FMGE 2025 Practice Questions

Q: What is the most common type of ventricular septal defect?

Membranous defect. ***Membranous defect***- This type of defect, also known as **perimembranous VSD**, is the most common form, accounting for approximately 70-80% of all ventricular septal defects [1].- It is located just below the aortic valve, involving the **proximal third** of the septum and is defined by its relationship to the fibrous trigones [1].*Muscular defect*- **Muscular VSDs** (or trabecular VSDs) are less common than membranous defects and can be found anywhere within the thick muscular portion of the septum.- These defects often have a higher rate of **spontaneous closure**, especially the small, multiple defects referred to as 'Swiss cheese' VSDs.*Non-development of the perimembranous part of the septum*- While the failure of complete septation of the **membranous portion** is the underlying embryological cause, the specific anatomical diagnosis defining the common VSD type is the *membranous defect*. - This phrasing is descriptive of the etiology but **membranous defect** identifies the most common resulting structure.*Incomplete fusion of the septum*- This is a generic description of the mechanism leading to VSD development (failure of the septal components to fuse correctly), but it does not specify the **most common anatomical location**.- The most critical and common fusion failure involves the development of the **membranous septum**, which results in the named *membranous defect*.

Q: A patient undergoing surgery is administered succinylcholine for muscle relaxation. Shortly after administration, he develops hyperthermia, muscle rigidity, tremors, and tachycardia. What is the most appropriate treatment for this condition?

Dantrolene sodium. ***Dantrolene sodium***- This is the specific and definitive antidote for **Malignant Hyperthermia (MH)**, characterized by signs like hyperthermia, muscle rigidity, and tachycardia after succinylcholine administration.- **Dantrolene** works directly on skeletal muscle by inhibiting the release of calcium from the **sarcoplasmic reticulum**, thereby interrupting the sustained muscle contraction and hypermetabolic state.*Neostigmine*- It is an **acetylcholinesterase inhibitor** used to reverse the effects of non-depolarizing neuromuscular blocking agents (e.g., rocuronium).- It is **contraindicated** in MH as it could potentially exacerbate muscle rigidity and the hypermetabolic crisis by increasing **acetylcholine** activity at the neuromuscular junction.*Atropine*- This is an **anticholinergic** drug primarily used to treat bradycardia or to dry secretions.- Although the patient exhibits severe tachycardia, atropine does not treat the underlying pathological hypermetabolism or the excessive calcium release that defines MH.*Midazolam*- This is a **benzodiazepine** used for anxiolysis, sedation, and if necessary, managing seizures.- While supportive care for MH might involve benzodiazepines if seizures occur due to hyperthermia, it is not the crucial drug needed to counteract the life-threatening hypermetabolic crisis.

Q: A patient scheduled for elective hip surgery is currently taking aspirin, enalapril, a multivitamin, and metoprolol. The surgery is planned in 5 days. What is the appropriate perioperative management for this patient?

Stop enalapril. ***Correct: Stop enalapril*** - **ACE inhibitors (enalapril) should be discontinued 24-48 hours before elective surgery** - Risk of **refractory intraoperative hypotension** during anesthesia induction, particularly with vasodilatory anesthetics - Associated with increased perioperative complications including hypotension requiring vasopressor support - Can be safely restarted postoperatively once hemodynamic stability is achieved *Incorrect: Stop aspirin to minimize perioperative bleeding risk* - **Aspirin should generally be continued** in patients with cardiovascular indications (CAD, stroke prevention) - Current guidelines recommend continuation for most surgeries except those with very high bleeding risk (neurosurgery, posterior chamber eye surgery) - **Hip surgery is NOT a contraindication** to aspirin continuation - The cardiovascular risk of stopping aspirin outweighs bleeding risk in most cases *Incorrect: Stop metoprolol to increase cardiac output* - **Beta-blockers should be continued perioperatively** in patients already taking them - Abrupt withdrawal increases risk of **rebound hypertension, tachycardia, myocardial ischemia, and MI** - Stopping beta-blockers can precipitate life-threatening cardiovascular events - Should be given on the morning of surgery with a sip of water *Incorrect: Increase aspirin dosage for additional analgesic benefit* - No indication to increase aspirin dose perioperatively - Aspirin is not used as a primary analgesic in surgical settings - Increasing dose would unnecessarily increase bleeding risk without therapeutic benefit

Q: Which of the following is not caused by food adulteration?

