FMGE 2019 Practice Questions

Q: Adam's apple in males is formed by the

Thyroid cartilage. ***Thyroid cartilage*** - The "Adam's apple" is anatomically known as the **laryngeal prominence**, which is formed by the anterior-most projection of the **thyroid cartilage**. - This prominence is typically more pronounced in males due to **hormonal influences** during puberty that lead to a larger larynx and vocal cords. *Hyoid bone* - The **hyoid bone** is a U-shaped bone located superior to the larynx that supports the tongue, but it does not form the "Adam's apple." - It is unique because it is the only bone in the human body not articulating with any other bone. *Epiglottis cartilage* - The **epiglottis** is a leaf-shaped elastic cartilage that covers the entrance to the larynx during swallowing to prevent food and liquid from entering the trachea. - It is positioned posterior to the thyroid cartilage and is not externally visible as the "Adam's apple." *Cricoid cartilage* - The **cricoid cartilage** is a complete ring of hyaline cartilage located inferior to the thyroid cartilage, forming the base of the larynx. - While it's a part of the larynx, it does not form the anterior projection known as the "Adam's apple."

Q: Avascular necrosis of the femoral head most commonly occurs due to disruption of which of the following arteries?

Medial circumflex femoral artery. ***Medial circumflex femoral artery*** - The **medial circumflex femoral artery** is the primary blood supply to the **femoral head** and **neck**, particularly through its retinacular branches. - Interruption of this blood flow, often due to trauma or other conditions, is the most common cause of **avascular necrosis** of the femoral head. *Lateral circumflex femoral artery* - The **lateral circumflex femoral artery** primarily supplies the **vastus lateralis muscle** and parts of the greater trochanter. - It contributes minimally and indirectly to the blood supply of the femoral head. *Obturator artery* - The **obturator artery** primarily supplies structures in the medial compartment of the thigh and makes a small contribution to the femoral head via the **artery of the ligamentum teres**, which is generally insufficient to prevent avascular necrosis alone. - This artery is most significant in children, but by adulthood, its contribution to femoral head vascularity is minor. *Profunda femoris artery* - The **profunda femoris artery** (deep femoral artery) is the largest branch of the femoral artery and gives rise to the circumflex femoral arteries. - Its direct contribution to the femoral head blood supply is generally through its branches (like the circumflex arteries), rather than directly.

Q: Subacute Sclerosing Panencephalitis is a rare and dangerous complication of;

Measles. ***Measles*** - **Subacute sclerosing panencephalitis (SSPE)** is a rare, fatal degenerative disease of the central nervous system caused by persistent infection with a defective **measles virus**. [1] - It typically develops **years after the initial measles infection**, affecting children and young adults, leading to cognitive decline, seizures, and motor dysfunction. [1], [2] *Rubella* - While rubella can cause congenital rubella syndrome, it is **not associated with SSPE**. - Complications of rubella usually involve birth defects, such as **cardiac malformations**, **deafness**, and **cataracts**, when acquired during pregnancy. *Varicella* - **Varicella-zoster virus (VZV)** causes chickenpox and shingles, but it is **not a known cause of SSPE**. - Neurological complications of VZV can include **cerebellar ataxia** or **encephalitis** acutely, or **postherpetic neuralgia** in later life. *Mumps* - Mumps virus can cause **parotitis**, **orchitis**, and **meningitis/encephalitis**, but it is **not implicated in the development of SSPE**. - The encephalitis associated with mumps typically occurs during the acute infection and generally has a good prognosis.

Q: A lady presents with amenorrhea and galactorrhea. What is the most likely cause?

Pituitary adenoma. ### Pituitary adenoma - A **prolactin-secreting pituitary adenoma** (prolactinoma) is the most common cause of sustained **hyperprolactinemia**, leading to both **amenorrhea** and **galactorrhea** [1]. - **Elevated prolactin levels** inhibit gonadotropin-releasing hormone (GnRH) pulsatility, leading to reduced LH and FSH, causing anovulation and amenorrhea, alongside direct stimulation of breast tissue for galactorrhea [1], [2]. ### *None of the options* - This option is incorrect as **pituitary adenoma** is a highly plausible cause for the presented symptoms. - The combination of **amenorrhea** and **galactorrhea** is a classic presentation of hyperprolactinemia, often due to a pituitary adenoma [1]. ### *Adrenal hyperplasia* - **Adrenal hyperplasia** typically involves overproduction of androgens or cortisol, leading to symptoms like **hirsutism**, **virilization**, or **Cushing's syndrome**, rather than galactorrhea [3]. - While it can cause menstrual irregularities, it does not directly cause **galactorrhea**, which is primarily linked to prolactin excess [1], [3]. ### *7α-hydroxylase deficiency* - **7α-hydroxylase deficiency** is a rare genetic disorder affecting **bile acid synthesis**, not directly related to reproductive hormones or prolactin regulation. - Its clinical manifestations are primarily related to **liver disease** due to abnormal bile acid metabolism and would not present with amenorrhea and galactorrhea.

