FMGE 2025 Practice Questions

Q: A patient presented to OPD with ophthalmoplegia and ptosis. Diagnosis of superior orbital fissure syndrome was confirmed after examination. Which nerves are compressed in this case ?

III, IV, V1, VI. ***III, IV, V1, VI*** - The **superior orbital fissure** is a critical anatomical passage that transmits the **oculomotor nerve (III)**, **trochlear nerve (IV)**, the **ophthalmic division of the trigeminal nerve (V1)**, and the **abducens nerve (VI)**. - Compression of these nerves collectively results in **ophthalmoplegia** (paralysis of eye muscles due to III, IV, VI involvement [1]) and **ptois** (drooping of the upper eyelid due to III involvement), which are the classic signs of superior orbital fissure syndrome. *III, IV, V1, V2* - This option is incorrect because the **maxillary division of the trigeminal nerve (V2)** does not pass through the superior orbital fissure. - V2 exits the skull through the **foramen rotundum** to supply the maxillary region, and is therefore not affected in this syndrome. *II, III, IV, VI* - This option is incorrect because the **optic nerve (II)** is not involved in superior orbital fissure syndrome. - The optic nerve passes through the **optic canal**, a separate opening. Involvement of the optic nerve would cause vision loss and indicate a more extensive condition like **orbital apex syndrome**. *II, III, IV, V1* - This is incorrect as it includes the **optic nerve (II)**, which, as mentioned, travels through the optic canal, not the superior orbital fissure. - The absence of vision loss or an **afferent pupillary defect** helps differentiate superior orbital fissure syndrome from pathologies involving the optic nerve.

Q: The artery that is palpated between the medial malleolus and the calcaneal tendon is?

Posterior tibial artery. ***Posterior tibial artery*** - This artery passes through the **tarsal tunnel**, located just posterior to the **medial malleolus** and anterior to the **calcaneal (Achilles) tendon**, making it the palpable artery at this specific site. - The **posterior tibial artery** pulse is a critical component of the lower limb vascular examination, essential for assessing blood supply to the foot, especially in cases of **peripheral arterial disease** [1]. *Anterior tibial artery* - This artery is located on the **anterior aspect** of the leg and ankle, running down the front of the leg between the tibia and fibula. - It becomes the **dorsalis pedis artery** as it crosses the ankle joint, so it is not found behind the medial malleolus. *Dorsalis pedis artery* - This artery is palpated on the **dorsum (top) of the foot**, typically lateral to the tendon of the extensor hallucis longus. - As a continuation of the **anterior tibial artery**, its pulse point is anatomically distinct from the area between the medial malleolus and the calcaneal tendon. *Popliteal artery* - The **popliteal artery** is found deep within the **popliteal fossa**, the space behind the knee joint. - It is a much more proximal vessel that bifurcates into the **anterior and posterior tibial arteries** well above the ankle.

Q: A deceased woman was sent for an autopsy. She was found dead in a locked room with a heat stove still running. What is the most likely cause of death?

CO poisoning. ***CO poisoning***- The context of a deceased person in a locked room with a running heat stove points strongly to inhalation of **Carbon Monoxide (CO)**, a colorless, odorless gas produced by incomplete combustion.- CO has a very high affinity for **hemoglobin**, forming **carboxyhemoglobin**, which impairs oxygen transport and causes death via chemical **asphyxia**.*Cyanide poisoning*- Cyanide prevents cellular oxygen utilization (histotoxic hypoxia) by non-competitively inhibiting **cytochrome oxidase** in the mitochondria.- While highly fatal, cyanide is usually associated with the smell of **bitter almonds** at the scene and is not typically produced by household heat stoves.*H₂S poisoning*- **Hydrogen sulfide (H₂S)** poisoning is characterized by a distinctive odor of **rotten eggs** and is frequently associated with occupational exposure (e.g., sewers or drilling).- This gas also causes tissue hypoxia by inhibiting cellular respiration, but the circumstances described favor simple CO production from combustion.*Aluminium phosphide poisoning*- **Aluminium phosphide (ALP)** liberates **phosphine gas** upon exposure to moisture or stomach acid, leading to systemic toxicity.- This type of poisoning is usually due to deliberate ingestion of pesticides and causes severe effects, particularly on the **myocardium**, which is inconsistent with the presented scenario.

