FMGE 2025 Practice Questions

Q: What stage of embryonic development is shown in the following image?

Blastocyst. ***Blastocyst*** - The image shows a structure with a distinct fluid-filled cavity (the **blastocoel**, labeled X), an inner cell mass (**embryoblast**), and an outer cell layer (**trophoblast**), which are the defining features of a blastocyst. - This stage occurs around day 5 post-fertilization and is responsible for implantation into the **endometrium** of the uterine wall, which is depicted superior to the blastocyst in the illustration. *Morula* - A morula is a solid, compacted ball of 16-32 cells (**blastomeres**) that precedes the blastocyst stage; it does not have the large internal cavity shown in the image. - The morula forms around day 3-4 after fertilization, and it is the entry of fluid into the morula that transforms it into a blastocyst. *Ova* - An ovum (plural: ova) is a single, unfertilized female gamete (egg cell). - The image shows a multicellular embryo that is the result of fertilization and several rounds of cell division, not a single cell. *Gastrula* - Gastrulation is the process that follows the blastocyst stage, where the embryo organizes into three primary germ layers: **ectoderm**, **mesoderm**, and **endoderm**. - The structure shown is a pre-implantation embryo and has not yet undergone gastrulation, which is characterized by the formation of the **primitive streak**.

Q: Which is the nodal ministry of disaster management?

Ministry of Home Affairs. ***Ministry of Home Affairs*** - The **Ministry of Home Affairs (MHA)** is the nodal ministry for disaster management in India as per the **Disaster Management Act, 2005** - The **National Disaster Management Authority (NDMA)** functions under the MHA and is chaired by the Prime Minister - MHA coordinates disaster management activities including prevention, mitigation, preparedness, response, and recovery - Responsible for policy formulation, capacity building, and overseeing state disaster management authorities *Ministry of Human Resource and Development* - Now renamed as Ministry of Education - Deals with educational policies and programs, not disaster management coordination *Ministry of Education* - Handles education sector disaster preparedness but is not the nodal ministry - May implement safety protocols in educational institutions during disasters *Ministry of Health and Family Welfare* - Plays a crucial role in health emergency response during disasters (medical relief, epidemic control) - However, it is a supporting ministry, not the nodal coordinating authority for disaster management

Q: A total of 60 patients were diagnosed with COVID-19. Out of which, 12 deaths were reported. Calculate the Case Fatality Rate?

20%. ***20%*** - The **Case Fatality Rate (CFR)** is calculated by dividing the number of deaths from a specific disease by the total number of confirmed cases of that disease, multiplied by **100** to get the percentage. - Based on the data: (12 deaths / 60 cases) * 100 = **0.20** * 100 = **20%**. *30%* - This result is incorrect; it would correspond to **18 deaths** out of 60 cases, not the reported 12 deaths. - A calculation error yielding **30%** does not align with the standard formula for CFR using the given figures. *40%* - This percentage represents a CFR where **24 deaths** were reported among 60 cases, which is double the actual number of fatalities. - Such a high error suggests a significant misapplication of the **CFR formula**. *10%* - This value is incorrect; **10%** CFR would be obtained if only **6 deaths** occurred (6/60 * 100). - This result significantly underestimates the **Case Fatality Rate** as it is half of the calculated actual rate.

Q: An elderly man presents with an ulcerative lesion at the inner canthus of his eye with pearly margins. On microscopic examination, it shows a palisading arrangement of cells. Identify the lesion:

Basal cell carcinoma. ***Basal cell carcinoma*** - The clinical presentation of an ulcerative lesion with **pearly margins**, especially in a sun-exposed area like the inner canthus, is a classic sign of nodular **basal cell carcinoma (BCC)** [1]. - Histologically, the pathognomonic feature is nests of **basaloid cells** with a **peripheral palisading** arrangement, as described and shown in the image [1], [2]. *Squamous cell carcinoma* - **Squamous cell carcinoma (SCC)** typically presents as a scaly, crusted, or erythematous lesion and usually lacks the characteristic **pearly** borders seen in BCC [2]. - Microscopically, SCC is characterized by invasive nests of atypical keratinocytes, often with the formation of **keratin pearls** and intercellular bridges, not palisading [2]. *Keratoacanthoma* - A **keratoacanthoma** is a rapidly growing, dome-shaped tumor with a central, **keratin-filled crater**, which is a distinct clinical feature not described here [2]. - Histologically, it resembles a well-differentiated SCC and does not show the basaloid cells with peripheral palisading characteristic of BCC [2]. *Melanocytic melanoma* - **Melanoma** is a malignancy of melanocytes, typically presenting as a pigmented lesion following the **ABCDE** criteria (Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving). - Histology shows atypical melanocytes, not basaloid cells. The cells may contain melanin pigment and have prominent nucleoli, which differs from the microscopic findings in this case. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1158-1160. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 643-645.

Q: What is the earliest sign of pregnancy on TVS?

G sac. ***G sac***- The **gestational sac** (G sac) is the first definitive sonographic sign of an intrauterine pregnancy (IUP) visible on TVS, typically appearing between **4.5 to 5 weeks** of gestation. - It is seen as a small, **anechoic** (fluid-filled) structure surrounded by a highly **echogenic rim** (trophoblastic tissue), often demonstrating the **double decidual sign**. *Yolk sac* - The **yolk sac** is visualized *after* the gestational sac, typically around **5 to 5.5 weeks** of gestation, located eccentrically within the gestational sac. - Its presence is crucial but is not the earliest structure seen on TVS. *Cardiac activity* - **Fetal cardiac activity** is usually first detectable by TVS comparatively later, generally around **6 to 6.5 weeks** of gestation. - The detection of cardiac activity requires the presence of a viable **fetal pole** (embryo). *Fetal pole* - The **fetal pole** (representing the early embryo) is generally first visualized by TVS around **5.5 to 6 weeks** of gestation. - While a very early finding, it appears slightly *after* the initial visualization of the **gestational sac** itself.

Q: A 42-year-old woman laborer presented with visible, soft, and fluctuating swelling in front of the knee, over the patella and some discomfort or difficulty with knee movement, MRI findings are given below. What is the diagnosis?

Housemaid's knee. ***Housemaid's knee*** - This condition, also known as **prepatellar bursitis**, involves inflammation and fluid accumulation in the bursa located directly in front of the patella, matching the MRI findings and the patient's clinical presentation. - It is frequently associated with occupations that require prolonged kneeling, such as being a laborer, leading to chronic irritation and swelling in this specific location. *Subdermal abscess* - A subdermal abscess would typically present with more pronounced signs of infection, such as significant warmth, **erythema** (redness), and systemic symptoms like fever, which are not mentioned in this case. - On MRI, an abscess often shows a more complex fluid collection with **rim enhancement** after contrast administration, distinguishing it from the simple bursal fluid seen here. *Gout* - Gout is an **intra-articular** arthritis caused by **urate crystal** deposition, which would cause swelling within the knee joint itself, not a localized collection in front of the patella. - The classic presentation is an acute, intensely painful, and red joint, most commonly the first **metatarsophalangeal joint** (podagra), which differs from this patient's presentation. *Rheumatoid arthritis* - Rheumatoid arthritis is a systemic inflammatory condition that typically causes **symmetric polyarthritis** of small joints in the hands and feet. - While it can affect the knee, it causes an **intra-articular** effusion (swelling within the joint space) and synovitis, not isolated prepatellar bursitis.

Q: Which gene mutation is most commonly associated with Burkitt's lymphoma?

