FMGE Q & A(Part 4)

psychiatry, surgery, orthopaedics, Anaesthesia, Optho

Q 194. All of the following are features of hallucination, except:

A. Depends on will of the observer
B. Occurs in inner subjective space
C. It is a vivid sensory perception
D. It occurs in absence of perceptual stimulus
Ans. A

Q 195. The following is suggestive of an organic cause of the behavioural symptoms:

A. Formal thought disorder
B. Auditory hallucinations
C. Delusion of fruit
D. Visual hallucinations
Ans. D

Q 196. Delusion is not present in:

A. Delirium
B. Mania
C. Depresion
D. Compulsive disorder
Ans. D

Q 197. An alcoholic is brought to the casualty, 3 days after he quit alcohol, with the complaint of irrelevant talking. On examination, he is found to be disoriented in time, place and person. He also has visual illusions and hallucinations. There is no history of head injury. The most probable diagnosis is:

A. Dementia praecox
B. Delirium tremens
C. Schizophrenia
D. Korsakoff psychosis
Ans. B

Q 198. Ram Lal, a 45 years old male came to the psychiatric OPD complaning of continuous, dull, non-progressive headache for the last 8 years. The patient has seen numerous neurologists in the belief that he has a brain tumor even though all his investigations have been normal. The patient insisted that he had a brain tumor and requested yet another workup. Psychiatric evaluation reveals disease conviction in the background of normal investigations. The most probable diagnosis is:

A. Hypochondriasis
B. Somatization disorer
C. Somatoform pain disorder
D. Conversion disorder
Ans. A

Q 199. A patient presented with short lasting episodic behavioural changes which include agitation & dream like state with thrashing movements of his limbs. He does not recall these episodes & has no apparant precipitating factor. The most likely diagnosis is:

A. Schizophrenia
B. Temporal lobe epilepsy
C. Panic episodes
D. Dissociative disorder
Ans. D

Q 200. A young lady presented with repeated episodes of overeating followed by purging after use of laxatives. She is probably suffering from:

A. Bulimia nervosa
B. Schizophrenia
C. Aorexia nervosa
D. Binge eating disorder
Ans. A

Q 201. An 11 years old boy is all the time so restless that the rest of the class is unable to concentrate. He is hardly ever in his seat and roams around the hall. He has difficulty in playing quietly. The most likely diagnosis is:

A. Attention-deficit hyperactivity disorder
B. Conduct disorder
C. Depressive disorder
D. Schizophrenia
Ans. A

Surgery

Q 202. A patient suddenly experienced pain radiating along the medial border of the dorsum of foot. Which of the following nerve is most likely to be accidently ligated:

A. Sural nerve
B. Saphenous nerve
C. Deep peroneal nerve
D. Genicular nerve
Ans. B

Q 203. In an adult patient with pleural effusion, the most appropriate site for pleurocentesis done by inserting a needle is in:

A. 5th intercostal space in midclavicular line
B. 7th intercostal space in midaxillary line
C. 2nd intercostal space adjacent to the sternum
D. 10th intercostal space adjacent to the vertebral column
Ans. B

Q 204. Measurements of intravascular pressure by a pulmonary artery catheter should be done:

A. At end expiration
B. At peak of inspiration
C. During mid inspiration
D. During mid expiration
Ans. A

Q 205. A 24 years old man falls on the ground when he is struck in the right temple by a baseball. While being driven to the hospital, he lapses into coma. He is unresponsive with the dilated right pupil when he reaches the emergency department. The most important step in initial management is:

A. Craniotomy
B. CT scan of the head
C. X-ray of the skull and cervical spine
D. Doppler ultrasound examination of the neck
Ans. A

Q 206. Kamla Rani, 75 years old woman, presents after 6 weeks with post myocardial infarction with mild CHF. There was past history of neck Surgery for parathyroid adenoma 5 years ago. EKG shows slow artrial fibrillation. Serum Ca2+ 13.0 mg/L and urinary Ca2+ is 300 g/24 h. On examination these is small mass in the paratracheal position behind the right clavicle. Appropriate management at this time is:

