FMGE 2018 Practice Questions

Q: Eustachian tube develops from:

1st pharyngeal pouch. ***1st pharyngeal pouch*** - The **Eustachian tube** (also known as the pharyngotympanic tube or auditory tube) develops from the **endoderm** of the first pharyngeal pouch. - This embryonic structure also gives rise to the **tympanic cavity** and the mastoid air cells, forming part of the middle ear. *2nd and 3rd pharyngeal pouch* - The **second pharyngeal pouch** primarily contributes to the development of the **palatine tonsils**. - The **third pharyngeal pouch** is involved in the formation of the **inferior parathyroid glands** and the **thymus**. *3rd pharyngeal pouch* - The **third pharyngeal pouch** specifically differentiates into the **inferior parathyroid glands** and the **thymus**. - It does not contribute to the formation of the Eustachian tube. *2nd pharyngeal pouch* - The **second pharyngeal pouch** is primarily associated with the development of the **palatine tonsils** and the tonsillar fossa. - It does not play a role in the embryological development of the Eustachian tube.

Q: CSF Otorrhea is due to trauma of:

Petrous temporal bone. ***Petrous temporal bone*** - **CSF otorrhea** (leakage of cerebrospinal fluid from the ear) most commonly results from a fracture of the **petrous portion of the temporal bone**. - This bone forms part of the skull base and houses structures of the inner and middle ear, a fracture here can create a direct communication between the **subarachnoid space** and the external ear canal. *Tympanic membrane* - A rupture of the **tympanic membrane** alone would lead to **otorrhea** (ear discharge), but it would primarily involve blood or middle ear fluid, not CSF. - While a ruptured tympanic membrane is necessary for CSF to exit the ear canal, the source of the CSF leak itself is proximal to the middle ear. *Cribriform plate* - A fracture of the **cribriform plate** typically results in **CSF rhinorrhea** (CSF leakage from the nose), as it is located structurally above the nasal cavity. - It is not directly involved in CSF leakage from the ear. *Parietal bone* - Fractures of the **parietal bone** are typically associated with epidural or subdural hematomas or brain injury, depending on the extent of the trauma. - They are not a usual cause of CSF leakage from the ear since this bone does not contain CSF pathways that directly communicate with the ear.

Q: Which is branching enzyme?

Amylo-1, 4-1, 6-transglycolase. ***Amylo-1, 4-1, 6-transglycolase*** - This enzyme is also known as **glycogen branching enzyme**. - It catalyzes the formation of **α-1,6-glycosidic bonds** by transferring a segment of four to six glucosyl residues from the non-reducing end of a growing glycogen chain to another chain. *Glycogen synthase* - This enzyme is responsible for the **elongation of glycogen chains** by forming **α-1,4-glycosidic bonds**. - It adds glucose units to the non-reducing end of a pre-existing glycogen primer. *Glycogen Phosphorylase* - This enzyme is involved in **glycogen degradation**. - It catalyzes the **phosphorolytic cleavage** of α-1,4-glycosidic bonds, releasing glucose-1-phosphate. *Glucose-6 phosphatase* - This enzyme is primarily found in the **liver** and kidneys and is crucial for **gluconeogenesis** and **glycogenolysis**. - It dephosphorylates glucose-6-phosphate to **free glucose**, allowing its release into the bloodstream.

Q: Preferred biochemical marker(s) in patients presenting with myocardial infarction:

Cardiac specific Troponins. ***Cardiac specific Troponins*** - **Cardiac troponins** (cTnI and cTnT) are the preferred and most sensitive and specific biomarkers for diagnosing **myocardial infarction (MI)**. - They are proteins released into the bloodstream when myocardial cells are damaged, and their levels rise within hours of MI onset and remain elevated for several days. *All of the options* - While other markers like **CK-MB** and **Myoglobin** were historically used, **cardiac troponins** have superior specificity and sensitivity for MI. - The latest guidelines from major cardiology societies recommend troponins as the primary diagnostic markers. *Myoglobin* - **Myoglobin** is an early marker, but it is not specific to cardiac muscle and can be elevated in various conditions involving skeletal muscle damage. - Its short half-life means it can return to normal quickly, making it less reliable for diagnosing MI, especially if there's a delay in presentation. *CK-MB* - **Creatine Kinase-MB (CK-MB)** is a more specific marker than total CK for cardiac muscle damage but is still less specific than cardiac troponins. - It can be elevated in conditions like **myocarditis** or **pericarditis**, and its levels typically peak and decline earlier than troponins, limiting its diagnostic window.

