FMGE 2018 Practice Questions

Q: Which bone attaches the sternum to the scapula?

Clavicle. **Explanation:** The **Clavicle** (collarbone) is the correct answer because it serves as the only bony attachment between the upper limb and the axial skeleton. This connection is formed through two primary joints: 1. **Sternoclavicular (SC) Joint:** The medial end of the clavicle articulates with the manubrium of the sternum. 2. **Acromiovicular (AC) Joint:** The lateral end of the clavicle articulates with the acromion process of the scapula. By bridging these two points, the clavicle acts as a "strut," holding the scapula and humerus away from the thorax to allow for maximum range of motion. **Why other options are incorrect:** * **Manubrium:** This is the superior part of the sternum itself. While it provides the site for clavicular attachment, it does not directly reach or attach to the scapula. * **First Rib:** It lies inferior to the clavicle and articulates with the manubrium and the T1 vertebra. It does not articulate with the scapula (the scapula "glides" over the ribs via the physiological scapulothoracic joint, but there is no bony attachment). * **Second Rib:** It articulates with the sternal angle (Angle of Louis) and the T2 vertebra, playing no role in connecting the sternum to the scapula. **High-Yield NEET-PG Pearls:** * **First bone to ossify:** The clavicle is the first bone in the body to begin ossification (5th–6th week of fetal life). * **Ossification type:** It is the only long bone that undergoes **intramembranous ossification** (though its ends undergo endochondral ossification). * **Fracture Site:** The most common site of fracture is the junction of the medial two-thirds and lateral one-third. * **Clinical Sign:** In clavicular fractures, the medial fragment is elevated by the **Sternocleidomastoid** muscle.

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

Mandibular. The facial nerve (CN VII) exits the stylomastoid foramen and enters the parotid gland, where it divides into five terminal branches that provide motor innervation to the muscles of facial expression. **1. Why Mandibular is Correct:** The **Marginal Mandibular branch** emerges from the lower part of the parotid gland and runs along or just below the lower border of the mandible. It supplies the muscles of the lower lip and chin, specifically the **depressor anguli oris, depressor labii inferioris, and mentalis**. Damage to this branch results in an asymmetrical smile due to the inability to depress the corner of the mouth on the affected side. **2. Why Other Options are Incorrect:** * **Temporal:** Supplies the muscles above the eye, including the frontalis, orbicularis oculi (upper part), and corrugator supercilii. * **Cervical:** Runs downward to supply the **platysma** muscle in the neck. * **Buccal:** Supplies the muscles of the cheek (**buccinator**) and the upper lip (orbicularis oris, levator labii superioris). While it contributes to the mouth area, the specific innervation for *lower lip depression* is mandibular. **3. High-Yield Clinical Pearls for NEET-PG:** * **Pes Anserinus:** The "goose's foot" pattern formed by the five terminal branches (Temporal, Zygomatic, Buccal, Mandibular, Cervical) within the parotid gland. * **Danger Zone:** The marginal mandibular nerve is vulnerable during submandibular gland surgery as it can dip up to 1–2 cm below the inferior border of the mandible. * **Buccinator Paradox:** The buccinator is a muscle of facial expression (supplied by the Buccal branch of CN VII) but is often confused with muscles of mastication (supplied by CN V3).

Q: A child presents with the skin lesions shown in the image. The most likely diagnosis is:

Impetigo contagiosa. ***Impetigo contagiosa*** - The image shows **honey-colored crusted lesions** around the mouth, which are highly characteristic of **impetigo contagiosa (non-bullous impetigo)**. - This form of impetigo is typically caused by *Staphylococcus aureus* or *Streptococcus pyogenes* and primarily affects superficial layers of the epidermis. *Bullous impetigo* - Characterized by **flaccid bullae** (blisters) that rupture to leave a thin, varnish-like crust, rather than the thick honey-colored crusts seen here. - It is exclusively caused by **Staphylococcus aureus** strains producing exfoliative toxins. *Ritter disease* - Also known as **Staphylococcal Scalded Skin Syndrome (SSSS)**, this condition involves widespread **erythema and exfoliation** resembling a burn. - It is a severe, systemic illness with widespread skin involvement, not localized crusted lesions like those pictured. *Ecthyma* - This is a more **deep-seated skin infection** that penetrates into the dermis, characterized by **"punched-out" ulcers** with thick, adherent crusts and often leaves scars. - While also caused by *Staphylococcus aureus* and/or *Streptococcus pyogenes*, its lesions are typically more severe and destructive than what is depicted.

