Obstetrics and Gynecology
2 questionsIf the division in the zygote occurs between 9-12 days after fertilization, which of the following twins is expected?
Which of the following is shown in the given image? 
FMGE 2023 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 191: If the division in the zygote occurs between 9-12 days after fertilization, which of the following twins is expected?
- A. Dichorionic diamniotic
- B. Monochorionic diamniotic
- C. Monochorionic monoamniotic (Correct Answer)
- D. Conjoint twins
Explanation: ***Monochorionic monoamniotic*** - Division of the inner cell mass (ICM) occurring between **9 and 12 days** after fertilization results in a twin pregnancy where both fetuses share a single **chorion** and a single **amnion**.- This stage marks division after the amnion has formed (around day 8) but before complete differentiation, leading to high risks like **cord entanglement**. *Dichorionic diamniotic* - This pattern results from division occurring very early, typically within the first **3 days** (2-cell stage to morula stage).- Since separation happens before the differentiation of the trophoblast and inner cell mass, both the **chorion** and the **amnion** are separate. *Conjoint twins* - Conjoint twins (Siamese twins) occur when the separation is delayed beyond the **13th day** after fertilization.- The division is incomplete, as it occurs *after* the formation of the **embryonic disc**. *Monochorionic diamniotic* - This type of twinning arises from division occurring between **4 and 8 days** after fertilization, typically during the blastocyst stage.- It leads to the sharing of the **chorion** but the development of separate **amnions**.
Question 192: Which of the following is shown in the given image? 
- A. Striae gravidarum
- B. Chloasma
- C. Linea alba
- D. Linea nigra (Correct Answer)
Explanation: ***Linea nigra*** - The image shows a dark, vertical line running down the midline of a pregnant woman's abdomen, which is the classic presentation of **linea nigra**. - This hyperpigmentation of the **linea alba** is a normal physiological change during pregnancy, caused by increased levels of hormones such as **melanocyte-stimulating hormone (MSH)** and **estrogen**. *Striae gravidarum* - **Striae gravidarum**, commonly known as stretch marks, are atrophic linear bands that result from the rapid stretching of the skin. They are not represented by the single, dark vertical line shown. - Initially, they appear as reddish or purplish lines (**striae rubrae**) and later fade to a silvery-white color (**striae albicantes**). *Chloasma* - **Chloasma**, or melasma, is a form of hyperpigmentation that appears on the face, particularly on the cheeks, forehead, and upper lip, often referred to as the "mask of pregnancy". - This condition affects facial skin and does not present as a line on the abdomen. *Linea alba* - The **linea alba** ("white line") is the fibrous connective tissue that runs down the midline of the abdomen in all individuals. It is typically pale and not easily visible. - During pregnancy, the **linea alba** darkens due to hormonal influences, transforming into the **linea nigra**. Therefore, the image shows the pigmented version, not the original linea alba.
Pathology
5 questionsThe given inclusion bodies are characteristic of which of the following organisms? 
A 70-year-old male comes with complaints of hip pain. An X-ray of the hip shows lytic lesions and elevated serum calcium levels. Bone marrow plasma cells are 42%, and the cells seen are given in the image below. What is the most likely diagnosis? 
The following picture shows a lymph node biopsy of a 30-year-old male with cervical lymphadenopathy. The diagnosis is
What type of cell is shown in the image below?
A 40-year-old female presents with frequent headaches. Investigation reveals raised intracranial pressure and the presence of a dural-based tumor. Which of the following histological findings correlate with the diagnosis?
FMGE 2023 - Pathology FMGE Practice Questions and MCQs
Question 191: The given inclusion bodies are characteristic of which of the following organisms? 
- A. Epstein-Barr virus
- B. Herpes simplex virus
- C. Cytomegalovirus (Correct Answer)
- D. Human papillomavirus
Explanation: ***Cytomegalovirus*** - The image displays cells with marked enlargement (**cytomegaly**) and large, basophilic intranuclear inclusion bodies surrounded by a clear halo, which is the classic **"owl's eye"** appearance pathognomonic for Cytomegalovirus (CMV) infection [1]. - These inclusions are composed of viral particles and are typically seen in various tissues, such as the lungs, kidneys, and gastrointestinal tract, especially in **immunocompromised** patients [1]. *Human papillomavirus* - HPV infection is histologically characterized by **koilocytes**, which are squamous epithelial cells with a non-staining perinuclear halo and a wrinkled, hyperchromatic nucleus. - These changes are typically seen in cervical smears (Pap smears) or skin warts and are distinct from the large intranuclear inclusions of CMV. *Epstein-Barr virus* - EBV infection, particularly in infectious mononucleosis, is identified by the presence of **atypical lymphocytes** (Downey cells) in the peripheral blood, which have abundant cytoplasm and indented nuclei. - EBV does not produce the characteristic "owl's eye" intranuclear inclusions seen in the provided image. *Herpes simplex virus* - HSV infection is characterized by **multinucleated giant cells** with molded nuclei and eosinophilic intranuclear inclusions known as **Cowdry type A bodies**. - While both are herpesviruses, the inclusions in HSV typically give a **"ground-glass"** appearance to the nucleus, which is different from the distinct, haloed "owl's eye" inclusion of CMV. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 367-368.
