FMGE 2018 Practice Questions

Q: Hypoglossal nerve supplies all of these muscles except:-

Palatoglossus. ***Palatoglossus*** - The **palatoglossus** muscle is innervated by the **pharyngeal plexus** (composed of contributions from the vagus and glossopharyngeal nerves), not the hypoglossal nerve. - It is the only extrinsic muscle of the tongue not supplied by the hypoglossal nerve, and its primary function is to elevate the posterior part of the tongue and narrow the oropharyngeal isthmus. *Styloglossus* - The **styloglossus** muscle is an **extrinsic tongue muscle** that originates from the styloid process and inserts into the side and undersurface of the tongue. - It is supplied by the **hypoglossal nerve** and acts to retract and elevate the tongue. *Genioglossus* - The **genioglossus** muscle is an **extrinsic tongue muscle** that originates from the mental spine of the mandible. - It is innervated by the **hypoglossal nerve** and is responsible for protruding and depressing the tongue, and its bilateral contraction is crucial in preventing airway obstruction during sleep (tongue falling back). *Hyoglossus* - The **hyoglossus** muscle is an **extrinsic tongue muscle** that originates from the hyoid bone and inserts into the side of the tongue. - It is supplied by the **hypoglossal nerve** and acts to depress and retract the tongue.

Q: Disease usually not seen in a country but brought from abroad is:

Exotic. ***Exotic*** - An **exotic disease** refers to a disease that is not native or usually found in a particular country or region but is introduced from abroad. - This term highlights its **foreign origin** and rarity within the local population. *Endemic* - An **endemic disease** is one that is constantly present in a population or region with a relatively stable prevalence within that population. - It describes a disease that is **native** to a specific area, not typically brought from abroad. *Epidemic* - An **epidemic** signifies a sudden increase in the number of cases of a disease in a population over a particular period, substantially exceeding what is normally expected. - While it can be introduced from abroad, the definition focuses on the **rapid spread** rather than the origin itself. *Zoonotic* - A **zoonotic disease** is an infectious disease that has jumped from an animal to humans. - This term describes the **mode of transmission** from animals, not necessarily its geographic origin or whether it's new to a country.

Q: A well of contaminated water resulting in an epidemic of acute watery diarrhea is a typical example for:

Common source, single exposure epidemic. ***Common source, single exposure epidemic*** - A contaminated well is a **classic example of a point source (single exposure) epidemic**, as seen in John Snow's famous Broad Street pump cholera outbreak. - People who drink from the contaminated well are exposed to the pathogen at **roughly the same time or over a short period**. - The epidemic curve shows a **sharp rise in cases within one incubation period**, followed by a rapid decline, creating a characteristic **single peaked curve**. - Even though the well remains accessible, each individual's exposure is typically a **discrete event**, not continuous. *Common source, continuous exposure epidemic* - This occurs when the **source remains contaminated and people are repeatedly exposed over an extended period**, such as persistent sewage leakage into a water supply. - The epidemic curve would show a **prolonged plateau** with cases occurring continuously as long as the exposure continues. - Unlike a contaminated well (discrete exposures), continuous exposure involves **ongoing, repetitive contact** with the pathogen source. *Propagated epidemic* - Involves **person-to-person transmission** where the disease spreads through successive generations of cases. - The epidemic curve shows **multiple peaks** or waves as the infection passes from one individual to another. - Waterborne diarrhea from a well is **not transmitted person-to-person** but through a common environmental source. *Slow epidemic* - This is **not a standard epidemiological classification** based on exposure patterns. - While epidemics can vary in speed, this term doesn't describe the **transmission dynamics** relevant to classifying outbreak patterns.

Q: Continuous murmur is heard in?

Patent ductus arteriosus. ***Patent ductus arteriosus*** - A **continuous murmur** in PDA is often described as a **"machinery-like" murmur**, audible throughout systole and diastole [1]. - This murmur is caused by the continuous flow of blood from the higher-pressure aorta into the lower-pressure pulmonary artery [1]. *Tetralogy of Fallot* - The murmur associated with Tetralogy of Fallot is typically a **systolic ejection murmur** heard at the upper left sternal border [1]. - This murmur is due to pulmonary stenosis and is not continuous, as it is related to ventricular ejection [1]. *Ventricular septal defect* - A VSD typically presents with a **holosystolic murmur**, meaning it is heard throughout systole [1]. - The murmur in VSD is confined to systole and does not extend into diastole, distinguishing it from a continuous murmur [1]. *Atrial septal defect* - An ASD is typically associated with a **systolic ejection murmur** over the pulmonic area due to increased flow across the pulmonary valve [1]. - There may also be a **diastolic rumble** across the tricuspid valve, but neither of these is a continuous murmur [1].

