Anatomy
1 questionsIdentify the structure marked as 'X' in the image below
FMGE 2025 - Anatomy FMGE Practice Questions and MCQs
Question 241: Identify the structure marked as 'X' in the image below
- A. Prevertebral fascia
- B. Pharyngobasilar fascia
- C. Buccopharyngeal fascia (Correct Answer)
- D. Alar fascia
Explanation: ***Buccopharyngeal fascia*** - This fascia is a subdivision of the **pretracheal layer** of the deep cervical fascia that encloses the pharynx, esophagus, and buccinator muscle. - The pointer 'X' correctly identifies this structure, which forms the anterior boundary of the **retropharyngeal space** located immediately posterior to the pharynx. *Prevertebral fascia* - This layer of deep cervical fascia encloses the **vertebral column** and the deep muscles of the neck (e.g., longus colli, scalene muscles). - It is located posterior to the **alar fascia** and forms the floor of the posterior triangle of the neck. *Pharyngobasilar fascia* - This is a strong fibrous sheet that forms the internal framework of the **pharyngeal wall**, situated between the mucous membrane and the muscular layer. - It is an **internal** structure and is not visible on the external surface of the pharynx as indicated in the image. *Alar fascia* - This is a thin fascial layer located between the **buccopharyngeal fascia** anteriorly and the **prevertebral fascia** posteriorly. - It subdivides the space behind the pharynx into the true **retropharyngeal space** and the more posterior **danger space**.
Community Medicine
2 questionsIdentify A and B in the image of the mosquito larvae given
Which of the following is the formula for sensitivity?
FMGE 2025 - Community Medicine FMGE Practice Questions and MCQs
Question 241: Identify A and B in the image of the mosquito larvae given
- A. A-Anopheles, B-Culex (Correct Answer)
- B. A-Culex, B-Anopheles
- C. A-Culex, B-Aedes
- D. A-Anopheles, B-Mansonia
Explanation: ***A-Anopheles, B-Culex*** - Larva A is identified as **Anopheles** because it rests **parallel** to the water surface and lacks a respiratory **siphon**, breathing through palmate hairs on its abdominal segments. - Larva B is identified as **Culex** as it hangs at an **angle** to the water surface and breathes through a long, narrow respiratory **siphon**. *A-Culex, B-Aedes* - This is incorrect as larva A exhibits the characteristics of **Anopheles** (no siphon, parallel resting), not **Culex**. - While **Aedes** larvae also hang at an angle, larva B's long siphon is more typical of **Culex**; **Aedes** larvae usually have a shorter, stouter siphon. *A-Culex, B-Anopheles* - This option incorrectly reverses the identities. Larva A is **Anopheles** and larva B is **Culex** based on their distinct resting postures and respiratory structures. - The key differentiating feature is the presence of a **siphon** in B (**Culex**) and its absence in A (**Anopheles**). *A-Anopheles, B-Mansonia* - Although the identification of A as **Anopheles** is correct, larva B is not **Mansonia**. - **Mansonia** larvae are unique as they attach to the roots of aquatic plants to obtain oxygen and do not hang from the surface, unlike the larva shown in B.
Question 242: Which of the following is the formula for sensitivity?
- A. TP/(TP+FN)x100 (Correct Answer)
- B. TN/(TN+FP)x100
- C. TP/(TP+FP)x100
- D. TN/(TN+FN)x100
Explanation: ***TP/(TP+FN)x100***- This is the formula for **sensitivity** (or True Positive Rate), which is the proportion of individuals who truly have the disease (**True Positives, TP**) who are correctly identified by the test.- The denominator $TP + FN$ accounts for all individuals who actually have the disease according to the **gold standard**, including those who tested negatively (**False Negatives, FN**).*TP/(TP+FP)x100*- This formula calculates the **Positive Predictive Value (PPV)**, which indicates the probability that a positive test result represents a true positive.- The denominator $TP + FP$ includes everyone who tested positive, regardless of their actual disease status (**True Positives** and **False Positives**).*TN/(TN+FP)x100*- This formula calculates **specificity** (or True Negative Rate), which is the proportion of individuals who are truly disease-free (**True Negatives, TN**) correctly identified by the test.- The denominator $TN + FP$ accounts for all individuals without the disease, including those who were incorrectly identified as positive (**False Positives, FP**).*TN/(TN+FN)x100*- This formula calculates the **Negative Predictive Value (NPV)**, which is the probability that a negative test result represents a true negative.- The denominator $TN + FN$ includes everyone who tested negative, reflecting the proportion of subjects with a negative test result who are truly disease-free.
