FMGE 2018 Practice Questions

Q: Retraction of scapula is done by

Trapezius. ***Trapezius*** - The **trapezius** muscle, particularly the middle fibers, is responsible for **retracting the scapula**, pulling it medially towards the vertebral column. - This action is crucial for stabilizing the shoulder girdle and enabling various arm movements. *Serratus anterior* - The **serratus anterior** is primarily responsible for **protraction of the scapula** (pulling it forward) and stabilizing it against the thoracic wall. - It also aids in upward rotation of the scapula. *Supraspinatus* - The **supraspinatus** muscle is a rotator cuff muscle involved in the **initiation of arm abduction** (lifting the arm away from the body). - It does not directly contribute to scapular retraction. *Subscapularis* - The **subscapularis** is another rotator cuff muscle, primarily responsible for **internal rotation of the arm** and stabilization of the glenohumeral joint. - It has no direct role in scapular retraction.

Q: What are these horizontal lines seen on the skin called?

Blaschko lines. ***Blaschko lines*** - **Blaschko lines** are invisible lines of normal skin development, thought to represent migration paths of **epidermal cells** during embryogenesis. - They become visible in certain skin conditions, such as **pigmentary disorders (e.g., incontinentia pigmenti)** and **linear epidermal nevi**, manifesting as distinctive linear or whorled patterns. *Dermatomes* - **Dermatomes** represent areas of skin innervated by a single **spinal nerve root**. - Conditions like **herpes zoster (shingles)** follow a dermatomal pattern. *Vascular development* - **Vascular development** refers to the formation of blood vessels, which are crucial for oxygen and nutrient delivery. - Anomalies in vascular development lead to conditions like **hemangiomas** or **vascular malformations**. *Lymphatic development* - **Lymphatic development** involves the formation of the lymphatic system, important for fluid balance and immune function. - Abnormalities can result in **lymphedema** or **lymphatic malformations**.

Q: Angiofibroma bleeds profusely because:

Vessels lack a contractile component. ***Vessels lack a contractile component*** - The distinctive feature of angiofibroma is the presence of **abundant, thin-walled blood vessels** that lack the typical muscular or elastic contractile layers found in normal arteries. - This structural deficiency prevents effective **vasoconstriction** and vessel closure, leading to severe and prolonged bleeding when injured. *It has multiple sites of origin* - While angiofibromas typically arise from the **nasopharynx**, their propensity to bleed is not related to having multiple sites of origin. - Their origin site does not inherently determine the vascular structure or bleeding risk. *It lacks a capsule* - The absence of a capsule can make surgical resection challenging and contribute to incomplete excision, but it does not directly explain the **profuse bleeding** from within the tumor itself. - Bleeding is primarily due to the internal vascular architecture rather than the presence or absence of a surrounding capsule. *None of the options* - This option is incorrect because the statement "Vessels lack a contractile component" accurately explains why angiofibromas bleed profusely. - The other options are not the primary reason for the extensive bleeding characteristic of these tumors.

Q: Confirmatory test of blood stain:

Spectroscopic test. ***Spectroscopic test*** - The **spectroscopic test** is considered a **confirmatory test** for bloodstains due to its ability to identify the characteristic **absorption spectrum of hemoglobin**. - It specifically detects the presence of **hemoglobin derivatives**, unequivocally confirming the presence of blood. *Kastle-Meyer test* - This is a **presumptive test** for blood, relying on the **peroxidase activity** of hemoglobin. - While sensitive, it can yield **false positives** due to other peroxidase-like substances (e.g., plant material, rust). *Benzidine test* - The **benzidine test** is also a **presumptive test** for blood based on peroxidase activity. - It is **highly sensitive** but has been largely replaced by other tests due to the **carcinogenic nature** of benzidine. *Orthotoluidine test* - Similar to the Kastle-Meyer and benzidine tests, the **orthotoluidine test** is a **presumptive test** that detects the peroxidase activity of hemoglobin. - It can also produce **false positive results** from various oxidizing agents or plant peroxidases.

Q: Biological indicator for determining efficacy of autoclaving is

Bacillus stearothermophilus. ***Bacillus stearothermophilus*** - *Bacillus stearothermophilus* (now *Geobacillus stearothermophilus*) is a **thermoduric spore-forming bacterium** used as a biological indicator for **autoclave efficacy**. - Its spores are highly **resistant to heat**, making them ideal for challenging the sterilization process. *Pseudomonas aeruginosa* - *Pseudomonas aeruginosa* is a **Gram-negative bacterium** known for causing hospital-acquired infections, but it is **not used as a biological indicator** for autoclaving. - It is **less resistant to heat** and sterilization methods compared to bacterial spores. *Clostridium perfringens* - *Clostridium perfringens* is a **spore-forming anaerobic bacterium** associated with gas gangrene and food poisoning. - While it forms spores, its **heat resistance profile is different** from that of *Bacillus stearothermophilus*, and it is not the standard biological indicator for autoclaving. *Salmonella typhi* - *Salmonella typhi* is a **Gram-negative bacterium** that causes typhoid fever. - It is a **pathogen but not a spore-former**, and therefore, it is easily killed by autoclaving and not suitable as a biological indicator for monitoring sterilization effectiveness.

