FMGE 2023 Practice Questions

Q: Identify the segment marked in red in the image below.

a.V. ***a.V*** - The highlighted area represents **Segment V** of the liver according to the **Couinaud classification**. It is located in the inferior portion of the **right anterior section**. - It lies inferior to **Segment VIII** and is separated from the medial segment (IVb) by the **middle hepatic vein**. *b.IVa* - **Segment IVa** is part of the **left medial section** and is located superiorly, just inferior to the diaphragm. - The structure shown is in the **right lobe** of the liver, not the left medial section. *c.VII* - **Segment VII** is located in the superior part of the **right posterior section** of the liver. - The highlighted segment is in the **anterior section**, separated from the posterior section by the **right hepatic vein**. *III* - **Segment III** is part of the **left lateral section** of the liver, located anteriorly and inferiorly within that section. - The highlighted structure is part of the **right lobe**, well to the right of the falciform ligament and middle hepatic vein.

Q: Identify the rib highlighted in the X-ray.

3rd rib posterior part. ***3rd rib posterior part*** - On a posteroanterior (PA) chest X-ray, the **posterior ribs** are more prominent and have a more horizontal orientation as they articulate with the thoracic vertebrae, which matches the highlighted structure. - When counting from the top, the first rib is the highest and most curved. The highlighted rib is clearly the third one down from the apex of the thorax, confirming it as the **3rd posterior rib**. *3rd rib anterior part* - The **anterior parts** of the ribs are more difficult to visualize and course downwards and medially towards the sternum. The highlighted rib is oriented horizontally. - Anterior ribs connect to the sternum via **costal cartilage**, which is not as radiopaque as bone and thus appears less distinct on an X-ray than the highlighted structure. *4th rib anterior part* - This option is incorrect as the highlighted structure is a **posterior rib**, not an anterior one, based on its orientation. - Additionally, counting reveals the rib to be the third, not the fourth. The **fourth rib** would be located inferior to the highlighted one. *1st rib anterior part* - The **1st rib** is the most superior and has a very sharp curvature, often partially obscured by the clavicle. The highlighted rib is located below the first and second ribs. - This is also incorrect because the image highlights the **posterior aspect** of a rib, not the anterior aspect.

Q: A child has elevated liver enzyme levels. A ring-like structure is noted on ocular examination. Which of the following is the cause for this?

Copper. ***Copper***- The combination of elevated **liver enzymes** (hepatitis/cirrhosis) and the characteristic **Kayser-Fleischer (KF) rings** visible on ocular examination is pathognomonic for **Wilson's disease**.- **Wilson's disease** is an inherited disorder involving defective biliary excretion of **copper**, causing its toxic accumulation in tissues, notably the liver, brain, and cornea.*Zinc*- Zinc is an essential trace element, but its deficiency presents primarily with **acrodermatitis enteropathica**, not hepatic failure and KF rings.- Zinc supplementation is sometimes used as a treatment for Wilson's disease because it inhibits the absorption of **copper** in the gut.*Selenium*- Deficiency of **Selenium** is associated with **Keshan disease** (cardiomyopathy) and impaired antioxidant protection, rather than liver disease with corneal rings.- High levels of selenium, though rare, can lead to hair loss and nail changes (**selenosis**).*Iron*- Excessive accumulation of **Iron** causes **hemochromatosis**, which leads to hepatomegaly, cirrhosis, and **bronze diabetes**.- Iron overload does not result in the formation of **Kayser-Fleischer rings**; these rings are exclusively caused by **copper** deposition in the Descemet membrane.

Q: In which of the following situations is ventouse not used?

Premature baby. ***Premature baby***- Ventouse traction carries a substantially higher risk of **neonatal intracranial hemorrhage** and **cephalhematoma** in premature infants due to the greater fragility and softness of the fetal skull and vasculature.- Vacuum extraction is generally contraindicated for fetuses less than **36 weeks gestation** or those weighing less than **2,500 grams**.*Prolonged second stage*- This represents a failure to progress during the expulsive phase of labor and is a primary indication for operative delivery to prevent adverse outcomes.- Ventouse is often preferred in cases of **arrest of descent** or prolonged pushing efforts, provided the cervix is fully dilated and the station is appropriate.*Maternal exhaustion*- This is a common indication for operative vaginal delivery, suggesting the mother is too fatigued to generate effective pushing efforts, leading to potential delivery stagnation.- Ventouse assists in shortening the second stage, thereby conserving maternal energy and reducing the risk associated with lengthy, ineffective pushing efforts.*Fetal distress*- Acute signs of **fetal compromise** (e.g., severe fetal bradycardia or late decelerations) necessitate the rapid termination of labor, often through operative vaginal delivery.- Ventouse is one of the methods used to achieve a quick and safe delivery when the fetal heart rate is non-reassuring and the fetal head is engaged.

