FMGE 2018 Practice Questions

Q: Foot eversion is caused by

Peroneus longus. ***Peroneus longus*** - The **peroneus longus** muscle (fibularis longus) is a primary evertor of the foot. - It originates from the head and upper lateral surface of the fibula, inserts into the medial cuneiform and first metatarsal, and its contraction pulls the foot outwards and downwards. *Tibialis anterior* - The **tibialis anterior** is the primary dorsiflexor and invertor of the foot. - It pulls the foot upwards and inwards, which is the opposite action of eversion. *Tibialis posterior* - The **tibialis posterior** is a strong invertor and plantar flexor of the foot. - It contributes to maintaining the arch of the foot and does not cause eversion. *Extensor digitorum* - The **extensor digitorum longus** primarily extends the toes and assists in dorsiflexion of the ankle. - While it may have a slight eversion component, it is not the primary muscle responsible for foot eversion.

Q: Syndrome of inappropriate ADH secretion is characterized by all of the following EXCEPT:-

Hypo-osmolar urine. ***Hypo-osmolar urine*** - Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is characterized by the secretion of ADH in excess of what is appropriate for the plasma osmolality. This excess ADH causes the kidneys to retain water, leading to **concentrated (hyper-osmolar) urine** [1]. - Therefore, **hypo-osmolar urine** is not a characteristic of SIADH; rather, **hyper-osmolar urine** is expected as the body tries to excrete concentrated urine to compensate for water retention. *Expanded fluid volume* - The excess ADH in SIADH leads to increased **water reabsorption** by the kidneys [1]. - This increased water retention can result in an **expanded extracellular fluid volume**, although usually without significant peripheral edema due to natriuretic peptide release [2]. *Hyponatremia* - The retained water dilutes the plasma sodium concentration, causing **dilutional hyponatremia** [2]. - This is a hallmark feature of SIADH, as the body holds onto too much free water [2]. *Water intoxication* - The characteristic features of SIADH, including **hyponatremia** and **increased total body water**, directly lead to a state of **water intoxication** [1]. - Symptoms can range from mild (nausea, malaise) to severe (seizures, coma) depending on the severity and rapidity of hyponatremia.

Q: Quellung reaction is seen with:

Pneumococcus. ***Pneumococcus*** - The Quellung reaction, also known as the **Neufeld reaction**, is a classic immunological test used to identify bacteria based on their **capsular polysaccharides**. - In the presence of specific antisera, the capsule of **_Streptococcus pneumoniae_** (Pneumococcus) swells visibly when viewed under a microscope, appearing larger and more refractile. - **Pneumococcus is the CLASSIC organism** associated with the Quellung reaction in clinical microbiology and is the standard answer in medical examinations. - While other encapsulated bacteria (_Haemophilus influenzae_, _Klebsiella pneumoniae_, _N. meningitidis_) can theoretically show capsular swelling, the test is primarily used for and associated with pneumococcal identification. *Gonococcus* - **_Neisseria gonorrhoeae_** (Gonococcus) is a Gram-negative diplococcus that causes sexually transmitted infections. - It does not possess a prominent polysaccharide capsule that exhibits the Quellung reaction in routine clinical practice. *Staphylococcus* - **_Staphylococcus_** species are Gram-positive cocci that form grape-like clusters. - While some staphylococci produce capsules or slime layers, these are not characterized using the Quellung reaction. *Streptococcus* - While _S. pneumoniae_ is technically a species of Streptococcus, in clinical terminology **"Pneumococcus" is the specific term** that denotes this particular organism. - When asked about the Quellung reaction, **"Pneumococcus" is the preferred and correct answer** rather than the broader genus term "Streptococcus." - The Quellung test is not routinely used for other Streptococcus species (like _S. pyogenes_, _S. agalactiae_) in standard clinical practice, making "Pneumococcus" the most accurate answer.

Q: After a normal delivery, when can combined oral contraceptives be started for a non-breastfeeding mother?

6 weeks. ***6 weeks*** - For **non-breastfeeding mothers**, combined oral contraceptives (COCs) are most safely initiated at **6 weeks postpartum** according to WHO Medical Eligibility Criteria. - At 6 weeks postpartum, the risk of **venous thromboembolism (VTE)** has returned to baseline, making this the safest timing (WHO MEC Category 1 - no restriction). - This timing balances both safety and effective contraception for mothers not breastfeeding. *Immediately after delivery* - Starting COCs immediately postpartum significantly increases the risk of **venous thromboembolism (VTE)** due to the hypercoagulable state after delivery. - This timing is contraindicated for combined hormonal methods (WHO MEC Category 3-4). *2 weeks* - At 2 weeks (14 days) postpartum, the VTE risk remains elevated in the early postpartum period. - Combined hormonal contraceptives are generally not recommended before 3 weeks (21 days) postpartum for non-breastfeeding women. - This timing does not meet standard safety guidelines. *12 weeks* - While 12 weeks postpartum is medically safe for initiating COCs, it is unnecessarily delayed. - This extended waiting period increases the risk of unintended pregnancy when effective contraception could be safely provided earlier at 6 weeks.

