FMGE 2018 Practice Questions

Q: Foot eversion is caused by

Peroneus longus. ***Peroneus longus*** - The **peroneus longus** muscle (fibularis longus) is a primary evertor of the foot. - It originates from the head and upper lateral surface of the fibula, inserts into the medial cuneiform and first metatarsal, and its contraction pulls the foot outwards and downwards. *Tibialis anterior* - The **tibialis anterior** is the primary dorsiflexor and invertor of the foot. - It pulls the foot upwards and inwards, which is the opposite action of eversion. *Tibialis posterior* - The **tibialis posterior** is a strong invertor and plantar flexor of the foot. - It contributes to maintaining the arch of the foot and does not cause eversion. *Extensor digitorum* - The **extensor digitorum longus** primarily extends the toes and assists in dorsiflexion of the ankle. - While it may have a slight eversion component, it is not the primary muscle responsible for foot eversion.

Q: Bleeding vessel in hemorrhoids is

Superior rectal artery. Superior rectal artery - Hemorrhoidal bleeding primarily originates from the **terminal branches of the superior rectal artery** within the hemorrhoidal plexus. - The hemorrhoidal cushions contain **arteriovenous anastomoses**, and bleeding occurs from rupture or erosion of the **arterial component**. - This explains why hemorrhoidal bleeding is typically **bright red** (oxygenated arterial blood) and can be brisk. - Modern surgical treatments like **hemorrhoidal artery ligation (HAL)** specifically target these arterial branches, confirming the arterial source of bleeding. Superior rectal vein - While the superior rectal vein drains the hemorrhoidal plexus and is dilated in hemorrhoids, it is **not the primary source of bleeding**. - The venous component contributes to the cushion engorgement but the **actual bleeding is arterial** in nature. - This is an older, outdated concept that has been revised with modern understanding of hemorrhoidal pathophysiology. Middle rectal vein - The middle rectal vein drains the **muscular wall of the rectum** and has minimal involvement in the hemorrhoidal venous plexus. - It is not a significant contributor to hemorrhoidal bleeding. Middle rectal artery - The middle rectal artery provides collateral blood supply to the rectum but plays a **minor role** compared to the superior rectal artery. - The **superior rectal artery** is the dominant arterial supply to the internal hemorrhoidal plexus and is the primary bleeding source.

Q: Which branch of facial nerve supplies muscles of lower lip

Marginal mandibular. ***Marginal mandibular*** - The **marginal mandibular branch** of the facial nerve innervates muscles of the lower lip and chin, including the **depressor labii inferioris**, **depressor anguli oris**, and **mentalis**. - Damage to this nerve causes an inability to depress the lower lip, leading to an **asymmetric smile**. *Buccal* - The **buccal branch** primarily innervates the **buccinator muscle** and the muscles of the upper lip. - It is crucial for **cheek compression** (e.g., blowing or sucking) and expression around the mouth. *Cervical* - The **cervical branch** supplies the **platysma muscle**, a broad sheet of muscle in the neck that helps depress the mandible and draw down the corners of the mouth. - It does not directly innervate the muscles of the lower lip. *Temporal* - The **temporal branch** provides motor innervation to the muscles of the forehead and around the eye, including the **frontalis** and **orbicularis oculi**. - It is responsible for actions like raising the eyebrows and closing the eyelids.

Q: Syndrome of inappropriate ADH secretion is characterized by all of the following EXCEPT:-

Hypo-osmolar urine. ***Hypo-osmolar urine*** - Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is characterized by the secretion of ADH in excess of what is appropriate for the plasma osmolality. This excess ADH causes the kidneys to retain water, leading to **concentrated (hyper-osmolar) urine** [1]. - Therefore, **hypo-osmolar urine** is not a characteristic of SIADH; rather, **hyper-osmolar urine** is expected as the body tries to excrete concentrated urine to compensate for water retention. *Expanded fluid volume* - The excess ADH in SIADH leads to increased **water reabsorption** by the kidneys [1]. - This increased water retention can result in an **expanded extracellular fluid volume**, although usually without significant peripheral edema due to natriuretic peptide release [2]. *Hyponatremia* - The retained water dilutes the plasma sodium concentration, causing **dilutional hyponatremia** [2]. - This is a hallmark feature of SIADH, as the body holds onto too much free water [2]. *Water intoxication* - The characteristic features of SIADH, including **hyponatremia** and **increased total body water**, directly lead to a state of **water intoxication** [1]. - Symptoms can range from mild (nausea, malaise) to severe (seizures, coma) depending on the severity and rapidity of hyponatremia.

