FMGE 2018 Practice Questions

Q: Sensory innervation of the cornea is by which nerve?

5th (ophthalmic division of the trigeminal nerve). ***5th (ophthalmic division of the trigeminal nerve)*** - The **trigeminal nerve (CN V)** is responsible for sensory innervation of the face, and its **ophthalmic division (V1)** specifically supplies the cornea. - This extensive sensory innervation explains the **extreme sensitivity of the cornea** to touch, temperature, and chemicals, and is crucial for the **corneal reflex**. *6th (Abducens nerve)* - The **abducens nerve (CN VI)** is a **motor nerve** responsible for innervating the **lateral rectus muscle**, which abducts the eye. - It has no role in the sensory innervation of the cornea. *3rd (Oculomotor nerve)* - The **oculomotor nerve (CN III)** is primarily a **motor nerve** responsible for innervating most of the **extraocular muscles** (superior, inferior, medial recti, inferior oblique) and the **levator palpebrae superioris**. - It also carries **parasympathetic fibers** for pupillary constriction and accommodation, but it does not provide sensory innervation to the cornea. *4th (Trochlear nerve)* - The **trochlear nerve (CN IV)** is a **motor nerve** that innervates the **superior oblique muscle**, which depresses and internally rotates the eye. - It has no function in corneal sensation.

Q: False statement about post-dural puncture headache (PDPH):

Headache is relieved in sitting standing position. ***Headache is relieved in sitting standing position*** - This statement is **false** because a cardinal feature of PDPH is that the headache is **worse in the upright position** (sitting or standing) and **relieved by lying flat**. - The postural nature of the headache is due to the continued leakage of CSF, leading to reduced intracranial pressure, which is exacerbated by gravity when upright. *Commonly occipito-frontal in location* - PDPH typically presents as a headache that can be **holocranial**, **occipital**, or **frontal**, often radiating to the neck. - The location is due to changes in **intracranial pressure** affecting pain-sensitive structures like blood vessels and meninges. *Onset of headache is usually 12-72 hours following procedure* - The onset of PDPH is typically **delayed**, occurring in the vast majority of cases between **12 to 72 hours** after the dural puncture. - Although it can occur immediately or up to five days later, this delayed presentation is characteristic. *Breach of dura* - PDPH is a direct consequence of the intentional or accidental **breach of the dura mater** during procedures like spinal anesthesia or lumbar puncture. - This breach allows for continuous leakage of **cerebrospinal fluid (CSF)**, leading to a reduction in intracranial pressure, which causes the headache.

Q: Recruitment phenomenon is seen in:

Meniere's disease. ***Meniere's disease*** - The recruitment phenomenon, characterized by an abnormal increase in the perception of loudness for a given increase in sound intensity, is a classic finding in **cochlear hearing loss**, often seen in conditions like **Meniere's disease**. - This occurs due to damage to the **outer hair cells** in the cochlea, which normally compress the dynamic range of hearing. *Otitis media with effusion* - This condition involves **conductive hearing loss** due to fluid in the middle ear, and typically does not cause the recruitment phenomenon. - The problem lies in sound transmission, not in the processing of loudness within the cochlea. *Otosclerosis* - This condition causes **conductive hearing loss** due to abnormal bone growth around the stapes footplate, impeding sound transmission to the inner ear. - While it affects hearing, it does not directly lead to altered loudness perception or recruitment, as the cochlea itself is often intact. *Acoustic nerve schwannoma* - This tumor affects the **vestibulocochlear nerve (CN VIII)**, causing **sensorineural hearing loss** that is typically retrocochlear (beyond the cochlea). - While it causes hearing loss, recruitment is usually absent or minimal, as the pathology is neural, not cochlear.

Q: All of the following are seen in Meniere's Disease except:

Ear Pain. ***Ear Pain*** - **Otalgia** (ear pain) is not a typical symptom of **Meniere's disease**. - While patients may experience discomfort due to pressure, sharp or significant pain is generally absent. *Fullness of ear* - A sensation of **aural fullness** or pressure in the affected ear is a characteristic symptom of Meniere's disease, often preceding a vertiginous attack. - This symptom is thought to be due to the buildup of **endolymphatic fluid** within the inner ear. *Vertigo* - **Episodic rotational vertigo** is a hallmark symptom of Meniere's disease, significantly impacting daily activities and often accompanied by nausea and vomiting. - These attacks are typically sudden, severe, and can last from 20 minutes to several hours. *Tinnitus* - **Tinnitus**, often described as a ringing, buzzing, or roaring sound, is a common symptom in patients with Meniere's disease. - It usually fluctuates in intensity and can worsen before or during a vertigo attack.

