-caval lymph nodes*- These nodes are the primary landing site for the **right testicular carcinoma** because the right testicular vein drains directly into the **Inferior Vena Cava (IVC)**.- For the left testis, the drainage is primarily routed to the **para-aortic** nodes, although some crossover to the pre-caval nodes may occur later. [Practice more FMGE 2023 questions on OnCourse]

282 Previous Year Questions with Answers & Explanations

282

Questions

Subjects

All (282)Anatomy (23)Anesthesiology (5)Biochemistry (15)Community Medicine (25)Dermatology (9)ENT (9)Forensic Medicine (9)Internal Medicine (43)Microbiology (11)Obstetrics and Gynecology (22)Ophthalmology (7)Orthopaedics (6)Pathology (14)Pediatrics (14)Pharmacology (20)Physiology (11)Psychiatry (5)Radiology (12)Surgery (22)

Anatomy

5 questions

Identify the histological image below.

A patient presents cyst on the neck with anterior to the sternocleidomastoid at the junction of the upper and middle third of the muscle. This cyst is due to the persistence of which of the following embryological clefts?

A patient presented to the OPD with an abnormal gait. On examination, a right-sided hip drop was observed when the patient was asked to stand on the left foot. Which of the following muscles are paralyzed in this patient?

The framework of the external nose:

A 55-year-old man is diagnosed with left testicular carcinoma. Which of the following lymph nodes is the first to be involved?

FMGE 2023 - Anatomy FMGE Practice Questions and MCQs

Question 1: Identify the histological image below.

A. Pseudostratified columnar epithelium
B. Non-keratinized squamous epithelium
C. Stratified squamous epithelium
D. Transitional epithelium (Correct Answer)

Explanation: ***Transitional epithelium***- This is also known as **urothelium** and is specialized to line the urinary tract (ureters, bladder, proximal urethra) due to its unique structure.- It is characterized by large, bulbous surface cells called **dome cells** or **umbrella cells**, which protect subepithelial layers from urine. *Pseudostratified columnar epithelium*- This epithelium appears layered because the nuclei are at different levels, but all cells rest on the **basement membrane**.- It is commonly found lining the respiratory tract (**trachea** and bronchi) where it typically features **cilia** and goblet cells. *Non-keratinized squamous epithelium*- This tissue consists of multiple layers of cells (stratified) where the surface cells are flattened and **nucleated**.- Locations include the lining of the **vagina**, esophagus, and oral cavity, where protection from abrasion is needed. *Stratified squamous epithelium*- This general category includes both keratinized and non-keratinized types, but it lacks the characteristic **dome cells** of urothelium.- Its main function is providing robust protection from **mechanical stress**, and it does not exhibit the high degree of stretchability seen in the bladder lining.

Question 2: A patient presents cyst on the neck with anterior to the sternocleidomastoid at the junction of the upper and middle third of the muscle. This cyst is due to the persistence of which of the following embryological clefts?

A. 1st cleft
B. 2nd cleft (Correct Answer)
C. 3rd cleft
D. 4th cleft

Explanation: ***2nd cleft***- A cyst appearing anterior to the **sternocleidomastoid muscle (SCM)**, especially at the junction of the upper and middle third, is the classical presentation of a second branchial cleft cyst (BCC) [1].- Persistence of the **cervical sinus**, which is formed by the rapid growth of the second arch covering the 2nd, 3rd, and 4th clefts, results in the most common type of BCC (over 90%).*1st cleft*- First branchial cleft cysts are rare and typically manifest near the **external auditory canal**, the angle of the mandible, or within the parotid gland [1].- These defects are often associated with the structures of the first arch, such as the **facial nerve** or parotid gland parenchyma.*3rd cleft*- Cysts derived from the third cleft are uncommon and usually present lower in the neck, often close to or piercing the **thyrohyoid membrane**.- A third cleft fistula would course **posterior to the carotid arteries** and anterior to the vagus nerve before ending in the pyriform sinus.*4th cleft*- Remnants of the fourth cleft are extremely rare and typically involve a fistula that tracks inferiorly to the great vessels (e.g., the **aortic arch** on the left side).- Fourth arch defects are often associated with recurrent **thyroiditis** or infection originating from the pyriform sinus.

