FMGE/MCI Medical Exam MCQs

Questions 1-10 (Anatomy & Biochemistry)

1. Which artery supplies the majority of the blood to the anterior wall of the heart?
   A. Right coronary artery
   B. Left circumflex artery
   C. Left anterior descending artery
   D. Posterior descending artery
2. Which part of the brain is primarily responsible for coordination and balance?
   A. Cerebellum
   B. Medulla oblongata
   C. Cerebrum
   D. Hypothalamus
3. In glycolysis, glucose is broken down into which of the following?
   A. Citrate
   B. Lactate
   C. Pyruvate
   D. Acetyl-CoA
4. Which vitamin is necessary for the synthesis of coagulation factors in the liver?
   A. Vitamin A
   B. Vitamin D
   C. Vitamin E
   D. Vitamin K
5. The thoracic duct drains into which of the following veins?
   A. Right subclavian vein
   B. Left subclavian vein
   C. Right brachiocephalic vein
   D. Left brachiocephalic vein
6. The Krebs cycle occurs in which part of the cell?
   A. Cytoplasm
   B. Nucleus
   C. Mitochondria
   D. Golgi apparatus
7. The optic nerve passes through which structure to enter the cranial cavity?
   A. Superior orbital fissure
   B. Optic canal
   C. Inferior orbital fissure
   D. Foramen rotundum
8. The hormone responsible for uterine contraction during childbirth is:
   A. Prolactin
   B. Oxytocin
   C. Estrogen
   D. Progesterone
9. Which amino acid is a precursor for the neurotransmitter serotonin?
   A. Tryptophan
   B. Tyrosine
   C. Glutamine
   D. Arginine
10. The blood-brain barrier is primarily maintained by which of the following cells?
    A. Microglia
    B. Oligodendrocytes
    C. Astrocytes
    D. Ependymal cells

Answers and Explanations 1-10:

1. C. Left anterior descending artery
   Explanation: The left anterior descending artery supplies the anterior wall of the heart, including the septum.
2. A. Cerebellum
   Explanation: The cerebellum is responsible for coordination and balance.
3. C. Pyruvate
   Explanation: Glycolysis breaks down glucose into pyruvate, which can then enter the Krebs cycle.
4. D. Vitamin K
   Explanation: Vitamin K is essential for the synthesis of clotting factors II, VII, IX, and X in the liver.
5. B. Left subclavian vein
   Explanation: The thoracic duct drains lymph into the left subclavian vein.
6. C. Mitochondria
   Explanation: The Krebs cycle takes place in the mitochondria, the powerhouse of the cell.
7. B. Optic canal
   Explanation: The optic nerve passes through the optic canal to enter the cranial cavity.
8. B. Oxytocin
   Explanation: Oxytocin stimulates uterine contractions during labor.
9. A. Tryptophan
   Explanation: Tryptophan is the precursor to serotonin, a neurotransmitter that influences mood.
10. C. Astrocytes
    Explanation: Astrocytes play a key role in maintaining the blood-brain barrier.

Questions 11-20 (Physiology & Pharmacology)

1. Which hormone increases water reabsorption in the kidneys by acting on the collecting ducts?
   A. Aldosterone
   B. Antidiuretic hormone (ADH)
   C. Renin
   D. Atrial natriuretic peptide (ANP)
2. Which of the following is the main neurotransmitter in the parasympathetic nervous system?
   A. Dopamine
   B. Norepinephrine
   C. Acetylcholine
   D. Serotonin
3. Which phase of the cardiac cycle is associated with the closing of the mitral and tricuspid valves?
   A. Atrial systole
   B. Isovolumetric contraction
   C. Ventricular ejection
   D. Isovolumetric relaxation
4. The clearance of which drug is primarily dependent on renal function?
   A. Metformin
   B. Warfarin
   C. Diazepam
   D. Digoxin
5. In the regulation of blood pressure, the baroreceptors are primarily located in which area?
   A. Aortic arch and carotid sinus
   B. Renal arteries
   C. Coronary arteries
   D. Pulmonary arteries
6. Which of the following medications is an angiotensin-converting enzyme (ACE) inhibitor?
   A. Amlodipine
   B. Enalapril
   C. Losartan
   D. Metoprolol
7. The primary effect of beta-blockers is:
   A. Bronchodilation
   B. Increased heart rate
   C. Decreased myocardial oxygen demand
   D. Vasodilation
8. Which electrolyte imbalance is most commonly associated with the use of loop diuretics like furosemide?
   A. Hyperkalemia
   B. Hypokalemia
   C. Hypernatremia
   D. Hyponatremia
9. The oxygen-hemoglobin dissociation curve shifts to the right in all of the following conditions except:
   A. Increased temperature
   B. Decreased pH
   C. Decreased 2,3-DPG
   D. Increased CO2
10. Which of the following is the mechanism of action of aspirin?
    A. Inhibition of thromboxane A2 production
    B. Inhibition of ADP receptors
    C. Inhibition of glycoprotein IIb/IIIa receptors
    D. Direct thrombin inhibition

