FMGE 2018 Practice Questions

Q: Pointing index finger is seen in which nerve injury

Median. ***Median*** - The **pointing index finger** sign occurs in **proximal median nerve injury** when attempting to make a fist, as the median nerve supplies **flexor digitorum superficialis (FDS)** and lateral half of **flexor digitorum profundus (FDP)**. - This creates the classic **"hand of benediction"** or **"pope's blessing"** sign where index and middle fingers remain extended due to loss of flexion capability. *Axillary* - Primarily innervates the **deltoid** and **teres minor muscles**, affecting **shoulder abduction** and external rotation. - Injury does not cause any **finger positioning abnormalities** or hand deformities. *Radial* - Injury causes **"wrist drop"** with inability to extend the wrist, thumb, and fingers at **MCP joints**. - Results in all fingers remaining **flexed due to unopposed flexor action**, not a pointing finger deformity. *Ulnar* - Injury causes **"claw hand"** deformity primarily affecting the **ring and little fingers** (4th and 5th digits). - Creates **hyperextension at MCP joints** and **flexion at PIP/DIP joints**, with the index finger typically less affected.

Q: Most common malignancy of maxillary antrum:

Squamous cell Carcinoma. ***Squamous cell Carcinoma*** - **Squamous cell carcinoma (SCC)** accounts for approximately **80% of all malignant tumors** of the maxillary antrum. - This prevalence is due to the **squamous metaplasia** of the respiratory epithelium lining the sinus, especially in response to chronic irritation or inflammation. *Mucoepidermoid Carcinoma* - While it can occur in the maxillary sinus, **mucoepidermoid carcinoma** is a rare tumor, typically arising from **minor salivary glands**. - It is far **less common** than squamous cell carcinoma in the maxillary antrum. *Adenoid cystic Carcinoma* - **Adenoid cystic carcinoma** is a relatively rare tumor that more commonly affects the **major and minor salivary glands** and is known for its **perineural invasion** and slow growth, but it is not the most common in the maxillary antrum. - Its presence in the maxillary sinus is usually an **extension from adjacent structures** or a primary tumor of minor salivary glands within the sinus. *Adenocarcinoma* - **Adenocarcinoma** of the maxillary antrum is less common than SCC, often associated with exposure to **wood dust** or **leather processing**. - It typically arises from **seromucinous glands** within the sinus lining, but its incidence is significantly lower than that of squamous cell carcinoma.

Q: In Goodpasture syndrome, which organ is involved apart from the lung?

Kidney. ***Kidney*** - Goodpasture syndrome is an **autoimmune disease** that primarily targets the a3 chain of **type IV collagen**, which is found in the **basement membranes** of both the glomeruli in the kidneys and the alveoli in the lungs. [1] - This leads to rapidly progressive **glomerulonephritis** and **pulmonary hemorrhage**, making the kidney a key organ involved alongside the lungs. [1] *Heart* - The heart is generally **not directly involved** in Goodpasture syndrome. - Cardiac symptoms are typically **secondary** to severe anemia from pulmonary hemorrhage or fluid overload from kidney failure. *Spleen* - The spleen is **not a target organ** for the autoantibodies in Goodpasture syndrome. - While it plays a role in immune responses, it is not directly damaged by the disease process itself. *Liver* - The liver is **not affected** by the autoantibodies in Goodpasture syndrome. - **Type IV collagen**, the autoantigen, is not a significant component of the liver basement membranes.

Q: Keratometry is done to assess:

Curvature of cornea. ***Curvature of cornea*** - **Keratometry** is specifically designed to measure the **radius of curvature of the anterior surface of the cornea**. - This measurement is essential for detecting and quantifying **astigmatism** and for fitting **contact lenses** and calculating **intraocular lens (IOL) power**. *Corneal thickness* - **Corneal thickness** is measured by **pachymetry**, not keratometry. - Pachymetry is used to assess conditions like **corneal edema** or prior to certain refractive surgeries. *Corneal sensation* - **Corneal sensation** is tested using a fine wisp of cotton or a **corneal aesthesiometer**. - This evaluates the integrity of the **corneal nerves** and blink reflex. *Corneal endothelium* - The **corneal endothelium** is assessed using **specular microscopy** to evaluate cell count, size, and shape. - This is important for surgical planning and monitoring **corneal dystrophies**.