Fluorosis. ***Fluorosis***- It results from excessive ingestion of **fluoride**, primarily through naturally high fluoride content in **drinking water** and not typically through intentional adulteration of processed food products.- The toxicity (dental or skeletal fluorosis) reflects a chronic environmental exposure problem rather than a case of acute or intentional food substance contamination.*Epidemic dropsy*- This condition is classically caused by the adulteration of **mustard oil** with **Argemone oil**, which contains the toxic alkaloid **sanguinarine**.- It is a recognized consequence of food fraud characterized by edema, skin pigmentation, and sometimes glaucoma.*Neurolathyrism*- It results from consuming food (such as chickpea flour) adulterated with excessive amounts of **Khesari dal (Lathyrus sativus)**.- The neurotoxin responsible is **BOAA (β-N-Oxalylamino-L-alanine)**, which causes irreversible motor neuron damage and spastic paraparesis.*Endemic ascites*- This condition, often presenting as **hepatic veno-occlusive disease (VOD)**, is caused by chronic consumption of food grains contaminated by **Pyrrolizidine alkaloids (PAs)**.- PAs are often found in weeds growing among food crops (like wheat or millets), and their inclusion during harvest is a form of accidental food contamination/adulteration leading to chronic liver damage.

Q: A 58-year-old woman comes to the clinic for a routine follow-up. She has a history of mild hypertension, which is well-controlled with medication. She reports no symptoms such as palpitations, dizziness, or chest pain. Her ECG shows a prolonged PR interval of 0.24 seconds with regular 1:1 AV conduction and narrow QRS complexes. What is the most likely diagnosis based on these ECG findings?

First-Degree AV Block. ***First-Degree AV Block*** - This ECG demonstrates a fixed and prolonged **PR interval** that is greater than 0.20 seconds (more than 5 small squares), which is the defining characteristic of a first-degree AV block. - There is a consistent **1:1 conduction** between the atria and ventricles, meaning every P wave is followed by a QRS complex, distinguishing it from higher-degree blocks. *Second-Degree AV Block* - This condition is characterized by intermittently **non-conducted P waves**, resulting in 'dropped' QRS complexes, which are not present in this ECG. - It has two types: **Mobitz I (Wenckebach)** with progressive PR prolongation before a dropped beat, and **Mobitz II** with a constant PR interval before an unpredictable dropped beat. *Third-Degree AV Block* - Also known as complete heart block, this involves complete **AV dissociation**, where there is no relationship between P waves and QRS complexes. - On an ECG, P waves and QRS complexes would occur at their own independent, regular rates, which is contrary to the 1:1 conduction seen here. *Bundle Branch Block* - The primary feature of a bundle branch block is a **wide QRS complex** (≥0.12 seconds) due to delayed ventricular depolarization. - The QRS complex in this ECG is **narrow** (<0.12 seconds), which rules out a bundle branch block.

Q: A 35-year-old woman presents with fluctuating muscle weakness, especially affecting her speech and swallowing. Repetitive nerve stimulation shows a decremental response. Her blood tests are negative for acetylcholine receptor (AChR) antibodies. Which of the following antibodies is most likely responsible for her symptoms?

Anti-MuSK antibodies. Detailed clinical evaluation of myasthenia gravis reveals that anti-MuSK antibodies target Muscle-Specific Kinase (MuSK), essential for clustering AChR at the NMJ [1]. Their presence confirms the diagnosis of Myasthenia Gravis (MG) in patients who are seronegative for AChR antibodies, often presenting with prominent bulbar and facial weakness [1]. Anti-dsDNA antibodies are specific for Systemic Lupus Erythematosus (SLE), an autoimmune disease that primarily causes arthritis, renal disease, and malar rash [2]. Although SLE can cause myositis or neuropathy, it does not typically present with the isolated, fluctuating postsynaptic weakness characteristic of Myasthenia Gravis and the decremental response. Anti-thyroid peroxidase (TPO) antibodies are primary markers for Hashimoto's thyroiditis, leading to hypothyroidism; screening for associated autoimmune thyroid disease is recommended in MG patients [1]. Anti-Ro antibodies, characteristic of Sjögren's Syndrome and SLE [2], primarily involve sicca symptoms and occasionally present with myositis, but not the hallmark features of ocular or bulbar MG.

Q: A 30-year-old female who delivered a healthy term baby one week ago is now presenting to the OBG clinic with complaints of fishy-smelling pale brownish vaginal discharge. What is the nature of this discharge?

