FMGE 2025 Practice Questions

Q: In a normal distribution, the mean value is 82, the SD is 1.5. Calculate the range of two standard deviations?

79-85. ***79-85***- For a **normal distribution**, the range covering two standard deviations (2 SD) is calculated using the formula: **Mean $\pm$ (2 $\times$ SD)**. The $2\sigma$ interval encompasses approximately **95.45%** of the data points.- Calculation: Lower limit $= 82 - (2 \times 1.5) = 82 - 3 = 79$. Upper limit $= 82 + (2 \times 1.5) = 85$. The correct range is **79-85**. *60-68*- This range is highly incorrect as it is centered far below the **mean of 82** and the width (8 units) is too wide for a total of 3 units (2 SD) dispersion. - The lower limit of 60 is over 14 standard deviations away from the mean, indicating it is an outlier range not relevant to the $2\sigma$ calculation. *50-57*- This range is excessively far from the **mean of 82** and its width (7 units) does not correspond to the required 3 units of dispersion needed for $\pm 2$ SD. - Ranges like this would include virtually none of the observations expected in a population with a mean of 82 and a small **standard deviation** of 1.5. *40-49*- This interval is centered around 44.5, which is highly divergent from the actual **mean of 82**, and therefore cannot represent the population's $\pm 2$ SD range. - In a normal distribution, the data is symmetric around the mean; any calculated range must therefore include the mean near its center, which this option fails to do.

Q: Which vaccine is contraindicated in pregnancy?

Varicella. ***Varicella (Correct Answer)*** - This is a **live attenuated vaccine** that is **contraindicated in pregnancy** due to the theoretical risk of causing congenital infection, such as **fetal varicella syndrome** - Vaccination should be postponed until the **postpartum period** - If an unprotected pregnant woman is exposed, **Varicella-Zoster Immune Globulin (VZIG)** may be indicated *Influenza (Incorrect)* - The **inactivated influenza vaccine** (injectable form) is **recommended and safe** for all pregnant women, regardless of the trimester - Vaccination protects both the mother and the newborn by reducing the risk of severe **influenza-related morbidity** in the mother - Provides passive antibody transfer to protect the infant during the first 6 months of life *Rabies (Incorrect)* - This is an **inactivated (non-live) vaccine** that is **safe to administer during pregnancy** if post-exposure prophylaxis (**PEP**) is indicated - The necessity of protection against a life-threatening disease like **rabies** outweighs the minimal risks associated with the inactivated vaccine - No contraindication in pregnancy when indicated *TDaP (Incorrect)* - TDaP (**Tetanus, Diphtheria, and acellular Pertussis**) is a **recommended non-live vaccine** given during *every* pregnancy - Ideally administered between **27-36 weeks of gestation** to ensure maximum maternal antibody transfer to the fetus - Provides passive immunity to the newborn against **pertussis** (whooping cough), protecting vulnerable infants

Q: Which of the following conditions is associated with Holman-Miller sign in the CT image given below?

Juvenile nasopharyngeal angiofibroma. ***Juvenile nasopharyngeal angiofibroma***- Holman-Miller sign refers to the classic imaging finding of **anterior bowing** of the posterior wall of the **maxillary sinus** due to the aggressive expansion of this benign tumor originating in the **sphenopalatine foramen**.- This highly **vascular** tumor typically affects **adolescent males** and presents with unilateral, recurrent, and severe epistaxis and nasal obstruction.*Maxillary sinusitis*- CT findings usually include non-specific features like **mucoperiosteal thickening**, air-fluid levels, or complete opacification, without significant displacement of the bony walls.- It is an inflammatory condition, caused by infection or allergy, which does not produce the bone displacement characteristic of aggressive local tumor growth like **JNA**.*Nasal polyp*- Nasal polyps arise from the nasal and sinus mucosa (often the **ethmoids**) and cause pressure-induced **bone erosion** or remodeling, but not the specific **anterior bowing** of the posterior maxillary wall.- They are typically associated with conditions such as **allergic rhinitis** or aspirin-exacerbated respiratory disease.*Rhinosporidiosis*- This condition is characterized by proliferative, **friable, strawberry-like masses** within the nasal cavity, caused by the organism *Rhinosporidium seeberi*.- Imaging usually shows only soft tissue masses within the nasal cavity or nasopharynx without the extensive **bony displacement** needed to produce Holman-Miller sign.