Q: A 6-year-old child is brought with the following lesion. He can develop lesions in which organ in future?

Small intestine. ***Small intestine*** - The image shows **perioral melanotic macules**, specifically around the mouth, which are classic cutaneous manifestations of **Peutz-Jeghers syndrome**. - Peutz-Jeghers syndrome is an **autosomal dominant disorder** characterized by these mucocutaneous pigmentations and an increased risk of developing **hamartomatous polyps** in the gastrointestinal tract. - The **small intestine** is the **most commonly affected site** for polyps in Peutz-Jeghers syndrome, with **60-90% of patients** developing small bowel polyps, particularly in the **jejunum**. - These polyps can cause complications including **intussusception**, bleeding, and obstruction. - Patients also have an increased risk of **malignancies** in the small intestine and other organs (breast, ovary, pancreas, colon). *Colon (Large Intestine)* - While colonic polyps do occur in Peutz-Jeghers syndrome (**20-30% of cases**), they are **less frequent** than small intestinal polyps. - The colon is a secondary site of involvement compared to the small intestine. - Increased risk of colorectal cancer exists but the predominant polyp site remains the small bowel. *Stomach* - Gastric polyps occur in **approximately 25% of patients** with Peutz-Jeghers syndrome. - While gastric involvement can occur, it is **less common** than small intestinal involvement. - The stomach is a secondary site compared to the small intestine. *Esophagus* - Esophageal involvement with polyps in Peutz-Jeghers syndrome is **very rare**. - The typical distribution of hamartomatous polyps extends from stomach to rectum, with minimal esophageal involvement. - Esophagus is the least commonly affected GI organ in this syndrome.

Q: A 35-year-old lady who presented with a 6-month painless fluctuant, non-transilluminant swelling with a thin watery discharge. Clinical diagnosis is?

TB. ***TB*** - **Tuberculosis (TB)** lymphadenopathy often presents as a **painless, fluctuant, non-transilluminant cervical swelling** (scrofula) with possible **thin, watery discharge** from a sinus tract [1]. - The 6-month duration indicates a **chronic process**, consistent with the indolent nature of TB infection [1]. *Brachial cyst* - A **branchial cleft cyst** typically presents as a **smooth, movable, and sometimes fluctuant neck mass**, but it is usually **transilluminant** unless infected. - While it can discharge, the fluid is often mucoid, and the discharge is less commonly described as thin and watery; also it typically develops during childhood or early adulthood. *Secondaries* - **Metastatic lymph nodes (secondaries)** are generally **firm, non-fluctuant, and non-tender**, and do not typically discharge thin watery fluid unless there is necrosis or ulceration of the overlying skin. - The absence of associated primary malignancy symptoms also makes this less likely. *Lymphoma* - **Lymphoma** presents as often **painless rubbery, firm, and non-fluctuant lymph node enlargement**, and discharge is not a typical feature unless there is skin involvement or ulceration in advanced stages. - The described fluctuance and watery discharge are not characteristic of simple lymphoma.

Question 1

Which bone attaches the sternum to the scapula?

Accepted Answer

Clavicle

Answer

Manubrium

Answer

First rib

Answer

Second rib

Question 2

Which branch of the facial nerve supplies the muscles of the lower lip?

Accepted Answer

Mandibular

Answer

Temporal

Answer

Cervical

Answer

Buccal

Question 3

A child presents with the skin lesions shown in the image. The most likely diagnosis is:

Accepted Answer

Impetigo contagiosa

Answer

Bullous impetigo

Answer

Ritter disease

Answer

Ecthyma

Question 4

A 6-year-old child is brought with the following lesion. He can develop lesions in which organ in future?

Accepted Answer

Small intestine

Answer

Esophagus

Answer

Colon (Large Intestine)

Answer

Stomach

Question 5

A 35-year-old lady who presented with a 6-month painless fluctuant, non-transilluminant swelling with a thin watery discharge. Clinical diagnosis is?

Accepted Answer

TB

Answer

Brachial cyst

Answer

Secondaries

Answer

Lymphoma

FMGE 2018

Anatomy

Dermatology

Pediatrics

Surgery