FMGE 2025 Practice Questions

Q: Which of the following veins is involved in the formation of esophageal varices?

Left gastric vein. ***Left gastric vein*** - The **left gastric vein** (coronary vein) is the primary vessel involved in esophageal varices formation through **portosystemic anastomoses** at the **gastroesophageal junction** during portal hypertension [1]. - It connects the **portal circulation** to the **systemic circulation** via esophageal veins, creating the most clinically significant pathway for variceal development [1]. *Left gastroepiploic vein* - This vein drains the **greater curvature of the stomach** and flows into the splenic vein, not forming significant connections with esophageal circulation. - It does not participate in **portosystemic anastomoses** at the esophageal level where varices typically develop. *Right gastric vein* - Drains the **lesser curvature of the stomach** and flows directly into the portal vein [2], with minimal anatomical connection to esophageal vessels. - Does not form the critical **portosystemic anastomoses** necessary for esophageal varices formation during portal hypertension. *Right gastroepiploic vein* - Drains the **greater curvature of the stomach** and connects to the superior mesenteric vein, distant from esophageal circulation. - Lacks the anatomical connections required for **portosystemic anastomoses** at the gastroesophageal junction where varices develop.

Q: Injury to which part causes difficulty in dorsiflexion of the foot?

B. ***B*** - This arrow points to the **head and neck of the fibula**. The **common fibular (peroneal) nerve** wraps around the fibular neck, making it susceptible to injury in this location. - Damage to the common fibular nerve results in paralysis of the muscles in the anterior and lateral compartments of the leg, leading to **foot drop**, which is the inability to dorsiflex and evert the foot. *A* - This arrow points to the **medial condyle of the femur**. Injury to this area typically affects the knee joint, potentially damaging ligaments like the MCL or the medial meniscus. - It does not directly involve the nerves responsible for foot dorsiflexion, which are located more laterally and distally. *C* - This arrow indicates the **shaft of the femur**. A fracture of the femoral shaft is a severe injury but does not typically cause isolated difficulty with foot dorsiflexion. - Foot drop could occur if the **sciatic nerve** is injured proximally in the thigh, but this would result in a more widespread neurological deficit affecting both plantarflexion and dorsiflexion. *D* - This arrow points to the **lateral condyle of the femur**. Similar to the medial condyle, an injury here would primarily compromise the structures of the knee joint itself, such as the LCL or lateral meniscus. - The course of the common fibular nerve is posterior to the lateral femoral condyle before it wraps around the fibular neck, so an isolated condylar fracture is unlikely to cause foot drop.

Q: A 30-year-old man came with choking episodes after ingestion of fish bone while eating. The fishbone got impacted at the level of T4 in the esophagus. Which is the most likely site of obstruction?

Arch of aorta. ***Arch of aorta*** - The esophagus has three principal anatomic constrictions where foreign bodies, such as swallowed fish bones, commonly lodge; the second constriction occurs at the level of **T4/T5** where the **arch of the aorta** passes anteriorly. - This large anatomical structure compresses the esophagus against the vertebral column, creating a localized narrowing precisely matching the T4 level described for the obstruction [1]. *Left bronchus* - The **left main bronchus** also crosses anterior to the esophagus and contributes significantly to the formation of the **middle esophageal constriction** at the T4/T5 level. - However, in standard radiological and endoscopic visualization, the compression caused by the arch of the aorta is often considered the dominant landmark at this specific location [1]. *Cricopharyngeus* - This structure forms the initial and **uppermost esophageal constriction** (upper esophageal sphincter), located at the level of the **C6 vertebra** (cervical spine). - Obstruction at the cricopharyngeus would occur in the neck, which is anatomically much higher than the reported **T4 (thoracic spine)** impaction site. *Diaphragm* - The passage of the esophagus through the **esophageal hiatus** of the diaphragm forms the **third and lowest physiological constriction**, typically located at the vertebral level of **T10**. - This site of potential foreign body obstruction is significantly distal and caudal to the T4 level described in the clinical case. Management of such objects often involves careful endoscopy under general anesthesia to prevent perforation [2].

