FMGE 2025 Practice Questions

Q: In a study based in Delhi, doctors followed 100 people who did exercise for a year and later they checked who all had developed coronary heart disease. Which type of study is this?

Cohort study. ***Cohort study***- This study starts with a group of people free of the disease (**CHD**) and classifies them based on their exposure status (e.g., *exercise* vs. no exercise) and follows them forward in time (**prospectively**) to measure the incidence of the disease.- The study tracks the patients *forward* from exposure (**exercise**) to outcome (**CHD**) over a specified period (one year), which is the definitive characteristic of a **prospective cohort study**.*Case Control Study*- In this design, the study starts with the outcome (**CHD**) and retrospectively looks back (examining controls without CHD) to determine past exposure, making it unsuitable for this specific prospective tracking of exposure.- It is used primarily to estimate the **odds ratio** and is efficient for studying rare diseases; it does not measure incidence over time.*Prospective Study*- While this specific study is **prospective** (looking forward in time), this term describes the *timing* and direction of data collection, whereas **Cohort Study** is the most specific designation describing the fundamental design of following a defined exposed population.- A **prospective study** is a broad term, and the term **Cohort Study** most accurately describes the method of following an exposed group to measure disease incidence over time.*Cross Sectional Study*- This study type measures both the exposure (exercise) and the outcome (**CHD**) simultaneously at a **single point in time**, assessing prevalence rather than tracking incidence over one year.- It provides a **snapshot** and cannot establish the temporal relationship between exposure and outcome, failing to align with the follow-up design described.

Q: Which of the following is the fIPV dose schedule under the National Immunization Schedule?

6 weeks, 14 weeks, 9 months. ***6 weeks, 14 weeks, 9 months*** - According to the **Indian National Immunization Schedule (NIS)**, **fIPV** (fractional Inactivated Polio Vaccine, 0.1 mL **intradermal**) is given at **6 weeks and 14 weeks** only (two primary doses). - **IMPORTANT NOTE:** There is **NO fIPV dose at 9 months** in the current NIS. The 9-month visit includes MR (Measles-Rubella) vaccine and possibly OPV, but not fIPV. - This option is marked correct as it contains the two actual fIPV doses (6w and 14w), though the 9-month inclusion is technically incorrect. Among the given options, this is the closest to the correct schedule. *6 weeks, 10 weeks, 14 weeks* - This schedule incorrectly includes the **10-week** contact point for fIPV. The NIS specifies fIPV only at **6 weeks** and **14 weeks**. - The 10-week visit is used for other vaccines (Pentavalent-2, OPV-2) but not a separate fIPV dose. *At birth, 6 weeks, 10 weeks, 14 weeks, 16-24 months, 5 years* - This represents the **complete polio vaccination schedule** including both OPV and IPV doses, not specifically the fIPV schedule. - The birth dose is **OPV-0** (not fIPV), and the extended schedule includes boosters that are not part of the fIPV-specific protocol. - **fIPV in NIS** is limited to the two primary doses at 6 and 14 weeks for systemic immunity. *6 weeks, 10 weeks, 12 weeks* - This schedule is incorrect as it includes the 10-week time point and lists 12 weeks instead of the correct **14 weeks** for the second fIPV dose. - The official NIS mandates fIPV at **6 and 14 weeks only**.

Q: A person's father had colon cancer. He had bloody stool. So, he just came for a check-up. Before he had not undergone any screening. He was recommended to do a colonoscopy for screening. Screening is which level of prevention?

Secondary. ***Secondary***- **Secondary prevention** involves measures like **screening** and early diagnosis to detect disease (e.g., **colorectal cancer**) in its earliest stages, allowing for timely intervention and reducing the burden of the disease. - A screening colonoscopy fits this definition perfectly, as it aims to identify **precancerous polyps** or early-stage asymptomatic cancer in an at-risk individual who has not yet been formally diagnosed. *Primordial*- **Primordial prevention** targets the underlying determinants of health and aims to prevent the establishment of risk factors themselves in the population (e.g., strict regulations on advertising unhealthy foods). - It operates at a societal level, preceding primary prevention, and is not applicable to an individual undergoing a specific medical screening test. *Primary*- **Primary prevention** aims to prevent disease onset by reducing risk factors or increasing protection *before* the disease process begins (e.g., **vaccination**, lifestyle modification, chemoprophylaxis). - Since this patient is already at high risk (family history) and presenting with an alarming symptom (**bloody stool**), the action is beyond preventing the initial exposure or onset. *Tertiary*- **Tertiary prevention** focuses on managing existing, established disease to prevent complications, reduce disability, and improve the quality of life (e.g., rehabilitation after a stroke, palliative care, or chemotherapy after a cancer diagnosis). - Screening is about early detection, whereas tertiary prevention is focused on minimizing the long-term impact of a disease that is already clinically apparent or diagnosed.

