FMGE 2018 Practice Questions

Q: Dorsum of first webspace is supplied by which nerve?

Deep peroneal. ***Deep peroneal*** - The **deep peroneal nerve** innervates the **first dorsal webspace** of the foot, which is a classic sensory test area for this nerve. - Damage to this nerve can result in **foot drop** and loss of sensation in this specific area. *Superficial peroneal* - The **superficial peroneal nerve** supplies the majority of the **dorsum of the foot**, excluding the first webspace and the ankle. - It handles sensation for the **anterolateral aspect** of the distal leg and most of the dorsal foot. *Sural* - The **sural nerve** provides sensation to the **posterolateral aspect of the leg** and the **lateral border of the foot**. - It is often used for **nerve grafting** due to its superficial course. *Posterior tibial* - The **posterior tibial nerve** provides sensation to the **sole of the foot** via its medial and lateral plantar branches. - It also innervates most of the **intrinsic muscles of the foot**, affecting motor function.

Q: Energy reserve of the body is:

Triglyceride. ***Triglyceride*** - **Triglycerides** are the primary form of **energy storage** in the body, stored predominantly in **adipose tissue**. - They provide a highly concentrated and long-term energy reserve, crucial for periods of fasting or increased energy demand. *Fibres* - **Dietary fibers** are indigestible plant-derived carbohydrates that contribute to digestive health but do not serve as a direct energy reserve for the body. - They are important for maintaining gut motility and regulating blood sugar, but are not metabolized for energy. *Carbohydrate* - **Carbohydrates** (primarily **glycogen**) serve as the **body's most immediate energy source**, stored in the liver and muscles. - However, glycogen stores are limited and are depleted much faster than triglyceride stores during prolonged energy needs. *Proteins* - **Proteins** have numerous structural and functional roles in the body, but are typically used for energy only in cases of **prolonged starvation** when carbohydrate and fat reserves are severely depleted. - Their primary function is not energy storage, and their breakdown for energy can lead to **muscle wasting** and compromise essential body functions.

Q: Ujjawala scheme is for prevention of

Child trafficking. **Child trafficking** - The **Ujjawala scheme** is a comprehensive project of the Ministry of Women and Child Development, Government of India, aimed at **preventing, rescuing, rehabilitating, reintegrating, and repatriating victims of human trafficking**, particularly women and children. - It addresses the severe human rights violation of **trafficking** by providing safe shelter, basic necessities, counseling, and vocational training to survivors. *Child marriage* - While child marriage is a serious issue, the primary focus of the **Ujjawala scheme** is on **combating human trafficking**, not specifically child marriage. - Other schemes like the **Prohibition of Child Marriage Act, 2006**, and various advocacy programs specifically target the prevention of child marriage. *Child abuse* - The **Ujjawala scheme** aims to help victims of trafficking, which often includes elements of abuse, but its direct mandate is focused on **trafficking as a whole**, not all forms of child abuse. - Other legislative frameworks and programs, such as the **Protection of Children from Sexual Offences (POCSO) Act, 2012**, directly address child abuse. *Child labour* - Although children involved in trafficking may be forced into child labor, the **Ujjawala scheme's** overarching objective is to tackle **human trafficking** in its entirety. - Specific efforts to combat child labor are primarily addressed by legislation like the **Child Labour (Prohibition and Regulation) Act, 1986**, and various campaigns against child exploitation.

Q: Treatment of choice for recurrent thyrotoxicosis after surgery is:-

Radioiodine. ***Radioiodine*** - **Radioiodine therapy (RAI)** is the preferred treatment for recurrent **thyrotoxicosis** after prior surgery, especially if the patient is elderly or has comorbidities, due to its effectiveness and safety profile. [1] - It works by destroying overactive thyroid cells, reducing hormone production and mitigating the risk of further surgical complications. *Observation & follow-up* - This approach is generally **insufficient** for managing recurrent thyrotoxicosis, which requires active treatment to control hormone levels. - Delaying proper treatment can lead to serious complications such as **cardiac arrhythmias**, **osteoporosis**, and **thyroid storm**. *Radioiodine followed by surgery* - Administering radioiodine followed by surgery is **not typically a standard approach** for recurrent thyrotoxicosis and may increase patient burden and risk. - Surgery after radioiodine therapy is usually reserved for cases of **malignancy** or large goiters with compressive symptoms that persist despite RAI. [1] *Further surgery* - **Repeat thyroid surgery** carries a significantly **higher risk of complications** such as recurrent laryngeal nerve injury, hypoparathyroidism, and excessive bleeding due to altered anatomy and scar tissue from the initial surgery. [1] - The efficacy may also be reduced compared to RAI, particularly in diffuse or widespread recurrence.

