FMGE 2023 Practice Questions

Q: The condition seen in the image results from failure of fusion of:

Medial nasal prominence and maxillary prominence. ***Medial nasal prominence and maxillary prominence*** - The upper lip is formed embryologically by the fusion of the two **medial nasal prominences** (which form the central philtrum) and the two **maxillary prominences** (which form the lateral parts of the upper lip). - Failure of these prominences to fuse results in a **cleft lip** (cheiloschisis), as depicted in the image, which can be unilateral or bilateral. *Lateral nasal prominence and maxillary prominence* - The fusion of the **lateral nasal prominence** and the **maxillary prominence** forms the side of the face and the nasolacrimal duct. - Failure of these structures to fuse results in an **oblique facial cleft**, a rare condition extending from the upper lip to the eye. *Lateral nasal prominence and mandibular prominence* - These two prominences do not fuse during facial development. The **lateral nasal prominence** forms the alae (wings) of the nose. - The **mandibular prominence** forms the lower jaw and the lower lip, which is anatomically separate from the nasal structures. *Medial nasal prominence and mandibular prominence* - The **medial nasal prominence** contributes to the upper lip and nose, while the **mandibular prominence** forms the lower lip and jaw. - These structures are located superior and inferior to the developing mouth, respectively, and do not fuse with each other.

Q: Identify the given histology slide:

Pancreas. ***Pancreas*** - The image displays a classic histological feature of the pancreas: a pale-staining cluster of endocrine cells, known as an **Islet of Langerhans**. - This islet is surrounded by more intensely stained, basophilic **acinar cells**, which constitute the exocrine component of the pancreas responsible for producing digestive enzymes. *Lymph node* - A lymph node has a distinct architecture with a **cortex** containing **lymphoid follicles** (often with germinal centers) and a **medulla**, which is not seen in this image. - The predominant cells would be lymphocytes, which appear as small, dark-staining cells, unlike the larger glandular cells shown here. *Glomerulus* - A glomerulus is a capillary tuft surrounded by **Bowman's capsule**, located within the renal cortex of the kidney. - The surrounding tissue would be composed of **renal tubules** (proximal and distal convoluted tubules), not the acinar cells seen in the slide. *Spleen* - The spleen is characterized by its division into **red pulp** (containing sinusoids and erythrocytes) and **white pulp** (lymphoid tissue surrounding a central artery). - The organized structure of islets and acini is distinct from the splenic architecture of lymphoid follicles and blood-filled sinuses.

Q: Which of the following structures marked in the image contains the splenic artery?

4. ***4*** - The pointer '4' indicates the **splenorenal ligament**, which contains the splenic artery and vein as they travel to the **splenic hilum**. - The **splenic artery** is a major branch of the celiac trunk and follows a tortuous course along the superior border of the pancreas before entering this ligament to reach the spleen. *2* - The pointer '2' indicates the **stomach**. - The splenic artery runs posterior to the stomach's lesser sac, but it is not contained within the stomach tissue itself. *1* - The pointer '1' indicates the **portal triad**, located within the **hepatoduodenal ligament**. - The portal triad consists of the **hepatic artery proper**, the **portal vein**, and the **common bile duct**, but not the splenic artery. *3* - The pointer '3' indicates the **spleen**, a lymphatic organ. - While the splenic artery's terminal branches ramify within the spleen, the main vessel is located within the splenorenal ligament (indicated by pointer 4) just before it enters the spleen.

Q: A patient in the ICU with an endotracheal tube now needs a tracheostomy tube. Which type of tube will you use?

