Anatomy
1 questionsWhich of the following structures does not form the boundary of Hesselbach's triangle?
FMGE 2024 - Anatomy FMGE Practice Questions and MCQs
Question 101: Which of the following structures does not form the boundary of Hesselbach's triangle?
- A. Inferior epigastric artery
- B. Vas deferens (Correct Answer)
- C. Inguinal ligament
- D. Rectus abdominis
Explanation: ***Correct: Vas deferens*** - The vas deferens is a component of the **spermatic cord**, which passes through the **deep inguinal ring**, located superior and lateral to Hesselbach's triangle - It does **not** form any of the boundaries of Hesselbach's triangle [1] - The spermatic cord is located deep to the inguinal canal and does not define any of the superficial boundaries *Incorrect: Inferior epigastric artery* - This vessel forms the **lateral border** (or superolateral border) of Hesselbach's triangle [1] - Its anatomical position differentiates between **direct inguinal hernias** (medial to the artery, through Hesselbach's triangle) and **indirect inguinal hernias** (lateral to it) *Incorrect: Rectus abdominis* - The lateral edge of the **rectus abdominis muscle** (or its sheath) defines the **medial boundary** of Hesselbach's triangle [1] - This medial boundary marks the point through which direct inguinal hernias can protrude medially *Incorrect: Inguinal ligament* - The **inguinal ligament** forms the **inferior boundary** (or base) of Hesselbach's triangle [1] - This ligament represents the thickened lower margin of the **external oblique aponeurosis** extending from the ASIS to the pubic tubercle [1]
Internal Medicine
1 questionsA 40-year-old man presents with gynecomastia. Ultrasound reveals a 1 cm solid mass within the body of the testis. Serum testosterone is 600 ng/dL, and estradiol is 35 pg/mL. What is the most likely diagnosis?
FMGE 2024 - Internal Medicine FMGE Practice Questions and MCQs
Question 101: A 40-year-old man presents with gynecomastia. Ultrasound reveals a 1 cm solid mass within the body of the testis. Serum testosterone is 600 ng/dL, and estradiol is 35 pg/mL. What is the most likely diagnosis?
- A. Leydig cell tumor (Correct Answer)
- B. Sertoli cell tumor
- C. Spermatocytic tumor
- D. Granulosa cell tumor
Explanation: ***Correct: Leydig cell tumor*** - **Most common** sex cord-stromal tumor in adults, accounting for **1-3%** of all testicular tumors - Arises from interstitial cells that produce **testosterone and estradiol** through aromatization [2], [4] - Classic presentation: **Gynecomastia** (30-40% of cases) due to increased estrogen production or altered testosterone/estrogen ratio [1], [3] - Typically presents as a **small, benign solid mass** (90% are <5 cm and benign) [3] - Ultrasound shows **solid, well-circumscribed intratesticular mass** [3] - Laboratory findings: **Elevated estradiol**, testosterone may be normal or elevated [3] *Incorrect: Sertoli cell tumor* - Less common sex cord-stromal tumor (also can cause gynecomastia but **much rarer** than Leydig cell tumor) - Only **10-20%** present with endocrine manifestations - More likely to present with painless testicular mass without hormonal effects - When hormonal effects occur, usually **estrogen production** but less pronounced than Leydig cell tumor *Incorrect: Spermatocytic tumor* - Germ cell tumor that occurs in **older men** (mean age 50-55 years) - **Does NOT produce hormones** - no gynecomastia - Presents as painless testicular enlargement - Typically larger masses, good prognosis, virtually **never metastasizes** *Incorrect: Granulosa cell tumor* - **Extremely rare** in males (primarily an ovarian tumor) - When it occurs in males, can produce estrogen and cause gynecomastia - However, represents **<1%** of testicular tumors in males - Leydig cell tumor is far more common with this presentation
Psychiatry
1 questionsWhat is the diagnosis for a patient who believes their bodily sensations or movements are controlled or influenced by an external agency?
FMGE 2024 - Psychiatry FMGE Practice Questions and MCQs
Question 101: What is the diagnosis for a patient who believes their bodily sensations or movements are controlled or influenced by an external agency?