Q: A 29 year old female presented with infertility. There is history of abdominal pain, dyspareunia, dysmenorrhea, menorrhagia. Most likely cause:

Endometriosis. ***Endometriosis*** - The classic triad of symptoms in this 29-year-old female—**dysmenorrhea**, **dyspareunia**, and **infertility**—is highly suggestive of endometriosis. - **Ectopic endometrial tissue** can cause chronic abdominal pain, menorrhagia, and inflammation, contributing to infertility. *Adenomyosis* - This condition involves the presence of **endometrial tissue within the myometrium**, leading to a thickened uterine wall. - While it can cause dysmenorrhea and menorrhagia, **infertility** is not its primary presentation, and it is less commonly associated with severe dyspareunia compared to endometriosis. *Cervicitis* - **Inflammation of the cervix** typically presents with vaginal discharge, post-coital bleeding, or pelvic pain. - It is not a common cause of primary infertility, severe dysmenorrhea, or dyspareunia as described. *Myomas* - Uterine **fibroids (leiomyomas)** are benign tumors that can cause heavy menstrual bleeding (menorrhagia), pelvic pressure, and sometimes infertility. - However, they are less commonly associated with the triad of severe dysmenorrhea and dyspareunia as prominently as seen in endometriosis.

Q: The eye in the newborn is:

Hypermetropia. ***Hypermetropia*** - The newborn eye is typically **shorter in axial length** (approximately 16-17 mm vs. 24 mm in adults), leading to a state of **physiological hypermetropia** (farsightedness) of about **+2 to +4 diopters**. - This is a **universal finding** in newborns and represents the most fundamental refractive characteristic of the newborn eye. - The eye gradually grows and typically reaches emmetropia (normal vision) by about **6-7 years of age**. *Myopia* - **Myopia** (nearsightedness) occurs when the eye is too long or the refractive power is too strong, causing light to focus in front of the retina. - Myopia is **not the physiological state** of the newborn eye and is uncommon at birth. - When present in newborns, it may indicate pathology or very premature birth. *Hypermetropic with regular astigmatism* - While **most newborns do have some degree of astigmatism** (0.5-2D) in addition to hypermetropia, typically "against-the-rule" astigmatism that decreases during the first year, the question asks for the **primary refractive characteristic**. - **Hypermetropia alone** is the universal and defining feature, whereas the amount of astigmatism varies considerably between individuals. - In standard clinical terminology, when describing the typical newborn eye, "hypermetropic" is the complete answer. *Hypermetropic with irregular astigmatism* - **Irregular astigmatism** is uncommon and is typically associated with corneal pathology, trauma, or surgery. - It is **not a physiological finding** in the normal newborn eye and would indicate an underlying abnormality if present.

Q: Germ cell tumour not seen in males:

Sertoli cell tumour. ***Correct: Sertoli cell tumour*** - Sertoli cell tumours are **sex cord-stromal tumours**, NOT germ cell tumours - They arise from specialized supporting cells in the testes (Sertoli cells) that normally nurture developing germ cells - These tumours produce hormones (estrogen, inhibin) and are distinct from germ cell neoplasias - Account for <1% of testicular tumours *Incorrect: Seminoma* - Seminoma IS a germ cell tumour - the **most common type** in males (40-50% of testicular germ cell tumours) [1] - Originates from malignant germ cells in the testes [1] - Characterized by uniform cells, lymphocytic infiltrate, and excellent prognosis with radiation sensitivity [3] *Incorrect: Choriocarcinoma* - Choriocarcinoma IS a highly aggressive **germ cell tumour** that occurs in males (testicular origin) [1] - Produces **human chorionic gonadotropin (hCG)** - important tumor marker [2] - Can occur as pure choriocarcinoma or as part of mixed germ cell tumour [2] - Characterized by syncytiotrophoblast and cytotrophoblast cells [2] *Incorrect: Teratoma* - Teratoma IS a germ cell tumour composed of tissues from all three embryonic germ layers (ectoderm, mesoderm, endoderm) [1] - Common in males (testicular teratoma) - can be mature or immature [1] - In adult males, even mature teratomas have malignant potential unlike in children [1] **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-980. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, p. 982. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 980-982.