Q: EDD ( Expected Date of Delivery) is calculated by:

Naegele's formula. ***Naegele's formula*** - **Naegele's formula** is the most common and widely accepted method for calculating the estimated date of delivery (EDD). - It involves adding one year, subtracting three months, and adding seven days to the **first day of the last menstrual period (LMP)**. *Cardiff Formula* - The **Cardiff Formula** is a method used for assessing fetal movements, particularly for monitoring fetal well-being, not for calculating EDD. - It establishes a baseline of fetal movements over a specific period to detect any significant decrease. *McDonald's rule* - **McDonald's rule** is a clinical method used to estimate the gestational age based on fundal height measurements. - While it helps in estimating gestational age, it is not primarily used for calculating the precise EDD. *Hadlock Formula* - The **Hadlock Formula** refers to a set of widely used ultrasound-based formulas for estimating fetal weight and gestational age, typically involving biometry measurements like BPD, HC, AC, and FL. - While accurate for gestational age estimation, it's an imaging-based method, not a direct calculation of EDD from the LMP like Naegele's.

Q: Cause of sudden loss of vision in a diabetic is due to:

Vitreous hemorrhage. ***Vitreous hemorrhage*** - **Vitreous hemorrhage** is the **most common cause** of sudden, painless vision loss in individuals with **proliferative diabetic retinopathy** - New, fragile blood vessels (neovascularization) on the retina in diabetes can rupture, leading to bleeding into the **vitreous gel** - Patients describe sudden onset of floaters, cobwebs, or a red haze obscuring vision *Central retinal vein occlusion* - **CRVO** causes sudden, painless vision loss with **retinal hemorrhages in all four quadrants** (blood and thunder appearance) - While diabetic patients are at increased risk, vision loss is typically less profound than vitreous hemorrhage - Fundoscopy shows widespread retinal hemorrhages, dilated tortuous veins, and cotton-wool spots *Neovascular glaucoma* - **Neovascular glaucoma** causes **painful** vision loss and elevated intraocular pressure due to new vessel growth on the iris and trabecular meshwork - While associated with diabetes, it usually presents with more **gradual onset** and pain, rather than sudden, painless vision loss - Characterized by rubeosis iridis and elevated IOP *Central retinal artery occlusion* - **CRAO** causes sudden, profound, painless monocular vision loss, often described as a "curtain coming down" - While diabetic patients are at higher risk for CRAO due to generalized atherosclerosis, it typically results in a **cherry-red spot** on the macula - This is usually embolic in nature and less specifically related to diabetic retinopathy itself

Q: Patient with history of blunt trauma to face presents with enophthalmos, diplopia on upward gaze and loss of sensitivity over cheek. True statement about this is:

It is a blow out fracture. ***It is a blow out fracture*** - The combination of **enophthalmos** (sunken eye), **diplopia on upward gaze** (due to **inferior rectus muscle entrapment**), and **loss of sensitivity over the cheek** (indicating infraorbital nerve involvement) are classic signs of an **orbital blowout fracture**. - These fractures typically involve the **orbital floor** or medial wall, caused by a direct impact to the orbit, which transmits force to the thin bony walls causing them to fracture while the orbital rim remains intact. *Maxillary fracture* - While the **infraorbital nerve** passes through the maxilla, a general maxillary fracture typically presents with broader symptoms such as **midfacial pain**, **swelling**, and **malocclusion**, which are not specified here. - Maxillary fractures often involve the **zygomaticomaxillary complex** or Le Fort patterns, which usually lead to more extensive facial abnormalities. *Zygomatic bone is most likely injured* - A **zygomatic arch fracture** would primarily cause **flattening of the cheek** and pain upon opening the mouth, not enophthalmos or diplopia on upward gaze. - While the zygoma forms part of the orbit, isolated zygomatic fractures rarely cause these specific orbital findings. *Frontal bone fracture* - **Frontal bone fractures** typically result from **high-impact trauma** and can involve the **frontal sinus**, leading to **forehead swelling**, **CSF rhinorrhea**, or **periorbital ecchymosis** (raccoon eyes). - The symptoms described are not characteristic of a frontal bone fracture.

Q: A lady had a trauma to the neck. X-ray is attached. What is the diagnosis?

Hangman's fracture. ***Hangman's fracture*** - A **Hangman's fracture** is a fracture of the **pars interarticularis of the C2 vertebra (axis)**, typically resulting from hyperextension and distractive forces, often seen in car accidents or judicial hangings. - The X-ray would show **bilateral pedicle fractures of C2**, with or without anterior displacement of C2 on C3. *Sciwora* - **SCIWORA** stands for **Spinal Cord Injury Without Radiographic Abnormality**, and it is primarily diagnosed when clinical signs of spinal cord injury are present but X-rays and CT scans show no bony abnormalities. - This patient's X-ray would show visible bony injury, ruling out SCIWORA. *Jefferson's fracture* - A **Jefferson's fracture** is a **burst fracture of the C1 vertebra (atlas)**, typically caused by axial loading with a compressive force, and involves fractures of the anterior and/or posterior arches of C1. - While it's also a cervical spine fracture, it specifically involves C1, not C2 as seen in a Hangman's fracture. *Clay shoveler fracture* - A **Clay shoveler's fracture** is an avulsion fracture of a **spinous process** in the lower cervical or upper thoracic spine, most commonly C6, C7, or T1. - It typically results from abrupt neck flexion and muscle pulling, and is a stable fracture that does not affect the C2 pars interarticularis.

