FMGE 2025 Practice Questions

Q: A 27-year-old woman presents with irregular periods, acne & excessive hair growth. What is the first line management?

Lifestyle modifications. ***Lifestyle modifications***- As many patients with **PCOS** are overweight or obese, lifestyle changes (diet and exercise) are crucial for tackling associated **insulin resistance** and obesity.- Weight loss, even modest amounts (5-10%), often significantly improves menstrual regularity, metabolic profiles, and symptoms of **hyperandrogenism**.*Metformin*- Used primarily to improve **insulin sensitivity** and may help regulate cycles, but it is typically initiated after lifestyle interventions have proven insufficient or when glucose intolerance is confirmed.- It is not recommended as the initial management strategy unless the patient has confirmed **Type 2 Diabetes** or severe insulin resistance.*OCPs*- Oral contraceptive pills are highly effective for managing symptoms like **hirsutism** (by increasing **SHBG** and decreasing free testosterone) and regulating menses.- While effective symptomatically, they are usually introduced after lifestyle changes have failed, or if symptoms are severe and require immediate hormonal suppression.*Clomiphene citrate*- This medication is specifically used as a **fertility treatment** to induce ovulation in anovulatory women with PCOS who are seeking pregnancy.- It does not treat the hyperandrogenism (acne, hirsutism) or metabolic issues associated with PCOS, and thus is not the first-line management for the presenting symptoms.

Q: What is the hormonal check for pregnancy at home?

Beta-HCG. ***Beta-HCG***- This hormone (specifically the **beta subunit of Human Chorionic Gonadotropin**) is detected by **home pregnancy test kits** in the urine, offering a simple and rapid test for confirming pregnancy.- It is produced by the **syncytiotrophoblast** cells after implantation and is the earliest reliable hormonal biomarker for clinically diagnosing pregnancy.*Estrogen*- While estrogen levels (e.g., **estriol**) increase significantly throughout pregnancy, they are not the hormone used for rapid, qualitative, early, **home-based detection**.- Estrogen levels fluctuate widely during the normal menstrual cycle, making it an unreliable early marker compared to HCG.*Progesterone*- Progesterone is essential for maintaining the uterine lining (**endometrium**) and supporting early pregnancy, but its measurement is typically reserved for evaluating **corpus luteum function** or threatened miscarriage.- Since progesterone levels rise naturally during the luteal phase of the regular cycle, it does not confirm pregnancy with the high specificity HCG offers.*HPL*- **Human Placental Lactogen (HPL)**, also known as **chorionic somatomammotropin**, is produced relatively later by the placenta.- Its primary role is in regulating maternal metabolism and fetal growth, and it is not typically detectable or useful for confirming a very **early home diagnosis** of pregnancy.

Q: Identify the CTG pattern?

Early deceleration. ***Early deceleration*** - This pattern is characterized by a gradual, symmetrical decrease in fetal heart rate (FHR) where the onset, nadir, and recovery of the deceleration coincide with the beginning, peak, and end of a uterine contraction, creating a **mirror image**. - Early decelerations are caused by **fetal head compression** during contractions, which elicits a vagal response. They are considered physiological and are not typically associated with fetal hypoxia or acidosis. *Late decelerations* - These are characterized by a gradual decrease in FHR where the nadir of the deceleration occurs **after the peak** of the uterine contraction, indicating a delayed response. - Late decelerations are a non-reassuring sign caused by **uteroplacental insufficiency**, suggesting impaired oxygen exchange to the fetus. *Variable* - These are abrupt, sharp drops in the FHR that are variable in shape (often V, U, or W-shaped) and have an inconsistent relationship with uterine contractions. - Variable decelerations are caused by **umbilical cord compression**, which obstructs blood flow to the fetus. *Normal* - A normal or reassuring CTG trace would have a baseline FHR between 110-160 bpm, moderate variability (5-25 bpm), and the presence of accelerations with or without early decelerations. - While early decelerations can be part of a normal picture, the question asks to identify the specific pattern of deceleration present, which is 'early deceleration'.

Q: Identify the medical device shown in the image.

