FMGE 2025 Practice Questions

Q: A farmer presents with fever and subconjunctival hemorrhage. The microscopic agglutination test is found to be positive. What is the diagnosis?

Leptospira. ***Leptospira***- The clinical presentation of fever in a patient with an occupation involving exposure to animal habitats (farmer), coupled with the classic finding of **subconjunctival hemorrhage** (conjunctival suffusion), highly suggests **Leptospirosis** (Weil's disease) [1]. - The **Microscopic Agglutination Test (MAT)** is the gold standard serological test for the diagnosis of **Leptospirosis**, supporting this etiology [1]. *Brucella* - *Brucella* causes **Brucellosis** (Undulant Fever), characterized primarily by cyclical undulating fevers, night sweats, and localized infection (e.g., osteomyelitis or epididymitis), not typically subconjunctival hemorrhage. - Diagnosis usually involves blood culture or the Standard Tube Agglutination Test (SAT), not MAT. *E coli* - *E. coli* is a common cause of GI infections, UTIs, and sepsis; systemic *E. coli* disease does not typically manifest with the specific finding of subconjunctival hemorrhage. - MAT is not used for the diagnosis of *E. coli* infections, which are confirmed primarily through culture. *Staph aureus* - *S. aureus* can cause a wide range of infections (skin infections, endocarditis, sepsis) but is not associated with the specific syndrome presenting here (farmer, subconjunctival hemorrhage). - Diagnosis relies on culture, not serological tests like MAT, which is specific for spirochetes.

Q: A patient sustained blunt trauma to the eye 6 months ago and now presents with blurring of vision. What is the most likely condition?

Iridodialysis. ***Iridodialysis*** - This condition involves the tearing of the **iris root** from its attachment to the **ciliary body**, which is a known complication of significant **blunt ocular trauma**. - The separation creates a secondary pupillary opening, leading to symptoms like **monocular diplopia**, **glare**, and blurred vision, consistent with the patient's presentation and the image showing a detached iris segment. *Ankyloblepharon* - Ankyloblepharon refers to the partial or complete **fusion of the eyelids**, which is a condition affecting the external adnexa, not the internal structures of the eye like the iris. - It is typically **congenital** or can result from severe chemical burns or trauma to the eyelids themselves, and does not match the clinical image. *Vossius Ring* - A Vossius ring is a circular deposit of **pigment** on the anterior surface of the **lens capsule** that occurs after blunt trauma presses the iris against the lens. - While it is an indicator of past trauma, it is a finding on the lens and is not the structural iris damage seen here. It doesn't typically cause chronic blurring of vision on its own. *Cycloiriditis* - Cycloiriditis, or **iridocyclitis**, is an **inflammatory** condition of the iris and ciliary body, presenting with pain, redness, and photophobia. - This is an inflammatory process, not a structural tear. Examination would show signs of **anterior uveitis** (cells and flare), not a physical separation of the iris tissue.

Q: A 5-month-old baby is brought by the mother with complaints of the left upper eyelid moving up and down during breastfeeding or thumb sucking, which disappears when the baby is not being fed. What is the most likely diagnosis?

Marcus Gunn Jaw-Winking Syndrome. ***Marcus Gunn Jaw-Winking Syndrome***- This classic presentation involves **trigemino-oculomotor synkinesis**, where activation of the mandibular division of the **trigeminal nerve (V3)** during sucking or chewing causes involuntary co-contraction of the levator palpebrae superioris muscle (innervated by CN III).- The resulting unilateral ptosis is temporarily relieved (eyelid elevates or 'winks') only during jaw movement, confirming the mechanical synkinetic link.*Lagophthalmos*- This condition describes the **inability to close the eyelids completely**, leading to risk of corneal exposure and drying.- It is usually caused by **facial nerve palsy (CN VII)**, severe proptosis, or scarring, and does not involve intermittent, movement-related eyelid retraction.*Myasthenia Gravis*- Myasthenia gravis causes **fatigable ptosis** and diplopia that typically worsens with sustained muscle use or activity (e.g., end of the day or prolonged crying/sucking), distinguishing it from synkinesis.- Congenital myasthenia involves poor sucking effort and generalized or ocular muscle weakness, but the trigger mechanism is *fatigue*, not specific jaw movement.*3rd CN palsy*- A complete third cranial nerve palsy results in **severe ptosis** (paralysis of the levator palpebrae superioris) and limitations in eye movement (superior, inferior, medial recti, inferior oblique).- Although ptosis occurs, CN III palsy does not explain the *intermittent* and *synkinetic* nature of the eyelid movement linked specifically to mandibular division (V3) activity.

