FMGE 2025 Practice Questions

Q: A PLHIV came with multiple dog bites with a punctured wound. Choose the correct management:

Local Treatment + RIG + Vaccine. ***Local Treatment + RIG + Vaccine***- This regimen is mandatory for **Category III** rabies exposure, defined by single or multiple transdermal bites or scratches, which includes the described punctured wounds.- **Rabies Immunoglobulin (RIG)**, providing passive immediate protection, must be infiltrated into and around the wound, followed by the complete scheduled series of the Rabies **Vaccine** to establish long-term active immunity.*Local wound cleaning*- While immediate and thorough local wound cleaning with soap, water, and an antiseptic is the **most crucial first step**, it is insufficient alone for preventing rabies transmission in a Category III exposure.- Punctured wounds carry a high risk of deep inoculation, necessitating both passive (**RIG**) and active (**Vaccine**) immunization immediately.*Vaccine*- The **rabies vaccine** provides active immunity, but this protection takes several days to weeks to develop.- In high-risk, severe exposures (Category III), immediate passive immunity via **Rabies Immunoglobulin (RIG)** is essential to neutralize the virus before the vaccine takes effect.*Local Treatment + RIG*- This approach provides immediate passive neutralization through **RIG** and effective wound management, but it critically omits the **rabies vaccine**.- Omission of the vaccine prevents the development of necessary long-term protective active immunity, leaving the patient vulnerable after the short-term effect of RIG wanes.

Q: A patient admitted with fever and nuchal rigidity. CSF analysis shows decreased glucose and increased protein and neutrophils. Which is the MOST IMPORTANT antibiotic for initial empirical treatment?

Ceftriaxone. Ceftriaxone - Ceftriaxone, a third-generation cephalosporin, is the most essential component of empirical treatment for bacterial meningitis due to its excellent CSF penetration and broad coverage [1]. - It effectively covers the most common bacterial causes of community-acquired meningitis: Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae [1]. - Note: Current guidelines recommend Ceftriaxone + Vancomycin as the optimal empirical regimen to cover penicillin-resistant S. pneumoniae (PRSP), but Ceftriaxone remains the primary/essential antibiotic in this combination [1]. Vancomycin - Vancomycin is critical for covering penicillin-resistant S. pneumoniae (PRSP) and is typically used in combination with Ceftriaxone in the empirical regimen. - It is not used as monotherapy due to poor CSF penetration and incomplete coverage of other common pathogens like N. meningitidis. Penicillin - Penicillin is no longer recommended for empirical treatment due to high prevalence of penicillin-resistant S. pneumoniae (PRSP) globally. - While effective against sensitive N. meningitidis, the need for broader coverage necessitates third-generation cephalosporins. Ampicillin - Ampicillin is added to cover Listeria monocytogenes in specific high-risk groups: patients >50 years, immunocompromised, pregnant women, or neonates. - It is ineffective as monotherapy for routine bacterial meningitis and lacks coverage for resistant strains of common pathogens.

Q: A 62-year-old male presents with left leg swelling and pain for 5 days and has a positive D-dimer test. Duplex ultrasonography confirms an extensive DVT involving the left popliteal and femoral veins. Which of the following is the most appropriate initial management strategy?

LMWH followed by oral anticoagulant. LMWH followed by oral anticoagulant - Low Molecular Weight Heparin (LMWH) is the preferred initial treatment for stable patients with extensive DVT due to its predictable response [1], [2], subcutaneous administration, and lower risk of heparin-induced thrombocytopenia (HIT) compared to UFH. - Following the initial parenteral therapy (LMWH or UFH), long-term treatment with an oral anticoagulant (such as a DOAC or warfarin) is necessary for at least 3 to 6 months to prevent thrombus extension and recurrent Pulmonary Embolism (PE) [1]. Unfractionated heparin followed by warfarin - Unfractionated Heparin (UFH) often requires hospitalization for IV administration and intense monitoring of aPTT levels [2], making LMWH the outpatient standard for stable patients. - UFH is typically reserved for patients with severe renal impairment (Creatinine Clearance < 30 mL/min) or those who are hemodynamically unstable and may require urgent reversal. Catheter-directed thrombolysis - This invasive therapy is reserved for patients with DVT accompanied by limb ischemia (phlegmasia cerulea dolens) [1] or for selected young patients with extensive proximal DVT and a low risk of bleeding. - It is associated with a significantly higher risk of major bleeding and is not the standard initial strategy for an uncomplicated extensive DVT [1]. IVC filter placement - An IVC filter is indicated only for patients with acute DVT who have an absolute contraindication to anticoagulation (e.g., active hemorrhage) or who experience recurrent PE despite adequate anticoagulation [1]. - Filter placement does not treat the existing deep vein clot and increases the long-term risk of recurrent DVT.