Balloon Tamponade. ***Balloon Tamponade*** - The image displays an intrauterine balloon, like a **Bakri balloon**, which is inflated within the uterine cavity to exert pressure on the bleeding surfaces of the endometrium. - This procedure, known as balloon tamponade, is a common and effective intervention for managing refractory **postpartum hemorrhage (PPH)**, particularly when caused by uterine atony. *Umbrella pack* - An umbrella pack is a method of uterine packing that uses gauze arranged in an "umbrella" fashion to apply pressure, rather than an inflatable balloon. - This technique is now less commonly used due to the availability of more effective and safer methods like balloon tamponade, and it carries a risk of **concealed hemorrhage**. *Parachute pack* - A parachute pack is another older gauze-packing technique used for uterine hemorrhage, distinct from the balloon device shown. - It has been largely superseded by modern interventions such as **uterine artery embolization** and balloon tamponade due to better outcomes and lower complication rates. *Cervical ablation* - Cervical ablation is a procedure to destroy abnormal tissue on the cervix, typically for treating **cervical dysplasia**, and does not involve an intrauterine balloon. - The image shows a device for hemorrhage control within the uterus, not a therapeutic procedure on the cervix itself.

Q: A 20-year-old male patient presented with localized pain, which is gradual in onset and worsened over time. X-ray showed the following finding. What is the diagnosis?

Osteosarcoma. ***Osteosarcoma*** - The X-ray shows a classic **sunburst appearance**, which represents spiculated periosteal new bone formation radiating outwards, a hallmark of osteosarcoma. - This diagnosis is supported by the patient's age (peak incidence in adolescence/young adulthood) and the tumor's location in the **metaphysis** of a long bone (distal tibia). *Ewing sarcoma* - This tumor typically presents with a lytic lesion and a lamellated, **"onion-skin" periosteal reaction**, which is different from the sunburst pattern seen here. - Ewing sarcoma most commonly arises in the **diaphysis** (shaft) of long bones or in flat bones like the pelvis. *Chondrosarcoma* - This is a malignant cartilage-forming tumor that typically affects older adults (usually >40 years), making it less likely in a 20-year-old. - Radiographically, it is characterized by **"ring-and-arc"** or **"popcorn" calcifications** within the tumor matrix, which are absent in this image. *Gout* - Gout is a form of inflammatory arthritis, not a bone tumor, and would present with acute joint pain and swelling rather than a gradual mass effect. - Radiographic findings in chronic gout include characteristic **"punched-out" erosions** with overhanging edges, which are completely different from the aggressive, bone-forming lesion shown.

Q: Which of the following is a primary use of this imaging modality? ![img-42.jpeg](img-42.jpeg)

Staging of esophageal cancer. ***Staging of esophageal cancer*** - The image displays an **Endoscopic Ultrasound (EUS)**, which is the most accurate modality for the locoregional staging of esophageal cancer. - EUS provides detailed imaging of the esophageal wall layers, allowing for precise assessment of the **depth of tumor invasion (T stage)** and involvement of **regional lymph nodes (N stage)**, which is critical for treatment planning. *Evaluation of gastroesophageal reflux disease (GERD)* - The diagnosis of GERD is primarily based on clinical symptoms and may be confirmed with **upper endoscopy** to look for esophagitis or **ambulatory pH monitoring**. - EUS is not used for evaluating reflux itself, as it doesn't measure acid exposure or lower esophageal sphincter function. *Identifying the cause of dysphagia* - The initial investigation for dysphagia typically involves a **barium esophagram** or a standard **upper endoscopy** to visualize the esophageal lumen directly. - EUS is a secondary test used to further characterize a mass or stricture already identified by other means, rather than as a primary tool for dysphagia workup. *Assessing cardiac and aortic pathology* - While EUS can visualize adjacent mediastinal structures, including the heart and aorta, it is not the primary imaging modality for their assessment. - **Echocardiography** is the standard for cardiac evaluation, and **CT or MR angiography** is superior for assessing aortic pathology.

Q: What is the investigation shown in the image?

