FMGE 2025 Practice Questions

Q: A patient with a family history of colon cancer undergoes colonoscopy for screening. This is an example of which level of prevention?

Secondary. ***Secondary (Correct Answer)*** - Screening procedures like **colonoscopy** are measures for the **early detection and timely treatment** of asymptomatic conditions, such as precancerous **polyps** or early-stage cancer - This level of prevention intervenes when the disease process may have started but is **not yet clinically evident**, aiming to reduce disease progression and **mortality** - Secondary prevention is the hallmark of screening programs in at-risk populations *Primary (Incorrect)* - Primary prevention aims to prevent the **onset** of disease by modifying risk factors or enhancing resistance (e.g., **vaccination**, regular exercise, dietary modifications) - Since the patient is undergoing a procedure to detect an existing (though potentially asymptomatic) pathology, this is beyond preventing the initial cause - Primary prevention would involve measures like promoting a high-fiber diet or reducing red meat consumption to prevent colon cancer from developing *Tertiary (Incorrect)* - Tertiary prevention focuses on minimizing the progression, complications, or disability caused by an **established symptomatic disease** (e.g., **chemotherapy** for diagnosed cancer, cardiac rehabilitation post-MI) - Screening is performed **before** the disease is advanced or causes symptoms, which is the domain of secondary prevention - Tertiary prevention applies after diagnosis and aims at rehabilitation and preventing complications *Primordial (Incorrect)* - Primordial prevention targets **social and environmental conditions** to inhibit the emergence of risk factors for disease in the population (e.g., **public policy** aimed at reducing saturated fat intake, tobacco control policies) - It operates at a broader, **systemic level** and does not involve individual patient screening or intervention measures - This is the most upstream level of prevention, addressing conditions that predispose to risk factor development

Q: What is the usual method of collecting a sample of urine to detect UTI?

Midstream catch. ***Midstream catch*** - This technique is the *standard, non-invasive method* for routine urine culture as it minimizes **contamination** from bacteria residing in the distal urethra and periurethral area. - By discarding the initial urine (starting stream) and collecting the middle portion, the sample is more representative of the urine contained within the **bladder**. *Early morning sample* - While an early morning sample is often preferred for optimal concentration (e.g., detecting **proteinuria** or **casts**), it is not the methodology for *minimizing contamination*. - The collection technique (midstream) is more critical than the time of day for ensuring a reliable sample for **UTI culture**. *Suprapubic catheter* - Suprapubic aspiration (SPA) provides an **uncontaminated specimen** (often considered the gold standard), but it is an invasive procedure requiring a needle insertion into the bladder. - It is reserved for specific situations, such as neonates or patients with ambiguous results, and is not the **usual** collection method. *Starting stream collection* - The starting stream is most likely to be contaminated with **urethral flora** (e.g., *Staphylococcus epidermidis* or environmental organisms). - Collecting the starting stream significantly increases the chance of **false positive** culture results, confusing the diagnosis of a true **UTI**.

Q: A patient is diagnosed with Cryptococcal meningitis. What is the treatment?

Flucytosine + L.Amp. ***Correct: Flucytosine + L.Amp (Liposomal Amphotericin B)*** - This is the **standard induction therapy** for Cryptococcal meningitis as per WHO and CDC guidelines [1] - **Combination therapy** is superior to monotherapy, reducing mortality and improving outcomes [1] - The induction phase lasts **2 weeks**, followed by consolidation with fluconazole [1] - Liposomal Amphotericin B has **better CNS penetration** and fewer nephrotoxic effects compared to conventional Amphotericin B - Flucytosine enhances fungicidal activity and reduces the risk of resistance [1] *Incorrect: L.Amp alone* - Monotherapy with Amphotericin B is **less effective** than combination therapy [1] - Higher rates of treatment failure and relapse when used alone - Should always be combined with flucytosine when available [1] *Incorrect: Fluconazole alone* - Fluconazole is used in **consolidation phase** (after induction) and maintenance therapy - **Not recommended for induction** due to its fungistatic (not fungicidal) action - Slower CSF sterilization compared to combination therapy *Incorrect: Flucytosine alone* - **Never used as monotherapy** due to rapid development of resistance - Must always be combined with Amphotericin B or Azoles - Has good CSF penetration but inadequate as sole agent

Q: A 23-year-old female visited the clinician with a solitary thyroid nodule and was advised for thyroid function tests where TSH level is 27.3 mU/L, T3 is 1.24 ng/mL, and T4 is 4.87 μg/dL. Which of the following manifestations is true regarding the condition?

