FMGE 2018 Practice Questions

Q: 'Cafeteria approach' is related with:

Contraception. ***Contraception*** - The **cafeteria approach** in contraception refers to offering a wide variety of **contraceptive methods** to individuals, allowing them to choose the option that best suits their needs, preferences, and circumstances. - This approach promotes **informed choice** and adherence by recognizing that no single contraceptive method is ideal for everyone. *Diet program* - While diet programs involve choices, the term **cafeteria approach** is not specifically or exclusively associated with the methodology of diet selection. - Diet programs typically focus on dietary guidelines or meal plans rather than a broad offering of methods. *National vector borne disease control programme* - This program focuses on managing and preventing **vector-borne diseases** through public health interventions, which does not involve individual "choices" in a cafeteria-style manner. - Its strategies include surveillance, vector control, and case management, without a direct "cafeteria approach" element. *Child and maternal health* - This broad field encompasses various health interventions, but the **cafeteria approach** is not a specific methodology used to describe comprehensive child and maternal health services. - While choices are involved in healthcare, this term is not standard in this context.

Q: Mainstay of treatment of glue ear -

Myringotomy + aeration to middle ear. ***Myringotomy + aeration to middle ear*** - **Myringotomy** involves creating a small incision in the eardrum to drain fluid, and inserting a **grommet (ventilation tube)** to aerate the middle ear, which is the primary treatment for persistent glue ear (otitis media with effusion). - This procedure aims to restore ventilation to the middle ear, allowing trapped fluid to drain and preventing recurrent fluid accumulation, which improves hearing. *Temporal bone resection* - This is a major surgical procedure involving the removal of part of the temporal bone, typically reserved for extensive **malignant tumors** or severe infections, and is not indicated for glue ear. - It carries significant risks and is disproportionate to the treatment of a benign condition like glue ear. *Tonsillectomy & adenoidectomy* - While **adenoidectomy** can sometimes be performed in conjunction with grommet insertion if enlarged adenoids contribute to eustachian tube dysfunction, it is not the **primary treatment** for glue ear itself. - **Tonsillectomy** is generally performed for recurrent tonsillitis and has no direct role in treating glue ear. *Radical Mastoidectomy* - This is a highly invasive surgical procedure involving the removal of the mastoid air cells and part of the external auditory canal, typically performed for severe **cholesteatoma** or chronic mastoiditis. - It is an extensive and risky operation that is not appropriate for the management of glue ear, which is a much milder condition.

Q: The most reliable criterion in Gustafson's criteria is:

Transparency of root. ***Transparency of root*** - This criterion, specifically **dentinal translucency**, is considered the most reliable age indicator in **Gustafson's criteria** due to its continuous and predictable increase with age. - The **translucency** results from the deposition of **secondary dentin** and obliteration of dentinal tubules, progressing from the apex towards the crown. *Attrition* - **Attrition** refers to the wear of tooth surfaces, which is highly variable and depends on diet, habits, and dental health, making it an unreliable age indicator. - While it generally increases with age, its rate is subject to many confounding factors. *Root resorption* - **Root resorption** is the progressive loss of tooth structure from the root and can be caused by various factors like trauma, infection, or orthodontic treatment, not solely age. - It is an unpredictable process and not a consistent age-related change. *Periodontosis* - **Periodontosis**, or **periodontal disease**, is inflammation and infection of the supporting structures around the teeth, influenced by oral hygiene and genetics. - While its prevalence may increase with age, it's not a direct and reliable physiological age marker for individuals.

Q: Which is NOT a feature of pleural effusion?

Muffled heart sound. ***Muffled heart sound*** - This is **NOT a feature of pleural effusion** and is the correct answer to this negation question. - Muffled heart sounds are characteristic of **pericardial effusion** or **cardiac tamponade**, where fluid accumulates in the pericardial sac around the heart itself. - Pleural effusion involves fluid in the pleural space surrounding the lungs, not the heart. - While massive pleural effusions can displace mediastinal structures, they do not typically cause muffled heart sounds. *Horizontal fluid level* - This **IS a feature** when air is also present in the pleural space (**hydropneumothorax**). - In **simple pleural effusion** (fluid only), the fluid typically forms a **meniscus-shaped curve** with blunting of the costophrenic angles on upright chest X-ray, not a horizontal level. - However, when both air and fluid are present, a distinct horizontal air-fluid level is visible on upright imaging. - Since the question asks about pleural effusion broadly, and effusions can be associated with air (empyema with gas-forming organisms, post-thoracentesis), this can be considered a radiological feature in certain contexts. *Low lung volume* - This **IS a feature** of pleural effusion. - The accumulating pleural fluid causes **compression atelectasis** of the adjacent lung parenchyma. - This results in **reduced functional lung volume** on the affected side, visible on chest imaging. *Decreased chest movements* - This **IS a feature** of pleural effusion. - Fluid in the pleural space restricts normal lung expansion and chest wall movement. - On physical examination, there are **diminished respiratory excursions** on the affected side. - This is one of the classic clinical signs of pleural effusion.