Q: A man fell on his shoulder with his head pushed in the opposite direction. He presented with the following deformity. Which nerve root values are most likely affected?

C5 and C6. ***C5 and C6*** - The clinical presentation of an adducted, internally rotated arm with an extended elbow and pronated forearm is known as the "**waiter's tip**" or "**porter's tip**" position. This is the classic sign of an upper brachial plexus injury, specifically **Erb's Palsy**. - This type of injury typically occurs from trauma that increases the angle between the neck and shoulder, such as a fall or during childbirth, affecting the **C5 and C6** nerve roots. This leads to paralysis of shoulder abductors (deltoid), external rotators (infraspinatus), and elbow flexors (biceps brachii). *C6 and C7* - An injury involving the **C7** root would predominantly cause weakness in the extensors of the elbow, wrist, and fingers, a condition often referred to as "**wrist drop**". - While the C6 root is involved, the primary features of the "waiter's tip" deformity (loss of shoulder abduction and external rotation) are most characteristic of a C5-C6 lesion, not a C6-C7 lesion. *C7 and C8* - A lesion of the **C7 and C8** nerve roots would primarily affect the muscles responsible for finger extension and wrist flexion. - This pattern of weakness does not align with the observed posture, which is defined by deficits in shoulder and elbow movements controlled by C5 and C6. *C8 and T1* - Injury to the **C8 and T1** roots results in a lower brachial plexus injury, known as **Klumpke's Palsy**, which typically occurs from a hyperabduction injury of the arm. - This condition affects the intrinsic muscles of the hand, leading to a "**claw hand**" deformity, which is clinically distinct from the deformity shown in the image.

Q: A 2-week-old infant is brought to the hospital. Parents report a history of a single fall, but X-ray reveals multiple fractures at different stages of healing. What is the most likely diagnosis?

Battered baby syndrome. ***Battered baby syndrome*** - The presence of **multiple fractures** at **different stages of healing** is the most definitive radiological sign of non-accidental injury, indicating repeated trauma over time. - There is a significant discrepancy between the history provided by the parents (a single fall) and the clinical findings, which is a major red flag for child abuse. *Osteogenesis imperfecta* - This is a genetic disorder characterized by brittle bones due to defective **collagen synthesis**, leading to fractures with minimal trauma. However, it does not explain the different stages of healing, which point to injuries occurring at different times. - Other clinical features, such as **blue sclerae**, hearing loss, and dentinogenesis imperfecta, would typically be present but are not mentioned in this case. *Accidental fall* - A single accidental fall would result in injuries that are all in the **same stage of healing**, which contradicts the X-ray findings in this infant. - The pattern and number of fractures are inconsistent with a simple fall, which usually causes a single, isolated injury like a linear skull fracture. *Birth trauma* - Injuries sustained during birth, such as a fractured **clavicle** or humerus, would all have occurred at the same time and thus be in the same healing phase. - At two weeks of age, any new fractures or fractures at different healing stages could not be attributed to the birth event.

Q: A doctor receives two summons, one to appear in court in a murder case and another to provide expert medical opinion. Which of the following should the doctor prioritise?

Appearance in the murder case. ***Appearance in the murder case*** - **Criminal cases, especially serious offenses like murder, take priority over civil matters** - Murder cases involve Section 302 IPC (serious criminal offense) and require immediate judicial attention - Courts give precedence to criminal proceedings over routine civil/administrative matters - The doctor has a legal obligation to prioritize serious criminal cases as they involve matters of justice and public interest *The summon received first* - Priority is NOT determined by chronological order of receipt - The nature and gravity of the case determines priority, not the timing of summons *Appearance for providing medical expert opinion* - This is likely a civil or routine administrative matter - While important, it takes lower priority compared to serious criminal cases like murder - Can typically be rescheduled more easily than criminal proceedings **Legal Principle:** In medical jurisprudence, when multiple summons are received, priority is given based on the gravity of the case: **Criminal cases > Civil cases**, and within criminal cases, serious offenses like murder take precedence over minor offenses.

Q: An elderly woman involved in a road traffic accident presents with difficulty in breathing and altered mental status. D-Dimer is elevated. X-ray shows a long bone fracture. What is the most likely diagnosis?

