FMGE 2025 Practice Questions

Q: Which of the following is the National Deworming Day?

10th February. ***10th February*** - The **National Deworming Day (NDD)** is observed annually on **February 10th** across India as the primary national observance to combat **Soil-Transmitted Helminths (STH)** infections - This day involves mass administration of **Albendazole** to children and adolescents (typically 1-19 years) through schools and Anganwadi centres - This is the officially recognized date for the **first annual round** of the national campaign *10th August* - While this date is used for deworming, it serves as the designated date for the **second round** or **follow-up dose** in states using a biannual strategy - This is not the primary National Deworming Day; **February 10th** remains the nationally recognized date for the official observance *10th March* - This date is incorrect and not officially associated with the **National Deworming Day** in India - The official campaign date is fixed to ensure standardized, synchronized provision of **Albendazole** nationwide *11th January* - **January 11th** is not the recognized date for either the first or second round of the **National Deworming Day** campaign - The program's schedule is intentionally set in February and August to maximize coverage and minimize disruption to academic schedules

Q: A child presents with a vesiculobullous, pustular rash around the mouth and on the extremities, along with alopecia and diarrhea. What is the most likely nutritional deficiency?

Zinc Deficiency. ***Zinc Deficiency*** - This clinical presentation represents a classic case of **acrodermatitis enteropathica**, a condition caused by zinc deficiency, characterized by a vesiculobullous, pustular, and eczematous rash in a **periorificial** (around the mouth) and **acral** distribution. - Other key features of zinc deficiency include **alopecia** (hair loss), chronic **diarrhea**, **impaired growth**, and **immunodeficiency**, leading to recurrent infections. *Vitamin C Deficiency* - Known as **scurvy**, this deficiency leads to impaired collagen synthesis, resulting in manifestations like **petechiae**, **ecchymoses**, perifollicular hemorrhage, **bleeding gums**, and **corkscrew hairs**. - In infants, it can present with **subperiosteal hemorrhages**, causing severe pain and reluctance to move (**pseudoparalysis**), but not the periorificial rash seen here. *Vitamin D Deficiency* - This deficiency primarily affects bone mineralization, leading to **rickets** in children and **osteomalacia** in adults. Clinical signs include **bowed legs** (genu varum), **rachitic rosary** (beading of the ribs), and **craniotabes** (soft skull). - Cutaneous manifestations are not a feature of vitamin D deficiency; its role is primarily in **calcium homeostasis** and bone health. *Copper Deficiency* - Copper deficiency primarily manifests with hematological abnormalities like **microcytic anemia** (refractory to iron treatment) and neurological symptoms such as **myelopathy** and peripheral neuropathy. - Cutaneous signs are rare but can include **hypopigmentation** of the skin and kinky, brittle hair (**pili torti**), which are features of the genetic disorder **Menkes disease**.

Q: Identify the treatment option with the image given below:

Type 3 tympanoplasty. ***Type 3 tympanoplasty*** - This procedure, also known as **myringostapediopexy**, involves placing a graft directly onto the head of the stapes, as depicted in the image. - It is indicated when both the **malleus** and **incus** are eroded or absent, but the stapes is intact and mobile, allowing for sound transmission directly to the stapes. *Type 1 Tympanoplasty* - This is a simple repair of a tympanic membrane perforation, also called **myringoplasty**, where the graft is placed to close the hole. - This procedure is only suitable when the **ossicular chain** is completely intact and mobile, which is not the case shown. *Type 2 tympanoplasty* - This is performed when the **malleus** is eroded, and the graft is placed onto the **incus** or the remaining part of the malleus. - The image shows that the incus is also absent, as the graft is placed directly on the stapes, making this option incorrect. *Type 4 tympanoplasty* - This procedure is indicated when only the **stapes footplate** remains and is mobile; the graft is placed directly on the footplate. - This creates a very shallow middle ear space, essentially shielding only the round window and Eustachian tube opening, a more extensive reconstruction than shown.

Q: A patient presented to the OPD with complaints of greenish black matter in the nose with foul-smelling discharge. What is the diagnosis?

