FMGE 2019 Practice Questions

Q: Celiac vessel is seen at which vertebral level?

T12. T12 - The celiac trunk arises from the abdominal aorta at the level of the twelfth thoracic vertebra (T12), just below the aortic hiatus of the diaphragm. - This is typically at the level of the upper border of L1 or lower border of T12. - It is the first major unpaired visceral branch and supplies the foregut organs (stomach, proximal duodenum, liver, spleen, pancreas). L2 - The renal arteries, which supply the kidneys, typically originate from the aorta at the level of the L1-L2 vertebra. - The inferior mesenteric artery (IMA) arises at approximately L3 level. - This level is significantly lower than the origin of the celiac trunk. T9 - At the level of T9, no major visceral branches arise from the aorta. - This level is above the aortic hiatus (at T12), so the aorta is still in the thoracic cavity. - The celiac trunk has not yet branched at this higher level. T10 - At T10, the aorta is still in the thoracic cavity, passing through the posterior mediastinum. - The aortic hiatus of the diaphragm is at T12, not T10. - No major unpaired visceral branches originate at this level.

Q: Endotracheal tube in the esophagus is best assessed by:

CO2 Exhalation. ***CO2 Exhalation*** - Measuring **CO2 exhalation** (capnography) is the most reliable method to confirm endotracheal tube placement, as CO2 is present in the trachea but not in the esophagus. - A persistent **waveform on the capnograph** indicates proper tracheal intubation. *Direct laryngoscopy* - While helpful for initial visualization during intubation, **direct laryngoscopy** cannot confirm continuous tracheal placement after the tube is advanced. - It only confirms the tube passing through the vocal cords, not its final position in the trachea versus esophagus. *Auscultation* - **Auscultation** can be misleading because stomach sounds can be transmitted to the chest, and breath sounds can be heard in the epigastrium even with esophageal intubation. - It relies on subjective interpretation and is less definitive than capnography. *Chest wall movement* - Observing **chest wall movement** is not a definitive sign, as the chest can still rise with esophageal intubation due to air entering the stomach. - This method is unreliable and can be mistaken for proper ventilation, leading to dangerous delays in correcting tube misplacement.

Q: Which structure of protein is not denatured after heating up to 100 degrees Celsius?

Primary. ***Primary*** - The **primary structure** refers to the specific linear sequence of **amino acids** forming the polypeptide chain, linked by **covalent peptide bonds**. - These strong **peptide bonds** are generally resistant to heat denaturation at 100°C, meaning the amino acid sequence remains intact. *Quaternary* - The **quaternary structure** involves the arrangement of multiple polypeptide subunits and is maintained by weaker interactions like **hydrophobic interactions**, hydrogen bonds, and salt bridges. - These interactions are highly susceptible to disruption by heat, causing the subunits to dissociate and the quaternary structure to be lost. *Tertiary* - The **tertiary structure** describes the three-dimensional folding of a single polypeptide chain, stabilized by various non-covalent interactions (e.g., hydrogen bonds, ionic bonds, hydrophobic interactions) and **disulfide bonds**. - Heat disrupts these weaker non-covalent interactions and can even break disulfide bonds, leading to the unfolding and loss of the specific 3D shape. *Secondary* - The **secondary structure** (e.g., **alpha-helices** and **beta-pleated sheets**) arises from hydrogen bonds between the backbone atoms of the polypeptide chain. - While peptide bonds remain intact, these vital **hydrogen bonds** are easily broken by heat, causing the unraveling of helices and sheets.

Q: Most abundant amino acid found in collagen?

Glycine. ***Glycine*** - **Glycine** is the most abundant amino acid in collagen, making up approximately one-third of its total amino acid content. - Its small size (due to a single hydrogen atom as its side chain) is crucial for the formation of the **triple helix structure** of collagen, allowing the tight packing of the three alpha chains. *Hydroxyproline* - **Hydroxyproline** is a modified amino acid derived from proline, and while abundant in collagen, it accounts for about 13% of the total amino acids, less than glycine. - It plays a vital role in stabilizing the collagen triple helix through **hydrogen bonding**. *Proline* - **Proline** is a structurally important amino acid in collagen, contributing to the kinks and turns necessary for the formation of the triple helix. - However, its abundance is less than that of glycine, making up around 10-17% of collagen's amino acids. *Lysine* - **Lysine** is a less abundant but essential amino acid in collagen, making up about 2-5% of its composition. - It is critical for **cross-linking** collagen fibers, which provides tensile strength, and can be hydroxylated to form **hydroxylysine**.

