FMGE 2025 Practice Questions

Q: Identify the bone indicated by the arrow in the image.

Navicular. ***Navicular*** - The arrow points to the navicular bone, a key tarsal bone located on the **medial side** of the foot. It articulates proximally with the **talus** and distally with the three **cuneiform** bones. - Its characteristic boat-like shape is identifiable on this AP radiograph, and it serves as the keystone of the **medial longitudinal arch** of the foot. *Cuboid* - The **cuboid** bone is located on the **lateral side** of the foot, articulating proximally with the **calcaneus** and distally with the fourth and fifth metatarsals. The indicated bone is medial. - The cuboid has a more cubical shape, which differentiates it from the scaphoid or boat-like shape of the navicular. *Intermediate cuneiform* - The **intermediate cuneiform** is located **distal** to the navicular bone and proximal to the base of the second metatarsal. The arrow points to a more proximal bone. - It is situated between the medial and lateral cuneiforms, forming part of the transverse arch of the foot. *Lateral cuneiform* - The **lateral cuneiform** is also located **distal** to the navicular, articulating with the third metatarsal. The arrow indicates the bone proximal to the cuneiform row. - It articulates with the intermediate cuneiform medially and the cuboid bone laterally, which is inconsistent with the indicated structure.

Q: In a study, an investigator compared the mean blood pressure and standard deviation between two independent groups. Which of the following is the most appropriate statistical test to assess the significance of the difference between the two means?

Unpaired t-test. ***Unpaired t-test***- It is the most appropriate statistical test used to compare the means of two independent (unrelated) groups when the data is continuous (like **blood pressure**).- This test assesses the null hypothesis that there is no significant difference between the **population means** of the two comparison groups.*Paired t-test*- This test is specifically designed to compare means when the observations are dependent, meaning the data comes from the **same subjects** measured twice (e.g., pre-treatment and post-treatment).- It is used for **within-group comparisons** rather than comparisons between two independent cohorts, as requested in the scenario.*Chi-square test*- The chi-square test is used to determine the association between **two categorical variables** (e.g., proportions or frequencies).- It is unsuitable here because the variable being compared (blood pressure) is **continuous data**, and the study requires comparing means, not counted frequencies.*ANOVA*- ANOVA (Analysis of Variance) is used when comparing the means of **three or more** independent groups.- While acceptable for two groups (where it gives equivalent results to the t-test), the **unpaired t-test** is the most specific and standard test for comparing means of exactly two independent samples.

Q: Fetal anaemia is primarily determined by Doppler assessment of which artery?

Middle cerebral artery. ***Middle cerebral artery***- The **Middle Cerebral Artery (MCA) peak systolic velocity (PSV)** is the most reliable non-invasive method for detecting moderate to severe fetal anemia.- An elevated MCA-PSV indicates increased cerebral blood flow velocity due to reduced blood viscosity (from anemia) and the **brain-sparing effect**.- *Umbilical artery*- Doppler assessment of the umbilical artery primarily evaluates **placental vascular resistance** (e.g., in fetal growth restriction) using indices like the resistive index (RI) or pulsatility index (PI).- While abnormalities like absent or reversed diastolic flow indicate severe placental insufficiency, they are not the primary diagnostic measure for fetal anemia.- *Ductus venosus*- Ductus venosus Doppler evaluates **fetal cardiac function** and is critical in assessing fetal compromise, especially in conditions leading to hydrops fetalis.- Although reverse flow can be an indicator of severe compromise and impending heart failure (potentially caused by severe anemia), it is secondary to MCA-PSV for the specific diagnosis of anemia.- *Uterine artery*- Uterine artery Doppler assesses **maternal placental perfusion** and resistance, primarily used for screening and monitoring conditions like **preeclampsia** and **fetal growth restriction**.- It measures maternal blood flow to the placenta and has no direct correlation or role in determining the severity of fetal anemia.

