FMGE 2023 Practice Questions

Q: On palpation at the site marked by the red arrow on the image, a bony ridge is felt. What is the vertebral level of the marked arrow?

T4-T5 intervertebral disc. ***T4-T5 intervertebral disc*** - The arrow points to the **sternal angle** (Angle of Louis), which is the palpable transverse ridge at the junction of the **manubrium** and the **body of the sternum**. - This important anatomical landmark is located at the level of the **intervertebral disc** between the **T4 and T5** thoracic vertebrae and marks the site of articulation of the **second costal cartilage**. *T3-T4 intervertebral disc* - This vertebral level is superior to the sternal angle. - The **spine of the scapula** is a surface landmark that corresponds approximately to the level of the **T3** vertebra. *T2-T3 intervertebral disc* - This vertebral level is significantly superior to the location marked. - The **suprasternal notch** (jugular notch) of the manubrium corresponds to the level of the intervertebral disc between **T2 and T3**. *T5-T6 intervertebral disc* - This level is inferior to the sternal angle. - It would correspond to a point lower on the body of the sternum, rather than the manubriosternal junction.

Q: To what level of vertebrae does the marked structure correspond?

At the junction of L3 & L4. ***At the junction of L3 & L4*** - The umbilicus, indicated by the arrow, is a key surface landmark that typically corresponds to the level of the **intervertebral disc** between the **L3 and L4 vertebrae**. - This anatomical relationship is important for clinical procedures, as the **supracristal plane** (a line between the iliac crests) crosses near the L4 vertebra, helping to landmark sites for **lumbar puncture**. *At the junction of L1 & L2* - This vertebral level corresponds to the **transpyloric plane**, which is a different landmark located superior to the umbilicus. - Important structures at the L1/L2 level include the **pylorus of the stomach**, the hila of the kidneys, and the termination of the spinal cord (**conus medullaris**) in adults. *At the junction of L2 & L3* - This level is superior to the anatomical position of the umbilicus. - It corresponds to the location of the inferior border of the third part of the **duodenum** and the origin of the **inferior mesenteric artery** is often around L3. *At the junction of T12 & L1* - This is a much higher vertebral level, associated with the origin of the **celiac trunk** and the **superior mesenteric artery** from the abdominal aorta. - It is located significantly superior to the umbilicus and is near the **diaphragmatic hiatus** for the aorta.

Q: Resistance of the tube shown below is primarily because of

Diameter. ***Diameter*** - According to **Poiseuille's law**, resistance to laminar flow is inversely proportional to the radius raised to the fourth power (r⁴). Therefore, even a small change in the tube's **diameter** has a profound effect on airflow resistance. - The image shows an endotracheal tube, where the internal diameter is the most critical factor determining the work of breathing for a patient, as it dictates the primary resistance to gas flow. *Curvature* - The curvature of the tube can induce **turbulent flow**, especially at high flow rates, which does increase resistance. - However, its contribution to total resistance is significantly less than that of the tube's internal **diameter**. *Circumference* - Circumference is directly proportional to the diameter (Circumference = π × Diameter), so it is related to resistance. - However, the physical principle governing flow resistance, **Poiseuille's law**, specifically uses the **radius (or diameter)** to the fourth power, making it the primary determinant, not circumference. *Length* - Resistance is directly proportional to the **length** of the tube. A longer tube will have more resistance than a shorter one of the same diameter. - While length is a factor, its effect is linear, whereas the effect of the **diameter** is exponential (to the fourth power), making diameter a much more significant variable.

Q: Which of the following is not a microelement?

