FMGE 2018 Practice Questions

Q: Masseter is supplied by which nerve?

Mandibular. ***Mandibular*** - The **masseter muscle** is a muscle of mastication, and all muscles of mastication are exclusively innervated by the **mandibular division** (V3) of the trigeminal nerve. - The mandibular nerve carries both **motor and sensory fibers**; its motor branches supply the masseter, temporalis, medial and lateral pterygoids, mylohyoid, anterior belly of digastric, tensor veli palatini, and tensor tympani. *Glossopharyngeal* - The **glossopharyngeal nerve (CN IX)** primarily supplies sensation to the posterior third of the tongue, the pharynx, and the tympanic membrane. - It also has motor functions, innervating the **stylopharyngeus muscle** and providing parasympathetic innervation to the parotid gland. *Facial* - The **facial nerve (CN VII)** is primarily responsible for innervating the **muscles of facial expression**. - It also carries taste sensation from the anterior two-thirds of the tongue and provides parasympathetic innervation to the lacrimal, submandibular, and sublingual glands. *Hypoglossal* - The **hypoglossal nerve (CN XII)** is exclusively a motor nerve. - It innervates all of the **intrinsic and extrinsic muscles of the tongue**, except for the palatoglossus muscle (which is innervated by the vagus nerve).

Q: Which structure connects Broca's area and Wernicke's area?

Arcuate fasciculus. ***Arcuate fasciculus*** - The **arcuate fasciculus** is a bundle of **association fibers** that connects the **Broca's area** (speech production) and **Wernicke's area** (speech comprehension) in the brain [1]. - Damage to this pathway can lead to **conduction aphasia**, where speech comprehension and production are relatively preserved, but repetition is severely impaired. *Fornix* - The **fornix** is a C-shaped bundle of nerve fibers in the brain that acts as the primary efferent (output) pathway of the **hippocampus**, a crucial structure for memory. - It carries signals from the hippocampus to the mammillary bodies and other subcortical structures, playing a key role in **episodic memory** and **spatial navigation**. *Anterior commissure* - The **anterior commissure** is a bundle of nerve fibers, located in front of the columns of the fornix, that connects the two **temporal lobes** and plays a role in pain sensation and memory. - It specifically connects parts of the **pyriform cortex** and **amygdalar nuclei** of the two hemispheres. *Corpus callosum* - The **corpus callosum** is a large, C-shaped nerve fiber bundle found beneath the cerebral cortex in the brain, connecting the **two cerebral hemispheres**. - It facilitates **interhemispheric communication**, allowing for the transfer of motor, sensory, and cognitive information between both sides of the brain [1].

Q: All are premalignant conditions of oral cavity except:

Oral lichen planus. ***Oral lichen planus*** - While certain forms of **oral lichen planus (OLP)**, particularly the erosive type, are considered to have a small potential for malignant transformation, it is generally considered a **potentially malignant disorder** rather than a definitively premalignant condition with high rates of progression. - Its transformation rates are significantly lower and less consistent across studies compared to other conditions listed. *Oral submucosal fibrosis* - This is a well-established **premalignant condition** characterized by chronic, progressive fibrotic changes in the oral mucosa, primarily due to **areca nut chewing**. - It has a high malignant transformation rate, particularly into **oral squamous cell carcinoma**. *Leucoplakia* - This is defined as a white plaque of the oral mucosa that cannot be rubbed off and cannot be characterized as any other diagnosable disease. - It is histologically often associated with **epithelial dysplasia** and has a significant risk of developing into **oral squamous cell carcinoma**, making it a definitive premalignant condition. *Chronic hyperplastic candidiasis* - This is a form of **mucocutaneous candidiasis** that presents as a persistent white plaque that cannot be scraped off. - Unlike other forms of candidiasis, it is considered a **premalignant lesion** with a potential for malignant transformation, especially if associated with epithelial dysplasia.

