FMGE 2018 Practice Questions

Q: Which branch of facial nerve supplies muscles of lower lip

Marginal mandibular. ***Marginal mandibular*** - The **marginal mandibular branch** of the facial nerve innervates muscles of the lower lip and chin, including the **depressor labii inferioris**, **depressor anguli oris**, and **mentalis**. - Damage to this nerve causes an inability to depress the lower lip, leading to an **asymmetric smile**. *Buccal* - The **buccal branch** primarily innervates the **buccinator muscle** and the muscles of the upper lip. - It is crucial for **cheek compression** (e.g., blowing or sucking) and expression around the mouth. *Cervical* - The **cervical branch** supplies the **platysma muscle**, a broad sheet of muscle in the neck that helps depress the mandible and draw down the corners of the mouth. - It does not directly innervate the muscles of the lower lip. *Temporal* - The **temporal branch** provides motor innervation to the muscles of the forehead and around the eye, including the **frontalis** and **orbicularis oculi**. - It is responsible for actions like raising the eyebrows and closing the eyelids.

Q: Pointing index finger is seen in which nerve injury

Median. ***Median*** - The **pointing index finger** sign occurs in **proximal median nerve injury** when attempting to make a fist, as the median nerve supplies **flexor digitorum superficialis (FDS)** and lateral half of **flexor digitorum profundus (FDP)**. - This creates the classic **"hand of benediction"** or **"pope's blessing"** sign where index and middle fingers remain extended due to loss of flexion capability. *Axillary* - Primarily innervates the **deltoid** and **teres minor muscles**, affecting **shoulder abduction** and external rotation. - Injury does not cause any **finger positioning abnormalities** or hand deformities. *Radial* - Injury causes **"wrist drop"** with inability to extend the wrist, thumb, and fingers at **MCP joints**. - Results in all fingers remaining **flexed due to unopposed flexor action**, not a pointing finger deformity. *Ulnar* - Injury causes **"claw hand"** deformity primarily affecting the **ring and little fingers** (4th and 5th digits). - Creates **hyperextension at MCP joints** and **flexion at PIP/DIP joints**, with the index finger typically less affected.

Q: Most common malignancy of maxillary antrum:

Squamous cell Carcinoma. ***Squamous cell Carcinoma*** - **Squamous cell carcinoma (SCC)** accounts for approximately **80% of all malignant tumors** of the maxillary antrum. - This prevalence is due to the **squamous metaplasia** of the respiratory epithelium lining the sinus, especially in response to chronic irritation or inflammation. *Mucoepidermoid Carcinoma* - While it can occur in the maxillary sinus, **mucoepidermoid carcinoma** is a rare tumor, typically arising from **minor salivary glands**. - It is far **less common** than squamous cell carcinoma in the maxillary antrum. *Adenoid cystic Carcinoma* - **Adenoid cystic carcinoma** is a relatively rare tumor that more commonly affects the **major and minor salivary glands** and is known for its **perineural invasion** and slow growth, but it is not the most common in the maxillary antrum. - Its presence in the maxillary sinus is usually an **extension from adjacent structures** or a primary tumor of minor salivary glands within the sinus. *Adenocarcinoma* - **Adenocarcinoma** of the maxillary antrum is less common than SCC, often associated with exposure to **wood dust** or **leather processing**. - It typically arises from **seromucinous glands** within the sinus lining, but its incidence is significantly lower than that of squamous cell carcinoma.

Q: Obstacles in concomitant squint are:

All of the options. ***All of the options*** - **Concomitant squint** involves **sensory obstacles** (e.g., amblyopia, eccentric fixation), **motor obstacles** (e.g., muscle imbalance, inadequate fusional vergence), and **central obstacles** (e.g., defective brain processing of visual information). - All these factors interact to cause and maintain the misalignment of the eyes. *Sensory obstacles* - These include conditions like **amblyopia** (lazy eye) due to suppression of the deviated eye's image, and **eccentric fixation**, where the fovea is not used for central vision. - While significant, sensory obstacles alone do not fully explain concomitant squint, as motor and central components are also crucial. *Motor obstacles* - These involve issues with the **extraocular muscles**, such as imbalance in muscle tone, or problems with the **neural control** of eye movements, leading to a deviation that is relatively constant in all gaze positions. - Motor obstacles are a key component but are often influenced by central and sensory factors. *Central obstacles* - These refer to problems within the brain's visual pathways and centers responsible for **fusion**, **vergence**, and maintaining **ocular alignment**. - Defective processing of visual input or an inability to maintain binocular vision can directly contribute to squint, highlighting the brain's role in coordinating eye movements.

Q: A child presents with a limp and limb shortening. The X-ray is shown below. What is the diagnosis?