Question 192: A 70-year-old male comes with complaints of hip pain. An X-ray of the hip shows lytic lesions and elevated serum calcium levels. Bone marrow plasma cells are 42%, and the cells seen are given in the image below. What is the most likely diagnosis? 
- A. Multiple myeloma (Correct Answer)
- B. ALL
- C. CML
- D. CLL
Explanation: ***Multiple myeloma*** - The patient's presentation with bone pain, **lytic bone lesions** on X-ray, **hypercalcemia**, and age >60 years is classic for multiple myeloma [1]. The diagnosis is confirmed by the bone marrow biopsy showing >10% clonal plasma cells (42% in this case) [2]. - The image displays a bone marrow aspirate with extensive infiltration by **plasma cells**, characterized by their eccentric nuclei, abundant basophilic cytoplasm, and a perinuclear halo (hof) [2]. Some binucleated forms are also visible, which can be seen in neoplastic plasmacytosis [2]. *CLL* - Chronic Lymphocytic Leukemia (CLL) is a malignancy of mature B-lymphocytes, not plasma cells. The characteristic finding on a peripheral smear would be **lymphocytosis** with many **smudge cells**. - While bone marrow infiltration occurs, it consists of small, mature-appearing lymphocytes with scant cytoplasm, which is morphologically distinct from the cells shown. *ALL* - Acute Lymphoblastic Leukemia (ALL) is a cancer of immature lymphoid cells called **lymphoblasts**. These cells typically have scant cytoplasm, a high nuclear-to-cytoplasmic ratio, and fine, dispersed chromatin. - ALL is most common in **children**, and while it can cause bone pain, the specific combination of lytic lesions, hypercalcemia, and mature plasma cell morphology is not characteristic. *CML* - Chronic Myeloid Leukemia (CML) is a myeloproliferative disorder involving the excessive production of **granulocytes** (neutrophils, eosinophils, basophils). The bone marrow would show granulocytic hyperplasia. - CML is genetically defined by the presence of the **Philadelphia chromosome** (BCR-ABL1 fusion gene) and clinically presents with marked leukocytosis and often massive splenomegaly, which are not features of this case. **References:** [1] Kumar v, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 608. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 616-619.
Question 193: The following picture shows a lymph node biopsy of a 30-year-old male with cervical lymphadenopathy. The diagnosis is
- A. Hodgkin disease (Correct Answer)
- B. Chronic lymphocytic leukemia (CLL)
- C. Human papillomavirus (HPV)
- D. Acute myeloid leukemia (AML)
Explanation: ***Hodgkin disease*** - The image displays a classic **Reed-Sternberg cell**, a large, often binucleated cell with prominent, eosinophilic nucleoli giving it an "owl's eye" appearance [1]. This finding is pathognomonic for Hodgkin disease [3]. - The clinical presentation of a young adult male with painless cervical lymphadenopathy is a typical initial sign of Hodgkin lymphoma, particularly the nodular sclerosis subtype [1], [2]. *Acute myeloid leukemia (AML)* - AML is a malignancy of myeloid precursors in the bone marrow. A lymph node biopsy would show infiltration by **myeloblasts**, which lack the characteristic binucleation and prominent eosinophilic nucleoli of Reed-Sternberg cells. - Key diagnostic features for AML include the presence of **Auer rods** (cytoplasmic inclusions) in blasts and positive staining for **myeloperoxidase (MPO)**. *Human papillomavirus (HPV)* - HPV is a virus associated with squamous cell carcinomas. Its characteristic cellular finding is the **koilocyte**, a squamous epithelial cell with a wrinkled, hyperchromatic nucleus and a perinuclear halo. - While HPV-related oropharyngeal cancer can metastasize to cervical lymph nodes, the biopsy would show nests of malignant squamous cells, not the distinct cellular morphology seen here. *Chronic lymphocytic leukemia (CLL)* - CLL is a proliferation of small, mature-appearing B-lymphocytes. A lymph node biopsy in CLL would show a diffuse infiltration of these small, monotonous lymphocytes, completely different from the large, atypical cell shown. - The peripheral blood smear is more characteristic for CLL, often showing numerous small lymphocytes and pathognomonic **smudge cells**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 614-616. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 616-618. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 616.