Calcium. ***Calcium***- Calcium is classified as a **macroelement** (or major mineral) because the body requires it in large quantities, often exceeding 100 mg daily.- It is essential for **bone mineralization**, muscle contraction, and is the most abundant mineral in the human body.*Copper*- Copper is a **microelement** (or trace mineral) and is required in amounts less than 100 mg per day.- It functions as a cofactor for several antioxidant and electron transport enzymes, crucial for **iron metabolism**.*Zinc*- Zinc is a **microelement** vital for immune function, protein synthesis, and is required in trace daily amounts.- It is a necessary cofactor for the function of over 300 enzymes, playing a key role in **gene expression** and wound healing.*Selenium*- Selenium is a **microelement** known for its antioxidant properties and is required in minute quantities (micrograms) daily.- It is structurally central to **glutathione peroxidase**, an enzyme that protects cells from oxidative damage.

Q: A 17-year-old woman with no comorbidities presents with numbness and paraesthesia of the fingers along with the characteristic finding as shown in the image below. She has no history of smoking or history of other illnesses. She mentions the episodes occur when she is under excess stress or during cold temperatures. What is the most likely diagnosis?

a. Raynaud's phenomenon. ***Raynaud's phenomenon*** (Keep the correct option at the top and the incorrect options in the order they are provided in the input) - The clinical picture of episodic digital **numbness**, paraesthesia, and color changes specifically triggered by **cold temperatures** or **stress** is pathognomonic for Raynaud's phenomenon. - Given the patient's young age (17) and lack of underlying illness (no comorbidities), this is strongly suggestive of **Primary Raynaud's phenomenon** (Raynaud's disease). *Buerger's disease* - **Buerger's disease** (Thromboangiitis obliterans) is highly associated with heavy **tobacco use**, which conflicts with the patient's history of no smoking. - This condition involves inflammation and thrombosis of medium and small arteries, typically leading to more severe fixed ischemia, ulcers, and **gangrene**, rather than transient vasospastic episodes. *Atherosclerosis* - **Atherosclerosis** is a fixed obstruction due to plaque buildup and is extremely rare in a healthy, young 17-year-old patient. - When present, it causes symptoms like **intermittent claudication** or rest pain, which are constant and exertional, unlike the acute, episodic nature of vasospasm. *Peripheral arterial disease* - **Peripheral arterial disease (PAD)** typically refers to occlusive disease (often atherosclerotic) that leads to reduced blood flow, causing symptoms that worsen with **exertion**. - Unlike Raynaud's, PAD does not typically cause acute, reversible, triphasic color changes in response to **cold** or emotional stress.

Q: Which of the following is not a component of qSOFA score?

LDH-Lactate dehydrogenase. ***LDH-Lactate dehydrogenase*** - The **quick Sequential Organ Failure Assessment (qSOFA) score** is a rapid bedside tool used to identify adult patients with suspected infection who are at high risk for poor outcomes, but it does not include laboratory markers like LDH. - qSOFA only includes three simple, readily available clinical criteria (respiratory rate, mental status, and systolic BP), therefore **LDH** is not a component. *Respiratory rate >22* - A **respiratory rate of 22 breaths per minute (or higher)** is one of the three components of the qSOFA score (a score of 1 point is given if RR ≥ 22) [1]. - This parameter indicates a potential compensatory mechanism for **metabolic acidosis** or severe underlying respiratory compromise due to infection. *Altered mental status* - **Altered mental status** (Glasgow Coma Scale score < 15 or any change from baseline) is a key component of the qSOFA score (1 point) [1]. - This reflects neurological **end-organ dysfunction** secondary to systemic inflammation and hypoperfusion (sepsis-associated encephalopathy). *Systolic blood pressure < 100 mmHg* - A systolic blood pressure (SBP) **less than 100 mmHg** is the third component of the qSOFA score (1 point) [1]. - This criterion indicates **hemodynamic compromise** and potential **shock**, reflecting severe circulatory dysfunction associated with sepsis.

Q: A patient is referred to a higher center with the diagnosis of fracture. On examination, the forearm pulses were not palpable. An upper arm X-ray was done, which is given below. Which artery is most likely to be injured in this condition?

