FMGE 2017 Practice Questions

Q: The cranial nerve passing through cavernous sinus is

Abducens. ***Abducens*** - The **abducens nerve (CN VI)** is the only cranial nerve that travels **through the substance of the cavernous sinus** itself, running alongside the internal carotid artery. - This unique intracavernous location makes it the most vulnerable cranial nerve to injury from cavernous sinus pathology (thrombosis, tumors, aneurysms). - Other nerves (CN III, IV, V1, V2) run in the **lateral wall** of the sinus, not through it. *Olfactory* - The **olfactory nerve (CN I)** runs from the nasal cavity through the cribriform plate to the olfactory bulb. - It does not traverse the cavernous sinus. *Facial* - The **facial nerve (CN VII)** exits the skull via the stylomastoid foramen and has a complex course through the temporal bone. - It does not pass through the cavernous sinus. *Optic* - The **optic nerve (CN II)** exits the orbit through the optic canal to reach the optic chiasm. - It does not travel through the cavernous sinus, though it is in close anatomical proximity to structures anterior to it.

Q: NOT a content of superior mediastinum

Left superior intercostal artery. ***Left superior intercostal artery*** - The **left superior intercostal artery** arises from the **costocervical trunk** (a branch of the subclavian artery) and is NOT considered a primary content of the superior mediastinum. - It descends to supply the **first and second (sometimes third) intercostal spaces** on the left side. - While it may pass near the superior mediastinum, it is anatomically classified with the **posterior mediastinum** structures. *Arch of aorta* - The **arch of the aorta** is a major structure within the **superior mediastinum** [1]. - It gives off three major branches: brachiocephalic trunk, left common carotid artery, and left subclavian artery [2]. - It extends from approximately the level of the **second costal cartilage** to the **lower border of T4 vertebra**. *Thymus* - The **thymus gland** is located in the **anterior mediastinum**, NOT the superior mediastinum [1]. - It lies posterior to the sternum and anterior to the pericardium and great vessels. - However, it may extend superiorly into the lower part of the neck, and in some classifications, its superior portion overlaps with the superior mediastinum [1]. *Pulmonary trunk* - The **pulmonary trunk** is located in the **middle mediastinum** within the pericardial sac, NOT the superior mediastinum [1]. - It originates from the **right ventricle** at a level below the superior mediastinum (which extends only to the sternal angle/T4-5 level). - It carries deoxygenated blood from the right ventricle to the lungs.

Q: Which of the following has a polygenic pattern of inheritance?

Diabetes mellitus. **Diabetes mellitus** - **Type 2 Diabetes Mellitus**, the most common form, is a classic example of a **polygenic disease**, meaning it results from the interaction of multiple genes and environmental factors. - Many genes contribute to aspects like **insulin resistance** and **beta-cell dysfunction**, leading to the disease. *Familial hypercholesterolemia* - This condition is inherited in an **autosomal dominant** pattern, primarily due to mutations in a single gene, most commonly the **LDL receptor gene**. - While other genes can influence cholesterol levels, the severe form of familial hypercholesterolemia is typically **monogenic**. *Resistant rickets* - **X-linked hypophosphatemia**, also known as vitamin D-resistant rickets, is inherited in an **X-linked dominant** pattern. - It is caused by mutations in the **PHEX gene**, which affects phosphate reabsorption in the kidneys. *G6PD* - **Glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency)** is an **X-linked recessive** disorder. - It is caused by mutations in a single gene on the X chromosome, making it a **monogenic** condition.

Q: Microsporum involves:

Skin and hair. ***Skin and hair*** - *Microsporum* species are **dermatophytes** that commonly cause superficial fungal infections - They have a particular predilection for keratinized tissues like **skin and hair**, leading to conditions such as **tinea capitis** (scalp ringworm) and **tinea corporis** (body ringworm) - This is the characteristic pattern for *Microsporum* species including *M. canis*, *M. audouinii*, and *M. gypseum* *Skin and nails* - While *Microsporum* can affect the skin, its involvement with **nails (onychomycosis)** is extremely rare - Nail infections are typically associated with **Trichophyton rubrum** or **T. mentagrophytes**, not *Microsporum* *Hair and nails* - **Nail involvement** is not a characteristic of *Microsporum* infections - The main sites of infection are hair and smooth skin, not nails *Skin, hair and nails* - Including **nails** as a site for *Microsporum* is inaccurate; its primary targets are skin and hair only - While some dermatophytes (like *Trichophyton*) can affect all three tissues, *Microsporum* has specific tropism for skin and hair

Q: Fatty liver with hepatomegaly is seen in:

