Dermatology
1 questionsA 45-year-old man with multiple sexual partners presents with a palmoplantar rash as seen below. On examination, he has epitrochlear lymphadenopathy. Which of the following is the likely diagnosis?
FMGE 2023 - Dermatology FMGE Practice Questions and MCQs
Question 31: A 45-year-old man with multiple sexual partners presents with a palmoplantar rash as seen below. On examination, he has epitrochlear lymphadenopathy. Which of the following is the likely diagnosis?
- A. Psoriasis
- B. Secondary syphilis (Correct Answer)
- C. Meningococcemia
- D. Stevens-Johnson syndrome
Explanation: ***Secondary syphilis*** - The classic rash of secondary syphilis is a diffuse, maculopapular eruption that characteristically involves the **palms and soles**, as seen in the image. A history of multiple sexual partners is a major risk factor. - **Epitrochlear lymphadenopathy** is a highly suggestive, though not pathognomonic, sign of secondary syphilis. Other systemic symptoms may include fever, malaise, and **condylomata lata**. *Psoriasis* - While psoriasis can affect the palms and soles (**palmoplantar psoriasis**), it typically presents as well-demarcated, erythematous plaques with a silvery scale, which differs from the rash shown. - Psoriasis is an autoimmune condition and is not associated with **epitrochlear lymphadenopathy** or risk factors like multiple sexual partners. *Meningococcemia* - This is an acute, life-threatening infection that presents with a **petechial or purpuric rash** that can become necrotic, not a papular rash on the palms and soles. - Patients with **meningococcemia** are typically systemically unwell with high fever, hypotension, and signs of meningitis, which are absent in this presentation. *Steven Johnson syndrome* - SJS is a severe mucocutaneous reaction characterized by **targetoid lesions**, bullae, and epidermal detachment, which are not features of the rash shown. - A key feature of SJS is severe involvement of at least two **mucous membranes** (e.g., oral, ocular, genital), which is not mentioned in this case.
ENT
3 questionsWhich of the following is true about laryngeal cancer stage T1bNOMO?
A patient who is a teacher by profession presents to the clinic with hoarseness of voice. What is the most likely diagnosis for this patient?
A patient presents with painful vesicles in the external auditory meatus and over the tympanic membrane. In addition to that, he also has facial nerve palsy. What is the most likely diagnosis and which is the site that is affected?
FMGE 2023 - ENT FMGE Practice Questions and MCQs
Question 31: Which of the following is true about laryngeal cancer stage T1bNOMO?
- A. Both vocal cords involved and fixed
- B. Both vocal cords involved, and mobile (Correct Answer)
- C. One vocal cord involved and fixed
- D. One vocal cord involved, and mobile
Explanation: ***Both vocal cords involved, and mobile***- The **T1** designation in glottic laryngeal cancer implies that the tumor is strictly limited to the **vocal cords** and that mobility is preserved (i.e., they are **mobile**).- The subsequent **T1b** substage defines tumors that involve **both vocal cords** (e.g., crossing the anterior or posterior commissure) while maintaining normal movement.*Both vocal cords involved and fixed*- **Vocal cord fixation** is a defining feature of **T3** glottic carcinoma, indicating deep invasion into the paralaryngeal space or underlying musculature.- This designation immediately excludes **T1** staging, which strictly requires preserved vocal cord **mobility**.*One vocal cord involved and fixed*- **Fixation** (immobility) places the tumor in **T3** or higher, regardless of tumor size or involvement of one versus both vocal cords.- **T1a** is defined by involvement of only **one vocal cord**, but critically, it must be mobile to be classified as T1.*One vocal cord involved, and mobile*- This specific description corresponds to **T1a** glottic laryngeal cancer, which involves the tumor being confined to the **glottis** and limited to only **one vocal cord**, with normal mobility.
Question 32: A patient who is a teacher by profession presents to the clinic with hoarseness of voice. What is the most likely diagnosis for this patient?