Q: Quellung reaction is seen with:

Pneumococcus. ***Pneumococcus*** - The Quellung reaction, also known as the **Neufeld reaction**, is a classic immunological test used to identify bacteria based on their **capsular polysaccharides**. - In the presence of specific antisera, the capsule of **_Streptococcus pneumoniae_** (Pneumococcus) swells visibly when viewed under a microscope, appearing larger and more refractile. - **Pneumococcus is the CLASSIC organism** associated with the Quellung reaction in clinical microbiology and is the standard answer in medical examinations. - While other encapsulated bacteria (_Haemophilus influenzae_, _Klebsiella pneumoniae_, _N. meningitidis_) can theoretically show capsular swelling, the test is primarily used for and associated with pneumococcal identification. *Gonococcus* - **_Neisseria gonorrhoeae_** (Gonococcus) is a Gram-negative diplococcus that causes sexually transmitted infections. - It does not possess a prominent polysaccharide capsule that exhibits the Quellung reaction in routine clinical practice. *Staphylococcus* - **_Staphylococcus_** species are Gram-positive cocci that form grape-like clusters. - While some staphylococci produce capsules or slime layers, these are not characterized using the Quellung reaction. *Streptococcus* - While _S. pneumoniae_ is technically a species of Streptococcus, in clinical terminology **"Pneumococcus" is the specific term** that denotes this particular organism. - When asked about the Quellung reaction, **"Pneumococcus" is the preferred and correct answer** rather than the broader genus term "Streptococcus." - The Quellung test is not routinely used for other Streptococcus species (like _S. pyogenes_, _S. agalactiae_) in standard clinical practice, making "Pneumococcus" the most accurate answer.

Q: Cause of sudden loss of vision in a diabetic is due to:

Vitreous hemorrhage. ***Vitreous hemorrhage*** - **Vitreous hemorrhage** is the **most common cause** of sudden, painless vision loss in individuals with **proliferative diabetic retinopathy** - New, fragile blood vessels (neovascularization) on the retina in diabetes can rupture, leading to bleeding into the **vitreous gel** - Patients describe sudden onset of floaters, cobwebs, or a red haze obscuring vision *Central retinal vein occlusion* - **CRVO** causes sudden, painless vision loss with **retinal hemorrhages in all four quadrants** (blood and thunder appearance) - While diabetic patients are at increased risk, vision loss is typically less profound than vitreous hemorrhage - Fundoscopy shows widespread retinal hemorrhages, dilated tortuous veins, and cotton-wool spots *Neovascular glaucoma* - **Neovascular glaucoma** causes **painful** vision loss and elevated intraocular pressure due to new vessel growth on the iris and trabecular meshwork - While associated with diabetes, it usually presents with more **gradual onset** and pain, rather than sudden, painless vision loss - Characterized by rubeosis iridis and elevated IOP *Central retinal artery occlusion* - **CRAO** causes sudden, profound, painless monocular vision loss, often described as a "curtain coming down" - While diabetic patients are at higher risk for CRAO due to generalized atherosclerosis, it typically results in a **cherry-red spot** on the macula - This is usually embolic in nature and less specifically related to diabetic retinopathy itself

Q: Obstacles in concomitant squint are:

All of the options. ***All of the options*** - **Concomitant squint** involves **sensory obstacles** (e.g., amblyopia, eccentric fixation), **motor obstacles** (e.g., muscle imbalance, inadequate fusional vergence), and **central obstacles** (e.g., defective brain processing of visual information). - All these factors interact to cause and maintain the misalignment of the eyes. *Sensory obstacles* - These include conditions like **amblyopia** (lazy eye) due to suppression of the deviated eye's image, and **eccentric fixation**, where the fovea is not used for central vision. - While significant, sensory obstacles alone do not fully explain concomitant squint, as motor and central components are also crucial. *Motor obstacles* - These involve issues with the **extraocular muscles**, such as imbalance in muscle tone, or problems with the **neural control** of eye movements, leading to a deviation that is relatively constant in all gaze positions. - Motor obstacles are a key component but are often influenced by central and sensory factors. *Central obstacles* - These refer to problems within the brain's visual pathways and centers responsible for **fusion**, **vergence**, and maintaining **ocular alignment**. - Defective processing of visual input or an inability to maintain binocular vision can directly contribute to squint, highlighting the brain's role in coordinating eye movements.

Q: Albers-Schönberg disease is:

Osteopetrosis. ***Osteopetrosis*** - **Albers-Schönberg disease** is another name for **osteopetrosis**, also known as **marble bone disease** [1]. - It is a group of rare genetic disorders characterized by abnormally **dense bones** due to a defect in **osteoclast** function, leading to impaired bone resorption [1]. *Osteoporosis* - **Osteoporosis** is characterized by decreased bone density and structural deterioration of bone tissue, leading to an increased risk of fractures. - It results from an imbalance where **bone resorption outpaces bone formation**, the opposite of osteopetrosis. *Paget* (Paget's disease of bone) - **Paget's disease of bone** involves localized areas of increased bone turnover, leading to disorganized bone remodeling and weakened, enlarged bones. - It is distinct from osteopetrosis, which involves a generalized increase in bone density. *Osteogenesis imperfecta* - **Osteogenesis imperfecta** (OI), or brittle bone disease, is a genetic disorder causing extremely fragile bones prone to fractures, often due to defects in **collagen production** [1]. - This condition presents with bone fragility and often blue sclera, which is the opposite of the increased bone density seen in osteopetrosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1188-1189.