Brachial artery. ***Brachial artery*** - The **brachial artery** runs in the anterior compartment of the arm, in close proximity to the humeral shaft. A mid-shaft humeral fracture, as shown in the X-ray, can directly injure or compress this vessel. - The clinical finding of impalpable **radial** and **ulnar pulses** strongly suggests a vascular injury proximal to the elbow, pointing directly to the brachial artery, which is the main arterial supply to the forearm. *Radial artery* - The **radial artery** is a terminal branch of the brachial artery located in the forearm. The fracture is in the humerus (upper arm), making a direct injury to the radial artery unlikely. - An absent radial pulse in this context is a *consequence* of the proximal brachial artery injury, not the primary site of damage. *Ulnar artery* - The **ulnar artery**, like the radial artery, is a major artery of the forearm that arises from the bifurcation of the brachial artery in the cubital fossa. It is not located near the humeral shaft fracture. - Injury to the ulnar artery alone would typically spare the radial pulse; the absence of both pulses points to a more proximal vascular compromise. *Anterior interosseous artery* - The **anterior interosseous artery** is a deep branch of the ulnar artery in the forearm. It is anatomically well-protected and distant from the site of the humeral fracture. - This artery is most commonly injured in association with complex forearm fractures, not humeral shaft fractures.

Q: Which of the following are true about nephroblastoma except:

Treatment is chemotherapy followed by surgery. ***Correct Answer: Treatment is chemotherapy followed by surgery*** This is the **INCORRECT** statement (which makes it the correct answer for this EXCEPT question): - In **COG (Children's Oncology Group) protocol** used in India and US: **Primary treatment is upfront nephrectomy** (surgery first) followed by chemotherapy - SIOP protocol uses preoperative chemotherapy, but this is NOT the standard approach in India/FMGE context - **Surgery-first approach** allows for accurate staging and immediate tumor removal *Incorrect: Most common intra abdominal malignancy in children* - This is **TRUE** - Nephroblastoma (Wilms tumor) is indeed the most common intra-abdominal malignancy in children (peak age 3-4 years) *Incorrect: Early lung mets* - This is **TRUE** - Wilms tumor has propensity for **early hematogenous spread to lungs** - Lungs are the most common site of metastasis - Chest X-ray/CT is mandatory for staging *Incorrect: Hematogenous spread* - This is **TRUE** - Wilms tumor spreads via **hematogenous route** to lungs (most common), liver, and other sites - Unlike neuroblastoma which can spread lymphatically

Q: A patient presents with urinary symptoms due to benign prostatic hyperplasia. Which of the following is used to manage the urinary symptoms in the initial stage of this condition?

Tamsulosin. ***Tamsulosin*** - **Alpha-1 adrenergic blocker** that relaxes smooth muscle in the prostate and bladder neck - Provides **rapid symptom relief** within days to weeks for moderate-to-severe LUTS (Lower Urinary Tract Symptoms) - **First-line medical therapy** for symptomatic BPH requiring treatment - Improves urinary flow rate and reduces obstructive symptoms (hesitancy, weak stream, incomplete emptying) *Finasteride* - 5-alpha reductase inhibitor that shrinks prostate size over time - Takes **6+ months** to show clinical benefit, not ideal for initial symptom relief - More appropriate for patients with large prostates (>40g) or as combination therapy *TURP (Transurethral Resection of Prostate)* - **Surgical intervention** reserved for refractory cases, complications, or failure of medical management - Not appropriate as initial management - Indications: recurrent retention, refractory hematuria, bladder stones, renal insufficiency due to BPH *Observation* - Appropriate for **asymptomatic or mildly symptomatic** patients (watchful waiting) - This patient presents with urinary symptoms requiring active management - Not suitable when symptoms are bothersome enough to prompt medical consultation

Q: Which is the least commonly used graft for coronary artery bypass graft (CABG)?