Q: Which of the following is not an indication for a cesarean section?

Previous history of macrosomia. ***Previous history of macrosomia***- A previous history of **macrosomia** (birth weight >4000g) results in an increased risk of shoulder dystocia but is typically managed with careful monitoring and induction/elective C-section based on *estimated* fetal weight in the current pregnancy, not the history alone.- This is a risk factor, not an absolute primary indication for an elective C-section during the current pregnancy unless the estimated current fetal weight is excessive (e.g., >4500g or >5000g in specific circumstances) or there are other complicating factors (e.g., poorly controlled diabetes).*Absolute cephalopelvic disproportion*- **Absolute cephalopelvic disproportion (CPD)** means the fetal head cannot pass through the maternal pelvis, rendering vaginal delivery impossible and risking uterine rupture.- This condition is an absolute mechanical indication for C-section to ensure a safe delivery for both mother and fetus.*Central placenta previa*- **Central placenta previa** (or complete previa) involves the placenta completely covering the internal cervical os, blocking the birth canal.- Attempting vaginal delivery would lead to immediate and massive **uncontrollable hemorrhage** upon cervical effacement or dilation, thus mandating an elective C-section.*Advanced carcinoma cervix*- **Advanced carcinoma cervix** requires delivery via C-section, primarily to prevent severe, life-threatening hemorrhage and potential tumor fragmentation/seeding if vaginal delivery is attempted.- Additionally, the tumor mass mechanically obstructs the birth canal, often making vaginal delivery anatomically impossible or highly risky.

Q: What is the level of the uterus immediately after delivery?

Below the umbilicus. ***Below the umbilicus*** Immediately after delivery, the uterus undergoes rapid contraction and the fundus is typically palpable **at or slightly below the level of the umbilicus**. This is due to myometrial contraction following placental separation. Within the first 12-24 hours postpartum, the fundus remains at approximately the umbilical level before beginning involution at approximately 1 cm per day. *Incorrect: Above pubic symphysis* This is too low for the immediate postpartum period. The uterus reaches this level only after several weeks of involution (around 2 weeks postpartum). *Incorrect: Below pubic symphysis* The uterus is palpable below the pubic symphysis only by 6 weeks postpartum when involution is complete and it has returned to its non-pregnant size. *Incorrect: Above umbilicus* The fundus is not palpable above the umbilicus immediately after delivery. A fundus above the umbilicus in the immediate postpartum period suggests uterine atony or retained products.

Q: Which of the following procedures is done with the instrument shown below?

Dilatation and curettage. ***Dilatation and curettage*** - The instrument shown is a **uterine curette** (specifically, a Sims uterine curette), which is the primary instrument used in D&C procedures. - D&C involves two steps: **dilatation** of the cervix using dilators (e.g., Hegar dilators) followed by **curettage** of the endometrial cavity using a curette. - This is a classic operative gynecological procedure used for diagnostic purposes (to obtain endometrial tissue) or therapeutic purposes (to evacuate uterine contents). - When asked about the procedure done with a uterine curette, the specific procedural name is **D&C**, not just endometrial sampling. *Endometrial sampling* - While D&C does sample the endometrium, the term "endometrial sampling" in modern practice typically refers to **office-based procedures** using simpler instruments. - Examples include **Pipelle catheter**, endometrial biopsy cannula, or Vabra aspirator, which are thin suction devices that do not require cervical dilatation. - These are outpatient procedures, whereas D&C with a curette is typically performed in an operating room under anesthesia. - The question asks about the specific procedure associated with the instrument (curette), which is D&C. *Hysterosalpingography* - This is a radiological procedure that involves injecting contrast dye into the uterus and fallopian tubes to assess their patency and shape. - It is performed using a **cannula** (like a Leech-Wilkinson cannula) or a balloon catheter to introduce the dye, not a curette. *Cervical sampling* - This procedure, such as a Pap smear, is performed to collect cells from the surface of the cervix (ectocervix and endocervical canal). - Instruments like an **Ayre's spatula** and a **cytobrush** are used for cervical sampling, not a uterine curette which is designed to bypass the cervix and reach the endometrial cavity.