Internal Medicine
1 questionsIn the context of mitral stenosis, which clinical feature is typically observed?
FMGE 2025 - Internal Medicine FMGE Practice Questions and MCQs
Question 241: In the context of mitral stenosis, which clinical feature is typically observed?
- A. S3 gallop
- B. Loud S1 (Correct Answer)
- C. Muffled heart sounds
- D. Absent S1
Explanation: ***Loud S1*** - Mitral stenosis keeps the mitral leaflets in an open position until late diastole, resulting in an **abrupt and forceful closure** at the onset of systole, producing an abnormally loud S1. - This loud, snapping S1 is one of the **classic auscultatory findings** in non-calcific, mobile mitral stenosis. - The intensity of S1 correlates with valve mobility; as the valve becomes more calcified and immobile, S1 becomes softer. *Absent S1* - An absent or soft S1 indicates a **severely calcified, immobile mitral valve** (very advanced stenosis) or significant mitral regurgitation. - In early to moderate mitral stenosis, the valve leaflets remain mobile enough to generate a loud closure sound. - Loss of S1 intensity suggests progression to severe, end-stage valvular disease. *S3 gallop* - An S3 gallop is a sign of **rapid ventricular filling** caused by volume overload, typically heard in left ventricular systolic heart failure or significant mitral regurgitation. - Since mitral stenosis **restricts diastolic filling** into the left ventricle, an S3 is generally not heard in pure, isolated mitral stenosis. - The presence of S3 in a patient with MS should raise suspicion for coexistent left ventricular dysfunction or mixed valvular disease. *Muffled heart sounds* - Muffled or distant heart sounds suggest pathologies that dampen sound conduction, such as **pericardial effusion**, severe obesity, or emphysema. - Mitral stenosis characteristically produces **accentuated sounds** (loud S1, opening snap, diastolic rumble) rather than muffled sounds. - The presence of muffled sounds should prompt evaluation for alternative or additional cardiac pathology.
Obstetrics and Gynecology
2 questions75% of iatrogenic ureteric injuries are due to gynaecological procedures. Which hysterectomy route has the least risk of ureteric injury?
A postmenopausal woman presents with irregular bleeding, endometrium biopsy shows endometrial hyperplasia without atypia. What is the likely management?
FMGE 2025 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 241: 75% of iatrogenic ureteric injuries are due to gynaecological procedures. Which hysterectomy route has the least risk of ureteric injury?
- A. Laparoscopic
- B. Robotic
- C. Vaginal (Correct Answer)
- D. Abdominal
Explanation: ***Vaginal***- The **vaginal** route typically involves less extensive dissection in the lateral pelvis where the ureters are located, thus minimizing the risk of direct trauma or clamping. - The operation focuses more on the inferior attachments, avoiding the critical area where the ureter passes near the **uterine arteries** (the 'water under the bridge'). *Laparoscopic* - The risk can be significant due to the use of energy devices leading to **thermal injury** or entrapment during suture placement in the cardinal and uterosacral ligaments. - Reduced tactile feedback and potential for altered **3D visualization** increase the likelihood of inadvertent injury during dissection near the pelvic sidewall. *Abdominal* - Although providing good visualization, the procedure requires deliberate dissection near the **pelvic sidewall** where the ureter is vulnerable during clamping and suturing of the **uterine arteries**. - Ureter disruption or ligation often occurs during procedures for large uteri or in cases of **pelvic pathology** (e.g., severe endometriosis, fibroids) that distort anatomy. *Robotic* - Similar to laparoscopic approaches, it carries risks related to extensive use of **electrosurgical energy** and dissection near the ureters for complex cases. - Despite offering enhanced dexterity and 3D visualization, the manipulation and application of clips/sutures to the **cardinal ligaments** still require high vigilance to avoid ureter compromise.