Question 3: A patient presented to the OPD with an abnormal gait. On examination, a right-sided hip drop was observed when the patient was asked to stand on the left foot. Which of the following muscles are paralyzed in this patient?

A. Right gluteus maximus and gluteus medius
B. Right gluteus medius and gluteus minimus
C. Left gluteus maximus and gluteus medius
D. Left gluteus medius and gluteus minimus (Correct Answer)

Explanation: ***Left gluteus medius and gluteus minimus*** - The Trendelenburg sign is positive when the pelvis drops on the side opposite the one being stood on (the unsupported side). - This indicates paralysis or weakness of the **hip abductors** on the **standing leg** (left side in this case), which are the gluteus medius and gluteus minimus, responsible for stabilizing the pelvis. - These muscles are innervated by the **superior gluteal nerve**. *Right gluteus maximus and gluteus medius* - Paralysis of muscles on the right side would typically manifest as a deficit when bearing weight on the **right leg** (causing the left hip to drop). - The **gluteus maximus** is mainly a powerful hip extensor (needed for climbing stairs, running, and rising from a seated position) and does not play the primary role in stabilizing the pelvis during single-leg stance. *Right gluteus medius and gluteus minimus* - If these muscles on the right side were paralyzed, the pelvis would drop on the **left side** when the patient attempts to stand on the right foot. - The finding of a right hip drop while standing on the left foot confirms the deficit is on the ipsilateral side of the standing limb (the **left side**). *Left gluteus maximus and gluteus medius* - While the **left gluteus medius** is correctly identified as being paralyzed, the inclusion of the gluteus maximus is inaccurate. - The **gluteus maximus** is innervated by the **inferior gluteal nerve** (not the superior gluteal nerve), and its paralysis causes difficulty with activities requiring hip extension, such as climbing stairs or rising from a chair (gluteus maximus lurch). - The Trendelenburg sign specifically tests the **superior gluteal nerve** and the hip abductors (gluteus medius and minimus), not the gluteus maximus.

Question 4: The framework of the external nose:

A. Upper 1/3rd bony and lower 2/3rd cartilaginous (Correct Answer)
B. Upper 1/2 is bony, and lower 1/2 is cartilaginous
C. Upper 2/3rd is bony and the lower 1/3rd is cartilaginous
D. None of the above

Explanation: ***Upper 1/3rd bony and lower 2/3rd cartilaginous*** - The superior portion (root and bridge) of the external nose is supported by the **nasal bones** and the **frontal process of the maxilla**, constituting the bony framework (approximately the upper third). - The inferior portion (apex and alae) is primarily supported by the **hyaline cartilages** (septal, lateral, and alar cartilages), which comprise the remaining two-thirds, ensuring flexibility. *Upper 1/2 is bony, and lower 1/2 is cartilaginous* - The anatomical ratio is not 1:1; the **cartilaginous component** provides the majority of the structure and length of the external nose, extending past the halfway point. - The **bony framework** includes the nasal bridge and is significantly shorter than the soft cartilaginous portion below it. *Upper 2/3rd is bony and the lower 1/3rd is cartilaginous* - This ratio is anatomically reversed and medically inaccurate, as it implies a dominant bony structure, which would make the nose **rigid**. - The **cartilaginous elements** are necessary for the mobility and shape of the nasal tip and alae, comprising the bulk (two-thirds) of the external framework. *None of the above* - Since the description "upper 1/3rd bony and lower 2/3rd cartilaginous" is anatomically accurate, this option is incorrect. - The correct anatomical framework is well-established in standard anatomy references and medical literature.

Question 5: A 55-year-old man is diagnosed with left testicular carcinoma. Which of the following lymph nodes is the first to be involved?