Q: Which of the following procedures is done with the instrument shown below? ![img-39.jpeg](img-39.jpeg)

Endometrial sampling. ***Endometrial sampling*** - The instrument shown is a **Sims uterine curette**, which is specifically designed with a fenestrated (windowed) tip to scrape and collect tissue from the uterine lining. - This procedure, also known as an **endometrial biopsy**, is performed to obtain a sample of the **endometrium** for histological examination, often to investigate abnormal uterine bleeding or infertility. - When asked about the **primary procedure** performed with this instrument, endometrial sampling is the most direct and specific answer. *Dilatation and curettage* - While a curette **is used** in a D&C, the question asks about the procedure done with **this specific instrument**. - D&C is a **two-step procedure**: cervical **dilatation** (using dilators) followed by **curettage** (using the curette). - The complete D&C procedure involves **multiple instruments**, whereas the curette shown specifically performs the endometrial sampling/curettage component. - Therefore, "endometrial sampling" more precisely describes what **this instrument alone** accomplishes. *Hysterosalpingography* - This is a radiological imaging procedure used to evaluate the uterus and fallopian tubes, not a tissue sampling method. - It involves injecting a contrast medium through the cervix using a **cannula**, followed by X-ray imaging. - A curette is not used in this procedure. *Cervical sampling* - This procedure, commonly for a **Pap smear**, uses instruments like an **Ayre's spatula** or a **cytobrush** to collect cells from the cervix. - A uterine curette is designed to reach the endometrium inside the uterus and is not used for sampling the cervix.

Q: Which of the following is the most common location of implantation in ectopic pregnancy? ![img-40.jpeg](img-40.jpeg)

A. ***A*** - Label A points to the **fallopian tube**, which is the site of over 95% of all ectopic pregnancies. The most common specific location within the tube is the **ampulla** (approximately 80% of tubal ectopics). - Risk factors such as **pelvic inflammatory disease (PID)**, previous tubal surgery, or endometriosis can damage the fallopian tube, impeding the transit of the fertilized ovum to the uterus. *D* - Label D indicates the **uterus**, which is the normal site for implantation in a healthy, **intrauterine pregnancy**. - By definition, an ectopic pregnancy is one that implants *outside* the uterine cavity, making this location incorrect. *B* - Label B indicates the **ovary**. An **ovarian ectopic pregnancy** is a rare form of ectopic implantation, constituting about 3% of cases. - This occurs if the egg is fertilized and implants on or within the ovary itself, before it enters the fallopian tube. *C* - Label C points to the **cervix**. A **cervical pregnancy** is a very rare type of ectopic pregnancy, accounting for less than 1% of cases. - This location is particularly dangerous due to a high risk of life-threatening **hemorrhage** because of the cervix's rich vascular supply.

Question 1

Identify the segment marked in red in the image below.

Accepted Answer

a.V

Answer

c.VII

Answer

b.IVa

Answer

d.III

Question 2

Identify the rib highlighted in the X-ray.

Accepted Answer

3rd rib posterior part

Answer

4th rib anterior part

Answer

3rd rib anterior part

Answer

1st rib anterior part

Question 3

A child has elevated liver enzyme levels. A ring-like structure is noted on ocular examination. Which of the following is the cause for this?

Accepted Answer

Copper

Answer

Zinc

Answer

Selenium

Answer

Iron

Question 4

In which of the following situations is ventouse not used?

Accepted Answer

Premature baby

Answer

Maternal exhaustion

Answer

Prolonged second stage

Answer

Fetal distress

Question 5

Which of the following is not an indication for a cesarean section?

Accepted Answer

Previous history of macrosomia

Answer

Central placenta previa

Answer

Absolute cephalopelvic disproportion

Answer

Advanced carcinoma cervix

Question 6

What is the level of the uterus immediately after delivery?

Accepted Answer

Below the umbilicus

Answer

Above pubic symphysis

Answer

Below pubic symphysis

Answer

Above umbilicus

Question 7

Which of the following procedures is done with the instrument shown below?

Accepted Answer

Dilatation and curettage

Answer

Endometrial sampling

Answer

Cervical sampling

Answer

Hysterosalpingography

Question 8

Which of the following procedures is done with the instrument shown below? ![img-39.jpeg](img-39.jpeg)

Accepted Answer

Endometrial sampling

Answer

Cervical sampling

Answer

Hysterosalpingography

Answer

Dilatation and curettage

Question 9

Which of the following is the most common location of implantation in ectopic pregnancy? ![img-40.jpeg](img-40.jpeg)

Accepted Answer

A

Answer

D

Answer

B

Answer

C

Question 10

A 5-year-old child presented with a history of edema of the face which later progressed to generalized edema. Urine showed massive proteinuria and light microscopy was normal. Electron microscopy showed effacement of podocyte foot processes. What is the diagnosis?

Accepted Answer

Minimal change disease

Answer

Post streptococcal glomerulonephritis

Answer

Focal segmental glomerulo sclerosis

Answer

Membranous glomerulonephritis

FMGE 2023

Anatomy

Biochemistry

Obstetrics and Gynecology

Pathology