FMGE 2025 Practice Questions

Q: A patient with a family history of colon cancer undergoes colonoscopy for screening. This is an example of which level of prevention?

Secondary. ***Secondary (Correct Answer)*** - Screening procedures like **colonoscopy** are measures for the **early detection and timely treatment** of asymptomatic conditions, such as precancerous **polyps** or early-stage cancer - This level of prevention intervenes when the disease process may have started but is **not yet clinically evident**, aiming to reduce disease progression and **mortality** - Secondary prevention is the hallmark of screening programs in at-risk populations *Primary (Incorrect)* - Primary prevention aims to prevent the **onset** of disease by modifying risk factors or enhancing resistance (e.g., **vaccination**, regular exercise, dietary modifications) - Since the patient is undergoing a procedure to detect an existing (though potentially asymptomatic) pathology, this is beyond preventing the initial cause - Primary prevention would involve measures like promoting a high-fiber diet or reducing red meat consumption to prevent colon cancer from developing *Tertiary (Incorrect)* - Tertiary prevention focuses on minimizing the progression, complications, or disability caused by an **established symptomatic disease** (e.g., **chemotherapy** for diagnosed cancer, cardiac rehabilitation post-MI) - Screening is performed **before** the disease is advanced or causes symptoms, which is the domain of secondary prevention - Tertiary prevention applies after diagnosis and aims at rehabilitation and preventing complications *Primordial (Incorrect)* - Primordial prevention targets **social and environmental conditions** to inhibit the emergence of risk factors for disease in the population (e.g., **public policy** aimed at reducing saturated fat intake, tobacco control policies) - It operates at a broader, **systemic level** and does not involve individual patient screening or intervention measures - This is the most upstream level of prevention, addressing conditions that predispose to risk factor development

Q: What is the usual method of collecting a sample of urine to detect UTI?

Midstream catch. ***Midstream catch*** - This technique is the *standard, non-invasive method* for routine urine culture as it minimizes **contamination** from bacteria residing in the distal urethra and periurethral area. - By discarding the initial urine (starting stream) and collecting the middle portion, the sample is more representative of the urine contained within the **bladder**. *Early morning sample* - While an early morning sample is often preferred for optimal concentration (e.g., detecting **proteinuria** or **casts**), it is not the methodology for *minimizing contamination*. - The collection technique (midstream) is more critical than the time of day for ensuring a reliable sample for **UTI culture**. *Suprapubic catheter* - Suprapubic aspiration (SPA) provides an **uncontaminated specimen** (often considered the gold standard), but it is an invasive procedure requiring a needle insertion into the bladder. - It is reserved for specific situations, such as neonates or patients with ambiguous results, and is not the **usual** collection method. *Starting stream collection* - The starting stream is most likely to be contaminated with **urethral flora** (e.g., *Staphylococcus epidermidis* or environmental organisms). - Collecting the starting stream significantly increases the chance of **false positive** culture results, confusing the diagnosis of a true **UTI**.

Q: A patient is diagnosed with Cryptococcal meningitis. What is the treatment?

Flucytosine + L.Amp. ***Correct: Flucytosine + L.Amp (Liposomal Amphotericin B)*** - This is the **standard induction therapy** for Cryptococcal meningitis as per WHO and CDC guidelines [1] - **Combination therapy** is superior to monotherapy, reducing mortality and improving outcomes [1] - The induction phase lasts **2 weeks**, followed by consolidation with fluconazole [1] - Liposomal Amphotericin B has **better CNS penetration** and fewer nephrotoxic effects compared to conventional Amphotericin B - Flucytosine enhances fungicidal activity and reduces the risk of resistance [1] *Incorrect: L.Amp alone* - Monotherapy with Amphotericin B is **less effective** than combination therapy [1] - Higher rates of treatment failure and relapse when used alone - Should always be combined with flucytosine when available [1] *Incorrect: Fluconazole alone* - Fluconazole is used in **consolidation phase** (after induction) and maintenance therapy - **Not recommended for induction** due to its fungistatic (not fungicidal) action - Slower CSF sterilization compared to combination therapy *Incorrect: Flucytosine alone* - **Never used as monotherapy** due to rapid development of resistance - Must always be combined with Amphotericin B or Azoles - Has good CSF penetration but inadequate as sole agent

Q: What is the recommended treatment for nephrotic syndrome in children?