Q: A patient has a history of a flying metallic foreign body injury to the eye. On examination, there is evidence of intraocular metallic foreign body with progressive visual deterioration. Which of the following substances is most likely causing the toxic deposition in ocular tissues?

Iron. ***Iron*** - A metallic flying foreign body (often iron-containing) retained in the eye causes **siderosis bulbi**, a condition characterized by toxic **iron deposition** in ocular structures. - Iron ions diffuse from the retained foreign body and deposit in the cornea, lens, iris, and retina, leading to **progressive visual loss** and characteristic findings like rust-brown discoloration of the anterior lens capsule, heterochromia iridis, and retinal toxicity. - Siderosis bulbi is a serious complication requiring urgent removal of the iron-containing foreign body. *Aluminum* - Aluminum foreign bodies can cause **chalcosis** when copper-containing, but pure aluminum is relatively **inert** in the eye. - Aluminum does not cause the same toxic deposition syndrome as iron and is not associated with siderosis bulbi. *Wood* - Wood is an **organic foreign body** that primarily causes severe **inflammatory reactions** and carries a high risk of **endophthalmitis** (intraocular infection). - Wood does not cause metallic ion deposition or the specific toxicity pattern seen in siderosis bulbi. *Glass* - Glass foreign bodies are generally **inert** and well-tolerated in the eye, causing primarily mechanical trauma. - Glass does not leach metallic ions and does not cause toxic chemical deposition like siderosis bulbi.

Q: A patient presents with vision problems and has a history of cataract surgery. OCT finding is shown below. What is the syndrome most likely associated with these findings?

Irvine-Gass Syndrome. ***Irvine-Gass Syndrome*** - This syndrome is defined as the development of **cystoid macular edema (CME)** after intraocular surgery, most commonly **cataract surgery**, which matches the patient's history. - The Optical Coherence Tomography (OCT) image clearly shows characteristic **intraretinal fluid-filled cysts** and thickening in the macular region, which are hallmark signs of CME. *Posner-Schlossman Syndrome* - This condition, also known as glaucomatocyclitic crisis, involves recurrent episodes of **acute unilateral uveitis** and **high intraocular pressure**. - While inflammation can cause CME, it is not the primary feature, and the diagnosis relies on signs of anterior chamber inflammation and pressure spikes, not postoperative macular changes. *Central Serous Retinopathy* - This condition is characterized by the accumulation of **subretinal fluid**, creating a serous detachment of the neurosensory retina, which appears as a large fluid-filled space under the retina on OCT. - The provided OCT shows **intraretinal cysts**, not subretinal fluid, which is the key differentiating feature from CSR. *Elschnig Pearls* - These are a type of **posterior capsule opacification (PCO)**, a common complication of cataract surgery where residual lens epithelial cells proliferate on the posterior capsule. - PCO causes blurry vision by obstructing the visual axis but is a condition of the lens capsule, not the retina, and would not produce the macular edema seen on this OCT.

Q: The cover-uncover test is performed to diagnose various eye conditions. Which of the following is not detected by this test?

Amblyopia. ***Amblyopia*** - Amblyopia, often called a "lazy eye," is a neurodevelopmental disorder characterized by reduced **visual acuity** in one eye, which is not correctable by refractive means alone. - It is diagnosed by assessing vision with tools like a **Snellen chart**, whereas the cover-uncover test is designed to evaluate **ocular alignment** and motor fusion, not sensory function like visual acuity. *Latent Squint* - A latent squint, or **heterophoria**, is a tendency for the eyes to misalign when binocular vision is interrupted, such as when one eye is covered. - The **uncover** portion of the test reveals a phoria, as the eye that was covered will move to re-establish fixation once the occluder is removed. *Manifest Squint* - A manifest squint, or **heterotropia**, is a constant, observable misalignment of one eye. - The **cover test** component identifies a tropia by observing the movement of the uncovered eye; if it moves to take up fixation when the other eye is covered, a manifest squint is present. *Lateral Nystagmus* - **Nystagmus** is an involuntary, rhythmic movement of the eyes. Certain types, like latent nystagmus, become apparent or worsen when one eye is occluded. - The cover-uncover test, by breaking binocular fusion, can elicit or accentuate **latent nystagmus**, making it observable to the examiner.

