FMGE 2025 Practice Questions

Q: A PLHIV came with multiple dog bites with a punctured wound. Choose the correct management:

Local Treatment + RIG + Vaccine. ***Local Treatment + RIG + Vaccine***- This regimen is mandatory for **Category III** rabies exposure, defined by single or multiple transdermal bites or scratches, which includes the described punctured wounds.- **Rabies Immunoglobulin (RIG)**, providing passive immediate protection, must be infiltrated into and around the wound, followed by the complete scheduled series of the Rabies **Vaccine** to establish long-term active immunity.*Local wound cleaning*- While immediate and thorough local wound cleaning with soap, water, and an antiseptic is the **most crucial first step**, it is insufficient alone for preventing rabies transmission in a Category III exposure.- Punctured wounds carry a high risk of deep inoculation, necessitating both passive (**RIG**) and active (**Vaccine**) immunization immediately.*Vaccine*- The **rabies vaccine** provides active immunity, but this protection takes several days to weeks to develop.- In high-risk, severe exposures (Category III), immediate passive immunity via **Rabies Immunoglobulin (RIG)** is essential to neutralize the virus before the vaccine takes effect.*Local Treatment + RIG*- This approach provides immediate passive neutralization through **RIG** and effective wound management, but it critically omits the **rabies vaccine**.- Omission of the vaccine prevents the development of necessary long-term protective active immunity, leaving the patient vulnerable after the short-term effect of RIG wanes.

Q: What is the most appropriate treatment for severe acne?

Isotretinoin. ***Isotretinoin***- This is the most effective and definitive treatment for **severe nodular or cystic acne** that has failed to respond to conventional treatments like topical agents and oral antibiotics. - It is a systemic retinoid that targets all four major pathogenic factors of acne: reducing **sebum production**, normalizing follicular keratinization, inhibiting *Cutibacterium acnes*, and providing anti-inflammatory effects.*Topical Tretinoin*- Topical retinoids are the first-line agents, primarily effective for **mild to moderate comedonal acne**. - They lack the necessary systemic penetration and potency to resolve deep-seated inflammation and nodules characteristic of **severe acne**.*Steroids*- Systemic steroids are generally reserved for highly specific, severe, and acute inflammatory complications of acne, such as **acne fulminans**, or used short-term to manage Isotretinoin-induced flares. - They are not the standard long-term treatment for severe acne due to significant systemic side effects and the fact that they do not address the underlying pathology of **sebum hypersecretion**.*Antibiotics*- Oral antibiotics (e.g., **doxycycline, minocycline**) are indicated for **moderate inflammatory acne**, often combined with topical retinoids. - They are typically insufficient as monotherapy for severe, scarring, nodulocystic acne, and overuse contributes significantly to **antibiotic resistance**.

Q: A patient admitted with fever and nuchal rigidity. CSF analysis shows decreased glucose and increased protein and neutrophils. Which is the MOST IMPORTANT antibiotic for initial empirical treatment?

Ceftriaxone. Ceftriaxone - Ceftriaxone, a third-generation cephalosporin, is the most essential component of empirical treatment for bacterial meningitis due to its excellent CSF penetration and broad coverage [1]. - It effectively covers the most common bacterial causes of community-acquired meningitis: Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae [1]. - Note: Current guidelines recommend Ceftriaxone + Vancomycin as the optimal empirical regimen to cover penicillin-resistant S. pneumoniae (PRSP), but Ceftriaxone remains the primary/essential antibiotic in this combination [1]. Vancomycin - Vancomycin is critical for covering penicillin-resistant S. pneumoniae (PRSP) and is typically used in combination with Ceftriaxone in the empirical regimen. - It is not used as monotherapy due to poor CSF penetration and incomplete coverage of other common pathogens like N. meningitidis. Penicillin - Penicillin is no longer recommended for empirical treatment due to high prevalence of penicillin-resistant S. pneumoniae (PRSP) globally. - While effective against sensitive N. meningitidis, the need for broader coverage necessitates third-generation cephalosporins. Ampicillin - Ampicillin is added to cover Listeria monocytogenes in specific high-risk groups: patients >50 years, immunocompromised, pregnant women, or neonates. - It is ineffective as monotherapy for routine bacterial meningitis and lacks coverage for resistant strains of common pathogens.

