Community Medicine
1 questionsWhich of the following is not a food adulteration disease?
FMGE 2025 - Community Medicine FMGE Practice Questions and MCQs
Question 281: Which of the following is not a food adulteration disease?
- A. Lathyrism
- B. Aflatoxicosis
- C. Dropsy
- D. Fluorosis (Correct Answer)
Explanation: ***Fluorosis***- It results from excessive intake of **fluoride**, primarily through naturally occurring high levels in **drinking water**.- While fluoride can be present in food, it is generally considered an **environmental exposure disease** rather than one caused by intentional food adulteration.*Lathyrism*- Caused by chronic consumption of **khesari dal** (*Lathyrus sativus*), which is often mixed as an adulterant in pulses like *Arhar dal*.- The toxicity is due to the neurotoxin **beta-N-oxalylamino-L-alanine (BOAA)**, leading to irreversible lower limb paralysis (**neurolathyrism**).*Dropsy*- Also known as **epidemic dropsy**, it is caused by edible oils (most commonly mustard oil) adulterated with **Argemone mexicana oil**.- The toxic substance responsible for the disease is **sanguinarine**, causing generalized edema, cardiac failure, and glaucoma.*Aflatoxicosis*- Caused by ingesting food (such as groundnuts, maize, or cereals) contaminated with **aflatoxins**, which are toxic metabolites produced by the fungus *Aspergillus*.- While often resulting from contamination due to poor storage, aflatoxins represent a major form of food poisoning resulting from the poor quality or mixing of contaminated ingredients, causing severe **hepatotoxicity**.
Internal Medicine
2 questionsA patient presents with unilateral throbbing pain, photophobia, nausea, and vomiting. The symptoms improve after taking sumatriptan. What is the most likely diagnosis?
A patient with a history of pneumonia develops pleural effusion. What is the expected finding in the pleural analysis for a complicated parapneumonic effusion?
FMGE 2025 - Internal Medicine FMGE Practice Questions and MCQs
Question 281: A patient presents with unilateral throbbing pain, photophobia, nausea, and vomiting. The symptoms improve after taking sumatriptan. What is the most likely diagnosis?
- A. Cluster headache
- B. Sinus headache
- C. Tension headache
- D. Migraine (Correct Answer)
Explanation: ***Migraine*** - The presentation of **unilateral**, **throbbing pain** combined with associated symptoms like **photophobia**, **nausea**, and **vomiting** constitutes the classic criteria for migraine [1]. - Dramatic symptomatic relief after taking **sumatriptan** (a **triptan**) is highly characteristic, as these drugs are specific abortive treatments for acute **migraine** attacks. *Tension headache* - This headache is typically **bilateral**, described as a **tightening** or **band-like** pressure, and is non-throbbing [1]. - It usually lacks associated features such as **nausea**, **vomiting**, or severe photophobia, and does not typically respond well to triptans. *Cluster headache* - While also highly painful and unilateral, cluster headaches are characterized by **excruciating, non-throbbing** pain, often localized to the **periorbital** or retro-orbital region [1]. - Key associated features are **autonomic**, including ipsilateral **lacrimation**, ptosis, miosis, and rhinorrhea, features not mentioned in this presentation. *Sinus headache* - This diagnosis is associated with symptoms of **sinusitis**, such as facial pressure, pain over the sinuses, fever, and purulent nasal discharge. - The pain is usually localized to the **maxillary** or **frontal** regions and is not typically a severe, throbbing pain that uniquely responds to triptans.
Question 282: A patient with a history of pneumonia develops pleural effusion. What is the expected finding in the pleural analysis for a complicated parapneumonic effusion?