- A. Vocal polyp
- B. Vocal cyst
- C. Reinke's oedema
- D. Vocal nodule (Correct Answer)
Explanation: ***Vocal nodules***- This is the most likely diagnosis as **vocal nodules** (or singer's nodules) are typically caused by chronic **vocal strain** and **misuse**, common in professions like teaching.- Nodules present as bilateral, symmetrical lesions at the junction of the anterior one-third and posterior two-thirds of the vocal cords, leading to persistent **hoarseness**.*Vocal polyp*- Usually presents as a **unilateral** mass and is often caused by a single acute instance of **vocal trauma** (e.g., screaming) or long-term irritants like smoking.- While causing hoarseness, polyps are less commonly associated with the chronic, bilateral lesions seen from professional voice abuse compared to nodules.*Vocal cyst*- These are retention cysts or epidermoid cysts, which are usually **unilateral** and are not primarily linked to the pathogenesis of professional voice overuse, although they can cause persistent hoarseness.- Cysts are formed when a mucus gland duct is blocked or when keratin builds up, and they are typically located sub-epithelially, appearing deeper than nodules.*Reinke's oedema*- This condition is almost exclusively associated with **heavy smoking** and is characterized by a gelatinous, bilateral swelling of the superficial lamina propria (*Reinke's space*).- While it causes severe hoarseness, the primary predisposing factor (smoking) is absent in the prompt, making nodules (vocal abuse) a more probable primary diagnosis based on the profession.
Question 33: A patient presents with painful vesicles in the external auditory meatus and over the tympanic membrane. In addition to that, he also has facial nerve palsy. What is the most likely diagnosis and which is the site that is affected?
- A. Ramsay Hunt syndrome and basal ganglion
- B. Ramsay Hunt syndrome and geniculate ganglion (Correct Answer)
- C. Melkersson syndrome and otic ganglion
- D. Melkersson syndrome and trigeminal ganglion
Explanation: ***Ramsay Hunt syndrome and geniculate ganglion*** - **Ramsay Hunt syndrome (herpes zoster oticus)** is caused by reactivation of varicella-zoster virus (VZV) in the **geniculate ganglion** of the facial nerve (CN VII) - **Classic triad:** Otalgia with vesicular eruption in the ear canal/tympanic membrane, ipsilateral facial nerve palsy, and auditory/vestibular symptoms - The **geniculate ganglion** is located at the genu (bend) of the facial nerve in the temporal bone and contains sensory neurons; VZV reactivation here causes the characteristic vesicular rash in the ear and facial paralysis - **Treatment:** High-dose antivirals (acyclovir/valacyclovir) plus corticosteroids within 72 hours, with eye protection if incomplete eyelid closure *Incorrect: Ramsay Hunt syndrome and basal ganglion* - While the diagnosis of Ramsay Hunt syndrome is correct based on the clinical presentation, the **basal ganglion** is incorrect - Basal ganglia are deep brain nuclei involved in motor control (caudate, putamen, globus pallidus), not sites of VZV reactivation or facial nerve involvement *Incorrect: Melkersson syndrome and otic ganglion* - **Melkersson-Rosenthal syndrome** presents with the triad of recurrent facial edema, relapsing facial palsy, and fissured tongue (lingua plicata) - It does **NOT** present with painful vesicular eruptions, which is the key distinguishing feature in this case - The **otic ganglion** is a parasympathetic ganglion associated with CN IX (glossopharyngeal nerve), not CN VII *Incorrect: Melkersson syndrome and trigeminal ganglion* - Melkersson-Rosenthal syndrome does not cause vesicular rash - The **trigeminal ganglion** (Gasserian ganglion) contains cell bodies of CN V sensory neurons; VZV reactivation here causes herpes zoster ophthalmicus, not Ramsay Hunt syndrome - Facial nerve palsy is not a feature of trigeminal nerve involvement
Internal Medicine
4 questionsWhich of the following is least likely to cause mucormycosis?
