FMGE 2025 Practice Questions

Q: What is the most common type of ventricular septal defect?

Membranous defect. ***Membranous defect***- This type of defect, also known as **perimembranous VSD**, is the most common form, accounting for approximately 70-80% of all ventricular septal defects [1].- It is located just below the aortic valve, involving the **proximal third** of the septum and is defined by its relationship to the fibrous trigones [1].*Muscular defect*- **Muscular VSDs** (or trabecular VSDs) are less common than membranous defects and can be found anywhere within the thick muscular portion of the septum.- These defects often have a higher rate of **spontaneous closure**, especially the small, multiple defects referred to as 'Swiss cheese' VSDs.*Non-development of the perimembranous part of the septum*- While the failure of complete septation of the **membranous portion** is the underlying embryological cause, the specific anatomical diagnosis defining the common VSD type is the *membranous defect*. - This phrasing is descriptive of the etiology but **membranous defect** identifies the most common resulting structure.*Incomplete fusion of the septum*- This is a generic description of the mechanism leading to VSD development (failure of the septal components to fuse correctly), but it does not specify the **most common anatomical location**.- The most critical and common fusion failure involves the development of the **membranous septum**, which results in the named *membranous defect*.

Q: A patient undergoing surgery is administered succinylcholine for muscle relaxation. Shortly after administration, he develops hyperthermia, muscle rigidity, tremors, and tachycardia. What is the most appropriate treatment for this condition?

Dantrolene sodium. ***Dantrolene sodium***- This is the specific and definitive antidote for **Malignant Hyperthermia (MH)**, characterized by signs like hyperthermia, muscle rigidity, and tachycardia after succinylcholine administration.- **Dantrolene** works directly on skeletal muscle by inhibiting the release of calcium from the **sarcoplasmic reticulum**, thereby interrupting the sustained muscle contraction and hypermetabolic state.*Neostigmine*- It is an **acetylcholinesterase inhibitor** used to reverse the effects of non-depolarizing neuromuscular blocking agents (e.g., rocuronium).- It is **contraindicated** in MH as it could potentially exacerbate muscle rigidity and the hypermetabolic crisis by increasing **acetylcholine** activity at the neuromuscular junction.*Atropine*- This is an **anticholinergic** drug primarily used to treat bradycardia or to dry secretions.- Although the patient exhibits severe tachycardia, atropine does not treat the underlying pathological hypermetabolism or the excessive calcium release that defines MH.*Midazolam*- This is a **benzodiazepine** used for anxiolysis, sedation, and if necessary, managing seizures.- While supportive care for MH might involve benzodiazepines if seizures occur due to hyperthermia, it is not the crucial drug needed to counteract the life-threatening hypermetabolic crisis.

Q: A patient scheduled for elective hip surgery is currently taking aspirin, enalapril, a multivitamin, and metoprolol. The surgery is planned in 5 days. What is the appropriate perioperative management for this patient?

Stop enalapril. ***Correct: Stop enalapril*** - **ACE inhibitors (enalapril) should be discontinued 24-48 hours before elective surgery** - Risk of **refractory intraoperative hypotension** during anesthesia induction, particularly with vasodilatory anesthetics - Associated with increased perioperative complications including hypotension requiring vasopressor support - Can be safely restarted postoperatively once hemodynamic stability is achieved *Incorrect: Stop aspirin to minimize perioperative bleeding risk* - **Aspirin should generally be continued** in patients with cardiovascular indications (CAD, stroke prevention) - Current guidelines recommend continuation for most surgeries except those with very high bleeding risk (neurosurgery, posterior chamber eye surgery) - **Hip surgery is NOT a contraindication** to aspirin continuation - The cardiovascular risk of stopping aspirin outweighs bleeding risk in most cases *Incorrect: Stop metoprolol to increase cardiac output* - **Beta-blockers should be continued perioperatively** in patients already taking them - Abrupt withdrawal increases risk of **rebound hypertension, tachycardia, myocardial ischemia, and MI** - Stopping beta-blockers can precipitate life-threatening cardiovascular events - Should be given on the morning of surgery with a sip of water *Incorrect: Increase aspirin dosage for additional analgesic benefit* - No indication to increase aspirin dose perioperatively - Aspirin is not used as a primary analgesic in surgical settings - Increasing dose would unnecessarily increase bleeding risk without therapeutic benefit

Q: A body brought for autopsy is cold and has developed rigor mortis in all 4 limbs and livor mortis at the back (fixed), but no signs of putrefaction. What will be the estimated time since death?

