FMGE 2025 Practice Questions

Q: Which nerve is affected in the hand deformity shown in the image at rest? ![img-59.jpeg](img-59.jpeg)

Ulnar. ***Ulnar*** - The image displays a characteristic **claw hand** deformity, specifically affecting the 4th and 5th digits, which is a classic sign of **ulnar nerve** palsy. - This occurs due to paralysis of the ulnar-innervated muscles, primarily the **medial two lumbricals** and the **interossei**, leading to unopposed extension at the metacarpophalangeal (MCP) joints and flexion at the interphalangeal (IP) joints of the ring and little fingers. *Median* - A **median nerve** injury typically causes an **“ape hand”** deformity due to thenar muscle atrophy or a **“hand of benediction”** sign, where the patient cannot flex the 2nd and 3rd fingers when asked to make a fist. - Unlike the ulnar claw seen at rest, the hand of benediction is an **active sign** (seen on attempted action) and involves different digits. *Musculocutaneous* - The **musculocutaneous nerve** supplies the muscles in the anterior compartment of the arm, such as the **biceps brachii** and **brachialis**, which are responsible for elbow flexion. - An injury to this nerve results in a weak elbow flexion and forearm supination, but it does not cause any deformity in the hand. *None* - The deformity shown is a well-recognized clinical sign known as the **claw hand**. - This sign is specifically and directly linked to a lesion of the **ulnar nerve**, making this option incorrect.

Q: Which is the nodal ministry of disaster management?

Ministry of Home Affairs. ***Ministry of Home Affairs*** - The **Ministry of Home Affairs (MHA)** is the nodal ministry for disaster management in India as per the **Disaster Management Act, 2005** - The **National Disaster Management Authority (NDMA)** functions under the MHA and is chaired by the Prime Minister - MHA coordinates disaster management activities including prevention, mitigation, preparedness, response, and recovery - Responsible for policy formulation, capacity building, and overseeing state disaster management authorities *Ministry of Human Resource and Development* - Now renamed as Ministry of Education - Deals with educational policies and programs, not disaster management coordination *Ministry of Education* - Handles education sector disaster preparedness but is not the nodal ministry - May implement safety protocols in educational institutions during disasters *Ministry of Health and Family Welfare* - Plays a crucial role in health emergency response during disasters (medical relief, epidemic control) - However, it is a supporting ministry, not the nodal coordinating authority for disaster management

Q: An elderly man presents with an ulcerative lesion at the inner canthus of his eye with pearly margins. On microscopic examination, it shows a palisading arrangement of cells. Identify the lesion:

Basal cell carcinoma. ***Basal cell carcinoma*** - The clinical presentation of an ulcerative lesion with **pearly margins**, especially in a sun-exposed area like the inner canthus, is a classic sign of nodular **basal cell carcinoma (BCC)** [1]. - Histologically, the pathognomonic feature is nests of **basaloid cells** with a **peripheral palisading** arrangement, as described and shown in the image [1], [2]. *Squamous cell carcinoma* - **Squamous cell carcinoma (SCC)** typically presents as a scaly, crusted, or erythematous lesion and usually lacks the characteristic **pearly** borders seen in BCC [2]. - Microscopically, SCC is characterized by invasive nests of atypical keratinocytes, often with the formation of **keratin pearls** and intercellular bridges, not palisading [2]. *Keratoacanthoma* - A **keratoacanthoma** is a rapidly growing, dome-shaped tumor with a central, **keratin-filled crater**, which is a distinct clinical feature not described here [2]. - Histologically, it resembles a well-differentiated SCC and does not show the basaloid cells with peripheral palisading characteristic of BCC [2]. *Melanocytic melanoma* - **Melanoma** is a malignancy of melanocytes, typically presenting as a pigmented lesion following the **ABCDE** criteria (Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving). - Histology shows atypical melanocytes, not basaloid cells. The cells may contain melanin pigment and have prominent nucleoli, which differs from the microscopic findings in this case. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1158-1160. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 643-645.