Q: Otomycosis is most commonly caused by:

Aspergillus fumigatus. ***Aspergillus fumigatus*** - **Aspergillus species**, particularly *A. fumigatus* and *A. niger*, are the most frequent causes of **otomycosis**, accounting for 80-90% of cases. - They thrive in damp, warm environments, making the external auditory canal an ideal site for their growth, often presenting with a **black or grayish fungal debris**. *Mucor* - **Mucor** is a less common cause of otomycosis and is more often associated with **rhinocerebral mucormycosis** in immunocompromised individuals. - While it can cause opportunistic infections, its prevalence in otomycosis is significantly lower compared to Aspergillus. *Actinomycetes* - **Actinomycetes** are **filamentous bacteria**, not fungi, and are typically associated with **actinomycosis**, a chronic suppurative infection. - They are known to cause infections in the head and neck, but not typically otomycosis, which is a fungal infection of the ear. *Candida albicans* - **Candida albicans** is the second most common cause of otomycosis, but it is less prevalent than Aspergillus species. - Infections by Candida tend to be more common in individuals with a history of **antibiotic use** or in **immunocompromised patients**, and often present with a *creamy white discharge*.

Q: For laser iridotomy which laser is used?

Nd YAG laser. ***Nd YAG laser*** - The **Nd:YAG laser** is the **primary laser used for laser iridotomy** due to its ability to create precise perforations in the iris. - This laser operates with a **photodisruptive mechanism**, generating plasma formation that effectively creates an opening in the iris. - It is the **treatment of choice for angle-closure glaucoma** and pupillary block. *Argon laser* - The **argon laser** was historically used for iridotomy but is now less commonly the primary choice due to its thermal effect causing more inflammation and scarring. - It is sometimes used in **sequential laser iridotomy** (argon first to thin the iris, followed by Nd:YAG to perforate) in cases where the iris is very thick or heavily pigmented. - Also used for **peripheral iridoplasty** and other thermal applications. *CO2 laser* - **CO2 lasers** are primarily used for **tissue ablation** in surgical procedures, particularly on the skin, eyelid lesions, or in general surgery. - They are **not suitable** for precise intraocular procedures like iridotomy due to their infrared wavelength (10,600 nm) and poor penetration through aqueous humor. *Excimer laser* - **Excimer lasers** are primarily used in **refractive surgery** (e.g., LASIK, PRK) to reshape the cornea. - They work by **photoablation** at 193 nm wavelength, precisely removing tissue layer by layer, and are not designed for creating an opening in the iris.

Q: Patient had an injury to thumb causing thumb abduction. Which of the following can happen?

Game keepers thumb. ***Gamekeeper's thumb*** - A **Gamekeeper's thumb**, or **skier's thumb**, is an injury to the **ulnar collateral ligament (UCL)** of the thumb's metacarpophalangeal (MCP) joint. - This injury commonly occurs due to a **forceful abduction** and hyperextension of the thumb. *Kaplan lesion* - A **Kaplan lesion** refers to an avulsion fracture of the radial styloid process, usually associated with scaphoid fractures. - This lesion is typically related to wrist injuries, not primarily thumb abduction. *Bennett fracture* - A **Bennett fracture** is an intra-articular fracture at the base of the first metacarpal bone. - It usually results from an axial load applied to a partially flexed thumb, rather than pure abduction. *Mallet finger* - A **mallet finger** is an injury to the **extensor tendon** of the finger, causing the fingertip to remain in a flexed position. - This injury typically affects the distal interphalangeal (DIP) joint of any finger and is not directly related to thumb abduction.

Q: The drug that causes fall in elderly patients with postural hypotension is:-

Prazosin. ***Prazosin*** - **Alpha-1 adrenergic blocker** used to treat hypertension and benign prostatic hyperplasia (BPH) - Commonly causes **orthostatic hypotension (postural hypotension)** as a side effect by blocking alpha-1 receptors on vascular smooth muscle, preventing compensatory vasoconstriction upon standing - Leads to **dizziness, lightheadedness, and falls**, especially in elderly patients who have reduced baroreceptor sensitivity - **First-dose phenomenon** is particularly notable, with marked hypotension after the initial dose *Acarbose* - Alpha-glucosidase inhibitor used to treat type 2 diabetes by reducing carbohydrate absorption in the intestine - Primary side effects are **gastrointestinal** (flatulence, diarrhea, abdominal discomfort) - Does not affect blood pressure or cause postural hypotension *Nor-adrenaline (Norepinephrine)* - **Vasopressor** and sympathomimetic agent that causes vasoconstriction through alpha-adrenergic receptor stimulation - **Increases blood pressure** and is used to treat severe hypotension in critical care settings - Would not cause falls due to postural hypotension; rather, it counteracts hypotension *Metformin* - **Biguanide** oral hypoglycemic agent for type 2 diabetes that primarily decreases hepatic glucose production and increases insulin sensitivity - Main side effects include gastrointestinal disturbances and rare lactic acidosis - Not associated with postural hypotension or increased risk of falls

