FMGE 2025 Practice Questions

Q: What is the embryological basis for the uterine anomaly shown in the images?

Non-fusion of paramesonephric ducts. ***Non-fusion of paramesonephric ducts*** - The image shows a **uterus didelphys**, which is a complete duplication of the uterus and cervix. This anomaly occurs due to a complete failure of the two **paramesonephric (Müllerian) ducts** to fuse medially during embryogenesis. - The **paramesonephric ducts** are the embryological precursors to the fallopian tubes, uterus, cervix, and the upper one-third of the vagina. Their proper fusion is essential for forming a single uterine cavity. *Non-fusion of mesonephric duct* - The **mesonephric (Wolffian) ducts** are precursors to male internal genitalia (e.g., epididymis, ductus deferens, seminal vesicles) and largely regress in females. - Remnants of the mesonephric duct in females may form **Gartner's cysts**, but they do not contribute to the formation of the uterus. *Failure of fusion of metanephric duct* - The **metanephric duct**, or **ureteric bud**, is involved in the development of the urinary system, specifically the ureters, renal pelves, calyces, and collecting ducts of the kidneys. - This structure is entirely unrelated to the embryological development of the female reproductive tract. *Complete agenesis of Müllerian structures* - Complete agenesis of the **Müllerian structures** results in the congenital absence of the uterus, fallopian tubes, and upper vagina, a condition known as **Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome**. - The image clearly depicts the presence of uterine horns and a cervix, which contradicts a diagnosis of agenesis (complete absence).

Q: The waveform shown in the image represents which of the following physiological parameters?

End-tidal carbon dioxide. ***End-tidal carbon dioxide*** - The image displays a **capnogram**, which is a graphical representation of the concentration or partial pressure of **carbon dioxide (CO2)** in respiratory gases over time. The y-axis is clearly labeled **CO2 (mmHg)**. - The characteristic rectangular waveform represents the respiratory cycle: the plateau indicates the exhalation of **alveolar gas**, and the peak at the end of the plateau is the **end-tidal CO2 (ETCO2)**, which normally ranges from 35-45 mmHg. *Arterial oxygen saturation* - Arterial oxygen saturation (SpO2) is measured by **pulse oximetry** and is reported as a **percentage**, not in mmHg. - The waveform associated with pulse oximetry is a **plethysmograph**, which reflects changes in blood volume in the tissue with each heartbeat, not respiratory gas exchange. *Functional residual capacity* - **Functional residual capacity (FRC)** is a static lung **volume** (measured in liters or milliliters), representing the amount of air remaining in the lungs after a normal exhalation. - It is not a dynamically changing parameter measured with each breath and cannot be represented by this type of real-time waveform. *Tidal volume* - **Tidal volume** is the **volume** of air inhaled or exhaled during a single breath, measured in milliliters or liters. - A graph of tidal volume over time (spirometry) would show a sinusoidal wave representing the volume change, which looks distinctly different from the capnogram shown.

Q: What is the primary function of the inflatable cuff of the endotracheal tube shown in the image?

Prevention of air leakage and aspiration. ***Prevention of air leakage and aspiration*** - When inflated, the cuff creates a seal against the wall of the **trachea**. This prevents air delivered during **positive pressure ventilation** from escaping around the tube, ensuring adequate tidal volume delivery to the lungs. - The seal also protects the airway by preventing oropharyngeal and gastric secretions from entering the lungs, thus reducing the risk of **aspiration pneumonia**. *Facilitation of vocal cord visualization* - Vocal cord visualization is achieved using a **laryngoscope** during the intubation procedure *before* the cuff is inflated. - The endotracheal tube cuff is positioned *below* the vocal cords; its inflation would not aid in their visualization. *Monitoring airway pressure* - Airway pressure (e.g., peak inspiratory pressure) is monitored through the **ventilator circuit**, not the cuff. The pressure within the cuff is monitored separately via the **pilot balloon** using a manometer. - While maintaining appropriate **cuff pressure** (typically 20-30 cm H2O) is vital to prevent tracheal injury, the cuff's primary function is sealing, not monitoring overall airway pressure. *Suctioning of lower respiratory tract secretions* - Suctioning is performed by passing a sterile **suction catheter** through the lumen of the endotracheal tube to clear secretions from the lower airways. - The cuff itself has no suctioning capability, although some specialized tubes have a separate **subglottic suction port** located above the cuff to remove pooled secretions.

Q: Which of the following is a recommended treatment for esophageal varices?

