FMGE 2025 Practice Questions

Q: Which of the following represents the most severe form of neural tube defect where neural tissue is completely exposed without overlying skin, vertebral arches, or meninges?

Open Neural tube defect. ***Open Neural tube defect*** - The image displays a severe congenital anomaly where the neural tube has failed to close, leaving the neural tissue completely exposed. This specific presentation is consistent with **rachischisis**, the most severe form of spina bifida. - Characteristic features visible are the complete absence of overlying skin, vertebral arches, and meninges, exposing the flattened, malformed spinal cord (neural placode) along the entire spine. *Meningocele* - A **meningocele** is a less severe defect where a sac containing only meninges and cerebrospinal fluid protrudes through an opening in the spine; the spinal cord itself is not displaced. - This is incorrect as the image clearly shows exposed **neural tissue**, which is not a feature of a simple meningocele. *Spina bifida* - **Spina bifida** is a broad term for a range of defects involving incomplete closure of the spine. It includes mild forms like **spina bifida occulta** and severe forms like myelomeningocele, which are typically localized. - The defect in the image is far more extensive than a typical localized spina bifida, affecting a large portion or the entire spine, making it a severe type of open neural tube defect known as rachischisis. *Myelomeningocele* - In a **myelomeningocele**, both the meninges and the spinal cord protrude through the defect, typically forming a sac on the infant's back. - The image does not show a contained sac but rather a completely open, flattened neural plate, which is characteristic of **rachischisis**, a more severe condition than a typical myelomeningocele.

Q: A disease with mitochondrial inheritance is inherited from which family member?

Mother. ***Mother*** - Mitochondrial inheritance is characterized by **maternal transmission** because almost all mitochondria in the zygote are derived from the **oocyte** (mother's egg cell). - Therefore, an affected mother will pass the disease to all of her children (sons and daughters), irrespective of sex. *Grandmother (paternal)* - The paternal grandmother passes her mitochondria to the **father**, but the father cannot transmit them to his offspring. - Inheritance is strictly maternal, meaning the genetic input from the paternal line (including the paternal grandmother) is **irrelevant** for mitochondrial DNA. *Father* - The **sperm contributes negligible mitochondrial DNA** to the fertilized egg; hence, fathers cannot pass on mitochondrial diseases to their children. - Paternal mitochondria are typically **ubiquitinated and degraded** following fertilization. *Both mother and father* - Inheritance from both parents is characteristic of **nuclear DNA** (Mendelian) disorders, such as autosomal dominant or recessive patterns. - Mitochondrial inheritance is distinctively **uniparental** and does not involve DNA contribution from both parents.

Q: The mascot 'Sapna' shown in the image is associated with which of the following programs?

National Leprosy eradication programme. ***National Leprosy eradication programme*** - 'Sapna' is the official mascot for India's **National Leprosy Eradication Programme (NLEP)**, symbolizing the dream of a leprosy-free nation. - The campaign aims to increase awareness, promote early case detection, and combat the stigma associated with **leprosy**, particularly among children. *National Tuberculosis Elimination Programme* - The **National Tuberculosis Elimination Programme (NTEP)** does not use 'Sapna' as its mascot; its campaigns often feature slogans like "TB Harega Desh Jeetega". - NTEP's focus is on strategies like **DOTS (Directly Observed Treatment, Short-course)** and promoting early diagnosis for persistent cough. *National Anti-Malaria Programme* - Anti-malaria campaigns, under the **National Vector Borne Disease Control Programme (NVBDCP)**, typically use imagery of mosquitoes to educate about prevention. - The key messages revolve around using **mosquito nets**, repellents, and eliminating stagnant water sources to prevent mosquito breeding. *National Polio Surveillance Program* - India's **Pulse Polio Immunization programme** used 'Bholu the Guard', an elephant, as its mascot. - The program's famous slogan was *"Do Boond Zindagi Ki"* (Two drops of life), emphasizing the importance of the **oral polio vaccine (OPV)**.

Q: In a class of 100 students, 80% students were immunised with measles, 12 were affected. What is the primary attack rate?