A. Inguinal lymph nodes
B. Para-aortic lymph nodes (Correct Answer)
C. Iliac lymph nodes
D. Pre-caval lymph nodes

Explanation: ***Para-aortic lymph nodes***- The testes originate in the retroperitoneum, and their lymphatic drainage follows the **gonadal vessels**, primarily draining to the **paraaortic** (L1/L2 level) nodes, irrespective of descent into the scrotum.- For the **left testis**, the primary landing site for metastatic cancer is the **para-aortic chain** due to its drainage pathway along the left gonadal vein into the left renal vein [1].*Inguinal lymph nodes*- These nodes drain the **scrotal skin**, coverings, and structures superficial to the **tunica vaginalis**, not the testis itself [1].- Involvement of inguinal nodes only occurs late in the disease if the tumor has invaded the scrotal wall, or post-scrotal trauma/surgery [1].*Iliac lymph nodes*- These nodes (internal and external) primarily drain the **pelvic structures** (e.g., bladder, prostate, lower limb).- They are considered second-echelon nodes for testicular cancer, typically involved only after spread to the primary retroperitoneal (para-aortic/paracaval) chains.*Pre-caval lymph nodes*- These nodes are the primary landing site for the **right testicular carcinoma** because the right testicular vein drains directly into the **Inferior Vena Cava (IVC)**.- For the left testis, the drainage is primarily routed to the **para-aortic** nodes, although some crossover to the pre-caval nodes may occur later.

Biochemistry

1 questions

In the liver, the Apo-B gene is completely translated to ApoB-100; in the intestine, it is translated to ApoB-48. Which of the following mechanism explains this?

Microbiology

1 questions

The culture media that is used to differentiate lactose fermenters and non-lactose fermenters is

Physiology

2 questions

The first heart sound coincides with which cardiac cycle phase?

Which among the following is true regarding creatinine clearance?

FMGE 2023 - Physiology FMGE Practice Questions and MCQs

Question 1: The first heart sound coincides with which cardiac cycle phase?

A. Rapid atrial filling
B. Aortic ejection
C. Isovolumetric contraction (Correct Answer)
D. Isovolumetric relaxation

Explanation: ***Isovolumetric contraction*** - The **first heart sound (S1)** is produced by the simultaneous closure of the **mitral** and **tricuspid** (atrioventricular) valves. - This closure occurs the moment ventricular pressure exceeds atrial pressure, marking the beginning of **ventricular systole** and the phase of isovolumetric contraction. *Rapid atrial filling* - Rapid atrial filling (or **rapid ventricular filling**) occurs during **early diastole** when the mitral and tricuspid valves open. - This phase is associated with the potential generation of a **third heart sound (S3)**, not S1. *Aortic ejection* - Aortic ejection occurs *after* S1, commencing when the **aortic valve** opens because left ventricular pressure exceeds aortic pressure. - This phase ends with the closure of the semilunar valves, which produces the second heart sound (**S2**). *Isovolumetric relaxation* - Isovolumetric relaxation begins immediately after the **second heart sound (S2)**, which is caused by the closure of the aortic and pulmonic valves. - This phase is fully contained within **early diastole**, preceding ventricular filling.

Question 2: Which among the following is true regarding creatinine clearance?

A. Equal to inulin clearance
B. It is less than inulin clearance
C. It is more than inulin clearance (Correct Answer)
D. Equal to renal plasma flow

Explanation: ***It is more than inulin clearance*** - Creatinine clearance **overestimates GFR** by approximately 10-20% compared to inulin clearance - This is because creatinine undergoes both **glomerular filtration AND tubular secretion** - The additional secretion increases the amount of creatinine excreted, making the calculated clearance higher - **Inulin clearance** remains the gold standard as inulin is only filtered (not secreted or reabsorbed) *Equal to inulin clearance* - Incorrect: Creatinine undergoes tubular secretion in addition to filtration, so clearances are not equal *It is less than inulin clearance* - Incorrect: This would only be true if creatinine were reabsorbed, but it is actually secreted, making its clearance higher *Equal to renal plasma flow* - Incorrect: Renal plasma flow is measured by PAH (para-aminohippuric acid) clearance (~650 mL/min), which is much higher than creatinine clearance (~120-130 mL/min) or GFR (~120 mL/min)

Radiology

1 questions

In the given barium swallow image, which of the following shows the left atrium impression on the esophagus?