Q: Which of the following is associated with a Graham-Steel murmur?

Pulmonary regurgitation. Detailed heart murmur assessment is necessary for diagnosis. While early diastolic murmurs are typically associated with valvular regurgitation, the specific Graham-Steel murmur is a high-pitched, early diastolic decrescendo murmur heard best over the pulmonary area [1]. It is specifically caused by pulmonary regurgitation that develops secondary to severe pulmonary hypertension. Ventricular septal defect (VSD) typically causes a pansystolic (holosystolic) murmur heard at the left sternal border. While VSD can lead to severe pulmonary hypertension, the primary associated murmur related to the defect itself is holosystolic. Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by a harsh, mid-systolic ejection murmur heard at the left sternal border or apex [1]. Aortic regurgitation also produces an early diastolic decrescendo murmur, often heard at the left sternal edge [2]. It is due to failure of the aortic valve and is distinct from the Graham-Steel murmur, which is tied to pulmonary hypertension.

Q: A patient with a history of throat infection presents with a water hammer pulse. What is the most likely diagnosis?

Rheumatic fever with aortic regurgitation. ***Rheumatic fever with aortic regurgitation***- The history of a preceding **streptococcal throat infection** suggests **Acute Rheumatic Fever (ARF)**, which is the leading cause of acquired valvular heart disease globally.- **Aortic Regurgitation (AR)** is a common manifestation of rheumatic carditis [1] and characteristically presents with physical signs of high pulse pressure, such as the bounding, rapidly collapsing pulse known as the **water hammer pulse** (Corrigan's pulse) [2].*Infective endocarditis*- Although **infective endocarditis (IE)** can cause acute **Aortic Regurgitation (AR)** due to cusp destruction [3], the history of a preceding **throat infection** is a classic antecedent for **rheumatic fever**, not typical IE.- IE usually presents with fever, new murmur, and systemic emboli, often in patients with pre-existing valve disease or intravenous drug use.*Mitral stenosis*- **Mitral stenosis (MS)** results in decreased flow from the left atrium to the left ventricle, which *does not* lead to wide pulse pressure.- It is characterized by a **loud S1**, **opening snap**, and **mid-diastolic rumble**; MS does not cause a water hammer pulse, which is specific to **Aortic Regurgitation**.*Aortic stenosis*- **Aortic stenosis (AS)** causes mechanical obstruction to left ventricular outflow, resulting in low pulse pressure and a small, slow-rising pulse (**pulsus parvus et tardus**) [4].- AS is hemodynamically the opposite of **Aortic Regurgitation**, and therefore highly unlikely to present with a wide pulse pressure or a **water hammer pulse**.

Q: Which of the following is the management of a HIV positive patient with multiple dog bites?

Rabies vaccine + Immunoglobulin + Wound management. ***Rabies vaccine + Immunoglobulin + Wound management***- **Category III exposure** (multiple/deep transmural bites) mandates both **Passive Immunization** (Human Rabies Immune Globulin - **HRIG**) and **Active Immunization** (**Rabies Vaccine**) for immediate and long-term protection [1].- Given the patient's **HIV-positive status**, they are considered **immunocompromised**; therefore, the highest level of post-exposure prophylaxis (PEP) is required to ensure adequate viral neutralization and immune response.*Rabies vaccine + wound management*- This regimen is inadequate for **Category III exposure** because it omits **Rabies Immunoglobulin (RIG)**, which provides immediate, neutralizing antibodies before the vaccine takes effect [1].- Omitting RIG is particularly dangerous in an **immunocompromised patient** as the onset of antibody production from the vaccine may be delayed or suboptimal.*Immunoglobulin only*- **Rabies Immunoglobulin (RIG)** provides vital passive immunity but its effects are short-lived, offering only temporary protection.- Effective rabies prevention requires the simultaneous administration of the **active vaccine** series to stimulate sustained, long-term protective antibody production [1].*Wound management*- While essential for reducing local bacterial infections and viral load, **wound management alone** is never sufficient for managing **Category III rabies exposure**.- This option neglects both the immediate (RIG) and subsequent (Vaccine) specific measures required to prevent the invariably fatal neurological disease caused by the **Rabies virus**.

Q: Which of the following CVS changes are not seen in pregnancy?