Q: A child is brought to the hospital with pinpoint pupils and difficulty breathing after playing at home. What is the most likely substance the child accidentally ingested?

Opioid. ***Opioid*** - Opioid toxicity classically causes the triad of **miosis (pinpoint pupils)**, **respiratory depression**, and **altered mental status**. - The difficulty breathing is a critical sign of opioid overdose due to reduced sensitivity of the brainstem's respiratory centers to **carbon dioxide**. - In a home setting, accidental ingestion of prescription opioid medications (morphine, codeine, oxycodone) is a common pediatric emergency. *Organophosphate* - While organophosphates cause **miosis** (pinpoint pupils) due to excessive parasympathetic stimulation, they typically cause a cholinergic crisis with copious secretions (salivation, lacrimation) and **bronchospasm** (wet lungs). - The clinical picture usually includes muscle weakness, fasciculations, and the pronounced **SLUDGE** syndrome (Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis), which differentiates it from isolated respiratory depression and miosis. - More commonly associated with agricultural or pesticide exposure rather than typical home ingestion. *Atropine* - Atropine is an anticholinergic agent that causes the opposite effects, specifically **mydriasis (dilated pupils)**, dry skin, and tachycardia (anticholinergic toxidrome). - Patients present with flushed, dry skin, urinary retention, hyperthermia, and altered mental status ("hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter"). - Would not cause pinpoint pupils or the respiratory depression seen in this case. *Benzodiazepine* - Benzodiazepines can cause **respiratory depression** and CNS depression, but they do not typically cause **miosis (pinpoint pupils)**. - Pupils are usually normal or slightly dilated with benzodiazepine overdose. - The absence of pinpoint pupils makes this diagnosis unlikely in this clinical presentation.

Q: Which of the following ion movements is primarily responsible for the repolarization phase (Phase 3) of an action potential, as depicted in the image?

Efflux of K ions. ***Efflux of K ions*** - Phase 3, the **repolarization** or falling phase, is initiated by the opening of voltage-gated **potassium (K+) channels** as the membrane potential peaks. - The outflow of positive K+ ions from the cell, known as **efflux**, causes the membrane potential to become negative again, returning it towards the resting state. *Efflux of Na ions* - The electrochemical gradient for **sodium (Na+)** strongly favors its movement into the cell (influx), not out of it (efflux). - While the **Na+/K+ pump** does move Na+ out of the cell, this is a slow, active process to maintain resting potential, not the cause of rapid repolarization. *Influx of Na ions* - The rapid influx (inflow) of **Na+** ions through voltage-gated channels is responsible for the **depolarization** phase (Phase 0), the sharp upstroke of the action potential. - During repolarization (Phase 3), these voltage-gated **Na+ channels** become inactivated, stopping the influx. *Resting membrane potential is maintained by the Na-K pump* - The **Na+/K+ pump** is crucial for establishing and maintaining the ion gradients for the **resting membrane potential** (Phase 4), not for the rapid repolarization phase itself. - Repolarization is a passive process resulting from ion flow through channels, which is much faster than the action of the Na+/K+ pump.

Q: Which among the following hormones, in a lactating mother, is responsible for the maintenance and proliferation of milk-secreting breast tissue?

Prolactin. ***Prolactin***- **Prolactin** is the key hormone responsible for establishing and maintaining **lactation** (milk production), and it drives the final proliferation and differentiation of the **alveolar epithelial cells** during the later stages of pregnancy and postpartum state.- While other hormones contribute to overall breast development, Prolactin ensures the functional readiness and continued growth/maintenance of the glandular tissue necessary for milk synthesis.*Oxytocin*- **Oxytocin** is responsible for the **milk ejection reflex** (let-down), causing the contraction of **myoepithelial cells** around the alveoli.- It does not promote the proliferative growth or differentiation of the secretory breast tissue itself.*Estrogen*- **Estrogen** is primarily responsible for the growth and development of the **ductal system** of the breast during puberty and pregnancy.- High levels of estrogen during pregnancy actively **inhibit** the full secretory function of prolactin until after delivery.*Progesterone*- **Progesterone** is crucial for the development of the **lobular-alveolar system** during pregnancy.- Its rapid decline after delivery is essential to remove the inhibitory block, allowing **prolactin** to fully initiate and manage milk secretion in the lactating phase.