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: What is the true statement about retinoscopy with a plane mirror?

Retinoscopy is done at 1 meter away from the patient.. ***Retinoscopy is done at 1 meter away from the patient.*** - Retinoscopy is typically performed at a **working distance** of 67 cm or 1 meter, to allow for the examiner to observe the reflex and to incorporate a working distance lens in the final calculation. - A 1-meter working distance requires a **-1.00 D sphere correction** to be subtracted from the spherical power found in retinoscopy to find the patient's actual refractive error. *In myopia, the red glow moves in the same direction.* - In **myopia**, using a plane mirror, the retinal reflex appears to move in the **opposite direction** to the movement of the retinoscope. - This "against" movement needs **concave (minus)** lenses to neutralize it. *In hypermetropia, the red glow moves in the opposite direction.* - In **hypermetropia**, using a plane mirror, the retinal reflex appears to move in the **same direction** as the movement of the retinoscope. - This "with" movement needs **convex (plus)** lenses to neutralize it. *In emmetropia, the red glow moves in the opposite direction.* - In **emmetropia**, the light from the retinoscope is focused on the retina, and the reflex also moves in the **same direction** as the retinoscope (when using a plane mirror) until neutralization. - An **emmetropic eye** theoretically requires no corrective lens, other than the working distance correction, to neutralize the reflex.

Q: Shortest-acting muscle relaxant is:

Succinylcholine. ***Correct: Succinylcholine*** - **Succinylcholine** is a depolarizing neuromuscular blocker with a rapid onset and a very short duration of action, typically **5-10 minutes**, due to its rapid hydrolysis by **plasma pseudocholinesterase**. - Its ultrashort action makes it ideal for **rapid sequence intubation** and other procedures requiring brief muscle relaxation. *Incorrect: Atracurium* - **Atracurium** is an intermediate-acting nondepolarizing muscle relaxant with a duration of action of approximately **20-35 minutes**. - Its metabolism occurs via Hoffman elimination and ester hydrolysis, making it suitable for patients with **renal or hepatic dysfunction**. *Incorrect: Tubocurarine* - **Tubocurarine** is a long-acting nondepolarizing muscle relaxant that is now rarely used due to its significant adverse effects, including **histamine release** and ganglion blockade. - Its duration of action can be **60-120 minutes**. *Incorrect: Pancuronium* - **Pancuronium** is a long-acting nondepolarizing muscle relaxant with a duration of action of **60-90 minutes**. - It is eliminated primarily by the **kidneys**, making its duration prolonged in patients with **renal impairment**.

Q: A child with diarrhea has deep & rapid respiration. Most likely diagnosis is:

Metabolic acidosis. ***Metabolic acidosis*** - Diarrhea leads to a loss of **bicarbonate** from the gastrointestinal tract, causing a decrease in blood pH [1]. - **Deep and rapid respirations** (Kussmaul breathing) are a compensatory mechanism to blow off CO2 and raise the blood pH [1], [2]. *Respiratory acidosis* - This condition results from **hypoventilation**, leading to CO2 retention and a reduced pH [2]. - Deep and rapid breathing would actually improve respiratory acidosis by expelling CO2. *Metabolic alkalosis* - Characterized by an **excess of bicarbonate** and an elevated blood pH [3]. - Compensatory mechanisms would involve decreased respiration to retain CO2, not increased [3]. *Respiratory alkalosis* - This is caused by **hyperventilation**, which leads to excessive CO2 expulsion and an elevated pH [2]. - While hyperventilation causes deep and rapid breathing, it leads to alkalosis, not acidosis (which is indicated by compensatory breathing in this scenario).

