FMGE 2025 Practice Questions

Q: Which nerve is affected in the hand deformity shown in the image at rest? ![img-59.jpeg](img-59.jpeg)

Ulnar. ***Ulnar*** - The image displays a characteristic **claw hand** deformity, specifically affecting the 4th and 5th digits, which is a classic sign of **ulnar nerve** palsy. - This occurs due to paralysis of the ulnar-innervated muscles, primarily the **medial two lumbricals** and the **interossei**, leading to unopposed extension at the metacarpophalangeal (MCP) joints and flexion at the interphalangeal (IP) joints of the ring and little fingers. *Median* - A **median nerve** injury typically causes an **“ape hand”** deformity due to thenar muscle atrophy or a **“hand of benediction”** sign, where the patient cannot flex the 2nd and 3rd fingers when asked to make a fist. - Unlike the ulnar claw seen at rest, the hand of benediction is an **active sign** (seen on attempted action) and involves different digits. *Musculocutaneous* - The **musculocutaneous nerve** supplies the muscles in the anterior compartment of the arm, such as the **biceps brachii** and **brachialis**, which are responsible for elbow flexion. - An injury to this nerve results in a weak elbow flexion and forearm supination, but it does not cause any deformity in the hand. *None* - The deformity shown is a well-recognized clinical sign known as the **claw hand**. - This sign is specifically and directly linked to a lesion of the **ulnar nerve**, making this option incorrect.

Q: Identify the CTG pattern?

Early deceleration. ***Early deceleration*** - This pattern is characterized by a gradual, symmetrical decrease in fetal heart rate (FHR) where the onset, nadir, and recovery of the deceleration coincide with the beginning, peak, and end of a uterine contraction, creating a **mirror image**. - Early decelerations are caused by **fetal head compression** during contractions, which elicits a vagal response. They are considered physiological and are not typically associated with fetal hypoxia or acidosis. *Late decelerations* - These are characterized by a gradual decrease in FHR where the nadir of the deceleration occurs **after the peak** of the uterine contraction, indicating a delayed response. - Late decelerations are a non-reassuring sign caused by **uteroplacental insufficiency**, suggesting impaired oxygen exchange to the fetus. *Variable* - These are abrupt, sharp drops in the FHR that are variable in shape (often V, U, or W-shaped) and have an inconsistent relationship with uterine contractions. - Variable decelerations are caused by **umbilical cord compression**, which obstructs blood flow to the fetus. *Normal* - A normal or reassuring CTG trace would have a baseline FHR between 110-160 bpm, moderate variability (5-25 bpm), and the presence of accelerations with or without early decelerations. - While early decelerations can be part of a normal picture, the question asks to identify the specific pattern of deceleration present, which is 'early deceleration'.

Q: Identify the medical device shown in the image.

Balloon Tamponade. ***Balloon Tamponade*** - The image displays an intrauterine balloon, like a **Bakri balloon**, which is inflated within the uterine cavity to exert pressure on the bleeding surfaces of the endometrium. - This procedure, known as balloon tamponade, is a common and effective intervention for managing refractory **postpartum hemorrhage (PPH)**, particularly when caused by uterine atony. *Umbrella pack* - An umbrella pack is a method of uterine packing that uses gauze arranged in an "umbrella" fashion to apply pressure, rather than an inflatable balloon. - This technique is now less commonly used due to the availability of more effective and safer methods like balloon tamponade, and it carries a risk of **concealed hemorrhage**. *Parachute pack* - A parachute pack is another older gauze-packing technique used for uterine hemorrhage, distinct from the balloon device shown. - It has been largely superseded by modern interventions such as **uterine artery embolization** and balloon tamponade due to better outcomes and lower complication rates. *Cervical ablation* - Cervical ablation is a procedure to destroy abnormal tissue on the cervix, typically for treating **cervical dysplasia**, and does not involve an intrauterine balloon. - The image shows a device for hemorrhage control within the uterus, not a therapeutic procedure on the cervix itself.

