FMGE 2019 Practice Questions

Q: Middle meningeal artery is a branch of which artery?

Maxillary artery. ***Maxillary artery*** - The **middle meningeal artery** is a major branch of the **maxillary artery**, which itself is a terminal branch of the **external carotid artery**. - It supplies blood to the **dura mater** and cranial bones and is notably vulnerable to injury in temporal bone fractures. *Superficial temporal artery* - The **superficial temporal artery** is the other terminal branch of the **external carotid artery** (alongside the maxillary artery). - It supplies the scalp and superficial temporal region but does not give rise to the middle meningeal artery. *Facial artery* - The **facial artery** is a branch of the **external carotid artery** but primarily supplies structures of the face, such as muscles of facial expression and superficial facial tissues. - It does not give rise to the middle meningeal artery, which has an intracranial course. *Ophthalmic artery* - The **ophthalmic artery** is a branch of the **internal carotid artery** and supplies structures within the orbit, including the eye. - It does not contribute to the blood supply of the dura mater in the area supplied by the middle meningeal artery.

Q: Spinal anaesthesia in an adult is given at this level:

L3-L4. ***L3-L4*** - This intervertebral space is a **safe and common site** for spinal anaesthesia in adults because the **spinal cord typically terminates at L1-L2** in adults. - Inserting the needle at L3-L4 minimizes the risk of **spinal cord injury** while still allowing access to the cerebrospinal fluid. *T12-L1* - This level is **too high** for routine spinal anaesthesia in adults, as it is often at or very near the **conus medullaris** (the end of the spinal cord). - Puncture at this level carries a **significant risk of direct spinal cord injury**. *L1-L2* - While technically possible, this level is still considered **higher risk** as it is often the **terminal end of the spinal cord** in adults. - The **cauda equina** is present below L1-L2, but the L3-L4 space offers a greater margin of safety. *L5-S1* - This intervertebral space is generally **too low and difficult to access** for consistent and effective spinal anaesthesia. - The **iliac crests typically align with L4**, making the L3-L4 or L4-L5 spaces more accessible for spinal puncture.

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: 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 name of this appearance which is seen in pellagra?

Casal's necklace. ***Casal's necklace*** - Characteristic of **pellagra**, it presents as a **dermatitis** localized around the neck in a "necklace" pattern due to **niacin deficiency**. - This sign is commonly associated with other symptoms of pellagra, such as **dermatitis**, **diarrhea**, and **dementia**. *Shawl sign* - This sign typically refers to **lupus erythematosus** and involves a **rash** on the shoulders, not associated with pellagra. - It is characterized by an **erythematous rash** in sun-exposed areas, distinct from the features of **pellagra**. *Gottron's papule* - These are **papules** seen in **dermatomyositis**, characterized by violaceous lesions on the fingers, not related to pellagra. - Their appearance is associated with **muscle weakness** and other features of dermatomyositis, rather than **niacin deficiency**. *Burn* - Refers to an injury from thermal exposure and does not relate to the **dermatological signs** of pellagra. - It is not a clinical feature and does not reflect the **nutritional deficiency** seen in this condition.

Q: Antemortem diagnosis of rabies is made with:

Corneal impression smear. ***Corneal impression smear*** - A **corneal impression smear** can detect viral antigens in the cornea using fluorescent antibody staining, a method that can be performed on living patients. - This technique provides a relatively rapid and non-invasive way to diagnose rabies **antemortem**. *Inoculation in culture media* - Rabies virus is notoriously difficult to culture in standard cell culture media, making this method impractical and unreliable for **antemortem diagnosis**. - While viral isolation is possible in specialized research settings, it is not a routine diagnostic tool for rabies in living patients. *Negri bodies in hippocampus* - **Negri bodies** are eosinophilic inclusions found in the cytoplasm of neurons, particularly in the hippocampus, which are pathognomonic for rabies. - However, their detection requires **postmortem brain tissue biopsy**, making this a **postmortem diagnostic** method, not antemortem. *Rabies virus specific antibodies* - While the presence of **rabies virus-specific antibodies** (particularly in CSF) can indicate exposure and infection, they often appear late in the disease course. - The detection of antibodies may not be reliable for early **antemortem diagnosis**, especially in naive individuals whose immune response has not yet fully developed.

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: Which of the following can be a cause of Oligohydramnios?