Atrophic rhinitis. ***Atrophic rhinitis***- This condition is characterized by progressive atrophy of the nasal mucosa and underlying turbinate bones, leading to excessively wide nasal cavities.- The presence of large, dry, **greenish-black crusts** that produce a very offensive, sickening smell (**ozena**) is the classic defining feature, matching the patient's presentation.*Allergic rhinitis*- This condition presents with symptoms like watery rhinorrhea, sneezing, nasal itching, and **conjunctivitis**, often triggered by specific allergens.- It is an inflammatory condition and does not result in the mucosal atrophy or the formation of large, fetid, **greenish-black crusts** (ozena).*Rhinitis caseosa*- This rare form is characterized by the accumulation of a firm, malodorous, **cheese-like** (caseous) material that acts as a foreign body within the nasal cavity, differentiating it from the general crusting of atrophic rhinitis.- While it causes a very foul smell, the material retrieved is typically described as caseous or putty-like, not the widespread greenish-black crusts typical of ozena.*Rhinitis sicca*- This condition involves localized **dryness** and minor crusting, often restricted to the anterior nasal septum, typically seen in dry climates or specific occupations.- It is characterized by persistent dryness and discomfort but generally lacks the severe **mucosal atrophy** or the intense, offensive odor (**ozena**) associated with generalized greenish-black crusts found in atrophic rhinitis.

Q: Which is the primary chemotherapeutic agent used for cervical cancer?

Platinum-based therapy. ***Platinum-based therapy*** - **Cisplatin** is the foundational chemotherapeutic agent utilized, often combined with radiation (**chemoradiation**) for locally advanced disease. - For metastatic or recurrent cervical cancer, combinations using platinum agents (**Cisplatin** or **Carboplatin**) along with **Paclitaxel** are standard first-line systemic treatments. *Immunotherapy* - **Immunotherapy**, specifically checkpoint inhibitors like **Pembrolizumab**, is approved for recurrent or metastatic cervical cancer that progresses after first-line chemotherapy. - It is not the initial or primary systemic treatment modality, which is founded upon platinum agents. *Hormonal therapy* - **Hormonal therapy** is primarily used for hormone-responsive cancers such as **breast cancer** (estrogen/progesterone receptors positive) or **prostate cancer**. - Cervical cancer is typically driven by **HPV infection** and carcinogenesis, making it largely unresponsive to sex hormones. *Targeted therapy* - **Targeted therapy**, such as the **anti-VEGF** agent **Bevacizumab**, is often utilized, but only *in addition to* platinum-based chemotherapy for advanced or recurrent disease. - It is used as an adjunct to systemic chemotherapy, which remains centered on platinum compounds.

Q: A woman with forceps delivery 24 hours ago presents with pain in the perineum. Her BP is 80/60 and on examination, there is a swelling with bluish discolouration. Which of the following steps are advised not to do?

Repair the wound in the ward. ***Repair the wound in the ward*** - This patient has a **perineal hematoma** with hemodynamic instability (BP 80/60 mmHg indicating hypovolemic shock) - Surgical evacuation of hematoma requires **proper anesthesia, adequate lighting, sterile conditions, and availability of resuscitation equipment** - all available in OT, not in ward - Ward-based repair would be inadequate and dangerous in an unstable patient - **Standard protocol:** Hemodynamically unstable obstetric emergencies require OT management *Inform senior about her* - This SHOULD be done immediately - Perineal hematoma with shock is a **medical emergency requiring senior consultation** - Essential for proper decision-making and management *Shift patient to OT* - This SHOULD be done as part of proper management - **Surgical evacuation of hematoma** under anesthesia is required - OT provides controlled environment for managing complications *Give Blood Transfusion* - This SHOULD be done urgently - BP 80/60 indicates **hypovolemic shock** from concealed bleeding in hematoma - **Resuscitation with blood products** is essential before and during surgical management - Cross-matched blood should be arranged immediately

Q: Fetal anaemia is monitored by?

MCA-PSV. ***MCA-PSV*** - **Middle Cerebral Artery-Peak Systolic Velocity (MCA-PSV)** is a non-invasive Doppler ultrasound method to assess for fetal anemia. It measures the peak velocity of blood flow in the fetal middle cerebral artery. - In anemic fetuses, blood viscosity decreases, leading to increased cardiac output and higher cerebral blood flow velocity. A value greater than **1.5 Multiples of the Median (MoM)** for gestational age is highly predictive of moderate to severe fetal anemia. *Maternal blood* - Maternal blood testing, such as the **Indirect Coombs Test (ICT)**, is used to detect maternal antibodies against fetal red blood cells, indicating maternal sensitization and risk of fetal hemolysis. - While a rising titer suggests an increased risk, it does not directly quantify the severity of anemia in the fetus itself; it serves as a screening tool to identify pregnancies needing closer surveillance. *Fetal blood* - Fetal blood sampling, performed via **cordocentesis**, is the gold standard for diagnosing and quantifying the degree of fetal anemia by directly measuring fetal hemoglobin. - However, it is an invasive procedure with significant risks (e.g., fetal loss, hemorrhage) and is reserved for confirming severe anemia indicated by non-invasive tests like MCA-PSV, or for therapeutic intervention like intrauterine transfusion. *Amniocentesis* - Historically, amniocentesis was used to measure the level of bilirubin in the amniotic fluid (spectrophotometry at ΔOD450) as an indirect marker of hemolysis. - This invasive method has been largely replaced by the non-invasive, safer, and more accurate MCA-PSV Doppler assessment for monitoring fetal anemia.