Q: What is the earliest sign of pregnancy on TVS?

G sac. ***G sac***- The **gestational sac** (G sac) is the first definitive sonographic sign of an intrauterine pregnancy (IUP) visible on TVS, typically appearing between **4.5 to 5 weeks** of gestation. - It is seen as a small, **anechoic** (fluid-filled) structure surrounded by a highly **echogenic rim** (trophoblastic tissue), often demonstrating the **double decidual sign**. *Yolk sac* - The **yolk sac** is visualized *after* the gestational sac, typically around **5 to 5.5 weeks** of gestation, located eccentrically within the gestational sac. - Its presence is crucial but is not the earliest structure seen on TVS. *Cardiac activity* - **Fetal cardiac activity** is usually first detectable by TVS comparatively later, generally around **6 to 6.5 weeks** of gestation. - The detection of cardiac activity requires the presence of a viable **fetal pole** (embryo). *Fetal pole* - The **fetal pole** (representing the early embryo) is generally first visualized by TVS around **5.5 to 6 weeks** of gestation. - While a very early finding, it appears slightly *after* the initial visualization of the **gestational sac** itself.

Q: Which nerve will be involved in the following finding at rest?

Ulnar. ***Ulnar*** - The image displays a classic **Ulnar Claw Hand**, a deformity that occurs at rest due to ulnar nerve palsy. It specifically affects the 4th and 5th digits. - This is caused by paralysis of the medial two **lumbricals** (3rd and 4th) and the **interossei** muscles, leading to unopposed extension at the metacarpophalangeal (MCP) joints and flexion at the interphalangeal (IP) joints of the ring and little fingers. *Median* - A **median nerve** injury typically results in an **“Ape Hand”** deformity (thenar atrophy) or a **“Hand of Benediction”** when the patient tries to make a fist, affecting the 1st, 2nd, and 3rd digits. - It does not cause the clawing of the 4th and 5th digits seen in the image. *Musculocutaneous* - The **musculocutaneous nerve** innervates the muscles of the anterior compartment of the arm, such as the **biceps brachii** and **brachialis**. - Injury to this nerve would lead to weakness in elbow flexion and supination, not a deformity of the hand. *None* - The deformity shown is a well-known clinical sign directly linked to a specific peripheral nerve injury. - As the presentation is characteristic of an ulnar nerve palsy, this option is incorrect.

Q: Identify the instrument shown in the image:

Bohler braun splint. ***Bohler braun splint*** - The instrument shown is a **Bohler-Braun splint** (or frame), which is used to apply skeletal traction for fractures of the lower limb, particularly the **femur** and **tibia**. - Its design allows the limb to be elevated with the knee in a flexed position, which helps relax the muscles and facilitates the reduction of the fracture through a system of pulleys and weights. *Thomas splint* - A **Thomas splint** is primarily used for first-aid immobilization of **femoral shaft fractures**. It consists of a padded ring that fits into the groin and two long metal rods. - It provides fixed traction but does not have the elaborate pulley and frame system for bed-based skeletal traction seen in the image. *Volkmann splint* - A **Volkmann splint** is a type of gutter splint used for injuries to the **forearm, wrist, and hand**, not the lower leg. - It is specifically designed to prevent **Volkmann's ischemic contracture**, a deformity resulting from compartment syndrome in the forearm. *Cramer wire* - A **Cramer wire splint** is a flexible, ladder-like splint made of wire that can be bent and molded to fit a limb for temporary immobilization. - It is used for emergency splinting and is not strong enough to provide the definitive skeletal traction required for major long bone fractures.

Q: A 42-year-old woman laborer presented with visible, soft, and fluctuating swelling in front of the knee, over the patella and some discomfort or difficulty with knee movement, MRI findings are given below. What is the diagnosis?