Q: A 62-year-old male presents with left leg swelling and pain for 5 days and has a positive D-dimer test. Duplex ultrasonography confirms an extensive DVT involving the left popliteal and femoral veins. Which of the following is the most appropriate initial management strategy?

LMWH followed by oral anticoagulant. LMWH followed by oral anticoagulant - Low Molecular Weight Heparin (LMWH) is the preferred initial treatment for stable patients with extensive DVT due to its predictable response [1], [2], subcutaneous administration, and lower risk of heparin-induced thrombocytopenia (HIT) compared to UFH. - Following the initial parenteral therapy (LMWH or UFH), long-term treatment with an oral anticoagulant (such as a DOAC or warfarin) is necessary for at least 3 to 6 months to prevent thrombus extension and recurrent Pulmonary Embolism (PE) [1]. Unfractionated heparin followed by warfarin - Unfractionated Heparin (UFH) often requires hospitalization for IV administration and intense monitoring of aPTT levels [2], making LMWH the outpatient standard for stable patients. - UFH is typically reserved for patients with severe renal impairment (Creatinine Clearance < 30 mL/min) or those who are hemodynamically unstable and may require urgent reversal. Catheter-directed thrombolysis - This invasive therapy is reserved for patients with DVT accompanied by limb ischemia (phlegmasia cerulea dolens) [1] or for selected young patients with extensive proximal DVT and a low risk of bleeding. - It is associated with a significantly higher risk of major bleeding and is not the standard initial strategy for an uncomplicated extensive DVT [1]. IVC filter placement - An IVC filter is indicated only for patients with acute DVT who have an absolute contraindication to anticoagulation (e.g., active hemorrhage) or who experience recurrent PE despite adequate anticoagulation [1]. - Filter placement does not treat the existing deep vein clot and increases the long-term risk of recurrent DVT.

Q: For the diagnosis of typhus, an antigen of Proteus is used. What is this type of antigen called?

Heterophile antigen. ***Heterophile antigen*** - These are antigens shared between different species, such as the antigenic determinants shared by *Rickettsia* (causing typhus) and certain strains of **Proteus** (used in the Weil-Felix test). - The diagnosis of typhus relies on the **Weil-Felix reaction**, which detects anti-rickettsial antibodies that cross-react and agglutinate with the non-motile *Proteus* antigens (e.g., **OX-19**). *Sequestered antigen* - This term refers to self-antigens that are normally hidden from the immune system (e.g., in the eye or testicles) but can cause **autoimmunity** if released (e.g., post-trauma). - They are involved in the loss of **self-tolerance** and are not used in diagnostic agglutination tests for external infections like typhus. *Super antigen* - These are powerful microbial toxins, such as **Toxic Shock Syndrome Toxin-1**, that cause massive, non-specific activation of T cells. - They bind directly to the outside of the MHC Class II molecules and the T-cell receptor (TCR) Vβ chain, leading to a dangerous **cytokine storm**, unrelated to the agglutination reaction. *Iso antigen* - Also called **alloantigens**, these are specific antigens found in some individuals of a species but not others (e.g., **blood group antigens**). - They are relevant to transfusion reactions and graft rejection but do not describe the cross-species reactivity utilized in the Weil-Felix test for typhus.

Q: A 2-week-old neonate was brought to the hospital with a complaint of non-bilious vomiting. While examining the baby, the physician noted a lump in the right upper quadrant, which showed movement while feeding. What is the likely diagnosis of this child?

