FMGE 2025 Practice Questions

Q: A 45-year-old patient presents with difficulty reacting to bright light. On examination, the pupillary light reflex is absent but the near reflex is preserved. Where is the lesion likely located?

Pretectal area of the midbrain. ***Pretectal area of the midbrain*** This clinical presentation describes **light-near dissociation** (Argyll Robertson pupil), where the pupillary light reflex is absent but the near (accommodation) reflex is preserved [2]. **Pathway Analysis:** - **Light reflex pathway**: Retina → optic nerve → optic tract → pretectal nucleus → bilateral Edinger-Westphal nuclei → pupillary constriction [1]. - **Near reflex pathway**: Visual cortex → frontal eye fields → Edinger-Westphal nucleus (bypasses pretectal area) **Why this lesion causes the finding:** A lesion in the **pretectal area** interrupts the light reflex pathway while sparing the near reflex pathway (which doesn't pass through the pretectal area), resulting in the characteristic light-near dissociation [2]. **Clinical significance:** - Classic finding in neurosyphilis (tabes dorsalis) [1] - Also seen in diabetes mellitus, multiple sclerosis, and midbrain lesions [1] - Pupils are typically small, irregular, and show poor light response *Incorrect - Edinger-Westphal nucleus* - This is the parasympathetic nucleus that provides the **final common pathway** for BOTH light and near reflexes [2] - A lesion here would abolish **both reflexes**, not cause dissociation *Incorrect - Optic nerve* - Lesion would cause an **afferent pupillary defect** (Marcus Gunn pupil) - Light reflex would be impaired in the affected eye, but near reflex would remain intact in both eyes - This doesn't explain bilateral light-near dissociation *Incorrect - Oculomotor nerve* - Carries parasympathetic fibers from Edinger-Westphal nucleus to the eye [2] - Lesion would cause **efferent defect** affecting both light AND near reflexes - Would also cause ptosis, ophthalmoplegia, and pupil dilation

Q: A girl with schizophrenia presents to a Primary Health Centre (PHC) in India. Which of the following online applications, provided by the Government of India (GOI), is used for mental health service support?

Tele MANAS. ***Tele MANAS*** - **Tele MANAS** (Tele Mental Health Assistance and Networking Across States) is the Government of India's national initiative providing **24/7 tele-counseling and mental health support** across the country, making it the correct service for a schizophrenia patient. - It functions as a **tele-mental health facility** under the National Mental Health Programme, offering critical assistance and linkage to specialized services. *eSanjeevani* - **eSanjeevani** is the GOI's national telemedicine platform providing **general healthcare consultations** through doctor-to-doctor (eSanjeevani HWC) and patient-to-doctor (eSanjeevani OPD) services. - While it offers broad healthcare services, it is **not the dedicated mental health support system** - that specific function is served by **Tele MANAS**. *NIKSHAY* - **NIKSHAY** is the standardized web-enabled application used for monitoring and tracking all patients diagnosed with **Tuberculosis (TB)** in India. - It handles notification, diagnosis, treatment adherence, and outcomes for **TB control**, having no operational role in providing mental health counseling. *U-WIN* - **U-WIN** is the digital platform developed by the GOI for managing and digitizing data related to the **Universal Immunization Programme (UIP)**. - It focuses specifically on **immunization records**, tracking vaccination status, scheduling, and overall coverage, making it unrelated to mental health services.

Q: A girl, after returning from a picnic, complains of pain in her eyes. She had not maintained proper hygiene of her contact lenses. What would be the cause?

Acanthamoeba. ***Acanthamoeba*** - **Acanthamoeba** is a free-living amoeba commonly found in water sources (tap water, lakes, swimming pools) and soil. - Poor contact lens hygiene, such as rinsing lenses or storing them in non-sterile solutions (like tap water, which might be encountered during a picnic or travel hygiene lapse), is a key risk factor for **Acanthamoeba keratitis (AK)**. - AK is characterized by severe ocular pain, often disproportionate to the clinical findings, and can lead to a pathognomonic **ring-shaped corneal infiltrate**. - The combination of **outdoor water exposure + contact lens use + poor hygiene** strongly suggests Acanthamoeba. *Pseudomonas aeruginosa* - **Pseudomonas aeruginosa** is the most common cause of **bacterial keratitis** in contact lens users, especially with improper hygiene. - It typically causes rapidly progressive, purulent corneal ulceration with a characteristic greenish discharge. - While very common in contact lens wearers, the clinical picture here (picnic setting with potential water exposure) more specifically points to a protozoal etiology. *Herpes simplex virus* - **Herpes simplex virus (HSV)** causes recurrent viral keratitis, typically presenting with characteristic **dendritic ulcers** on the cornea. - HSV transmission is via contact with infected bodily fluids or reactivation of latent virus, not through contact lens solution contamination. *Fusarium* - **Fusarium** is a fungus that can cause fungal keratitis in contact lens wearers, particularly with exposure to organic matter or contaminated lens solutions. - Fungal keratitis tends to have a more indolent course with feathery, elevated stromal infiltrates. - While possible in contact lens users, the specific epidemiological context and clinical pattern here favor Acanthamoeba over Fusarium.