Q: Provision of services at Suraksha Clinic includes

STI/RTI services. ***STI/RTI services*** - **Suraksha clinics** are specifically designed under the National AIDS Control Programme (NACP) to provide comprehensive diagnostic, treatment, and counseling services for individuals with **sexually transmitted infections (STIs) and reproductive tract infections (RTIs)** including HIV. - They focus on promoting sexual health and preventing the spread of STIs through education, awareness, and clinical management. *Blood transfusion safety services* - These services are typically handled by **blood banks** and specialized transfusion medicine departments, focusing on donor screening, blood processing, and safe transfusion practices. - They are not a primary service offered by **Suraksha clinics**, which are geared towards STI/RTI management. *Immunization services* - Immunization services are usually provided at **primary health centers**, pediatric clinics, or through public health campaigns aimed at preventing infectious diseases via vaccination. - While important for public health, they are not the core offering of **Suraksha clinics**. *Diarrhea control services* - Diarrhea control services, including oral rehydration therapy and hygiene education, are typically offered by **general practitioners**, community health workers, and maternal and child health programs. - These are distinct from the specialized focus of **Suraksha clinics** on STI/RTI services.

Q: The recommended upper limit for free residual chlorine in drinking water according to WHO guidelines is:

0.5 mg/L. ***0.5 mg/L*** - The World Health Organization (WHO) recommends maintaining a free residual chlorine level of **0.2-0.5 mg/L** at the point of delivery, with **0.5 mg/L representing the upper end of this recommended range**. - This level provides adequate disinfection throughout the distribution system while minimizing taste and odor complaints. - WHO states there is no health-based upper limit for chlorine, as concentrations used for disinfection are well below levels of health concern, but 0.5 mg/L is commonly cited as the practical upper target for operational purposes. *0.4 mg/L* - While this falls within the acceptable range (0.2-0.5 mg/L), it is not the upper end of the WHO recommended range. - This level provides good disinfection but is not the maximum recommended operational target. *0.2 mg/L* - A free residual chlorine level of **0.2 mg/L** represents the **minimum recommended concentration** at the point of delivery to ensure adequate disinfection. - This is the lower end of the WHO recommended range, not the upper limit. *0.3 mg/L* - This concentration falls in the middle of the WHO recommended range (0.2-0.5 mg/L). - While adequate for disinfection, it is neither the minimum nor the maximum recommended operational level.

Q: Most common site of intracranial metastasis is from primary carcinoma of

Lungs. ***Lungs*** - **Lung cancer** is the most common primary tumor to metastasize to the brain, accounting for approximately **40-50% of all intracranial metastases**. - This high incidence is due to the advanced stage at diagnosis for many lung cancers and the rich vascular supply of the brain. [1] *Testes* - While germ cell tumors of the testes can metastasize to the brain, it is a relatively rare event compared to lung cancer. - Brain metastases from testicular cancer are more common with **choriocarcinoma** histology. *Stomach* - **Gastric cancer** can metastasize to the brain, but it is uncommon, occurring in less than 1% of cases. - When it does occur, it generally indicates widespread disease and a poor prognosis. *Breast* - **Breast cancer** is another common source of brain metastases, but it ranks **second to lung cancer** as a primary source. - The incidence of brain metastases from breast cancer is increasing, partly due to improved systemic treatments extending patient survival.

Q: Crescent forming glomerulonephritis is:-

RPGN. ***RPGN*** - **Rapidly progressive glomerulonephritis (RPGN)** is a clinical syndrome characterized by a rapid decline in **renal function** over weeks to months, often due to severe glomerular injury. - The hallmark **histological feature** of RPGN is the formation of **crescents** in more than 50% of the glomeruli, which are proliferations of parietal epithelial cells and infiltrating macrophages [1]. *MCN* - **Minimal change nephropathy (MCN)** is characterized by **diffuse effacement of podocyte foot processes** on electron microscopy, with normal findings on light microscopy. - It typically presents as **nephrotic syndrome** and does not involve crescent formation. *MPGN* - **Membranoproliferative glomerulonephritis (MPGN)** involves thickening of the glomerular basement membrane with a "tram-track" appearance and mesangial proliferation [2]. - While MPGN can occasionally have focal crescents in some cases, **crescent formation is not a defining or characteristic feature** of MPGN [2]. - MPGN typically presents with nephritic-nephrotic syndrome. *All of the options* - This option is incorrect because only RPGN is characterized by **crescent formation** as a defining feature. - MCN does not involve crescents, and MPGN does not characteristically present with extensive crescent formation, thus invalidating this choice. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 528-529. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 925-926.

Q: Which of the following receptors mediate stretch reflex?