Q: Enteropeptidase enzyme is secreted by:

Duodenum. ***Duodenum*** - **Enteropeptidase** (also known as enterokinase) is a key enzyme primarily secreted by the mucosal cells of the **duodenum**. - Its main function is to activate **trypsinogen** (from the pancreas) into **trypsin**, initiating a cascade of protein digestion. *Ileum* - The ileum is primarily involved in the absorption of **vitamin B12** and **bile salts**. - It does not significantly contribute to the secretion of digestive enzymes like enteropeptidase. *Stomach* - The stomach secretes **pepsin** (to digest proteins) and **hydrochloric acid**, and is involved in initial protein digestion. - It does not produce enteropeptidase, which acts much later in the digestive process. *Jejunum* - The jejunum is a major site for the absorption of **nutrients** like carbohydrates, fats, and proteins. - While it has some brush border enzymes, the primary secretion of enteropeptidase occurs in the duodenum.

Q: Surgery is indicated in Ulcerative Colitis in all except?

Colonic polyp. ***Colonic polyp*** - **Colonic polyps** in ulcerative colitis (UC) are often managed with **endoscopic polypectomy** and surveillance; surgery (colectomy) for polyps is typically reserved for those with **high-grade dysplasia** or **colorectal cancer**. - Simple polyps themselves, without high-grade dysplasia or malignancy, do not independently warrant surgical intervention in UC. *Toxic megacolon* - **Toxic megacolon** is a severe and life-threatening complication of UC characterized by rapid **colonic dilation** and systemic toxicity, which carries a high risk of perforation and mortality. - Urgent surgical intervention, often **subtotal colectomy**, is indicated to prevent perforation and manage sepsis. *Colonic obstruction* - Although uncommon in UC, **colonic obstruction** can occur due to strictures, fibrosis, or malignant transformation, causing symptoms like abdominal pain, distension, and vomiting. - When medically refractory or associated with significant symptoms or suspicion of malignancy, surgery is often required to relieve the obstruction. *Failure of medical management* - **Chronic medically refractory UC** is one of the most common indications for elective colectomy, accounting for approximately 20-30% of surgical cases. - When patients fail to respond to maximal medical therapy including corticosteroids, immunomodulators, and biologics, or experience steroid-dependent disease with unacceptable side effects, surgical intervention with **proctocolectomy** may be required for definitive management.

Question 1

Hypoglossal nerve supplies all of these muscles except:-

Accepted Answer

Palatoglossus

Answer

Styloglossus

Answer

Genioglossus

Answer

Hyoglossus

Question 2

Disease usually not seen in a country but brought from abroad is:

Accepted Answer

Exotic

Answer

Endemic

Answer

Epidemic

Answer

Zoonotic

Question 3

A well of contaminated water resulting in an epidemic of acute watery diarrhea is a typical example for:

Accepted Answer

Common source, single exposure epidemic

Answer

Propagated epidemic

Answer

Slow epidemic

Answer

Common source, continuous exposure epidemic

Question 4

Continuous murmur is heard in?

Accepted Answer

Patent ductus arteriosus

Answer

Tetralogy of fallot

Answer

Ventricular septal defect

Answer

Atrial septal defect

Question 5

Otomycosis is most commonly caused by:

Accepted Answer

Aspergillus fumigatus

Answer

Mucor

Answer

Actinomycetes

Answer

Candida albicans

Question 6

For laser iridotomy which laser is used?

Accepted Answer

Nd YAG laser

Answer

Argon laser

Answer

CO2 laser

Answer

Excimer laser

Question 7

Patient had an injury to thumb causing thumb abduction. Which of the following can happen?

Accepted Answer

Game keepers thumb

Answer

Kaplan lesion

Answer

Mallet finger

Answer

Bennett fracture

Question 8

The drug that causes fall in elderly patients with postural hypotension is:-

Accepted Answer

Prazosin

Answer

Acarbose

Answer

Nor-adrenaline

Answer

Metformin

Question 9

Enteropeptidase enzyme is secreted by:

Accepted Answer

Duodenum

Answer

Ileum

Answer

Stomach

Answer

Jejunum

Question 10

Surgery is indicated in Ulcerative Colitis in all except?

Accepted Answer

Colonic polyp

Answer

Toxic megacolon

Answer

Colonic obstruction

Answer

Failure of medical management

FMGE 2018

Anatomy

Community Medicine

Internal Medicine

Microbiology

Ophthalmology

Orthopaedics

Pharmacology

Physiology

Surgery