Lochia Serosa. ***Lochia Serosa***- This stage of postpartum discharge typically begins around **day 4** and lasts until **day 10** postpartum, aligning perfectly with the patient’s presentation at one week (7 days) after delivery.- It is characterized by a **pale brownish** or pinkish, watery discharge, consisting of old blood, serum, and leukocytes. The described "fishy smell" likely results from bacterial colonization, common in this stage, but the timing dictates the stage.*Lochia Rubra*- This is the initial, heavy stage of lochia, which occurs during the first **1 to 3 days** postpartum.- The discharge is predominantly **bright red** and bloody, containing large amounts of decidua and tissue fragments, not pale brownish.*Lochia Alba*- This is the final stage of lochia, usually beginning after **day 10** (or even two weeks) and may persist for several weeks.- It is typically **creamy, white, or yellowish** in color, containing predominantly leukocytes, epithelial cells, and mucus.*Leukorrhea*- This is a broad term for **non-bloody vaginal discharge** related to normal physiological changes (like ovulation) or pathological conditions (like vaginitis).- While lochia contains many components of leukorrhea (white cells), **lochia** is the specific and correct term for the expected postpartum discharge composed of blood, serum, and tissue.

Q: A baby presents with the clinical features shown in the image, including characteristic perioral and perianal rash along with a history of diarrhea. Which of the following is the most likely deficiency responsible for this condition?

Zinc Deficiency. ***Zinc Deficiency*** - The clinical triad of **periorificial** (perioral, perianal) and **acral dermatitis**, **alopecia**, and **diarrhea** is characteristic of **Acrodermatitis Enteropathica**, which is caused by zinc deficiency. - The rash seen in the image, an eczematous, vesiculobullous, and crusted eruption around the mouth and eyes, is the hallmark cutaneous manifestation of this condition. *Niacin Deficiency* - Niacin (Vitamin B3) deficiency results in **Pellagra**, classically presenting with the “3 Ds”: **dermatitis**, **diarrhea**, and **dementia**. - The dermatitis of pellagra is a **photosensitive rash**, typically in sun-exposed areas like the neck (**Casal's necklace**), and does not have a periorificial distribution. *Selenium Deficiency* - Selenium deficiency is primarily associated with **cardiomyopathy** (**Keshan disease**) and skeletal myopathy (**Kashin-Beck disease**). - While it can cause nail bed changes (whitening) and hair loss, it is not associated with the characteristic periorificial rash seen in the image. *Magnesium Deficiency* - Hypomagnesemia primarily causes **neuromuscular hyperexcitability**, leading to symptoms like **tetany**, **tremors**, seizures, and **cardiac arrhythmias** (e.g., Torsades de pointes). - It does not cause a characteristic dermatological rash like the one presented.

Q: A newborn child is brought to the emergency department with respiratory difficulty. On evaluation, the child was found to have a posterolateral defect, as shown in the x-ray given. What is the diagnosis?

Bochdalek hernia. ***Bochdalek hernia*** - This is the most common type of **congenital diaphragmatic hernia (CDH)**, representing about 85-90% of cases, and is characterized by a defect in the **posterolateral** aspect of the diaphragm. - It most commonly occurs on the **left side**, allowing abdominal contents like the stomach and intestines to herniate into the chest, leading to **pulmonary hypoplasia** and severe respiratory distress in a newborn, which is consistent with the X-ray findings. *Morgagni hernia* - This is a rare type of CDH involving an **anteromedial** defect in the diaphragm, specifically through the foramen of Morgagni, not a posterolateral one. - It is more commonly found on the **right side** and is often asymptomatic, typically diagnosed incidentally later in life rather than causing acute respiratory failure in a newborn. *Hiatal hernia* - This involves the protrusion of the upper part of the stomach into the thorax through the **esophageal hiatus**, a different anatomical location than the defect in this case. - Hiatal hernias are most often associated with **gastroesophageal reflux disease (GERD)** and are uncommon causes of severe respiratory distress in the neonatal period. *Traumatic diaphragmatic hernia* - This is an **acquired** condition resulting from blunt or penetrating trauma to the chest or abdomen that causes a rupture of the diaphragm. - The patient is a newborn, making a **congenital defect** the cause of the hernia, not trauma.

Q: Identify the type of diaphragmatic hernia shown in the X-ray.