Q: Sporulation occurs in which phase of bacterial growth curve:

Stationary phase. ***Stationary phase*** - When **nutrients become limited** and waste products accumulate, bacteria enter the stationary phase, triggering **sporulation** in spore-forming species as a survival mechanism. - In this phase, the rate of **bacterial growth equals the rate of bacterial death**, leading to a plateau in population size. *Decline phase* - The decline phase is characterized by a **net decrease in viable cells** due to continued depletion of nutrients and high accumulation of toxic waste products. - While cells are certainly stressed, sporulation typically occurs *before* this phase, as a preventative measure to survive impending harsh conditions. *Lag phase* - During the lag phase, bacteria are **adapting to new environmental conditions** and synthesizing necessary enzymes and components. - There is no increase in cell number during this phase, and they are preparing for growth, not entering a survival state like sporulation. *Log phase* - The log phase (or exponential phase) is characterized by **rapid binary fission** and exponential increase in bacterial numbers due to optimal growth conditions and abundant nutrients. - Cells are actively dividing; sporulation, which halts active division to form a dormant spore, would be counterproductive at this stage.

Q: The drug of choice for hyperthyroidism in third trimester of pregnancy is:

Carbimazole. ***Carbimazole*** - **Carbimazole** (metabolized to methimazole) is the **drug of choice in the third trimester** of pregnancy for managing hyperthyroidism. - The teratogenic risk of methimazole/carbimazole is confined to the **first trimester** (embryopathy includes aplasia cutis, choanal atresia, esophageal atresia). By the third trimester, organogenesis is complete and this risk has passed. - **Propylthiouracil (PTU)** is associated with severe **hepatotoxicity**, which is why current guidelines recommend switching from PTU to methimazole/carbimazole after the first trimester. - Both drugs cross the placenta, but in the third trimester, the safety profile favors carbimazole over PTU. *Propylthiouracil* - **PTU** is preferred only in the **first trimester** to avoid methimazole-associated congenital anomalies during the critical period of organogenesis. - After the first trimester, patients should be switched to methimazole/carbimazole due to PTU's risk of severe **hepatotoxicity** (including fulminant hepatic failure requiring transplantation). - PTU is not the drug of choice for the third trimester despite having lower placental transfer. *Sodium iodide* - **Sodium iodide** is used acutely in **thyroid storm** or as preoperative preparation for thyroidectomy, not for chronic management of hyperthyroidism. - Prolonged use can cause the **Wolff-Chaikoff effect** (temporary inhibition of thyroid hormone synthesis) followed by escape phenomenon and worsening hyperthyroidism. - Can cause fetal goiter and hypothyroidism with chronic use, making it unsuitable for long-term pregnancy management. *Radioactive iodine* - **Radioactive iodine** is **absolutely contraindicated** in pregnancy at any stage. - It crosses the placenta after 10-12 weeks of gestation and destroys the fetal thyroid gland, causing permanent **fetal hypothyroidism** and **cretinism**. - Must be avoided in pregnancy; pregnancy should be excluded before radioactive iodine therapy.

Q: Antidote for opioid poisoning:

Naloxone. ***Naloxone*** - **Naloxone** is a pure **opioid antagonist** that reverses the effects of opioid overdose by competing for and binding to opioid receptors. - It is crucial in emergent situations to restore **respiratory drive** and consciousness in patients with opioid-induced respiratory depression. *Pethidine* - **Pethidine** is an **opioid analgesic** itself, primarily used for pain management, and would worsen opioid poisoning. - It works by binding to opioid receptors, leading to centrally mediated pain relief, making it contraindicated in overdose. *Flumazenil* - **Flumazenil** is an antagonist for **benzodiazepines**, used to reverse their sedative and respiratory depressant effects. - It has no effect on opioid receptors and would not be effective in treating opioid poisoning. *Physostigmine* - **Physostigmine** is a **cholinesterase inhibitor** used to reverse anticholinergic toxicity. - It increases acetylcholine levels at the synapse and is not indicated for opioid overdose.

Q: In this normal menstrual cycle graph, the mark 'X' represents levels of which hormone?

Progesterone. ***Progesterone*** - The mark 'X' (blue line) represents a hormone that significantly rises during the **luteal phase** after ovulation, reaching its peak around day 21-24 and then declining if pregnancy does not occur. - This pattern is characteristic of **progesterone**, which is primarily produced by the corpus luteum after ovulation to prepare the uterus for potential implantation. *LH* - **Luteinizing Hormone (LH)** is characterized by a sharp, transient peak just before ovulation (around day 14), which triggers the release of the egg. The blue line does not show this pre-ovulatory surge. - After ovulation, LH levels generally fall and remain relatively low throughout the luteal phase, unlike the sustained high levels shown by the blue line. *FSH* - **Follicle-Stimulating Hormone (FSH)** levels are typically higher during the early follicular phase, promoting follicle growth, and then decrease as estrogen rises. There is a smaller, transient peak around ovulation. - The blue line's profile, with its primary peak in the mid-luteal phase, does not match the typical FSH secretion pattern. *Estrogen* - **Estrogen** (specifically estradiol) typically shows a prominent peak during the late follicular phase, preceding the LH surge, and a secondary, smaller peak in the mid-luteal phase. - The blue line's peak is much higher and more sustained during the luteal phase than expected for estrogen, which is usually represented by the red curve in such graphs.