IHPS. ***Correct: IHPS (Infantile Hypertrophic Pyloric Stenosis)*** - Classic presentation: **2-8 weeks old neonate** with progressive **non-bilious projectile vomiting** - Hallmark finding: **Palpable olive-shaped mass in right upper quadrant** (hypertrophied pyloric muscle) - **Visible peristaltic waves** from left to right upper abdomen, especially after feeding - Associated with **hypochloremic hypokalemic metabolic alkalosis** - Treatment: Ramstedt pyloromyotomy *Incorrect: Duodenal atresia* - Presents within **first day of life** (not at 2 weeks) - Causes **bilious vomiting** (obstruction distal to ampulla of Vater) - "Double bubble" sign on X-ray - Associated with Down syndrome *Incorrect: Esophageal atresia* - Presents **immediately after birth** with drooling and choking - No palpable abdominal mass - Diagnosed with **inability to pass nasogastric tube** - Often associated with tracheoesophageal fistula (TEF) *Incorrect: Intussusception* - Typical age: **6-36 months** (not neonates) - Presents with **colicky abdominal pain** and "currant jelly" stools - Palpable "sausage-shaped" mass in right upper quadrant - Treatment: Air/hydrostatic reduction

Q: A 4-year-old unvaccinated child presents with fever, rash, and Bitot spots. What is the appropriate line of management?

Vitamin A Supplementation. ***Vitamin A Supplementation*** - **Bitot spots** are pathognomonic for **xerophthalmia** due to **Vitamin A deficiency**, a serious complication of measles in malnourished children - **High-dose Vitamin A supplementation** (200,000 IU on two consecutive days per WHO guidelines) is the **critical priority** to prevent blindness and reduce measles-related mortality - Supportive care (hydration, fever management, nutrition) is also essential but the key differentiator in this question is recognizing and treating the **Vitamin A deficiency** indicated by Bitot spots *Measles Vaccine + Vitamin A Supplementation* - While **Vitamin A** is correct, the **measles vaccine is contraindicated** during acute febrile illness with active measles infection - Vaccination is prophylactic, not treatment for active disease - After recovery, catch-up vaccination should be considered if child remains unvaccinated *Measles Vaccine* - Administering measles vaccine during **acute measles infection** is inappropriate - This option ignores the **urgent need for Vitamin A** when Bitot spots are present - Missing Vitamin A supplementation risks **irreversible blindness** *Supportive Care* - While supportive care (hydration, fever control, nutrition) is essential in measles management, it does not address the **specific deficiency** indicated by Bitot spots - **Vitamin A supplementation is mandatory** when xerophthalmia signs are present - Supportive care alone without Vitamin A carries high risk of **permanent ocular damage**

Q: A 45-year-old man is found unconscious after a fall from a ladder. In the emergency department, his eyes do not open even in response to pain; he is making incomprehensible sounds, and he exhibits abnormal flexion in response to painful stimuli. What is his Glasgow Coma Scale (GCS) score?

6. ***Correct Answer: 6*** - The GCS score is calculated by summing Eye (E), Verbal (V), and Motor (M) responses - E=1 (no eye opening to pain) + V=2 (incomprehensible sounds) + M=3 (abnormal flexion/decorticate posturing) = **6** - A GCS ≤8 indicates **severe head injury** requiring definitive airway management *Incorrect: 5* - A score of 5 would require an even lower motor response: M=2 (abnormal extension/decerebrate posturing) or M=1 (no motor response) - The patient demonstrates M=3 (abnormal flexion), making the total score 6, not 5 *Incorrect: 7* - A score of 7 would require a higher verbal or motor component - For example: E=1 + V=3 (inappropriate words) + M=3 = 7, or E=1 + V=2 + M=4 (withdrawal from pain) = 7 - The patient's V=2 (incomprehensible sounds) and E=1 prevent reaching a total of 7 *Incorrect: 8* - A GCS of 8 requires significantly better responses, such as M=4 (withdraws from pain) or V=3 (inappropriate words) combined with M=4 - The patient's M=3 (abnormal flexion) and V=2 (incomprehensible sounds) are too low to reach 8

Q: Which of the following is the classical triad of acute cholangitis?