Housemaid's knee. ***Housemaid's knee*** - This condition, also known as **prepatellar bursitis**, involves inflammation and fluid accumulation in the bursa located directly in front of the patella, matching the MRI findings and the patient's clinical presentation. - It is frequently associated with occupations that require prolonged kneeling, such as being a laborer, leading to chronic irritation and swelling in this specific location. *Subdermal abscess* - A subdermal abscess would typically present with more pronounced signs of infection, such as significant warmth, **erythema** (redness), and systemic symptoms like fever, which are not mentioned in this case. - On MRI, an abscess often shows a more complex fluid collection with **rim enhancement** after contrast administration, distinguishing it from the simple bursal fluid seen here. *Gout* - Gout is an **intra-articular** arthritis caused by **urate crystal** deposition, which would cause swelling within the knee joint itself, not a localized collection in front of the patella. - The classic presentation is an acute, intensely painful, and red joint, most commonly the first **metatarsophalangeal joint** (podagra), which differs from this patient's presentation. *Rheumatoid arthritis* - Rheumatoid arthritis is a systemic inflammatory condition that typically causes **symmetric polyarthritis** of small joints in the hands and feet. - While it can affect the knee, it causes an **intra-articular** effusion (swelling within the joint space) and synovitis, not isolated prepatellar bursitis.

Q: Which gene mutation is most commonly associated with Burkitt's lymphoma?

C-myc. ***C-myc*** - Burkitt's lymphoma is characterized by the **t(8;14) translocation** in 80% of cases [1] - This translocation juxtaposes the **C-myc oncogene (chromosome 8)** with the **immunoglobulin heavy chain locus (chromosome 14)** [1] - Results in **constitutive overexpression of C-myc**, driving uncontrolled cell proliferation [1] - This is a **pathognomonic molecular feature** of Burkitt's lymphoma [1] - Variants include t(2;8) and t(8;22) involving immunoglobulin light chain loci [1] *p53* - Tumor suppressor gene involved in many cancers - Not the characteristic mutation defining Burkitt's lymphoma - May be involved in disease progression but not the hallmark feature *Rb* - Retinoblastoma gene, another tumor suppressor - Associated with retinoblastoma and osteosarcoma - Not characteristic of Burkitt's lymphoma *p21* - Cyclin-dependent kinase inhibitor (CDKN1A) - Involved in cell cycle regulation - Not the defining genetic alteration in Burkitt's lymphoma **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 324-325.

Q: A child presents with a right transverse palmar crease, a cardiac defect, survival into childhood, and mild intellectual impairment. What chromosomal mechanism is most likely associated with these findings?

Mosaicism. ***Mosaicism*** - **Mosaicism** is the presence of two or more cell lines with different genetic constitutions in a single individual, allowing for a **milder phenotype** of chromosomal syndromes like Trisomy 21. - The combination of classic Down syndrome features (transverse palmar crease, cardiac defect) with relatively **mild intellectual impairment** and survival into childhood with better outcomes suggests **Mosaic Down Syndrome** (mosaic Trisomy 21). - In mosaicism, only a proportion of cells carry the extra chromosome 21, resulting in **less severe manifestations** compared to complete trisomy. *Incorrect: Trisomy* - While **complete Trisomy 21** (Down syndrome) presents with similar features, it typically causes **more severe intellectual disability** and greater phenotypic expression. - The emphasis on **"mild" intellectual impairment** in this case points toward mosaicism rather than complete trisomy. *Incorrect: Haploid* - **Haploid** refers to a cell having only one set of chromosomes (n=23), a state that is **incompatible with human survival** beyond early embryonic development. - A complete haploid individual cannot survive into **childhood**. *Incorrect: Monosomy* - **Monosomy** (loss of one chromosome, 2n-1) for autosomes is typically **lethal in utero**, making survival into childhood impossible. - The only viable monosomy is **Monosomy X** (Turner syndrome), which presents with distinct features (short stature, webbed neck, ovarian dysgenesis) without the characteristic Down syndrome features described.