Q: Dip at 4000 Hz in pure tone audiometry indicates:

Noise induced hearing loss. ***Noise induced hearing loss*** - A characteristic **"4 kHz Notch"** or dip in the audiogram is a hallmark of **noise-induced hearing loss**, resulting from damage to the **cochlear hair cells** in this frequency range. - This specific frequency is most susceptible to damage from loud noise exposure due to the physical properties of the **basilar membrane**. *Meniere's disease* - Typically presents with **low-frequency hearing loss**, often fluctuating, along with **tinnitus**, **vertigo**, and a feeling of **aural fullness**. - A dip at 4000 Hz is not a characteristic audiometric finding for **Meniere's disease**. *Age related hearing loss* - Also known as **presbycusis**, it is typically a **symmetrical, progressive, sensorineural hearing loss** that primarily affects **higher frequencies**, but it usually presents as a more gradual slope rather than a sharp dip at a specific frequency like 4 kHz. - While high frequencies are affected, the pattern is usually a broader high-frequency loss, not an isolated notch. *Otosclerosis* - This condition is a form of **conductive hearing loss** (though it can have a sensorineural component in advanced stages) due to abnormal bone growth around the **stapes footplate**. - Its classic audiometric finding is a **Carhart notch** around 2000 Hz, with a conductive hearing loss pattern, rather than a sensorineural dip at 4000 Hz.

Q: Which is the primary organ involved in Goodpasture syndrome?

Kidney. Kidney - Goodpasture syndrome is an autoimmune disease primarily characterized by the production of antibodies against the alpha-3 chain of type IV collagen in the glomerular basement membrane (GBM) and alveolar basement membrane [1]. - This leads to rapidly progressive glomerulonephritis and pulmonary hemorrhage, making the kidneys and lungs the main affected organs, with the kidneys being the primary and universally involved organ [1]. Adrenals - The adrenal glands are not directly involved in the pathogenesis or primary pathology of Goodpasture syndrome. - Conditions like Addison's disease or Cushing's syndrome affect the adrenals, which are distinct from Goodpasture syndrome. Liver - The liver is not a target organ for the antibodies involved in Goodpasture syndrome. - Diseases like autoimmune hepatitis or primary biliary cholangitis primarily affect the liver. Brain - The brain is not affected by the specific autoantibodies targeting type IV collagen in Goodpasture syndrome. - Neurological conditions such as vasculitis of the central nervous system or multiple sclerosis involve the brain.

Q: Inverse stretch reflex is mediated :

Golgi tendon organ. ***Golgi tendon*** - The **Golgi tendon organ (GTO)** is a **proprioceptor** located at the junction of muscle fibers and tendons, sensitive to changes in muscle tension. - When muscle tension becomes excessive, the GTO is activated, inhibiting the alpha motor neurons innervating that muscle, leading to muscle relaxation, which is the **inverse stretch reflex**. *Unmyelinated C fibres* - These fibers are primarily involved in transmitting **slow, dull pain** and **temperature sensations**, but not proprioceptive reflexes. - Their conduction velocity is much slower than that required for rapid protective reflexes. *Dorsal Column* - The dorsal column-medial lemniscus pathway is responsible for transmitting **fine touch, vibration, and proprioception** to the brain, but it is an ascending sensory pathway and does not directly mediate spinal reflexes. - This pathway is involved in conscious perception, not the direct arc of a reflex. *Muscle spindle* - The **muscle spindle** is responsible for the **stretch reflex** (myotatic reflex), which causes muscle contraction in response to stretch. - It detects changes in **muscle length and rate of change of length**, which is distinct from the inverse stretch reflex mediated by the GTO.

