FMGE 2025 Practice Questions

Q: Under IDSP, which diseases are included under sentinel surveillance?

HIV + HBV. ***HIV + HBV***- **Sentinel surveillance** under IDSP is utilized for diseases where continuous monitoring of specific, defined sites (sentinel sites) provides crucial incidence or prevalence trends, such as **HIV** and **Hepatitis B Virus (HBV)**.- This method is essential for monitoring these diseases as it provides reliable data on prevalence and long-term trends, often focusing on high-risk or specific population groups.*HIV + TB*- While **HIV** is included in sentinel surveillance, **Tuberculosis (TB)** is primarily monitored through **passive surveillance** using mandatory case notification to track incidence and treatment outcomes.- TB is a reportable disease utilizing a robust notification system (e.g., Nikshay portal in India), which differs from the specialized, site-specific sampling used for sentinel surveillance.*Malaria + Dengue*- **Malaria** and **Dengue** are typically included in **syndromic and presumptive surveillance** streams under IDSP due to their potential for rapid outbreaks and the need for immediate, widespread reporting.- Monitoring for these vector-borne diseases focuses on early detection of outbreaks involving fever in defined geographical areas, rather than long-term prevalence trends at specialized sentinel sites.*Measles + Diphtheria*- These diseases are **vaccine-preventable diseases** and are monitored using **enhanced surveillance** protocols to achieve elimination/eradication targets.- Enhanced surveillance requires immediate investigation and reporting of every suspected case to track coverage gaps and initiate immediate public health measures, differing from the sentinel approach.

Q: A patient presents with acute onset symmetric lower limb flaccid paralysis and absent deep tendon reflexes. Which condition is most likely?

Guillain-Barré syndrome. ***Guillain-Barré syndrome*** - This acute disorder is a **peripheral neuropathy** characterized by ascending, rapidly worsening, **symmetric weakness (flaccidity)** [1]. - The key distinguishing feature is the early and profound loss of deep tendon reflexes known as **areflexia**, corresponding to the damage of peripheral motor nerves/roots (a true lower motor neuron syndrome) [1]. *Multiple sclerosis* - MS is a **central nervous system** disorder causing demyelination in the brain and spinal cord, typically resulting in **upper motor neuron signs**. - Symptoms typically include spasticity, hyperreflexia, and sensory deficits, which directly contrast with the flaccidity and areflexia seen in this patient. *Amyotrophic lateral sclerosis* - ALS involves damage to both upper and lower motor neurons; while it causes LMN symptoms like flaccidity and atrophy, there is often concurrent **hyperreflexia or mixed reflexes** (UMN involvement) [2]. - It is a chronic, progressive neuronal disorder, not primarily defined by the acute, global **areflexia** consistent with GBS [2]. *Spinal cord injury* - Acute spinal cord injury leads to **spinal shock**, causing transient flaccid paralysis and areflexia below the level of the lesion, which eventually evolves into **spasticity and hyperreflexia**. - Unless the injury involves the **cauda equina** (LMN structure), persistent LMN signs with areflexia below the injury level are usually temporary or localized.

Q: In a patient with electric burns and stable vital signs, red-colored urine is observed. What is the most likely finding in the patient's blood work?

Increased potassium levels. ***Increased potassium levels***- Electric burns cause extensive muscle breakdown (known as **rhabdomyolysis**), releasing high concentrations of intracellular contents, especially **potassium**.- This release results in **hyperkalemia**, which is the most immediate and life-threatening electrolyte abnormality observed after massive muscle injury. *Increased creatinine levels*- While rhabdomyolysis often leads to **acute kidney injury (AKI)** due to myoglobin deposition [1], causing increased creatinine, hyperkalemia is the earlier and more acutely dangerous serological derangement.- Increased creatinine reflects impaired renal function and usually develops hours to days after the initial injury. *RBCs in urine*- The red color in the urine is primarily due to **myoglobinuria** (free myoglobin released from damaged muscle) and not typically due to **hematuria** (intact red blood cells).- Urine dipstick tests will be positive for blood because myoglobin and hemoglobin are structurally similar, but microscopy shows few or no red blood cells [1]. *Decreased hemoglobin levels*- Decreased hemoglobin (anemia) is usually a consequence of severe hemorrhage, which is not the primary complication of electrical injury causing rhabdomyolysis.- In the acute burn phase, patients often experience fluid shifts that can lead to **hemoconcentration**, potentially resulting in a transient increase in relative hemoglobin levels.