- A. C. Othello syndrome
- B. D. Somatic passivity (Correct Answer)
- C. A. Delusion of nihilism
- D. B. Delusion of reference
Explanation: ***Somatic passivity***- This symptom describes the delusional belief that one's **bodily sensations**, movements, or actions (e.g., movements of the limbs, feelings in the body) are being controlled or imposed upon by an **external agency** or force.- It is considered one of **Schneider's First-Rank Symptoms** (FRS) of **schizophrenia**, highlighting profound disturbances in self-boundaries and agency.*Delusion of nihilism*- This delusion, often seen in severe depression or psychosis (e.g., **Cotard's syndrome**), is the belief that one is dead, does not exist, or that parts of the body or the world do not exist.- It does not involve the feeling of **external control** or influence over existing bodily movements or sensations.*Delusion of reference*- This is the belief that otherwise innocuous or neutral events, objects, or people's actions in the environment have a particular and unusual meaning specifically **referring to oneself**.- It relates to interpreting the environment (e.g., hearing a radio broadcast talking *about* them), not the feeling of bodily movements being **controlled by external forces**.*Othello syndrome*- Also known as **morbid jealousy** or **delusional jealousy**, this is a specific type of delusional disorder characterized by the fixed, unfounded belief that one's partner is being **unfaithful**.- It is focused strictly on relationships and fidelity and has no association with beliefs of external control over **somatic functions**.
Radiology
3 questionsWhich among the following is most radiosensitive?
Radioisotope used in PET-CT scan?
Ideal thickness of lead aprons to be worn by workers in radiology department?
FMGE 2024 - Radiology FMGE Practice Questions and MCQs
Question 101: Which among the following is most radiosensitive?
- A. D. Muscle
- B. A. Testis (Correct Answer)
- C. B. Bone
- D. C. Nerve
Explanation: ***Testis*** - The testes contain actively proliferating **spermatogonial stem cells**, making them one of the most radiosensitive organs in the body after the lymphoid tissue and bone marrow. - According to the **Law of Bergonié and Tribondeau**, tissues with high mitotic activity and low differentiation are highly radiosensitive. *Bone* - Mature bone tissue is relatively radioresistant, particularly when compared to highly proliferative organs like the gonads or hematopoietic tissue. - While the red bone marrow within the bone is highly sensitive, the osteocytes and bone matrix are much more resistant to immediate radiation effects. *Nerve* - Nerve tissue is composed of highly specialized, terminally differentiated cells (neurons) that are non-proliferative. - Due to the lack of mitotic activity, the central nervous system and peripheral nerves exhibit very high radioresistance. *Muscle* - Muscle tissue (skeletal, cardiac, and smooth) is differentiated and consists of terminally post-mitotic cells. - Like nerve tissue, muscle is highly radioresistant, requiring large doses of radiation to induce functional or structural damage.
Question 102: Radioisotope used in PET-CT scan?
- A. Iodine
- B. Radium
- C. Cesium-131
- D. 18F-FDG (Correct Answer)
Explanation: ***18F-FDG*** - It is a **glucose analogue** labeled with the positron-emitting isotope **Fluorine-18**, making it the ideal tracer for measuring metabolic activity in tissues. - It is widely used in PET-CT because highly metabolic cells (like cancer cells and active neurons) accumulate it, allowing visualization of **hypermetabolic activity**. *Iodine* - Refers typically to **Iodine-131** or **Iodine-123**, which are primarily used in **thyroid imaging** and therapy. - These isotopes are **gamma emitters** detected by SPECT, not positron emitters required for PET. *Radium* - **Radium-223** (Radium chloride) is an **alpha emitter** used therapeutically for **metastatic prostate cancer** affecting the bone. - It is not a positron emitter and is not designed for diagnostic functional imaging scans like PET. *Cesium-131* - **Cesium-131** is a low-energy **gamma emitter** primarily used in **brachytherapy seeds** for localized radiation treatment. - It does not undergo positron decay and is therefore unsuitable for generating the specific annihilation photons required for PET scanning.
Question 103: Ideal thickness of lead aprons to be worn by workers in radiology department?
- A. 0.75mm
- B. 0.5mm (Correct Answer)
- C. 2mm
- D. 1mm
Explanation: ***0.5mm***- This thickness is considered the standard and ideal lead equivalent for the front of protective aprons worn by radiology personnel, providing adequate shielding against **scatter radiation**.- A **0.5 mm** lead equivalent attenuates approximately 97% of the scatter radiation generated during standard fluoroscopic procedures (at 100 kVp), offering optimal protection balanced against manageable weight.*1mm*- A **1mm** lead equivalent apron provides marginally greater attenuation but is significantly heavier, leading to high risk of **musculoskeletal injury** due to the excessive load.- This high thickness is generally unnecessary, as the additional protection gained does not outweigh the ergonomic burden imposed by the increased **weight and stiffness**.*0.75mm*- While offering adequate protection, **0.75mm** is heavier than the standardized 0.5mm minimum requirement for routine fluoroscopy and general radiography protection.- The current standards and practice focus on using **0.5mm** lead equivalent to minimize staff injury and fatigue while ensuring sufficient protection against diagnostic X-rays.*2mm*- A **2mm** lead equivalent apron is extremely heavy and completely impractical for daily operational use due to the severe restrictions on mobility and the significant **physical strain**.- Protection levels that high are typically unnecessary because departmental personnel are protected primarily against low-energy **scatter radiation**, not the high-intensity primary X-ray beam.