Cuffed tracheostomy tube. ***Cuffed tracheostomy tube*** - A **cuffed tracheostomy tube** is mandatory in the ICU setting, especially when transitioning from an endotracheal tube, because it provides a seal necessary for **positive pressure ventilation** (PPCV). - The cuff also provides crucial protection against the aspiration of **oral secretions** and **gastric contents**, which is a high risk in critically ill, often sedated, ICU patients. *Uncuffed tracheostomy tube* - *Uncuffed tubes* are inadequate for patients requiring mechanical ventilation as they cannot create the necessary sealed circuit to deliver **tidal volume**. - These tubes are generally reserved for stable patients who require a chronic airway, are not on ventilation, and have a low risk of **aspiration**. *Metallic tracheostomy tube.* - **Metallic tracheostomy tubes** (like those used historically or specific specialized tubes) are typically uncuffed and are not suitable for patients requiring mandatory **mechanical ventilation** or aspiration protection in the acute ICU setting. - They are primarily used for *long-term placement* in ambulatory patients who require a stable, durable airway and often need their tube removed and cleaned frequently. *Endotracheal tube* - An **endotracheal tube (ETT)** is the device currently in use and is being *replaced* by a tracheostomy, making this option incorrect. - While the ETT provides airway management, a tracheostomy tube offers advantages for **long-term airway maintenance** (e.g., improved comfort, easier weaning, better oral hygiene).

Q: Which of the following is the process of breaking the clavicle during delivery?

Cleidotomy. ***Cleidotomy*** - This is a destructive obstetric procedure where the fetal clavicle is intentionally broken or cut to reduce the **bisacromial diameter**. It is utilized primarily in cases of severe, unrelieved **shoulder dystocia**, especially if the fetus has already succumbed (**Fetal demise**). *Craniotomy* - This is a destructive procedure aimed at reducing the size of the **fetal head** by crushing or perforating the skull. It is performed when the fetal head is impacted and delivery is otherwise impossible, usually only if there is **fetal demise**. *Symphysiotomy* - This procedure involves surgically incising the **fibrocartilage** of the **pubic symphysis** to widen the pelvic outlet. It is used to relieve **obstructed labor** due to minor cephalopelvic disproportion, allowing vaginal delivery. *Zavanelli manoeuvre* - This is an emergency procedure for severe **shoulder dystocia** where the delivered fetal head is pushed back into the birth canal (**cephalic replacement**). It mandates immediate delivery via **Cesarean section** following the replacement.

Q: Which of the following is the best parameter for estimation of fetal age by ultrasound in 1st trimester?

Crown rump length. ***Crown rump length*** - The **Crown Rump Length (CRL)** is the most accurate parameter for estimating gestational age during the **first trimester** (up to 12 weeks of gestation). - This is because biological variation between fetuses is minimal during early development, providing a narrow range of error (typically ±5-7 days). *Biparietal Diameter* - **Biparietal Diameter (BPD)** becomes the primary parameter for dating in the **second trimester** (after 12 weeks of gestation). - Its accuracy in the first trimester is significantly lower than CRL due to difficulty in obtaining standardized measurements and higher potential for measurement variability. *Head circumference* - **Head circumference (HC)** is highly utilized, often alongside BPD, for fetal growth assessment and dating near the mid-to-late second trimester. - Like BPD, HC is not the most precise measure for dating during the **first trimester** when CRL dominates. *Abdominal circumference* - **Abdominal circumference (AC)** is mainly used to assess **fetal weight** and growth, often becoming inaccurate for dating due to high biological variability later in gestation. - It is the least accurate parameter for establishing gestational age in the **first trimester** compared to CRL, BPD, and HC.

Q: Which of the following does not suggest a medical cause of mental illness?

Auditory hallucination. ***Auditory hallucination***- **Auditory hallucinations** (especially voices commenting or conversing) are highly characteristic features of **primary psychiatric disorders** like schizophrenia.- In contrast, hallucinations associated with underlying medical conditions (organic causes or delirium) are typically **visual**, **tactile**, or **olfactory**.*Elderly age*- New onset of psychiatric symptoms (e.g., psychosis, acute confusion) in an **elderly patient** should raise suspicion for a **medical or neurological etiology** until proven otherwise.- The risk of conditions like **delirium**, **vascular dementia**, or adverse drug effects contributing to psychiatric symptoms is significantly higher in this age group.*Loss of consciousness*- **Loss of consciousness (LOC)** is a critical sign of a **neurological insult** or severe systemic medical illness (e.g., seizures, syncope, metabolic coma).- Primary psychiatric illnesses, by definition, do not cause true **unresponsiveness** or **altered sensorium** associated with genuine LOC.*Acute onset*- A syndrome that appears with **acute or sudden onset** (especially involving cognitive changes, confusion, or marked mood shifts) is often highly suggestive of **delirium** or an **acute medical/toxic etiology**.- Many classic primary psychiatric disorders, such as **Schizophrenia**, typically have a more **insidious** or gradual development, often over months or years.