Q: Based on the provided X-ray image, identify the most likely diagnosis.

Osteosarcoma. ***Osteosarcoma*** - The X-ray demonstrates a classic **"sunburst"** or **"sun-ray"** appearance, which is a periosteal reaction caused by tumor spicules radiating outwards. This is a hallmark sign of osteosarcoma. - This malignant tumor typically arises in the **metaphysis** of long bones, such as the distal femur, proximal tibia, and proximal humerus, and is often associated with a soft tissue mass and aggressive bone destruction. *Ewing sarcoma* - Radiographically, Ewing sarcoma more commonly presents with a lamellated or **"onion-skin"** periosteal reaction or a destructive, **"moth-eaten"** appearance. - It is a **small round blue cell tumor** that typically affects the **diaphysis** of long bones in children and young adults. *Chondrosarcoma* - This is a malignant tumor of cartilage-producing cells, characterized by **"popcorn"** or **"ring-and-arc"** calcifications on X-ray, which are not seen in this image. - Chondrosarcoma typically affects older adults (over 40) and commonly involves the bones of the pelvis and trunk. *Gout* - Gout is a form of inflammatory arthritis, not a tumor. Its classic radiographic finding is **"punched-out"** erosions with sclerotic margins and overhanging edges, often called **"rat-bite"** erosions. - It does not cause a sunburst periosteal reaction and commonly affects the first metatarsophalangeal joint.

Question 1

Which nerve is affected in the hand deformity shown in the image at rest? ![img-59.jpeg](img-59.jpeg)

Accepted Answer

Ulnar

Answer

Median

Answer

Musculocutaneous

Answer

None

Question 2

Which is the nodal ministry of disaster management?

Accepted Answer

Ministry of Home Affairs

Answer

Ministry of Human Resource and Development

Answer

Ministry of Education

Answer

Ministry of Health and Family Welfare

Question 3

An elderly man presents with an ulcerative lesion at the inner canthus of his eye with pearly margins. On microscopic examination, it shows a palisading arrangement of cells. Identify the lesion:

Accepted Answer

Basal cell carcinoma

Answer

Melanocytic melanoma

Answer

Keratoacanthoma

Answer

Squamous cell carcinoma

Question 4

What is the earliest sign of pregnancy on TVS?

Accepted Answer

G sac

Answer

Fetal pole

Answer

Cardiac activity

Answer

Yolk sac

Question 5

Which nerve will be involved in the following finding at rest?

Accepted Answer

Ulnar

Answer

Median

Answer

Musculocutaneous

Answer

None

Question 6

Identify the instrument shown in the image:

Accepted Answer

Bohler braun splint

Answer

Thomas splint

Answer

Volkmann splint

Answer

Cramer wire

Question 7

A 42-year-old woman laborer presented with visible, soft, and fluctuating swelling in front of the knee, over the patella and some discomfort or difficulty with knee movement, MRI findings are given below. What is the diagnosis?

Accepted Answer

Housemaid's knee

Answer

Rheumatoid arthritis

Answer

Gout

Answer

Subdermal abscess

Question 8

Which gene mutation is most commonly associated with Burkitt's lymphoma?

Accepted Answer

C-myc

Answer

p53

Answer

Rb

Answer

p21

Question 9

A child presents with a right transverse palmar crease, a cardiac defect, survival into childhood, and mild intellectual impairment. What chromosomal mechanism is most likely associated with these findings?

Accepted Answer

Mosaicism

Answer

Haploid

Answer

Monosomy

Answer

Trisomy

Question 10

Based on the provided X-ray image, identify the most likely diagnosis.

Accepted Answer

Osteosarcoma

Answer

Chondrosarcoma

Answer

Gout

Answer

Ewing sarcoma

FMGE 2025

Anatomy

Community Medicine

Dermatology

Obstetrics and Gynecology

Orthopaedics

Pathology

Radiology