Q: A patient presents with a painless ulcer in the eye. On examination, a long, branching ulcer with desquamated epithelium is seen on the cornea. What is the most likely diagnosis?

Neurotrophic ulcer. ***Neurotrophic ulcer***- The defining feature of a **neurotrophic ulcer** is the **painless** nature of the epithelial defect, resulting from damage to the **trigeminal nerve** (CN V1) leading to loss of corneal sensation.- The ulcer morphology, described as a persistent epithelial defect (ulcer) with a desquamated, **geographic** or long-branching appearance, is characteristic of the poor healing seen in the setting of chronic denervation.*Fungal ulcer*- Fungal ulcers typically cause marked pain, photophobia, and conjunctival injection, which contrasts sharply with the painless presentation in this patient.- Morphologically, they are often characterized by elevated, gray-white ulcers with **feathery borders** and commonly exhibit satellite lesions or an underlying **immune ring**.*Dendritic ulcer*- A **dendritic ulcer** is pathognomonic for **Herpes Simplex Virus (HSV) keratitis** and is usually associated with significant pain and foreign body sensation.- While it is branching, it stains vividly, and its key features are **terminal bulbs** at the ends of the branches, differentiating it from the desquamated, geographic type of defect seen in neurotrophic disease.*Bacterial corneal ulcer*- Bacterial corneal ulcers are extremely painful, rapidly progressive, and associated with profound inflammation, ciliary injection, and often significant **anterior chamber reaction (hypopyon)**.- They usually present as dense, whitish-yellow **stromal infiltrates** with an overlying epithelial defect, not a painless, superficially desquamated pattern.

Q: A 45-year-old patient with eye examination findings of a deep anterior chamber and jet-black pupil is prescribed +12D glasses. Likely diagnosis?

Aphakia. **Aphakia** - The natural lens contributes approximately +15 to +20 diopters of refractive power; its absence (aphakia) results in severe **hypermetropia**, requiring a strong convex lens, typically around **+10D to +12D**, for correction. - The clinical findings—a **deep anterior chamber** (due to the backward displacement of the iris) and a distinctive **jet-black pupil** (due to the lack of the lens obscuring the view of the retina/fundus)—are classic signs of aphakia. *Pseudophakia* - **Pseudophakia** is the state of having an **intraocular lens (IOL)**, which restores the eye's refractive power, meaning the patient typically needs minimal spectacle correction, usually < +3D, not +12D. - While the pupil might appear black, the necessary post-operative correction power rules out residual uncorrected aphakia that requires +12D. *Myopia* - **Myopia** (nearsightedness) requires **concave (minus)** lenses for correction, standing in direct contrast to the strong **convex (+12D)** lens prescribed to this patient. - Myopia is caused by excessive axial length or corneal curvature, and it does not result in a pathologically deep anterior chamber or necessitate high-plus glasses. *Hypermetropia* - Although aphakia causes hypermetropia, primary, non-aphakic **hypermetropia** is usually corrected with lenses significantly weaker than **+12D** (typically < +6D). - Primary hypermetropia is usually related to a short axial length but is not typically associated with the defining features of a **jet-black pupil** or an abnormally **deep anterior chamber**.

Q: A patient presents with painful lid swelling. On examination, a pus point is observed at the base of an eyelash. Which of the following glands is involved?

Zeis gland. ***Correct: Zeis gland*** - An acute pyogenic infection of the **Gland of Zeis** (a sebaceous gland associated with the eyelash follicle) is defined as an **external hordeolum** (stye). - The presence of a localized, painful swelling with a **pus point directed externally at the base of an eyelash** is the hallmark presentation of a stye. - External hordeolum classically involves the Zeis gland, though Moll glands may also be implicated. *Incorrect: Meibomian gland* - Infection of the Meibomian glands (located deep within the tarsal plate) leads to an **internal hordeolum**. - An internal hordeolum usually presents with swelling pointing *inward* toward the conjunctival surface, not externally at the lash base. *Incorrect: Lacrimal gland* - The lacrimal gland is located in the **superolateral aspect** of the orbit and is responsible for tear production. - Infection (**dacryoadenitis**) causes swelling in the upper, outer part of the eye, presenting as an **S-shaped curve** of the lid margin, distinct from a localized eyelid margin infection. *Incorrect: Moll gland* - Moll glands are modified **apocrine sweat glands** that also open near the lash follicle. - While their infection can contribute to external hordeolum, the **Zeis gland** (sebaceous) is classically cited as the primary source of acute, localized pus point at the base of the eyelash in standard teaching.