Q: Malignancy in a multinodular goiter is most often:-

Papillary carcinoma. ***Papillary carcinoma*** - **Papillary carcinoma** is the most common type of thyroid cancer, accounting for about 80-85% of all thyroid malignancies [1], [2]. - It often arises in the setting of multifocal disease or within a **multinodular goiter**, particularly when a dominant nodule undergoes malignant transformation [2]. *Anaplastic carcinoma* - **Anaplastic carcinoma** is a very aggressive and rare form of thyroid cancer, typically presenting as a rapidly growing neck mass in elderly patients [2]. - While it can occur in a multinodular goiter, it is far less common than papillary carcinoma and carries a much poorer prognosis [2]. *Follicular carcinoma* - **Follicular carcinoma** is the second most common type of thyroid cancer (10-15%) and is often difficult to distinguish from benign follicular adenomas without surgical excision [2]. - While it can be found in a multinodular goiter, **papillary carcinoma** is still statistically more frequent in this context [1]. *Medullary carcinoma* - **Medullary carcinoma** originates from the parafollicular C cells of the thyroid and accounts for about 1-2% of all thyroid cancers [2]. - It is often associated with inherited syndromes like **Multiple Endocrine Neoplasia type 2 (MEN2)** and is distinct from tumors arising from follicular cells within a multinodular goiter [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1098-1099. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 429-430.

Q: Which of the following infectious diseases is the most likely cause of granuloma formation?

Leprosy. ***Leprosy*** - Leprosy is a classic example of a chronic infection that leads to **granuloma formation**, particularly in its tuberculoid and borderline tuberculoid forms [1]. - The immune response to *Mycobacterium leprae* involves the formation of **macrophage-rich granulomas** to contain the infection, often affecting the skin and nerves [2]. *Syphilis* - While syphilis can cause **gummas**, which are granulomatous lesions, these are typically seen in tertiary syphilis and are less characteristic of granuloma formation across all stages compared to leprosy [3]. - Gummas are often **necrotic** and can be widespread, but the primary pathology of syphilis involves vasculitis and inflammation rather than classic granulomatous tissue reaction. *Cat scratch disease* - Caused by *Bartonella henselae*, this infection typically leads to **lymphadenopathy** with **stellate microabscesses** and sometimes epithelioid granulomas, but the granulomas are usually less prominent and distinct than those seen in leprosy. - The histological features are dominated by **suppurative necrosis** within lymphoid tissue rather than well-formed, non-caseating granulomas. *Trench fever* - Trench fever, caused by *Bartonella quintana*, primarily presents with **fever**, **bone pain**, and a **maculopapular rash**. - It does not typically cause **granuloma formation**; the pathology is more related to bacteremia and inflammation of vascular endothelium. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 385-386. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 638-639. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, p. 360.

Q: Compression ventilation ratio in case of Neonatal CPR:

3:1. ***3:1*** - In **neonatal CPR**, a compression to ventilation ratio of **3 compressions per 1 breath** is recommended. This ratio prioritizes ventilation due to the most common cause of cardiac arrest in neonates being **hypoxia**. - This ratio aims to deliver sufficient oxygen while maintaining adequate cardiac output for the unique physiology of newborns. *30:2* - A 30:2 ratio is generally recommended for **adult CPR** when a single rescuer is present, as adults often have initial cardiac etiologies. - This ratio would provide insufficient ventilations for a neonate whose primary arrest cause is typically respiratory. *100:8* - This ratio is not a standard recommendation for any age group in Cardiopulmonary Resuscitation guidelines. - It would lead to an imbalance, offering a disproportionately high number of compressions relative to ventilations, which is not optimal for neonatal resuscitation. *15:2* - A 15:2 ratio is typically recommended for **pediatric CPR** when two or more rescuers are present. - While closer to the neonatal requirement for ventilation, it still does not provide the immediate and frequent ventilations needed for neonates.

Q: A 6-year-old child presents with hepatosplenomegaly and generalized lymphadenopathy along with fever. The child developed a rash after being administered ampicillin. What could be the possible diagnosis?

Infectious mononucleosis. ***Infectious mononucleosis*** - The combination of **hepatosplenomegaly**, **generalized lymphadenopathy**, and fever in a child is highly suggestive of infectious mononucleosis, typically caused by the **Epstein-Barr virus (EBV)**. - A characteristic feature is the development of a **maculopapular rash** following the administration of ampicillin or amoxicillin. *Kawasaki disease* - Characterized by **fever**, generalized rash, lymphadenopathy, and mucocutaneous inflammation, but typically does not involve significant **hepatosplenomegaly**. - The rash in Kawasaki disease is not typically triggered by **ampicillin**. *Scarlet fever* - Caused by a **Streptococcus pyogenes** infection and presents with a characteristic **sandpaper-like rash**, **strawberry tongue**, and fever. - It usually does not involve significant **hepatosplenomegaly** or a rash specifically induced by ampicillin. *HIV infection* - While HIV can cause **generalized lymphadenopathy** and **hepatosplenomegaly**, especially in children, the sudden onset of a rash specifically after ampicillin administration is not a hallmark of acute or chronic HIV infection. - Other opportunistic infections and **growth failure** would likely be present in advanced HIV.