Q: Which of the following is true about pterygium?

Conjunctival invasion making a flap over cornea. ***Conjunctival invasion making a flap over cornea*** - A **pterygium** is characterized by the growth of **fibrovascular tissue** from the conjunctiva onto the cornea. - This growth typically forms a **triangular flap**, with its apex extending towards the center of the corneal surface. *Fatty deposition of sclera* - This description is more indicative of **pinguecula**, which is a **yellowish, fatty deposit** on the conjunctiva, usually on the nasal side, but it does not invade the cornea. - Unlike pterygium, a **pinguecula** remains confined to the conjunctiva and does not grow across the limbus onto the cornea. *Inflammation of cornea* - While a pterygium can sometimes cause irritation or inflammation, its primary characteristic is a **degenerative growth of tissue**, not primarily an inflammatory condition of the cornea itself. - **Keratitis** refers to inflammation of the cornea, which can have various causes, but it is not the defining feature of pterygium. *Dead epithelial debris accumulation* - The accumulation of dead epithelial debris is not the principal histological feature of a pterygium. - Pterygium involves **hyperplasia of conjunctival epithelium** and **subepithelial fibrovascular tissue growth**, not merely dead cell accumulation.

Q: Average hypermetropia in a newborn is

+ 2.5 D. ***+ 2.5 D*** - Most **newborns** are **hypermetropic** (farsighted) due to a shorter axial length of the eye. - The average hypermetropic correction needed at birth is approximately **+2.5 diopters (D)**. *+ 10 D* - A hyperopia of **+10 D** would represent a very significant degree of **hypermetropia**, far exceeding the typical physiological range for a newborn. - Such high hyperopia in a newborn might suggest an **ocular anomaly** or a condition like **microphthalmia**. *+ 1 D* - A hyperopia of **+1 D** is a mild degree of hypermetropia, which is less than the average physiological hyperopia found in **newborns**. - While within a normal range for some infants, it does not represent the typical average for **newborns**. *+ 5 D* - A hyperopia of **+5 D** is a higher degree of hypermetropia than the average seen in **newborns**. - While possible, it is not the most common or average refractive error at birth, which is typically around **+2.5 D**.

Q: Which nerve is commonly damaged in fracture of neck of fibula?

Common peroneal. ***Common peroneal*** - The **common peroneal nerve** (also known as the **common fibular nerve**) wraps superficially around the **neck of the fibula**, making it highly vulnerable to injury in fractures of this region. - Damage to this nerve typically results in **foot drop** and sensory loss over the dorsum of the foot and lateral leg, due to impaired dorsiflexion and eversion. *Tibial* - The **tibial nerve** lies in the posterior compartment of the leg and is generally well-protected, making it less susceptible to injury from a fibular neck fracture. - Injury to the tibial nerve would primarily affect plantarflexion of the foot and sensation to the sole. *Superficial peroneal* - The **superficial peroneal nerve** is a branch of the common peroneal nerve that descends along the lateral compartment of the leg. - While it originates from the common peroneal, a direct fracture of the fibular neck is more likely to injure the main common peroneal trunk rather than just this specific branch, leading to a broader deficit. *Deep peroneal* - The **deep peroneal nerve** is another branch of the common peroneal nerve that runs through the anterior compartment of the leg. - Similar to the superficial peroneal nerve, a fracture at the fibular neck is more likely to affect the main **common peroneal nerve** directly.