60%. ***60%*** - The **Primary Attack Rate** measures the number of new cases among the susceptible population during an outbreak; the susceptible population must first be determined by excluding the immunized students. - Calculation: The total susceptible population is 100 students - 80 immunized students = **20 susceptible contacts**. Primary Attack Rate = (12 affected / 20 susceptible) × 100 = **60%**. *80%* - This figure represents the percentage of students in the class who were **immunised** (80 out of 100), not the attack rate among the susceptible population. - Using 80 as the denominator would incorrectly calculate the rate among the protected group (12/80 = 15%). *70%* - This option is mathematically incorrect and does not result from the standard calculation of **Primary Attack Rate** using the given data (12 cases among 20 susceptible individuals). - It is likely derived from an incorrect calculation or failure to correctly identify the **susceptible population** for the denominator. *50%* - This value is incorrect, as the observed number of affected students (12) leads to a higher rate than 50% when calculated against the susceptible population (20). - A **Primary Attack Rate** of 50% would only account for 10 affected students (50% of 20 susceptible individuals).

Q: After how long is a patient advised to use alternative contraception following a vasectomy?

3 months. ***Correct: 3 months*** - After vasectomy, **residual viable sperm remain in the distal vas deferens** and ejaculatory ducts - Alternative contraception is required for **at least 3 months** or **20 ejaculations** (whichever is later) - **Semen analysis should confirm azoospermia** before discontinuing alternative contraception - This is the standard recommendation per WHO and national family planning guidelines *Incorrect: 1 month* - Too short a duration; sperm clearance is usually incomplete at 1 month - Does not allow sufficient time for sperm elimination from the reproductive tract *Incorrect: 2 months* - Still shorter than the recommended 3-month period - May not ensure complete sperm clearance in all patients *Incorrect: 6 months* - Longer than necessary; while very safe, it exceeds standard guideline recommendations - Most men achieve azoospermia well before 6 months

Q: Which of the following is the population norm for an ASHA worker?

1000-2500. ***Correct: 1000-2500*** The **official population norm** for ASHA worker deployment under the **National Health Mission (NHM)** is **1 ASHA per 1000-2500 population**. - The standard minimum coverage is **1000 population** in plain/non-tribal areas - In larger villages with population up to **2500**, a single ASHA may be deployed - Beyond 2500 population, **additional ASHA workers** are deployed - This range represents the official operational guideline for ASHA coverage *Incorrect: 1000-1500* - While this range includes the standard 1000 population norm, it **underestimates the upper limit** - The official NHM guideline allows a single ASHA to cover up to **2500 population** in large villages - This option artificially restricts the official range *Incorrect: 2000-2500* - This range **misses the lower limit** of the official norm, which starts at **1000 population** - A single ASHA worker should be deployed starting from 1000 population, not only at 2000+ - This would result in **under-deployment** of ASHA workers in smaller villages *Incorrect: 700-1000* - This range does not represent the standard population norm for ASHA deployment - While ASHA workers in **tribal/hilly/difficult terrain** may cover smaller habitations (minimum 100 population), **700-1000 is not an official range** specified in NHM guidelines - The standard norm begins at **1000 population** for plain areas

Q: A 45-year-old male was admitted with respiratory distress. CT showed a nasal polyp with fluid collection in the sinus. Drainage of which of the following is obstructed?

Maxillary sinus. ***Maxillary sinus*** - The coronal CT scan clearly shows opacification (fluid collection) in the right **maxillary sinus**, the large air-filled space located inferior to the orbit and lateral to the nasal cavity. - Nasal polyps commonly arise in the **middle meatus**, which is the primary drainage site for the maxillary sinus via the **maxillary ostium**. Obstruction here leads to fluid retention and sinusitis. *Ethmoidal sinus* - The **ethmoidal sinuses** are a complex of small air cells located between the orbits. While some mild mucosal thickening may be present, they are not the site of the large, complete fluid collection seen in the image. - These sinuses also drain into the **middle meatus** (anterior and middle ethmoidal cells) and **superior meatus** (posterior ethmoidal cells), but the primary pathology shown is not within the ethmoid air cells themselves. *Sphenoidal sinus* - The **sphenoidal sinus** is located more posteriorly within the sphenoid bone, behind the ethmoid sinuses, and is not the sinus shown to be opacified in this anterior coronal view. - It drains into the **sphenoethmoidal recess**, a location superior and posterior to the superior turbinate, anatomically distinct from the area affected by the polyp. *Frontal sinus* - The **frontal sinuses** are situated superior to the orbits within the frontal bone. The image shows these sinuses are well-aerated and free of significant fluid. - Drainage of the frontal sinus occurs via the **frontonasal duct** into the **middle meatus**. Obstruction would cause fluid buildup superior to the eye, which is not seen here.