Intercostal artery. ***Intercostal artery***- This artery is **rarely used** in CABG due to its small caliber, difficult harvesting, and high risk of **graft spasm**.- Its use is generally restricted to highly unusual circumstances or when all major **arterial** and **venous conduits** are unavailable. *Long saphenous vein*- The **long saphenous vein (LSV)** is the most common venous graft and is frequently used, particularly for targets other than the LAD.- Though easily accessible and long, LSV grafts have significantly lower long-term patency rates compared to arterial grafts due to susceptibility to **intimal hyperplasia** and atherosclerosis. *Internal mammary artery* - The **Internal Mammary Artery (IMA)** (or Internal Thoracic Artery) is universally considered the **gold standard** graft, particularly for the Left Anterior Descending (LAD) artery.- It offers the highest long-term patency (often >90% at 10 years), making it the most commonly preferred graft, not the least common. *Radial artery*- The **radial artery (RA)** is widely used as a second arterial conduit, offering excellent long-term patency rates superior to vein grafts but slightly less than the IMA.- Preoperative evaluation using the **Allen's test** is necessary to confirm adequate collateral circulation via the ulnar artery before harvesting.

Question 1

On palpation at the site marked by the red arrow on the image, a bony ridge is felt. What is the vertebral level of the marked arrow?

Accepted Answer

T4-T5 intervertebral disc

Answer

T5-T6 intervertebral disc

Answer

T3-T4 intervertebral disc

Answer

T2-T3 intervertebral disc

Question 2

To what level of vertebrae does the marked structure correspond?

Accepted Answer

At the junction of L3 & L4

Answer

At the junction of L1 & L2

Answer

At the junction of L2 & L3

Answer

At the junction of T12 & L1

Question 3

Resistance of the tube shown below is primarily because of

Accepted Answer

Diameter

Answer

Curvature

Answer

Length

Answer

Circumference

Question 4

Which of the following is not a microelement?

Accepted Answer

Calcium

Answer

Copper

Answer

Selenium

Answer

Zinc

Question 5

A 17-year-old woman with no comorbidities presents with numbness and paraesthesia of the fingers along with the characteristic finding as shown in the image below. She has no history of smoking or history of other illnesses. She mentions the episodes occur when she is under excess stress or during cold temperatures. What is the most likely diagnosis?

Accepted Answer

a. Raynaud's phenomenon

Answer

b. Buerger's disease

Answer

c. Atherosclerosis

Answer

d. Peripheral arterial disease

Question 6

Which of the following is not a component of qSOFA score?

Accepted Answer

LDH-Lactate dehydrogenase

Answer

Systolic blood pressure < 100 mmHg

Answer

Respiratory rate >22

Answer

Altered mental status

Question 7

A patient is referred to a higher center with the diagnosis of fracture. On examination, the forearm pulses were not palpable. An upper arm X-ray was done, which is given below. Which artery is most likely to be injured in this condition?

Accepted Answer

Brachial artery

Answer

Radial artery

Answer

Anterior interosseous artery

Answer

Ulnar artery

Question 8

Which of the following are true about nephroblastoma except:

Accepted Answer

Treatment is chemotherapy followed by surgery

Answer

Most common intra abdominal malignancy in children

Answer

Early lung mets

Answer

Hematogenous spread

Question 9

A patient presents with urinary symptoms due to benign prostatic hyperplasia. Which of the following is used to manage the urinary symptoms in the initial stage of this condition?

Accepted Answer

Tamsulosin

Answer

Finasteride

Answer

Observation

Answer

TURP-Transurethral resection of prostate

Question 10

Which is the least commonly used graft for coronary artery bypass graft (CABG)?

Accepted Answer

Intercostal artery

Answer

Radial artery

Answer

Long saphenous vein

Answer

Internal mammary artery

FMGE 2023

Anatomy

Anesthesiology

Biochemistry

Internal Medicine

Orthopaedics

Pediatrics

Surgery