Q: Inhibin is secreted by:

Sertoli cells. ***Sertoli cells*** - **Sertoli cells** are located in the seminiferous tubules of the testes and play a crucial role in spermatogenesis. - They secrete **inhibin**, a hormone that selectively inhibits the secretion of follicle-stimulating hormone (FSH) from the anterior pituitary gland. *Peg cells* - **Peg cells** (non-ciliated secretory cells) are found in the lining of the fallopian tubes, not the testes. - They produce **tubal fluid** which nourishes the ovum and spermatozoa, and aids in sperm capacitation. *Leydig cells* - **Leydig cells** are found in the interstitial tissue between the seminiferous tubules of the testes. - Their primary function is to produce and secrete **androgens**, such as testosterone, in response to luteinizing hormone (LH). *Interstitial cells* - This term is a general descriptor for cells located in the spaces between functional tissues or organs. - In the context of the testes, **Leydig cells** are the primary interstitial cells responsible for hormone production, while **Sertoli cells** are part of the seminiferous tubules.

Q: Patient with history of blunt trauma to face presents with enophthalmos, diplopia on upward gaze and loss of sensitivity over cheek. True statement about this is:

It is a blow out fracture. ***It is a blow out fracture*** - The combination of **enophthalmos** (sunken eye), **diplopia on upward gaze** (due to **inferior rectus muscle entrapment**), and **loss of sensitivity over the cheek** (indicating infraorbital nerve involvement) are classic signs of an **orbital blowout fracture**. - These fractures typically involve the **orbital floor** or medial wall, caused by a direct impact to the orbit, which transmits force to the thin bony walls causing them to fracture while the orbital rim remains intact. *Maxillary fracture* - While the **infraorbital nerve** passes through the maxilla, a general maxillary fracture typically presents with broader symptoms such as **midfacial pain**, **swelling**, and **malocclusion**, which are not specified here. - Maxillary fractures often involve the **zygomaticomaxillary complex** or Le Fort patterns, which usually lead to more extensive facial abnormalities. *Zygomatic bone is most likely injured* - A **zygomatic arch fracture** would primarily cause **flattening of the cheek** and pain upon opening the mouth, not enophthalmos or diplopia on upward gaze. - While the zygoma forms part of the orbit, isolated zygomatic fractures rarely cause these specific orbital findings. *Frontal bone fracture* - **Frontal bone fractures** typically result from **high-impact trauma** and can involve the **frontal sinus**, leading to **forehead swelling**, **CSF rhinorrhea**, or **periorbital ecchymosis** (raccoon eyes). - The symptoms described are not characteristic of a frontal bone fracture.

Question 1

Foot eversion is caused by

Accepted Answer

Peroneus longus

Answer

Tibialis anterior

Answer

Tibialis posterior

Answer

Extensor digitorum

Question 2

Bleeding vessel in hemorrhoids is

Accepted Answer

Superior rectal artery

Answer

Superior rectal vein

Answer

Middle rectal vein

Answer

Middle rectal artery

Question 3

Which branch of facial nerve supplies muscles of lower lip

Accepted Answer

Marginal mandibular

Answer

Buccal

Answer

Cervical

Answer

Temporal

Question 4

Syndrome of inappropriate ADH secretion is characterized by all of the following EXCEPT:-

Accepted Answer

Hypo-osmolar urine

Answer

Expanded fluid volume

Answer

Hyponatremia

Answer

Water intoxication

Question 5

Quellung reaction is seen with:

Accepted Answer

Pneumococcus

Answer

Gonococcus

Answer

Staphylococcus

Answer

Streptococcus

Question 6

Cause of sudden loss of vision in a diabetic is due to:

Accepted Answer

Vitreous hemorrhage

Answer

Central retinal vein occlusion

Answer

Neovascular glaucoma

Answer

Central retinal artery occlusion

Question 7

Obstacles in concomitant squint are:

Accepted Answer

All of the options

Answer

Sensory obstacles

Answer

Motor obstacles

Answer

Central obstacles

Question 8

Albers-Schönberg disease is:

Accepted Answer

Osteopetrosis

Answer

Osteoporosis

Answer

Paget

Answer

Osteogenesis imperfecta

Question 9

Inhibin is secreted by:

Accepted Answer

Sertoli cells

Answer

Peg cells

Answer

Leydig cells

Answer

Interstitial cells

Question 10

Patient with history of blunt trauma to face presents with enophthalmos, diplopia on upward gaze and loss of sensitivity over cheek. True statement about this is:

Accepted Answer

It is a blow out fracture

Answer

Maxillary fracture

Answer

Zygomatic bone is most likely injured

Answer

Frontal bone fracture

FMGE 2018

Anatomy

Internal Medicine

Microbiology

Ophthalmology

Pathology

Physiology

Surgery