Q: A patient with CSOM presented to the OPD with seizures. On examination, homonymous hemianopia was present. Identify the condition based on the CT scan given below.

Temporal abscess. ***Temporal abscess*** - The patient's history of **CSOM** (Chronic Suppurative Otitis Media) is a classic risk factor for an **otogenic brain abscess**, with the temporal lobe being the most common site due to its proximity to the middle ear and mastoid. - The clinical signs of **seizures** and **homonymous hemianopia** (from involvement of optic radiations), combined with the characteristic **ring-enhancing lesion** on the CT scan, are pathognomonic for a temporal lobe abscess. *Cerebellar abscess* - A cerebellar abscess would present with signs of **cerebellar dysfunction**, such as **ataxia**, **nystagmus**, and **dysmetria**, which are absent in this patient's presentation. - While also a potential complication of otitis media, the focal neurological deficit of **homonymous hemianopia** localizes the lesion to the cerebrum, not the cerebellum. *Extradural abscess* - An extradural abscess is located between the dura mater and the skull and appears as a **lens-shaped (biconvex)** collection on CT, which is morphologically distinct from the **intraparenchymal, ring-enhancing lesion** shown. - Such an abscess is less likely to cause focal signs like hemianopia unless there is significant mass effect on the underlying brain parenchyma. *Meningitis* - Meningitis involves diffuse inflammation of the meninges and does not typically form a **focal, ring-enhancing mass** on a CT scan; findings are often normal or show diffuse meningeal enhancement. - The presence of a specific focal neurological deficit like **homonymous hemianopia** strongly points towards a localized lesion like an abscess rather than diffuse meningitis.

Q: 75% of iatrogenic ureteric injuries are due to gynaecological procedures. Which hysterectomy route has the least risk of ureteric injury?

Vaginal. ***Vaginal***- The **vaginal** route typically involves less extensive dissection in the lateral pelvis where the ureters are located, thus minimizing the risk of direct trauma or clamping. - The operation focuses more on the inferior attachments, avoiding the critical area where the ureter passes near the **uterine arteries** (the 'water under the bridge'). *Laparoscopic* - The risk can be significant due to the use of energy devices leading to **thermal injury** or entrapment during suture placement in the cardinal and uterosacral ligaments. - Reduced tactile feedback and potential for altered **3D visualization** increase the likelihood of inadvertent injury during dissection near the pelvic sidewall. *Abdominal* - Although providing good visualization, the procedure requires deliberate dissection near the **pelvic sidewall** where the ureter is vulnerable during clamping and suturing of the **uterine arteries**. - Ureter disruption or ligation often occurs during procedures for large uteri or in cases of **pelvic pathology** (e.g., severe endometriosis, fibroids) that distort anatomy. *Robotic* - Similar to laparoscopic approaches, it carries risks related to extensive use of **electrosurgical energy** and dissection near the ureters for complex cases. - Despite offering enhanced dexterity and 3D visualization, the manipulation and application of clips/sutures to the **cardinal ligaments** still require high vigilance to avoid ureter compromise.

Q: A 50 year old female presented with a breast mass that was operated and the microscopic examination in given. What is the diagnosis?

Mucinous carcinoma breast. ***Mucinous carcinoma breast*** - The micrograph shows clusters and nests of relatively uniform tumor cells floating in abundant extracellular **mucin**, which is the hallmark of this diagnosis. - This subtype of invasive ductal carcinoma is typically well-differentiated, hormone receptor-positive (**ER/PR positive**), and carries a more favorable prognosis than conventional invasive ductal carcinoma. *Lobular carcinoma breast* - This carcinoma is characterized by small, discohesive tumor cells infiltrating the stroma individually or in a **single-file** or **“Indian file”** pattern, which is not seen here [1]. - A key feature is the loss of **E-cadherin** expression, leading to the discohesive nature of the cells [3]. *Medullary carcinoma* - Histologically, this tumor presents as poorly differentiated cells arranged in solid, **syncytial sheets** with a prominent **lymphoplasmacytic infiltrate** [2]. - The image lacks both the syncytial growth pattern and the dense inflammatory background characteristic of medullary carcinoma [2]. *Phyllodes tumour* - This is a biphasic **fibroepithelial tumor**, characterized by a hypercellular stromal component and an epithelial component arranged in a **leaf-like** (phyllodes) architecture. - The defining feature is the proliferating stroma, whereas the image shows a carcinoma defined by its epithelial cells and extracellular mucin. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-455. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 455-456. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1068-1069.