Q: A 3-year-old child presents with epiphora, and probing reveals a soft block at 7 mm. What is the best treatment option for this condition?

Conjunctivodacryocystorhinostomy (CDCR). ***Conjunctivodacryocystorhinostomy (CDCR) / Jones Tube*** - A **soft block** on probing indicates an obstruction within the **canalicular system**, as the probe meets a spongy resistance and cannot enter the lacrimal sac. - **Conjunctivodacryocystorhinostomy (CDCR)**, also known as conjunctival DCR or Jones tube placement, is the surgical procedure that bypasses the obstructed canaliculi by creating a new passage from the conjunctival sac to the nasal cavity with a Jones tube. - In this case, the soft block at 7 mm suggests canalicular obstruction, which cannot be addressed by standard DCR procedures that target nasolacrimal duct obstruction. *Endonasal Dacryocystorhinostomy (DCR)* - This procedure is the treatment of choice for **nasolacrimal duct (NLD) obstruction**, not canalicular obstruction. - NLD obstruction is identified by a **hard stop** during probing, where the probe passes through the canaliculi and contacts the bony lacrimal fossa wall. *External Dacryocystorhinostomy (DCR)* - Like the endonasal approach, external DCR is indicated for **NLD obstruction** (a **hard stop**), which is not the finding in this case. - It involves creating a fistula between the lacrimal sac and nasal mucosa through an external skin incision. *Dacryocystectomy* - This procedure involves the complete removal of the lacrimal sac and is reserved for conditions like **lacrimal sac tumors** or intractable chronic dacryocystitis. - It is a destructive procedure that eliminates the sac as a source of infection but does not resolve the **epiphora** (tearing).

Q: A patient presents with high blood pressure accompanied by a decrease in heart rate. What is the most likely physiological mechanism responsible for this response?

Stimulation of baroreceptors. ***Stimulation of baroreceptors*** - High blood pressure causes stretching of the arterial walls (especially the **carotid sinus** and **aortic arch**), leading to robust activation of the **baroreceptors**. - This activation sends inhibitory signals to the vasomotor center, resulting in increased **parasympathetic (vagal) tone** to the heart, which causes reflex **bradycardia** (decreased heart rate). *Inhibition of baroreceptors* - Inhibition occurs when **blood pressure is low**; decreased stretch signals lead to increased sympathetic output. - This response typically causes **tachycardia** and peripheral vasoconstriction in an effort to raise the blood pressure, which contradicts the observed bradycardia. *Bezold-Jarisch reflex (J reflex)* - This reflex is triggered by intense chemical or mechanical stimulation of intracardiac receptors, usually resulting in **hypotension** and **bradycardia**. - It is frequently associated with conditions like **myocardial ischemia** or severe cardiac depressant drugs, but does not explain hypertension. *Stimulation of chemoreceptors* - Peripheral chemoreceptors are primarily stimulated by conditions such as **hypoxia**, severe acidosis, or hypercapnia. - While stimulation causes systemic vasoconstriction (raising BP) and reflex bradycardia, the baroreceptor mechanism is the most direct and primary regulator linking elevated BP to decreased HR.

Q: A doctor asked the patient what her age is and she told him that she is married to an older man, and she has 2 kids of 15 and 18 years, and she is 39 years old. What is the disorder present?

Circumstantial speech. ***Circumstantial speech***- This thought process is characterized by including **excessive, irrelevant details** in the conversation before finally reaching the point or answering the question.- The patient eventually answered the question (age 39) but only after providing unnecessary associated details (married to an older man, kids' ages).*Derailment*- Also known as **loose associations**, this involves a continuous shifting from one subject to another in a way that is illogical or completely unrelated.- In derailment, the main point or question is usually completely lost as the flow moves to an entirely new, unlinked topic.*Flight of ideas*- This involves a rapid, continuous succession of thoughts where the shift between topics is based on **distractibility or recognizable associations** (like rhyming or wordplay).- It is typically characterized by **pressured speech** and is often seen in the manic phase of **Bipolar Disorder**.*Tangentiality*- This speech pattern occurs when the patient responds to a question in an obliquely relevant way but **never provides the actual answer** or reaches the main point.- The thread of conversation moves away from the initial topic (takes a tangent) and does not return, unlike **circumstantial speech**.