A. Repeat neck Surgery
B. Treatment with technetium -99
C. Observation and repeat serum Ca2+ in two months
D. Ultrasound-guided alcohol injection of the mass
Ans. D

Q 207. Not a feature of de Quervain’s disease:

A. Autoimmune in etiology
B. Raised ESR
C. Tends to regress spontaneously
D. Painful & associated with enlargement of thyroid
Ans. A

Q 208. A 35 years old woman has had recurrent episodes of headache and sweating. Her mother had renal calculi and died of thyroid cancer. Physical observations revealed a thyroid nodule and ipsilateral enlarged cervical lymph nodes. Before performing thyroid Surgery the woman’s physician should order:

A. Thyroid scan
B. Estimation of hydroxy indole acetic acid in urine
C. Estimation of urinary metanephrines, VMA and catecholamines
D. Estimation of TSH, and TRH levels in serum
Ans. C

Q 209. All of the following are associated with thyroid storm, except:

A. Surgery for thyroiditis
B. Surgery for thyrotoxicosis
C. Stressful illness in thyrotoxicosis
D. I131 therapy for thyrotoxicosis
Ans. A

Q 210. Needle biopsy of solitary thyroid nodule in a young woman with palpable cervical lymph nodes on the same sides demonstrates amyloid in stroma of lesion. Likely diagnosis is:

A. Medullary carcinoma thyroid
B. Follicular carcinoma thyroid
C. Thyroid adenoma
D. Multinodular goitre
Ans. A

Q 211. A 26 years old woman presents with a palpable thyroid nodule, and needle biopsy demonstrates amyloid in the stroma of the lesion. A cervical lymph node is palpable on the same side as the lesion. The preferred treatment should be:

A. Removal of the involved node, the isthmus,and the enlarged lymph node
B. Removal of the involved lobe, the isthmus, a portion of the opposite lobe, and the enlarged lymph node
C. Total thyroidectomy and modified neck dissection on the side of the enlarged lymph node
D. Total thyroidectomy and irradiation of the cervical lymph nodes
Ans. C

Q 212. The most common tumor of the salivary gland is:

A. Mucoepidermoid tumor
B. Warthin’s tumor
C. Acinic cell tumor
D. Pleomorphic adenoma
Ans. D

Q 213. The premalignant condition with the highest probability of progression to malignancy is:

A. Dysplasia
B. Hyperplasia
C. Leucoplakia
D. Erythroplakia
Ans. D

Q 214. An old man who is edentulous developed squamous cell CA in buccal mucosa that has infiltrated to the alveolus. Following is not indicated in treatment:

A. Radiotherapy
B. Segmental mandibulectomy
C. Marginal mandibulectomy involving removal of the outer table only
D. Marginal mandibulectomy involving removal of upper half of mandible
Ans. C

Q 215. Corkscrew esophagus is seen in which of the following condition?

A. Carcinoma esophagus
B. Scleroderma
C. Achalasia cardia
D. Diffuse esophagus spasm
Ans. D

Q 216. Treatment for achalasia associated with high rate of recurrence:

A. Pneumatic dilatation
B. Laparoscopic myotomy
C. Opefl surgical myotomy
D. Botulinum toxin
Ans. D

Q 217. Barrett’s esophagus is:

A. Lower esophagus lined by columnar epithelium
B. Upper esophagus lined by columnar epithelium
C. Lower esophagus lined by ciliated epithelium
D. Lower esophagus lined by pseudostratified epithelium
Ans. A

Q 218. The adenocarcinoma of esophagus developes in:

A. Barrett’s esophagus
B. Long standing achalasia
C. Corrosive stricture
D. Alcohol abuse
Ans. A

Q 219. The lowest recurrence of peptic ulcer is associated with:

A. Gastric resection
B. Vagotomy + drainage
C. Vagotomy + antrectomy
D. Highly selective vagotomy
Ans. C

Q 220. Risk factor for development of gastric CA:

A. Blood group O
B. Duodenal ulcer
C. Intestinal hyperplasia
D. Intestinal metaplasia type III
Ans. D

Q 221. In a case of hypertrophic pyloric stenosis, the metabolic disturbance is:

A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis with paradoxical aciduria
D. Metabolic alkalosis with alkaline urine
Ans. C

Q 222. All the following indicates early gastric cancer except:

A. Involvement of mucosa
B. Involvement of mucosa and submucosa
C. Involvement of mucosa, submucosa and muscularis
D. Involvement of mucosa, submucosa and adjacent lymph nodes
Ans. C

Q 223. In gastric outlet obstruction in a peptic ulcer patient, the site of obstruction is most likely to be:

A. Antrum
B. Duodenum
C. Pylorus
D. Pyloric canal
Ans. B

Q 224. Ramesh met an accident with a car and has been in ‘deep coma’ for the last 15 days. The most suitable route for the administration of protein and calories is by:

A. Jejunostomy tube feeding
B. Gastrostomy tube feeding
C. Nasogastric tube feeding
D. Central venous hyperalimentation
Ans. A

Q 225. A 10 months old infant present with acute intestinal obstruction. Contrast enema X-ray shows the intussusception. Likely cause is:

A. Peyer’s patch hypertrophy
B. Mekel’s diverticulum
C. Mucosal polyp
D. Duplication cyst
Ans. A

Q 226. After undergoing Surgery , for carcinoma of colon, a 44 year old patient developed single liver metastasis of 2 cm. What do you do next:

A. Resection
B. Chemo-radiation
C. Acetic acid injection
D. Radiofrequency ablation
Ans. A

Q 227. Ten days after a splenectomy for blunt abdominal trauma, a 23 years old man complains of upper abdominal and lower chest pain exacerbated by deep breathing. He is anorectic but ambulatory and otherwise making satisfactory progress. On physical examination, his temperature is 38.2°C (108°F) rectally, and he has decreased breath sounds at the left lung base. His abdominal wound appears to be healing well. bowel sound are active and there are no peritoneal signs. Rectal examination is negative. The WBC count is 12,500 per mm3 with a shift to left. Chest X-ray shows plate like atelectasis of the left lung field. Abdominal X-rays show a nonspecific gas pattern in the bowel and an air-fluid level in the left upper quadrant. Serum amylase is 150 Somogyi units/ dl (normal 60 to 80). The most likely diagnosis is:

A. Subphrenic abscess
B. Pancreatitis
C. Pulmonary embolism
D. Subfascial wound infection
Ans. A

Q 228. Sentinel lymph node biopsy is an important part of the management of which of the following conditions?

A. Carcinoma prostate
B. Carcinoma breast
C. Carcinoma lung
D. Carcinoma nasopharynx
Ans. B

Q 229. A man who weighs 70 kg (154 pounds) is transfered to a burn center 4 weeks after sustaining a second and third-degree burn injury to 45% of his total body surface area. Prior to accident, the patients weight was 90 kg (198 pounds). The patient has not been given anything by mouth since the injury except for antacids because of previous ulcer history. On physical examination, the patient’s burn wounds are clean, but only minimal healing is evident and thick adherent eschar is present. The patient’s abdomen is soft and nondistended, and active bowel sounds are heard. His stools are trace-positive for blood, and he has a right inguinal hernia, which appears to be easily reducible. He has poor range of motion of all involved joints and has developed early axillary and popliteal fossae flexion contractures. In managing this patient at this stage of his injury, top priority must be given to correcting:

A. The presence of blood in stools by the increasing the dose of antacids and H1 receptor blocker
B. The open, poorly healing burn wounds treated by surgical excision and grafting
C. The inguinal hernia treated by surgical repair using local Anaesthesia
D. The nutritional status by oral supplementation or parenteral hyperalimentation
Ans. D

Q 230. A 14 years old girl sustains a steam bum measuring 6 by 7 inches over the ulnar aspect of her right forearm. Blisters develop over the entire area of the bum wound, and by the time the patient is seen 6 hours after the injury, some of the blisters have ruptured spontaneously. In addition to debridement of the necrotic epithelium, all the following
therapeutic regiments might be considered appropriate for this patient except:

A. Application of silver sulfadiazine and daily washes, but no dressing
B. Application of polyvinylpyrrolidone foam, daily washes and a light occlusive dressing changed daily
C. Application of mafenide acetate cream, but no daily washes or dressing
D. Heterograft application with sutures to secure it in place and daily washes, but no dressing
Ans. D

Q 231. All of the following are the clinical features of thromboangitis obliterans except:

A. Raynaud’s phenomenon
B. Claudication of extremeties
C. Absence of popliteal pulse
D. Migratory superficial thrombophlebitis
Ans. C

Q 232. Rani, a 16 years old girl who has non-pitting edema of recent onset affecting her right leg but no other symptoms is referred for evaluation. True statements about this patient include:

A. Prophylactic antibiotics are indicated
B. A lymphagiongram will show hypoplasia of the lymphatics
C. Elastic stocking and diuretics will lead to a normal appearance of the limb
D. A variety of operations will ultimately lead to a normal appearance of the limb
Ans. B

Q 233. Kamla, a 59 years old woman, has a left femoral vein thrombosis during a pregnancy 30 year ago. The left greater saphenous vein had been stripped at age 21. She now presents with a large non healing ulceration over the medial left calf, which has continuously progressed despite bedrest, elevation, and use of a support stocking. Descending phlebography of the left leg demonstrates a patent deep venous system, with free flow of dye from the groin to foot. The first profunda femoris valve is competent. Appropriate management might include which of the following:

A. Division of the superficial femoral vein in the groin and transposition of its distal end onto the profunda femoris vein below the level of the competent profunda valve
B. Saphenous venous crossover graft with anastomosis of the end of the right saphenous vein onto the side of competent femoral vein
C. Ligated iliofemoral venous thrombectomy with creation of the temporary arteriovenous fistula
D. Subfascial ligation of perforating veins in the left calf.
Ans. A

Q 234. On her third day of hospitalization, a 70 years old woman who is being treated with antibiotics for acute cholecystitis develops increased pain and tenderness in the right upper quadrant with a palpable mass. Her temperature rises to 40°C (104°F) her blood pressure falls to 80/60 mmHg. Hematemesis, and melena ensue and petechiae are noted. Laboratory studies reveal thrombocytopenia, prolonged prothrombin time, and a decreased fibrinogen level. The most important step in the correction of this patient’s coagulopathy is:

A. Exploratory laparotomy
B. Administration of heparin
C. Administration of aminocaproic acide
D. Administration of fresh frozen plasma
Ans. A

Q 235. A 64 years old previously healthy man is admitted to a hospital because of a closed head injury and ruptured spleen following a road side automobile accident. During the first 4 days of hospitalization, following laparotomy and splenectomy, he receives 5% dextrose, 0.5% normal saline solution at a rate of 125 mL/h. Recorded daily fluid outputs include 450 to 600 mL of nasogastric drainage and 700 to 1000 mL of urine. The patient
is somnolent but easily aroused until the morning of the 5th hospital day, when he is noted to be in deep coma. By the afternoon, he begins having seizures. The following laboratory data are obtained. Serum electrolytes (mEq/L): Na+ 130; K+ 1.9; CI– 96; HCO3– 19. Serum osmolality 260 mOsm/L. Urine electrolytes (mEq/L): Na+ 61; K+ 18. Which of the following statements about diagnosis or treatment of this patient’s condition is true:

A. Emergency carotid arteriogram is to be done
B. Secondary to metabolic acidosis there is hypokalemia
C. A small qantity of hypertonic saline should be given
D. IV infusion of 20 ml of 50% MgSO4 is given over a period of 4 hours
Ans. C

Q 236. All of the following statements about acute adrenal insufficiency are true except:

A. Hyperglycemia is usually present
B. Acute adrenal insufficiency usually is secondary to exogenous glucocorticoid administration
C. Acute adrenal insufficiency presents with weakness, vomiting, fever, and hypotension
D. Hyponatremia occurs because of impaired renal tubule sodium resorption
Ans. A

Q 237. All of the following are correct statements about radiological evaluation of a pateint with Cushing’s syndrome except:

A. MRI of the sella turcica will identify a pituitary cause for Cushing’s syndrome
B. Petrosal sinus sampling is the best way to distinguish a pituitary tumor from an ectopic ACTH producing tumor.
C. MRI of the adrenals may distinguish adrenal adenoma from carcinoma
D. Adrenal CT scan distinguishes adrenal cortical hyperplasia from an adrenal tumor
Ans. A

Orthopaedics

Q 238. Carpel tunnel syndrome is due to compression of:

A. Radial nerve
B. Ulnar nerve
C. Palmar branch of the ulnar nerve
D. Median nerve
Ans. D

Q 239. Most common nerve involved in the FRACTURE of surgical neck of humerus is:

A. Median
B. Radial
C. Ulnar
D. Axillary
Ans. D

Q 240. All of the following are associated with supracondylar FRACTURE of humerus, except:

A. It is uncommon after 15 years of age
B. Extension type FRACTURE is more common than the flexion type
C. Cubitus varus deformity commonly results following malunion
D. Ulnar nerve is most commonly involved
Ans. D

Q 241. A 40 years old man, was admitted with FRACTURE shaft femur following a road traffic accident. On 2nd day he became disoriented. He was found to be tachypnoeic, and had conjunctival petechiae. Most likely diagnosis is:

A. Pulmonary embolism
B. Sepsis syndrome
C. Fat embolism
D. Haemothorax
Ans. C

Q 242. Kumar, a 31 years old motorcyclist sustained injury over his right hip joint. X-ray revealed a posterior dislocation of the right hip joint. The clinical attitude of the affected lower limb will be:

A. External rotation, extension & abduction
B. Internal rotation, flexion & adduction
C. Internal rotation, extension & abduction
D. External rotation, flexion & abduction
Ans. B

Q 243. Pappu, 7 years old young boy, had FRACTURE of lateral condyle of femur. He developed malunion as the FRACTURE was not reduced anatomically. Malunion will produce:

A. Genu valgum
B. Genu varum
C. Genu recurvatum
D. Dislocation of knee
Ans. A

Q 244. Patellar tendon bearing POP cast is indicated in the following FRACTURE :

A. Patella
B. Tibia
C. Medial malleolus
D. Femur
Ans. B

Q 245. Inversion injury at the ankle can cause all of the following except:

A. FRACTURE tip of lateral melleolus
B. FRACTURE base of the 5th metatarsal
C. Sprain of extensor digitorum brevis
D. FRACTURE of sustentaculam tali
Ans. C

Q 246. A previously healthy 45 years old laborer suddenly develops acute lower back pain with right-leg pain & weakness of dorsiflexion of the right great toe. Which of the following is true:

A. Immediate treatment should include analgesics, muscle relaxants & back strengthening exercises
B. The appearance of the foot drop indicates early surgical intervention
C. If the neurological signs resolve within 2 to 3 weeks but low back pain persists, the proper treatment would include fusion of affected lumbar vertebra
D. If the neurological signs fail to resolve within 1 week, lumbar laminectomy and excision of any herniated nucleus pulposus should be done
Ans. B

Q 247. Acute osteomylitis is most commonly caused by:

A. Staphylococcus aureus
B. Actinomyces bovis
C. Nocardia asteroides
D. Borrelia vincentii
Ans. A

Q 248. A 45 years male presented with an expansile lesion in the centre of femoral metaphysis. The lesion shows endosteal scalloping & punctuate calcifications. Most likely diagnosis is:

A. Osteosarcoma
B. Chondrosarcoma
C. Simple bone cyst
D. Fibrous dysplasia
Ans. B

Q 249. Raju, a 10 years old child, presents with predisposition to fractures, anemia, hepatosplenomegaly and a diffusely increased radiographic density of bones. The most likely diagnosis is:

A. Osteogenesis imperfecta
B. Pyenodysotosis
C. Myelofibrosis
D. Osteopetrosis
Ans. D

Q 250. Hari Vardhman, 9 years old child, presents with scoliosis, hairy tuft in the SKIN of back and neurological deficit. Plain X-rays reveal multiple vertebral anomalies & a vertical bony spur overlying lumbar spine on AP view. The most probable diagnosis is:

A. Dorsal dermal sinus
B. Diastometamyelia
C. Tight filum terminale
D. Caudal regresion syndrome
Ans. B

Q 251. In a patient with head injury, unexplained hypotension warrants evaluation of:

A. Upper cervical spine
B. Lower cervical spine
C. Thoracic spine
D. Lumbar spine
Ans. C

Q 252. Complete transection of the spinal cord at the C1 level produces all of the following effects except:

A. Hypotension
B. Limited respiratory effort
C. Anaesthesia below the level of the lesion
D. Areflexia below the level of the lesion
Ans. B

Anaesthesia

Q 253. The gas which produces systemic toxicity without causing local irritation is:

A. Ammonia
B. Carbon monoxide
C. Hydrocyanic acid
D. Sulfur dioxide
Ans. B

Q 254. In a patient with fixed respiratory obstruction helium is used along with oxygen instead of plain oxygen because:

A. It increases oxygenation
B. It decreases turbulence
C. It decreases the dead space
D. It provides analgesia
Ans. B

Q 255. Upper respiratory tract infection is a common problem in children. All the following anesthetic complications can occur in children with respiratory infections, except:

A. Bacteremia
B. Halothane granuloma
C. Increased mucosal bleeding
D. Laryngospasm
Ans. B 

Ophthalmology

Q 256. In the normal human right eye , the peripheral field of vision is usually least:

A. On the left side (nasally)
B. In the downward direction
C. In the upward direction
D. On the right side (temporally)
Ans. C

Q 257. Tonography helps you to determine:

A. The rate of formation of aqueous
B. The facility

C. The levels of intraocular presure at different times
D. The field changes
Ans. B

Q 258. Any spectral colour can be matched by a mixture of three monochromatic lights (red, green, blue) in different proportions. If a person needs more of one of the colour for matching than a normal person, then he has a colour anomaly. More red colour is needed in the case of:

A. Deuteranomaly
B. Tritanomaly
C. Protanomaly
D. Tritanomaly
Ans. C

Q 259. The colours best appreciated by the central cones of our foveo-macular area are:

A. Red and blue
B. Blue and green
C. Red and green
D. Blue and yellow
Ans. C

Q 260. Epiphora is:

A. Cerebrospinal fluid running from the nose after FRACTURE of anterior cranial fossa
B. An epiphenomenors of a cerebral tumor
C. An abnormal overflow of tears due to obstruction of lacrimal duct
D. Eversion of lower eyelid following injury
Ans. C

Q 261. A 35 years old hypermetrope is using 1.50 D sphere both eyes. Whenever his glasses slip downward on his nose he will feel that his near vision:

A. Becomes enlarged
B. Becomes distorted
C. Becomes decreased
D. Remains the same
Ans. A

Q 262. Occulomoter nerve palsy affects all of the following muscles, except:

A. Medial rectus
B. Inferior oblique
C. Lateral rectus
D. Levetor palpabrae superioris
Ans. C

Q 263. Kusum Lata presents with acute painful red eye and mildly dilated vertically oval pupil. Most likely diagnosis is:

A. Acute retrobulbar neuritis
B. Acute angle closure glaucoma
C. Acute anterior uveitis
D. Severe keratoconjunctivitis
Ans. B

Q 264. You have been referred a midle-aged patient to rule out open angle glaucoma. Which of the following findings will help in the diagnosis:

A. Cupping of the disc
B. Depth of anterior chamber
C. Visual acuity and refractive error
D. Angle of the anterior chamber
Ans. A

Q 265. In a case of hypertensive uveitis, most useful drug to reduce intraocular pressure is:

A. Pilocarpine
B. Latanoprost
C. Physostigmine
D. Dipivefrine
Ans. B

Q 266. A patient having glaucoma develops blepharoconjunctivitis after instilling some anti-glaucoma drug. Which of the following drug can be responsible for it:

A. Timolol
B. Latanoprost
C. Dipivefrine
D. Pilocarpine
Ans. C