Endoscopic ligation. ***Endoscopic ligation*** - This is a first-line endoscopic therapy for both actively bleeding esophageal varices and for the primary and secondary prevention of variceal hemorrhage [1]. - The procedure, also known as **variceal banding**, involves placing small rubber bands around the varices to ligate them, leading to thrombosis and eventual sloughing off [1]. *Transjugular intrahepatic portosystemic shunt (TIPS)* - TIPS is considered a second-line or salvage therapy for variceal bleeding that is refractory to endoscopic and pharmacological treatments [2]. - It is an invasive procedure that creates a shunt to reduce **portal pressure**, but it is reserved for uncontrolled bleeding due to risks such as **hepatic encephalopathy** [2]. *Intravenous labetalol* - While non-selective beta-blockers like **propranolol** or **nadolol** are used for the prophylaxis of variceal bleeding, they are not the treatment for an acute bleed. Vasoactive drugs like **terlipressin** or **octreotide** are used instead [1]. - Labetalol is a beta-blocker primarily used to manage **hypertension** and is not indicated for the acute management of variceal hemorrhage. *Oral amoxicillin* - Antibiotic prophylaxis (typically with intravenous third-generation cephalosporins like **ceftriaxone**) is recommended in patients with cirrhosis and variceal bleeding to prevent **spontaneous bacterial peritonitis (SBP)**. - Antibiotics do not treat the varices directly or stop the bleeding; they are given to reduce mortality associated with infections in this patient population.

Q: A patient presents with obstructed labor, and on abdominal examination, a groove or band is palpable across the uterus. What is the most likely diagnosis?

Bandl’s ring. ***Bandl’s ring***- This is the **pathological retraction ring** that forms in cases of prolonged **obstructed labor**, separating the thick, upper, contracted uterine segment from the thin, distended lower uterine segment.- Its presence as a palpable groove or band across the abdomen is a critical sign of **impending uterine rupture** and mandates immediate intervention.*Constriction ring*- This is a localized persistent contraction or **spasm of the circular uterine muscle fibers** occurring at any level, hindering the passage of the fetus but not necessarily indicating imminent rupture.- Unlike Bandl's ring, it is usually not a high, visible, or palpable abdominal band indicating severe obstruction and **uterine overdistention**.*Schroeder's ring*- This term is not the standardized term used to describe the **pathological retraction ring** visible externally in severe obstructed labor.- While it may sometimes be confused with terms related to cervical changes, **Bandl's ring** is the definitive diagnosis for the palpable groove in this clinical context.*Contraction ring*- This term is often used synonymously with the normal **physiological retraction ring** which forms between the active and passive segments during normal labor.- Although it involves muscle contraction, it lacks the specific **pathological significance** and height within the abdomen characteristic of Bandl’s ring in severe obstruction.

Q: A pregnant woman is being assessed for induction of labor. On vaginal examination: Cervical dilation: 2 cm, Effacement: 20%, Cervical consistency: Soft, Position: Midline, Station: -2. What is the modified Bishop Score?

Score 5 - Unfavorable. ***Score 5 - Unfavorable*** - This score is calculated by assigning points based on cervical parameters: **Dilation 2 cm (1 pt)**, **Effacement 20% (0 pts)**, **Consistency Soft (2 pts)**, **Position Midline (1 pt)**, and **Station -2 (1 pt)**, totaling **5 points**. - A Bishop Score of 5 or less indicates an **unfavorable cervix**, suggesting a low likelihood of successful vaginal delivery following induction without prior cervical ripening. *Score 7 - Favorable* - A score of 7 or higher is generally considered highly **favorable** for successful induction, meaning the cervix is likely to respond well to oxytocin. - To reach a score of 7, the patient would need two additional points, such as effacement of 60% (2 points) instead of 20% (0 points), or improved station. *Score 6 - Borderline* - A score of 6 is considered **borderline** or marginally favorable, but many clinicians still prefer cervical ripening before proceeding with oxytocin. - This would require an improvement in one parameter, such as the fetal station moving from -2 (1 pt) to -1 or 0 (2 pts). *Score 3 - Highly unfavorable* - A score of 3 indicates a very **unripe cervix** (e.g., firm consistency, posterior position, minimal dilation and effacement) with very low chance of successful induction. - The current patient scores 5 points with favorable features (soft consistency, midline position), making a score as low as 3 impossible with the given findings.

Q: During the management of shoulder dystocia in childbirth, which of the following is the earliest and first maneuver typically attempted?

McRoberts maneuver. ***McRoberts maneuver***- This is universally considered the **first-line** and **least invasive** procedure for shoulder dystocia management.- It involves sharply flexing the mother's hips against her abdomen (knees-to-chest), which rotates the **pubic symphysis** cephalad and flattens the lumbar lordosis, increasing the functional AP diameter of the pelvis.*Woods corkscrew maneuver*- This is a **second-line** rotational maneuver attempted if McRoberts and suprapubic pressure fail.- It involves applying pressure to the posterior aspect of the anterior shoulder to rotate the fetal shoulders 180 degrees.*Rubin maneuver*- This is a **second-line** rotational maneuver where the physician places fingers behind the anteriorly impacted shoulder.- The goal is to push the shoulder towards the fetal chest, rotating the shoulders into the oblique diameter.*Delivery of posterior arm*- This is a highly invasive maneuver usually reserved for when less invasive positional and rotational techniques have failed.- Successfully extracting the posterior arm significantly reduces the **bisacromial diameter**, facilitating delivery.