Answers and Explanations 11-20:

1. B. Antidiuretic hormone (ADH)
   Explanation: ADH, also known as vasopressin, acts on the collecting ducts to increase water reabsorption.
2. C. Acetylcholine
   Explanation: Acetylcholine is the primary neurotransmitter of the parasympathetic nervous system.
3. B. Isovolumetric contraction
   Explanation: Isovolumetric contraction occurs when the ventricles contract but the semilunar valves are still closed.
4. D. Digoxin
   Explanation: Digoxin is cleared primarily by the kidneys, so renal function affects its clearance.
5. A. Aortic arch and carotid sinus
   Explanation: Baroreceptors located in the aortic arch and carotid sinus help regulate blood pressure by sensing changes in stretch.
6. B. Enalapril
   Explanation: Enalaprilis an ACE inhibitor that works by inhibiting the conversion of angiotensin I to angiotensin II, reducing blood pressure.
7. C. Decreased myocardial oxygen demand
   Explanation: Beta-blockers decrease heart rate and contractility, which reduces myocardial oxygen demand, making them useful in managing angina.
8. B. Hypokalemia
   Explanation: Loop diuretics like furosemide can cause significant potassium loss, leading to hypokalemia.
9. C. Decreased 2,3-DPG
   Explanation: A rightward shift of the oxygen-hemoglobin dissociation curve occurs with increased temperature, increased CO2, or decreased pH. A decrease in 2,3-DPG would shift the curve to the left.
10. A. Inhibition of thromboxane A2 production
    Explanation: Aspirin inhibits the enzyme cyclooxygenase (COX), leading to reduced thromboxane A2 production, which in turn inhibits platelet aggregation.

Questions 21-30 (Microbiology & Pathology)

1. Which of the following organisms is the most common cause of community-acquired pneumonia?
   A. Streptococcus pneumoniae
   B. Klebsiella pneumoniae
   C. Pseudomonas aeruginosa
   D. Mycoplasma pneumoniae
2. The presence of Howell-Jolly bodies on a blood smear is indicative of:
   A. Iron deficiency anemia
   B. Vitamin B12 deficiency
   C. Functional asplenia
   D. Chronic liver disease
3. The causative agent of gas gangrene is:
   A. Clostridium tetani
   B. Clostridium perfringens
   C. Staphylococcus aureus
   D. Escherichia coli
4. A 70-year-old male presents with hematuria and flank pain. A CT scan shows a solid mass in the kidney. The most likely diagnosis is:
   A. Wilms' tumor
   B. Renal cell carcinoma
   C. Transitional cell carcinoma
   D. Angiomyolipoma
5. The Philadelphia chromosome is associated with which of the following conditions?
   A. Chronic myelogenous leukemia (CML)
   B. Acute lymphoblastic leukemia (ALL)
   C. Acute myelogenous leukemia (AML)
   D. Hodgkin's lymphoma
6. Which of the following is a gram-negative diplococcus that causes urethritis?
   A. Neisseria gonorrhoeae
   B. Streptococcus pyogenes
   C. Haemophilus influenzae
   D. Escherichia coli
7. A Papanicolaou (Pap) smear is primarily used for the detection of:
   A. Endometrial cancer
   B. Cervical dysplasia
   C. Ovarian cancer
   D. Vulvar cancer
8. Which of the following is a feature of irreversible cell injury?
   A. Cellular swelling
   B. Fatty change
   C. Mitochondrial damage
   D. Membrane blebbing
9. The characteristic "slapped cheek" appearance is seen in which viral infection?
   A. Measles
   B. Rubella
   C. Parvovirus B19
   D. Varicella zoster
10. The presence of Reed-Sternberg cells is diagnostic of:
    A. Burkitt's lymphoma
    B. Hodgkin's lymphoma
    C. Non-Hodgkin's lymphoma
    D. Multiple myeloma

Answers and Explanations 21-30:

1. A. Streptococcus pneumoniae
   Explanation: Streptococcus pneumoniae is the most common cause of community-acquired pneumonia, especially in adults.
2. C. Functional asplenia
   Explanation: Howell-Jolly bodies are remnants of nuclear material seen in red blood cells, typically found in individuals with functional asplenia or after splenectomy.
3. B. Clostridium perfringens
   Explanation: Clostridium perfringens is a gram-positive, spore-forming bacterium responsible for gas gangrene, characterized by myonecrosis.
4. B. Renal cell carcinoma
   Explanation: Renal cell carcinoma is the most common primary tumor of the kidney in adults, typically presenting with hematuria and flank pain.
5. A. Chronic myelogenous leukemia (CML)
   Explanation: The Philadelphia chromosome (translocation t(9;22)) is associated with chronic myelogenous leukemia.
6. A. Neisseria gonorrhoeae
   Explanation: Neisseria gonorrhoeae is a gram-negative diplococcus that causes gonorrhea, which commonly presents with urethritis.
7. B. Cervical dysplasia
   Explanation: A Pap smear is used to screen for cervical dysplasia and cervical cancer, detecting precancerous changes in cervical cells.
8. C. Mitochondrial damage
   Explanation: Mitochondrial damage is a key feature of irreversible cell injury, leading to cell death.
9. C. Parvovirus B19
   Explanation: Parvovirus B19 causes erythema infectiosum, or "fifth disease," characterized by a "slapped cheek" rash in children.
10. B. Hodgkin's lymphoma
    Explanation: Reed-Sternberg cells, which are large, abnormal lymphocytes, are characteristic of Hodgkin's lymphoma.

Questions 31-40 (Internal Medicine & Surgery)

1. A 55-year-old male presents with a pulsatile abdominal mass and sudden onset of severe back pain. What is the most likely diagnosis?
   A. Acute pancreatitis
   B. Ruptured abdominal aortic aneurysm
   C. Diverticulitis
   D. Appendicitis
2. Which of the following is the most common cause of peptic ulcer disease?
   A. Nonsteroidal anti-inflammatory drugs (NSAIDs)
   B. Alcohol
   C. H. pylori infection
   D. Zollinger-Ellison syndrome
3. In a patient with suspected myocardial infarction, which of the following is the earliest marker to rise?
   A. Troponin I
   B. Myoglobin
   C. CK-MB
   D. Lactate dehydrogenase (LDH)
4. Which of the following is a common complication of chronic pancreatitis?
   A. Pancreatic pseudocyst
   B. Cholecystitis
   C. Cirrhosis
   D. Hepatitis
5. A 68-year-old male with a history of smoking presents with hemoptysis, weight loss, and recurrent pneumonia. A chest X-ray shows a mass in the right upper lobe. What is the most likely diagnosis?
   A. Tuberculosis
   B. Pulmonary embolism
   C. Bronchogenic carcinoma
   D. Sarcoidosis
6. Which of the following is the best initial test for the diagnosis of deep vein thrombosis (DVT)?
   A. Venogram
   B. D-dimer test
   C. Doppler ultrasound
   D. CT angiography
7. Which of the following is the most common type of gallstone?
   A. Cholesterol stones
   B. Pigment stones
   C. Mixed stones
   D. Bilirubin stones
8. A 45-year-old female presents with jaundice, pruritus, and a positive anti-mitochondrial antibody. What is the most likely diagnosis?
   A. Primary sclerosing cholangitis
   B. Autoimmune hepatitis
   C. Primary biliary cirrhosis
   D. Alcoholic liver disease
9. The "triple therapy" regimen for Helicobacter pylori eradication includes all of the following EXCEPT: B. Amoxicillin
   C. Clarithromycin
   D. Metronidazole
10. A patient with acute appendicitis presents with rebound tenderness and pain at McBurney's point. Which of the following is the most appropriate management?
    A. Observation
    B. Intravenous antibiotics
    C. Appendectomy
    D. Laparotomy

Answers and Explanations 31-40:

1. B. Ruptured abdominal aortic aneurysm
   Explanation: A pulsatile abdominal mass and sudden onset of severe back pain in an older male are classic signs of a ruptured abdominal aortic aneurysm, which is a surgical emergency.
2. C. H. pylori infection
   Explanation: Helicobacter pylori infection is the most common cause of peptic ulcer disease. NSAIDs are the second most common cause.
3. B. Myoglobin
   Explanation: Myoglobin is the earliest marker to rise in myocardial infarction, although it is not specific. Troponin I is more specific but rises later.
4. A. Pancreatic pseudocyst
   Explanation: Pancreatic pseudocyst is a common complication of chronic pancreatitis, especially in patients with a history of alcohol abuse.
5. C. Bronchogenic carcinoma
   Explanation: Hemoptysis, weight loss, and a mass in the upper lobe in a smoker are suggestive of lung cancer, specifically bronchogenic carcinoma.
6. C. Doppler ultrasound
   Explanation: Doppler ultrasound is the best initial test for diagnosing deep vein thrombosis. D-dimer can help rule out DVT, but ultrasound provides direct visualization.
7. A. Cholesterol stones
   Explanation: Cholesterol stones are the most common type of gallstones, making up about 80% of cases.
8. C. Primary biliary cirrhosis
   Explanation: Primary biliary cirrhosis is an autoimmune disease characterized by positive anti-mitochondrial antibodies, jaundice, and pruritus.
9. D. Metronidazole
   Explanation: The standard "triple therapy" for H. pylori infection includes a proton pump inhibitor, amoxicillin, and clarithromycin. Metronidazole can be used as an alternative in penicillin-allergic patients.
10. C. Appendectomy
    Explanation: Appendectomy is the treatment of choice for acute appendicitis. Antibiotics may be used as a preoperative measure, but surgery is required.

Questions 41-50 (Anesthesiology & Critical Care)

1. Which of the following is the most reliable clinical sign of malignant hyperthermia during anesthesia?
   A. Hypertension
   B. Hyperkalemia
   C. Tachycardia
   D. Increased end-tidal CO2
2. The best way to confirm endotracheal intubation is:
   A. Chest movement
   B. Auscultation of breath sounds
   C. End-tidal CO2 monitoring
   D. Fogging of the tube
3. Which of the following is used to reverse the effects of non-depolarizing neuromuscular blockers?
   A. Succinylcholine
   B. Neostigmine
   C. Atropine
   D. Fentanyl
4. A patient undergoing major surgery develops hypotension after induction of anesthesia. Which of the following medications is most likely to increase the blood pressure?
   A. Epinephrine
   B. Nitroglycerin
   C. Propofol
   D. Midazolam
5. A 60-year-old man with a history of COPD is undergoing surgery. Which of the following anesthetic agents is most appropriate for this patient?
   A. Desflurane
   B. Halothane
   C. Isoflurane
   D. Sevoflurane
6. Which of the following is a common side effect of spinal anesthesia?
   A. Tachycardia
   B. Hypotension
   C. Hypertension
   D. Seizures
7. The most common cause of death in patients with septic shock is:
   A. Hypovolemia
   B. Cardiac arrest
   C. Multiple organ dysfunction syndrome (MODS)
   D. Pulmonary embolism
8. A patient undergoing general anesthesia experiences severe bronchospasm. The most appropriate treatment is:
   A. Succinylcholine
   B. Albuterol
   C. Morphine
   D. Ketamine
9. The Mallampati classification is used to assess:
   A. Difficulty of airway intubation
   B. Risk of aspiration
   C. Need for mechanical ventilation
   D. Oxygenation status
10. The most appropriate first-line treatment for anaphylaxis in the operating room is:
    A. Intravenous fluids
    B. Epinephrine
    C. Antihistamines
    D. Corticosteroids

Answers and Explanations 41-50:

1. D. Increased end-tidal CO2
   Explanation: Increased end-tidal CO2 is a reliable early sign of malignant hyperthermia, which can be life-threatening if not treated promptly.
2. C. End-tidal CO2 monitoring
   Explanation: End-tidal CO2 monitoring is the most reliable method for confirming endotracheal intubation, as it reflects gas exchange in the lungs.
3. B. Neostigmine
   Explanation: Neostigmine is an acetylcholinesterase inhibitor that reverses the effects of non-depolarizing neuromuscular blockers by increasing acetylcholine levels.
4. A. Epinephrine
   Explanation: Epinephrine is a potent vasoconstrictor and increases blood pressure in cases of anesthesia-induced hypotension.
5. D. Sevoflurane
   Explanation: Sevoflurane is preferred in patients with COPD because it is less irritating to the respiratory tract than other agents like desflurane.
6. B. Hypotension
   Explanation: Hypotension is a common side effect of spinal anesthesia due to sympathetic blockade.
7. C. Multiple organ dysfunction syndrome (MODS)
   Explanation: The most common cause of death in septic shock is multiple organ dysfunction syndrome, which results from widespread inflammation and tissue damage.
8. B. Albuterol
   Explanation: Albuterol is a bronchodilator and is the treatment of choice for severe bronchospasm during anesthesia.
9. A. Difficulty of airway intubation
   Explanation: The Mallampati classification is used to predict the difficulty of airway management and intubation based on the visibility of oral structures.
10. B. Epinephrine
    Explanation: Epinephrine is the first-line treatment for anaphylaxis, as it reverses bronchoconstriction and improves blood pressure.