FMGE 2025 Practice Questions

Q: Identify the structure marked as 'X' in the image below

Buccopharyngeal fascia. ***Buccopharyngeal fascia*** - This fascia is a subdivision of the **pretracheal layer** of the deep cervical fascia that encloses the pharynx, esophagus, and buccinator muscle. - The pointer 'X' correctly identifies this structure, which forms the anterior boundary of the **retropharyngeal space** located immediately posterior to the pharynx. *Prevertebral fascia* - This layer of deep cervical fascia encloses the **vertebral column** and the deep muscles of the neck (e.g., longus colli, scalene muscles). - It is located posterior to the **alar fascia** and forms the floor of the posterior triangle of the neck. *Pharyngobasilar fascia* - This is a strong fibrous sheet that forms the internal framework of the **pharyngeal wall**, situated between the mucous membrane and the muscular layer. - It is an **internal** structure and is not visible on the external surface of the pharynx as indicated in the image. *Alar fascia* - This is a thin fascial layer located between the **buccopharyngeal fascia** anteriorly and the **prevertebral fascia** posteriorly. - It subdivides the space behind the pharynx into the true **retropharyngeal space** and the more posterior **danger space**.

Q: Identify A and B in the image of the mosquito larvae given

A-Anopheles, B-Culex. ***A-Anopheles, B-Culex*** - Larva A is identified as **Anopheles** because it rests **parallel** to the water surface and lacks a respiratory **siphon**, breathing through palmate hairs on its abdominal segments. - Larva B is identified as **Culex** as it hangs at an **angle** to the water surface and breathes through a long, narrow respiratory **siphon**. *A-Culex, B-Aedes* - This is incorrect as larva A exhibits the characteristics of **Anopheles** (no siphon, parallel resting), not **Culex**. - While **Aedes** larvae also hang at an angle, larva B's long siphon is more typical of **Culex**; **Aedes** larvae usually have a shorter, stouter siphon. *A-Culex, B-Anopheles* - This option incorrectly reverses the identities. Larva A is **Anopheles** and larva B is **Culex** based on their distinct resting postures and respiratory structures. - The key differentiating feature is the presence of a **siphon** in B (**Culex**) and its absence in A (**Anopheles**). *A-Anopheles, B-Mansonia* - Although the identification of A as **Anopheles** is correct, larva B is not **Mansonia**. - **Mansonia** larvae are unique as they attach to the roots of aquatic plants to obtain oxygen and do not hang from the surface, unlike the larva shown in B.

Q: Which of the following is the formula for sensitivity?

TP/(TP+FN)x100. ***TP/(TP+FN)x100***- This is the formula for **sensitivity** (or True Positive Rate), which is the proportion of individuals who truly have the disease (**True Positives, TP**) who are correctly identified by the test.- The denominator $TP + FN$ accounts for all individuals who actually have the disease according to the **gold standard**, including those who tested negatively (**False Negatives, FN**).*TP/(TP+FP)x100*- This formula calculates the **Positive Predictive Value (PPV)**, which indicates the probability that a positive test result represents a true positive.- The denominator $TP + FP$ includes everyone who tested positive, regardless of their actual disease status (**True Positives** and **False Positives**).*TN/(TN+FP)x100*- This formula calculates **specificity** (or True Negative Rate), which is the proportion of individuals who are truly disease-free (**True Negatives, TN**) correctly identified by the test.- The denominator $TN + FP$ accounts for all individuals without the disease, including those who were incorrectly identified as positive (**False Positives, FP**).*TN/(TN+FN)x100*- This formula calculates the **Negative Predictive Value (NPV)**, which is the probability that a negative test result represents a true negative.- The denominator $TN + FN$ includes everyone who tested negative, reflecting the proportion of subjects with a negative test result who are truly disease-free.

Q: In a study based in Delhi, doctors followed 100 people who did exercise for a year and later they checked who all had developed coronary heart disease. Which type of study is this?

Cohort study. ***Cohort study***- This study starts with a group of people free of the disease (**CHD**) and classifies them based on their exposure status (e.g., *exercise* vs. no exercise) and follows them forward in time (**prospectively**) to measure the incidence of the disease.- The study tracks the patients *forward* from exposure (**exercise**) to outcome (**CHD**) over a specified period (one year), which is the definitive characteristic of a **prospective cohort study**.*Case Control Study*- In this design, the study starts with the outcome (**CHD**) and retrospectively looks back (examining controls without CHD) to determine past exposure, making it unsuitable for this specific prospective tracking of exposure.- It is used primarily to estimate the **odds ratio** and is efficient for studying rare diseases; it does not measure incidence over time.*Prospective Study*- While this specific study is **prospective** (looking forward in time), this term describes the *timing* and direction of data collection, whereas **Cohort Study** is the most specific designation describing the fundamental design of following a defined exposed population.- A **prospective study** is a broad term, and the term **Cohort Study** most accurately describes the method of following an exposed group to measure disease incidence over time.*Cross Sectional Study*- This study type measures both the exposure (exercise) and the outcome (**CHD**) simultaneously at a **single point in time**, assessing prevalence rather than tracking incidence over one year.- It provides a **snapshot** and cannot establish the temporal relationship between exposure and outcome, failing to align with the follow-up design described.