Q: Most common cardiac abnormality in Noonan syndrome is:-

Pulmonary stenosis. ***Pulmonary stenosis*** - **Valvular pulmonary stenosis**, particularly a dysplastic pulmonary valve, is the **most common cardiac defect** found in individuals with Noonan syndrome. - This condition can lead to an obstruction of blood flow from the right ventricle into the **pulmonary artery**. *Atrial septal defect* - While **atrial septal defects (ASDs)** can occur in Noonan syndrome, they are less common than pulmonary stenosis. - ASDs are characterized by a hole in the septum separating the two upper chambers of the heart. *Tetralogy of Fallot* - **Tetralogy of Fallot** is a complex congenital heart defect involving four specific abnormalities, which is not the most common cardiac finding in Noonan syndrome. - It is typically associated with a different set of genetic syndromes or occurs sporadically. *Ventricular septal defect* - **Ventricular septal defects (VSDs)** are also observed in some cases of Noonan syndrome but are less prevalent than pulmonary stenosis. - VSDs involve a hole in the wall separating the heart's lower two chambers.

Q: Exenatide is a new drug used in diabetes mellitus. Mechanism of action of this drug is:-

Release of insulin acting as agonist of GLP-1 receptors. ***Release of insulin acting as agonist of GLP-1 receptors*** - **Exenatide** is a **glucagon-like peptide-1 (GLP-1) receptor agonist**, mimicking the action of endogenous GLP-1. - This leads to glucose-dependent **insulin release**, suppression of **glucagon secretion**, delayed **gastric emptying**, and increased **satiety**, all contributing to improved glycemic control. *Inhibition of DPP-4* - This mechanism describes the action of **DPP-4 inhibitors** (e.g., sitagliptin, saxagliptin), which prevent the breakdown of endogenous GLP-1 and other **incretin hormones**. - While both GLP-1 agonists and DPP-4 inhibitors target the incretin system, exenatide directly acts as an agonist, rather than preventing breakdown. *Inhibiting intestinal absorption of carbohydrates* - This mechanism describes drugs like **alpha-glucosidase inhibitors** (e.g., acarbose, miglitol), which delay carbohydrate absorption from the gut. - Exenatide's primary action is not on carbohydrate absorption but rather on pancreatic hormone secretion and gastric emptying. *Stimulation of PPAR-gamma* - This mechanism describes **thiazolidinediones** (TZDs) like pioglitazone and rosiglitazone, which enhance **insulin sensitivity** by acting on **peroxisome proliferator-activated receptor-gamma (PPAR-gamma)** in adipose tissue. - Exenatide belongs to a different class of antidiabetic drugs with a distinct mechanism of action.

Question 1

Retraction of scapula is done by

Accepted Answer

Trapezius

Answer

Serratus anterior

Answer

Supraspinatus

Answer

Subscapularis

Question 2

What are these horizontal lines seen on the skin called?

Accepted Answer

Blaschko lines

Answer

Dermatomes

Answer

Vascular development

Answer

Lymphatic development

Question 3

Angiofibroma bleeds profusely because:

Accepted Answer

Vessels lack a contractile component

Answer

It has multiple sites of origin

Answer

It lacks a capsule

Answer

None of the options

Question 4

Confirmatory test of blood stain:

Accepted Answer

Spectroscopic test

Answer

Kastle-Meyer test

Answer

Benzidine test

Answer

Orthotoluidine test

Question 5

Biological indicator for determining efficacy of autoclaving is

Accepted Answer

Bacillus stearothermophilus

Answer

Pseudomonas aeruginosa

Answer

Clostridium perfringens

Answer

Salmonella typhi

Question 6

A 29 year old female presented with infertility. There is history of abdominal pain, dyspareunia, dysmenorrhea, menorrhagia. Most likely cause:

Accepted Answer

Endometriosis

Answer

Adenomyosis

Answer

Cervicitis

Answer

Myomas

Question 7

The eye in the newborn is:

Accepted Answer

Hypermetropia

Answer

Myopia

Answer

Hypermetropic with regular astigmatism

Answer

Hypermetropic with irregular astigmatism

Question 8

Germ cell tumour not seen in males:

Accepted Answer

Sertoli cell tumour

Answer

Seminoma

Answer

Choriocarcinoma

Answer

Teratoma

Question 9

Most common cardiac abnormality in Noonan syndrome is:-

Accepted Answer

Pulmonary stenosis

Answer

Atrial septal defect

Answer

Tetralogy of Fallot

Answer

Ventricular septal defect

Question 10

Exenatide is a new drug used in diabetes mellitus. Mechanism of action of this drug is:-

Accepted Answer

Release of insulin acting as agonist of GLP-1 receptors

Answer

Inhibiting intestinal absorption of carbohydrates

Answer

Stimulation of PPAR-gamma

Answer

Inhibition of DPP-4

FMGE 2018

Anatomy

Dermatology

ENT

Forensic Medicine

Microbiology

Obstetrics and Gynecology

Ophthalmology

Pathology

Pediatrics

Pharmacology