Question 242: A postmenopausal woman presents with irregular bleeding, endometrium biopsy shows endometrial hyperplasia without atypia. What is the likely management?
- A. Estradiol
- B. OCP
- C. Danazol
- D. LNG-IUS (Correct Answer)
Explanation: ***LNG-IUS*** - The **Levonorgestrel-releasing intrauterine system (LNG-IUS)** is a first-line treatment for endometrial hyperplasia without atypia as it delivers a high concentration of **progestin** directly to the endometrium. - This local therapy effectively reverses hyperplasia by causing endometrial atrophy with minimal systemic side effects, making it an excellent choice for postmenopausal women. *OCP* - **Oral contraceptive pills (OCPs)** contain both estrogen and progestin. Administering estrogen is contraindicated as endometrial hyperplasia is caused by unopposed estrogen stimulation. - OCPs are generally indicated for **premenopausal** women for contraception or cycle regulation, not for treating hyperplasia in the postmenopausal population. *Estradiol* - **Estradiol** is a form of estrogen. The pathophysiology of endometrial hyperplasia involves excessive endometrial proliferation due to unopposed estrogen. - Giving estradiol would worsen the condition and increase the risk of progression to **atypical hyperplasia** and endometrial carcinoma. *Danazol* - **Danazol** is a synthetic steroid with anti-estrogenic and weak androgenic properties that can induce endometrial atrophy, but it is not a first-line treatment. - Its use is limited by significant **androgenic side effects**, such as hirsutism, acne, and weight gain, making progestins the preferred therapeutic choice.
Pathology
1 questionsA 50 year old female presented with a breast mass that was operated and the microscopic examination in given. What is the diagnosis?
FMGE 2025 - Pathology FMGE Practice Questions and MCQs
Question 241: A 50 year old female presented with a breast mass that was operated and the microscopic examination in given. What is the diagnosis?
- A. Mucinous carcinoma breast (Correct Answer)
- B. Medullary carcinoma
- C. Lobular carcinoma breast
- D. Phyllodes tumour
Explanation: ***Mucinous carcinoma breast*** - The micrograph shows clusters and nests of relatively uniform tumor cells floating in abundant extracellular **mucin**, which is the hallmark of this diagnosis. - This subtype of invasive ductal carcinoma is typically well-differentiated, hormone receptor-positive (**ER/PR positive**), and carries a more favorable prognosis than conventional invasive ductal carcinoma. *Lobular carcinoma breast* - This carcinoma is characterized by small, discohesive tumor cells infiltrating the stroma individually or in a **single-file** or **“Indian file”** pattern, which is not seen here [1]. - A key feature is the loss of **E-cadherin** expression, leading to the discohesive nature of the cells [3]. *Medullary carcinoma* - Histologically, this tumor presents as poorly differentiated cells arranged in solid, **syncytial sheets** with a prominent **lymphoplasmacytic infiltrate** [2]. - The image lacks both the syncytial growth pattern and the dense inflammatory background characteristic of medullary carcinoma [2]. *Phyllodes tumour* - This is a biphasic **fibroepithelial tumor**, characterized by a hypercellular stromal component and an epithelial component arranged in a **leaf-like** (phyllodes) architecture. - The defining feature is the proliferating stroma, whereas the image shows a carcinoma defined by its epithelial cells and extracellular mucin. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-455. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 455-456. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1068-1069.
Radiology
2 questionsA patient presented to the OPD with a sudden onset of shortness of breath. Identify the condition with the radiological image given below.
Which of the following is shown in the image below (circled)?
FMGE 2025 - Radiology FMGE Practice Questions and MCQs
Question 241: A patient presented to the OPD with a sudden onset of shortness of breath. Identify the condition with the radiological image given below.