Q: An exaggerated pain response to a normally painful stimulus is called:

Hyperalgesia. ***Hyperalgesia*** - This term describes an **increased sensitivity to pain** where a stimulus that is normally painful is perceived as even more painful than usual. - It often results from **damage to nociceptive afferent pathways** or central sensitization. *Causalgia* - This is an older term now largely replaced by complex regional pain syndrome type II (**CRPS II**), characterized by severe, burning pain following a **nerve injury**. - Unlike hyperalgesia, it specifically refers to a **syndrome of severe pain** after nerve trauma, not just an increased response to noxious stimuli. *Allodynia* - This refers to pain caused by a stimulus that **does not normally provoke pain**, such as light touch or brushing of the skin. - It differs from hyperalgesia, which is an exaggerated response to a **normally painful stimulus**. *Hypersensitivity* - This is a **general term** meaning an increased physical or allergic sensitivity to a substance or condition. - It is a **broader concept** and not as specific to pain perception as hyperalgesia or allodynia.

Q: Dye for Sentinel Lymph Node Biopsy is injected in which of the following sites?

Areola. ***Areola*** - The **areola** is the primary site for injecting dye in sentinel lymph node biopsy because it is rich in **lymphatic vessels** that directly drain into the regional lymph nodes. - This method ensures the dye follows the natural lymphatic drainage pathway, accurately identifying the **first lymph node** to receive drainage from the tumor. *Nipple* - While the nipple is part of the breast, it has a less dense network of **lymphatic vessels** compared to the areola. - Injection directly into the nipple may not consistently identify the sentinel lymph node as effectively as periareolar or intratumoral injections. *Axilla* - The **axilla** contains the regional lymph nodes that are the *target* for identification, not the site of dye injection. - Injecting dye directly into the axilla would bypass the lymphatic drainage from the tumor, making the biopsy ineffective. *Tail of spence* - The **tail of Spence** is an extension of breast tissue into the axilla, and while it contains breast tissue, it is not the most optimal or primary site for dye injection. - The lymphatic drainage from the tail of Spence would still rely on the broader lymphatic network, which is best accessed via the central breast regions like the areola.

Question 1

Masseter is supplied by which nerve?

Accepted Answer

Mandibular

Answer

Glossopharyngeal

Answer

Facial

Answer

Hypoglossal

Question 2

Which structure connects Broca's area and Wernicke's area?

Accepted Answer

Arcuate fasciculus

Answer

Fornix

Answer

Anterior commissure

Answer

Corpus callosum

Question 3

All are premalignant conditions of oral cavity except:

Accepted Answer

Oral lichen planus

Answer

Oral submucosal fibrosis

Answer

Leucoplakia

Answer

Chronic hyperplastic candidiasis

Question 4

Dip at 4000 Hz in pure tone audiometry indicates:

Accepted Answer

Noise induced hearing loss

Answer

Meniere's disease

Answer

Age related hearing loss

Answer

Otosclerosis

Question 5

Which is the primary organ involved in Goodpasture syndrome?

Accepted Answer

Kidney

Answer

Adrenals

Answer

Liver

Answer

Brain

Question 6

A 32 year old pregnant woman presents with 36 week pregnancy with complaints of pain abdomen and decreased fetal movements. Upon examination PR= 96/min, BP = 156/100 mm Hg, FHR = 128 bpm. On per-vaginum examination there is altered blood seen and cervix is soft 1 cm dilated. What is the preferred management?

Accepted Answer

Perform cesarean section

Answer

Observation and monitoring

Answer

Initiate labor induction

Answer

Administer medications to delay labor

Question 7

What is the mechanism of secondary healing?

Accepted Answer

Granulation tissue

Answer

Neovascularization

Answer

Scab formation

Answer

Granuloma formation

Question 8

Inverse stretch reflex is mediated :

Accepted Answer

Golgi tendon organ

Answer

Unmyelinated C fibres

Answer

Dorsal Column

Answer

Muscle spindle

Question 9

An exaggerated pain response to a normally painful stimulus is called:

Accepted Answer

Hyperalgesia

Answer

Causalgia

Answer

Allodynia

Answer

Hypersensitivity

Question 10

Dye for Sentinel Lymph Node Biopsy is injected in which of the following sites?

Accepted Answer

Areola

Answer

Nipple

Answer

Axilla

Answer

Tail of spence

FMGE 2018

Anatomy

Dental

ENT

Internal Medicine

Obstetrics and Gynecology

Pathology

Physiology

Surgery