Bochdalek hernia. ***Bochdalek hernia*** - This is the most common type of congenital diaphragmatic hernia (CDH), accounting for over 80% of cases, and is characterized by a defect in the **posterolateral** aspect of the diaphragm. - The X-ray shows classic findings: multiple **gas-filled bowel loops** in the left hemithorax, causing **mediastinal shift** to the right and compression of the left lung, which is consistent with a left-sided Bochdalek hernia. *Morgagni hernia* - This is a rare, **anteromedial** diaphragmatic defect that occurs through the **foramen of Morgagni**, typically on the right side. - It is less common than Bochdalek hernia and often discovered incidentally in older children or adults, presenting with less severe respiratory symptoms. *Hiatal hernia* - This involves the protrusion of the upper part of the stomach through the **esophageal hiatus** into the chest. - It is a midline defect and typically presents with **gastroesophageal reflux disease (GERD)**, not the extensive herniation of multiple abdominal organs seen in this neonatal X-ray. *Traumatic diaphragmatic hernia* - This is an **acquired** condition resulting from severe blunt or penetrating trauma to the chest or abdomen, not a congenital defect. - While it can appear similar on imaging, the clinical context of a newborn (as suggested by the image) makes a congenital cause like Bochdalek hernia the most likely diagnosis.

Question 1

What is the most common type of ventricular septal defect?

Accepted Answer

Membranous defect

Answer

Incomplete fusion of the septum

Answer

Non-development of the perimembranous part of the septum

Answer

Muscular defect

Question 2

A patient undergoing surgery is administered succinylcholine for muscle relaxation. Shortly after administration, he develops hyperthermia, muscle rigidity, tremors, and tachycardia. What is the most appropriate treatment for this condition?

Accepted Answer

Dantrolene sodium

Answer

Neostigmine

Answer

Midazolam

Answer

Atropine

Question 3

A patient scheduled for elective hip surgery is currently taking aspirin, enalapril, a multivitamin, and metoprolol. The surgery is planned in 5 days. What is the appropriate perioperative management for this patient?

Accepted Answer

Stop enalapril

Answer

Stop aspirin to minimize perioperative bleeding risk

Answer

Stop metoprolol to increase cardiac output

Answer

Increase aspirin dosage for additional analgesic benefit

Question 4

Which of the following is not caused by food adulteration?

Accepted Answer

Fluorosis

Answer

Endemic ascites

Answer

Epidemic dropsy

Answer

Neurolathyrism

Question 5

A 58-year-old woman comes to the clinic for a routine follow-up. She has a history of mild hypertension, which is well-controlled with medication. She reports no symptoms such as palpitations, dizziness, or chest pain. Her ECG shows a prolonged PR interval of 0.24 seconds with regular 1:1 AV conduction and narrow QRS complexes. What is the most likely diagnosis based on these ECG findings?

Accepted Answer

First-Degree AV Block

Answer

Third-Degree AV Block

Answer

Second-Degree AV Block

Answer

Bundle Branch Block

Question 6

A 35-year-old woman presents with fluctuating muscle weakness, especially affecting her speech and swallowing. Repetitive nerve stimulation shows a decremental response. Her blood tests are negative for acetylcholine receptor (AChR) antibodies. Which of the following antibodies is most likely responsible for her symptoms?

Accepted Answer

Anti-MuSK antibodies

Answer

Anti-TPO antibodies

Answer

Anti-dsDNA antibodies

Answer

Anti-Ro antibodies

Question 7

A 30-year-old female who delivered a healthy term baby one week ago is now presenting to the OBG clinic with complaints of fishy-smelling pale brownish vaginal discharge. What is the nature of this discharge?

Accepted Answer

Lochia Serosa

Answer

Leukorrhea

Answer

Lochia Rubra

Answer

Lochia Alba

Question 8

A baby presents with the clinical features shown in the image, including characteristic perioral and perianal rash along with a history of diarrhea. Which of the following is the most likely deficiency responsible for this condition?

Accepted Answer

Zinc Deficiency

Answer

Niacin Deficiency

Answer

Selenium Deficiency

Answer

Magnesium Deficiency

Question 9

A newborn child is brought to the emergency department with respiratory difficulty. On evaluation, the child was found to have a posterolateral defect, as shown in the x-ray given. What is the diagnosis?

Accepted Answer

Bochdalek hernia

Answer

Morgagni hernia

Answer

Hiatal hernia

Answer

Traumatic diaphragmatic hernia

Question 10

Identify the type of diaphragmatic hernia shown in the X-ray.

Accepted Answer

Bochdalek hernia

Answer

Morgagni hernia

Answer

Hiatal hernia

Answer

Traumatic diaphragmatic hernia

FMGE 2025

Anatomy

Anesthesiology

Community Medicine

Internal Medicine

Obstetrics and Gynecology

Pediatrics

Surgery