Q: A woman had a difficult labour. She complains of dribbling of urine 7 days after delivery. What is the diagnosis?

VVF. ***VVF***- **Vesicovaginal fistula (VVF)** is the most common genitourinary fistula following obstetrical trauma, often resulting from pressure necrosis due to **prolonged obstructed labor**. The typical presentation is continuous **dribbling of urine** from the vagina, starting several days (often 3-7 days) after the event when the necrotic tissue sloughs off.*UVF*- **Ureterovaginal fistula (UVF)** typically results from injury during **gynecological surgery** (like hysterectomy) rather than primarily from complicated labor itself.- While it also causes continuous urinary leakage, the diagnosis usually requires advanced imaging (IV Urography) to confirm ureteric involvement.*Rectovaginal fistula*- This fistula connects the **rectum** and the **vagina**, leading to the passage of **flatus** and **fecal matter** through the vagina.- It is directly related to damage to the perineum (3rd or 4th-degree lacerations) and does **not** cause urinary leakage.*VUF*- **Vesicouterine fistula (VUF)** involves communication between the bladder and the uterine cavity, almost exclusively occurring after a **Cesarean section**.- While urine can leak into the vagina, classic differentiating features often include secondary **amenorrhea** and **cyclic hematuria (Menouria)**.

Q: A child presents with features of short stature, muscle weakness, and learning disability. Chromosome analysis reveals a deletion on the long arm of chromosome 15q on the paternal side. What is the most likely diagnosis?

Prader-Willi syndrome. ***Correct: Prader-Willi syndrome*** - Caused by deletion or loss of function of **paternally inherited genes on chromosome 15q11-q13** - Classic features include **hypotonia, hyperphagia leading to obesity, short stature, hypogonadism, and learning disabilities** - The paternal origin of the deletion is key to diagnosis (genomic imprinting disorder) - Diagnostic criteria: characteristic facial features (almond-shaped eyes, narrow forehead), small hands and feet *Incorrect: Angelman syndrome* - Also involves chromosome 15q11-q13 but from **maternal deletion** (not paternal) - Features: severe intellectual disability, ataxia, happy demeanor with inappropriate laughter, seizures - Different clinical presentation despite same chromosomal region (imprinting disorder) *Incorrect: Rett syndrome* - X-linked dominant disorder caused by **MECP2 gene mutation** on chromosome X (not 15) - Primarily affects females with normal early development followed by regression - Characteristic hand-wringing movements and loss of purposeful hand skills *Incorrect: Cri du chat syndrome* - Caused by deletion on the **short arm of chromosome 5p** (not 15) - Named for characteristic cat-like cry in infancy - Features: microcephaly, wide-set eyes, low-set ears, severe intellectual disability

Q: Following a fight between 2 groups, a boy was brought with severe pain in the chest, distended neck veins, dyspnea, and a BP of 80/50 mmHg. X-ray shows the following findings: What is the diagnosis?

Tension Pneumothorax. ***Tension pneumothorax*** - The clinical presentation of severe dyspnea, **distended neck veins**, and **hypotension** (BP 80/50 mmHg) after trauma is a classic triad for tension pneumothorax, which is a medical emergency. - The chest X-ray confirms this diagnosis by showing a completely collapsed right lung with a significant **contralateral shift of the mediastinum and trachea** to the left, and flattening of the right hemidiaphragm, indicating high intrapleural pressure. *Primary Spontaneous Pneumothorax* - This type of pneumothorax occurs without any preceding trauma or underlying lung disease, typically in tall, thin young men due to the rupture of **apical blebs**. - The patient's presentation follows a fight, clearly indicating a **traumatic etiology**, which rules out a spontaneous pneumothorax. *Traumatic Pneumothorax* - While the cause is trauma, this is a less specific diagnosis. The term **Tension pneumothorax** is more accurate given the life-threatening signs of **hemodynamic instability** and **mediastinal shift**. - A simple traumatic pneumothorax does not typically involve the one-way valve mechanism that leads to the progressive accumulation of air and the resulting **obstructive shock** seen in this patient. *Bilateral Pneumothorax* - This diagnosis is incorrect as the chest X-ray clearly demonstrates a **unilateral** condition affecting only the right side. - The left lung, although compressed by the shifted mediastinum, remains inflated with visible lung markings extending to the chest wall.