Q: A 2-week-old neonate was brought to the hospital with a complaint of non-bilious vomiting. While examining the baby, the physician noted a lump in the right upper quadrant, which showed movement while feeding. What is the likely diagnosis of this child?

IHPS. ***Correct: IHPS (Infantile Hypertrophic Pyloric Stenosis)*** - Classic presentation: **2-8 weeks old neonate** with progressive **non-bilious projectile vomiting** - Hallmark finding: **Palpable olive-shaped mass in right upper quadrant** (hypertrophied pyloric muscle) - **Visible peristaltic waves** from left to right upper abdomen, especially after feeding - Associated with **hypochloremic hypokalemic metabolic alkalosis** - Treatment: Ramstedt pyloromyotomy *Incorrect: Duodenal atresia* - Presents within **first day of life** (not at 2 weeks) - Causes **bilious vomiting** (obstruction distal to ampulla of Vater) - "Double bubble" sign on X-ray - Associated with Down syndrome *Incorrect: Esophageal atresia* - Presents **immediately after birth** with drooling and choking - No palpable abdominal mass - Diagnosed with **inability to pass nasogastric tube** - Often associated with tracheoesophageal fistula (TEF) *Incorrect: Intussusception* - Typical age: **6-36 months** (not neonates) - Presents with **colicky abdominal pain** and "currant jelly" stools - Palpable "sausage-shaped" mass in right upper quadrant - Treatment: Air/hydrostatic reduction

Q: Following a fight between 2 groups, a boy was brought with severe pain in the chest, distended neck veins, dyspnea, and a BP of 80/50 mmHg. X-ray shows the following findings: What is the diagnosis?

Tension Pneumothorax. ***Tension pneumothorax*** - The clinical presentation of severe dyspnea, **distended neck veins**, and **hypotension** (BP 80/50 mmHg) after trauma is a classic triad for tension pneumothorax, which is a medical emergency. - The chest X-ray confirms this diagnosis by showing a completely collapsed right lung with a significant **contralateral shift of the mediastinum and trachea** to the left, and flattening of the right hemidiaphragm, indicating high intrapleural pressure. *Primary Spontaneous Pneumothorax* - This type of pneumothorax occurs without any preceding trauma or underlying lung disease, typically in tall, thin young men due to the rupture of **apical blebs**. - The patient's presentation follows a fight, clearly indicating a **traumatic etiology**, which rules out a spontaneous pneumothorax. *Traumatic Pneumothorax* - While the cause is trauma, this is a less specific diagnosis. The term **Tension pneumothorax** is more accurate given the life-threatening signs of **hemodynamic instability** and **mediastinal shift**. - A simple traumatic pneumothorax does not typically involve the one-way valve mechanism that leads to the progressive accumulation of air and the resulting **obstructive shock** seen in this patient. *Bilateral Pneumothorax* - This diagnosis is incorrect as the chest X-ray clearly demonstrates a **unilateral** condition affecting only the right side. - The left lung, although compressed by the shifted mediastinum, remains inflated with visible lung markings extending to the chest wall.

