FMGE 2023 Practice Questions

Q: Which of the following structures passes through the foramen marked by the arrow? ![img-53.jpeg](img-53.jpeg)

Thoracic duct. ***Thoracic duct*** - The arrow in the image points to the **aortic hiatus**, which is the most posterior of the three major openings in the diaphragm, located at the vertebral level of **T12**. - This hiatus provides passage for the **aorta**, the **thoracic duct**, and the **azygos vein** from the thorax into the abdomen. *Oesophagus* - The oesophagus passes through its own opening, the **oesophageal hiatus**, which is located more anteriorly and superiorly at the **T10** vertebral level within the muscular part of the diaphragm. - This opening is formed by the fibers of the **right crus** of the diaphragm and also transmits the **vagal trunks**. *Inferior vena cava* - The inferior vena cava traverses the diaphragm through the **caval opening**, the most anterior and superior opening, situated at the **T8** vertebral level. - This foramen is located within the **central tendon** of the diaphragm and also allows passage for branches of the **right phrenic nerve**. *Sympathetic trunk* - The sympathetic trunk does not pass through any of the major apertures but rather descends posterior to the diaphragm. - It typically passes behind the **medial arcuate ligament** or pierces the **crus of the diaphragm** to enter the abdomen.

Q: Identify the nerve indicated by the arrow in the image.

Ulnar nerve. ***Ulnar nerve*** - The arrow points to the area posterior to the **medial epicondyle** of the humerus, which is the location of the **cubital tunnel**. - The **ulnar nerve** passes superficially through this tunnel, making it susceptible to compression or injury, and is commonly known as the "funny bone". *Radial nerve* - The **radial nerve** travels down the posterior aspect of the humerus in the **radial groove** and then crosses the elbow joint anterior to the **lateral epicondyle**. - It is primarily responsible for innervating the **extensor muscles** of the forearm and hand. *Median nerve* - The **median nerve** descends through the **anterior compartment** of the arm and passes through the **cubital fossa**, which is anterior to the elbow joint. - It innervates most of the **flexor muscles** of the forearm and the **thenar muscles** of the hand. *Musculocutaneous nerve* - The **musculocutaneous nerve** is found in the **anterior compartment** of the arm, where it pierces the coracobrachialis muscle and runs between the biceps brachii and brachialis muscles. - It supplies the **flexor muscles** of the arm and provides sensory innervation to the **lateral forearm**.

Q: Which nerve can be injured when a fracture is sustained in the area marked with the red arrow in the image? ![img-54.jpeg](img-54.jpeg)

Ulnar nerve. ***Ulnar nerve*** - The arrow points to the **medial epicondyle** of the humerus. The ulnar nerve runs in a groove on the posterior surface of the medial epicondyle, making it vulnerable to injury in this location. - A fracture of the medial epicondyle can cause direct trauma or entrapment of the ulnar nerve, leading to numbness and tingling in the fourth and fifth digits and weakness of the intrinsic hand muscles. *Radial nerve* - The radial nerve is most commonly injured in fractures of the **mid-shaft of the humerus**, where it travels in the **radial groove**. - Injury to the radial nerve typically results in **wrist drop**, characterized by the inability to extend the wrist and fingers. *Median nerve* - The median nerve is most at risk with **supracondylar fractures** of the humerus, as it passes anterior to the elbow joint. - This nerve is also famously associated with **carpal tunnel syndrome** when compressed at the wrist. *Musculocutaneous nerve* - The musculocutaneous nerve is located in the **anterior compartment** of the arm and is not in close proximity to the medial epicondyle. - Injury to this nerve, which is rare from fractures, results in weakness of elbow flexion (**biceps brachii** and **brachialis**) and sensory loss over the lateral forearm.

Q: Post-mortem examination of a dead body reveals contraction of the hands with absent primary relaxation. What is this suggestive of?

Cadaveric spasm. ***Cadaveric spasm (Correct Answer)*** - Cadaveric spasm (also called **instantaneous rigor**) occurs **immediately upon death**, without passing through the stage of **primary muscular flaccidity**. - The key diagnostic feature is **absent primary relaxation**, which distinguishes it from typical rigor mortis. - This phenomenon often involves a **tight grasp** on an object (e.g., weapon, hair) and is characteristic of death occurring under conditions of **intense emotional stress** or **great physical exertion**. - It is **localized** (commonly hands) and **permanent** once formed. *Rigor mortis (Incorrect)* - Rigor mortis is a **delayed** post-mortem stiffening that begins **2-4 hours after death**. - Critically, it is **preceded by a period of primary flaccidity** (primary relaxation), unlike cadaveric spasm. - It is a **generalized** metabolic change caused by **ATP depletion** and affects all muscles sequentially. - It is **temporary** and eventually resolves. *Livor mortis (Incorrect)* - Livor mortis (post-mortem lividity) describes the **purplish discoloration** of dependent parts of the body due to gravity-induced pooling of blood. - This is a **coloring phenomenon** related to circulation cessation, not a form of **muscular contraction** or stiffening. *Algor mortis (Incorrect)* - Algor mortis is the process of **post-mortem cooling** of the body until it reaches ambient temperature. - This helps estimate the **time since death** but has no relationship with **muscle rigidity** or contraction.