Q: Identify the procedure shown in the image

Intravenous Pyelogram. ***Intravenous Pyelogram*** - In this procedure, a contrast agent is injected **intravenously** and is then excreted by the kidneys, allowing for visualization of the entire urinary tract, including the renal calyces, pelvis, ureters, and bladder. - The image demonstrates the **nephrogram phase** (contrast in the kidney parenchyma) and the **excretory phase** (contrast in the collecting systems and ureters) simultaneously on both sides, which is characteristic of an IVP. *Retrograde pyelogram* - This procedure involves the injection of contrast material directly into the ureter via a **cystoscope** passed into the bladder, resulting in retrograde (bottom-to-top) filling of the collecting system. - A **ureteral catheter** would typically be visible on the image, and usually, only one side is opacified at a time, which is not the case here. *Combined Retrograde Pyelogram and Ureteroscopy* - This is an invasive procedure where a **ureteroscope** (a thin, flexible camera) is passed up the ureter to directly visualize and treat pathologies like stones or tumors. - The presence of the **ureteroscope** or other instruments would be evident on the radiograph, which are absent in this image. *Antegrade pyelography* - This technique involves inserting a needle or catheter through the skin of the back directly into the renal collecting system (**percutaneous access**) to inject contrast. - A **percutaneous nephrostomy tube** or needle would be visible on the image, which is not seen here.

Q: A 4-year-old boy was brought to the emergency department with complaints of melena and acute intermittent pain in the right iliac region. On surgical exploration, a diverticulum containing gastric mucosa was found. What is the diagnosis? ![img-71.jpeg](img-71.jpeg)

Meckel's diverticulum. ***Meckel's diverticulum*** - This is a remnant of the **vitelline duct** and is the most common congenital anomaly of the gastrointestinal tract, classically presenting with painless rectal bleeding in a young child. - The symptoms of **melena** and right iliac fossa pain are due to ulceration caused by acid secretion from ectopic **gastric mucosa**, which is found in about 50% of symptomatic cases. *Appendicular lump* - An appendicular lump is an inflammatory mass formed by the inflamed appendix and adjacent structures, typically presenting with fever, pain, and a palpable mass in the right iliac fossa. - It does not contain ectopic gastric mucosa and would not be the primary cause of melena; the image shows a distinct diverticulum, not an inflammatory phlegmon. *Carcinoid* - A carcinoid is a **neuroendocrine tumor** that can occur in the GI tract, but it appears as a solid, yellowish tumor, which is different from the structure shown in the image. - While it can cause bleeding or obstruction, the classic history of bleeding from ectopic gastric mucosa is not associated with carcinoid tumors. *Obstructed bowel loops* - This is a clinical finding rather than a specific diagnosis. While a Meckel's diverticulum can cause bowel obstruction (e.g., through **intussusception** or volvulus), the image and history point to the diverticulum as the primary pathology. - The image shows a specific anatomical structure (the diverticulum), not the general appearance of dilated, obstructed bowel loops proximal to a blockage.

Q: A 26 year old female was brought to ER post fire incidence. Her face and lower limbs were spared. Based on the burn distribution shown, calculate the percentage of body surface area affected.

40-50%. ***40-50%*** - The **Rule of Nines** is used to estimate the Total Body Surface Area (TBSA) of burns in adults. According to this rule, the anterior trunk is 18%, each upper limb is 9%, and the posterior trunk is 18%. - In this patient, burns cover the entire anterior trunk (18%), both upper limbs (9% + 9% = 18%), and likely the upper posterior trunk (approx. 9%), totaling around **45%**, which falls in this range. This calculation is critical for fluid resuscitation. *5-10%* - This percentage represents a much smaller burn area, equivalent to approximately one full arm (9%) or the head (9%). - The visual evidence clearly shows extensive burns involving the entire torso and both arms, far exceeding this estimation. *20-30%* - This TBSA would typically represent burns covering the entire anterior trunk (18%) plus one arm (9%), totaling 27%. - This estimate is incorrect as it fails to account for the burns on the second upper limb and the likely involvement of the back. *10-15%* - A burn of this size would involve an area such as the anterior chest (9%) or one leg from the knee down. - This option significantly underestimates the burn severity, as the anterior trunk alone accounts for 18% of the TBSA.