Pain, jaundice, fever. ***Correct: Pain, jaundice, fever*** - This is **Charcot's triad**, the classical presentation of acute cholangitis - Represents the three cardinal clinical features: **RUQ abdominal pain**, **jaundice** (from biliary obstruction), and **fever with rigors** (from ascending infection) - Acute cholangitis is a bacterial infection of the bile ducts, typically occurring due to biliary obstruction (most commonly from choledocholithiasis) - When hypotension and altered mental status are added to Charcot's triad, it becomes **Reynolds pentad** (indicating severe/suppurative cholangitis) *Incorrect: Pain, ↑ WBC, ↑ Bilirubin* - While these findings may be present in acute cholangitis, this is not the classical **clinical triad** - Laboratory findings are supportive but not part of the classical triad definition *Incorrect: Fever, jaundice, ↑ WBC* - Missing the key clinical feature of **RUQ pain** - Includes laboratory finding (↑ WBC) rather than clinical presentation *Incorrect: Pain, jaundice, shock* - This combination represents part of **Reynolds pentad** but is missing fever - Reynolds pentad = Charcot's triad + hypotension + altered mental status - Not the classical triad being asked in the question

Question 1

A PLHIV came with multiple dog bites with a punctured wound. Choose the correct management:

Accepted Answer

Local Treatment + RIG + Vaccine

Answer

Local wound cleaning

Answer

Local Treatment + RIG

Answer

Vaccine

Question 2

What is the most appropriate treatment for severe acne?

Accepted Answer

Isotretinoin

Answer

Topical Tretinoin

Answer

Antibiotics

Answer

Steroids

Question 3

A patient admitted with fever and nuchal rigidity. CSF analysis shows decreased glucose and increased protein and neutrophils. Which is the MOST IMPORTANT antibiotic for initial empirical treatment?

Accepted Answer

Ceftriaxone

Answer

Vancomycin

Answer

Penicillin

Answer

Ampicillin

Question 4

A 62-year-old male presents with left leg swelling and pain for 5 days and has a positive D-dimer test. Duplex ultrasonography confirms an extensive DVT involving the left popliteal and femoral veins. Which of the following is the most appropriate initial management strategy?

Accepted Answer

LMWH followed by oral anticoagulant

Answer

Unfractionated heparin followed by warfarin

Answer

Catheter-directed thrombolysis

Answer

IVC filter placement

Question 5

For the diagnosis of typhus, an antigen of Proteus is used. What is this type of antigen called?

Accepted Answer

Heterophile antigen

Answer

Iso antigen

Answer

Super antigen

Answer

Sequestered antigen

Question 6

Which of the following is not related to disease progression?

Accepted Answer

Duration

Answer

Depth

Answer

Stage of Cancer

Answer

Site

Question 7

A 2-week-old neonate was brought to the hospital with a complaint of non-bilious vomiting. While examining the baby, the physician noted a lump in the right upper quadrant, which showed movement while feeding. What is the likely diagnosis of this child?

Accepted Answer

IHPS

Answer

Duodenal atresia

Answer

Esophageal atresia

Answer

Intusussception

Question 8

A 4-year-old unvaccinated child presents with fever, rash, and Bitot spots. What is the appropriate line of management?

Accepted Answer

Vitamin A Supplementation

Answer

Measles Vaccine

Answer

Supportive Care

Answer

Measles Vaccine + Vitamin A Supplementation

Question 9

A 45-year-old man is found unconscious after a fall from a ladder. In the emergency department, his eyes do not open even in response to pain; he is making incomprehensible sounds, and he exhibits abnormal flexion in response to painful stimuli. What is his Glasgow Coma Scale (GCS) score?

Accepted Answer

6

Answer

7

Answer

8

Answer

5

Question 10

Which of the following is the classical triad of acute cholangitis?

Accepted Answer

Pain, jaundice, fever

Answer

Pain, $\uparrow$ WBC, $\uparrow$ Bilirubin

Answer

Fever, jaundice, $\uparrow$ WBC

Answer

Pain, jaundice, shock

FMGE 2025

Community Medicine

Dermatology

Internal Medicine

Microbiology

Pathology

Pediatrics

Surgery