Q: A patient was asked a direct question about her age. Instead, she provided excessive and unnecessary details about her marriage and children before eventually answering the question. This is characteristic of which speech pattern?

Circumstantial speech. **_Circumstantial speech_** - This pattern is characterized by the inclusion of **excessive, unnecessary details** and parenthetical remarks that delay the completion of a thought or the answer to a question. The speaker eventually returns to the original point or answers the question after a circuitous route, meaning the **goal of the thought is eventually reached**. *Derailment* - Also known as **loose associations**, this refers to a pattern where the speaker shifts topics that are unrelated or connected only remotely and illogically. It represents a significant form of **formal thought disorder**, where the train of thought breaks down, often observed in schizophrenia. *Flight of ideas* - This involves an extremely rapid, pressured speech pattern where the thoughts accelerate and quickly shift from one topic to the next, often connected by **punning, rhyming, or environmental stimuli**. It is a prominent feature of the **manic phase** of bipolar disorder, reflecting accelerated cognitive processing. *Tangentiality* - The speaker moves from the initial thought to another thought that is related but fails to return to the original point or answer the question (**Goal of the thought is never reached**). This differs from circumstantiality because the subject deviates and **never actually answers the direct question** posed by the interviewer.

Question 1

A farmer presents with fever and subconjunctival hemorrhage. The microscopic agglutination test is found to be positive. What is the diagnosis?

Accepted Answer

Leptospira

Answer

Brucella

Answer

E coli

Answer

Staph aureus

Question 2

A patient sustained blunt trauma to the eye 6 months ago and now presents with blurring of vision. What is the most likely condition?

Accepted Answer

Iridodialysis

Answer

Vossius Ring

Answer

Cycloiriditis

Answer

Ankyloblepharon

Question 3

A 5-month-old baby is brought by the mother with complaints of the left upper eyelid moving up and down during breastfeeding or thumb sucking, which disappears when the baby is not being fed. What is the most likely diagnosis?

Accepted Answer

Marcus Gunn Jaw-Winking Syndrome

Answer

Myasthenia Gravis

Answer

3rd CN palsy

Answer

Lagophthalmos

Question 4

A patient has a history of a flying metallic foreign body injury to the eye. On examination, there is evidence of intraocular metallic foreign body with progressive visual deterioration. Which of the following substances is most likely causing the toxic deposition in ocular tissues?

Accepted Answer

Iron

Answer

Glass

Answer

Aluminum

Answer

Wood

Question 5

A patient presents with vision problems and has a history of cataract surgery. OCT finding is shown below. What is the syndrome most likely associated with these findings?

Accepted Answer

Irvine-Gass Syndrome

Answer

Central Serous Retinopathy

Answer

Posner-Schlossman Syndrome

Answer

Elschnig Pearls

Question 6

The cover-uncover test is performed to diagnose various eye conditions. Which of the following is not detected by this test?

Accepted Answer

Amblyopia

Answer

Lateral Nystagmus

Answer

Manifest Squint

Answer

Latent Squint

Question 7

A 3-year-old child presents with epiphora, and probing reveals a soft block at 7 mm. What is the best treatment option for this condition?

Accepted Answer

Conjunctivodacryocystorhinostomy (CDCR)

Answer

External Dacryocystorhinostomy (DCR)

Answer

Endonasal Dacryocystorhinostomy (DCR)

Answer

Dacryocystectomy

Question 8

A patient presents with high blood pressure accompanied by a decrease in heart rate. What is the most likely physiological mechanism responsible for this response?

Accepted Answer

Stimulation of baroreceptors

Answer

Inhibition of baroreceptors

Answer

Stimulation of chemoreceptors

Answer

Bezold-Jarisch reflex (J reflex)

Question 9

A doctor asked the patient what her age is and she told him that she is married to an older man, and she has 2 kids of 15 and 18 years, and she is 39 years old. What is the disorder present?

Accepted Answer

Circumstantial speech

Answer

Flight of ideas

Answer

Tangentiality

Answer

Derailment

Question 10

A patient was asked a direct question about her age. Instead, she provided excessive and unnecessary details about her marriage and children before eventually answering the question. This is characteristic of which speech pattern?

Accepted Answer

Circumstantial speech

Answer

Derailment

Answer

Flight of ideas

Answer

Tangentiality

FMGE 2025

Internal Medicine

Ophthalmology

Physiology

Psychiatry