Q: A 2-month-old male infant presents with a scrotal swelling that has been present since birth. Now, the swelling has become suddenly painful, red, and irreducible. What is the most likely diagnosis?

Strangulated inguinal hernia. **Strangulated inguinal hernia** - The presence of a scrotal swelling since birth strongly suggests an underlying indirect inguinal hernia, common due to a **patent processus vaginalis** in infants. - Sudden onset of severe pain, marked **irreducibility**, and **erythema** (redness) indicates vascular compromise of the contents (often bowel), classifying it as a surgical emergency (strangulation). *Acute epididymo-orchitis* - This condition is exceedingly rare in 2-month-old infants unless associated with underlying **urinary tract anomalies** or sepsis, and typically presents acutely without a long-standing mass. - The pain and swelling would usually involve the testicle/epididymis itself, accompanied by fever, and is less likely to present with the history of a mass existing **since birth**. *Testicular torsion* - Torsion usually presents with an extremely rapid onset of severe testicular pain without a history of a chronic mass, and often occurs due to inadequate fixation (**bell-clapper deformity**). - While painful, torsion involves the testicle and is generally diagnosed by absence of flow on **Doppler ultrasound**, unlike a hernia mass. *Incarcerated inguinal hernia* - An incarcerated hernia is irreducible because the contents are trapped, but the key differentiating factor is the lack of **vascular compromise**. - The presence of severe pain, tenderness, and redness (erythema) indicates progression beyond simple incarceration to **strangulation**, necessitating immediate intervention.

Question 1

What is the embryological basis for the uterine anomaly shown in the images?

Accepted Answer

Non-fusion of paramesonephric ducts

Answer

Failure of fusion of metanephric duct

Answer

Non-fusion of mesonephric duct

Answer

Complete agenesis of Müllerian structures

Question 2

The waveform shown in the image represents which of the following physiological parameters?

Accepted Answer

End-tidal carbon dioxide

Answer

Tidal volume

Answer

Arterial oxygen saturation

Answer

Functional residual capacity

Question 3

What is the primary function of the inflatable cuff of the endotracheal tube shown in the image?

Accepted Answer

Prevention of air leakage and aspiration

Answer

Suctioning of lower respiratory tract secretions

Answer

Facilitation of vocal cord visualization

Answer

Monitoring airway pressure

Question 4

Which of the following refers to the tendency of an individual’s relative position within a distribution (e.g., BP levels) to remain consistent over time, meaning those with high BP in childhood often remain at the higher end of BP in adulthood, and those with low BP tend to stay lower, even though absolute values may change with age?

Accepted Answer

Tracking of blood pressure

Answer

Regression to the mean

Answer

Rule of halves

Answer

Cohort effect

Question 5

Which of the following is a recommended treatment for esophageal varices?

Accepted Answer

Endoscopic ligation

Answer

Transjugular intrahepatic portosystemic shunt (TIPS)

Answer

Intravenous labetalol

Answer

Oral amoxicillin

Question 6

A patient presents with obstructed labor, and on abdominal examination, a groove or band is palpable across the uterus. What is the most likely diagnosis?

Accepted Answer

Bandl’s ring

Answer

Constriction ring

Answer

Contraction ring

Answer

Schroeder's ring

Question 7

A pregnant woman is being assessed for induction of labor. On vaginal examination: Cervical dilation: 2 cm, Effacement: 20%, Cervical consistency: Soft, Position: Midline, Station: -2. What is the modified Bishop Score?

Accepted Answer

Score 5 - Unfavorable

Answer

Score 7 - Favorable

Answer

Score 6 - Borderline

Answer

Score 3 - Highly unfavorable

Question 8

During the management of shoulder dystocia in childbirth, which of the following is the earliest and first maneuver typically attempted?

Accepted Answer

McRoberts maneuver

Answer

Delivery of posterior arm

Answer

Woods corkscrew maneuver

Answer

Rubin maneuver

Question 9

A 2-month-old male infant presents with a scrotal swelling that has been present since birth. Now, the swelling has become suddenly painful, red, and irreducible. What is the most likely diagnosis?

Accepted Answer

Strangulated inguinal hernia

Answer

Incarcerated inguinal hernia

Answer

Acute epididymo-orchitis

Answer

Testicular torsion

Question 10

A patient underwent split-thickness skin grafting for a burn injury on the arm. On post-operative day 6, he develops stiffness of the arm during physiotherapy. What is the most appropriate next step in management?

Accepted Answer

Passive extension of the joint under direct visualization of the graft

Answer

Continue physiotherapy without intervention

Answer

Surgical excision of contracture

Answer

Remove the graft and regraft the area

FMGE 2025

Anatomy

Anesthesiology

Community Medicine

Internal Medicine

Obstetrics and Gynecology

Surgery