FMGE 2025 Practice Questions

Q: A patient presents with loss of sensation on the posterior surface of the ear along with a lesion. Which structure is most likely involved?

Greater Auricular Nerve. ***Greater Auricular Nerve***- The **Greater Auricular Nerve (GAN)**, originating from the cervical plexus (C2, C3), provides sensory innervation to the **skin over the mastoid process** and the **posterior surface of the auricle (ear)**.- Damage (lesion involvement) to this nerve results specifically in **sensory loss (anesthesia)** in its distribution area, matching the patient's presentation.*Internal Jugular Vein*- This is a large deep vein responsible for major **venous drainage** of the head and neck, not sensory innervation.- Involvement would cause **venous congestion** or potentially severe complications related to thrombosis, not isolated sensory loss.*External Jugular Vein*- This is a superficial vein responsible for minor **venous drainage** of the face and head, running lateral to the sternocleidomastoid muscle.- Any compromise to this vein affects the circulatory system (**venous return**) and does not lead to sensory deficits.*External Carotid Artery*- This is a major artery supplying the extracranial structures of the head; its primary function is **blood supply (perfusion)**.- Lesions would typically cause signs of **ischemia** or hemorrhage in its distribution, not an isolated nerve-related sensory loss on the posterior ear.

Q: A 35 y/o asthmatic patient is scheduled for a minor surgical procedure. Which induction agent and muscle relaxant combination is safest for this patient?

Ketamine and Vecuronium. ***Ketamine and Vecuronium***- **Ketamine** is strongly recommended for asthmatics as it possesses potent **bronchodilating properties** via its sympathomimetic effects, helping prevent **bronchospasm**.- **Vecuronium** is an intermediate-acting non-depolarizing muscle relaxant that causes **minimal to no histamine release**, ensuring cardiovascular stability and avoiding airway irritation.*Propofol and Succinylcholine*- While **Propofol** is often used and generally considered safe (neutral to mild bronchodilation), **Succinylcholine**, a depolarizing agent, carries a potential risk of **histamine release**, although low.- The combination is generally acceptable but less preferred than Ketamine based on the strength of Ketamine's **bronchodilating effect**.*Ketamine and d-tubocurarine*- **Ketamine** is beneficial due to its **bronchodilating effect**, but **d-tubocurarine (DTC)** is highly associated with massive **histamine release**.- DTC often causes severe **hypotension** and significant **bronchospasm**, making it extremely unsafe for an asthmatic patient.*Thiopental and Rocuronium*- **Thiopental**, a barbiturate, is associated with a risk of **histamine release** and potential exacerbation of asthma symptoms or cough upon induction.- Although **Rocuronium** is a safe, low-histamine muscle relaxant, the use of **Thiopental** makes this combination less safe than using Ketamine.

Q: Which of the following health programmes is supported by DANIDA?

Blindness. ***Blindness*** - The **National Programme for Control of Blindness (NPCB)**, initiated in 1976, has historically received extensive financial and technical support from the **Danish International Development Agency (DANIDA)** for implementing **cataract surgery** and eye care services. - DANIDA's support was crucial in developing infrastructure, training ophthalmic personnel, and promoting primary eye care in the early and middle phases of the program. *TB* - The national TB control efforts (RNTCP/NTEP) primarily rely on domestic funding and significant support from the **Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)** and the **World Bank**. - The strategy centers on **Directly Observed Treatment, Short-course (DOTS)** and subsequent patient-centric care. *Malaria* - Malaria control is overseen by the **National Vector Borne Disease Control Programme (NVBDCP)**, which is typically supported by the Government of India, the **WHO**, and large global health funders like **GFATM**. - The main tools include vector control (e.g., **Insecticide Treated Nets**) and prompt diagnosis/treatment. *HIV* - HIV/AIDS programs, managed by the National AIDS Control Organisation (**NACO**), are heavily funded by the Government of India, along with major international partners like **GFATM** and the **US President’s Emergency Plan for AIDS Relief (PEPFAR)**. - Historically, **DANIDA** has not been the primary collaborating international agency for large-scale HIV/AIDS intervention programs in India.