Metabolic syndrome. ***Metabolic syndrome*** - **Metabolic syndrome** is characterized by a cluster of conditions, including **insulin resistance**, obesity, hypertension, and dyslipidemia, which frequently lead to **non-alcoholic fatty liver disease (NAFLD)** and subsequent hepatomegaly [1]. - The accumulation of fat in the liver is a direct consequence of the metabolic derangements, leading to hepatic steatosis, inflammation, and potential fibrosis, with **hepatomegaly** often being a palpable clinical sign [1]. *Marasmus* - **Marasmus** is a form of severe protein-energy malnutrition characterized by significant **weight loss** and muscle wasting, but typically **does not involve fatty liver** or hepatomegaly. - In marasmus, caloric intake is severely deficient, leading to the mobilization of fat stores rather than accumulation in the liver [2]. *Nutmeg liver* - **Nutmeg liver** is a characteristic pathological finding in **congestive hepatopathy**, most often due to **right-sided heart failure**. - It results from chronic passive venous congestion, causing a mottled appearance with alternating areas of congestion and normal parenchyma, but not primarily **fatty infiltration**. *Wilson disease* - **Wilson disease** is a rare genetic disorder of **copper metabolism** that leads to excessive copper accumulation in various organs, including the liver, brain, and eyes. - While it can cause hepatomegaly and liver disease, the primary pathology is copper overload, not **fatty infiltration**, though steatosis can occur secondary to chronic liver injury. *Additional Note* - Enlargement of the liver due to fatty infiltration occurs when triacylglycerol accumulation exceeds the liver's capacity to secrete VLDL, a process seen in conditions like uncontrolled diabetes and certain metabolic stresses [2].

Q: In uveitis, site of keratic precipitate is:

Corneal endothelium. ***Corneal endothelium*** - **Keratic precipitates (KPs)** are inflammatory cellular deposits that adhere to the **posterior surface of the cornea**, specifically the endothelial layer, in uveitis. - They represent aggregates of inflammatory cells, such as macrophages and lymphocytes, that have migrated from the inflamed anterior chamber. *Lens anterior capsule* - The **anterior capsule of the lens** is a smooth, acellular membrane and does not typically accumulate inflammatory deposits like **keratic precipitates**. - While inflammatory cells can be observed in the **anterior chamber**, they do not specifically adhere to the lens capsule in this manner. *Lens posterior capsule* - Similar to the anterior capsule, the **posterior capsule of the lens** is not the site for deposition of **keratic precipitates**. - Inflammation affecting the lens would typically present as cataract formation or direct lens inflammation, not KPs. *Corneal stroma* - The **corneal stroma** is the thickest layer of the cornea and is primarily composed of collagen fibrils and keratocytes. - While inflammation can affect the stroma (e.g., in stromal keratitis), **keratic precipitates** specifically form on the **innermost layer**, the endothelium, facing the anterior chamber.

Q: Most common type of lesion in Pott's spine:

Paradiscal. ***Paradiscal*** - **Paradiscal lesions** are the most characteristic and common type of lesion in Pott's spine (approximately 50% of cases), preferentially affecting the anterior vertebral body adjacent to the intervertebral disc [1]. - This location is rich in **vascularity**, allowing Mycobacterium tuberculosis to spread more easily and cause significant destruction of the vertebral bodies and discs [1]. - Typically results in **angular kyphosis (gibbus deformity)** due to anterior vertebral collapse. *Posterior* - **Posterior lesions** affect the posterior elements of the vertebrae including the pedicles, laminae, and spinous processes. - This is the **rarest type** of tuberculous spinal involvement. - May present with neurological deficits due to posterior encroachment on the spinal canal. *Central* - A **central lesion** in Pott's spine involves primarily the vertebral body itself, without specific early involvement of the disc space or adjacent vertebrae. - This type is less common than paradiscal lesions and typically leads to **vertebra plana** (flat vertebra) or uniform **compression fracture** rather than angular kyphosis. *Anterior* - **Anterior lesions** affect the front part of the vertebral body and can lead to a wedge-shaped collapse. - While the anterior column is frequently involved, the term "anterior" is less specific than "paradiscal" in describing the most common initial location that characteristically spreads to the intervertebral disc space. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1197-1198.

Q: Which is the most specific clinical feature for diagnosis of Kwashiorkor?

Easy pluckable hair. ***Easy pluckable hair*** - **Easy pluckable hair** is a highly specific clinical sign of Kwashiorkor, indicating severe **protein deficiency** affecting hair follicle integrity. - This symptom, often accompanied by changes in hair color and texture (e.g., **flag sign**), highlights the chronic lack of essential amino acids. *Edema* - **Edema** is a prominent feature of Kwashiorkor, resulting from low **oncotic pressure** due to **hypoalbuminemia**. - While characteristic, edema can also be seen in other conditions like **cardiac**, **renal**, or **hepatic failure**, making it less specific than hair changes. *Fatty liver* - **Fatty liver** (hepatic steatosis) is commonly observed in Kwashiorkor due to impaired synthesis and export of **VLDL** from the liver. - Although characteristic, fatty liver can also occur in **obesity**, **alcoholism**, and **diabetes**, reducing its specificity as a standalone diagnostic feature. *Low serum albumin* - **Low serum albumin** is a hallmark biochemical finding in Kwashiorkor, reflecting severe **protein malnutrition** and reduced hepatic synthesis. - While critical for diagnosis, hypoalbuminemia can also be caused by severe **liver disease**, **nephrotic syndrome**, or **malabsorption**, limiting its specificity for Kwashiorkor alone.