Q: A 20-year-old male patient presented with localized pain, which is gradual in onset and worsened over time. X-ray showed the following finding. What is the diagnosis?

Osteosarcoma. ***Osteosarcoma*** - The X-ray shows a classic **sunburst appearance**, which represents spiculated periosteal new bone formation radiating outwards, a hallmark of osteosarcoma. - This diagnosis is supported by the patient's age (peak incidence in adolescence/young adulthood) and the tumor's location in the **metaphysis** of a long bone (distal tibia). *Ewing sarcoma* - This tumor typically presents with a lytic lesion and a lamellated, **"onion-skin" periosteal reaction**, which is different from the sunburst pattern seen here. - Ewing sarcoma most commonly arises in the **diaphysis** (shaft) of long bones or in flat bones like the pelvis. *Chondrosarcoma* - This is a malignant cartilage-forming tumor that typically affects older adults (usually >40 years), making it less likely in a 20-year-old. - Radiographically, it is characterized by **"ring-and-arc"** or **"popcorn" calcifications** within the tumor matrix, which are absent in this image. *Gout* - Gout is a form of inflammatory arthritis, not a bone tumor, and would present with acute joint pain and swelling rather than a gradual mass effect. - Radiographic findings in chronic gout include characteristic **"punched-out" erosions** with overhanging edges, which are completely different from the aggressive, bone-forming lesion shown.

Q: Which nerve will be involved in the following finding at rest?

Ulnar. ***Ulnar*** - The image displays a classic **Ulnar Claw Hand**, a deformity that occurs at rest due to ulnar nerve palsy. It specifically affects the 4th and 5th digits. - This is caused by paralysis of the medial two **lumbricals** (3rd and 4th) and the **interossei** muscles, leading to unopposed extension at the metacarpophalangeal (MCP) joints and flexion at the interphalangeal (IP) joints of the ring and little fingers. *Median* - A **median nerve** injury typically results in an **“Ape Hand”** deformity (thenar atrophy) or a **“Hand of Benediction”** when the patient tries to make a fist, affecting the 1st, 2nd, and 3rd digits. - It does not cause the clawing of the 4th and 5th digits seen in the image. *Musculocutaneous* - The **musculocutaneous nerve** innervates the muscles of the anterior compartment of the arm, such as the **biceps brachii** and **brachialis**. - Injury to this nerve would lead to weakness in elbow flexion and supination, not a deformity of the hand. *None* - The deformity shown is a well-known clinical sign directly linked to a specific peripheral nerve injury. - As the presentation is characteristic of an ulnar nerve palsy, this option is incorrect.

Q: Identify the instrument shown in the image:

Bohler braun splint. ***Bohler braun splint*** - The instrument shown is a **Bohler-Braun splint** (or frame), which is used to apply skeletal traction for fractures of the lower limb, particularly the **femur** and **tibia**. - Its design allows the limb to be elevated with the knee in a flexed position, which helps relax the muscles and facilitates the reduction of the fracture through a system of pulleys and weights. *Thomas splint* - A **Thomas splint** is primarily used for first-aid immobilization of **femoral shaft fractures**. It consists of a padded ring that fits into the groin and two long metal rods. - It provides fixed traction but does not have the elaborate pulley and frame system for bed-based skeletal traction seen in the image. *Volkmann splint* - A **Volkmann splint** is a type of gutter splint used for injuries to the **forearm, wrist, and hand**, not the lower leg. - It is specifically designed to prevent **Volkmann's ischemic contracture**, a deformity resulting from compartment syndrome in the forearm. *Cramer wire* - A **Cramer wire splint** is a flexible, ladder-like splint made of wire that can be bent and molded to fit a limb for temporary immobilization. - It is used for emergency splinting and is not strong enough to provide the definitive skeletal traction required for major long bone fractures.

Q: Based on the provided chest X-ray images, what is the most likely diagnosis?