C-myc. ***C-myc*** - Burkitt's lymphoma is characterized by the **t(8;14) translocation** in 80% of cases [1] - This translocation juxtaposes the **C-myc oncogene (chromosome 8)** with the **immunoglobulin heavy chain locus (chromosome 14)** [1] - Results in **constitutive overexpression of C-myc**, driving uncontrolled cell proliferation [1] - This is a **pathognomonic molecular feature** of Burkitt's lymphoma [1] - Variants include t(2;8) and t(8;22) involving immunoglobulin light chain loci [1] *p53* - Tumor suppressor gene involved in many cancers - Not the characteristic mutation defining Burkitt's lymphoma - May be involved in disease progression but not the hallmark feature *Rb* - Retinoblastoma gene, another tumor suppressor - Associated with retinoblastoma and osteosarcoma - Not characteristic of Burkitt's lymphoma *p21* - Cyclin-dependent kinase inhibitor (CDKN1A) - Involved in cell cycle regulation - Not the defining genetic alteration in Burkitt's lymphoma **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 324-325.

Q: A child presents with a right transverse palmar crease, a cardiac defect, survival into childhood, and mild intellectual impairment. What chromosomal mechanism is most likely associated with these findings?

Mosaicism. ***Mosaicism*** - **Mosaicism** is the presence of two or more cell lines with different genetic constitutions in a single individual, allowing for a **milder phenotype** of chromosomal syndromes like Trisomy 21. - The combination of classic Down syndrome features (transverse palmar crease, cardiac defect) with relatively **mild intellectual impairment** and survival into childhood with better outcomes suggests **Mosaic Down Syndrome** (mosaic Trisomy 21). - In mosaicism, only a proportion of cells carry the extra chromosome 21, resulting in **less severe manifestations** compared to complete trisomy. *Incorrect: Trisomy* - While **complete Trisomy 21** (Down syndrome) presents with similar features, it typically causes **more severe intellectual disability** and greater phenotypic expression. - The emphasis on **"mild" intellectual impairment** in this case points toward mosaicism rather than complete trisomy. *Incorrect: Haploid* - **Haploid** refers to a cell having only one set of chromosomes (n=23), a state that is **incompatible with human survival** beyond early embryonic development. - A complete haploid individual cannot survive into **childhood**. *Incorrect: Monosomy* - **Monosomy** (loss of one chromosome, 2n-1) for autosomes is typically **lethal in utero**, making survival into childhood impossible. - The only viable monosomy is **Monosomy X** (Turner syndrome), which presents with distinct features (short stature, webbed neck, ovarian dysgenesis) without the characteristic Down syndrome features described.

Q: A girl presents with microcephaly and a high-pitched cry. Which of the following is the most likely chromosomal abnormality?

Deletion. ***Deletion***- The combination of **microcephaly** and a peculiar **high-pitched cry** (often described as 'cat-like') is the hallmark clinical presentation of **Cri-du-chat syndrome**.- Cri-du-chat syndrome is caused by a **deletion** of the distal part of the short arm of chromosome 5 (5p-).*Isochromosome*- An **isochromosome** is a structural chromosomal abnormality where an arm is duplicated, resulting in two copies of one arm and none of the other (e.g., often seen in X chromosome abnormalities like **Turner syndrome**).- This type of structural error does not typically result in the specific features of Cri-du-chat syndrome, which require the loss of specific genes on **chromosome 5 short arm**.*Trisomy*- **Trisomy** is the presence of an extra copy of a chromosome (47 total chromosomes, e.g., **Down syndrome - Trisomy 21**).- Syndromes resulting from autosomal trisomies (like Patau or Edwards) present with different constellations of congenital and developmental abnormalities, lacking the pathognomonic **cat-like cry**.*Mosaicism*- **Mosaicism** describes the presence of two or more populations of cells with different genotypes in one individual, often mitigating the severity of major aneuploidies.- While it can occur with some deletions, **mosaicism** is not the primary mechanism or classification for the specific **Cri-du-chat syndrome** which is defined by the **5p deletion**.

Q: Based on the provided MRI images of the knee (A and B), which show a well-defined fluid collection anterior to the patella, what is the most likely diagnosis?