Q: Study of death in all aspects is known as:

Thanatology. ***Correct: Thanatology*** - It is the academic and scientific study of death, encompassing **medical, psychological, social, and ethical aspects** related to dying and death. - The term comes from the Greek word *Thanatos* (death) and *logia* (study). - This is the comprehensive field that studies death "in all aspects" as stated in the question. *Incorrect: Forensic anthropology* - Involves the application of physical anthropology and osteology (study of bones) to **legal issues** in forensic contexts. - Primarily focuses on the **identification and examination of human skeletal remains** to aid law enforcement. - This is a specialized subset of forensic science, not the general study of death itself. *Incorrect: Toxicology* - The scientific study of the adverse effects of **chemical, physical, or biological agents** on living organisms and ecosystems. - While crucial for determining causes of death involving **poisoning or drugs**, it is a specialized branch of forensic science. - Not the comprehensive study of death in all its aspects. *Incorrect: Molecular death* - Refers specifically to the death of **individual cells and tissues** that occurs post-mortem following somatic death. - This is a **biological process or state**, not a field of study or academic discipline. - Distinguished from somatic death (death of the whole organism) and brain death.

Q: Following the recovery of a skull by the police, the relatives of a missing person want to confirm his identity. Which of the following techniques can be used to figure out a person's identity using the skull and photograph of the person?

Superimposition. ***Superimposition*** - **Superimposition technique** involves electronically or manually overlaying the antemortem photograph onto the recovered skull image to align key craniometric points (e.g., orbits, nasal aperture, chin). - This method is specifically designed to visually compare the distinctive features and contours of the facial structure recorded in the photograph with the underlying skeletal structure of the **skull**, confirming identity. *Anthropometry* - **Anthropometry** is the scientific study of the measurements and proportions of the human body, specifically used in forensic science to estimate age, sex, and stature from skeletal remains. - While useful for broad identification parameters, it relies on quantitative measurements of the skull (like cranial indices) and does not involve the direct visual comparison required when matching a photograph. *DNA fingerprinting* - **DNA fingerprinting** requires comparison of the recovered genetic profile from the bone tissue with a known reference sample (e.g., from suspected relatives or personal items). - Although highly accurate, this technique does not utilize the *photograph* as the primary comparative material; it compares genetic information, not morphological features. *Cheiloscopy* - **Cheiloscopy** is the forensic technique involving the analysis and identification of lip prints (furrows and wrinkles on the lips). - This technique is completely irrelevant for identification based on a **skull** and a general antemortem photograph.

Q: Identify the following instrument used by obstetricians:

Outlet forceps. ***Outlet forceps*** - The instrument shown is a type of **outlet forceps**, specifically **Wrigley's forceps**, characterized by its short shanks and blades designed to minimize trauma. - These are used for **low-forceps deliveries** when the fetal head is visible on the perineum, requiring minimal traction and no rotation for delivery. *Kielland forceps* - **Kielland forceps** are primarily used for **rotational deliveries**, especially in cases of deep transverse arrest, and feature a minimal pelvic curve and a sliding lock. - The forceps in the image lack the characteristic sliding lock and long shanks of Kielland forceps. *Tucker Mclane forceps* - **Tucker-McLane forceps** have overlapping shanks and solid or pseudofenestrated blades, making them a type of classical forceps used for various mid-pelvic applications. - The instrument pictured has a distinctly different design with shorter components, not matching the Tucker-McLane structure. *Pipers forceps* - **Piper's forceps** are specialized instruments with long, curved shanks and a perineal curve, designed exclusively for delivering the **aftercoming head in a breech presentation**. - The forceps in the image are too short and lack the specific curvature required for managing a breech delivery.

Q: In which of the following cases is the drug below contraindicated?

Malpresentation of fetus. ***Malpresentation of fetus*** - The drug shown is **Oxytocin**, which induces strong uterine contractions. If the fetus is in an abnormal position (e.g., **transverse lie**, **breech**), forcing labor with oxytocin can lead to **uterine rupture** or **cord prolapse**. - Inducing labor in the setting of malpresentation is contraindicated because a safe vaginal delivery is not possible, and it significantly increases the risk of severe **fetal distress** and **maternal trauma**. *Heart disease in mother* - While caution is needed due to potential cardiovascular effects like **hypotension** and water retention, maternal heart disease is a relative contraindication, not an absolute one. - Oxytocin is crucial in the third stage of labor to prevent **postpartum hemorrhage**, which is a major concern in patients with cardiac conditions. *Premature labour* - Oxytocin is used to *induce* or *augment* labor, whereas in premature labor, the primary goal is often **tocolysis** (stopping contractions) with drugs like magnesium sulfate or nifedipine. - It is not a contraindication if a medically indicated preterm delivery is planned; rather, it is used when the decision to deliver has been made. *Hypothyroidism* - Maternal hypothyroidism, especially when well-controlled, is not a recognized contraindication for the use of oxytocin. - There is no known adverse interaction between thyroid status and the action of oxytocin on the uterus.