Q: Which of the following is the use of Shakir's tape?

Appropriate technology. ***Appropriate technology*** - *Shakir's tape* (or **Mid-Upper Arm Circumference/MUAC tape**) is a simple, **low-cost device** used for screening **acute malnutrition** in children, making it an example of appropriate technology for primary healthcare settings - Appropriate technology refers to tools, techniques, and practices that are **practical, sustainable, and easily adaptable** to local conditions, perfectly describing the utility and design of Shakir's tape - It exemplifies the WHO principle of appropriate technology: simple, affordable, culturally acceptable, and maintainable with local resources *Intersectoral coordination* - This refers to collaboration between different sectors (e.g., health, education, agriculture) to achieve health goals - Shakir's tape is a **diagnostic/screening tool**, not a mechanism for policy coordination - Does not involve the organizational structures or policy dialogue necessary for effective intersectoral action *Equitable distribution* - This principle focuses on fair allocation of resources (e.g., vaccines, drugs, services) - While assessing malnutrition helps prioritize resource distribution, the tape itself is a **screening tool**, not a distribution mechanism - Equitable distribution is driven by **policy and resource management**, whereas the tape is a device used in **clinical assessment** *Community participation* - This involves involving the local population in health planning and implementation - While health workers often use the tape within the community, the tape itself is a **measurement instrument**, not a method for fostering participation - Community participation is achieved through **dialogue, decision-making inclusion**, and volunteerism, not through a specific measuring tool

Q: Which of the following is not caused by food adulteration?

Fluorosis. ***Fluorosis***- It results from excessive ingestion of **fluoride**, primarily through naturally high fluoride content in **drinking water** and not typically through intentional adulteration of processed food products.- The toxicity (dental or skeletal fluorosis) reflects a chronic environmental exposure problem rather than a case of acute or intentional food substance contamination.*Epidemic dropsy*- This condition is classically caused by the adulteration of **mustard oil** with **Argemone oil**, which contains the toxic alkaloid **sanguinarine**.- It is a recognized consequence of food fraud characterized by edema, skin pigmentation, and sometimes glaucoma.*Neurolathyrism*- It results from consuming food (such as chickpea flour) adulterated with excessive amounts of **Khesari dal (Lathyrus sativus)**.- The neurotoxin responsible is **BOAA (β-N-Oxalylamino-L-alanine)**, which causes irreversible motor neuron damage and spastic paraparesis.*Endemic ascites*- This condition, often presenting as **hepatic veno-occlusive disease (VOD)**, is caused by chronic consumption of food grains contaminated by **Pyrrolizidine alkaloids (PAs)**.- PAs are often found in weeds growing among food crops (like wheat or millets), and their inclusion during harvest is a form of accidental food contamination/adulteration leading to chronic liver damage.

Q: A 58-year-old woman comes to the clinic for a routine follow-up. She has a history of mild hypertension, which is well-controlled with medication. She reports no symptoms such as palpitations, dizziness, or chest pain. Her ECG shows a prolonged PR interval of 0.24 seconds with regular 1:1 AV conduction and narrow QRS complexes. What is the most likely diagnosis based on these ECG findings?

First-Degree AV Block. ***First-Degree AV Block*** - This ECG demonstrates a fixed and prolonged **PR interval** that is greater than 0.20 seconds (more than 5 small squares), which is the defining characteristic of a first-degree AV block. - There is a consistent **1:1 conduction** between the atria and ventricles, meaning every P wave is followed by a QRS complex, distinguishing it from higher-degree blocks. *Second-Degree AV Block* - This condition is characterized by intermittently **non-conducted P waves**, resulting in 'dropped' QRS complexes, which are not present in this ECG. - It has two types: **Mobitz I (Wenckebach)** with progressive PR prolongation before a dropped beat, and **Mobitz II** with a constant PR interval before an unpredictable dropped beat. *Third-Degree AV Block* - Also known as complete heart block, this involves complete **AV dissociation**, where there is no relationship between P waves and QRS complexes. - On an ECG, P waves and QRS complexes would occur at their own independent, regular rates, which is contrary to the 1:1 conduction seen here. *Bundle Branch Block* - The primary feature of a bundle branch block is a **wide QRS complex** (≥0.12 seconds) due to delayed ventricular depolarization. - The QRS complex in this ECG is **narrow** (<0.12 seconds), which rules out a bundle branch block.