Q: A 49-year-old female from Nagaland presented with right-sided hearing loss and tinnitus. On examination, dull tympanic membrane with lymph nodes in the posterior triangle of the neck was seen. Which of the following is the management for the condition?

Radiotherapy. ***Correct: Radiotherapy*** - This clinical presentation is **classic for nasopharyngeal carcinoma (NPC)**: middle-aged patient from **Nagaland** (endemic region for NPC in Northeast India), unilateral serous otitis media (dull TM, hearing loss, tinnitus from Eustachian tube obstruction), and **posterior triangle lymphadenopathy** (most characteristic feature) - **NPC is highly radiosensitive** and radiotherapy is the primary treatment modality for all stages - Concurrent chemoradiotherapy is the standard for locally advanced disease - The geographic origin (Nagaland) is a critical clue as NPC has high incidence in Northeast India, Southeast Asia, and Southern China (associated with EBV infection and dietary factors) *Incorrect: Grommet insertion + Steroids* - Treats only the **secondary middle ear effusion**, not the underlying malignancy - Would delay definitive diagnosis and treatment of NPC - May temporarily relieve hearing symptoms but doesn't address the cancer *Incorrect: Steroids* - No role in the treatment of nasopharyngeal carcinoma - May mask symptoms and delay diagnosis - Does not address the underlying malignancy or lymphadenopathy *Incorrect: Grommet insertion* - Only addresses the **symptomatic serous otitis media**, not the primary pathology - The presence of posterior triangle lymph nodes makes malignancy the priority - Any adult with unilateral serous otitis media + cervical lymphadenopathy requires nasopharyngoscopy and biopsy to rule out NPC before symptomatic treatment

Q: A patient presents to the OPD with hearing loss. On examination: - Rinne test - Positive in the left ear and negative in the right ear - Weber's test - lateralization towards the left - Bone conduction test - Reduced in the right ear and similar in the left ear. Interpret the findings.

Sensorineural hearing loss in right ear. ***Sensorineural hearing loss in right ear***- The **Weber test** lateralizes toward the **left ear**, which acts as the better ear. In cases of **unilateral sensorineural hearing loss (SNHL)**, sound lateralizes to the *unaffected* ear.- The **Bone Conduction (BC)** hearing is explicitly reported as **reduced in the right ear**, which is the definitive finding for damage to the **cochlea** or **auditory nerve** (SNHL).*Sensorineural hearing loss in left ear*- If SNHL was present in the left ear, the **Weber test** would lateralize to the *right ear* (the better ear), contradicting the finding of lateralization to the left.- The Rinne test is **positive** in the left ear (AC > BC), and BC is similar to normal, confirming that the left ear is functioning normally or has only mild SNHL.*Conductive hearing loss in left ear*- A **positive Rinne test** in the left ear (AC > BC) essentially rules out significant **conductive hearing loss (CHL)** in that ear, as CHL results in a negative Rinne test (BC > AC).- While Weber lateralization to the left is consistent with CHL in the left ear, the simultaneous positive Rinne test and normal BC assessment contradict this diagnosis.*Conductive hearing loss in right ear.*- Although the **Rinne test is negative** in the right ear (BC > AC), suggesting CHL, the **Weber test lateralizes to the left**; Weber lateralizes to the *affected* ear only in CHL.- Furthermore, **Bone Conduction is reduced** in the right ear, which is inconsistent with simple CHL, where BC is expected to be normal (or elevated due to masking).

Q: A child presents with telecanthus, hypertelorism, antimongoloid slant, and cardiac defects. What is the most likely chromosomal abnormality?