Q: Double depression is seen in:

Depression with dysthymia. ***Depression with dysthymia*** - **Double depression** is a specific mood disorder characterized by the co-occurrence of a **major depressive episode** on top of a pre-existing **dysthymic disorder** (persistent depressive disorder). - This means an individual experiences the chronic, milder symptoms of dysthymia, which are then worsened by the more severe symptoms of a major depressive episode. *Depression with anxiety attack* - While depression and anxiety attacks can co-occur, this specific combination is not referred to as **double depression**. - **Anxiety attacks** are acute episodes of intense fear and discomfort, often associated with panic disorder, and are distinct from chronic low-grade depressive symptoms. *Major depression with OCD* - **Obsessive-compulsive disorder (OCD)** is a distinct anxiety disorder characterized by obsessions and compulsions, which can co-occur with major depression. - However, the term **double depression** specifically refers to the combination of major depression and dysthymia, not other psychiatric comorbidities. *Major depressive disorder from 2 years* - Experiencing **major depressive disorder for 2 years** implies a chronic course of major depression. - If the symptoms meet the criteria for major depressive disorder continuously for at least two years, it might be termed **chronic major depressive disorder**, but not double depression, unless there was an underlying dysthymia.

Q: Best treatment strategy for carcinoma of the anal canal:

Chemoradiation. ***Chemoradiation*** - Carcinoma of the anal canal is primarily treated with **chemoradiation** (combinations of chemotherapy and radiation therapy) as the standard of care to achieve **organ preservation**. - This combined approach improves local control and survival rates compared to either modality alone, making it the **primary curative strategy** for most localized anal canal cancers. *Radiation* - While radiation therapy is a crucial component of anal canal cancer treatment, using it alone (**monotherapy**) is generally less effective than chemoradiation. - **Local recurrence rates** are higher with radiation alone compared to combined modality treatment. *Surgery* - Surgery, specifically **abdominoperineal resection (APR)**, is typically reserved for **recurrent disease** or cases where chemoradiation fails. - Initial radical surgery for anal canal cancer leads to significant morbidity (e.g., permanent colostomy) and is generally avoided as a primary treatment due to the success of chemoradiation. *Chemotherapy* - Chemotherapy alone is **not curative** for localized anal canal carcinoma. - It is primarily used in combination with radiation (chemoradiation) to sensitize the tumor to radiation and improve local control, or as treatment for **metastatic disease**.

Question 1

Pointing index finger is seen in which nerve injury

Accepted Answer

Median

Answer

Axillary

Answer

Radial

Answer

Ulnar

Question 2

Most common malignancy of maxillary antrum:

Accepted Answer

Squamous cell Carcinoma

Answer

Muco-epidermoid Carcinoma

Answer

Adenoid cystic Carcinoma

Answer

Adenocarcinoma

Question 3

In Goodpasture syndrome, which organ is involved apart from the lung?

Accepted Answer

Kidney

Answer

Heart

Answer

Spleen

Answer

Liver

Question 4

Keratometry is done to assess:

Accepted Answer

Curvature of cornea

Answer

Corneal thickness

Answer

Corneal sensation

Answer

Corneal endothelium

Question 5

Malignancy in a multinodular goiter is most often:-

Accepted Answer

Papillary carcinoma

Answer

Anaplastic carcinoma

Answer

Follicular carcinoma

Answer

Medullary carcinoma

Question 6

Which of the following infectious diseases is the most likely cause of granuloma formation?

Accepted Answer

Leprosy

Answer

Syphilis

Answer

Cat scratch disease

Answer

Trench fever

Question 7

Compression ventilation ratio in case of Neonatal CPR:

Accepted Answer

3:1

Answer

30:2

Answer

100:8

Answer

15:2

Question 8

A 6-year-old child presents with hepatosplenomegaly and generalized lymphadenopathy along with fever. The child developed a rash after being administered ampicillin. What could be the possible diagnosis?

Accepted Answer

Infectious mononucleosis

Answer

Kawasaki disease

Answer

Scarlet fever

Answer

HIV infection

Question 9

Double depression is seen in:

Accepted Answer

Depression with dysthymia

Answer

Depression with anxiety attack

Answer

Major depression with OCD

Answer

Major depressive disorder from 2 years

Question 10

Best treatment strategy for carcinoma of the anal canal:

Accepted Answer

Chemoradiation

Answer

Radiation

Answer

Surgery

Answer

Chemotherapy

FMGE 2018

Anatomy

ENT

Internal Medicine

Ophthalmology

Pathology

Pediatrics

Psychiatry

Surgery