Weight gain. ***Weight gain***- The patient's thyroid function tests (TFTs), showing a **highly elevated TSH** (27.3 mU/L) and **low T4** (4.87 μg/dL), confirm a diagnosis of **Primary Hypothyroidism** [1].- Weight gain is a classic symptom of hypothyroidism, resulting from reduced **basal metabolic rate** and frequently accompanied by **fluid retention** leading to *myxedema* [2]. *Heat intolerance*- Heat intolerance is a characteristic feature of **Hyperthyroidism**, where excess thyroid hormone increases heat production.- Patients with hypothyroidism typically experience **cold intolerance** due to decreased thermogenesis [2]. *Tachycardia*- **Tachycardia** (increased heart rate) is a common cardiovascular manifestation of **Hyperthyroidism** due to enhanced adrenergic effects [2].- Hypothyroidism generally leads to **bradycardia** (slow heart rate) and reduced cardiac contractility [2]. *Diarrhea*- Diarrhea is associated with **Hyperthyroidism** because of increased gastrointestinal motility.- Patients suffering from hypothyroidism commonly present with decreased bowel motility, leading to **constipation** [2].

Q: In a child presenting with a beaded appearance in the chest with the following X-ray, what is the diagnosis? ![img-94.jpeg](img-94.jpeg)

Rickets. ***Rickets*** - The clinical finding of a "beaded appearance" in the chest refers to **rachitic rosary**, which is a classic sign of rickets caused by the enlargement of the costochondral junctions. - The wrist X-ray confirms the diagnosis by showing characteristic features of defective bone mineralization, including **cupping**, **fraying**, and widening of the distal metaphysis of the radius and ulna. *Scurvy* - Scurvy, caused by **vitamin C deficiency**, typically presents with **bleeding gums**, poor wound healing, and perifollicular hemorrhage, not skeletal deformities like a rachitic rosary. - Radiographic findings in scurvy include a **white line of Fraenkel** (a dense metaphyseal line) and subperiosteal hemorrhages, which are absent in the provided X-ray. *Beri Beri* - Beri Beri is a result of **thiamine (vitamin B1) deficiency** and primarily manifests with neurological (dry beriberi) or cardiovascular (wet beriberi) symptoms. - This condition does not cause the characteristic skeletal abnormalities or radiographic changes seen in rickets. *Pellagra* - Pellagra is caused by **niacin (vitamin B3) deficiency** and is characterized by the classic triad of **dermatitis**, **diarrhea**, and **dementia** (the "3 Ds"). - It is a systemic illness that does not involve the skeletal system in the manner described or shown in the X-ray.

Q: A patient with diffuse severely contaminated peritonitis underwent laparotomy and was left open after surgery. Which of the following might help?

VAC. ***VAC***- **VAC (Vacuum-Assisted Closure)** is the gold standard for managing the damage control abdomen (laparostomy) following severe peritonitis, as it actively drains contaminated fluid and reduces **peritoneal edema**.- By applying controlled **negative pressure**, VAC protects the underlying visceral contents, prevents fascial retraction, and facilitates a definitive delayed primary or secondary fascial closure.*Normal saline soaked gauze*- This traditional method provides only passive protection and is inferior because it allows **contaminated exudates** to pool within the abdomen, increasing the risk of residual infection.- It necessitates multiple, often painful, changes and does not effectively prevent **fascial retraction**, making subsequent closure more challenging than with VAC.*Prefer closure after laparotomy*- Immediate closure in the context of **severe diffuse contamination** is contraindicated due to an unacceptably high risk of septic complications and residual **intraperitoneal infection**.- Primary closure may also lead to **Abdominal Compartment Syndrome (ACS)** due to significant bowel and peritoneal edema, which has high associated morbidity and mortality.*Antibiotic soaked gauze*- Local application of **antibiotic-soaked gauze** lacks scientific support and does not replace effective systemic antibiotic therapy combined with adequate drainage.- Like NS gauze, it is unable to create a controlled environment for fluid removal or prevent **fascial domain loss**, making definitive closure difficult.