Surgery
3 questionsWhich of the following is not an indication for splenectomy?
A patient underwent surgery for pilonidal sinus, which type of flap is used in this surgery?
Which nerve is most commonly injured during indirect inguinal hernia surgery?
FMGE 2024 - Surgery FMGE Practice Questions and MCQs
Question 101: Which of the following is not an indication for splenectomy?
- A. Hairy cell leukemia
- B. Thrombocytopenia
- C. Iatrogenic splenic trauma
- D. Bone marrow failure (Correct Answer)
Explanation: ***Bone marrow failure*** - In bone marrow failure (e.g., aplastic anemia), the spleen serves as an important site of **extramedullary hematopoiesis** (compensatory blood cell production outside the bone marrow) - Splenectomy would **remove this compensatory mechanism** and worsen the patient's condition - Therefore, bone marrow failure is a **contraindication**, not an indication for splenectomy *Hairy cell leukemia* - This is a chronic B-cell lymphoproliferative disorder with massive splenomegaly - Splenectomy is indicated when medical treatment fails or for symptomatic relief *Thrombocytopenia* - Immune thrombocytopenic purpura (ITP) is a classic indication for splenectomy - Performed when medical management (steroids, IVIG) fails - Spleen is the primary site of platelet destruction in ITP *Iatrogenic splenic trauma* - Intraoperative injury to the spleen during abdominal surgery - Splenectomy is indicated when hemostasis cannot be achieved or injury is severe (Grade IV-V)
Question 102: A patient underwent surgery for pilonidal sinus, which type of flap is used in this surgery?
- A. Rhomboid flap (Correct Answer)
- B. Free flap
- C. Rotational flap
- D. Advancement flap
Explanation: ***Rhomboid flap***- The **Limberg flap** is a classic type of rhomboid transposition flap widely used for closing the deep, large defect left after wide excision of a pilonidal sinus.- This flap provides excellent tissue coverage, shifts the scar away from the midline natal cleft, and significantly reduces tension, leading to lower rates of **recurrence**.*Advanced flap*- An advancement flap involves moving tissue linearly forward, which often results in high tension when used to close the typical wide, ovoid defect remaining after pilonidal sinus excision.- They are less suitable for deep and wide midline defects compared to rotational or transposition flaps because they do not effectively flatten the **natal cleft** or distribute tension laterally.*Rotational flap*- While rotational flaps (like the **Karydakis flap**) are effective for pilonidal disease by excising the disease and closing the defect laterally, the **Limberg flap** is specifically a rhomboid transposition flap and is arguably the most classic answer for a geometric local flap used in this surgery.- Simple rotational flaps might be used, but the effectiveness and precision provided by the rhomboid geometry for large defects make the Limberg (rhomboid) technique particularly notable.*Free flap*- **Free flaps** involve microsurgical anastomosis to connect tissue from a distant site, a level of surgical complexity unnecessary for standard pilonidal sinus reconstruction.- These flaps are reserved for very large, complex defects, often requiring coverage where local tissue has been destroyed by cancer or **osteomyelitis**, which is usually not the case in routine pilonidal surgery.
Question 103: Which nerve is most commonly injured during indirect inguinal hernia surgery?
- A. Genitofemoral nerve
- B. Obturator nerve
- C. Femoral nerve
- D. Ilioinguinal nerve (Correct Answer)
Explanation: ***Ilioinguinal nerve*** - This nerve travels superficial to the **external oblique aponeurosis** along the inguinal canal, making it extremely susceptible to direct trauma from surgical incisions, suture placement, or mesh fixation near the **pubic tubercle**. - Injury results in chronic pain and paresthesia (burning sensation) along its distribution, affecting the groin, lateral base of the penis/scrotum, and medial aspect of the thigh (**ilioinguinal neuralgia**). *Femoral nerve* - The femoral nerve lies deep to the **inguinal ligament** lateral to the femoral artery (part of the **NAVEL** bundle), a position deep and lateral to the primary operative field for indirect hernia repair. - Injury is rare in standard open inguinal hernia repair but can occur during deep retraction, or if the hernia dissection extends deeply and laterally below the inguinal ligament. *Genitofemoral nerve* - The genital branch traverses the inguinal canal within the **spermatic cord** and can be injured; however, the ilioinguinal nerve is more frequently involved due to its proximity to the surgical incision lines. - Injury to the genital branch specifically causes loss of the **cremaster reflex** and sensory loss over the anterior scrotum or labia. *Obturator nerve* - This nerve is located deep within the pelvis, passing through the **obturator canal** to supply the adductor muscles and medial thigh skin. - It is anatomically remote from the standard superficial and anterior approach required during routine indirect inguinal hernia repair.