Q: Normal anion gap is___ mmol/L?

8-16. ***8-16*** - The normal range for the **anion gap** is generally considered to be 8-16 mmol/L, reflecting the unmeasured anions in the plasma. - This range can vary slightly between laboratories, but **8-16 mmol/L** is the most commonly accepted range in clinical practice. *30-34* - This range is significantly **higher than normal** and would indicate a **high anion gap metabolic acidosis**, rather than a normal anion gap. - A high anion gap suggests an accumulation of **unmeasured acids** in the body, such as in lactic acidosis or ketoacidosis. *20-24* - This value is also **elevated** compared to the normal range, suggesting a high anion gap. - An anion gap in this range would prompt investigation into causes of **metabolic acidosis** with an increased anion gap. *0-4* - This range is significantly **lower than normal** and could indicate a **low or negative anion gap**, which is a rare finding. - A low anion gap is often associated with conditions like **hypoalbuminemia**, multiple myeloma (due to paraproteins), or severe hypernatremia.

Q: PA view of chest X-ray is given here. What is the diagnosis?

Right Pneumothorax with left tracheal shift. ***Right Pneumothorax with left tracheal shift*** - The image shows a large **radiolucency (black area) on the right side** of the chest, indicative of **air in the pleural space**, consistent with a **right-sided pneumothorax**. - The **trachea is shifted towards the left** (away from the pneumothorax), which is the **expected finding** in pneumothorax due to increased pressure in the right pleural space pushing mediastinal structures to the contralateral side. - In pneumothorax, the trachea and mediastinum shift **away from** the affected side due to the pressure effect of air accumulation in the pleural cavity. - This **contralateral tracheal deviation** is a classic radiological sign of pneumothorax and helps confirm the diagnosis. *Right Pneumothorax with right tracheal shift* - While the **right pneumothorax** is correctly identified, the tracheal shift direction is incorrect. - In pneumothorax, the trachea shifts **away from** the affected side (contralateral), not toward it (ipsilateral). - **Ipsilateral tracheal shift** would suggest volume loss (atelectasis) or lung collapse, not pneumothorax alone. *Left Pneumothorax with right tracheal shift* - The pneumothorax is clearly on the **right side**, not the left. - The radiolucency and absent lung markings are visible on the right hemithorax. - A left pneumothorax would show these findings on the left side. *Left Pneumothorax with left tracheal shift* - There is **no pneumothorax on the left side** of the chest. - The left lung shows normal vascular markings and no evidence of pleural air. - This combination would be medically implausible as it suggests pneumothorax with ipsilateral shift.

Question 1

Adam's apple in males is formed by the

Accepted Answer

Thyroid cartilage

Answer

Hyoid bone

Answer

Epiglottis cartilage

Answer

Cricoid cartilage

Question 2

Avascular necrosis of the femoral head most commonly occurs due to disruption of which of the following arteries?

Accepted Answer

Medial circumflex femoral artery

Answer

Lateral circumflex femoral artery

Answer

Obturator artery

Answer

Profunda femoris artery

Question 3

Subacute Sclerosing Panencephalitis is a rare and dangerous complication of;

Accepted Answer

Measles

Answer

Rubella

Answer

Varicella

Answer

Mumps

Question 4

A lady presents with amenorrhea and galactorrhea. What is the most likely cause?

Accepted Answer

Pituitary adenoma

Answer

None of the options

Answer

Adrenal hyperplasia

Answer

7α-hydroxylase deficiency

Question 5

Sporulation occurs in which phase of bacterial growth curve:

Accepted Answer

Stationary phase

Answer

Decline phase

Answer

Lag phase

Answer

Log phase

Question 6

The drug of choice for hyperthyroidism in third trimester of pregnancy is:

Accepted Answer

Carbimazole

Answer

Sodium iodide

Answer

Radioactive iodine

Answer

Propylthiouracil

Question 7

Antidote for opioid poisoning:

Accepted Answer

Naloxone

Answer

Pethidine

Answer

Flumazenil

Answer

Physostigmine

Question 8

In this normal menstrual cycle graph, the mark 'X' represents levels of which hormone?

Accepted Answer

Progesterone

Answer

LH

Answer

FSH

Answer

Estrogen

Question 9

Normal anion gap is___ mmol/L?

Accepted Answer

8-16

Answer

30-34

Answer

20-24

Answer

0-4

Question 10

PA view of chest X-ray is given here. What is the diagnosis?

Accepted Answer

Right Pneumothorax with left tracheal shift

Answer

Left Pneumothorax with right tracheal shift

Answer

Left Pneumothorax with left tracheal shift

Answer

Right Pneumothorax with right tracheal shift

FMGE 2019

Anatomy

Internal Medicine

Microbiology

Pharmacology

Physiology

Radiology