Steroids. ***Steroids***- **Corticosteroids** (typically Prednisone/Prednisolone) are the recommended **first-line therapy** for pediatric nephrotic syndrome, as *minimal change disease* (**MCD**) is the most common cause (90% of cases).- The vast majority of children with MCD are **steroid-sensitive**, exhibiting remission (proteinuria cessation) within 2-4 weeks of high-dose treatment.*Steroids and cyclophosphamide*- Combination therapy including **cyclophosphamide** is typically reserved for children who show **steroid dependence** or **frequent relapses**, not for initial therapy.- Adding cyclophosphamide as a first-line agent is unnecessary due to its potential for significant **gonadal toxicity** and other systemic side effects.*Cyclophosphamide*- **Cyclophosphamide** is a powerful **second-line immunosuppressive agent** used primarily for children who are steroid-dependent or **steroid-resistant**.- Using it as initial monotherapy is inappropriate because children with MCD usually respond well to steroids alone, avoiding risks like **myelosuppression**.*ACE inhibitors*- **Angiotensin-converting enzyme (ACE) inhibitors** are used primarily to reduce **proteinuria** by lowering **glomerular hydrostatic pressure**.- Their role is generally adjunctive management for resistant proteinuria or for treating associated **hypertension**, not as the primary agent to induce remission.

Q: The given image shows an ulcer. Identify the marked structure.

Edge. ***Edge*** - The marked structure represents the side of the ulcer, connecting the **margin** to the **floor**, which is correctly termed the **edge**. - The characteristics of the edge (e.g., sloping, punched-out, undermined) are crucial for determining the ulcer's etiology, such as in **tuberculous ulcers** (undermined) or **malignant ulcers** (everted). *Margin* - The **margin** is the area of skin immediately surrounding the ulcer, essentially the "rim" on the surface. - The arrow is pointing into the crater of the ulcer, not the tissue around its periphery. *Floor* - The **floor** is the bottom, visible surface of the ulcer crater itself. - The marked structure is the wall leading down to the floor, not the floor itself. *Base* - The **base** is the tissue deep to the ulcer, upon which it rests, and is typically assessed by palpation for induration. - It is not a visible structure on inspection, unlike the edge which is clearly marked in the diagram.

Q: A 33-year-old male presents with sudden onset acute abdominal pain, constipation for 1 day, persistent hiccups, and occasional vomiting. An abdominal X-ray was performed. Identify the pathology.

Sigmoid volvulus. ***Sigmoid volvulus*** - The abdominal X-ray demonstrates the classic **"coffee bean" sign**, which is a pathognomonic finding for sigmoid volvulus, representing a massively dilated loop of the sigmoid colon. - The clinical presentation of acute abdominal pain, distension, and constipation is consistent with a **large bowel obstruction**, which is caused by the twisting of the sigmoid colon on its mesentery. *Caecal volvulus* - Radiographically, a caecal volvulus typically appears as a kidney-shaped or comma-shaped dilated loop of bowel displaced towards the **left upper quadrant**, which is not seen in this image. - It is less common than sigmoid volvulus and is often associated with a mobile cecum and the absence of prior abdominal surgery. *Intussusception* - Intussusception, the telescoping of one bowel segment into another, is more common in children and classically presents with a **"target sign"** on ultrasound or CT. - While it can cause obstruction in adults, the radiographic finding of a massive, single, air-filled loop is not characteristic of intussusception. *Mechanical obstruction* - This is a general term for physical blockage of the bowel lumen. While sigmoid volvulus is a specific cause of mechanical obstruction, the X-ray provides specific findings that point to a more precise diagnosis. - Non-specific signs of mechanical obstruction, such as multiple dilated bowel loops with **air-fluid levels**, are different from the characteristic single-loop dilation seen here.

Q: A patient with diffuse severely contaminated peritonitis underwent laparotomy and was left open after surgery. Which of the following might help?

VAC. ***VAC***- **VAC (Vacuum-Assisted Closure)** is the gold standard for managing the damage control abdomen (laparostomy) following severe peritonitis, as it actively drains contaminated fluid and reduces **peritoneal edema**.- By applying controlled **negative pressure**, VAC protects the underlying visceral contents, prevents fascial retraction, and facilitates a definitive delayed primary or secondary fascial closure.*Normal saline soaked gauze*- This traditional method provides only passive protection and is inferior because it allows **contaminated exudates** to pool within the abdomen, increasing the risk of residual infection.- It necessitates multiple, often painful, changes and does not effectively prevent **fascial retraction**, making subsequent closure more challenging than with VAC.*Prefer closure after laparotomy*- Immediate closure in the context of **severe diffuse contamination** is contraindicated due to an unacceptably high risk of septic complications and residual **intraperitoneal infection**.- Primary closure may also lead to **Abdominal Compartment Syndrome (ACS)** due to significant bowel and peritoneal edema, which has high associated morbidity and mortality.*Antibiotic soaked gauze*- Local application of **antibiotic-soaked gauze** lacks scientific support and does not replace effective systemic antibiotic therapy combined with adequate drainage.- Like NS gauze, it is unable to create a controlled environment for fluid removal or prevent **fascial domain loss**, making definitive closure difficult.