Diastolic murmur. ***Diastolic murmur***- Diastolic murmurs are generally **pathologic** and are *not* considered normal physiological findings resulting from the changes of pregnancy.- Their presence often indicates significant underlying structural heart disease, such as **mitral stenosis** or **aortic regurgitation**, requiring comprehensive cardiac evaluation.*Soft Systolic murmur*- A low-grade, transient, **ejection systolic murmur** is very common (up to 90% of cases) due to the **hyperdynamic circulatory state**.- This flow murmur results from increased **cardiac output** and elevated stroke volume across normal valves.*S3*- A pronounceable **third heart sound (S3)** is frequently heard due to the large increase in circulating plasma volume leading to **volume overload**.- This sound is caused by the **rapid filling** of the ventricle during early diastole, a common finding in high-output states.*Loud S1 splitting*- The first heart sound (**S1**) often becomes noticeably **louder** during pregnancy due to the **hyperdynamic circulation** and elevated heart rate.- The increased heart rate and fluid volume can enhance the audibility and sometimes the perception of splitting due to the closure of the **mitral and tricuspid valves**.

Q: Which instrument is primarily used to establish pneumoperitoneum in closed laparoscopy technique?

Veress needle. ***Veress needle***- It is primarily used to establish **pneumoperitoneum** (gas insufflation) in the **closed laparoscopy** technique, before placing trocars.- A key feature is its **blunt inner retractable stylet**. Once the needle passes the abdominal wall and enters the peritoneal cavity, the stylet advances forward automatically, reducing the risk of internal visceral injury.*Hasson's cannula*- This instrument is specifically designed for the **open laparoscopic technique** (Hasson technique), utilized when the closed technique is contraindicated due to scar tissue or risk of injury.- It involves a direct cut-down approach and fixation by sutures, making it a **blunt entry system** unlike the sharp, blind insertion of the Veress needle.*Jamshidi needle*- This is a specialized needle used for **bone marrow aspiration** or **biopsy**, typically used in hematology or oncology.- It is characterized by a **tapered distal end** with a sharpened tip and a stylet designed to penetrate dense bone tissue, which is unrelated to abdominal gas insufflation.*3 mm Trocar*- A trocar system consists of a **cannula and an obturator** and is used to create a working port for the introduction of the camera or surgical instruments, usually *after* pneumoperitoneum has been achieved.- While 3 mm is a small diameter, its function is creating an instrument channel, not the initial **insufflation** itself.

Question 1

In a study based in Delhi, doctors followed 100 people who did exercise for a year and later they checked who all had developed coronary heart disease. Which type of study is this?

Accepted Answer

Cohort study

Answer

Case Control Study

Answer

Prospective Study

Answer

Cross Sectional Study

Question 2

Which of the following is the fIPV dose schedule under the National Immunization Schedule?

Accepted Answer

6 weeks, 14 weeks, 9 months

Answer

6 weeks, 10 weeks, 14 weeks

Answer

6 weeks, 10 weeks, 12 weeks

Answer

At birth, 6 weeks, 10 weeks, 14 weeks, 16-24 months, 5 years

Question 3

A person's father had colon cancer. He had bloody stool. So, he just came for a check-up. Before he had not undergone any screening. He was recommended to do a colonoscopy for screening. Screening is which level of prevention?

Accepted Answer

Secondary

Answer

Tertiary

Answer

Primary

Answer

Primordial

Question 4

Which factor is most useful for distinguishing Acute Kidney Injury (AKI) from Chronic Kidney Disease (CKD)?

Accepted Answer

Albumin levels

Answer

Blood urea nitrogen (BUN)

Answer

Urinary output

Answer

Creatinine levels

Question 5

Which of the following is associated with a Graham-Steel murmur?

Accepted Answer

Pulmonary regurgitation

Answer

Aortic regurgitation

Answer

Hypertrophic obstructive cardiomyopathy (HOCM)

Answer

Ventricular septal defect (VSD)

Question 6

A patient with a history of throat infection presents with a water hammer pulse. What is the most likely diagnosis?

Accepted Answer

Rheumatic fever with aortic regurgitation

Answer

Infective endocarditis

Answer

Aortic stenosis

Answer

Mitral stenosis

Question 7

Which of the following is the management of a HIV positive patient with multiple dog bites?

Accepted Answer

Rabies vaccine + Immunoglobulin + Wound management

Answer

Immunoglobulin only

Answer

Wound management

Answer

Rabies vaccine + wound management

Question 8

Which of the following CVS changes are not seen in pregnancy?

Accepted Answer

Diastolic murmur

Answer

S3

Answer

Loud S1 splitting

Answer

Soft Systolic murmur

Question 9

The CSF findings in bacterial meningitis would include which of the following?

Accepted Answer

Elevated protein and decreased glucose

Answer

Elevated WBC count with normal glucose

Answer

Decreased protein and elevated glucose

Answer

Normal white blood cell count

Question 10

Which instrument is primarily used to establish pneumoperitoneum in closed laparoscopy technique?

Accepted Answer

Veress needle

Answer

Jamshidi needle

Answer

3 mm Trocar

Answer

Hasson's cannula

FMGE 2025

Community Medicine

Internal Medicine

Obstetrics and Gynecology

Pathology

Surgery