Pulmonary Edema. ***Pulmonary Edema*** - The chest X-ray demonstrates diffuse, bilateral opacities with a central, perihilar distribution, creating the classic **"bat wing"** or **"butterfly"** appearance characteristic of pulmonary edema. - This pattern is caused by the accumulation of fluid in the **alveolar spaces**, often secondary to left-sided heart failure (cardiogenic pulmonary edema). *Hydrothorax* - Hydrothorax is a type of **pleural effusion** specifically involving serous fluid. The primary abnormality in the provided image is within the lung **parenchyma**, not the pleural space. - A significant hydrothorax would present as a homogenous opacification in the dependent parts of the lung with a **meniscus sign**, which is not the dominant feature here. *Pleural Effusion* - A pleural effusion is fluid in the **pleural space**, which would cause **blunting of the costophrenic angles** and a meniscus-shaped opacity. While a small effusion may be present, the main finding is the extensive **alveolar infiltrates**. - The central distribution of opacities seen in the image is not typical for an isolated pleural effusion, which collects in the most dependent areas. *Pulmonary Fibrosis* - Pulmonary fibrosis is a chronic condition that appears as **reticular opacities**, **honeycombing**, and lung volume loss on X-ray, which are signs of **interstitial scarring**. - The image shows acute **airspace (alveolar) opacities**, not the chronic interstitial changes typical of fibrosis.

Q: A 65-year-old patient presents with abdominal distension and constipation. What is the most likely diagnosis based on the abdominal X-ray shown?

Sigmoid Volvulus. ***Sigmoid Volvulus*** - The abdominal X-ray shows a classic **coffee bean sign**, which is a massively dilated, inverted U-shaped loop of the sigmoid colon rising from the pelvis. - The loop is characteristically **ahaustral** (lacking haustra) and its apex points towards the right upper quadrant, confirming the diagnosis of sigmoid volvulus. *Caecal Volvulus* - A caecal volvulus typically appears as a **kidney-shaped** or comma-shaped dilated loop of bowel, often located in the left upper quadrant or mid-abdomen. - Unlike the sigmoid, the dilated caecum in a volvulus usually retains its **haustral markings**. *Intestinal Obstruction* - While a volvulus does cause an intestinal obstruction, this option is a general finding rather than the specific diagnosis indicated by the classic radiographic sign. - General large bowel obstruction typically shows colonic dilation proximal to the blockage, without the specific twisted appearance of the **coffee bean sign**. *Small Bowel Volvulus* - A small bowel volvulus would involve dilated loops of the small bowel, which would typically show **valvulae conniventes** (plicae circulares). - This condition is rare in adults and the image clearly shows a dilated, **ahaustral** segment of the large bowel, which is inconsistent with small bowel anatomy.

Q: Based on the provided X-ray image, identify the most likely diagnosis.

Osteosarcoma. ***Osteosarcoma*** - The X-ray demonstrates a classic **"sunburst"** or **"sun-ray"** appearance, which is a periosteal reaction caused by tumor spicules radiating outwards. This is a hallmark sign of osteosarcoma. - This malignant tumor typically arises in the **metaphysis** of long bones, such as the distal femur, proximal tibia, and proximal humerus, and is often associated with a soft tissue mass and aggressive bone destruction. *Ewing sarcoma* - Radiographically, Ewing sarcoma more commonly presents with a lamellated or **"onion-skin"** periosteal reaction or a destructive, **"moth-eaten"** appearance. - It is a **small round blue cell tumor** that typically affects the **diaphysis** of long bones in children and young adults. *Chondrosarcoma* - This is a malignant tumor of cartilage-producing cells, characterized by **"popcorn"** or **"ring-and-arc"** calcifications on X-ray, which are not seen in this image. - Chondrosarcoma typically affects older adults (over 40) and commonly involves the bones of the pelvis and trunk. *Gout* - Gout is a form of inflammatory arthritis, not a tumor. Its classic radiographic finding is **"punched-out"** erosions with sclerotic margins and overhanging edges, often called **"rat-bite"** erosions. - It does not cause a sunburst periosteal reaction and commonly affects the first metatarsophalangeal joint.

