FMGE 2019 Practice Questions

Q: The highlighted muscle is supplied by which nerve?

Musculocutaneous nerve. ***Musculocutaneous nerve*** - The **musculocutaneous nerve** innervates all three muscles in the **anterior compartment of the arm**: the biceps brachii, brachialis, and coracobrachialis. - The **biceps brachii** is a prominent muscle located in the anterior compartment of the arm, responsible for **flexion of the elbow** and **supination of the forearm**. *Median nerve* - The **median nerve** primarily innervates muscles in the **anterior compartment of the forearm** (except for the flexor carpi ulnaris and medial half of the flexor digitorum profundus) and some thenar muscles in the hand. - It does not supply any muscles in the anterior compartment of the arm. *Ulnar nerve* - The **ulnar nerve** innervates the **flexor carpi ulnaris** and the medial half of the **flexor digitorum profundus** in the forearm, as well as most intrinsic hand muscles. - It does not supply muscles of the anterior compartment of the arm. *Radial nerve* - The **radial nerve** innervates all muscles in the **posterior compartment of the arm** (triceps brachii) and forearm, which are primarily involved in **extension**. - It also has no role in innervating the muscles of the anterior compartment of the arm.

Q: What is the most common oral cancer?

Squamous cell ca. ***Squamous cell ca*** - **Squamous cell carcinoma (SCC)** accounts for over **90% of all oral cancers**, making it the most prevalent type. - It arises from the **stratified squamous epithelium** lining the oral cavity. *Transition cell ca* - This term is more commonly associated with tumors of the **urinary tract**, such as transitional cell carcinoma of the bladder. - **Transitional cell carcinomas** are not typically found in the oral cavity. *Mucoepidermoid* - **Mucoepidermoid carcinoma** is the most common primary malignant tumor of **salivary glands**, not the oral cavity lining. - While salivary glands are in the oral region, this type of cancer originates specifically from these glands. *Adenocarcinoma* - **Adenocarcinoma** originates from **glandular tissue** and represents a small percentage of oral cancers. - It is much **less common** than squamous cell carcinoma in the oral cavity.

Q: Which type of gout is seen in a patient who is on treatment of CML?

Secondary gout. ***Secondary gout*** - **Secondary gout** occurs when a high uric acid level is a consequence of another medical condition or its treatment, such as **chronic myelogenous leukemia (CML)** [1]. - The increased cell turnover in CML, especially during treatment, leads to a significant release of **purines**, which are then metabolized into **uric acid**, causing hyperuricemia and gout [1]. *Pseudogout* - **Pseudogout** is caused by the deposition of **calcium pyrophosphate dihydrate (CPPD)** crystals, not uric acid crystals, in the joints [2]. - While it can mimic gout attacks, it has a different underlying pathophysiology and is not directly linked to CML or its treatment. *Acute gout* - **Acute gout** describes the sudden onset of severe pain, swelling, and redness in a joint, which is a common presentation of any type of gout, whether primary or secondary. - This term refers to a **gout flare** rather than the underlying cause of the hyperuricemia. *Primary gout* - **Primary gout** occurs due to an intrinsic metabolic defect in purine metabolism or renal excretion of uric acid, without an identifiable underlying disease [1]. - In this scenario, the gout is secondary to CML and its treatment, making **primary gout** an incorrect classification [1].

Q: The following serological status is noted in a patient: HbsAg positive and HbeAg positive. Diagnosis is?

Active hepatitis B with high infectivity. ***Active hepatitis B with high infectivity*** - The presence of **HBsAg** indicates ongoing **hepatitis B infection** (either acute or chronic) [1]. - The presence of **HBeAg** signifies active **viral replication** and **high infectivity**, meaning the patient can easily transmit the virus [1]. *Chronic viral hepatitis* - While the patient does have hepatitis B, simply stating "chronic viral hepatitis" is less specific and doesn't fully capture the **infectivity status**. - **Chronic hepatitis B** is defined by **HBsAg persistence** for more than six months, but a high infectivity state is specifically implied by HBeAg positivity [1]. *Remote infection* - **Remote infection** would typically be indicated by the presence of **anti-HBs** and **anti-HBc IgG** antibodies, with no detectable HBsAg [1]. - The patient's **HBsAg positive** status rules out a remote infection where the virus has been cleared [1]. *Resolved hepatitis B infection* - A resolved hepatitis B infection is characterized by **loss of HBsAg** and the development of **anti-HBs antibodies**, indicating immunity [1]. - The patient's **HBsAg positive** status definitively indicates that the infection is not resolved and is still active [1].