12-24 hrs. ***Correct Option: 12-24 hrs*** - At this stage, **rigor mortis** is typically fully established across all muscle groups (maximal development occurs around 12 hours) and has not yet started to resolve. - **Livor mortis** becomes **fixed** (non-blanching upon pressure) usually after 12 hours, placing the time since death beyond the initial 12-hour window. - **Putrefaction** has not yet begun, which is consistent with this timeframe as putrefactive changes typically start after 24 hours. *Incorrect Option: 6-12 hrs* - During this period, **rigor mortis** is still developing (maximal development is typically approached at 12 hours) and might not be present in all four limbs (starts in smaller joints/upper limbs). - **Livor mortis** is usually present but often still **unfixed** or only partially fixed, meaning it might shift or blanch with pressure. *Incorrect Option: 24-48 hrs* - Around 24 hours, **rigor mortis** generally begins to resolve (**passing off**) starting from the face and neck, contradicting the finding of full rigor in all four limbs. - This timeframe is when the first signs of **putrefaction** (e.g., green discoloration of the abdomen) usually become visible, which is stated to be absent in the body. *Incorrect Option: 36-48 hrs* - By 36 to 48 hours, **rigor mortis** is typically completely resolved (**secondary flaccidity**). - Putrefaction would likely be significantly advanced during this period, including potential signs like marked **marbling** or abdominal swelling.

Q: Which electrolyte abnormality will lead to cardiac arrhythmia in patients with severe vomiting?

Hypokalemia. ***Hypokalemia*** - Severe vomiting leads to significant loss of gastric acid and subsequent volume depletion, often resulting in **metabolic alkalosis** and substantial **potassium** loss (due to renal compensation and direct GI loss) [1]. - **Hypokalemia** directly affects cardiac muscle repolarization, predisposing the patient to various arrhythmias, including **ventricular tachycardia** (e.g., *Torsades de pointes*) [2], [3]. *Hyponatremia* - While severe vomiting can cause hyponatremia (due to volume loss and inappropriate ADH release), symptomatic effects are primarily **neurological** (e.g., seizures, confusion), not typically cardiac arrhythmias [2]. - The effect on the heart tends to be mild unless the drop is very rapid and severe; it primarily influences **myocardial contractility** through fluid shifts [2]. *Hyperkalemia* - Hyperkalemia causes severe and characteristic ECG changes (tall, peaked T waves, broadened QRS, possible asystole), but it is **not associated** with severe vomiting, which typically causes **hypokalemia** [2]. - Hyperkalemia is more commonly seen in conditions like **renal failure** or acidosis [4]. *Hypocalcemia* - Hypocalcemia primarily affects the heart by causing **prolongation of the QT interval**, which can increase the risk of *Torsades de pointes*, similar to hypokalemia. - However, calcium losses from simple gastric vomiting are generally **not as dramatic** or primary as the potassium losses, making hypokalemia the most direct and common cause of arrhythmia in this specific clinical scenario [1].

Q: A 39-year-old patient with HIV and a CD4 count of 139 cells/μL presents with altered sensorium and impaired consciousness. CSF examination using an India ink preparation reveals a positive result. Which organism is most likely responsible?

Cryptococcus neoformans. ***Cryptococcus neoformans***- The classic finding of a positive **India ink preparation** upon CSF examination indicates the large polysaccharide **capsule** characteristic of this yeast.- In patients with advanced HIV (**CD4 <200** cells/μL), *C. neoformans* is the most common cause of **fungal meningoencephalitis** presenting with altered mental status.*Aspergillus fumigatus*- CNS infection with *Aspergillus* usually manifests as **focal cerebral lesions** (abscesses) or hemorrhagic infarction due to angioinvasion, not typically diffuse meningitis.- Diagnosis generally relies on culturing the fungus, **histopathology** showing septate hyphae, or detecting **galactomannan antigen** in the serum or CSF.*Histoplasma capsulatum*- While it can cause disseminated infection in patients with AIDS, CNS involvement is less frequent than *Cryptococcus* and the yeast is **intracellular** (within macrophages).- Detection typically utilizes **Histoplasma antigen testing** in urine or serum, as the small yeasts do not possess the large capsule highlighted by India ink.*Candida albicans*- *Candida* is a common cause of superficial or disseminated infection, but isolated **Candida meningitis** is rare, usually seen after neurosurgery or hematogenous seeding.- *Candida* **lacks the prominent capsule** that would produce a positive result on an India ink preparation.