Q: A 24-year-old primigravida presents with painful vaginal bleeding in the first trimester. On USG, a well-formed gestation ring with central echoes from the embryo indicates a healthy fetus, and there is observation of fetal cardiac motion. What is the most probable diagnosis?

Threatened abortion. ***Threatened abortion***- This diagnosis applies when there is **vaginal bleeding** (often painful) in the first 20 weeks of pregnancy, but the **cervix is closed** and **fetal viability** (confirmed by fetal cardiac motion) is observed on ultrasound.- It is the most common cause of bleeding in early pregnancy and signifies that while the pregnancy is at risk, it is still continuing with a live fetus.*Inevitable abortion*- This diagnosis is characterized by vaginal bleeding accompanied by cervical changes, specifically **cervical dilation**, making continuation of the pregnancy unlikely.- Viable fetal cardiac activity rules out inevitable or ongoing abortion processes.*Incomplete abortion*- This involves the partial expulsion of the products of conception; USG would show **retained placental tissue** or fetal tissue and the loss of fetal viability.- The existence of **fetal cardiac motion** and a complete gestation ring confirms the pregnancy is still intact and rules out incomplete expulsion.*Complete abortion*- In this scenario, all products of conception have been expelled, resulting in an **empty uterine cavity** on ultrasound.- The presence of a **well-formed gestation ring** and an actively moving embryo/fetus clearly excludes complete abortion.

Q: A patient with a known marginal placenta presents for follow-up. On ultrasound, a 4 x 4 cm placental mass is noted invading into the urinary bladder. What is the most likely diagnosis?

Placenta percreta. ***Placenta percreta*** - This is the most severe form of the **placenta accreta spectrum**, where the placental villi penetrate through the entire uterine wall, including the **serosa**, and invade adjacent organs. - The ultrasound finding of a placental mass invading the **urinary bladder** is the classic presentation of **placenta percreta**. *Placenta previa* - This term describes the location of the placenta, where it partially or completely covers the **internal cervical os**. It does not describe the depth of invasion. - Although **placenta previa** is a significant risk factor for placenta accreta spectrum disorders, the invasion into the bladder points to a specific diagnosis of abnormal adherence, not just location. *Placenta increta* - In **placenta increta**, the placental villi invade into the **myometrium** (uterine muscle) but do not penetrate through to the serosa or adjacent organs. - This represents the intermediate form of the accreta spectrum, more severe than accreta but less severe than percreta. *Placenta accreta* - In **placenta accreta**, the placental villi are abnormally attached to the **myometrium**, but they do not invade the uterine muscle itself. This is the least invasive form of the spectrum. - The finding of invasion into the **urinary bladder** rules out simple accreta, as this requires penetration through the entire myometrium and serosa, which is characteristic of percreta.

Q: A patient develops profuse uterine bleeding after a lower segment cesarean section (LSCS). Despite administration of oxytocin and other uterotonics, the bleeding continues. What is the 1st line conservative surgical management?

Uterine balloon tamponade. ***Uterine balloon tamponade*** - This is the **first-line conservative surgical intervention** when uterine atony persists despite maximum medical management (oxytocin, methylergometrine, carboprost, misoprostol). - Devices like the **Bakri balloon** are inserted rapidly to apply counter-pressure to the uterine walls, effectively halting bleeding in 80-90% of cases while preserving the uterus. - This is a **Tier 2 intervention** that bridges medical management and invasive surgical procedures. *Uterine artery embolization* - This specialized technique requires immediate availability of an **interventional radiology suite** and hemodynamically stable patient for transport. - It is typically pursued after conservative mechanical procedures (tamponade or compression sutures) have failed, or in specialized centers where it's immediately available. - Considered a **Tier 3 intervention**. *Internal iliac artery ligation* - This complex invasive surgical procedure is performed when simpler techniques like **balloon tamponade** or **B-Lynch compression sutures** have failed. - It is typically reserved as a step before hysterectomy, aimed at reducing pelvic blood flow. - Also a **Tier 3 intervention**. *Hysterectomy* - **Hysterectomy** is the **last-resort, life-saving measure** (Tier 4) when all conservative mechanical, surgical, and medical options have failed to control massive hemorrhage. - The goal is to implement conservative measures rapidly to **preserve fertility** before resorting to definitive surgery.