A 35-year-old woman takes aspirin for a headache, later presented with wheezing and breathlessness. Along with these two symptoms, what other clinical findings are likely to be found in this condition?
A 20-year-old male presented with yellowish discoloration of his skin and sclera. He is otherwise normal. He gives a history of viral infection 10 days ago, which was resolved 2 days back. He also gives a history of similar episodes in the past following any illness. Lab values are given below. What is the most likely diagnosis? Serum bilirubin: 2.4 mg/dL Unconjugated bilirubin: 2.1mg/dL Conjugated bilirubin: 0.3mg/dL Serum AST and ALT: Normal
A 25-year-old male presents with mild jaundice noticed during a recent febrile illness. He gives a history of similar episodes in the past following any illness or periods of fasting. Physical examination reveals mild icterus with no hepatosplenomegaly. Lab values are given below: Serum bilirubin: 2.4 mg/dL Unconjugated bilirubin: 2.1 mg/dL Conjugated bilirubin: 0.3 mg/dL Serum AST and ALT: Normal What is the most likely diagnosis?
FMGE 2023 - Internal Medicine FMGE Practice Questions and MCQs
Question 31: Which of the following is least likely to cause mucormycosis?
- A. Neutropenia
- B. Broad spectrum antibiotics (Correct Answer)
- C. Uncontrolled diabetes without DKA
- D. Prolonged use of steroid
Explanation: ***Broad spectrum antibiotics*** - While broad-spectrum antibiotics predispose to many fungal infections (especially *Candida* infections) by disrupting the normal **microbiome**, they are not typically considered a direct, primary risk factor for **mucormycosis** [1]. - *Mucorales* are ubiquitous molds, and their pathogenicity is primarily related to defects in **phagocytic function** (like in neutropenia) [2] or **acidosis/iron overload** (like in DKA), not bacterial flora changes [2]. *Neutropenia* - Profound **neutropenia** (low neutrophil count) significantly impairs the host's ability to clear fungal spores, making it one of the most important risk factors for invasive mold infections, including **mucormycosis** [2]. - Neutrophils are crucial for the primary defense against **Mucorales** by killing the spores and hyphae. *Uncontrolled diabetes without DKA* - Even without **diabetic ketoacidosis (DKA)**, poorly controlled diabetes leads to impaired phagocyte function and immunosuppression, increasing the risk of invasive fungal infections like *Mucorales* and **Candida** [2], [3]. - The high glucose environment, especially in the **nasal mucosa**, can facilitate the growth and invasion of these fungi. *Prolonged use of steroid* - Glucocorticoids cause generalized **immunosuppression** by impairing the function of phagocytes and T-lymphocytes, thereby increasing susceptibility to opportunistic infections [3]. - High-dose or prolonged corticosteroid use is a well-established risk factor for severe and disseminated **mucormycosis** as it compromises the innate immune response.
Question 32: A 35-year-old woman takes aspirin for a headache, later presented with wheezing and breathlessness. Along with these two symptoms, what other clinical findings are likely to be found in this condition?
- A. IgE release
- B. Nasal polyp (Correct Answer)
- C. Extrinsic asthma
- D. Drug interaction
Explanation: ***Nasal polyp***- This clinical scenario is classic for **Aspirin-Exacerbated Respiratory Disease (AERD)**, also known as **Samter's Triad**, a condition characterized by three key components.- The three components of Samter's Triad are **asthma** (wheezing/breathlessness), chronic rhinosinusitis with **nasal polyps**, and sensitivity to aspirin/NSAIDs [1].*IgE release*- **Aspirin sensitivity** is a pseudoallergic reaction driven by abnormal metabolism of **arachidonic acid**, specifically involving the COX-1 pathway, and is thus typically **non-IgE mediated**.- This pathway disturbance leads to the overproduction of bronchoconstrictive **leukotrienes** (LTC4, LTD4, LTE4), which are the primary mediators of the reaction.*Extrinsic asthma*- **Extrinsic asthma** refers to allergic asthma, which relies on **IgE-mediated Type I hypersensitivity** reactions triggered by environmental allergens.- AERD is classified as a form of **intrinsic (non-allergic) asthma** because the trigger mechanism is pharmacological/metabolic rather than immunological (allergen-specific IgE) [1].*Drug interaction*- The adverse reaction seen here is an **idiosyncratic drug hypersensitivity reaction** stemming from the patient's underlying disease (AERD), not interaction with another drug.- A true **drug interaction** occurs when one drug alters the absorption, distribution, metabolism, or excretion of another drug, which is irrelevant to leukotriene overproduction.