Q: The primary function of NIH (National Institutes of Health) is

Medical research. ***Medical research*** - The **National Institutes of Health (NIH)** is the primary biomedical research agency of the United States, comprising 27 institutes and centers - Its stated mission is to seek fundamental knowledge about living systems and apply that knowledge to **enhance health, lengthen life, and reduce illness and disability** - The NIH conducts and funds **medical research** across virtually all areas of medicine and public health, making this its core primary function - It is the world's largest public funder of biomedical research, with a budget primarily dedicated to research grants and intramural research programs *Disease surveillance* - Disease surveillance is primarily the responsibility of the **CDC (Centers for Disease Control and Prevention)**, not the NIH - While NIH research may inform surveillance strategies, **monitoring and tracking disease patterns** is not the NIH's primary organizational function - The NIH focuses on understanding disease mechanisms and developing interventions through research *Public health policy* - The NIH provides **evidence-based research** that informs public health policy but does not primarily create or enforce policy - Policy-making authority rests with the **Department of Health and Human Services (HHS)** and other regulatory agencies like the FDA - The NIH's role is to generate the scientific knowledge base that guides policy decisions *Clinical trials* - The NIH conducts and funds extensive **clinical trials** through its Clinical Center and grant mechanisms - However, clinical trials are a **methodology of medical research**, not a separate primary function - Clinical trials serve the broader mission of medical research by testing hypotheses and interventions developed through basic and translational research

Q: Yellow fever vaccine is valid for?

Lifelong. ***Life long*** - As per the **International Health Regulations (IHR) 2005**, a single dose of yellow fever vaccine provides **lifelong protection**, eliminating the need for booster doses. - This change in policy reflects robust evidence demonstrating sustained immunity beyond 10 years, making previous 10-year validity periods obsolete. *20 years* - While reflecting a prolonged period of protection, **20 years** is not the officially recognized validity period. - The latest WHO recommendations state **lifelong validity**, superseding previous duration estimates. *5 years* - A 5-year validity period was used historically but is now outdated. - **Evidence has shown long-term immunity**, supporting a much longer, effectively lifelong, protection. *10 years* - The **10-year validity** was the standard for many years, necessitating booster doses for travelers. - This has been updated to **lifelong validity** based on conclusive data proving persistent protective immunity.

Q: What is the most likely diagnosis in an individual with normal serum alkaline phosphatase, normal PTH, normal Vitamin D3, and elevated serum calcium?

Multiple myeloma. ***Multiple myeloma*** [4] - This condition is often associated with **osteolytic lesions** that lead to the release of calcium into the blood, causing **hypercalcemia**. - **PTH**, **alkaline phosphatase**, and **Vitamin D3** levels are typically normal in this scenario because their regulatory pathways are not primarily affected [1]. *Nutritional rickets* [2] - Characterized by **low calcium** and **phosphate levels**, usually with **elevated alkaline phosphatase** and **PTH** due to inadequate vitamin D or calcium intake [3]. - This patient exhibits **elevated serum calcium**, ruling out rickets. *Hyperparathyroidism* - Both **primary** and **secondary hyperparathyroidism** would present with **elevated PTH** levels, which is stated as normal in the case description [1]. - **Hypercalcemia** in hyperparathyroidism is caused by bone resorption and increased renal reabsorption of calcium, driven by high PTH [5]. *Vitamin D intoxication* - Would lead to **hypercalcemia** and **elevated Vitamin D3** levels, alongside **suppressed PTH** levels, which contradicts the described normal PTH and normal Vitamin D3 [1]. - The excessive vitamin D would increase calcium absorption from the gut and bone resorption not seen here.

Q: Which heart sound is almost always considered pathological?

S4. ***S4*** - An **S4 heart sound**, or **atrial gallop**, is almost always indicative of **pathology**, specifically a **stiff or non-compliant ventricle**. - It occurs due to vigorous atrial contraction forcing blood into a **non-compliant ventricle**, commonly seen in conditions like **hypertensive heart disease**, **aortic stenosis**, and **hypertrophic cardiomyopathy**. *S2* - **S2** represents the **closure of the aortic and pulmonic valves** and is a normal physiological heart sound [2]. - While it can be altered in pathology (e.g., fixed splitting, paradoxical splitting), the sound itself is a normal component of the cardiac cycle [1]. *S1* - **S1** represents the **closure of the mitral and tricuspid valves** and is a normal physiological heart sound [1]. - Variations in its intensity or splitting can occur in disease states, but the presence of S1 itself is normal. *S3* - An **S3 heart sound**, or **ventricular gallop**, can be a normal finding in **children**, **young adults**, and **pregnant individuals**, often referred to as a **physiological S3**. - However, in adults over 40, an S3 often indicates **ventricular dysfunction** due to rapid filling into a dilated ventricle [3], as seen in **heart failure** [1].