Q: A child presents with recurrent Staphylococcus infections. Laboratory examination shows very low levels of immunoglobulins (G, A, M, E), and a low quantity of B cells. There is a normal reaction to environmental antigens on the skin. What is the most likely diagnosis?

Bruton's agammaglobulinemia. ***Bruton's agammaglobulinemia***- This X-linked disease is caused by a defect in the **Bruton tyrosine kinase (BTK)** gene, which is essential for B-cell maturation.- The deficiency results in a severe block in B-cell development, leading to **near absence of mature B cells** and consequently, extremely **low levels of all immunoglobulin isotypes** (IgG, A, M, E).*DiGeorge syndrome*- Primary feature is **T-cell deficiency** due to failure of the 3rd and 4th pharyngeal pouches, leading to **thymic hypoplasia**; this would typically impair the skin test response. - Although B cell numbers can sometimes be affected, the hallmark is severe T-cell deficiency, and Ig levels are often normal or near-normal, unlike the pan-hypogammaglobulinemia seen here.*Hyper IgM syndrome*- This condition is characterized by a failure in **isotype switching** (often due to defects in **CD40L**), resulting in normal or high levels of **IgM** but very low levels of IgG, IgA, and IgE.- B cells are present in normal counts, distinguishing it from this patient who has very few B cells and very low IgM.*Common variable immunodeficiency*- CVID typically presents later, in adolescence or adulthood, and causes **hypogammaglobulinemia** (low IgG and usually low IgA/IgM).- While B-cell function is impaired, patients usually have **normal B-cell counts**, contrasting with the severe reduction in B cells seen in this child.

Q: Hormone responsible for milk ejection reflex in the image shown?

Oxytocin. ***Oxytocin*** - The image shows a baby breastfeeding, which involves the **suckling reflex**. This reflex triggers the release of oxytocin from the posterior pituitary gland. - Oxytocin is crucial for the **milk ejection reflex** (or let-down reflex), as it causes the contraction of myoepithelial cells surrounding the alveoli in the mammary glands, expelling milk. *TSH* - Thyroid-Stimulating Hormone (TSH) is released from the anterior pituitary and its primary role is to stimulate the **thyroid gland** to produce thyroid hormones. - It is involved in regulating the body's **metabolism** and is not directly responsible for lactation. *GH* - Growth Hormone (GH) is secreted by the anterior pituitary and is essential for overall **somatic growth**, particularly of bones and muscles. - While it contributes to mammary gland development, it does not mediate the immediate process of milk ejection during breastfeeding. *FSH* - Follicle-Stimulating Hormone (FSH) is an anterior pituitary hormone that plays a key role in the reproductive cycle. - It stimulates the growth of **ovarian follicles** in females and **spermatogenesis** in males, and is not involved in lactation.

Q: A patient presented to the OPD with a sudden onset of shortness of breath. Identify the condition with the radiological image given below.

Laryngotracheobronchitis. ***Laryngotracheobronchitis*** - The AP neck radiograph displays the classic **"steeple sign,"** which is a tapered narrowing of the subglottic trachea (indicated by the arrow) due to inflammation. - This condition, also known as **croup**, is typically caused by a viral infection (most commonly **parainfluenza virus**) and presents with a characteristic **barking cough** and inspiratory stridor. *Epiglottitis* - This condition is characterized by the **"thumb sign"** on a *lateral* neck X-ray, which shows a swollen epiglottis, not the subglottic narrowing seen here. - Patients typically present more severely with high fever, **drooling**, dysphagia, and assume a **"tripod" posture**, which differs from the presentation of croup. *Bronchitis* - Bronchitis is an inflammation of the larger airways (bronchi) and would not produce findings in the subglottic region of a neck X-ray. - The primary symptom is a productive cough, and a **chest X-ray**, not a neck X-ray, would be the relevant imaging, which is often normal. *Laryngomalacia* - This is a congenital condition causing inspiratory stridor due to the collapse of soft laryngeal structures; it is not an acute infectious process. - The diagnosis is typically confirmed with **flexible laryngoscopy**, and plain radiographs are usually normal and do not show a steeple sign.

