FMGE 2023 — Anatomy

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 Anatomy PYQs 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 Anatomy PYQs 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 Anatomy PYQs 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 Anatomy PYQs 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 Anatomy PYQs on OnCourse]

23 Previous Year Questions with Answers & Explanations

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?

Identify the sinus marked in the image.

Which of the following is the right lateral rectus yoke muscle?

In relation to which wall of the orbit are the canaliculi that open into the lacrimal sac present?

Which lymph node is most commonly involved in prostate cancer?

Q10

Identify the segment marked in red in the image below.

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.

Question 6: Identify the sinus marked in the image.

A. Pyriform sinus
B. Ethmoid sinus
C. Maxillary sinus (Correct Answer)
D. Frontal sinus

Explanation: ***Maxillary sinus*** - The image correctly identifies the **maxillary sinuses**, which are the largest paranasal sinuses located within the body of the maxilla, lateral to the nasal cavity and inferior to the orbits. - These sinuses are often implicated in **sinusitis**, and pain from an infection can be referred to the maxillary (upper) teeth. *Frontal sinus* - The **frontal sinuses** are located superior to the orbits, within the frontal bone of the forehead. In the diagram, these are represented by the purple structures above the eyes. - They are not situated in the cheek area as highlighted by the red circle. *Pyriform sinus* - The **pyriform sinus** (or fossa) is not a paranasal sinus but a recess on either side of the laryngopharynx, involved in swallowing. - It is located in the throat, much inferior to the structures shown in the facial diagram. *Ethmoid sinus* - The **ethmoid sinuses** are a collection of small air cells located between the orbits, within the ethmoid bone. In the diagram, they are the light blue structures superior to the maxillary sinuses. - They are situated medial to the orbits and superior to the highlighted maxillary sinuses.

Question 7: Which of the following is the right lateral rectus yoke muscle?

A. Right superior oblique
B. Left medial rectus (Correct Answer)
C. Right medial rectus
D. Left lateral rectus

Explanation: ***Left medial rectus***- The **yoke muscle** concept is based on **Hering's Law of Equal Innervation**, which requires equal stimulation for the muscle pair responsible for parallel movement in both eyes.- When the **right lateral rectus** abducts the right eye during gaze to the right (**dextroversion**), the **left medial rectus** must simultaneously adduct the left eye to maintain conjugate gaze [1]. *Right superior oblique*- This muscle primarily causes **intorsion** and depression of the right eye, and is not involved in primary lateral movements [1].- It acts conjugately with the **Left Inferior Rectus** when the gaze is directed down and to the right. *Left lateral rectus*- This muscle is responsible for **abduction of the left eye**, which contributes to gaze to the **left (levoversion)** [1].- It is the yoke muscle for the **Right medial rectus**. *Right medial rectus*- This muscle is the **antagonist** of the right lateral rectus, responsible for adduction of the right eye [1].- It works with the left lateral rectus when moving the gaze to the **left (levoversion)**.

Question 8: In relation to which wall of the orbit are the canaliculi that open into the lacrimal sac present?

A. Medial wall (Correct Answer)
B. Superior wall
C. Inferior wall
D. Lateral wall

Explanation: ***Medial wall*** - The **lacrimal sac**, into which the canaliculi open, is lodged in the **lacrimal fossa**, which is anatomically a component of the medial wall of the orbit [1]. - Both the superior and inferior **lacrimal canaliculi** run medially from their respective puncta towards the lacrimal sac, confirming their close association with the medial wall. *Lateral wall* - This wall is primarily formed by the **zygomatic bone** and the greater wing of the **sphenoid**, serving mainly for muscular attachment (e.g., lateral rectus). - It is completely separated from the lacrimal drainage apparatus, which is confined to the medial aspect of the orbit. *Superior wall* - The superior wall (roof) is chiefly composed of the **frontal bone** and separates the orbit from the **anterior cranial fossa**. - Although the lacrimal gland is housed in a fossa on the roof's anterolateral aspect, the excretory part (sac and canaliculi) is located medially. *Inferior wall* - The inferior wall (floor) is mainly formed by the **maxilla** and separates the orbit from the **maxillary sinus** [1]. - It contains the **infraorbital groove and canal** but is anatomically distant from the structures involved in tear drainage into the lacrimal sac.

Question 9: Which lymph node is most commonly involved in prostate cancer?

A. a.Deep inguinal
B. b.Pelvic
C. d.Internal iliac (Correct Answer)
D. c.Superficial inguinal

Explanation: ***Internal iliac*** - The **internal iliac (hypogastric) lymph nodes** are the **primary and most common** site of lymphatic drainage from the prostate gland. - These nodes, along with the **obturator** and **external iliac** nodes, form the regional pelvic lymph node basin for prostate cancer metastasis. - In prostate cancer staging, metastasis to regional pelvic nodes (N1 disease) most commonly involves the **internal iliac nodes** as the first echelon. - This is the most anatomically specific and clinically relevant answer for the primary lymphatic drainage of the prostate. *Deep inguinal* - **Deep inguinal nodes** drain structures distal to the prostate, such as the lower limb and parts of the external genitalia. - These nodes are not part of the primary drainage pathway for the prostate gland. - Involvement would only occur in very advanced disease with extensive spread. *Pelvic* - While "pelvic lymph nodes" is a correct broad anatomical term encompassing the internal iliac, obturator, and external iliac nodes, it is **too non-specific** for this question. - When asked for the **most common** specific lymph node group involved, the answer should identify the **primary drainage site** (internal iliac) rather than the general region. *Superficial inguinal* - These nodes primarily drain the skin and superficial tissues of the lower abdominal wall, perineum, and lower limbs. - They are not involved in primary prostatic drainage and would only be affected in extremely advanced disease with local invasion.

Question 10: Identify the segment marked in red in the image below.

A. a.V (Correct Answer)
B. c.VII
C. b.IVa
D. d.III

Explanation: ***a.V*** - The highlighted area represents **Segment V** of the liver according to the **Couinaud classification**. It is located in the inferior portion of the **right anterior section**. - It lies inferior to **Segment VIII** and is separated from the medial segment (IVb) by the **middle hepatic vein**. *b.IVa* - **Segment IVa** is part of the **left medial section** and is located superiorly, just inferior to the diaphragm. - The structure shown is in the **right lobe** of the liver, not the left medial section. *c.VII* - **Segment VII** is located in the superior part of the **right posterior section** of the liver. - The highlighted segment is in the **anterior section**, separated from the posterior section by the **right hepatic vein**. *III* - **Segment III** is part of the **left lateral section** of the liver, located anteriorly and inferiorly within that section. - The highlighted structure is part of the **right lobe**, well to the right of the falciform ligament and middle hepatic vein.