Q: A 35-year-old man wakes up after sleeping with his arm draped over a chair and complains of pain. Which of the following accurately describes the order of susceptibility of nerve fibers in the given condition?

A > B > C. ***A > B > C***- The clinical scenario describes **neuropraxia** (transient functional block) due to **compression and ischemia**, such as in 'Saturday night palsy'.- A fibers have the largest diameter and the heaviest myelination, making them the most vulnerable to conduction block resulting from **focal demyelination** caused by mechanical stress. *A B > A*- This order represents the susceptibility of nerve fibers to **local anesthetic agents** (pharmacologic block), not mechanical compression. - Local anesthetics preferentially block smaller, unmyelinated C fibers (pain and temperature sensation), followed by B and then A fibers (motor/proprioception). *C B fibers > C fibers) to compression injury.

Q: A woman from Delhi travels to Ladakh, a high-altitude region. Soon after arrival, she develops symptoms such as breathlessness, headache, and lightheadedness. What is the primary underlying mechanism responsible for her symptoms?

Respiratory alkalosis. ***Respiratory alkalosis***- Acute exposure to high altitude decreases the **partial pressure of inspired oxygen ($P_{I}O_2$)**, leading to **hypoxemia**, which stimulates the peripheral chemoreceptors (carotid bodies) to increase the respiratory drive (hyperventilation).- This hyperventilation causes a massive *washout* of **carbon dioxide ($ ext{CO}_2$)**, resulting in low arterial $ ext{P}_{ ext{a}} ext{CO}_2$ (hypocapnia) and an immediate increase in blood $ ext{pH}$ (alkalosis).*Respiratory acidosis*- This condition is characterized by **hypoventilation** resulting in the retention of $ ext{CO}_2$ and a resultant drop in $ ext{pH}$.- Acute high altitude exposure leads to increased ventilation (hyperventilation), making this mechanism incorrect.*Metabolic alkalosis*- This state results from excess plasma **bicarbonate ($ ext{HCO}_3^{-})$** or significant loss of $ ext{H}^{+}$ (e.g., protracted vomiting, loop diuretics).- This is not the primary acid-base disturbance leading to acute mountain sickness (AMS) symptoms.*Metabolic acidosis*- This state is the **delayed renal compensatory mechanism** for respiratory alkalosis, where the kidneys increase the excretion of $ ext{bicarbonate}$.- While it occurs, it is a secondary compensation that takes 24–48 hours and is not the *primary underlying mechanism* responsible for the immediate symptoms upon arrival.

Q: An alcoholic patient is admitted to the hospital 48 hours after his last drink. He presents with altered consciousness, disorientation, and severe agitation. What is the most likely diagnosis?

Delirium tremens. ***Correct: Delirium tremens*** - **Classic presentation** with altered consciousness, disorientation, and severe agitation occurring **48 hours after last drink** (typical onset 48-72 hours) - Represents the **most severe form of alcohol withdrawal syndrome** - Clinical features include autonomic hyperactivity, confusion, visual/tactile hallucinations, and psychomotor agitation - **Medical emergency** requiring immediate treatment with benzodiazepines and supportive care - Mortality rate 5-15% if untreated *Incorrect: Korsakoff psychosis* - **Chronic condition** resulting from thiamine (vitamin B1) deficiency in chronic alcoholism - Characterized by **anterograde amnesia** and **confabulation**, not acute delirium - Does not present with acute altered consciousness or severe agitation - Timeline does not fit acute withdrawal scenario *Incorrect: Alcohol withdrawal symptoms* - While DT is technically a form of alcohol withdrawal, this option refers to **minor/uncomplicated withdrawal** - Minor withdrawal symptoms (tremors, anxiety, sweating, nausea) typically occur **6-24 hours** after last drink, not at 48 hours - The **severity** (altered consciousness, disorientation) indicates progression to DT, not simple withdrawal - Uncomplicated withdrawal does not present with delirium or significant confusion *Incorrect: Cocaine intoxication* - Patient is described as **alcoholic with 48 hours since last drink** - no history of cocaine use mentioned - Cocaine intoxication would present with **euphoria, hyperactivity, paranoia**, and cardiovascular symptoms (tachycardia, hypertension) - Timeline doesn't fit - intoxication occurs during use, not days after last alcohol consumption

Q: In the given image, which vein is mainly affected?