Fat embolism. ***Fat embolism*** - The patient's presentation of **respiratory distress** (difficulty breathing) and **altered mental status** following a significant long bone fracture (femur, as seen on X-ray) is classic for **Fat Embolism Syndrome (FES)**. - This syndrome occurs when fat globules from the fractured bone marrow enter the bloodstream, leading to microvascular occlusion and inflammation in the lungs and brain. An elevated **D-Dimer** is also a common, albeit non-specific, finding. *Gas gangrene* - This is a rapidly progressing soft tissue infection caused by **Clostridium perfringens**, characterized by severe pain, swelling, **crepitus** (gas in tissues), and foul-smelling discharge at the wound site, which are not described here. - The primary symptoms in this case are systemic (pulmonary and neurological), not localized to the fracture site with signs of a necrotizing infection. *Infection* - While infection is a risk with fractures, the acute onset of severe respiratory and neurological symptoms is not a typical presentation for a post-traumatic wound infection or **osteomyelitis**. - Sepsis could cause these symptoms, but FES is a more direct and common complication specifically linked to the mechanics of a long bone fracture in the immediate post-trauma period. *Pulmonary embolism* - A pulmonary **thromboembolism** (from a blood clot) is a valid concern after trauma and can cause shortness of breath and an elevated D-Dimer. - However, the prominent **altered mental status** is less characteristic of a typical pulmonary embolism and points more strongly towards the cerebral effects of fat microemboli in FES.

Q: The provided image displays a fracture. Based on the X-ray, identify the type of fracture shown.

Intertrochanteric fracture. ***Intertrochanteric fracture*** - The fracture line is located in the region between the **greater** and **lesser trochanters** of the femur, which is the defining characteristic of this fracture type. - These are **extracapsular** fractures, common in the elderly, and often present with a **shortened** and **externally rotated** limb due to the unopposed pull of the iliopsoas on the lesser trochanter. *Subtrochanteric Fracture* - A subtrochanteric fracture occurs in the proximal femoral shaft, beginning at or up to 5 cm distal to the **lesser trochanter**. The fracture shown is located superior to this region. - These fractures are often associated with high-energy trauma in younger individuals or can be pathological fractures related to long-term **bisphosphonate** use. *Femoral Neck Fracture* - This is an **intracapsular** fracture occurring in the area between the femoral head and the greater trochanter. The fracture in the image is located distal to the femoral neck. - Femoral neck fractures carry a high risk of **avascular necrosis (AVN)** of the femoral head due to disruption of the retinacular arteries, a complication less common in intertrochanteric fractures. *Pubic Rami Fracture* - This fracture involves the **pelvic girdle**, specifically the superior or inferior pubic ramus. The radiograph clearly shows the fracture is located in the proximal **femur**. - Patients with pubic rami fractures typically present with groin pain and inability to bear weight, but the femur itself is not fractured.

Q: The image displays a clinical maneuver. Which ligament's integrity is being assessed by this test?

Anterior cruciate ligament. ***Anterior cruciate ligament*** - The image demonstrates the **Anterior Drawer Test**, a clinical maneuver used to assess the integrity of the **Anterior Cruciate Ligament (ACL)**. - During this test, the examiner pulls the tibia anteriorly; excessive forward movement of the tibia relative to the femur indicates a positive test, suggesting an **ACL tear**. *Posterior cruciate ligament* - The **Posterior Cruciate Ligament (PCL)** is assessed with the **Posterior Drawer Test**, which involves pushing the tibia posteriorly, the opposite motion of what is shown. - The PCL prevents the posterior translation of the tibia, and its rupture is often associated with a **dashboard injury** or a direct blow to the anterior tibia. *Medial collateral ligament* - The **Medial Collateral Ligament (MCL)** is tested using the **Valgus Stress Test**, where a force is applied to the lateral side of the knee to test for medial joint space opening. - This maneuver is performed with the knee in slight flexion (20-30 degrees) and full extension, a different position and action than depicted. *Lateral collateral ligament* - The **Lateral Collateral Ligament (LCL)** is evaluated with the **Varus Stress Test**, where a force is applied to the medial side of the knee to check for lateral joint space opening. - This test, like the valgus stress test, is performed at different degrees of flexion and is distinct from the drawer test shown in the image.