Q: A man presents to the hospital with a bizarre behavior. He is unable to recall his personal identity and has no memory of how he traveled 100 km to reach the hospital. A collateral history reveals he experienced a traumatic earthquake a few months ago. Which of the following is the most likely diagnosis?

Dissociative amnesia. ***Dissociative amnesia*** - The presentation of sudden, unplanned travel away from home (called **dissociative fugue**) combined with an inability to recall important **autobiographical information** (personal identity) is the classic manifestation of severe dissociative amnesia. - This disorder is overwhelmingly triggered by psychological stress or **trauma**, such as the patient's recent experience of a traumatic earthquake. *Dissociative identity disorder* - This disorder requires the presence of two or more distinct personality states (or **alters**) that recurrently take control of the person's behavior, which is not described here. - While amnesia is a feature, the primary pathology is the fragmentation of identity, not just the loss of personal autobiographical memory without distinct alters. *Schizophrenia* - Schizophrenia is characterized by **psychotic features** such as delusions, hallucinations, and grossly disorganized thinking and behavior, which are absent in this presentation. - The core deficit here is memory and identity retrieval linked to trauma, not a primary thought disorder or persistent **psychosis**. *Global amnesia* - **Transient Global Amnesia (TGA)** involves anterograde amnesia (inability to form new memories) and retrograde amnesia (loss of recent past memories). - Crucially, in contrast to dissociative amnesia, severe impairment of **personal identity** and highly selective memory loss linked to trauma are typically absent in TGA.

Q: A 28-year-old software engineer presents with sleep disturbances, low mood, and stress for the past 3 months. He attributes his symptoms to ongoing problems at work. He has no prior psychiatric history. Which of the following is the most likely diagnosis?

Adjustment disorder. ***Adjustment disorder*** - This diagnosis is characterized by the development of emotional or behavioral symptoms in response to an identifiable **psychosocial stressor** (ongoing work problems) occurring within **3 months** of the onset of the stressor. - The patient's symptoms (low mood, stress, sleep disturbances) are clinically significant but do not meet the full diagnostic criteria for a more severe disorder like **Major Depressive Disorder** or **Generalized Anxiety Disorder**. *Generalized anxiety disorder* - This disorder primarily involves **excessive anxiety and worry** about numerous events or activities, occurring more days than not for at least **6 months**. - The patient's symptoms are directly tied to a specifiable stressor, making adjustment disorder a better fit than the broader, persistent worry characteristic of GAD. *Acute stress disorder* - This diagnosis requires exposure to a **traumatic stressor** (e.g., threat to life or serious injury), which is not the etiology described here (work problems). - Furthermore, symptoms must resolve within **one month** of the traumatic event; this patient's symptoms have persisted for 3 months. *Post-traumatic stress disorder (PTSD)* - Similar to acute stress disorder, PTSD requires exposure to an actual or threatened **death, serious injury, or sexual violence**, which is not indicated by the vignette. - Core features of PTSD include **intrusive memories** (flashbacks), avoidance of stimuli, and hyperarousal, none of which are reported by the patient.

Q: A female presents with symptoms of being excessively talkative, hyperactive, sleeping very little, and spending large amounts of money on shopping sprees. When confronted, she becomes irritable. What is the most likely diagnosis?

Bipolar I + Mania. ***Bipolar I + Mania***- The presentation of *pressured speech* (excessively talkative), *decreased need for sleep*, *hyperactivity*, and severe *impulsivity* (large spending) meets the criteria for a **full manic episode**.- A manic episode is defined by lasting at least one week, causing severe functional impairment, and is necessary for the diagnosis of **Bipolar I Disorder**.*Bipolar II + Hypomania*- Symptoms of a **hypomanic episode** are similar but are less severe, last a minimum of 4 consecutive days, and *do not cause marked functional impairment* or require hospitalization.- The patient’s severe symptoms (reckless spending, irritability upon confrontation) leading to major social/occupational problems indicate **mania**, not hypomania.*Obsessive-compulsive disorder*- This disorder is characterized by intrusive, recurrent **obsessions** (thoughts) and repetitive **compulsions** (behaviors) performed to relieve anxiety, which are not the primary symptoms here.- While spending could be impulsive, it is part of a cluster of mood and activity disturbances, not an ego-dystonic ritualistic compulsion.*Schizophrenia*- The primary features of **Schizophrenia** involve psychosis, such as **hallucinations**, **delusions**, and **disorganized thinking**, which are not described in this presentation.- Although irritability and hyperactivity may overlap, the core presentation is dominated by symptoms of a disruptive mood state, making a primary mood disorder more likely.