Q: Four patients were brought to the casualty after sustaining trauma. Which of the following is the correct match among the following?

Gaze palsy is - Midbrain lesion. ***Gaze palseis-Mid brain lesion***- **Vertical gaze palsies** are commonly associated with lesions affecting the **midbrain**, particularly the **pretectal area** and the rostral interstitial nucleus of the **medial longitudinal fasciculus (riMLF)**.- Trauma or increased intracranial pressure leading to compression in this region, such as in **Parinaud syndrome**, can result in impaired upward or downward gaze.*Extradural hemorrhage (EDH)- Pin point pupil*- An **EDH** typically causes rapid mass effect and subsequent **uncal herniation**, leading to compression of the **oculomotor nerve (CN III)** and resulting in a fixed, **dilated pupil** (mydriasis) ipsilateral to the lesion.- **Pinpoint pupils** are classically associated with damage to the descending sympathetic pathways in the **pons** (pontine hemorrhage) or opioid overdose.*Penetrating injury to eustachian tube- CSF otorrhea*- **CSF otorrhea** (leakage of CSF from the ear) occurs due to a tear in the dura mater and the **temporal bone**, specifically involving the **petrous segment** and tympanic membrane rupture.- Injury to the **Eustachian tube** primarily connects the middle ear to the nasopharynx; damage here would typically cause air leak or middle ear bleeding, not primary CSF leakage through the external auditory canal.*Penetrating injury to eye- Battle sign*- **Battle sign** is ecchymosis (bruising) over the **mastoid process** and is a hallmark clinical indicator of a **basilar skull fracture**, usually involving the middle cranial fossa (temporal bone).- Penetrating injuries to the eye are associated with localized ocular trauma (e.g., globe rupture, hyphema) but are not typically linked to this specific sign of underlying skull base injury.

Q: A homosexual man complains of painful defecation and mass protruding from the anal canal. Biopsy reveals squamous cell carcinoma of anus. Correct management for this patient is

Combined chemoradiation. ***Combined chemoradiation***- **Combined chemoradiation (Nigro protocol)** is the standard of care and preferred, organ-preserving primary treatment for most stages of squamous cell carcinoma of the anus.- This curative regimen typically involves sequential or concurrent use of **5-Fluorouracil**, **Mitomycin C** (or Cisplatin), and focused external beam radiation therapy, resulting in high rates of complete remission.*Chemotherapy*- Chemotherapy alone is insufficient as a curative primary modality for localized anal carcinoma and is inferior to combined treatment.- Systemic chemotherapy is primarily reserved for the management of **metastatic** disease or palliation in advanced, unresectable cases.*Abdominoperineal repair*- **Abdominoperineal resection (APR)**, which creates a permanent colostomy, is primarily reserved as a highly morbid **salvage operation** for locoregional failure following initial chemoradiation.- Primary APR is rarely performed because combined chemoradiation offers similar long-term survival rates with sphincter preservation.*Wide local excision*- **Wide local excision (WLE)** is only appropriate for very small (T1, <2cm), well-differentiated tumors located at the anal margin (perianal skin), which are much less common.- A bulky, protruding mass usually indicates a deeper primary tumor or involvement of the anal canal, requiring definitive **chemoradiation** rather than surgery.