Q: Most common organism causing the pelvic inflammatory disease?

Chlamydia. ***Chlamydia*** - **Chlamydia trachomatis** is the most common bacterial cause of **pelvic inflammatory disease (PID)**, often leading to subtle or asymptomatic infections [1]. - Untreated chlamydial infections can ascend from the lower genital tract, causing inflammation and scarring in the fallopian tubes and other pelvic organs [1]. *Gardnerella Vaginalis* - **Gardnerella vaginalis** is primarily associated with **bacterial vaginosis (BV)**, a common cause of vaginal discharge. - While BV can sometimes predispose to PID, *Gardnerella* itself is not considered a primary causative agent of ascending PID. *Bacteroides* - **Bacteroides species** are anaerobic bacteria that are part of the normal vaginal flora and can be found in some cases of PID, particularly in **tubo-ovarian abscesses** [1]. - However, they are typically considered secondary invaders or coinfecting organisms rather than the initial causative agent of PID. *Neisseria gonorrhoeae* - **Neisseria gonorrhoeae** is a common and significant cause of **pelvic inflammatory disease (PID)**, historically being the most recognized pathogen [1]. - While still prevalent and capable of causing severe PID, **Chlamydia trachomatis** has surpassed it in overall incidence as the leading cause of PID [1].

Q: Post-menopausal woman, fell down in washroom. What is the most common fracture she may suffer?

Colles fracture. ***Colles fracture*** - This fracture commonly occurs in **post-menopausal women** due to **osteoporosis** and typically results from a fall onto an **outstretched hand**. - It involves a **distal radius fracture** with **dorsal displacement** and often radial angulation. *Smith fracture* - A Smith fracture involves a **distal radius fracture** with **volar displacement**, usually caused by a fall onto the back of the hand. - While it can occur in post-menopausal women, it is less common than a Colles fracture in such a scenario. *Monteggia's fracture* - This fracture involves a **fracture of the ulna** with **dislocation of the radial head**. - It usually results from a direct blow to the forearm or a fall with extreme pronation, which is less typical for a simple fall in a post-menopausal woman. *Galeazzi fracture* - A Galeazzi fracture involves a **fracture of the radius** with **dislocation of the distal radioulnar joint (DRUJ)**. - This injury is less common and typically results from a fall onto an outstretched hand with the forearm in pronation, and it is not the most common fracture in this demographic.

Question 1

Celiac vessel is seen at which vertebral level?

Accepted Answer

T12

Answer

L2

Answer

T9

Answer

T10

Question 2

Endotracheal tube in the esophagus is best assessed by:

Accepted Answer

CO2 Exhalation

Answer

Direct laryngoscopy

Answer

Auscultation

Answer

Chest wall movement

Question 3

Which structure of protein is not denatured after heating up to 100 degrees Celsius?

Accepted Answer

Primary

Answer

Quaternary

Answer

Tertiary

Answer

Secondary

Question 4

Most abundant amino acid found in collagen?

Accepted Answer

Glycine

Answer

Hydroxyproline

Answer

Proline

Answer

Lysine

Question 5

The primary function of NIH (National Institutes of Health) is

Accepted Answer

Medical research

Answer

Public health policy

Answer

Clinical trials

Answer

Disease surveillance

Question 6

Yellow fever vaccine is valid for?

Accepted Answer

Lifelong

Answer

20 years

Answer

5 years

Answer

10 years

Question 7

What is the most likely diagnosis in an individual with normal serum alkaline phosphatase, normal PTH, normal Vitamin D3, and elevated serum calcium?

Accepted Answer

Multiple myeloma

Answer

Nutritional rickets

Answer

Hyperparathyroidism

Answer

Vitamin D intoxication

Question 8

Which heart sound is almost always considered pathological?

Accepted Answer

S4

Answer

S2

Answer

S1

Answer

S3

Question 9

Most common organism causing the pelvic inflammatory disease?

Accepted Answer

Chlamydia

Answer

Gardnerella Vaginalis

Answer

Bacteroides

Answer

Neisseria gonorrhoeae

Question 10

Post-menopausal woman, fell down in washroom. What is the most common fracture she may suffer?

Accepted Answer

Colles fracture

Answer

Smith fracture

Answer

Monteggia's fracture

Answer

Galeazzi fracture

FMGE 2019

Anatomy

Anesthesiology

Biochemistry

Community Medicine

Internal Medicine

Obstetrics and Gynecology

Orthopaedics