Intravenous Pyelogram (IVP). ***Intravenous Pyelogram (IVP)*** - This investigation involves the intravenous injection of a **water-soluble iodinated contrast agent**, which is then excreted by the kidneys, allowing visualization of the entire urinary tract. - The image shows a plain radiograph where the **renal pelves**, **calyces**, both **ureters**, and the **bladder** are simultaneously opacified, which is characteristic of contrast being filtered and passed down the urinary system. *Retrograde Pyelogram* - In this procedure, contrast is injected directly into the **ureteric orifices** via a catheter placed during **cystoscopy**, filling the system from the bottom up. - It typically provides a denser opacification than an IVP and is often performed unilaterally. It does not assess renal function as the contrast is not filtered by the kidneys. *Computed Tomography (CT) Urography* - CT Urography uses intravenous contrast but acquires images using **computed tomography**, producing detailed, cross-sectional, and 3D reformatted images of the urinary tract. - The image provided is a two-dimensional **projectional radiograph** (a standard X-ray), not a CT scan which would show axial, coronal, or sagittal slices. *Magnetic Resonance Urography* - This technique uses **magnetic fields and radio waves** to generate images, avoiding ionizing radiation. It is excellent for visualizing soft tissues. - The image shown is clearly an X-ray, identifiable by the high contrast visualization of dense structures like bone, which differs significantly from the appearance of an MR image.

Q: A chest X-ray is shown below. What is the most likely diagnosis?

Pulmonary oedema. ***Pulmonary oedema*** - The chest X-ray shows classic features of pulmonary oedema, including **bilateral diffuse opacities**, particularly in the perihilar region (a "bat's wing" appearance), and **cephalization** of the pulmonary vessels. - These findings indicate the accumulation of fluid within the lung's interstitial and alveolar spaces, commonly due to increased pulmonary capillary hydrostatic pressure, often from **left-sided heart failure**. *Hydrothorax* - Hydrothorax refers to the accumulation of serous fluid (transudate) specifically within the **pleural space**, not the lung parenchyma itself. - Radiographically, this would present as **blunting of the costophrenic angle** and a **meniscus sign**, which are not the primary features seen in this image. *Pleural effusion* - This is a general term for fluid in the pleural space. The dominant pathology in the provided X-ray is within the **lung parenchyma**, not the pleural cavity. - While a small reactive effusion can accompany pulmonary oedema, the main findings are the diffuse **alveolar infiltrates**, not a large fluid collection obscuring the lung base. *Pulmonary fibrosis* - Pulmonary fibrosis involves chronic **scarring of lung tissue**, which appears as **reticular patterns**, **honeycombing**, or traction bronchiectasis on an X-ray. - The opacities in this image are hazy and "fluffy," which is characteristic of acute fluid accumulation, not the fine, linear patterns of chronic fibrosis.

Q: A 65-year-old patient presents with abdominal distension and constipation. What is the most likely diagnosis based on the abdominal X-ray shown?

Sigmoid Volvulus. ***Sigmoid Volvulus*** - The abdominal X-ray shows a classic **coffee bean sign**, which is a massively dilated, inverted U-shaped loop of the sigmoid colon rising from the pelvis. - The loop is characteristically **ahaustral** (lacking haustra) and its apex points towards the right upper quadrant, confirming the diagnosis of sigmoid volvulus. *Caecal Volvulus* - A caecal volvulus typically appears as a **kidney-shaped** or comma-shaped dilated loop of bowel, often located in the left upper quadrant or mid-abdomen. - Unlike the sigmoid, the dilated caecum in a volvulus usually retains its **haustral markings**. *Intestinal Obstruction* - While a volvulus does cause an intestinal obstruction, this option is a general finding rather than the specific diagnosis indicated by the classic radiographic sign. - General large bowel obstruction typically shows colonic dilation proximal to the blockage, without the specific twisted appearance of the **coffee bean sign**. *Small Bowel Volvulus* - A small bowel volvulus would involve dilated loops of the small bowel, which would typically show **valvulae conniventes** (plicae circulares). - This condition is rare in adults and the image clearly shows a dilated, **ahaustral** segment of the large bowel, which is inconsistent with small bowel anatomy.

Q: A 70-year-old patient presents with absolute constipation and abdominal distension. The X-ray abdomen is given below. What is the most likely diagnosis?

