FMGE 2025 Practice Questions

Q: Identify the marked area in the image given.

Pouch of Douglas. ***Pouch of Douglas*** - This is the **rectouterine pouch**, a peritoneal reflection between the posterior wall of the uterus and the anterior aspect of the rectum. - As the most dependent part of the female peritoneal cavity, it's a common site for fluid collection (blood, pus) and can be accessed for procedures like **culdocentesis**, as depicted by the needle. *Morrison's pouch* - Also known as the **hepatorenal pouch**, this is a potential space in the upper abdomen between the liver and the right kidney. - It is anatomically located far superior to the pelvic region shown in the image. *Vesicouterine pouch* - This is the peritoneal pouch located between the anterior surface of the uterus and the posterior surface of the urinary bladder. - The image clearly marks the space posterior to the uterus, not anterior. *Ischioanal Fossa* - This is a fat-filled space located lateral to the anal canal and inferior to the pelvic diaphragm within the perineum. - It is an extraperitoneal structure and not the intraperitoneal recess marked in the image.

Q: A Tzanck smear prepared from a vesicle shows multinucleated giant cells. What is the diagnosis?

HSV. ***HSV*** - The Tzanck smear is a rapid cytological test used to detect the viral cytopathic effects seen in vesicles caused by the *Herpesviridae* family, including **Herpes Simplex Virus (HSV)** and **Varicella-Zoster Virus (VZV)**. - The finding of **multinucleated giant cells** (also called **Tzanck cells**) formed by the fusion of infected keratinocytes is highly characteristic of herpetic infections. - **Important note**: The Tzanck smear **cannot distinguish between HSV and VZV** as both produce identical cytopathic effects. However, among the given options, **only HSV** is from the Herpesviridae family that causes vesicular lesions with this classic finding. - Clinical context (location, distribution, patient age) and confirmatory tests like **PCR** or **viral culture** are needed to differentiate HSV from VZV definitively. *HIV* - **HIV** (Human Immunodeficiency Virus) is diagnosed through blood tests, such as fourth-generation antigen/antibody screens or **PCR** for viral load. - The Tzanck smear is a test for vesicular dermatoses and **does not** play a role in the diagnosis of HIV infection. - HIV does not cause vesicles with multinucleated giant cells. *HPV* - **HPV** (Human Papillomavirus) causes warts and condylomas, which are diagnosed histologically showing characteristic **koilocytes** (squamous cells with perinuclear halos). - HPV lesions are **papular or verrucous**, not vesicular, and therefore would not yield multinucleated giant cells on Tzanck smear. - HPV does not belong to the Herpesviridae family. *EBV* - **EBV** (Epstein-Barr Virus) primarily causes Infectious Mononucleosis and is diagnosed using serological tests, such as the **Monospot test** (detecting heterophile antibodies) or EBV-specific antibodies. - EBV is **not associated with vesicular eruptions** and does not produce Tzanck-positive lesions. - EBV belongs to the Herpesviridae family but manifests systemically rather than with characteristic skin vesicles.

Q: A patient reports difficulty switching between movements and experiences uncontrollable hand movements. What is the most likely diagnosis?

Dysdiadochokinesis. ***Dysdiadochokinesis***- This term refers to the impairment in the ability to perform **rapid alternating movements**, directly matching the complaint of "difficulty switching between movements" [2].- It is a classic sign of **cerebellar dysfunction**, which also accounts for the associated **uncontrollable movements** (often reflecting associated **ataxia** or **dysmetria**) [3].*Intentional Tremor*- This tremor is absent at rest, but its amplitude increases significantly as the patient attempts to reach a **visual target** (e.g., during the finger-to-nose test).- While it is a sign of **cerebellar disease**, the primary complaint in the stem is difficulty *switching* movements, which is characteristic of **dysdiadochokinesis**.*Metamorphosis*- This neurological term typically refers to **perceptual distortion** (specifically, *metamorphopsia* is the distortion of visual size or shape), which is unrelated to motor control or coordination.- It is not the term used to describe the inability to perform **rapid alternating movements** or uncontrolled movements due to cerebellar pathology.*Resting Tremor*- A resting tremor is maximal when the limb is completely relaxed and **supported against gravity**, classically seen in **Parkinson's disease** [1].- This tremor usually **improves significantly** or disappears entirely when the patient performs voluntary action, distinguishing it from intentional tremors and general lack of coordination.

Q: A 3-month-old child has a respiratory rate of 56/min with no chest indrawing and no danger signs. As per IMNCI what is the most appropriate diagnosis?

Pneumonia. ***Pneumonia***- As per IMNCI guidelines, for a child aged 2 months up to 12 months, a respiratory rate of $\geq 50$ breaths/min is classified as **fast breathing**.- Since the child has **fast breathing** (56/min) but lacks **chest indrawing** or **danger signs**, the yellow category of **Pneumonia** is diagnosed.*Cold and cough*- This classification is utilized when the child has cough or cold but shows **no fast breathing** and **no chest indrawing** (Green classification, No Pneumonia).*Severe Pneumonia*- This classification requires the presence of **chest indrawing** or any **general danger sign** (e.g., lethargy, convulsions, inability to drink) alongside fast breathing or stridor (Red classification).*Allergy*- IMNCI focuses on classifying levels of severity of common infections (like respiratory infections, diarrhea, fever) for immediate management, and **allergy** is not one of the primary classification categories.