Q: A 9-month-old infant is brought for a routine check-up. Which of the following developmental milestones is most likely to be present at this age?

Creeps well on hands and knees. ***Creeps well on hands and knees***- By 9 months, most infants can **pull themselves to stand** and are typically proficient in **creeping** (moving on hands and knees), which is essential for independent exploration.- While some infants crawl (belly down) by 7 months, true **creeping** on hands and knees is the expected major **gross motor milestone** by 9 months.*Mature grasp*- A **mature grasp**, also known as the **fine pincer grasp** (using the tips of the index finger and thumb), is typically achieved later, around **10 to 12 months** of age.- At 9 months, infants generally use an **inferior or crude pincer grasp** or release objects with variable control.*Can hop on one foot*- This is a **gross motor milestone** requiring advanced balance and coordination, typically achieved between **3 and 4 years** of age (preschool age).- A 9-month-old infant lacks the necessary **neuromuscular maturity** and lower limb strength for single-leg weight bearing and hopping.*Runs steadily*- The ability to **run steadily** is usually a milestone achieved around **18 to 24 months** of age (toddler years), after the child has mastered independent walking (12–15 months).- At 9 months, the focus is on **non-ambulatory mobility**, such as creeping and cruising along furniture.

Question 1

Which of the following veins is involved in the formation of esophageal varices?

Accepted Answer

Left gastric vein

Answer

Left gastroepiploic vein

Answer

Right gastric vein

Answer

Right gastroepiploic vein

Question 2

Injury to which part causes difficulty in dorsiflexion of the foot?

Accepted Answer

B

Answer

D

Answer

C

Answer

A

Question 3

A 30-year-old man came with choking episodes after ingestion of fish bone while eating. The fishbone got impacted at the level of T4 in the esophagus. Which is the most likely site of obstruction?

Accepted Answer

Arch of aorta

Answer

Diaphragm

Answer

Left bronchus

Answer

Cricopharyngeus

Question 4

A man fell on his shoulder with his head pushed in the opposite direction. He presented with the following deformity. Which nerve root values are most likely affected?

Accepted Answer

C5 and C6

Answer

C7 and C8

Answer

C6 and C7

Answer

C8 and T1

Question 5

A 2-week-old infant is brought to the hospital. Parents report a history of a single fall, but X-ray reveals multiple fractures at different stages of healing. What is the most likely diagnosis?

Accepted Answer

Battered baby syndrome

Answer

Accidental fall

Answer

Birth trauma

Answer

Osteogenesis imperfecta

Question 6

A doctor receives two summons, one to appear in court in a murder case and another to provide expert medical opinion. Which of the following should the doctor prioritise?

Accepted Answer

Appearance in the murder case

Answer

The summon received first

Answer

Appearance for providing medical expert opinion

Answer

None of the above

Question 7

An elderly woman involved in a road traffic accident presents with difficulty in breathing and altered mental status. D-Dimer is elevated. X-ray shows a long bone fracture. What is the most likely diagnosis?

Accepted Answer

Fat embolism

Answer

Pulmonary embolism

Answer

Infection

Answer

Gas gangrene

Question 8

The provided image displays a fracture. Based on the X-ray, identify the type of fracture shown.

Accepted Answer

Intertrochanteric fracture

Answer

Pubic rami fracture

Answer

Femoral neck fracture

Answer

Subtrochanteric fracture

Question 9

The image displays a clinical maneuver. Which ligament's integrity is being assessed by this test?

Accepted Answer

Anterior cruciate ligament

Answer

Medial collateral ligament

Answer

Posterior cruciate ligament

Answer

Lateral collateral ligament

Question 10

A 9-month-old infant is brought for a routine check-up. Which of the following developmental milestones is most likely to be present at this age?

Accepted Answer

Creeps well on hands and knees

Answer

Runs steadily

Answer

Can hop on one foot

Answer

Mature grasp

FMGE 2025

Anatomy

Forensic Medicine

Orthopaedics

Pediatrics