Housemaid's knee. ***Housemaid's knee*** - The MRI shows fluid accumulation specifically in the **prepatellar bursa**, which is located anterior to the patella. This finding is the hallmark of prepatellar bursitis. - This condition is colloquially termed **"Housemaid's knee"** as it commonly results from chronic irritation and inflammation of the bursa due to repetitive kneeling. *Subdermal abscess* - A **subdermal abscess** would appear as a collection of pus in the subcutaneous tissue, often with irregular borders and significant surrounding **inflammatory changes (cellulitis)**, which are not the primary findings here. - The fluid collection is well-defined and confined to the anatomical location of the **prepatellar bursa**, not a disorganized subcutaneous collection. *Gout* - Gout typically presents as an acute **intra-articular** inflammation with a large joint effusion. Chronic gout can show characteristic **"rat-bite" erosions** on imaging, which are not visible here. - While gout can cause bursitis, the diagnosis is confirmed by identifying **negatively birefringent urate crystals** in aspirated fluid, and the imaging is less specific than for simple bursitis. *Rheumatoid arthritis* - Rheumatoid arthritis is a systemic disease causing **synovitis** and **pannus formation**, leading to joint destruction and bone erosions, none of which are seen in the image. - While bursitis can be associated with rheumatoid arthritis, it is typically part of a widespread **polyarthritis**, not an isolated finding as shown.

Question 1

What stage of embryonic development is shown in the following image?

Accepted Answer

Blastocyst

Answer

Gastrula

Answer

Morula

Answer

Ova

Question 2

Which is the nodal ministry of disaster management?

Accepted Answer

Ministry of Home Affairs

Answer

Ministry of Human Resource and Development

Answer

Ministry of Education

Answer

Ministry of Health and Family Welfare

Question 3

A total of 60 patients were diagnosed with COVID-19. Out of which, 12 deaths were reported. Calculate the Case Fatality Rate?

Accepted Answer

20%

Answer

40%

Answer

10%

Answer

30%

Question 4

An elderly man presents with an ulcerative lesion at the inner canthus of his eye with pearly margins. On microscopic examination, it shows a palisading arrangement of cells. Identify the lesion:

Accepted Answer

Basal cell carcinoma

Answer

Melanocytic melanoma

Answer

Keratoacanthoma

Answer

Squamous cell carcinoma

Question 5

What is the earliest sign of pregnancy on TVS?

Accepted Answer

G sac

Answer

Fetal pole

Answer

Cardiac activity

Answer

Yolk sac

Question 6

A 42-year-old woman laborer presented with visible, soft, and fluctuating swelling in front of the knee, over the patella and some discomfort or difficulty with knee movement, MRI findings are given below. What is the diagnosis?

Accepted Answer

Housemaid's knee

Answer

Rheumatoid arthritis

Answer

Gout

Answer

Subdermal abscess

Question 7

Which gene mutation is most commonly associated with Burkitt's lymphoma?

Accepted Answer

C-myc

Answer

p53

Answer

Rb

Answer

p21

Question 8

A child presents with a right transverse palmar crease, a cardiac defect, survival into childhood, and mild intellectual impairment. What chromosomal mechanism is most likely associated with these findings?

Accepted Answer

Mosaicism

Answer

Haploid

Answer

Monosomy

Answer

Trisomy

Question 9

A girl presents with microcephaly and a high-pitched cry. Which of the following is the most likely chromosomal abnormality?

Accepted Answer

Deletion

Answer

Mosaicism

Answer

Trisomy

Answer

Isochromosome

Question 10

Based on the provided MRI images of the knee (A and B), which show a well-defined fluid collection anterior to the patella, what is the most likely diagnosis?

Accepted Answer

Housemaid's knee

Answer

Rheumatoid arthritis

Answer

Gout

Answer

Subdermal abscess

FMGE 2025

Anatomy

Community Medicine

Dermatology

Obstetrics and Gynecology

Orthopaedics

Pathology

Pediatrics

Radiology