Q: A patient presents to the emergency department with confusion. On examination, he opens his eyes to pain, shows abnormal flexion to pain, and is disoriented in speech. What is his Glasgow Coma Scale (GCS) score?

9. ***9***- The Glasgow Coma Scale (GCS) total score is the sum of scores for Eye (E), Verbal (V), and Motor (M) responses (E+V+M). - **Eye Opening (E)** score is 2 for opening eyes only to **painful stimuli** (4=Spontaneous, 1=None). - **Verbal Response (V)** score is 4 for **disoriented in speech**, which is categorized as disoriented/confused conversation (5=Oriented, 3=Inappropriate Words). - **Motor Response (M)** score is 3 for showing **abnormal flexion** (Decorticate posturing) to pain (6=Obeys Commands, 1=None). Total GCS = 2 + 4 + 3 = **9**. *11* - A GCS of 11 is too high for this clinical presentation, as it implies a much better neurological status, typically requiring higher E, V, and M scores (e.g., E3/4, V4/5, M4/5). - This score conflicts with the patient's severe responses: E=2 (to pain) and M=3 (**abnormal flexion**), which together limit the maximum possible GCS to 11 (2+5+4). *12* - A GCS of 12 represents a moderate head injury, which is inconsistent with the patient demonstrating **abnormal flexion** (M=3), a sign often associated with severe injury or significant cerebral dysfunction. - Achieving a score of 12 would necessitate very strong cognitive responses (e.g., E4, V5, M3), which contradict the observed responses of E=2 and M=3. *10* - While close to the correct score, 10 would require a combination like E2, V5, M3, meaning the patient should be **oriented verbally** (V=5). - The patient is explicitly described as "**disoriented in speech**," which dictates a verbal score of V=4 or less, thus ruling out GCS 10.

Q: Identify the part of the ulcer indicated by the arrow in the image.

Edge. ***Edge*** - The arrow correctly identifies the **edge** of the ulcer, which is the **side wall extending from the margin down to the floor**. - The characteristics of the edge (e.g., sloping, punched-out, undermined, rolled, everted) are crucial for determining the ulcer's etiology and whether it is healing or progressing. - Edge characteristics help differentiate between **healing ulcers** (sloping edge), **tuberculous ulcers** (undermined edge), **malignant ulcers** (everted/rolled edge), and **syphilitic ulcers** (punched-out edge). *Margin* - The **margin** is the junction line that separates the ulcer from the surrounding normal tissue. - It represents the **outermost perimeter** of the ulcer. The arrow points inside this boundary, specifically to the wall of the ulcer, not the margin itself. *Floor* - The **floor** is the visible **bottom surface** of the ulcer crater, composed of exposed subcutaneous tissue or deeper structures. - The arrow is pointing to the **side wall**, not the bottom surface. - The floor can be covered by healthy granulation tissue (pink, healing), slough (yellow), or necrotic debris (black eschar). *Base* - The **base** refers to the **tissue upon which the ulcer rests** and is assessed by **palpation**, not visualization. - It describes the deep aspect beneath the floor - can be indurated (hardened, suggests malignancy), mobile, or fixed to deeper structures like fascia, tendon, or bone.

Q: A 34-year-old male undergoes an open appendectomy for acute appendicitis. The choice of incision was McBurney's incision. Postoperatively, after a few days, he presents with pain and bulging in the right lower quadrant, which is diagnosed as an indirect inguinal hernia. Which nerve injury during the appendectomy is most likely responsible for this complication?