DDH. ***DDH*** - **DDH (Developmental Dysplasia of the Hip)** often presents with a **limp**, **limb shortening**, and characteristic X-ray findings showing a **dislocated or dysplastic hip joint**. - The image would likely show the **femoral head displaced** from the acetabulum, confirming the diagnosis. *SCFE* - **SCFE (Slipped Capital Femoral Epiphysis)** presents with pain and a limp, but typically involves the **femoral head slipping posteriorly and inferiorly** relative to the femoral neck. - It usually occurs in **adolescents** who are overweight or rapidly growing, and the X-ray would show the **epiphysis displaced** rather than a fully dislocated hip. *Fracture neck of femur* - A **fracture of the neck of the femur** in a child is a rare traumatic injury that would present with **acute pain** and inability to bear weight. - The X-ray would clearly show a **break in the continuity** of the femoral neck, which is distinct from the developmental abnormality seen in DDH. *Perthes* - **Perthes disease** involves **avascular necrosis of the femoral head** and typically presents with a limp and pain, often in younger children (4-10 years old). - X-rays would show signs of **collapse, fragmentation, and later reossification** of the femoral head, rather than a dislocated hip.

Q: Malignancy in a multinodular goiter is most often:-

Papillary carcinoma. ***Papillary carcinoma*** - **Papillary carcinoma** is the most common type of thyroid cancer, accounting for about 80-85% of all thyroid malignancies [1], [2]. - It often arises in the setting of multifocal disease or within a **multinodular goiter**, particularly when a dominant nodule undergoes malignant transformation [2]. *Anaplastic carcinoma* - **Anaplastic carcinoma** is a very aggressive and rare form of thyroid cancer, typically presenting as a rapidly growing neck mass in elderly patients [2]. - While it can occur in a multinodular goiter, it is far less common than papillary carcinoma and carries a much poorer prognosis [2]. *Follicular carcinoma* - **Follicular carcinoma** is the second most common type of thyroid cancer (10-15%) and is often difficult to distinguish from benign follicular adenomas without surgical excision [2]. - While it can be found in a multinodular goiter, **papillary carcinoma** is still statistically more frequent in this context [1]. *Medullary carcinoma* - **Medullary carcinoma** originates from the parafollicular C cells of the thyroid and accounts for about 1-2% of all thyroid cancers [2]. - It is often associated with inherited syndromes like **Multiple Endocrine Neoplasia type 2 (MEN2)** and is distinct from tumors arising from follicular cells within a multinodular goiter [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1098-1099. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 429-430.

Q: Compression ventilation ratio in case of Neonatal CPR:

3:1. ***3:1*** - In **neonatal CPR**, a compression to ventilation ratio of **3 compressions per 1 breath** is recommended. This ratio prioritizes ventilation due to the most common cause of cardiac arrest in neonates being **hypoxia**. - This ratio aims to deliver sufficient oxygen while maintaining adequate cardiac output for the unique physiology of newborns. *30:2* - A 30:2 ratio is generally recommended for **adult CPR** when a single rescuer is present, as adults often have initial cardiac etiologies. - This ratio would provide insufficient ventilations for a neonate whose primary arrest cause is typically respiratory. *100:8* - This ratio is not a standard recommendation for any age group in Cardiopulmonary Resuscitation guidelines. - It would lead to an imbalance, offering a disproportionately high number of compressions relative to ventilations, which is not optimal for neonatal resuscitation. *15:2* - A 15:2 ratio is typically recommended for **pediatric CPR** when two or more rescuers are present. - While closer to the neonatal requirement for ventilation, it still does not provide the immediate and frequent ventilations needed for neonates.

Q: Inhibin is secreted by:

Sertoli cells. ***Sertoli cells*** - **Sertoli cells** are located in the seminiferous tubules of the testes and play a crucial role in spermatogenesis. - They secrete **inhibin**, a hormone that selectively inhibits the secretion of follicle-stimulating hormone (FSH) from the anterior pituitary gland. *Peg cells* - **Peg cells** (non-ciliated secretory cells) are found in the lining of the fallopian tubes, not the testes. - They produce **tubal fluid** which nourishes the ovum and spermatozoa, and aids in sperm capacitation. *Leydig cells* - **Leydig cells** are found in the interstitial tissue between the seminiferous tubules of the testes. - Their primary function is to produce and secrete **androgens**, such as testosterone, in response to luteinizing hormone (LH). *Interstitial cells* - This term is a general descriptor for cells located in the spaces between functional tissues or organs. - In the context of the testes, **Leydig cells** are the primary interstitial cells responsible for hormone production, while **Sertoli cells** are part of the seminiferous tubules.