Q: What is the earliest time after myocardial infarction when triphenyl tetrazolium chloride (TTC) staining can detect infarcted tissue?

3 hours. ***3 hours***- **TTC (Triphenyl Tetrazolium Chloride)** staining detects viable myocardium by reacting with **lactate dehydrogenase** (LDH) and other mitochondrial dehydrogenases, resulting in a **brick-red color** [1].- Necrotic myocardium loses these enzymes, preventing the color change and leaving the infarcted tissue **pale yellow**; this process usually takes at least **3 hours** post-occlusion to be grossly detectable [1].*1 hour*- The time interval is too short for the complete depletion of **dehydrogenases** from the infarcted cells necessary to prevent the TTC reaction and produce a visually distinct **pale area**.- Reliable gross detection by TTC requires cellular necrosis advanced enough to cause enzyme leakage, which typically requires more time than 1 hour [1].*30 minutes*- At 30 minutes post-MI, myocardial damage is often still in the stage of **reversible injury**, and the cell membranes and internal enzyme systems are still largely intact [2].- This limited timeframe does not allow for sufficient enzyme leakage or inactivation required to produce a clear negative (unstained) reaction with the **tetrazolium salt** [1].*Immediately*- Immediate staining will show uniformly red tissue because sufficient time has not passed for the irreversible cell injury (**necrosis**) and subsequent loss of intrinsic **enzymatic activity**.- Myocardium must undergo several hours of severe ischemia and necrosis before the gross chemical findings detected by **TTC** become apparent [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 552-554. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 552.

Question 1

Which of the following is the National Deworming Day?

Accepted Answer

10th February

Answer

11th January

Answer

10th August

Answer

10th March

Question 2

A child presents with a vesiculobullous, pustular rash around the mouth and on the extremities, along with alopecia and diarrhea. What is the most likely nutritional deficiency?

Accepted Answer

Zinc Deficiency

Answer

Vitamin C Deficiency

Answer

Vitamin D Deficiency

Answer

Copper Deficiency

Question 3

Identify the treatment option with the image given below:

Accepted Answer

Type 3 tympanoplasty

Answer

Type 2 tympanoplasty

Answer

Type 4 tympanoplasty

Answer

Type 1 tympanoplasty

Question 4

A patient presented to the OPD with complaints of greenish black matter in the nose with foul-smelling discharge. What is the diagnosis?

Accepted Answer

Atrophic rhinitis

Answer

Rhinitis caseosa

Answer

Allergic rhinitis

Answer

Rhinitis sicca

Question 5

Which is the primary chemotherapeutic agent used for cervical cancer?

Accepted Answer

Platinum-based therapy

Answer

Immunotherapy

Answer

Hormonal therapy

Answer

Targeted therapy

Question 6

A woman with forceps delivery 24 hours ago presents with pain in the perineum. Her BP is 80/60 and on examination, there is a swelling with bluish discolouration. Which of the following steps are advised not to do?

Accepted Answer

Repair the wound in the ward

Answer

Inform senior about her

Answer

Shift patient to OT

Answer

Give Blood Transfusion

Question 7

Fetal anaemia is monitored by?

Accepted Answer

MCA-PSV

Answer

Amniocentesis

Answer

Maternal blood

Answer

Fetal blood

Question 8

What is the earliest time after myocardial infarction when triphenyl tetrazolium chloride (TTC) staining can detect infarcted tissue?

Accepted Answer

3 hours

Answer

1 hour

Answer

30 minutes

Answer

Immediately

Question 9

Which of the following is a change seen in irreversible cell injury?

Accepted Answer

Amorphous density of mitochondria

Answer

Cellular Swelling

Answer

Bleb formation

Answer

Clumping of chromatin

Question 10

Histopathological examination showed follicular cells with abundant pink eosinophilic cytoplasm WITHOUT nuclear grooves or ground-glass nuclei. This is most characteristic of?

Accepted Answer

Follicular CA

Answer

Papillary CA

Answer

Medullary CA

Answer

Anaplastic CA

FMGE 2025

Community Medicine

Dermatology

ENT

Obstetrics and Gynecology

Pathology