Q: A 35-year-old woman presents with fluctuating muscle weakness, especially affecting her speech and swallowing. Repetitive nerve stimulation shows a decremental response. Her blood tests are negative for acetylcholine receptor (AChR) antibodies. Which of the following antibodies is most likely responsible for her symptoms?

Anti-MuSK antibodies. Detailed clinical evaluation of myasthenia gravis reveals that anti-MuSK antibodies target Muscle-Specific Kinase (MuSK), essential for clustering AChR at the NMJ [1]. Their presence confirms the diagnosis of Myasthenia Gravis (MG) in patients who are seronegative for AChR antibodies, often presenting with prominent bulbar and facial weakness [1]. Anti-dsDNA antibodies are specific for Systemic Lupus Erythematosus (SLE), an autoimmune disease that primarily causes arthritis, renal disease, and malar rash [2]. Although SLE can cause myositis or neuropathy, it does not typically present with the isolated, fluctuating postsynaptic weakness characteristic of Myasthenia Gravis and the decremental response. Anti-thyroid peroxidase (TPO) antibodies are primary markers for Hashimoto's thyroiditis, leading to hypothyroidism; screening for associated autoimmune thyroid disease is recommended in MG patients [1]. Anti-Ro antibodies, characteristic of Sjögren's Syndrome and SLE [2], primarily involve sicca symptoms and occasionally present with myositis, but not the hallmark features of ocular or bulbar MG.

Q: All of the following are protected by OCPs except?

Carcinoma breast. ***Carcinoma breast*** - OCPs do not protect against **breast cancer**; large meta-analyses suggest a small, transient increase in risk, particularly with **current or recent use**, which generally dissipates 10 years after stopping. - This marginal increase in risk is attributed to the **estrogen component**, which promotes proliferation in hormone-sensitive breast tissue. *Carcinoma endometrium* - OCPs offer significant long-term protection against **endometrial cancer**, mediated primarily by the **progestin component**, which induces endometrial atrophy. - Protection lasts for many years after discontinuing OCPs and is one of the most prominent non-contraceptive benefits. *Colonic cancer* - OCP use is associated with a reduced risk of **colorectal cancer**, a benefit that appears to be related to the duration of use. - This protective effect is thought to be mediated by the actions of estrogen on bile acid metabolism and subsequent modulation of cell proliferation in the **colonic mucosa**. *Ovarian cancer* - OCPs provide robust, durable protection against **ovarian cancer**, with the risk reduction correlating significantly with the duration of intake. - The primary protective mechanism is the **suppression of ovulation**, which reduces trauma and proliferation of the ovarian surface epithelium.

Q: A mother brings her 5-month-old baby to the clinic for a routine pediatric check-up. The pediatrician observes that the baby actively looks at his mother's face and responds with interest as she talks to him, showing recognition and engagement. At what age is this developmental milestone typically first achieved?

3 months. ***3 months*** - This is the age when infants typically develop a **true social smile** and demonstrate increased interest and sustained gazing at faces, especially parents, showing early **recognition and engagement**. - At this stage, the coordination of vision and social interaction allows the baby to purposefully interact with the caregiver (reciprocal face-to-face exchange), often involving cooing and looking directly at the eyes. - This milestone represents a key social-emotional developmental marker in early infancy. *2 months* - At 2 months, infants typically begin exhibiting a **social smile**, but the sustained, attentive engagement, recognition, and responsive interaction described are usually not fully consistent until 3 months. - Visual skills are improving, but fixation is often transient, and recognition remains basic without the active, responsive interest observed in this scenario. *6 months* - By 6 months, recognition of familiar people is well established; this period is often characterized by the onset of **stranger anxiety** and more mature motor skills like sitting unsupported. - This stage focuses more on object manipulation (e.g., passing objects hand-to-hand) and early communication (babbling) rather than the initial emergence of face recognition and sustained social gaze. *9 months* - Milestones at 9 months include advanced motor skills such as the development of the **pincer grasp** and standing while holding onto furniture, as well as complex communication like understanding simple commands. - While social interaction is highly sophisticated, the initial establishment of active face recognition and responsive engagement (the core of the scenario) occurs much earlier, typically by 3 months.