Q: What is the mode of transmission of genetic material to bacteria through bacteriophage?

Transduction. ***Transduction*** - **Transduction** is the process by which foreign DNA is introduced into a bacterium by a **bacteriophage** (a virus that infects bacteria). - This occurs when a bacteriophage carries bacterial DNA from one bacterium to another, often as a result of errors during viral replication. *Transformation* - **Transformation** involves the uptake of **naked DNA** from the environment by a bacterial cell. - This process does not involve a bacteriophage as an intermediary for genetic transfer. *Conjugation* - **Conjugation** is the transfer of genetic material between bacterial cells by direct cell-to-cell contact through a **pilus**. - This process requires physical contact between two bacteria and does not involve bacteriophages. *Translation* - **Translation** is the process by which messenger RNA (mRNA) is decoded to produce a specific protein. - This is a fundamental step in gene expression and is distinctly different from genetic material transmission between organisms.

Q: Chronic viral hepatitis is seen with all of the following viruses, except?

HEV. ***HEV*** - While HEV can cause acute hepatitis, it **rarely progresses to chronic infection** in immunocompetent individuals. - Chronic HEV infection is primarily seen in **immunocompromised patients**, such as organ transplant recipients. *HCV* - **Hepatitis C virus** is well-known for its high propensity to establish chronic infection, with about 75-85% of acutely infected individuals developing **chronic hepatitis** [1]. - Chronic HCV infection can lead to **cirrhosis**, liver failure, and hepatocellular carcinoma [1]. *HBV* - **Hepatitis B virus** is a major cause of chronic hepatitis worldwide, especially when acquired perinatally or in early childhood [1]. - Approximately 5-10% of immunocompetent adults who acquire acute HBV infection progress to **chronic hepatitis** [1]. *HDV* - **Hepatitis D virus** is a defective virus that requires co-infection with HBV to replicate; therefore, chronic HDV infection only occurs in individuals with chronic HBV. - Co-infection or superinfection with HDV often **accelerates the progression of liver disease** to cirrhosis and liver failure.

Q: Football player with knee injury diagnosed as medial collateral ligament injury. Which structure is most commonly associated with this type of injury?

Medial meniscus. ***Medial meniscus*** - The **medial meniscus** is commonly injured in conjunction with the **medial collateral ligament** due to their anatomical proximity and shared role in knee stability. - The MCL is a primary restraint to **valgus stress**, and strong valgus forces that injure the MCL can also transmit stress to the medial meniscus, leading to tears. *Lateral meniscus* - The **lateral meniscus** is less frequently injured alongside the MCL because it is typically more mobile and not directly attached to the MCL. - Injuries to the lateral meniscus are more often associated with **anterior cruciate ligament (ACL) tears** or significant *rotational forces*. *Anterior cruciate ligament* - The **anterior cruciate ligament** is primarily injured by **non-contact pivoting** or **hyperextension injuries**, and while it can be part of the "unhappy triad" (along with MCL and medial meniscus tears), an isolated MCL injury does not most commonly implicate it. - ACL tears lead to **anterior instability** of the tibia relative to the femur, which is a different biomechanical mechanism than an isolated MCL injury. *Posterior Cruciate Ligament* - The **posterior cruciate ligament** is injured by a direct blow to the anterior tibia while the knee is flexed or during a dashboard injury, leading to **posterior instability**. - Its injury mechanism is distinct from that of the MCL, which is primarily due to **valgus stress**.

Q: Berry aneurysm most commonly occurs due to?

Medial layer and internal elastic lamina defect. ***Medial layer and internal elastic lamina defect*** - **Berry aneurysms** are most commonly saccular dilatations that occur at arterial bifurcations in the **Circle of Willis** [1]. - These aneurysms result from a congenital or acquired weakness in the **tunica media** and the **internal elastic lamina** at these bifurcation points, making the vessel wall susceptible to high pressures [1]. *Muscle and adventitial layer defect* - Defects primarily in the **muscle layer** (media) and **adventitia** are less commonly the primary cause of berry aneurysms. - While all layers contribute to vessel integrity, the specific absence in the medial and internal elastic lamina is key for berry aneurysms [1]. *Endothelial injury of vessel due to HTN* - While hypertension is a significant **risk factor** for aneurysm formation and rupture, it primarily exacerbates existing structural weaknesses rather than being the direct cause of the initial structural defect. - **Endothelial injury alone** is not the primary anatomical defect responsible for generating berry aneurysms; it contributes to atherosclerosis, which can lead to other types of aneurysms. *Adventitia defect* - A defect solely in the **adventitia** is not the primary predisposing factor for berry aneurysms. - The adventitia provides external support, but the integrity of the media and internal elastic lamina is crucial for maintaining the vessel's structural strength against intraluminal pressure [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1272-1273.