Q: A neonate was born to a controlled gestational diabetes mother. At the time of birth, he was fine but 4 days later, he developed dyspnea with SpO2 80% at room air. What is the initial management?

Give 100% O2. ***Give 100% O2***- The infant is suffering from **severe hypoxemia** (SpO2 80%), which is a life-threatening emergency requiring immediate stabilization.- The initial step in managing severe, unexplained neonatal hypoxemia or respiratory distress is to administer **100% oxygen** (maximal FiO2) to quickly improve SpO2 above critical levels (typically targeting >90-95%) while investigations or ventilation preparations are made.*Give 21% to 30% O2*- This concentration range represents minimal supplementation and is insufficient for treating **severe hypoxemia** (SpO2 80%) in a neonate.- Such low levels of supplemental oxygen are typically reserved for patients with very **mild desaturations** or during the process of weaning oxygen support.*Give 50% O2*- While this is a higher concentration than room air, 50% O2 may still be inadequate for the initial stabilization of an infant with **SpO2 80%**.- In severe, life-threatening hypoxemia, the priority is maximum oxygen concentration (100% O2) delivery to ensure rapid correction of tissue hypoxia.*Observation*- An oxygen saturation of 80% signifies acute **respiratory failure** or severe compromise and must be treated as a medical emergency, not simply observed.- **Observation** without immediate intervention inevitably leads to worsening hypoxemia, potential end-organ damage, and cardiorespiratory arrest.

Q: Mechanism of action of botulinum toxin is:

Inhibits the release of acetylcholine. ***Inhibits the release of Acetylcholine***- Botulinum toxin (BoNT) is a **zinc metalloprotease** that cleaves **SNARE proteins** (e.g., SNAP-25) essential for vesicular fusion and neurotransmitter release.- By preventing the exocytosis of **acetylcholine (ACh)** vesicles at the **neuromuscular junction**, BoNT causes irreversible chemical denervation and resulting **flaccid paralysis**.*Inhibits Elongation factor 2*- Inhibition of **Elongation factor 2 (EF-2)** targets the host cell's **protein synthesis** machinery, leading to cell death.- This mechanism is characteristic of toxins like **Diphtheria toxin** and *Pseudomonas aeruginosa* **Exotoxin A**, not botulinum toxin.*Inhibits the release of GABA*- While BoNT can inhibit the release of various neurotransmitters, its defining clinical effect of **flaccid paralysis** is primarily due to inhibition of **acetylcholine** at the peripheral neuromuscular junction.- Inhibition of **GABA** (an inhibitory neurotransmitter) in the CNS would typically lead to increased CNS excitability or spasms, which is contrary to the effects of botulism.*Increases cAMP*- Increasing intracellular **cAMP** levels, usually via activation of **adenylate cyclase**, is the mechanism used by toxins such as **cholera toxin** and **pertussis toxin**.- This mechanism primarily causes large fluid shifts (diarrhea) or cellular dysfunction (like impaired phagocytosis) and is unrelated to botulinum toxin's paralytic action.

Q: Which of the following factors causes a rightward shift in the oxygen-hemoglobin dissociation curve?

Increase in CO₂. ***Increase in CO₂*** - An increase in the partial pressure of **carbon dioxide (PCO₂)** in the blood leads to a decrease in pH (increased H⁺ concentration), a phenomenon known as the **Bohr effect**. - This acidic environment stabilizes the **taut (T) state** of hemoglobin, reducing its affinity for oxygen and facilitating oxygen unloading to metabolically active tissues, thus causing a **rightward shift**. *Increase in O₂* - An increase in the partial pressure of **oxygen (PO₂)** represents a movement *along* the existing curve to the right, leading to a higher hemoglobin saturation percentage. - It does not alter the intrinsic affinity of hemoglobin for oxygen and therefore does not cause a shift of the entire curve. *Decrease in CO₂* - A decrease in **PCO₂** leads to an increase in blood pH (respiratory alkalosis), which increases hemoglobin's affinity for oxygen. - This increased affinity impairs oxygen release to tissues and causes a **leftward shift** of the curve, promoting oxygen uptake in the lungs. *Decrease in temperature* - A decrease in body **temperature** (hypothermia) increases the affinity of hemoglobin for oxygen. - This makes it more difficult for hemoglobin to release oxygen to the tissues, resulting in a **leftward shift** of the curve.