Q: A 70-year-old patient presents with absolute constipation and abdominal distension. The X-ray abdomen is given below. What is the most likely diagnosis?

Sigmoid Volvulus. ***Sigmoid Volvulus*** - The abdominal X-ray demonstrates the classic **"coffee bean" sign**, which is a massively dilated, haustra-less loop of the sigmoid colon that appears bent upon itself, originating from the pelvis. - This diagnosis aligns with the clinical presentation of an elderly patient with **absolute constipation** and significant **abdominal distension**, which are hallmark features of a closed-loop large bowel obstruction caused by sigmoid volvulus. *Caecal Volvulus* - A caecal volvulus typically presents as a **kidney-bean** or **comma-shaped** dilated structure that is displaced from the right lower quadrant towards the left upper quadrant, which is morphologically distinct from the inverted U-shape seen in the image. - The dilated cecum in a caecal volvulus often retains some **haustral markings**, unlike the smooth, featureless appearance of the dilated sigmoid colon seen here. *Intestinal Obstruction* - While sigmoid volvulus is a cause of intestinal obstruction, this is a non-specific diagnosis. The radiological findings are specific enough to identify the underlying cause. - A general diagnosis of intestinal obstruction doesn't account for the pathognomonic **"coffee bean" sign**, which specifically points to sigmoid volvulus as the etiology. *Small Bowel Volvulus* - The dilated loop in the X-ray lacks **valvulae conniventes** (also known as plicae circulares), which are characteristic transverse folds of the small bowel. The loop's appearance is consistent with the large bowel. - The caliber of the distended loop is exceptionally large, which is more typical for a colonic obstruction rather than a small bowel obstruction, which usually involves multiple, smaller-caliber loops.

Question 1

Which nerve is affected in the hand deformity shown in the image at rest? ![img-59.jpeg](img-59.jpeg)

Accepted Answer

Ulnar

Answer

Median

Answer

Musculocutaneous

Answer

None

Question 2

Identify the CTG pattern?

Accepted Answer

Early deceleration

Answer

Late deceleration

Answer

Variable

Answer

Normal

Question 3

Identify the medical device shown in the image.

Accepted Answer

Balloon Tamponade

Answer

Umbrella pack

Answer

Parachute pack

Answer

Cervical ablation

Question 4

A 20-year-old male patient presented with localized pain, which is gradual in onset and worsened over time. X-ray showed the following finding. What is the diagnosis?

Accepted Answer

Osteosarcoma

Answer

Ewing sarcoma

Answer

Chondrosarcoma

Answer

Gout

Question 5

Which nerve will be involved in the following finding at rest?

Accepted Answer

Ulnar

Answer

Median

Answer

Musculocutaneous

Answer

None

Question 6

Identify the instrument shown in the image:

Accepted Answer

Bohler braun splint

Answer

Thomas splint

Answer

Volkmann splint

Answer

Cramer wire

Question 7

Based on the provided chest X-ray images, what is the most likely diagnosis?

Accepted Answer

Pulmonary Edema

Answer

Hydrothorax

Answer

Pleural Effusion

Answer

Pulmonary Fibrosis

Question 8

A 65-year-old patient presents with abdominal distension and constipation. What is the most likely diagnosis based on the abdominal X-ray shown?

Accepted Answer

Sigmoid Volvulus

Answer

Caecal Volvulus

Answer

Intestinal Obstruction

Answer

Small Bowel Volvulus

Question 9

Based on the provided X-ray image, identify the most likely diagnosis.

Accepted Answer

Osteosarcoma

Answer

Chondrosarcoma

Answer

Gout

Answer

Ewing sarcoma

Question 10

A 70-year-old patient presents with absolute constipation and abdominal distension. The X-ray abdomen is given below. What is the most likely diagnosis?

Accepted Answer

Sigmoid Volvulus

Answer

Caecal Volvulus

Answer

Intestinal Obstruction

Answer

Small Bowel Volvulus

FMGE 2025

Anatomy

Obstetrics and Gynecology

Orthopaedics

Radiology

Surgery