Q: Which of the following is shown in the image below (circled)?

Osteomeatal complex. ***Osteomeatal complex*** - The circled area highlights the **osteomeatal complex (OMC)**, a functional unit of the lateral nasal wall located in the middle meatus. - The OMC is the final common drainage pathway for the **frontal**, **maxillary**, and **anterior ethmoid sinuses**, and its obstruction is a primary cause of chronic rhinosinusitis. *Columella* - The **columella** is the external, soft tissue structure that separates the nostrils at the base of the nose. - It is an external feature and is not an internal bony or mucosal structure visible in this coronal CT view of the paranasal sinuses. *Nasal valve* - The **nasal valve** is the narrowest segment of the nasal airway, located much more anteriorly in the nasal cavity, near the nostril opening. - It is a functional area defined by the junction of the nasal septum and the upper lateral cartilage, not the region shown in the middle meatus. *Crest of maxilla* - The **crest of the maxilla**, or nasal crest, is a bony ridge on the floor of the nasal cavity where the inferior edge of the nasal septum articulates. - The circled structure is located superiorly and laterally within the middle meatus, not on the inferior floor of the nasal cavity.

Q: In the context of mitral stenosis, which clinical feature is typically observed?

Loud S1. ***Loud S1*** - Mitral stenosis keeps the mitral leaflets in an open position until late diastole, resulting in an **abrupt and forceful closure** at the onset of systole, producing an abnormally loud S1. - This loud, snapping S1 is one of the **classic auscultatory findings** in non-calcific, mobile mitral stenosis. - The intensity of S1 correlates with valve mobility; as the valve becomes more calcified and immobile, S1 becomes softer. *Absent S1* - An absent or soft S1 indicates a **severely calcified, immobile mitral valve** (very advanced stenosis) or significant mitral regurgitation. - In early to moderate mitral stenosis, the valve leaflets remain mobile enough to generate a loud closure sound. - Loss of S1 intensity suggests progression to severe, end-stage valvular disease. *S3 gallop* - An S3 gallop is a sign of **rapid ventricular filling** caused by volume overload, typically heard in left ventricular systolic heart failure or significant mitral regurgitation. - Since mitral stenosis **restricts diastolic filling** into the left ventricle, an S3 is generally not heard in pure, isolated mitral stenosis. - The presence of S3 in a patient with MS should raise suspicion for coexistent left ventricular dysfunction or mixed valvular disease. *Muffled heart sounds* - Muffled or distant heart sounds suggest pathologies that dampen sound conduction, such as **pericardial effusion**, severe obesity, or emphysema. - Mitral stenosis characteristically produces **accentuated sounds** (loud S1, opening snap, diastolic rumble) rather than muffled sounds. - The presence of muffled sounds should prompt evaluation for alternative or additional cardiac pathology.

Q: Which of the following is associated with a Graham-Steel murmur?

Pulmonary regurgitation. Detailed heart murmur assessment is necessary for diagnosis. While early diastolic murmurs are typically associated with valvular regurgitation, the specific Graham-Steel murmur is a high-pitched, early diastolic decrescendo murmur heard best over the pulmonary area [1]. It is specifically caused by pulmonary regurgitation that develops secondary to severe pulmonary hypertension. Ventricular septal defect (VSD) typically causes a pansystolic (holosystolic) murmur heard at the left sternal border. While VSD can lead to severe pulmonary hypertension, the primary associated murmur related to the defect itself is holosystolic. Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by a harsh, mid-systolic ejection murmur heard at the left sternal border or apex [1]. Aortic regurgitation also produces an early diastolic decrescendo murmur, often heard at the left sternal edge [2]. It is due to failure of the aortic valve and is distinct from the Graham-Steel murmur, which is tied to pulmonary hypertension.

Q: A postmenopausal woman presents with irregular bleeding, endometrium biopsy shows endometrial hyperplasia without atypia. What is the likely management?