Sigmoid Volvulus. ***Sigmoid Volvulus*** - The abdominal X-ray demonstrates the classic **"coffee bean" sign**, which is a massively dilated, haustra-less loop of the sigmoid colon that appears bent upon itself, originating from the pelvis. - This diagnosis aligns with the clinical presentation of an elderly patient with **absolute constipation** and significant **abdominal distension**, which are hallmark features of a closed-loop large bowel obstruction caused by sigmoid volvulus. *Caecal Volvulus* - A caecal volvulus typically presents as a **kidney-bean** or **comma-shaped** dilated structure that is displaced from the right lower quadrant towards the left upper quadrant, which is morphologically distinct from the inverted U-shape seen in the image. - The dilated cecum in a caecal volvulus often retains some **haustral markings**, unlike the smooth, featureless appearance of the dilated sigmoid colon seen here. *Intestinal Obstruction* - While sigmoid volvulus is a cause of intestinal obstruction, this is a non-specific diagnosis. The radiological findings are specific enough to identify the underlying cause. - A general diagnosis of intestinal obstruction doesn't account for the pathognomonic **"coffee bean" sign**, which specifically points to sigmoid volvulus as the etiology. *Small Bowel Volvulus* - The dilated loop in the X-ray lacks **valvulae conniventes** (also known as plicae circulares), which are characteristic transverse folds of the small bowel. The loop's appearance is consistent with the large bowel. - The caliber of the distended loop is exceptionally large, which is more typical for a colonic obstruction rather than a small bowel obstruction, which usually involves multiple, smaller-caliber loops.

Question 1

A 27-year-old woman presents with irregular periods, acne & excessive hair growth. What is the first line management?

Accepted Answer

Lifestyle modifications

Answer

OCPs

Answer

Metformin

Answer

Clomiphene citrate

Question 2

What is the hormonal check for pregnancy at home?

Accepted Answer

Beta-HCG

Answer

Estrogen

Answer

Progesterone

Answer

HPL

Question 3

Identify the CTG pattern?

Accepted Answer

Early deceleration

Answer

Late deceleration

Answer

Variable

Answer

Normal

Question 4

Identify the medical device shown in the image.

Accepted Answer

Balloon Tamponade

Answer

Umbrella pack

Answer

Parachute pack

Answer

Cervical ablation

Question 5

A 20-year-old male patient presented with localized pain, which is gradual in onset and worsened over time. X-ray showed the following finding. What is the diagnosis?

Accepted Answer

Osteosarcoma

Answer

Ewing sarcoma

Answer

Chondrosarcoma

Answer

Gout

Question 6

Which of the following is a primary use of this imaging modality?

![img-42.jpeg](img-42.jpeg)

Accepted Answer

Staging of esophageal cancer

Answer

Evaluation of gastroesophageal reflux disease (GERD)

Answer

Identifying the cause of dysphagia

Answer

Assessing cardiac and aortic pathology

Question 7

What is the investigation shown in the image?

Accepted Answer

Intravenous Pyelogram (IVP)

Answer

Retrograde Pyelogram

Answer

Computed Tomography (CT) Urography

Answer

Magnetic Resonance Urography

Question 8

A chest X-ray is shown below. What is the most likely diagnosis?

Accepted Answer

Pulmonary oedema

Answer

Hydrothorax

Answer

Pleural effusion

Answer

Pulmonary fibrosis

Question 9

A 65-year-old patient presents with abdominal distension and constipation. What is the most likely diagnosis based on the abdominal X-ray shown?

Accepted Answer

Sigmoid Volvulus

Answer

Caecal Volvulus

Answer

Intestinal Obstruction

Answer

Small Bowel Volvulus

Question 10

A 70-year-old patient presents with absolute constipation and abdominal distension. The X-ray abdomen is given below. What is the most likely diagnosis?

Accepted Answer

Sigmoid Volvulus

Answer

Caecal Volvulus

Answer

Intestinal Obstruction

Answer

Small Bowel Volvulus

FMGE 2025

Obstetrics and Gynecology

Orthopaedics

Radiology

Surgery