Q: A person has a false belief that he owns a lot of property and that someone he knows is trying to take it away from him. Which of the following best describes the type of delusions he is experiencing?

Delusion of grandeur and persecution. ***Delusion of grandeur and persecution***- The belief in owning a lot of property reflects **delusion of grandeur**, which is characterized by an exaggerated belief in one's wealth, importance, or abilities.- The belief that someone is trying to take their property away indicates a **delusion of persecution**, where the individual feels threatened or believes others are conspiring to harm them.*Delusion of grandeur and reference*- This option correctly identifies **delusion of grandeur** (owning vast property), but incorrectly identifies the second component.- **Delusion of reference** refers to the erroneous belief that common events, objects, or people have a specific, usually negative, meaning directed towards oneself (e.g., people on TV are talking about them). The patient is directly targeted, indicating persecution.*Delusion of nihilism*- Neither of the patient's described beliefs fit **delusion of nihilism** (Cotard syndrome), which is the false conviction that one's self, parts of the body, or the entire world do not exist.- This patient exhibits high self-importance (**grandeur**) and being targeted (**persecution**), not beliefs related to non-existence.*Delusion of grandeur and nihilism*- While **delusion of grandeur** is present, the patient's worry about someone stealing property is a persecutory type of delusion, not a **delusion of nihilism**.- The themes of persecution and grandeur found here are inconsistent with the theme of non-existence or loss of existence central to **nihilistic delusions**.

Question 1

A 45-year-old patient presents with difficulty reacting to bright light. On examination, the pupillary light reflex is absent but the near reflex is preserved. Where is the lesion likely located?

Accepted Answer

Pretectal area of the midbrain

Answer

Edinger–Westphal nucleus

Answer

Optic nerve

Answer

Oculomotor nerve

Question 2

A girl with schizophrenia presents to a Primary Health Centre (PHC) in India. Which of the following online applications, provided by the Government of India (GOI), is used for mental health service support?

Accepted Answer

Tele MANAS

Answer

eSanjeevani

Answer

NIKSHAY

Answer

U-WIN

Question 3

A girl, after returning from a picnic, complains of pain in her eyes. She had not maintained proper hygiene of her contact lenses. What would be the cause?

Accepted Answer

Acanthamoeba

Answer

Pseudomonas aeruginosa

Answer

Herpes simplex virus

Answer

Fusarium

Question 4

A patient presents with a painless ulcer in the eye. On examination, a long, branching ulcer with desquamated epithelium is seen on the cornea. What is the most likely diagnosis?

Accepted Answer

Neurotrophic ulcer

Answer

Bacterial corneal ulcer

Answer

Fungal ulcer

Answer

Dendritic ulcer

Question 5

A 45-year-old patient with eye examination findings of a deep anterior chamber and jet-black pupil is prescribed +12D glasses. Likely diagnosis?

Accepted Answer

Aphakia

Answer

Pseudophakia

Answer

Hypermetropia

Answer

Myopia

Question 6

A patient presents with painful lid swelling. On examination, a pus point is observed at the base of an eyelash. Which of the following glands is involved?

Accepted Answer

Zeis gland

Answer

Lacrimal gland

Answer

Meibomian gland

Answer

Moll gland

Question 7

A man presents to the hospital with a bizarre behavior. He is unable to recall his personal identity and has no memory of how he traveled 100 km to reach the hospital. A collateral history reveals he experienced a traumatic earthquake a few months ago. Which of the following is the most likely diagnosis?

Accepted Answer

Dissociative amnesia

Answer

Dissociative identity disorder

Answer

Schizophrenia

Answer

Global amnesia

Question 8

A 28-year-old software engineer presents with sleep disturbances, low mood, and stress for the past 3 months. He attributes his symptoms to ongoing problems at work. He has no prior psychiatric history. Which of the following is the most likely diagnosis?

Accepted Answer

Adjustment disorder

Answer

Generalized anxiety disorder

Answer

Post-traumatic stress disorder (PTSD)

Answer

Acute stress disorder

Question 9

A female presents with symptoms of being excessively talkative, hyperactive, sleeping very little, and spending large amounts of money on shopping sprees. When confronted, she becomes irritable. What is the most likely diagnosis?

Accepted Answer

Bipolar I + Mania

Answer

Schizophrenia

Answer

Obsessive-compulsive disorder

Answer

Bipolar II + Hypomania

Question 10

A person has a false belief that he owns a lot of property and that someone he knows is trying to take it away from him. Which of the following best describes the type of delusions he is experiencing?

Accepted Answer

Delusion of grandeur and persecution

Answer

Delusion of grandeur and nihilism

Answer

Delusion of grandeur and reference

Answer

Delusion of nihilism

FMGE 2025

Anatomy

Community Medicine

Microbiology

Ophthalmology

Psychiatry