Q: Most common complication of extra capsular fracture of neck of femur is:

Non union. ***Non union*** - **Non-union** is a common complication in extracapsular femoral neck fractures due to the **disrupted blood supply** and mechanical forces across the fracture site. - The **fracture fragments** may fail to heal properly, leading to persistent pain, instability, and functional impairment. *Malunion* - **Malunion** occurs when the fracture heals in an **unacceptable anatomical position**, causing deformity or altered biomechanics. - While it can be a complication, **non-union** is generally more prevalent and problematic in extracapsular femoral neck fractures. *Ischemic necrosis* - **Ischemic necrosis** (or avascular necrosis) is less common in extracapsular femoral neck fractures compared to intracapsular fractures. - This is because the **extracapsular location** often spares the crucial blood supply to the femoral head, which is frequently compromised in intracapsular injuries. *Pulmonary complications* - **Pulmonary complications** (e.g., pneumonia, pulmonary embolism) are significant risks in elderly patients with hip fractures due to prolonged immobility and surgery. - However, direct fracture-related complications like **non-union** are distinct and represent issues specifically with bone healing.

Q: Management of a violent patient in psychiatry includes all except:

CBT. ***CBT*** - **Cognitive Behavioral Therapy (CBT)** is a long-term psychological intervention aimed at changing maladaptive thought patterns and behaviors. It is **not suitable for immediate management** of an acutely violent patient. - While CBT can be beneficial for aggression management in a stable patient, it requires patient cooperation, cognitive engagement, and time, which are not available during a **violent psychiatric emergency**. *Haloperidol* - **Haloperidol** is a potent typical antipsychotic frequently used in acute settings for rapid tranquilization of violent or severely agitated patients. - It is effective in reducing **psychosis-related agitation** and can be administered **intramuscularly** for quick onset of action. - Often used in combination with benzodiazepines for optimal control of acute violence. *ECT* - **Electroconvulsive Therapy (ECT)** may be considered in **severe, treatment-resistant cases** of violence associated with conditions like uncontrolled mania, catatonic excitement, or psychotic depression when pharmacological interventions have failed. - While not used for immediate acute management due to logistical requirements (consent, anesthesia, specialized setup), it can be an effective option for severe psychiatric conditions with persistent violence. - It works by inducing a brief controlled seizure, which can rapidly alleviate severe symptoms. *BZD* - **Benzodiazepines (BZDs)** like lorazepam or diazepam are **first-line agents** in the acute management of violent or agitated patients due to their rapid anxiolytic, sedative, and muscle relaxant properties. - They are particularly useful for **calming acute agitation** and are often combined with antipsychotics for rapid tranquilization. - Can be administered intramuscularly or intravenously for quick action in psychiatric emergencies.

Question 1

'Cafeteria approach' is related with:

Accepted Answer

Contraception

Answer

Diet program

Answer

National vector borne disease control programme

Answer

Child and maternal health

Question 2

Mainstay of treatment of glue ear -

Accepted Answer

Myringotomy + aeration to middle ear

Answer

Temporal bone resection

Answer

Tonsillectomy & adenoidectomy

Answer

Radical Mastoidectomy

Question 3

The most reliable criterion in Gustafson's criteria is:

Accepted Answer

Transparency of root

Answer

Attrition

Answer

Root resorption

Answer

Periodontosis

Question 4

Which is NOT a feature of pleural effusion?

Accepted Answer

Muffled heart sound

Answer

Horizontal fluid level

Answer

Low lung volume

Answer

Decreased chest movements

Question 5

Which of the following is true about pterygium?

Accepted Answer

Conjunctival invasion making a flap over cornea

Answer

Fatty deposition of sclera

Answer

Inflammation of cornea

Answer

Dead epithelial debris accumulation

Question 6

Average hypermetropia in a newborn is

Accepted Answer

+ 2.5 D

Answer

+ 10 D

Answer

+ 1 D

Answer

+ 5 D

Question 7

Which nerve is commonly damaged in fracture of neck of fibula?

Accepted Answer

Common peroneal

Answer

Tibial

Answer

Superficial peroneal

Answer

Deep peroneal

Question 8

Most common complication of extra capsular fracture of neck of femur is:

Accepted Answer

Non union

Answer

Malunion

Answer

Ischemic necrosis

Answer

Pulmonary complications

Question 9

Virchow's triad includes all except:-

Accepted Answer

Platelet thrombus

Answer

Stasis of blood flow

Answer

Endothelial injury

Answer

Hypercoagulability

Question 10

Management of a violent patient in psychiatry includes all except:

Accepted Answer

CBT

Answer

Haloperidol

Answer

ECT

Answer

BZD

FMGE 2018

Community Medicine

ENT

Forensic Medicine

Internal Medicine

Ophthalmology

Orthopaedics

Pathology

Psychiatry