Q: Drug of choice for treatment of akathisia is:-

Propranolol. ***Propranolol*** - **Beta-blockers** like propranolol are considered first-line for treating **akathisia**, especially in cases induced by antipsychotics. - They work by reducing the **adrenergic hyperactivity** and the sensation of inner restlessness characteristic of akathisia. *Haloperidol* - Haloperidol is a **first-generation antipsychotic** that is a common cause of drug-induced **akathisia**. - Administering it would likely **worsen** rather than treat the condition. *Fluoxetine* - Fluoxetine is a **selective serotonin reuptake inhibitor (SSRI)** used to treat depression and anxiety disorders. - It is not indicated for the treatment of **akathisia** and can sometimes induce or worsen motor restlessness. *Lithium* - Lithium is a **mood stabilizer** primarily used for bipolar disorder. - It is not a treatment for **akathisia** and can itself cause various neurological side effects, though akathisia is less common.

Q: A nondiabetic, nonhypertensive patient has occasional extra heartbeats. The doctor informed them it is benign, but the patient continues to seek investigations from doctor to doctor. This is a type of:

Illness Anxiety Disorder. ***Illness Anxiety Disorder*** - This condition is characterized by **preoccupation with having or acquiring a serious illness**, despite minimal or no somatic symptoms, or an excessive preoccupation if symptoms are present. - The patient's repeated seeking of investigations despite medical assurance of a benign condition aligns with the diagnostic criteria of **illness anxiety disorder**, where reassurance has little effect. *Depression* - While **depressive symptoms** (e.g., low mood, anhedonia) can coexist with health anxieties, the primary driver here is the fear of serious illness rather than pervasive sadness or loss of interest. - Patients with depression typically report a **generalized dysphoria** or lack of energy, which is not the central issue described. *Conversion disorder* - Involves **neurological symptoms** (e.g., paralysis, blindness, seizures) that are incompatible with recognized neurological conditions and are not intentionally produced. - The patient's concern is about a benign cardiac finding, not the sudden onset of **functional neurological deficits**. *Somatoform pain* - This term is older and has largely been replaced by **Somatic Symptom Disorder with predominant pain**, where psychological factors play a significant role in the onset, severity, exacerbation, or maintenance of pain. - The patient's main concern is about the **implication of a benign symptom** rather than experiencing overwhelming pain itself.

Question 1

The cranial nerve passing through cavernous sinus is

Accepted Answer

Abducens

Answer

Olfactory

Answer

Facial

Answer

Optic

Question 2

NOT a content of superior mediastinum

Accepted Answer

Left superior intercostal artery

Answer

Arch of aorta

Answer

Thymus

Answer

Pulmonary trunk

Question 3

Which of the following has a polygenic pattern of inheritance?

Accepted Answer

Diabetes mellitus

Answer

Familial hypercholesterolemia

Answer

Resistant rickets

Answer

G6PD

Question 4

Microsporum involves:

Accepted Answer

Skin and hair

Answer

Skin and nails

Answer

Hair and nails

Answer

Skin, hair and nails

Question 5

Fatty liver with hepatomegaly is seen in:

Accepted Answer

Metabolic syndrome

Answer

Marasmus

Answer

Nutmeg liver

Answer

Wilson disease

Question 6

In uveitis, site of keratic precipitate is:

Accepted Answer

Corneal endothelium

Answer

Lens anterior capsule

Answer

Lens posterior capsule

Answer

Corneal stroma

Question 7

Most common type of lesion in Pott's spine:

Accepted Answer

Paradiscal

Answer

Posterior

Answer

Central

Answer

Question 8

Which is the most specific clinical feature for diagnosis of Kwashiorkor?

Accepted Answer

Easy pluckable hair

Answer

Edema

Answer

Fatty liver

Answer

Low serum albumin

Question 9

Drug of choice for treatment of akathisia is:-

Accepted Answer

Propranolol

Answer

Haloperidol

Answer

Fluoxetine

Answer

Lithium

Question 10

A nondiabetic, nonhypertensive patient has occasional extra heartbeats. The doctor informed them it is benign, but the patient continues to seek investigations from doctor to doctor. This is a type of:

Accepted Answer

Illness Anxiety Disorder

Answer

Depression

Answer

Conversion disorder

Answer

Somatoform pain

FMGE 2017

Anatomy

Biochemistry

Dermatology

Internal Medicine

Ophthalmology

Pathology

Pediatrics

Psychiatry