Q: A 30-year-old female who delivered a healthy term baby one week ago is now presenting to the OBG clinic with complaints of fishy-smelling pale brownish vaginal discharge. What is the nature of this discharge?

Lochia Serosa. ***Lochia Serosa***- This stage of postpartum discharge typically begins around **day 4** and lasts until **day 10** postpartum, aligning perfectly with the patient’s presentation at one week (7 days) after delivery.- It is characterized by a **pale brownish** or pinkish, watery discharge, consisting of old blood, serum, and leukocytes. The described "fishy smell" likely results from bacterial colonization, common in this stage, but the timing dictates the stage.*Lochia Rubra*- This is the initial, heavy stage of lochia, which occurs during the first **1 to 3 days** postpartum.- The discharge is predominantly **bright red** and bloody, containing large amounts of decidua and tissue fragments, not pale brownish.*Lochia Alba*- This is the final stage of lochia, usually beginning after **day 10** (or even two weeks) and may persist for several weeks.- It is typically **creamy, white, or yellowish** in color, containing predominantly leukocytes, epithelial cells, and mucus.*Leukorrhea*- This is a broad term for **non-bloody vaginal discharge** related to normal physiological changes (like ovulation) or pathological conditions (like vaginitis).- While lochia contains many components of leukorrhea (white cells), **lochia** is the specific and correct term for the expected postpartum discharge composed of blood, serum, and tissue.

Q: A baby presents with the clinical features shown in the image, including characteristic perioral and perianal rash along with a history of diarrhea. Which of the following is the most likely deficiency responsible for this condition?

Zinc Deficiency. ***Zinc Deficiency*** - The clinical triad of **periorificial** (perioral, perianal) and **acral dermatitis**, **alopecia**, and **diarrhea** is characteristic of **Acrodermatitis Enteropathica**, which is caused by zinc deficiency. - The rash seen in the image, an eczematous, vesiculobullous, and crusted eruption around the mouth and eyes, is the hallmark cutaneous manifestation of this condition. *Niacin Deficiency* - Niacin (Vitamin B3) deficiency results in **Pellagra**, classically presenting with the “3 Ds”: **dermatitis**, **diarrhea**, and **dementia**. - The dermatitis of pellagra is a **photosensitive rash**, typically in sun-exposed areas like the neck (**Casal's necklace**), and does not have a periorificial distribution. *Selenium Deficiency* - Selenium deficiency is primarily associated with **cardiomyopathy** (**Keshan disease**) and skeletal myopathy (**Kashin-Beck disease**). - While it can cause nail bed changes (whitening) and hair loss, it is not associated with the characteristic periorificial rash seen in the image. *Magnesium Deficiency* - Hypomagnesemia primarily causes **neuromuscular hyperexcitability**, leading to symptoms like **tetany**, **tremors**, seizures, and **cardiac arrhythmias** (e.g., Torsades de pointes). - It does not cause a characteristic dermatological rash like the one presented.

Q: A newborn child is brought to the emergency department with respiratory difficulty. On evaluation, the child was found to have a posterolateral defect, as shown in the x-ray given. What is the diagnosis?

Bochdalek hernia. ***Bochdalek hernia*** - This is the most common type of **congenital diaphragmatic hernia (CDH)**, representing about 85-90% of cases, and is characterized by a defect in the **posterolateral** aspect of the diaphragm. - It most commonly occurs on the **left side**, allowing abdominal contents like the stomach and intestines to herniate into the chest, leading to **pulmonary hypoplasia** and severe respiratory distress in a newborn, which is consistent with the X-ray findings. *Morgagni hernia* - This is a rare type of CDH involving an **anteromedial** defect in the diaphragm, specifically through the foramen of Morgagni, not a posterolateral one. - It is more commonly found on the **right side** and is often asymptomatic, typically diagnosed incidentally later in life rather than causing acute respiratory failure in a newborn. *Hiatal hernia* - This involves the protrusion of the upper part of the stomach into the thorax through the **esophageal hiatus**, a different anatomical location than the defect in this case. - Hiatal hernias are most often associated with **gastroesophageal reflux disease (GERD)** and are uncommon causes of severe respiratory distress in the neonatal period. *Traumatic diaphragmatic hernia* - This is an **acquired** condition resulting from blunt or penetrating trauma to the chest or abdomen that causes a rupture of the diaphragm. - The patient is a newborn, making a **congenital defect** the cause of the hernia, not trauma.

Q: Identify the type of diaphragmatic hernia shown in the X-ray.