- A. Epiglottitis
- B. Bronchitis
- C. Laryngotracheobronchitis (Correct Answer)
- D. Laryngomalacia
Explanation: ***Laryngotracheobronchitis*** - The AP neck radiograph displays the classic **"steeple sign,"** which is a tapered narrowing of the subglottic trachea (indicated by the arrow) due to inflammation. - This condition, also known as **croup**, is typically caused by a viral infection (most commonly **parainfluenza virus**) and presents with a characteristic **barking cough** and inspiratory stridor. *Epiglottitis* - This condition is characterized by the **"thumb sign"** on a *lateral* neck X-ray, which shows a swollen epiglottis, not the subglottic narrowing seen here. - Patients typically present more severely with high fever, **drooling**, dysphagia, and assume a **"tripod" posture**, which differs from the presentation of croup. *Bronchitis* - Bronchitis is an inflammation of the larger airways (bronchi) and would not produce findings in the subglottic region of a neck X-ray. - The primary symptom is a productive cough, and a **chest X-ray**, not a neck X-ray, would be the relevant imaging, which is often normal. *Laryngomalacia* - This is a congenital condition causing inspiratory stridor due to the collapse of soft laryngeal structures; it is not an acute infectious process. - The diagnosis is typically confirmed with **flexible laryngoscopy**, and plain radiographs are usually normal and do not show a steeple sign.
Question 242: Which of the following is shown in the image below (circled)?
- A. Osteomeatal complex (Correct Answer)
- B. Nasal valve
- C. Columella
- D. Crest of maxilla
Explanation: ***Osteomeatal complex*** - The circled area highlights the **osteomeatal complex (OMC)**, a functional unit of the lateral nasal wall located in the middle meatus. - The OMC is the final common drainage pathway for the **frontal**, **maxillary**, and **anterior ethmoid sinuses**, and its obstruction is a primary cause of chronic rhinosinusitis. *Columella* - The **columella** is the external, soft tissue structure that separates the nostrils at the base of the nose. - It is an external feature and is not an internal bony or mucosal structure visible in this coronal CT view of the paranasal sinuses. *Nasal valve* - The **nasal valve** is the narrowest segment of the nasal airway, located much more anteriorly in the nasal cavity, near the nostril opening. - It is a functional area defined by the junction of the nasal septum and the upper lateral cartilage, not the region shown in the middle meatus. *Crest of maxilla* - The **crest of the maxilla**, or nasal crest, is a bony ridge on the floor of the nasal cavity where the inferior edge of the nasal septum articulates. - The circled structure is located superiorly and laterally within the middle meatus, not on the inferior floor of the nasal cavity.
Surgery
1 questionsIdentify the sign given in the image below:
FMGE 2025 - Surgery FMGE Practice Questions and MCQs
Question 241: Identify the sign given in the image below:
- A. Handkerchief sign
- B. Double target sign (Correct Answer)
- C. Beta 2 transferrin sign
- D. Tear drop sign
Explanation: ***Double target sign*** - The image displays the **double target sign**, also known as the **halo sign**, which is highly suggestive of a **basilar skull fracture**. - This sign appears when blood mixed with **cerebrospinal fluid (CSF)** is dropped onto an absorbent surface; the heavier red blood cells accumulate in the center, while the lighter CSF diffuses outward, forming a distinct ring. *Beta 2 transferrin sign* - This is not a visual sign but a highly specific laboratory test used to confirm a **CSF leak**. **Beta-2 transferrin** is a protein almost exclusively found in CSF. - The test involves analyzing fluid collected from the nose or ear (rhinorrhea or otorrhea) to detect the presence of this specific protein, confirming its origin is CSF. *Handkerchief sign* - The **handkerchief sign** (or reservoir sign) refers to the clinical observation of a patient with **CSF rhinorrhea** who constantly has to wipe their nose due to the continuous, watery discharge. - It describes a patient's action rather than the appearance of the fluid itself on a surface. *Tear drop sign* - The **tear drop sign** is a radiological finding seen on orbital imaging (X-ray or CT scan), not a clinical sign on a cloth. - It indicates an **orbital floor (blowout) fracture**, where orbital contents, such as fat and the inferior rectus muscle, herniate into the maxillary sinus, resembling a hanging teardrop.