Q: Identify the procedure shown in the image

Intravenous Pyelogram. ***Intravenous Pyelogram*** - In this procedure, a contrast agent is injected **intravenously** and is then excreted by the kidneys, allowing for visualization of the entire urinary tract, including the renal calyces, pelvis, ureters, and bladder. - The image demonstrates the **nephrogram phase** (contrast in the kidney parenchyma) and the **excretory phase** (contrast in the collecting systems and ureters) simultaneously on both sides, which is characteristic of an IVP. *Retrograde pyelogram* - This procedure involves the injection of contrast material directly into the ureter via a **cystoscope** passed into the bladder, resulting in retrograde (bottom-to-top) filling of the collecting system. - A **ureteral catheter** would typically be visible on the image, and usually, only one side is opacified at a time, which is not the case here. *Combined Retrograde Pyelogram and Ureteroscopy* - This is an invasive procedure where a **ureteroscope** (a thin, flexible camera) is passed up the ureter to directly visualize and treat pathologies like stones or tumors. - The presence of the **ureteroscope** or other instruments would be evident on the radiograph, which are absent in this image. *Antegrade pyelography* - This technique involves inserting a needle or catheter through the skin of the back directly into the renal collecting system (**percutaneous access**) to inject contrast. - A **percutaneous nephrostomy tube** or needle would be visible on the image, which is not seen here.

Q: A patient with grade 2 hemorrhoids underwent surgery, identify the instrument.

Haemorrhoids band kit. ***Haemorrhoids band kit*** - The image shows a **band ligator** applying a small elastic band to the base of an internal hemorrhoid, which is the procedure known as **rubber band ligation**. - This technique is a common office-based procedure for **grade I, II, and selected grade III** internal hemorrhoids, causing them to necrose and slough off by cutting off their blood supply. *Haemorrhoids resection kit* - This kit contains instruments for a formal **hemorrhoidectomy**, a surgical procedure that involves excising the hemorrhoidal tissue, typically reserved for severe **grade III and IV hemorrhoids**. - A resection is a more invasive procedure involving cutting and suturing, which is different from the banding method shown. *Stapler kit* - A stapler kit is used for a **stapled hemorrhoidopexy** (PPH procedure), which involves a circular stapler to resect a ring of mucosa above the hemorrhoids and lift them back into a normal position. - The instrument and the principle of action (resection and fixation) are distinct from the ligation shown in the image. *CO2 laser* - **Laser hemorrhoidoplasty** uses a laser probe to deliver energy to shrink the hemorrhoidal plexus; it does not involve the application of a mechanical band. - The instrument is a thin laser fiber, which looks different from the ligator depicted in the illustration.

Q: A 45-year-old man is found unconscious after a fall from a ladder. In the emergency department, his eyes do not open even in response to pain; he is making incomprehensible sounds, and he exhibits abnormal flexion in response to painful stimuli. What is his Glasgow Coma Scale (GCS) score?

6. ***Correct Answer: 6*** - The GCS score is calculated by summing Eye (E), Verbal (V), and Motor (M) responses - E=1 (no eye opening to pain) + V=2 (incomprehensible sounds) + M=3 (abnormal flexion/decorticate posturing) = **6** - A GCS ≤8 indicates **severe head injury** requiring definitive airway management *Incorrect: 5* - A score of 5 would require an even lower motor response: M=2 (abnormal extension/decerebrate posturing) or M=1 (no motor response) - The patient demonstrates M=3 (abnormal flexion), making the total score 6, not 5 *Incorrect: 7* - A score of 7 would require a higher verbal or motor component - For example: E=1 + V=3 (inappropriate words) + M=3 = 7, or E=1 + V=2 + M=4 (withdrawal from pain) = 7 - The patient's V=2 (incomprehensible sounds) and E=1 prevent reaching a total of 7 *Incorrect: 8* - A GCS of 8 requires significantly better responses, such as M=4 (withdraws from pain) or V=3 (inappropriate words) combined with M=4 - The patient's M=3 (abnormal flexion) and V=2 (incomprehensible sounds) are too low to reach 8

Q: Which of the following is the classical triad of acute cholangitis?