Microdeletion. ***Microdeletion***- The combination of craniofacial irregularities like **telecanthus** and **hypertelorism**, along with congenital **cardiac defects** (often conotruncal like **Tetralogy of Fallot**), is the classical presentation of the **22q11.2 deletion syndrome** (DiGeorge syndrome or VCFS).- A **microdeletion** is the loss of a small, contiguous segment of a chromosome, identifiable via **Fluorescence In Situ Hybridization (FISH)** or chromosomal microarray, which is the underlying cause of this syndrome.*Translocation*- **Translocations** (exchange of genetic material between non-homologous chromosomes) are typically associated with large structural rearrangements or specific syndromes like **familial Down syndrome**, not the specific phenotype described here.- These features are characteristic of a small, defined contiguous gene deletion syndrome, which is not the primary consequence of a standard **translocation**.*Inversion*- An **inversion** is the reversal of a segment within a chromosome; while pathogenic if breakpoints disrupt critical genes, it is not the primary chromosomal mechanism responsible for the **22q11.2 deletion syndrome**.- Most inversions are **balanced rearrangements** and often have no phenotypic consequence unless gene expression is significantly altered.*Trisomy*- **Trisomy** refers to an extra whole copy of a chromosome (e.g., Trisomy 13, 18, 21), and the resulting syndromes have unique and different facial features (e.g., **Trisomy 21** classically presents with upslanting palpebral fissures).- While trisomies cause significant cardiac defects, the specific constellation of **telecanthus** and **antimongoloid slant** helps differentiate this from common trisomy syndromes.

Question 1

Which of the following represents the most severe form of neural tube defect where neural tissue is completely exposed without overlying skin, vertebral arches, or meninges?

Accepted Answer

Open Neural tube defect

Answer

Meningocele

Answer

Spina bifida

Answer

Myelomeningocele

Question 2

A disease with mitochondrial inheritance is inherited from which family member?

Accepted Answer

Mother

Answer

Father

Answer

Both mother and father

Answer

Grandmother (paternal)

Question 3

The mascot 'Sapna' shown in the image is associated with which of the following programs?

Accepted Answer

National Leprosy eradication programme

Answer

National Tuberculosis Elimination Programme

Answer

National Anti-Malaria Programme

Answer

National Polio Surveillance Program

Question 4

In a class of 100 students, 80% students were immunised with measles, 12 were affected. What is the primary attack rate?

Accepted Answer

60%

Answer

80%

Answer

70%

Answer

50%

Question 5

After how long is a patient advised to use alternative contraception following a vasectomy?

Accepted Answer

3 months

Answer

6 months

Answer

1 month

Answer

2 months

Question 6

Which of the following is the population norm for an ASHA worker?

Accepted Answer

1000-2500

Answer

1000-1500

Answer

2000-2500

Answer

700-1000

Question 7

A 45-year-old male was admitted with respiratory distress. CT showed a nasal polyp with fluid collection in the sinus. Drainage of which of the following is obstructed?

Accepted Answer

Maxillary sinus

Answer

Ethmoidal sinus

Answer

Frontal sinus

Answer

Sphenoidal sinus

Question 8

A 49-year-old female from Nagaland presented with right-sided hearing loss and tinnitus. On examination, dull tympanic membrane with lymph nodes in the posterior triangle of the neck was seen. Which of the following is the management for the condition?

Accepted Answer

Radiotherapy

Answer

Grommet insertion + Steroids

Answer

Steroids

Answer

Grommet insertion

Question 9

A patient presents to the OPD with hearing loss. On examination: - Rinne test - Positive in the left ear and negative in the right ear - Weber's test - lateralization towards the left - Bone conduction test - Reduced in the right ear and similar in the left ear. Interpret the findings.

Accepted Answer

Sensorineural hearing loss in right ear

Answer

Conductive hearing loss in left ear

Answer

Conductive hearing loss in right ear

Answer

Sensorineural hearing loss in left ear

Question 10

A child presents with telecanthus, hypertelorism, antimongoloid slant, and cardiac defects. What is the most likely chromosomal abnormality?

Accepted Answer

Microdeletion

Answer

Inversion

Answer

Translocation

Answer

Trisomy

FMGE 2025

Anatomy

Biochemistry

Community Medicine

ENT

Pediatrics