Question 33: A 20-year-old male presented with yellowish discoloration of his skin and sclera. He is otherwise normal. He gives a history of viral infection 10 days ago, which was resolved 2 days back. He also gives a history of similar episodes in the past following any illness. Lab values are given below. What is the most likely diagnosis? Serum bilirubin: 2.4 mg/dL Unconjugated bilirubin: 2.1mg/dL Conjugated bilirubin: 0.3mg/dL Serum AST and ALT: Normal
- A. Criggler-Najar type 1 syndrome
- B. Gilbert syndrome (Correct Answer)
- C. Rotor syndrome
- D. Dubin-Johnson syndrome
Explanation: ***Gilbert syndrome*** - This condition is characterized by **unconjugated hyperbilirubinemia** (as seen by 2.1 mg/dL unconjugated vs. 0.3 mg/dL conjugated) that is mild, typically <3 mg/dL, and intermittent. [1] The history of similar episodes following **stress**, **vigorous exercise**, or **illness** (like the recent viral infection) is a classic trigger for this condition, which is caused by reduced activity of the **UGT1A1 enzyme**. [1] *Dubin-Johnson syndrome* - This syndrome results in **conjugated (direct) hyperbilirubinemia** due to defective excretion of conjugated bilirubin (MRP2 transporter defect). *Criggler-Najar type 1 syndrome* - This is a severe congenital deficiency of the **UGT1A1 enzyme**, leading to markedly and persistently elevated **unconjugated bilirubin** (often >20 mg/dL) and usually resulting in **kernicterus** and death in infancy. [1] The patient presents later in life (20 years old) with only mild, fluctuating unconjugated hyperbilirubinemia, ruling out Type 1 severity. *Rotor syndrome* - Similar to Dubin-Johnson, Rotor syndrome causes **conjugated (direct) hyperbilirubinemia** due to hepatocyte storage and transport defects, which contradicts the patient's lab findings of predominantly unconjugated bilirubin. Unlike Dubin-Johnson, Rotor syndrome does **not** cause black pigmentation of the liver.
Question 34: A 25-year-old male presents with mild jaundice noticed during a recent febrile illness. He gives a history of similar episodes in the past following any illness or periods of fasting. Physical examination reveals mild icterus with no hepatosplenomegaly. Lab values are given below: Serum bilirubin: 2.4 mg/dL Unconjugated bilirubin: 2.1 mg/dL Conjugated bilirubin: 0.3 mg/dL Serum AST and ALT: Normal What is the most likely diagnosis?