Q: A patient has MCV <80, MCH <23. Which type of anaemia shall be classified?

Microcytic hypochromic. ***Microcytic hypochromic*** - A **Mean Corpuscular Volume (MCV)** less than **80 fL** indicates **microcytosis** (small red blood cells) [1]. - A **Mean Corpuscular Hemoglobin (MCH)** less than **23 pg** indicates **hypochromia** (pale red blood cells due to reduced hemoglobin content) [1]. *Normocytic normochromic* - This classification refers to red blood cells with **normal MCV (80-100 fL)** and **normal MCH (27-32 pg)**. - Examples include anemia of chronic disease or acute blood loss, which do not fit the given lab values. *Normocytic hypochromic* - While **hypochromia (MCH 100 fL**, which is the opposite of the given MCV of <80. - The term "hyperchromic" is generally not used for anemia classification because red blood cells have a maximal hemoglobin concentration and cannot be truly hyperchromic. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Q: Neologism is seen in:

Schizophrenia. ***Schizophrenia*** - **Neologisms** are newly coined words that have meaning only to the person who invents them, and they are a characteristic **thought disorder** symptom often observed in schizophrenia. - This symptom reflects the **disorganized thinking** and **impaired communication** typical of the disorder. *Mania* - While individuals in a manic episode may exhibit **rapid speech**, **flight of ideas**, and **pressured speech**, they typically do not create entirely new words (neologisms). - Their speech is usually characterized by **excessive quantity** and quick topic changes, rather than word invention. *Depression* - Depression is associated with **poverty of speech**, **slowed thought processes**, and a focus on negative themes. - **Neologisms** are not a feature of depressive episodes. *Dysphasia* - **Dysphasia** (or aphasia) refers to an impairment in the production or comprehension of language due to brain injury, such as stroke. - While speech may be **disrupted** or **grammatically incorrect**, it primarily involves difficulty using existing words correctly rather than producing entirely new ones.

Question 1

The highlighted muscle is supplied by which nerve?

Accepted Answer

Musculocutaneous nerve

Answer

Median nerve

Answer

Ulnar nerve

Answer

Radial nerve

Question 2

What is the most common oral cancer?

Accepted Answer

Squamous cell ca

Answer

Transition cell ca

Answer

Mucoepidermoid

Answer

Adenocarcinoma

Question 3

Which type of gout is seen in a patient who is on treatment of CML?

Accepted Answer

Secondary gout

Answer

Pseudogout

Answer

Acute gout

Answer

Primary gout

Question 4

The following serological status is noted in a patient: HbsAg positive and HbeAg positive. Diagnosis is?

Accepted Answer

Active hepatitis B with high infectivity

Answer

Chronic viral hepatitis

Answer

Remote infection

Answer

Resolved hepatitis B infection

Question 5

What is the mode of transmission of genetic material to bacteria through bacteriophage?

Accepted Answer

Transduction

Answer

Transformation

Answer

Conjugation

Answer

Translation

Question 6

Chronic viral hepatitis is seen with all of the following viruses, except?

Accepted Answer

HEV

Answer

HCV

Answer

HBV

Answer

HDV

Question 7

Football player with knee injury diagnosed as medial collateral ligament injury. Which structure is most commonly associated with this type of injury?

Accepted Answer

Medial meniscus

Answer

Lateral meniscus

Answer

Anterior cruciate ligament

Answer

Posterior Cruciate Ligament

Question 8

Berry aneurysm most commonly occurs due to?

Accepted Answer

Medial layer and internal elastic lamina defect

Answer

Muscle and adventitial layer defect

Answer

Endothelial injury of vessel due to HTN

Answer

Adventitia defect

Question 9

A patient has MCV <80, MCH <23. Which type of anaemia shall be classified?

Accepted Answer

Microcytic hypochromic

Answer

Normocytic normochromic

Answer

Normocytic hypochromic

Answer

Hyperchromic macrocytic

Question 10

Neologism is seen in:

Accepted Answer

Schizophrenia

Answer

Mania

Answer

Depression

Answer

Dysphasia

FMGE 2019

Anatomy

Dental

Internal Medicine

Microbiology

Orthopaedics

Pathology

Psychiatry