Q: A patient with grade 2 hemorrhoids underwent surgery, identify the instrument.

Haemorrhoids band kit. ***Haemorrhoids band kit*** - The image shows a **band ligator** applying a small elastic band to the base of an internal hemorrhoid, which is the procedure known as **rubber band ligation**. - This technique is a common office-based procedure for **grade I, II, and selected grade III** internal hemorrhoids, causing them to necrose and slough off by cutting off their blood supply. *Haemorrhoids resection kit* - This kit contains instruments for a formal **hemorrhoidectomy**, a surgical procedure that involves excising the hemorrhoidal tissue, typically reserved for severe **grade III and IV hemorrhoids**. - A resection is a more invasive procedure involving cutting and suturing, which is different from the banding method shown. *Stapler kit* - A stapler kit is used for a **stapled hemorrhoidopexy** (PPH procedure), which involves a circular stapler to resect a ring of mucosa above the hemorrhoids and lift them back into a normal position. - The instrument and the principle of action (resection and fixation) are distinct from the ligation shown in the image. *CO2 laser* - **Laser hemorrhoidoplasty** uses a laser probe to deliver energy to shrink the hemorrhoidal plexus; it does not involve the application of a mechanical band. - The instrument is a thin laser fiber, which looks different from the ligator depicted in the illustration.

Question 1

Under IDSP, which diseases are included under sentinel surveillance?

Accepted Answer

HIV + HBV

Answer

Measles + Diphtheria

Answer

Malaria + Dengue

Answer

HIV + TB

Question 2

A patient presents with acute onset symmetric lower limb flaccid paralysis and absent deep tendon reflexes. Which condition is most likely?

Accepted Answer

Guillain-Barré syndrome

Answer

Multiple sclerosis

Answer

Spinal cord injury

Answer

Amyotrophic lateral sclerosis

Question 3

In a patient with electric burns and stable vital signs, red-colored urine is observed. What is the most likely finding in the patient's blood work?

Accepted Answer

Increased potassium levels

Answer

Decreased hemoglobin levels

Answer

Increased creatinine levels

Answer

RBCs in urine

Question 4

A woman had a difficult labour. She complains of dribbling of urine 7 days after delivery. What is the diagnosis?

Accepted Answer

VVF

Answer

Rectovaginal fistula

Answer

UVF

Answer

VUF

Question 5

A child presents with features of short stature, muscle weakness, and learning disability. Chromosome analysis reveals a deletion on the long arm of chromosome 15q on the paternal side. What is the most likely diagnosis?

Accepted Answer

Prader-Willi syndrome

Answer

Rett syndrome

Answer

Angelman syndrome

Answer

Cri du chat syndrome

Question 6

Following a fight between 2 groups, a boy was brought with severe pain in the chest, distended neck veins, dyspnea, and a BP of 80/50 mmHg. X-ray shows the following findings: What is the diagnosis?

Accepted Answer

Tension Pneumothorax

Answer

Primary Spontaneous Pneumothorax

Answer

Bilateral Pneumothorax

Answer

Traumatic Pneumothorax

Question 7

Identify the procedure shown in the image

Accepted Answer

Intravenous Pyelogram

Answer

Combined Retrograde Pyelogram and Ureteroscopy

Answer

Antegrade pyelography

Answer

Retrograde pyelogram

Question 8

A 4-year-old boy was brought to the emergency department with complaints of melena and acute intermittent pain in the right iliac region. On surgical exploration, a diverticulum containing gastric mucosa was found. What is the diagnosis? ![img-71.jpeg](img-71.jpeg)

Accepted Answer

Meckel's diverticulum

Answer

Appendicular lump

Answer

Obstructed bowel loops

Answer

Carcinoid

Question 9

A 26 year old female was brought to ER post fire incidence. Her face and lower limbs were spared. Based on the burn distribution shown, calculate the percentage of body surface area affected.

Accepted Answer

40-50%

Answer

20-30%

Answer

5-10%

Answer

10-15%

Question 10

A patient with grade 2 hemorrhoids underwent surgery, identify the instrument.

Accepted Answer

Haemorrhoids band kit

Answer

Stapler kit

Answer

CO2 laser

Answer

Haemorrhoids resection kit

FMGE 2025

Community Medicine

Internal Medicine

Obstetrics and Gynecology

Pediatrics

Radiology

Surgery