- A. Dubin-Johnson syndrome
- B. Gilbert syndrome (Correct Answer)
- C. Rotor syndrome
- D. Criggler-Najar type 1 syndrome
Explanation: ***Gilbert syndrome*** - It is characterized by isolated, mild, intermittent **unconjugated hyperbilirubinemia** (total bilirubin <4 mg/dL), often triggered by stress, fasting, illness, or dehydration, matching the patient's history of episodes following illness [1]. - The underlying cause is reduced activity (typically 30%) of the enzyme **uridine diphosphoglucuronate glucuronosyltransferase (UGT1A1)**, necessary for conjugating bilirubin, but liver function (AST/ALT) remains normal [1], [3]. *Dubin-Johnson syndrome* - This is characterized by **conjugated (direct) hyperbilirubinemia** due to defective excretion of bilirubin into the bile canaliculi, contrasting with the predominantly unconjugated pattern seen here [2]. - The liver tissue typically shows **black pigmentation** due to epinephrine metabolite accumulation, which is a key pathological feature. *Criggler-Najar type 1 syndrome* - This syndrome involves a severe or complete absence of the **UGT1A1 enzyme**, leading to very high levels of **unconjugated bilirubin** (often >20 mg/dL) that cause **kernicterus** and usually death in infancy, which is not consistent with a history of recurrent mild episodes in an adult [1]. - It requires lifelong treatment, typically with **phototherapy** and **liver transplantation**, due to the severe defect [1]. *Rotor syndrome* - Similar to Dubin-Johnson syndrome, Rotor syndrome also causes **conjugated (direct) hyperbilirubinemia** due to impaired hepatic storage and excretion of conjugated bilirubin, which contradicts the laboratory findings of mostly unconjugated bilirubin.
Microbiology
2 questionsWhich among the following culture media is used in the identification of Salmonella?
Which among the following parasites directly invade the skin?
FMGE 2023 - Microbiology FMGE Practice Questions and MCQs
Question 31: Which among the following culture media is used in the identification of Salmonella?
- A. PLET medium
- B. BCYE medium
- C. Wilson and Blair medium (Correct Answer)
- D. Stuart's medium
Explanation: ***Wilson and Blair medium*** - Wilson and Blair medium, also known as **Bismuth Sulfite Agar (BSA)**, is a highly selective and differential medium used primarily for the isolation of **Salmonella** species, particularly *S. Typhi*. - **Salmonella** colonies typically appear **black** on this medium due to the precipitation of **bismuth sulfite** caused by **hydrogen sulfide ($ ext{H₂S}$)** production. *PLET medium* - PLET (Polymyxin-Lysozyme-EDTA-Thallium Acetate) medium is a selective agar strictly used for the isolation of **Bacillus anthracis**. - The medium contains selective agents that suppress the growth of most contaminating bacteria while allowing the growth of *B. anthracis*. *BCYE medium* - **BCYE** (Buffered Charcoal Yeast Extract) medium is the gold standard for culturing **Legionella pneumophila**. - *Legionella* is fastidious and requires **L-cysteine** and **iron salts** which are provided by the BCYE formulation. *Stuart's medium* - Stuart's medium is a **transport medium**, not an identification or culture medium, used for preserving the viability of delicate pathogens during transit. - It is often utilized for transporting specimens containing fastidious organisms such as **Neisseria gonorrhoeae**.
Question 32: Which among the following parasites directly invade the skin?
- A. Schistosoma mansoni (Correct Answer)
- B. Wuchereria bancrofti
- C. Onchocerca volvulus
- D. Dracunculus medinensis
Explanation: ***Schistosoma mansoni***- The infectious stage, the **cercariae**, actively penetrate the intact skin of the human host when swimming or wading in contaminated water. - This stage bypasses the need for an insect vector and directly initiates infection, often causing **'swimmer's itch'** at the site of entry.*Dracunculus medinensis*- This infection is acquired by the oral route through ingestion of **copepods** (water fleas) containing the larval stage in drinking water.- While the mature female worm creates a painful **blister** to exit the skin, it does not invade the skin to initiate the infection.*Wuchereria bancrofti*- This parasite is transmitted by the bite of an **infected mosquito** (e.g., *Culex*), which deposits infective larvae near the bite site.- The larvae enter the host through the **puncture wound** created by the mosquito bite, not by actively penetrating intact dermal layers.*Onchocerca volvulus*- The transmission involves the bite of an infected **blackfly** (*Simulium* species), which transmits the infective larvae (microfilariae) into the host.- The larvae enter through the **wound site** created by the fly bite and subsequent manipulation of the wound by the vector (not direct skin invasion).