Q: Identify the sign given in the image below:

Double target sign. ***Double target sign*** - The image displays the **double target sign**, also known as the **halo sign**, which is highly suggestive of a **basilar skull fracture**. - This sign appears when blood mixed with **cerebrospinal fluid (CSF)** is dropped onto an absorbent surface; the heavier red blood cells accumulate in the center, while the lighter CSF diffuses outward, forming a distinct ring. *Beta 2 transferrin sign* - This is not a visual sign but a highly specific laboratory test used to confirm a **CSF leak**. **Beta-2 transferrin** is a protein almost exclusively found in CSF. - The test involves analyzing fluid collected from the nose or ear (rhinorrhea or otorrhea) to detect the presence of this specific protein, confirming its origin is CSF. *Handkerchief sign* - The **handkerchief sign** (or reservoir sign) refers to the clinical observation of a patient with **CSF rhinorrhea** who constantly has to wipe their nose due to the continuous, watery discharge. - It describes a patient's action rather than the appearance of the fluid itself on a surface. *Tear drop sign* - The **tear drop sign** is a radiological finding seen on orbital imaging (X-ray or CT scan), not a clinical sign on a cloth. - It indicates an **orbital floor (blowout) fracture**, where orbital contents, such as fat and the inferior rectus muscle, herniate into the maxillary sinus, resembling a hanging teardrop.

Question 1

In a normal distribution, the mean value is 82, the SD is 1.5. Calculate the range of two standard deviations?

Accepted Answer

79-85

Answer

60-68

Answer

40-49

Answer

50-57

Question 2

Which vaccine is contraindicated in pregnancy?

Accepted Answer

Varicella

Answer

TDaP

Answer

Rabies

Answer

Influenza

Question 3

Which of the following conditions is associated with Holman-Miller sign in the CT image given below?

Accepted Answer

Juvenile nasopharyngeal angiofibroma

Answer

Nasal polyp

Answer

Rhinosporidiosis

Answer

Maxillary sinusitis

Question 4

A patient with CSOM presented to the OPD with seizures. On examination, homonymous hemianopia was present. Identify the condition based on the CT scan given below.

Accepted Answer

Temporal abscess

Answer

Meningitis

Answer

Cerebellar abscess

Answer

Extradural abscess

Question 5

75% of iatrogenic ureteric injuries are due to gynaecological procedures. Which hysterectomy route has the least risk of ureteric injury?

Accepted Answer

Vaginal

Answer

Laparoscopic

Answer

Robotic

Answer

Abdominal

Question 6

A 50 year old female presented with a breast mass that was operated and the microscopic examination in given. What is the diagnosis?

Accepted Answer

Mucinous carcinoma breast

Answer

Medullary carcinoma

Answer

Lobular carcinoma breast

Answer

Phyllodes tumour

Question 7

A child presents with recurrent Staphylococcus infections. Laboratory examination shows very low levels of immunoglobulins (G, A, M, E), and a low quantity of B cells. There is a normal reaction to environmental antigens on the skin. What is the most likely diagnosis?

Accepted Answer

Bruton's agammaglobulinemia

Answer

Common variable immunodeficiency

Answer

Hyper IgM syndrome

Answer

DiGeorge syndrome

Question 8

Hormone responsible for milk ejection reflex in the image shown?

Accepted Answer

Oxytocin

Answer

GH

Answer

TSH

Answer

FSH

Question 9

A patient presented to the OPD with a sudden onset of shortness of breath. Identify the condition with the radiological image given below.

Accepted Answer

Laryngotracheobronchitis

Answer

Epiglottitis

Answer

Bronchitis

Answer

Laryngomalacia

Question 10

Identify the sign given in the image below:

Accepted Answer

Double target sign

Answer

Handkerchief sign

Answer

Beta 2 transferrin sign

Answer

Tear drop sign

FMGE 2025

Community Medicine

ENT

Obstetrics and Gynecology

Pathology

Pediatrics

Physiology

Radiology

Surgery