Question 194: What type of cell is shown in the image below?
- A. Mott cells
- B. Faggot cell
- C. Sézary-Lutzner cells
- D. Reed Sternberg cell (Correct Answer)
Explanation: ***Reed Sternberg cell*** - This is a classic **Reed-Sternberg cell**, characterized by its large size, bilobed or multinucleated appearance, and prominent eosinophilic nucleoli, which create a pathognomonic "**owl-eye**" look [1], [2]. - These cells are the neoplastic hallmark of **Hodgkin lymphoma** and are crucial for its diagnosis [2]. *Faggot cell* - Faggot cells are malignant promyelocytes containing numerous **Auer rods** that are bundled together, resembling a bundle of sticks. - They are characteristically seen in **Acute Promyelocytic Leukemia (APL)**, a subtype of AML, and are not depicted in the image. *Mott cells* - Mott cells are plasma cells with cytoplasm packed with **Russell bodies**, which are eosinophilic globules of immunoglobulin, giving the cell a "grape-like" appearance. - They are found in conditions with chronic plasma cell stimulation or plasma cell neoplasms like **multiple myeloma**, but their morphology is distinct from the cell shown. *Sézary-Lutzner cells* - These are malignant T-lymphocytes characterized by a highly convoluted, **cerebriform (brain-like) nucleus**. - They are the hallmark cells of cutaneous T-cell lymphomas, such as **Mycosis Fungoides** and **Sézary syndrome**, and lack the "owl-eye" nucleoli seen in the image. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 614-618. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 556-557.
Question 195: A 40-year-old female presents with frequent headaches. Investigation reveals raised intracranial pressure and the presence of a dural-based tumor. Which of the following histological findings correlate with the diagnosis?
- A. Flexner - Wintersteiner rosettes
- B. Psammoma bodies with whorling of tumor cells (Correct Answer)
- C. Homer - Wright rosettes
- D. Fried egg appearance
Explanation: ***Psammoma bodies with whorling of tumor cells***- The clinical picture of a **dural-based tumor** [2] causing symptoms of **raised intracranial pressure** (headache) is highly suggestive of a **Meningioma**.- **Psammoma bodies** (laminated calcified concretions) formed by the degeneration of the whorled cell clusters [1] are the classic histological hallmark of the transitional and **meningothelial meningioma** subtypes.*Fried egg appearance*- This histological appearance, characterized by clear perinuclear halos, is the classic finding for **Oligodendroglioma**, a type of parenchymal brain tumor.- Oligodendrogliomas typically arise within the cerebral **white matter** and are usually not primarily dural-based.*Flexner - Wintersteiner rosettes*- These are specialized structures representing an attempt at **retinal differentiation** and are the characteristic feature of **Retinoblastoma**.- They are also sometimes seen in highly aggressive midline CNS tumors, such as **Pineoblastoma**.*Homer - Wright rosettes*- These are seen in tumors exhibiting divergent **neuroectodermal differentiation** but lack a true central lumen or fenestration.- They are the characteristic histological finding in **Medulloblastoma** (a cerebellar tumor) and **Neuroblastoma** (a tumor of the adrenal medulla or sympathetic chain). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 727-728. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1316-1317.
Pediatrics
2 questionsA child presents with the findings shown in the image below. What is the true statement regarding this condition?
A 5-year-old girl is brought to the clinic with a fever, cough, red eyes, running nose, and rash. The appearance of the child is shown below. What is the diagnosis? 
FMGE 2023 - Pediatrics FMGE Practice Questions and MCQs
Question 191: A child presents with the findings shown in the image below. What is the true statement regarding this condition?