Q: MC cause of nephrotic syndrome in adults:-

Focal segmental glomerulosclerosis. **Focal segmental glomerulosclerosis** - **Focal segmental glomerulosclerosis (FSGS)** is the most common cause of **primary nephrotic syndrome in adults**, particularly in African Americans and individuals with HIV or obesity [1]. - It involves **scarring** of some glomeruli (focal) and only parts of affected glomeruli (segmental), leading to **proteinuria** and progression to end-stage renal disease [2]. *Minimal change disease* - While it is the most common cause of **nephrotic syndrome in children**, it accounts for a smaller proportion of adult cases [1]. - Characterized by normal-appearing glomeruli on light microscopy but **effacement of foot processes** on electron microscopy. *Good-pasture syndrome* - This is an **autoimmune disease** causing rapidly progressive glomerulonephritis, often associated with **pulmonary hemorrhage** [3]. - It is a much rarer cause of nephrotic syndrome and is characterized by **anti-GBM antibodies** [3]. *Membranous GN* - It is a common cause of **nephrotic syndrome in adults**, particularly in Caucasians, but **Focal Segmental Glomerulosclerosis (FSGS)** has surpassed it as the overall most common primary cause. - Characterized by thickening of the **glomerular basement membrane** due to immune complex deposition, often detected by **anti-PLA2R antibodies** [2].

Q: A child presents with night blindness, delayed dark adaptation. Which investigation is to be done further to confirm the diagnosis?

ERG. ***ERG*** - **Electroretinography (ERG)** measures the electrical responses of various retinal cells, including **rods** and **cones**, to light stimuli. - In conditions like **retinitis pigmentosa** which cause night blindness and delayed dark adaptation, ERG will show characteristic abnormal or extinguished responses, confirming retinal dysfunction. *Retinoscopy* - **Retinoscopy** is an objective method to assess the refractive error of the eye by observing the light reflex from the retina. - It does not directly evaluate the functional integrity of photoreceptors or diagnose conditions causing **night blindness**. *Dark adaptometry* - **Dark adaptometry** measures the time it takes for the eye to adapt to dim light after exposure to bright light, quantifying the function of **rod photoreceptors**. - While it can *detect* delayed dark adaptation, it is a functional test that assesses the symptom, not the underlying cause provided by ERG. *EOG* - **Electrooculography (EOG)** measures the potential difference between the cornea and the retina, primarily assessing the function of the **retinal pigment epithelium (RPE)**. - While useful for conditions like **Best's disease**, it is less direct for evaluating generalized rod dysfunction causing night blindness compared to ERG.

Q: Blow out fracture can be due to:

Tennis ball injury. ***Tennis ball injury*** - A tennis ball injury to the orbit can cause a **blowout fracture** due to either direct impact compressing the globe or hydraulic pressure from the ball transmission of force, leading to a fracture of the orbital floor or medial wall. - The impact forces the orbital contents posteriorly, increasing intraorbital pressure which in turn causes the weakest bony walls (usually the floor or medial wall) to fracture outwards into the maxillary or ethmoid sinuses, respectively. *Punch at the chin from below* - A punch to the chin from below typically results in fractures of the **mandible**, particularly the condyles or angle. - This mechanism does not directly transmit force to the orbital rim or globe in a way that would cause a classic blowout fracture. *Sudden fall* - A sudden fall can cause various types of fractures depending on the impact site, but it is not a specific or common mechanism for a **blowout fracture**. - Falls usually lead to fractures of the extremities, hips, or skull other than the orbit, depending on how the body impacts the ground. *Chisel and hammer injury* - A chisel and hammer injury would more likely cause a **localized, penetrating injury** or a focal fracture at the point of impact on the face or skull. - This type of injury does not typically generate the diffuse hydraulic pressure within the orbit needed to cause a **blowout fracture** of the orbital floor or medial wall.

Q: Heart failure cells are:-

Pigmented alveolar macrophages. ***Pigmented alveolar macrophages*** - **Heart failure cells** are **alveolar macrophages** that have phagocytosed **hemosiderin** [1], which is derived from extravasated red blood cells. - This occurs in conditions causing **pulmonary congestion** and **hemorrhage**, most notably in chronic left-sided heart failure [2]. *Lipofuscin granules in cardiac cells* - **Lipofuscin** is a "wear-and-tear" pigment that accumulates in various aging cells, including **cardiac myocytes** [3]. - While present in heart cells, **lipofuscin granules** do not represent the classic "heart failure cells" which are found in the lung [3]. *Pigmented cells in pancreas* - **Pigmented cells in the pancreas** are not a recognized pathological entity described as "heart failure cells." - This option is medically irrelevant in the context of heart failure pathophysiology. *Pigmented hepatocytes* - **Pigmented hepatocytes** can be seen in various conditions, such as **hemochromatosis** (iron overload) or certain drug-induced liver injuries. - However, they are not referred to as "heart failure cells," which specifically refers to hemosiderin-laden macrophages in the lungs. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 75-76. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 536-537. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, p. 75.