Q: A 25-year-old patient presents to the surgical OPD with a painless left inguinal reducible mass. On examination cough impulse is positive. After further investigations, the patient is diagnosed with an inguinal hernia. What is the surgical management of this patient?

b.Hernioplasty. ***Hernioplasty***- **Hernioplasty**, which utilizes a prosthetic mesh (e.g., **Lichtenstein technique**), is the universally accepted standard for repairing adult inguinal hernias to achieve a tension-free repair.- This method provides a **tension-free repair** of the posterior inguinal wall, leading to significantly lower recurrence rates compared to traditional suture repairs.*Herniotomy*- **Herniotomy** involves only the excision of the hernia sac and is typically reserved for **indirect inguinal hernias in children**, where the muscle wall is robust.- In an adult, failing to repair the inherent weakness of the **inguinal canal floor** after sac removal results in an unacceptably high risk of hernia recurrence.*Wait and watch*- This approach is mainly reserved for **elderly or comorbid patients** with minimally symptomatic or asymptomatic reducible hernias who are considered high risk for surgery.- For a fit 25-year-old, surgery is recommended to prevent future potentially life-threatening complications like **strangulation** or chronic pain.*Emergency laparotomy*- A full **laparotomy** is an extensive abdominal incision utilized for exploring the acute abdomen or managing complicated intra-abdominal sepsis.- This procedure is unnecessary as the hernia is described as **reducible** and **painless**, indicating an elective repair is warranted, not an emergency exploration.

Question 1

The condition seen in the image results from failure of fusion of:

Accepted Answer

Medial nasal prominence and maxillary prominence

Answer

Lateral nasal prominence and mandibular prominence

Answer

Lateral nasal prominence and maxillary prominence

Answer

Medial nasal prominence and mandibular prominence

Question 2

Identify the given histology slide:

Accepted Answer

Pancreas

Answer

Lymph node

Answer

Spleen

Answer

Glomerulus

Question 3

Which of the following structures marked in the image contains the splenic artery?

Accepted Answer

4

Answer

3

Answer

2

Answer

1

Question 4

A patient in the ICU with an endotracheal tube now needs a tracheostomy tube. Which type of tube will you use?

Accepted Answer

Cuffed tracheostomy tube

Answer

Metallic tracheostomy tube

Answer

Endotracheal tube

Answer

Uncuffed tracheostomy tube

Question 5

Which of the following is the process of breaking the clavicle during delivery?

Accepted Answer

Cleidotomy

Answer

Zavanelli manoeuvre

Answer

Craniotomy

Answer

Symphysiotomy

Question 6

Which of the following is the best parameter for estimation of fetal age by ultrasound in 1st trimester?

Accepted Answer

Crown rump length

Answer

Biparietal Diameter

Answer

Abdominal circumference

Answer

Head circumference

Question 7

Which of the following does not suggest a medical cause of mental illness?

Accepted Answer

Auditory hallucination

Answer

Acute onset

Answer

Elderly age

Answer

Loss of consciousness

Question 8

Four patients were brought to the casualty after sustaining trauma. Which of the following is the correct match among the following?

Accepted Answer

Gaze palsy is - Midbrain lesion

Answer

b.Penetrating injury to eustachian tube- CSF otorrhea

Answer

c.Penetrating injury to eye- Battle sign

Answer

a.Extradural hemorrhage (EDH)- Pin point pupil

Question 9

A homosexual man complains of painful defecation and mass protruding from the anal canal. Biopsy reveals squamous cell carcinoma of anus. Correct management for this patient is

Accepted Answer

Combined chemoradiation

Answer

Wide local excision

Answer

Chemotherapy

Answer

Abdominoperineal repair

Question 10

A 25-year-old patient presents to the surgical OPD with a painless left inguinal reducible mass. On examination cough impulse is positive. After further investigations, the patient is diagnosed with an inguinal hernia. What is the surgical management of this patient?

Accepted Answer

b.Hernioplasty

Answer

a.Herniotomy

Answer

c.Wait and watch

Answer

d.Emergency laparotomy

FMGE 2023

Anatomy

Anesthesiology

Obstetrics and Gynecology

Psychiatry

Surgery