Ilioinguinal nerve. ***Ilioinguinal nerve*** - The **ilioinguinal nerve** (L1) runs between the internal oblique and transversus abdominis muscles in the inguinal region and passes through the superficial inguinal ring - During **McBurney's incision** (muscle-splitting incision at McBurney's point), the ilioinguinal nerve is at risk of injury as it traverses the layers of the anterior abdominal wall - **Mechanism of hernia formation:** Injury to the ilioinguinal nerve causes denervation and atrophy of the internal oblique and transversus abdominis muscles, which weakens the posterior wall of the inguinal canal - This muscular weakness predisposes to **indirect inguinal hernia** formation through the internal inguinal ring - **Classic presentation:** Pain and bulging in the inguinal region post-appendectomy *Pudendal nerve* - Arises from S2-S4 and runs through the **pelvis and perineum** (pudendal canal) - Not at risk during appendectomy as it is far from the surgical field - Injury would cause perineal sensory loss and sphincter dysfunction, not hernia *Genitofemoral nerve* - Runs on the psoas muscle and divides into genital and femoral branches - While the genital branch passes through the inguinal canal, injury typically causes **sensory loss** in the groin and scrotum/labia - Does **not** cause motor weakness or hernia formation *Femoral nerve* - Runs beneath the **inguinal ligament** in the femoral triangle - Not at risk during McBurney's incision - Injury would cause quadriceps weakness and loss of knee extension, not hernia

Question 1

A patient with a family history of colon cancer undergoes colonoscopy for screening. This is an example of which level of prevention?

Accepted Answer

Secondary

Answer

Primary

Answer

Tertiary

Answer

Primordial

Question 2

What is the usual method of collecting a sample of urine to detect UTI?

Accepted Answer

Midstream catch

Answer

Starting stream collection

Answer

Early morning sample

Answer

Suprapubic catheter

Question 3

Which of the following is the correct arrangement about the levels of health care?

Accepted Answer

1- Sub Centre and PHC are primary level, 2- CHC is secondary level, 3- Medical colleges and hospitals are tertiary

Answer

1- CHC is primary level, 2- Sub Centre and PHC are secondary level, 3- Medical colleges and hospitals are tertiary

Answer

1- Medical colleges and hospitals are primary level, 2- CHC is secondary level, 3- Sub Centre and PHC are tertiary

Answer

1- PHC is primary level, 2- Sub Centre is secondary level, 3- Medical colleges and hospitals are tertiary

Question 4

A patient is diagnosed with Cryptococcal meningitis. What is the treatment?

Accepted Answer

Flucytosine + L.Amp

Answer

L.Amp

Answer

Fluconazole

Answer

Flucytosine

Question 5

A 23-year-old female visited the clinician with a solitary thyroid nodule and was advised for thyroid function tests where TSH level is 27.3 mU/L, T3 is 1.24 ng/mL, and T4 is 4.87 μg/dL. Which of the following manifestations is true regarding the condition?

Accepted Answer

Weight gain

Answer

Diarrhea

Answer

Tachycardia

Answer

Heat intolerance

Question 6

In a child presenting with a beaded appearance in the chest with the following X-ray, what is the diagnosis? ![img-94.jpeg](img-94.jpeg)

Accepted Answer

Rickets

Answer

Beri Beri

Answer

Pellagra

Answer

Scurvy

Question 7

A patient with diffuse severely contaminated peritonitis underwent laparotomy and was left open after surgery. Which of the following might help?

Accepted Answer

VAC

Answer

Prefer closure after laparotomy

Answer

Normal saline soaked gauze

Answer

Antibiotic soaked gauze

Question 8

A patient presents to the emergency department with confusion. On examination, he opens his eyes to pain, shows abnormal flexion to pain, and is disoriented in speech. What is his Glasgow Coma Scale (GCS) score?

Accepted Answer

9

Answer

12

Answer

11

Answer

10

Question 9

Identify the part of the ulcer indicated by the arrow in the image.

Accepted Answer

Edge

Answer

Floor

Answer

Margin

Answer

Base

Question 10

A 34-year-old male undergoes an open appendectomy for acute appendicitis. The choice of incision was McBurney's incision. Postoperatively, after a few days, he presents with pain and bulging in the right lower quadrant, which is diagnosed as an indirect inguinal hernia. Which nerve injury during the appendectomy is most likely responsible for this complication?

Accepted Answer

Ilioinguinal nerve

Answer

Pudendal nerve

Answer

Genitofemoral nerve

Answer

Femoral nerve

FMGE 2025

Community Medicine

Internal Medicine

Pediatrics

Surgery