Q: Purpose of adding zinc to insulin in commercial preparations for treatment of diabetes mellitus is:-

To make it long acting. ***To make it long acting*** - **Zinc** is added to insulin formulations, particularly **neutral protamine Hagedorn (NPH) insulin**, to create larger crystal complexes [1]. - These larger complexes **slow down the absorption** of insulin from the subcutaneous injection site, thereby prolonging its duration of action [2]. *To make it short acting* - **Short-acting insulins** like regular insulin are not formulated with zinc, as their purpose is rapid onset and a shorter duration. - Adding zinc would counteract the desired rapid-acting pharmacokinetic profile. *To make it fast acting* - **Fast-acting insulins** (insulin analogs) have specific amino acid modifications that alter their self-association properties to ensure rapid absorption, not the addition of zinc [2]. - Zinc actually works against the goal of fast action by promoting aggregation. *Addition of zinc makes the insulin effective orally* - Insulin is a **peptide hormone** and is generally destroyed by digestive enzymes in the gastrointestinal tract, making oral administration ineffective regardless of zinc presence [3]. - Efforts to create oral insulin involve complex delivery systems, not simple zinc addition.

Q: What is needed for prothrombin to thrombin conversion?

Calcium. ***Calcium*** - **Calcium ions (Ca2+)** are absolutely essential cofactors for the conversion of **prothrombin to thrombin** in the coagulation cascade. - They are required for the formation and function of the **prothrombinase complex** (Factor Xa + Factor Va + Ca2+ + phospholipid surface). - Calcium binds to **γ-carboxyglutamic acid (Gla) residues** on prothrombin and Factor Xa, enabling them to anchor to phospholipid surfaces where the conversion occurs. - This is why **EDTA and citrate** (calcium chelators) are used as anticoagulants in blood collection tubes. *Magnesium* - **Magnesium** is an important cofactor for numerous enzymatic reactions (e.g., ATP-dependent enzymes, DNA/RNA polymerases). - However, it is **not directly involved** in the prothrombin to thrombin conversion step of the coagulation cascade. - Its primary roles are in DNA synthesis, muscle function, and nerve transmission. *Sodium* - **Sodium** is vital for maintaining fluid balance, osmotic pressure, nerve impulses, and muscle contractions. - It does **not play a direct role** as a cofactor in the prothrombinase complex or prothrombin to thrombin conversion. *Potassium* - **Potassium** is essential for maintaining cell membrane potential, nerve impulses, cardiac function, and muscle contraction. - It is **not a cofactor** for the enzymatic reactions involved in the coagulation cascade.

Question 1

Dorsum of first webspace is supplied by which nerve?

Accepted Answer

Deep peroneal

Answer

Superficial peroneal

Answer

Sural

Answer

Posterior tibial

Question 2

Energy reserve of the body is:

Accepted Answer

Triglyceride

Answer

Fibres

Answer

Carbohydrate

Answer

Proteins

Question 3

Ujjawala scheme is for prevention of

Accepted Answer

Child trafficking

Answer

Child marriage

Answer

Child abuse

Answer

Child labour

Question 4

Treatment of choice for recurrent thyrotoxicosis after surgery is:-

Accepted Answer

Radioiodine

Answer

Observation & follow-up

Answer

Radioiodine followed by surgery

Answer

Further surgery

Question 5

MC cause of nephrotic syndrome in adults:-

Accepted Answer

Focal segmental glomerulosclerosis

Answer

Minimal change disease

Answer

Good-pasture syndrome

Answer

Membranous GN

Question 6

A child presents with night blindness, delayed dark adaptation. Which investigation is to be done further to confirm the diagnosis?

Accepted Answer

ERG

Answer

Retinoscopy

Answer

Dark adaptometry

Answer

EOG

Question 7

Blow out fracture can be due to:

Accepted Answer

Tennis ball injury

Answer

Punch at the chin from below

Answer

Sudden fall

Answer

Chisel and hammer injury

Question 8

Heart failure cells are:-

Accepted Answer

Pigmented alveolar macrophages

Answer

Lipofuscin granules in cardiac cells

Answer

Pigmented cells in pancreas

Answer

Pigmented hepatocytes

Question 9

Purpose of adding zinc to insulin in commercial preparations for treatment of diabetes mellitus is:-

Accepted Answer

To make it long acting

Answer

To make it short acting

Answer

To make it fast acting

Answer

Addition of zinc makes the insulin effective orally

Question 10

What is needed for prothrombin to thrombin conversion?

Accepted Answer

Calcium

Answer

Magnesium

Answer

Sodium

Answer

Potassium

FMGE 2018

Anatomy

Biochemistry

Community Medicine

Internal Medicine

Ophthalmology

Pathology

Pharmacology

Physiology