Question 1

A patient presents with loss of sensation on the posterior surface of the ear along with a lesion. Which structure is most likely involved?

Accepted Answer

Greater Auricular Nerve

Answer

External Carotid Artery

Answer

External Jugular Vein

Answer

Internal Jugular Vein

Question 2

A 35 y/o asthmatic patient is scheduled for a minor surgical procedure. Which induction agent and muscle relaxant combination is safest for this patient?

Accepted Answer

Ketamine and Vecuronium

Answer

Propofol and Succinylcholine

Answer

Ketamine and d-tubocurarine

Answer

Thiopental and Rocuronium

Question 3

Which of the following health programmes is supported by DANIDA?

Accepted Answer

Blindness

Answer

HIV

Answer

TB

Answer

Malaria

Question 4

Which of the following is the use of Shakir's tape?

Accepted Answer

Appropriate technology

Answer

Intersectoral coordination

Answer

Community participation

Answer

Equitable distribution

Question 5

Which of the following is not caused by food adulteration?

Accepted Answer

Fluorosis

Answer

Endemic ascites

Answer

Epidemic dropsy

Answer

Neurolathyrism

Question 6

A 58-year-old woman comes to the clinic for a routine follow-up. She has a history of mild hypertension, which is well-controlled with medication. She reports no symptoms such as palpitations, dizziness, or chest pain. Her ECG shows a prolonged PR interval of 0.24 seconds with regular 1:1 AV conduction and narrow QRS complexes. What is the most likely diagnosis based on these ECG findings?

Accepted Answer

First-Degree AV Block

Answer

Third-Degree AV Block

Answer

Second-Degree AV Block

Answer

Bundle Branch Block

Question 7

A 35-year-old woman presents with fluctuating muscle weakness, especially affecting her speech and swallowing. Repetitive nerve stimulation shows a decremental response. Her blood tests are negative for acetylcholine receptor (AChR) antibodies. Which of the following antibodies is most likely responsible for her symptoms?

Accepted Answer

Anti-MuSK antibodies

Answer

Anti-TPO antibodies

Answer

Anti-dsDNA antibodies

Answer

Anti-Ro antibodies

Question 8

A 32 y/o pregnant woman presents for her routine antenatal check-up at 28 weeks gestation. She has a history of obesity but no previous history of diabetes. Her fasting plasma glucose level is 104 mg/dL, and her 2-hour plasma glucose level after a 75g Oral Glucose Tolerance Test (OGTT) is 167 mg/dL. Based on these findings, what is the most appropriate next step?

Accepted Answer

Diagnose her with GDM and initiate dietary modifications with close monitoring of blood glucose levels.

Answer

Start lifestyle modifications and repeat OGTT at 32 weeks gestation.

Answer

Monitor her closely without intervention since her glucose levels are borderline.

Answer

Diagnose her with pre-existing diabetes and initiate insulin therapy.

Question 9

All of the following are protected by OCPs except?

Accepted Answer

Carcinoma breast

Answer

Colonic cancer

Answer

Carcinoma endometrium

Answer

Ovarian cancer

Question 10

A mother brings her 5-month-old baby to the clinic for a routine pediatric check-up. The pediatrician observes that the baby actively looks at his mother's face and responds with interest as she talks to him, showing recognition and engagement. At what age is this developmental milestone typically first achieved?

Accepted Answer

3 months

Answer

9 months

Answer

2 months

Answer

6 months

FMGE 2025

Anatomy

Anesthesiology

Community Medicine

Internal Medicine

Obstetrics and Gynecology

Pediatrics