Q: In the jugular venous pressure (JVP) waveform, the "a" wave corresponds to:

Right Atrial contraction. ***Right Atrial contraction*** - The **'a' wave** is the first positive deflection in the JVP waveform and is produced by the increase in right atrial pressure during **atrial systole** (contraction). - This wave occurs just before the first heart sound (S1) and is notably absent in conditions like **atrial fibrillation** where coordinated atrial contraction is lost. *Tricuspid valve bulging into Right atria* - The bulging of the closed **tricuspid valve** into the right atrium at the beginning of ventricular systole contributes to the **'c' wave**. - The 'c' wave follows the 'a' wave and also reflects the transmitted pulsation from the adjacent **carotid artery**. *Right Atrial relaxation* - Right atrial relaxation leads to a fall in pressure, which is represented by the **'x' descent**. - This descent follows the 'c' wave and is caused by both atrial relaxation and the downward pulling of the atrial floor during ventricular contraction. *Right atrial filling* - The **'v' wave** represents the rise in right atrial pressure due to passive venous filling from the vena cavae while the tricuspid valve is closed. - This wave peaks just before the tricuspid valve opens at the beginning of diastole.

Q: A 55-year-old man presents to the hospital with auditory hallucinations and inability to recognize his own family members. He reports his last alcohol intake was 48 hours ago. What is the most likely diagnosis?

Delirium tremens. ***Delirium tremens***- This severe form of alcohol withdrawal typically manifests 48 to 96 hours after the last drink, aligning perfectly with the patient's 48-hour abstinence period.- The presence of **auditory hallucinations** combined with **inability to recognize family members** (indicating **delirium** or **global disorientation**) confirms the diagnosis of Delirium Tremens (DT), which also includes autonomic hyperactivity.*Alcoholic hallucinosis*- This condition is characterized primarily by **auditory hallucinations** but generally occurs earlier, typically 12 to 24 hours after cessation.- Crucially, alcoholic hallucinosis occurs with a **clear sensorium** (clear consciousness), meaning there is no significant **delirium** or global confusion, unlike the presentation described.*Alcohol-induced psychosis*- While this broad category encompasses alcohol-related psychotic symptoms, **Delirium Tremens** is the specific and most appropriate diagnosis for the severe, time-locked withdrawal syndrome involving **delirium**, hallucinations, and autonomic instability 48 hours post-cessation.- This term is less specific and fails to capture the emergent nature and associated **autonomic hyperactivity** seen in DT.*Schizophrenia*- Schizophrenia is a **primary psychotic disorder** with a typical onset in early adulthood and a chronic course; the acute onset of psychosis temporally linked to **alcohol cessation** suggests an organic etiology.- The presence of **global confusion/disorientation** (inability to recognize family) is highly indicative of **delirium** and rules out schizophrenia, which does not involve a clouding of consciousness.

Question 1

Identify the marked area in the image given.

Accepted Answer

Pouch of Douglas

Answer

Morrison's pouch

Answer

Vesicouterine pouch

Answer

Ischioanal Fossa

Question 2

A Tzanck smear prepared from a vesicle shows multinucleated giant cells. What is the diagnosis?

Accepted Answer

HSV

Answer

EBV

Answer

HIV

Answer

HPV

Question 3

A patient reports difficulty switching between movements and experiences uncontrollable hand movements. What is the most likely diagnosis?

Accepted Answer

Dysdiadochokinesis

Answer

Metamorphosis

Answer

Resting Tremor

Answer

Intentional Tremor

Question 4

A 3-month-old child has a respiratory rate of 56/min with no chest indrawing and no danger signs. As per IMNCI what is the most appropriate diagnosis?

Accepted Answer

Pneumonia

Answer

Cold and cough

Answer

Severe Pneumonia

Answer

Allergy

Question 5

A neonate was born to a controlled gestational diabetes mother. At the time of birth, he was fine but 4 days later, he developed dyspnea with SpO2 80% at room air. What is the initial management?

Accepted Answer

Give 100% O2

Answer

Observation

Answer

Give 50% O2

Answer

Give 21% to 30% O2

Question 6

What is the mechanism of action of botulinum toxin?

Accepted Answer

Inhibits acetylcholine release from the presynaptic terminal

Answer

Blocks the postsynaptic acetylcholine receptor

Answer

Inhibits acetylcholine reuptake

Answer

Inhibits acetylcholinesterase

Question 7

Mechanism of action of botulinum toxin is:

Accepted Answer

Inhibits the release of acetylcholine

Answer

Increases cAMP

Answer

Inhibits the release of GABA

Answer

Inhibits Elongation Factor 2

Question 8

Which of the following factors causes a rightward shift in the oxygen-hemoglobin dissociation curve?

Accepted Answer

Increase in CO₂

Answer

Increase in O₂

Answer

Decrease in CO₂

Answer

Decrease in temperature

Question 9

In the jugular venous pressure (JVP) waveform, the "a" wave corresponds to:

Accepted Answer

Right Atrial contraction

Answer

Tricuspid valve bulging into Right atria

Answer

Right Atrial relaxation

Answer

Right atrial filling

Question 10

A 55-year-old man presents to the hospital with auditory hallucinations and inability to recognize his own family members. He reports his last alcohol intake was 48 hours ago. What is the most likely diagnosis?

Accepted Answer

Delirium tremens

Answer

Schizophrenia

Answer

Alcoholic hallucinosis

Answer

Alcohol-induced psychosis

FMGE 2025

Anatomy

Dermatology

Internal Medicine

Pediatrics

Pharmacology

Physiology

Psychiatry