Q: In which of the following cases is the drug below contraindicated? ![img-52.jpeg](img-52.jpeg)

Malpresentation of fetus. ***Malpresentation of fetus*** - Administering **oxytocin** with fetal malpresentation (e.g., transverse lie, breech) is contraindicated as the powerful contractions against an undeliverable fetus can cause **uterine rupture**. - It also significantly increases the risk of **fetal distress**, cord prolapse, and birth trauma, making a cesarean section the necessary and safer mode of delivery. *Heart disease in mother* - Oxytocin is not absolutely contraindicated and is often used cautiously for labor induction or to prevent **postpartum hemorrhage**, which would be especially dangerous in a patient with heart disease. - Careful monitoring is required due to its potential antidiuretic and cardiovascular effects, but its benefits in preventing hemorrhage often outweigh the risks. *Premature labour* - While **tocolytics** are used to stop premature labor, oxytocin may be used to *induce* labor if a preterm delivery is medically indicated (e.g., severe preeclampsia, fetal distress). - Therefore, prematurity itself is not a contraindication; the clinical goal (stopping vs. inducing labor) determines the appropriate medication. *Hypothyroidism* - Maternal hypothyroidism, when properly managed, is not a contraindication for the use of **oxytocin**. - The drug's mechanism of action on uterine smooth muscle is unrelated to thyroid hormone pathways.

Q: Which of the following is the process of breaking the clavicle during delivery?

Cleidotomy. ***Cleidotomy*** - This is a destructive obstetric procedure where the fetal clavicle is intentionally broken or cut to reduce the **bisacromial diameter**. It is utilized primarily in cases of severe, unrelieved **shoulder dystocia**, especially if the fetus has already succumbed (**Fetal demise**). *Craniotomy* - This is a destructive procedure aimed at reducing the size of the **fetal head** by crushing or perforating the skull. It is performed when the fetal head is impacted and delivery is otherwise impossible, usually only if there is **fetal demise**. *Symphysiotomy* - This procedure involves surgically incising the **fibrocartilage** of the **pubic symphysis** to widen the pelvic outlet. It is used to relieve **obstructed labor** due to minor cephalopelvic disproportion, allowing vaginal delivery. *Zavanelli manoeuvre* - This is an emergency procedure for severe **shoulder dystocia** where the delivered fetal head is pushed back into the birth canal (**cephalic replacement**). It mandates immediate delivery via **Cesarean section** following the replacement.

Question 1

Which of the following structures passes through the foramen marked by the arrow? ![img-53.jpeg](img-53.jpeg)

Accepted Answer

Thoracic duct

Answer

Oesophagus

Answer

Sympathetic trunk

Answer

Inferior vena cava

Question 2

Identify the nerve indicated by the arrow in the image.

Accepted Answer

Ulnar nerve

Answer

Radial nerve

Answer

Musculocutaneous nerve

Answer

Median nerve

Question 3

Which nerve can be injured when a fracture is sustained in the area marked with the red arrow in the image? ![img-54.jpeg](img-54.jpeg)

Accepted Answer

Ulnar nerve

Answer

Radial nerve

Answer

Musculocutaneous nerve

Answer

Median nerve

Question 4

Post-mortem examination of a dead body reveals contraction of the hands with absent primary relaxation. What is this suggestive of?

Accepted Answer

Cadaveric spasm

Answer

Rigor mortis

Answer

Algor mortis

Answer

Livor mortis

Question 5

Study of death in all aspects is known as:

Accepted Answer

Thanatology

Answer

Forensic anthropology

Answer

Toxicology

Answer

Molecular death

Question 6

Following the recovery of a skull by the police, the relatives of a missing person want to confirm his identity. Which of the following techniques can be used to figure out a person's identity using the skull and photograph of the person?

Accepted Answer

Superimposition

Answer

Anthropometry

Answer

DNA fingerprinting

Answer

Cheiloscopy

Question 7

Identify the following instrument used by obstetricians:

Accepted Answer

Outlet forceps

Answer

Tucker-McLane forceps

Answer

Kielland forceps

Answer

Piper's forceps

Question 8

In which of the following cases is the drug below contraindicated?

Accepted Answer

Malpresentation of fetus

Answer

Premature labour

Answer

Hypothyroidism

Answer

Heart disease in mother

Question 9

In which of the following cases is the drug below contraindicated? ![img-52.jpeg](img-52.jpeg)

Accepted Answer

Malpresentation of fetus

Answer

Heart disease in mother

Answer

Premature labour

Answer

Hypothyroidism

Question 10

Which of the following is the process of breaking the clavicle during delivery?

Accepted Answer

Cleidotomy

Answer

Zavanelli manoeuvre

Answer

Craniotomy

Answer

Symphysiotomy

FMGE 2023

Anatomy

Forensic Medicine

Obstetrics and Gynecology