Q: In gastric outlet obstruction in a peptic ulcer patient, the site of obstruction is most likely to be:

Pylorus. ***Pylorus*** - The **pylorus** is the most common site of obstruction in gastric outlet obstruction caused by **peptic ulcer disease**. This is due to **scarring** and **inflammation** from chronic ulcers in or near this region. - Obstruction at the pylorus impedes the normal flow of digested food from the stomach into the **duodenum**. *Duodenum* - While ulcers can occur in the **duodenum** (specifically the duodenal bulb), they are less likely to cause a complete obstruction of the gastric outlet. - **Duodenal ulcers** are more common than gastric ulcers, but rarely lead to severe narrowing causing outlet obstruction. *Antrum* - The **gastric antrum** is part of the stomach leading up to the pylorus. Although ulcers can occur here, obstruction is less common compared to the **pylorus** itself. - Obstruction due to antral pathology typically occurs closer to the **pyloric sphincter**. *Fundus* - The **fundus** is the upper, dome-shaped part of the stomach. It is very rarely the site of obstruction in the context of gastric outlet obstruction from peptic ulcer disease. - Obstructions in the fundus are usually associated with other pathologies, such as **tumors** or **gastric volvulus**, not peptic ulcers causing outlet obstruction.

Q: Which of the following is FALSE regarding deep second-degree burns?

Show blanching response. ***Show blanching response (FALSE - Correct Answer)*** - This is the **FALSE statement**. Deep second-degree burns typically show **absent or diminished blanching response**, not a positive blanching response. - A **blanching response** indicates intact blood flow to the capillaries, which is typical of **superficial partial-thickness burns** only. - In **deep second-degree burns**, the damage extends deeper into the reticular dermis, involving the **dermal capillary plexus**, leading to loss of the blanching response. *Heal by scar deposition (TRUE)* - **Deep second-degree burns** damage the dermal elements responsible for regeneration, necessitating significant **scar deposition** for healing. - Due to destruction of many **dermal appendages** (hair follicles, sebaceous glands), complete regeneration without scarring is unlikely. *Painless (TRUE)* - While superficial burns are very painful, **deep second-degree burns** can be relatively **painless** due to destruction of **nerve endings** in the deeper dermis. - The variable destruction of **nociceptors** means patients may experience both painful areas and areas of reduced sensation or numbness. *Damage to deeper dermis (TRUE)* - **Deep second-degree burns** are characterized by injury extending into the **reticular dermis** (deeper layer), which lies beneath the papillary dermis. - This level of damage affects significant **dermal structures** including hair follicles, sweat glands, and nerve endings.

Question 1

Sensory innervation of the cornea is by which nerve?

Accepted Answer

5th (ophthalmic division of the trigeminal nerve)

Answer

6th (Abducens nerve)

Answer

3rd (Oculomotor nerve)

Answer

4th (Trochlear nerve)

Question 2

False statement about post-dural puncture headache (PDPH):

Accepted Answer

Headache is relieved in sitting standing position

Answer

Commonly occipito-frontal in location

Answer

Onset of headache is usually 12-72 hours following procedure

Answer

Breach of dura

Question 3

Recruitment phenomenon is seen in:

Accepted Answer

Meniere's disease

Answer

Otitis media with effusion

Answer

Otosclerosis

Answer

Acoustic nerve schwannoma

Question 4

All of the following are seen in Meniere's Disease except:

Accepted Answer

Ear Pain

Answer

Fullness of ear

Answer

Vertigo

Answer

Tinnitus

Question 5

Most common site of intracranial metastasis is from primary carcinoma of

Accepted Answer

Lungs

Answer

Testes

Answer

Stomach

Answer

Breast

Question 6

What is the true statement about retinoscopy with a plane mirror?

Accepted Answer

Retinoscopy is done at 1 meter away from the patient.

Answer

In myopia, the red glow moves in the same direction.

Answer

In hypermetropia, the red glow moves in the opposite direction.

Answer

In emmetropia, the red glow moves in the opposite direction.

Question 7

Shortest-acting muscle relaxant is:

Accepted Answer

Succinylcholine

Answer

Atracurium

Answer

Tubocurarine

Answer

Pancuronium

Question 8

A child with diarrhea has deep & rapid respiration. Most likely diagnosis is:

Accepted Answer

Metabolic acidosis

Answer

Respiratory acidosis

Answer

Metabolic alkalosis

Answer

Respiratory alkalosis

Question 9

In gastric outlet obstruction in a peptic ulcer patient, the site of obstruction is most likely to be:

Accepted Answer

Pylorus

Answer

Duodenum

Answer

Antrum

Answer

Fundus

Question 10

Which of the following is FALSE regarding deep second-degree burns?

Accepted Answer

Show blanching response

Answer

Heal by scar deposition

Answer

Painless

Answer

Damage to deeper dermis

FMGE 2018

Anatomy

Anesthesiology

ENT

Internal Medicine

Ophthalmology

Pharmacology

Physiology

Surgery