Great saphenous vein. ***Great saphenous vein*** - The image displays prominent varicose veins along the **medial aspect of the leg**, which corresponds to the anatomical path of the **great saphenous vein (GSV)**. - The GSV is the most frequently affected vein in varicose vein disease due to valvular incompetence, leading to venous reflux and the characteristic tortuous dilatation seen in the picture. *Short saphenous vein* - The **short saphenous vein (SSV)** ascends along the **posterior aspect of the calf**. Varicosities primarily from the SSV would be most visible on the back of the leg. - While some posterior varicosities may be present, the predominant involvement shown is medial, making the GSV the main affected vessel. *Femoral vein* - The **femoral vein** is a major vessel of the **deep venous system**, not the superficial system. - Varicose veins are a disease of **superficial veins**; deep veins like the femoral vein do not become varicose. *Perforator veins* - **Perforator veins** connect the superficial venous system to the deep system. Their incompetence is a crucial factor in the development of venous hypertension and varicosities. - However, the large, dilated vessels visible on the skin are part of a major superficial trunk (the GSV in this case), not the perforators themselves, which are much smaller connecting vessels.

Question 1

A patient presented to OPD with ophthalmoplegia and ptosis. Diagnosis of superior orbital fissure syndrome was confirmed after examination. Which nerves are compressed in this case ?

Accepted Answer

III, IV, V1, VI

Answer

III, IV, V1, V2

Answer

II, III, IV, V1

Answer

II, III, IV, VI

Question 2

The artery that is palpated between the medial malleolus and the calcaneal tendon is?

Accepted Answer

Posterior tibial artery

Answer

Popliteal artery

Answer

Anterior tibial artery

Answer

Dorsalis pedis artery

Question 3

A deceased woman was sent for an autopsy. She was found dead in a locked room with a heat stove still running. What is the most likely cause of death?

Accepted Answer

CO poisoning

Answer

Cyanide poisoning

Answer

H₂S poisoning

Answer

Aluminium phosphide poisoning

Question 4

A child is brought to the hospital with pinpoint pupils and difficulty breathing after playing at home. What is the most likely substance the child accidentally ingested?

Accepted Answer

Opioid

Answer

Benzodiazepine

Answer

Atropine

Answer

Organophosphate

Question 5

Which of the following ion movements is primarily responsible for the repolarization phase (Phase 3) of an action potential, as depicted in the image?

Accepted Answer

Efflux of K ions

Answer

Influx of Na ions

Answer

Efflux of Na ions

Answer

Resting membrane potential is maintained by the Na-K pump

Question 6

Which among the following hormones, in a lactating mother, is responsible for the maintenance and proliferation of milk-secreting breast tissue?

Accepted Answer

Prolactin

Answer

Estrogen

Answer

Oxytocin

Answer

Progesterone

Question 7

A 35-year-old man wakes up after sleeping with his arm draped over a chair and complains of pain. Which of the following accurately describes the order of susceptibility of nerve fibers in the given condition?

Accepted Answer

A > B > C

Answer

C < B < A

Answer

A < B < C

Answer

C > B > A

Question 8

A woman from Delhi travels to Ladakh, a high-altitude region. Soon after arrival, she develops symptoms such as breathlessness, headache, and lightheadedness. What is the primary underlying mechanism responsible for her symptoms?

Accepted Answer

Respiratory alkalosis

Answer

Metabolic alkalosis

Answer

Metabolic acidosis

Answer

Respiratory acidosis

Question 9

An alcoholic patient is admitted to the hospital 48 hours after his last drink. He presents with altered consciousness, disorientation, and severe agitation. What is the most likely diagnosis?

Accepted Answer

Delirium tremens

Answer

Korsakoff psychosis

Answer

Alcohol withdrawal symptoms

Answer

Cocaine intoxication

Question 10

In the given image, which vein is mainly affected?

Accepted Answer

Great saphenous vein

Answer

Perforator veins

Answer

Femoral vein

Answer

Short saphenous vein

FMGE 2025

Anatomy

Forensic Medicine

Pharmacology

Physiology

Psychiatry

Surgery