Q: A patient presents to the emergency department with confusion. On examination, he opens his eyes to pain, shows abnormal flexion to pain, and is disoriented in speech. What is his Glasgow Coma Scale (GCS) score?

9. ***9***- The Glasgow Coma Scale (GCS) total score is the sum of scores for Eye (E), Verbal (V), and Motor (M) responses (E+V+M). - **Eye Opening (E)** score is 2 for opening eyes only to **painful stimuli** (4=Spontaneous, 1=None). - **Verbal Response (V)** score is 4 for **disoriented in speech**, which is categorized as disoriented/confused conversation (5=Oriented, 3=Inappropriate Words). - **Motor Response (M)** score is 3 for showing **abnormal flexion** (Decorticate posturing) to pain (6=Obeys Commands, 1=None). Total GCS = 2 + 4 + 3 = **9**. *11* - A GCS of 11 is too high for this clinical presentation, as it implies a much better neurological status, typically requiring higher E, V, and M scores (e.g., E3/4, V4/5, M4/5). - This score conflicts with the patient's severe responses: E=2 (to pain) and M=3 (**abnormal flexion**), which together limit the maximum possible GCS to 11 (2+5+4). *12* - A GCS of 12 represents a moderate head injury, which is inconsistent with the patient demonstrating **abnormal flexion** (M=3), a sign often associated with severe injury or significant cerebral dysfunction. - Achieving a score of 12 would necessitate very strong cognitive responses (e.g., E4, V5, M3), which contradict the observed responses of E=2 and M=3. *10* - While close to the correct score, 10 would require a combination like E2, V5, M3, meaning the patient should be **oriented verbally** (V=5). - The patient is explicitly described as "**disoriented in speech**," which dictates a verbal score of V=4 or less, thus ruling out GCS 10.

Question 1

A patient with a family history of colon cancer undergoes colonoscopy for screening. This is an example of which level of prevention?

Accepted Answer

Secondary

Answer

Primary

Answer

Tertiary

Answer

Primordial

Question 2

What is the usual method of collecting a sample of urine to detect UTI?

Accepted Answer

Midstream catch

Answer

Starting stream collection

Answer

Early morning sample

Answer

Suprapubic catheter

Question 3

Which of the following is the correct arrangement about the levels of health care?

Accepted Answer

1- Sub Centre and PHC are primary level, 2- CHC is secondary level, 3- Medical colleges and hospitals are tertiary

Answer

1- CHC is primary level, 2- Sub Centre and PHC are secondary level, 3- Medical colleges and hospitals are tertiary

Answer

1- Medical colleges and hospitals are primary level, 2- CHC is secondary level, 3- Sub Centre and PHC are tertiary

Answer

1- PHC is primary level, 2- Sub Centre is secondary level, 3- Medical colleges and hospitals are tertiary

Question 4

A patient is diagnosed with Cryptococcal meningitis. What is the treatment?

Accepted Answer

Flucytosine + L.Amp

Answer

L.Amp

Answer

Fluconazole

Answer

Flucytosine

Question 5

What is the recommended treatment for nephrotic syndrome in children?

Accepted Answer

Steroids

Answer

ACE inhibitors

Answer

Cyclophosphamide

Answer

Steroids and cyclophosphamide

Question 6

The given image shows an ulcer. Identify the marked structure.

Accepted Answer

Edge

Answer

Base

Answer

Floor

Answer

Margin

Question 7

A 33-year-old male presents with sudden onset acute abdominal pain, constipation for 1 day, persistent hiccups, and occasional vomiting. An abdominal X-ray was performed. Identify the pathology.

Accepted Answer

Sigmoid volvulus

Answer

Intussusception

Answer

Caecal volvulus

Answer

Mechanical obstruction

Question 8

During laparoscopic surgery, which vessel(s) should be specifically avoided during lateral trocar insertion?

Accepted Answer

Both Superior epigastric artery and Inferior epigastric artery

Answer

Superior epigastric artery

Answer

Abdominal aorta

Answer

Inferior epigastric artery

Question 9

A patient with diffuse severely contaminated peritonitis underwent laparotomy and was left open after surgery. Which of the following might help?

Accepted Answer

VAC

Answer

Prefer closure after laparotomy

Answer

Normal saline soaked gauze

Answer

Antibiotic soaked gauze

Question 10

A patient presents to the emergency department with confusion. On examination, he opens his eyes to pain, shows abnormal flexion to pain, and is disoriented in speech. What is his Glasgow Coma Scale (GCS) score?

Accepted Answer

9

Answer

12

Answer

11

Answer

10

FMGE 2025

Community Medicine

Internal Medicine

Pediatrics

Surgery