- A. Kwashiorkor due to calorie malnutrition
- B. Marasmus due to calorie malnutrition
- C. Kwashiorkor due to protein malnutrition (Correct Answer)
- D. Marasmus due to protein malnutrition
Explanation: ***Kwashiorkor due to protein malnutrition*** - The image shows a child with characteristic features of **Kwashiorkor**, including generalized **edema** (swollen legs and feet) and a **distended abdomen** due to hypoalbuminemia and hepatomegaly. - This condition is a form of severe acute malnutrition caused primarily by a dietary **protein deficiency**, often in the setting of adequate or near-adequate calorie intake. *Kwashiorkor due to calorie malnutrition* - The primary cause of **Kwashiorkor** is insufficient **protein** intake, which leads to decreased plasma oncotic pressure and edema; a deficiency in calories is not the defining etiological factor. - Severe **calorie deficiency** is the main feature of **Marasmus**, which presents with severe wasting rather than edema. *Marasmus due to protein malnutrition* - The clinical presentation in the image is **Kwashiorkor**, not **Marasmus**, as evidenced by the presence of significant **edema**. - Marasmus is caused by a combined deficiency of **both protein and calories**, leading to severe wasting and an emaciated appearance. *Marasmus due to calorie malnutrition* - **Marasmus** is characterized by severe **wasting** of subcutaneous fat and muscle, resulting in a 'skin and bones' appearance, which is absent in this child. - The presence of a 'pot belly' and **pitting edema** are the hallmark signs that differentiate **Kwashiorkor** from **Marasmus**.
Question 192: A 5-year-old girl is brought to the clinic with a fever, cough, red eyes, running nose, and rash. The appearance of the child is shown below. What is the diagnosis? 
- A. Measles (Correct Answer)
- B. Chickenpox
- C. Mumps
- D. Erythema infectiosum
Explanation: ***Measles*** - The clinical presentation of fever with the classic triad of **cough, coryza, and conjunctivitis** (the "3 Cs") is highly suggestive of measles (rubeola). - The image shows **Koplik's spots** (small white spots on the buccal mucosa), which are pathognomonic for measles and appear before the characteristic maculopapular rash. *Mumps* - Mumps is primarily characterized by **parotitis**, a painful swelling of the salivary glands, which is not described in this patient. - The classic prodrome of the "3 Cs" and Koplik's spots are absent in mumps. *Chickenpox* - The rash in chickenpox (varicella) is **vesicular**, often described as a "dewdrop on a rose petal," and appears in crops. This is different from the maculopapular rash of measles. - While a fever and malaise can occur, the prominent upper respiratory symptoms and conjunctivitis of measles are not typical of chickenpox. *Erythema infectiosum* - Caused by **Parvovirus B19**, this condition is characterized by a distinctive "**slapped-cheek**" rash on the face. - It is followed by a **lacy, reticular rash** on the trunk and extremities, which is inconsistent with the patient's presentation.
Radiology
1 questionsA cancer patient undergoing radiotherapy is given a dose of 1.8 to 2 Gy once daily for 5 days per week for a duration of 6 to 8 weeks. What is this type of radiotherapy called?
FMGE 2023 - Radiology FMGE Practice Questions and MCQs
Question 191: A cancer patient undergoing radiotherapy is given a dose of 1.8 to 2 Gy once daily for 5 days per week for a duration of 6 to 8 weeks. What is this type of radiotherapy called?
- A. Hyper fractionated radiotherapy
- B. Brachytherapy
- C. Regular Fractionated radiotherapy (Correct Answer)
- D. Accelerated fractionation radiotherapy
Explanation: ***Regular Fractionated radiotherapy***- This schedule uses biologically effective doses typically between **1.8 to 2.0 Gy** delivered once per day, 5 days per week, which is the standard of care for many cancers.- This conventional fractionation regimen allows for optimal **tumor cell kill** while providing sufficient time for normal tissues to repair sublethal damage between fractions (the principle of **Repair**).*Hyper fractionated radiotherapy*- This involves giving smaller doses per fraction (typically **<1.8 Gy**) delivered **more than once a day**.- The goal is often to reduce **late toxicities** to normal tissues while sometimes escalating the total dose delivered.*Accelerated fractionation radiotherapy*- This approach delivers the total treatment dose over a **significantly shorter overall treatment time** than standard fractionation, often involving multiple fractions per day or higher daily doses.- It is primarily used to counteract the effects of **accelerated tumor cell repopulation** during the course of treatment.*Brachytherapy*- This is a type of radiotherapy where the radiation source (sealed isotopes) is placed **inside or next to the tumor** (internal radiation), which is a delivery technique, not an external fractionation schedule.- It can be delivered as **High Dose Rate (HDR)** or **Low Dose Rate (LDR)** therapy.