Bochdalek hernia. ***Bochdalek hernia*** - This is the most common type of congenital diaphragmatic hernia (CDH), accounting for over 80% of cases, and is characterized by a defect in the **posterolateral** aspect of the diaphragm. - The X-ray shows classic findings: multiple **gas-filled bowel loops** in the left hemithorax, causing **mediastinal shift** to the right and compression of the left lung, which is consistent with a left-sided Bochdalek hernia. *Morgagni hernia* - This is a rare, **anteromedial** diaphragmatic defect that occurs through the **foramen of Morgagni**, typically on the right side. - It is less common than Bochdalek hernia and often discovered incidentally in older children or adults, presenting with less severe respiratory symptoms. *Hiatal hernia* - This involves the protrusion of the upper part of the stomach through the **esophageal hiatus** into the chest. - It is a midline defect and typically presents with **gastroesophageal reflux disease (GERD)**, not the extensive herniation of multiple abdominal organs seen in this neonatal X-ray. *Traumatic diaphragmatic hernia* - This is an **acquired** condition resulting from severe blunt or penetrating trauma to the chest or abdomen, not a congenital defect. - While it can appear similar on imaging, the clinical context of a newborn (as suggested by the image) makes a congenital cause like Bochdalek hernia the most likely diagnosis.

Question 1

What is the most common type of ventricular septal defect?

Accepted Answer

Membranous defect

Answer

Incomplete fusion of the septum

Answer

Non-development of the perimembranous part of the septum

Answer

Muscular defect

Question 2

A patient undergoing surgery is administered succinylcholine for muscle relaxation. Shortly after administration, he develops hyperthermia, muscle rigidity, tremors, and tachycardia. What is the most appropriate treatment for this condition?

Accepted Answer

Dantrolene sodium

Answer

Neostigmine

Answer

Midazolam

Answer

Atropine

Question 3

A patient scheduled for elective hip surgery is currently taking aspirin, enalapril, a multivitamin, and metoprolol. The surgery is planned in 5 days. What is the appropriate perioperative management for this patient?

Accepted Answer

Stop enalapril

Answer

Stop aspirin to minimize perioperative bleeding risk

Answer

Stop metoprolol to increase cardiac output

Answer

Increase aspirin dosage for additional analgesic benefit

Question 4

A body brought for autopsy is cold and has developed rigor mortis in all 4 limbs and livor mortis at the back (fixed), but no signs of putrefaction. What will be the estimated time since death?

Accepted Answer

12-24 hrs

Answer

24-48 hrs

Answer

6-12 hrs

Answer

36-48 hrs

Question 5

Which electrolyte abnormality will lead to cardiac arrhythmia in patients with severe vomiting?

Accepted Answer

Hypokalemia

Answer

Hyponatremia

Answer

Hyperkalemia

Answer

Hypocalcemia

Question 6

A 39-year-old patient with HIV and a CD4 count of 139 cells/μL presents with altered sensorium and impaired consciousness. CSF examination using an India ink preparation reveals a positive result. Which organism is most likely responsible?

Accepted Answer

Cryptococcus neoformans

Answer

Candida albicans

Answer

Histoplasma capsulatum

Answer

Aspergillus fumigatus

Question 7

A 30-year-old female who delivered a healthy term baby one week ago is now presenting to the OBG clinic with complaints of fishy-smelling pale brownish vaginal discharge. What is the nature of this discharge?

Accepted Answer

Lochia Serosa

Answer

Leukorrhea

Answer

Lochia Rubra

Answer

Lochia Alba

Question 8

A baby presents with the clinical features shown in the image, including characteristic perioral and perianal rash along with a history of diarrhea. Which of the following is the most likely deficiency responsible for this condition?

Accepted Answer

Zinc Deficiency

Answer

Niacin Deficiency

Answer

Selenium Deficiency

Answer

Magnesium Deficiency

Question 9

A newborn child is brought to the emergency department with respiratory difficulty. On evaluation, the child was found to have a posterolateral defect, as shown in the x-ray given. What is the diagnosis?

Accepted Answer

Bochdalek hernia

Answer

Morgagni hernia

Answer

Hiatal hernia

Answer

Traumatic diaphragmatic hernia

Question 10

Identify the type of diaphragmatic hernia shown in the X-ray.

Accepted Answer

Bochdalek hernia

Answer

Morgagni hernia

Answer

Hiatal hernia

Answer

Traumatic diaphragmatic hernia

FMGE 2025

Anatomy

Anesthesiology

Forensic Medicine

Internal Medicine

Microbiology

Obstetrics and Gynecology

Pediatrics

Surgery