Q: Double depression is seen in:

Depression with dysthymia. ***Depression with dysthymia*** - **Double depression** is a specific mood disorder characterized by the co-occurrence of a **major depressive episode** on top of a pre-existing **dysthymic disorder** (persistent depressive disorder). - This means an individual experiences the chronic, milder symptoms of dysthymia, which are then worsened by the more severe symptoms of a major depressive episode. *Depression with anxiety attack* - While depression and anxiety attacks can co-occur, this specific combination is not referred to as **double depression**. - **Anxiety attacks** are acute episodes of intense fear and discomfort, often associated with panic disorder, and are distinct from chronic low-grade depressive symptoms. *Major depression with OCD* - **Obsessive-compulsive disorder (OCD)** is a distinct anxiety disorder characterized by obsessions and compulsions, which can co-occur with major depression. - However, the term **double depression** specifically refers to the combination of major depression and dysthymia, not other psychiatric comorbidities. *Major depressive disorder from 2 years* - Experiencing **major depressive disorder for 2 years** implies a chronic course of major depression. - If the symptoms meet the criteria for major depressive disorder continuously for at least two years, it might be termed **chronic major depressive disorder**, but not double depression, unless there was an underlying dysthymia.

Q: Bleeding vessel in hemorrhoids is

Superior rectal artery. Superior rectal artery - Hemorrhoidal bleeding primarily originates from the **terminal branches of the superior rectal artery** within the hemorrhoidal plexus. - The hemorrhoidal cushions contain **arteriovenous anastomoses**, and bleeding occurs from rupture or erosion of the **arterial component**. - This explains why hemorrhoidal bleeding is typically **bright red** (oxygenated arterial blood) and can be brisk. - Modern surgical treatments like **hemorrhoidal artery ligation (HAL)** specifically target these arterial branches, confirming the arterial source of bleeding. Superior rectal vein - While the superior rectal vein drains the hemorrhoidal plexus and is dilated in hemorrhoids, it is **not the primary source of bleeding**. - The venous component contributes to the cushion engorgement but the **actual bleeding is arterial** in nature. - This is an older, outdated concept that has been revised with modern understanding of hemorrhoidal pathophysiology. Middle rectal vein - The middle rectal vein drains the **muscular wall of the rectum** and has minimal involvement in the hemorrhoidal venous plexus. - It is not a significant contributor to hemorrhoidal bleeding. Middle rectal artery - The middle rectal artery provides collateral blood supply to the rectum but plays a **minor role** compared to the superior rectal artery. - The **superior rectal artery** is the dominant arterial supply to the internal hemorrhoidal plexus and is the primary bleeding source.

Question 1

Which branch of facial nerve supplies muscles of lower lip

Accepted Answer

Marginal mandibular

Answer

Buccal

Answer

Cervical

Answer

Temporal

Question 2

Pointing index finger is seen in which nerve injury

Accepted Answer

Median

Answer

Axillary

Answer

Radial

Answer

Ulnar

Question 3

Most common malignancy of maxillary antrum:

Accepted Answer

Squamous cell Carcinoma

Answer

Muco-epidermoid Carcinoma

Answer

Adenoid cystic Carcinoma

Answer

Adenocarcinoma

Question 4

Obstacles in concomitant squint are:

Accepted Answer

All of the options

Answer

Sensory obstacles

Answer

Motor obstacles

Answer

Central obstacles

Question 5

A child presents with a limp and limb shortening. The X-ray is shown below. What is the diagnosis?

Accepted Answer

DDH

Answer

SCFE

Answer

Fracture neck of femur

Answer

Perthes

Question 6

Malignancy in a multinodular goiter is most often:-

Accepted Answer

Papillary carcinoma

Answer

Anaplastic carcinoma

Answer

Follicular carcinoma

Answer

Medullary carcinoma

Question 7

Compression ventilation ratio in case of Neonatal CPR:

Accepted Answer

3:1

Answer

30:2

Answer

100:8

Answer

15:2

Question 8

Inhibin is secreted by:

Accepted Answer

Sertoli cells

Answer

Peg cells

Answer

Leydig cells

Answer

Interstitial cells

Question 9

Double depression is seen in:

Accepted Answer

Depression with dysthymia

Answer

Depression with anxiety attack

Answer

Major depression with OCD

Answer

Major depressive disorder from 2 years

Question 10

Bleeding vessel in hemorrhoids is

Accepted Answer

Superior rectal artery

Answer

Superior rectal vein

Answer

Middle rectal vein

Answer

Middle rectal artery

FMGE 2018

Anatomy

ENT

Ophthalmology

Orthopaedics

Pathology

Pediatrics

Physiology

Psychiatry

Surgery