Pain, jaundice, fever. ***Correct: Pain, jaundice, fever*** - This is **Charcot's triad**, the classical presentation of acute cholangitis - Represents the three cardinal clinical features: **RUQ abdominal pain**, **jaundice** (from biliary obstruction), and **fever with rigors** (from ascending infection) - Acute cholangitis is a bacterial infection of the bile ducts, typically occurring due to biliary obstruction (most commonly from choledocholithiasis) - When hypotension and altered mental status are added to Charcot's triad, it becomes **Reynolds pentad** (indicating severe/suppurative cholangitis) *Incorrect: Pain, ↑ WBC, ↑ Bilirubin* - While these findings may be present in acute cholangitis, this is not the classical **clinical triad** - Laboratory findings are supportive but not part of the classical triad definition *Incorrect: Fever, jaundice, ↑ WBC* - Missing the key clinical feature of **RUQ pain** - Includes laboratory finding (↑ WBC) rather than clinical presentation *Incorrect: Pain, jaundice, shock* - This combination represents part of **Reynolds pentad** but is missing fever - Reynolds pentad = Charcot's triad + hypotension + altered mental status - Not the classical triad being asked in the question

Question 1

A PLHIV came with multiple dog bites with a punctured wound. Choose the correct management:

Accepted Answer

Local Treatment + RIG + Vaccine

Answer

Local wound cleaning

Answer

Local Treatment + RIG

Answer

Vaccine

Question 2

A patient admitted with fever and nuchal rigidity. CSF analysis shows decreased glucose and increased protein and neutrophils. Which is the MOST IMPORTANT antibiotic for initial empirical treatment?

Accepted Answer

Ceftriaxone

Answer

Vancomycin

Answer

Penicillin

Answer

Ampicillin

Question 3

A 62-year-old male presents with left leg swelling and pain for 5 days and has a positive D-dimer test. Duplex ultrasonography confirms an extensive DVT involving the left popliteal and femoral veins. Which of the following is the most appropriate initial management strategy?

Accepted Answer

LMWH followed by oral anticoagulant

Answer

Unfractionated heparin followed by warfarin

Answer

Catheter-directed thrombolysis

Answer

IVC filter placement

Question 4

Which of the following is not related to disease progression?

Accepted Answer

Duration

Answer

Depth

Answer

Stage of Cancer

Answer

Site

Question 5

A 2-week-old neonate was brought to the hospital with a complaint of non-bilious vomiting. While examining the baby, the physician noted a lump in the right upper quadrant, which showed movement while feeding. What is the likely diagnosis of this child?

Accepted Answer

IHPS

Answer

Duodenal atresia

Answer

Esophageal atresia

Answer

Intusussception

Question 6

Following a fight between 2 groups, a boy was brought with severe pain in the chest, distended neck veins, dyspnea, and a BP of 80/50 mmHg. X-ray shows the following findings: What is the diagnosis?

Accepted Answer

Tension Pneumothorax

Answer

Primary Spontaneous Pneumothorax

Answer

Bilateral Pneumothorax

Answer

Traumatic Pneumothorax

Question 7

Identify the procedure shown in the image

Accepted Answer

Intravenous Pyelogram

Answer

Combined Retrograde Pyelogram and Ureteroscopy

Answer

Antegrade pyelography

Answer

Retrograde pyelogram

Question 8

A patient with grade 2 hemorrhoids underwent surgery, identify the instrument.

Accepted Answer

Haemorrhoids band kit

Answer

Stapler kit

Answer

CO2 laser

Answer

Haemorrhoids resection kit

Question 9

A 45-year-old man is found unconscious after a fall from a ladder. In the emergency department, his eyes do not open even in response to pain; he is making incomprehensible sounds, and he exhibits abnormal flexion in response to painful stimuli. What is his Glasgow Coma Scale (GCS) score?

Accepted Answer

6

Answer

7

Answer

8

Answer

5

Question 10

Which of the following is the classical triad of acute cholangitis?

Accepted Answer

Pain, jaundice, fever

Answer

Pain, $\uparrow$ WBC, $\uparrow$ Bilirubin

Answer

Fever, jaundice, $\uparrow$ WBC

Answer

Pain, jaundice, shock

FMGE 2025

Community Medicine

Internal Medicine

Pathology

Pediatrics

Radiology

Surgery