Renal agenesis. ***Renal agenesis*** - **Fetal urine production** is the primary source of **amniotic fluid** in the latter half of pregnancy, so **bilateral renal agenesis** prevents this production. - Oligohydramnios due to renal agenesis is often associated with **Potter sequence**, characterized by facial anomalies, limb deformities, and pulmonary hypoplasia due to prolonged severe oligohydramnios. *Macrosomia* - **Macrosomia** (large baby) is not a cause of oligohydramnios; a larger fetus does not directly reduce amniotic fluid volume. - In fact, conditions like **gestational diabetes** which can cause macrosomia, are often associated with **polyhydramnios** (excess amniotic fluid) due to increased fetal urination. *Multiparity* - **Multiparity** (having had multiple previous pregnancies) is not directly associated with oligohydramnios. - While it can be a risk factor for certain pregnancy complications, it does not physiologically lead to reduced amniotic fluid. *Twins* - A multifetal pregnancy, such as **twins**, can sometimes be associated with complications like **twin-to-twin transfusion syndrome**, where one twin might develop oligohydramnios and the other polyhydramnios. - However, the presence of twins itself does not intrinsically cause oligohydramnios; it is a potential complication of specific twin types or their pathologies rather than a direct cause.

Q: Prostatic cancer mostly seen in

Posterior. ***Posterior*** - The **peripheral zone** of the prostate, which is located posteriorly, is the most common site for the development of **prostatic adenocarcinoma**. - This anatomical location is why a **digital rectal exam (DRE)** is an important screening tool, as palpable nodules can be detected [1]. *Lateral* - While prostatic tissue extends laterally, this region is not the predominant site for cancer development. - Cancers originating here are less common than those in the posterior peripheral zone. *Anterior* - The **anterior fibromuscular stroma** and the anterior portion of the prostate are rarely the primary sites for prostate cancer. - Tumors found here are often extensions from more posteriorly located cancers. *Medial* - The **transition zone**, which is located medially and surrounds the urethra, is the most common site for **benign prostatic hyperplasia (BPH)**, not prostate cancer. - While cancer can occur in this zone, it is less frequent than in the peripheral zone.

Q: Abdominal pain, fever and jaundice. This triad is known as;

Charcot's triad. ***Charcot's triad*** - **Charcot's triad** consists of **abdominal pain**, **fever**, and **jaundice**, indicating **acute cholangitis** [1]. - This triad is a hallmark of **biliary tract obstruction** with concurrent infection [1]. *Renault's triad* - This is a **distractor** name; there is no recognized medical triad called "Renault's triad." - It does not describe any specific clinical presentation or set of symptoms. *Virchow triad* - **Virchow triad** describes factors that predispose to **thrombus formation**: **endothelial injury**, **stasis**, and **hypercoagulability**. - It is associated with conditions like **deep vein thrombosis (DVT)** and **pulmonary embolism**, not cholangitis. *Saint's triad* - **Saint's triad** refers to the co-occurrence of **gallstones**, **hiatal hernia**, and **diverticulosis**. - This triad describes three unrelated gastrointestinal conditions and is distinct from the symptoms of cholangitis.

Question 1

Middle meningeal artery is a branch of which artery?

Accepted Answer

Maxillary artery

Answer

Superficial temporal artery

Answer

Facial artery

Answer

Ophthalmic artery

Question 2

Spinal anaesthesia in an adult is given at this level:

Accepted Answer

L3-L4

Answer

T12-L1

Answer

L1-L2

Answer

L5-S1

Question 3

Most abundant amino acid found in collagen?

Accepted Answer

Glycine

Answer

Hydroxyproline

Answer

Proline

Answer

Lysine

Question 4

Yellow fever vaccine is valid for?

Accepted Answer

Lifelong

Answer

20 years

Answer

5 years

Answer

10 years

Question 5

What is the name of this appearance which is seen in pellagra?

Accepted Answer

Casal's necklace

Answer

Shawl sign

Answer

Gottron's papule

Answer

Burn

Question 6

Antemortem diagnosis of rabies is made with:

Accepted Answer

Corneal impression smear

Answer

Inoculation in culture media

Answer

Negri bodies in hippocampus

Answer

Rabies virus specific antibodies

Question 7

Most common organism causing the pelvic inflammatory disease?

Accepted Answer

Chlamydia

Answer

Gardnerella Vaginalis

Answer

Bacteroides

Answer

Neisseria gonorrhoeae

Question 8

Which of the following can be a cause of Oligohydramnios?

Accepted Answer

Renal agenesis

Answer

Macrosomia

Answer

Multiparity

Answer

Twins

Question 9

Prostatic cancer mostly seen in

Accepted Answer

Posterior

Answer

Lateral

Answer

Answer

Medial

Question 10

Abdominal pain, fever and jaundice. This triad is known as;

Accepted Answer

Charcot's triad

Answer

Renault's triad

Answer

Virchow triad

Answer

Saint's triad

FMGE 2019

Anatomy

Anesthesiology

Biochemistry

Community Medicine

Dermatology

Microbiology

Obstetrics and Gynecology

Surgery