Q: A patient's fetal heart rate tracing is shown in the image. The tracing shows variable deceleration. What does that indicate?

Umbilical cord compression. ***Umbilical cord compression*** - Variable decelerations are characterized by an **abrupt decrease** in fetal heart rate with a variable onset, duration, and shape, which is the classic sign of **umbilical cord compression**. - The compression of the umbilical cord causes a reflex **baroreceptor-mediated** slowing of the heart rate, which resolves when the compression is relieved. *Fetal head compression* - This causes **early decelerations**, which are gradual, uniform in shape, and mirror the uterine contraction. - Early decelerations are a result of a **vagal response** to increased intracranial pressure during contractions and are generally considered benign. *Uteroplacental insufficiency* - This leads to **late decelerations**, where the nadir of the deceleration occurs after the peak of the contraction. - Late decelerations signify impaired oxygen exchange at the placenta and are associated with fetal **hypoxemia**. *Maternal hypotension* - Maternal hypotension can reduce blood flow to the placenta, causing **uteroplacental insufficiency**. - This would result in **late decelerations** or potentially a **prolonged deceleration**, not the characteristic variable pattern.

Q: In a case of face presentation during labor, which diameter is seen?

Submentobregmatic. ***Submentobregmatic*** - In a **face presentation**, the fetal head is completely extended (deflexed), causing the face to present first in the birth canal. - The presenting diameter is the **submentobregmatic**, which measures approximately **9.5 cm** and extends from the junction of the neck and chin to the anterior fontanelle (bregma). *Mentobregmatic* - This term is sometimes used, but the precise engaging diameter in a face presentation is the **submentobregmatic** diameter. - The **mento-vertical** diameter (**14 cm**), which is the largest, is associated with a **brow presentation** and is too large for a vaginal delivery. *Suboccipitobregmatic* - This is the presenting diameter in a normal, **well-flexed vertex presentation**, which is the most common and favorable presentation. - It measures approximately **9.5 cm** and extends from the nape of the neck (subocciput) to the bregma. *Occipitofrontal* - This diameter is seen when the head is in a **military attitude** (partially deflexed), where neither flexion nor extension is complete. - It measures about **11.5 cm**, which is larger than the ideal presenting diameter and can prolong labor.

Q: Identify the imaging study shown in the image.

Intravenous pyelogram (IVP). ***Intravenous pyelogram (IVP)*** - This imaging study involves the **intravenous injection** of a contrast agent, which is then excreted by the kidneys, allowing for visualization of the entire urinary tract, including the kidneys, ureters, and bladder, as seen in the image. - The antegrade (forward) filling of the renal calyces, pelvis, ureters, and bladder is the classic appearance of an IVP, which assesses both the structure and function of the urinary system. *Pelvic X-ray* - A standard pelvic X-ray is a **plain radiograph** without any contrast material, primarily used to visualize the pelvic bones. - The image clearly shows opacification of the urinary tract with a contrast agent, which is not a feature of a plain pelvic X-ray. *Retrograde pyelogram* - This procedure involves injecting contrast material directly into the ureters via a **cystoscope** in a retrograde (backward) fashion, from the bladder towards the kidneys. - The image shows contrast originating from the kidneys and flowing down to the bladder, which is characteristic of an **antegrade** study like an IVP, not a retrograde one. *Micturating cystourethrogram (MCUG)* - In an MCUG, contrast is instilled directly into the bladder via a **urinary catheter** to assess the bladder and urethra, primarily during voiding. - While reflux into the ureters can be seen, the primary filling of the entire upper urinary tract via renal excretion, as shown here, is the defining feature of an IVP.

Q: A patient presents with bilateral hilar lymphadenopathy with eggshell calcification on chest X-ray. What is the most likely diagnosis?