Muscle spindle. ***Muscle spindle*** - Muscle spindles are **stretch-sensitive receptors** located within the muscle belly that detect changes in muscle length and the rate of change in length. - When a muscle is stretched, the muscle spindles are activated, sending signals via **afferent neurons** to the spinal cord, which then initiates a reflex contraction of the same muscle to counteract the stretch—this is the basis of the stretch reflex. *Golgi tendon organ* - **Golgi tendon organs** are located in the tendons and respond to changes in **muscle tension**, not muscle length. Its primary role is to prevent excessive muscle contraction. - When activated by high tension, Golgi tendon organs inhibit the muscle, leading to relaxation (inverse stretch reflex), which is opposite to the stretch reflex. *Meissner's corpuscles* - **Meissner's corpuscles** are **mechanoreceptors** located in the superficial layers of the skin, primarily responsible for detecting **light touch** and **vibrations**. - They are not involved in the regulation of muscle length or tension and therefore do not mediate the stretch reflex. *Merkel's disc* - **Merkel's discs** are **mechanoreceptors** found in the basal layer of the epidermis, specialized for detecting **sustained pressure** and **texture**. - These receptors contribute to fine tactile discrimination but are unrelated to the proprioceptive mechanisms of the stretch reflex.

Q: Most common immediate complication after splenectomy?

Hemorrhage. **Hemorrhage** - **Hemorrhage** is the most common immediate complication due to the spleen's rich blood supply and its close proximity to major vessels such as the **splenic artery and vein**. - Surgical trauma, inadequate ligation, or dislodgment of ligatures can lead to significant blood loss post-splenectomy. *Fistula* - Fistula formation, such as a **pancreatic fistula**, can occur but is less common immediately post-splenectomy compared to hemorrhage. - This complication typically develops due to injury to the **pancreatic tail** during splenic dissection, leading to leakage of pancreatic enzymes. *Bleeding from gastric mucosa* - Bleeding from the **gastric mucosa** (e.g., from stress ulcers or gastritis) is a potential complication after any major surgery but is not the most common immediate complication specific to splenectomy. - While the stomach is in close proximity, direct injury to the gastric mucosa causing significant bleeding is less frequent than hemorrhage from the splenic bed. *Pancreatitis* - **Pancreatitis** can be a severe complication of splenectomy, resulting from injury to the **pancreatic tail** during the procedure. - While it can manifest immediately, its incidence is generally lower than that of hemorrhage.

Question 1

Eustachian tube develops from:

Accepted Answer

1st pharyngeal pouch

Answer

2nd and 3rd pharyngeal pouch

Answer

3rd pharyngeal pouch

Answer

2nd pharyngeal pouch

Question 2

CSF Otorrhea is due to trauma of:

Accepted Answer

Petrous temporal bone

Answer

Tympanic membrane

Answer

Cribriform plate

Answer

Parietal bone

Question 3

Which is branching enzyme?

Accepted Answer

Amylo-1, 4-1, 6-transglycolase

Answer

Glycogen synthase

Answer

Glycogen Phosphorylase

Answer

Glucose-6 phosphatase

Question 4

Preferred biochemical marker(s) in patients presenting with myocardial infarction:

Accepted Answer

Cardiac specific Troponins

Answer

All of the options

Answer

Myoglobin

Answer

CK-MB

Question 5

Provision of services at Suraksha Clinic includes

Accepted Answer

STI/RTI services

Answer

Blood transfusion safety services

Answer

Immunization services

Answer

Diarrhea control services

Question 6

The recommended upper limit for free residual chlorine in drinking water according to WHO guidelines is:

Accepted Answer

0.5 mg/L

Answer

0.4 mg/L

Answer

0.2 mg/L

Answer

0.3 mg/L

Question 7

Most common site of intracranial metastasis is from primary carcinoma of

Accepted Answer

Lungs

Answer

Testes

Answer

Stomach

Answer

Breast

Question 8

Crescent forming glomerulonephritis is:-

Accepted Answer

RPGN

Answer

MCN

Answer

All of the options

Answer

MPGN

Question 9

Which of the following receptors mediate stretch reflex?

Accepted Answer

Muscle spindle

Answer

Golgi tendon organ

Answer

Meissner's corpuscles

Answer

Merkel's disc

Question 10

Most common immediate complication after splenectomy?

Accepted Answer

Hemorrhage

Answer

Fistula

Answer

Bleeding from gastric mucosa

Answer

Pancreatitis

FMGE 2018

Anatomy

Biochemistry

Community Medicine

Internal Medicine

Pathology

Physiology

Surgery