Q: Albers-Schönberg disease is:

Osteopetrosis. ***Osteopetrosis*** - **Albers-Schönberg disease** is another name for **osteopetrosis**, also known as **marble bone disease** [1]. - It is a group of rare genetic disorders characterized by abnormally **dense bones** due to a defect in **osteoclast** function, leading to impaired bone resorption [1]. *Osteoporosis* - **Osteoporosis** is characterized by decreased bone density and structural deterioration of bone tissue, leading to an increased risk of fractures. - It results from an imbalance where **bone resorption outpaces bone formation**, the opposite of osteopetrosis. *Paget* (Paget's disease of bone) - **Paget's disease of bone** involves localized areas of increased bone turnover, leading to disorganized bone remodeling and weakened, enlarged bones. - It is distinct from osteopetrosis, which involves a generalized increase in bone density. *Osteogenesis imperfecta* - **Osteogenesis imperfecta** (OI), or brittle bone disease, is a genetic disorder causing extremely fragile bones prone to fractures, often due to defects in **collagen production** [1]. - This condition presents with bone fragility and often blue sclera, which is the opposite of the increased bone density seen in osteopetrosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1188-1189.

Q: Shortest acting local anaesthetic

Chloroprocaine. ***Chloroprocaine*** - **Chloroprocaine** is known for its rapid onset and very **short duration of action**, typically lasting 30-60 minutes, due to its **rapid hydrolysis** by plasma and liver esterases. - Its quick metabolism makes it suitable for short procedures where a brief blockade is desired, minimizing the risk of systemic toxicity. *Dibucaine* - **Dibucaine** is a local anesthetic with a **long duration of action**, typically 2 to 4 hours, which is much longer than chloroprocaine. - It is used topically and in spinal anesthesia, but its prolonged effect makes it unsuitable as the shortest-acting option. *Procaine* - **Procaine** is an ester-type local anesthetic with a relatively **short duration of action** (approximately 30-60 minutes), but it is generally longer than that of chloroprocaine. - It was one of the first synthetic local anesthetics and is less potent and shorter-acting than many modern agents. *Cocaine* - **Cocaine** has a moderate duration of action as a local anesthetic, typically lasting 60-90 minutes, which is longer than chloroprocaine. - While it is a potent local anesthetic and vasoconstrictor, its high abuse potential and systemic side effects limit its clinical use, mainly to topical application in otolaryngology.

Question 1

Foot eversion is caused by

Accepted Answer

Peroneus longus

Answer

Tibialis anterior

Answer

Tibialis posterior

Answer

Extensor digitorum

Question 2

Syndrome of inappropriate ADH secretion is characterized by all of the following EXCEPT:-

Accepted Answer

Hypo-osmolar urine

Answer

Expanded fluid volume

Answer

Hyponatremia

Answer

Water intoxication

Question 3

Quellung reaction is seen with:

Accepted Answer

Pneumococcus

Answer

Gonococcus

Answer

Staphylococcus

Answer

Streptococcus

Question 4

After a normal delivery, when can combined oral contraceptives be started for a non-breastfeeding mother?

Accepted Answer

6 weeks

Answer

Immediately after delivery

Answer

2 weeks

Answer

12 weeks

Question 5

EDD ( Expected Date of Delivery) is calculated by:

Accepted Answer

Naegele's formula

Answer

Cardiff Formula

Answer

McDonald's rule

Answer

Hadlock Formula

Question 6

Cause of sudden loss of vision in a diabetic is due to:

Accepted Answer

Vitreous hemorrhage

Answer

Central retinal vein occlusion

Answer

Neovascular glaucoma

Answer

Central retinal artery occlusion

Question 7

Patient with history of blunt trauma to face presents with enophthalmos, diplopia on upward gaze and loss of sensitivity over cheek. True statement about this is:

Accepted Answer

It is a blow out fracture

Answer

Maxillary fracture

Answer

Zygomatic bone is most likely injured

Answer

Frontal bone fracture

Question 8

A lady had a trauma to the neck. X-ray is attached. What is the diagnosis?

Accepted Answer

Hangman's fracture

Answer

Sciwora

Answer

Jefferson's fracture

Answer

Clay shoveler fracture

Question 9

Albers-Schönberg disease is:

Accepted Answer

Osteopetrosis

Answer

Osteoporosis

Answer

Paget

Answer

Osteogenesis imperfecta

Question 10

Shortest acting local anaesthetic

Accepted Answer

Chloroprocaine

Answer

Dibucaine

Answer

Procaine

Answer

Cocaine

FMGE 2018

Anatomy

Internal Medicine

Microbiology

Obstetrics and Gynecology

Ophthalmology

Orthopaedics

Pathology

Pharmacology