Silicosis. ***Silicosis*** - The presence of **bilateral hilar lymphadenopathy** with **eggshell calcification** is a classic, pathognomonic finding for silicosis. - This pneumoconiosis is caused by inhalation of silica dust, often seen in miners and sandblasters, and typically shows multiple small nodules predominantly in the **upper lung zones**. *Sarcoidosis* - While sarcoidosis is a common cause of **bilateral hilar lymphadenopathy**, the presence of **eggshell calcification** is much less frequent compared to silicosis. - Calcification in sarcoidosis, when it occurs, is more often amorphous or diffuse, not the distinct peripheral rim seen in the image. *Tuberculosis* - Tuberculosis can cause hilar lymphadenopathy, but it is often **unilateral**, and calcification typically occurs in a healed **Ghon complex** as a solid, dense nodule. - The specific pattern of **eggshell calcification** is not a characteristic feature of tuberculosis. *Pneumoconiosis due to asbestos* - Asbestosis characteristically involves the **lower lung zones** and is associated with **pleural plaques**, pleural thickening, and interstitial fibrosis. - Significant hilar lymphadenopathy and **eggshell calcification** are not typical features of asbestos-related lung disease.

Question 1

Identify the bone indicated by the arrow in the image.

Accepted Answer

Navicular

Answer

Intermediate cuneiform

Answer

Lateral cuneiform

Answer

Cuboid

Question 2

In a study, an investigator compared the mean blood pressure and standard deviation between two independent groups. Which of the following is the most appropriate statistical test to assess the significance of the difference between the two means?

Accepted Answer

Unpaired t-test

Answer

Chi-square test

Answer

ANOVA

Answer

Paired t-test

Question 3

Fetal anaemia is primarily determined by Doppler assessment of which artery?

Accepted Answer

Middle cerebral artery

Answer

Umbilical artery

Answer

Uterine artery

Answer

Ductus venosus

Question 4

A 24-year-old primigravida presents with painful vaginal bleeding in the first trimester. On USG, a well-formed gestation ring with central echoes from the embryo indicates a healthy fetus, and there is observation of fetal cardiac motion. What is the most probable diagnosis?

Accepted Answer

Threatened abortion

Answer

Inevitable abortion

Answer

Complete abortion

Answer

Incomplete abortion

Question 5

A patient with a known marginal placenta presents for follow-up. On ultrasound, a 4 x 4 cm placental mass is noted invading into the urinary bladder. What is the most likely diagnosis?

Accepted Answer

Placenta percreta

Answer

Placenta accreta

Answer

Placenta previa

Answer

Placenta increta

Question 6

A patient develops profuse uterine bleeding after a lower segment cesarean section (LSCS). Despite administration of oxytocin and other uterotonics, the bleeding continues. What is the 1st line conservative surgical management?

Accepted Answer

Uterine balloon tamponade

Answer

Hysterectomy

Answer

Internal iliac artery ligation

Answer

Uterine artery embolization

Question 7

A patient's fetal heart rate tracing is shown in the image. The tracing shows variable deceleration. What does that indicate?

Accepted Answer

Umbilical cord compression

Answer

Maternal hypotension

Answer

Fetal head compression

Answer

Uteroplacental insufficiency

Question 8

In a case of face presentation during labor, which diameter is seen?

Accepted Answer

Submentobregmatic

Answer

Mentobregmatic

Answer

Occipitofrontal

Answer

Suboccipitobregmatic

Question 9

Identify the imaging study shown in the image.

Accepted Answer

Intravenous pyelogram (IVP)

Answer

Pelvic X-ray

Answer

Micturating cystourethrogram (MCUG)

Answer

Retrograde pyelogram

Question 10

A patient presents with bilateral hilar lymphadenopathy with eggshell calcification on chest X-ray. What is the most likely diagnosis?

Accepted Answer

Silicosis

Answer

Tuberculosis

Answer

Sarcoidosis

Answer

Pneumoconiosis due to asbestos

FMGE 2025

Anatomy

Community Medicine

Obstetrics and Gynecology

Radiology