LNG-IUS. ***LNG-IUS*** - The **Levonorgestrel-releasing intrauterine system (LNG-IUS)** is a first-line treatment for endometrial hyperplasia without atypia as it delivers a high concentration of **progestin** directly to the endometrium. - This local therapy effectively reverses hyperplasia by causing endometrial atrophy with minimal systemic side effects, making it an excellent choice for postmenopausal women. *OCP* - **Oral contraceptive pills (OCPs)** contain both estrogen and progestin. Administering estrogen is contraindicated as endometrial hyperplasia is caused by unopposed estrogen stimulation. - OCPs are generally indicated for **premenopausal** women for contraception or cycle regulation, not for treating hyperplasia in the postmenopausal population. *Estradiol* - **Estradiol** is a form of estrogen. The pathophysiology of endometrial hyperplasia involves excessive endometrial proliferation due to unopposed estrogen. - Giving estradiol would worsen the condition and increase the risk of progression to **atypical hyperplasia** and endometrial carcinoma. *Danazol* - **Danazol** is a synthetic steroid with anti-estrogenic and weak androgenic properties that can induce endometrial atrophy, but it is not a first-line treatment. - Its use is limited by significant **androgenic side effects**, such as hirsutism, acne, and weight gain, making progestins the preferred therapeutic choice.

Q: Which of the following CVS changes are not seen in pregnancy?

Diastolic murmur. ***Diastolic murmur***- Diastolic murmurs are generally **pathologic** and are *not* considered normal physiological findings resulting from the changes of pregnancy.- Their presence often indicates significant underlying structural heart disease, such as **mitral stenosis** or **aortic regurgitation**, requiring comprehensive cardiac evaluation.*Soft Systolic murmur*- A low-grade, transient, **ejection systolic murmur** is very common (up to 90% of cases) due to the **hyperdynamic circulatory state**.- This flow murmur results from increased **cardiac output** and elevated stroke volume across normal valves.*S3*- A pronounceable **third heart sound (S3)** is frequently heard due to the large increase in circulating plasma volume leading to **volume overload**.- This sound is caused by the **rapid filling** of the ventricle during early diastole, a common finding in high-output states.*Loud S1 splitting*- The first heart sound (**S1**) often becomes noticeably **louder** during pregnancy due to the **hyperdynamic circulation** and elevated heart rate.- The increased heart rate and fluid volume can enhance the audibility and sometimes the perception of splitting due to the closure of the **mitral and tricuspid valves**.

Question 1

Identify the structure marked as 'X' in the image below

Accepted Answer

Buccopharyngeal fascia

Answer

Prevertebral fascia

Answer

Pharyngobasilar fascia

Answer

Alar fascia

Question 2

Identify A and B in the image of the mosquito larvae given

Accepted Answer

A-Anopheles, B-Culex

Answer

A-Culex, B-Anopheles

Answer

A-Culex, B-Aedes

Answer

A-Anopheles, B-Mansonia

Question 3

Which of the following is the formula for sensitivity?

Accepted Answer

TP/(TP+FN)x100

Answer

TN/(TN+FP)x100

Answer

TP/(TP+FP)x100

Answer

TN/(TN+FN)x100

Question 4

In a study based in Delhi, doctors followed 100 people who did exercise for a year and later they checked who all had developed coronary heart disease. Which type of study is this?

Accepted Answer

Cohort study

Answer

Case Control Study

Answer

Prospective Study

Answer

Cross Sectional Study

Question 5

Which of the following is shown in the image below (circled)?

Accepted Answer

Osteomeatal complex

Answer

Nasal valve

Answer

Columella

Answer

Crest of maxilla

Question 6

In the context of mitral stenosis, which clinical feature is typically observed?

Accepted Answer

Loud S1

Answer

S3 gallop

Answer

Muffled heart sounds

Answer

Absent S1

Question 7

Which factor is most useful for distinguishing Acute Kidney Injury (AKI) from Chronic Kidney Disease (CKD)?

Accepted Answer

Albumin levels

Answer

Blood urea nitrogen (BUN)

Answer

Urinary output

Answer

Creatinine levels

Question 8

Which of the following is associated with a Graham-Steel murmur?

Accepted Answer

Pulmonary regurgitation

Answer

Aortic regurgitation

Answer

Hypertrophic obstructive cardiomyopathy (HOCM)

Answer

Ventricular septal defect (VSD)

Question 9

A postmenopausal woman presents with irregular bleeding, endometrium biopsy shows endometrial hyperplasia without atypia. What is the likely management?

Accepted Answer

LNG-IUS

Answer

Estradiol

Answer

OCP

Answer

Danazol

Question 10

Which of the following CVS changes are not seen in pregnancy?

Accepted Answer

Diastolic murmur

Answer

S3

Answer

Loud S1 splitting

Answer

Soft Systolic murmur

FMGE 2025

Anatomy

Community Medicine

ENT

Internal Medicine

Obstetrics and Gynecology