- A. Pleural LDH less than 0.6 of plasma LDH
- B. Pleural protein/plasma protein ratio less than 0.5
- C. Pleural pH less than 7.2 (Correct Answer)
- D. Pleural LDH less than 2/3rd of plasma LDH
Explanation: ***Pleural pH less than 7.2***- This finding is the critical biochemical parameter defining a **complicated parapneumonic effusion** or **empyema** [1].- The low pH results from high local acid production (lactic acid, CO2) due to bacterial metabolism and inflammatory cell activity, which strongly indicates the need for **chest tube drainage** [1].*Pleural protein/plasma protein ratio less than 0.5*- This ratio is characteristic of a **transudative pleural effusion** (e.g., heart failure or nephrotic syndrome).- Parapneumonic effusions are inflammatory processes that result in **exudative effusions**, where this ratio is typically greater than 0.5 according to **Light’s criteria** [1].*Pleural LDH less than 2/3rd of plasma LDH*- High pleural fluid LDH is a key feature of an **exudative effusion**; therefore, LDH levels would generally be expected to be higher than this threshold in a parapneumonic effusion.- The standard Light's criteria dictate that pleural LDH must be greater than 2/3rds the upper limit of normal serum LDH for an effusion to be classified as an **exudate** [1].*Pleural LDH less than 0.6 of plasma LDH*- In an exudative process like a parapneumonic effusion, the pleural fluid LDH to serum LDH ratio is expected to be **greater than 0.6**.- A ratio less than 0.6 is characteristic of a **transudative effusion**.
Obstetrics and Gynecology
6 questionsA 38 year old woman presents with complaints of heavy menstrual bleeding, pelvic discomfort, and frequent urination. On physical examination, her uterus is found to be irregularly enlarged. Which of the following is the most likely diagnosis?
A 25-year-old female presents with irregular menstrual cycles, acne, and excessive hair growth. An ultrasound reveals multiple ovarian cysts. What is the most likely diagnosis?
A 25-year-old female presents with complaints of a yellowish-green, foul-smelling vaginal discharge. She reports painful urination and pain during intercourse & no itching. On speculum examination, her vulva and vaginal walls appear inflamed. What is the causative agent?
A 35-year-old female patient presents to the clinic for evaluation of her fertility status. She has been trying to conceive for over a year without success. Which of the following is the single best test for assessing her ovarian reserve?
A 28-year-old pregnant woman at 33 weeks gestation presents for a routine prenatal visit. She reports decreased fetal movements over the past two days. She has a history of gestational diabetes, and her pregnancy has been otherwise uneventful. The doctor decides to perform antepartum fetal surveillance. Which of the following is the most appropriate initial test to assess the fetal well-being in this scenario?
During the active management of the third stage of labor, which intervention is recommended to prevent postpartum hemorrhage primarily due to uterine atony?
FMGE 2025 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 281: A 38 year old woman presents with complaints of heavy menstrual bleeding, pelvic discomfort, and frequent urination. On physical examination, her uterus is found to be irregularly enlarged. Which of the following is the most likely diagnosis?
- A. Leiomyoma (Correct Answer)
- B. Ovarian cyst
- C. Endometriosis
- D. Polycystic ovary syndrome (PCOS)
Explanation: ***Leiomyoma***- The constellation of **heavy menstrual bleeding (menorrhagia)**, pelvic pressure symptoms (like frequent urination), and an **irregularly enlarged uterus** is the classic clinical presentation for **uterine leiomyomas (fibroids)**.- These benign tumors of the myometrium cause menorrhagia if they are submucosal, and pressure symptoms if they grow large and compress the surrounding bladder or bowel.*Endometriosis*- This condition is characterized by endometrial tissue outside the uterus, leading primarily to severe **dysmenorrhea**, **dyspareunia**, and chronic pelvic pain due to adhesions.- While it can cause pelvic symptoms, it does not typically result in an **irregularly enlarged uterus**; that finding strongly points to fibroids or adenomyosis.*Ovarian cyst*- A mass due to an ovarian cyst is an **adnexal** finding, meaning it arises from the ovary and is distinct from the uterine corpus.- Although very large cysts can cause pressure on the bladder, the uterus itself would not be described as **irregularly enlarged** in this diagnosis.*Polycystic ovary syndrome (PCOS)*- PCOS is defined by chronic anovulation and hyperandrogenism, typically leading to **oligomenorrhea** (infrequent periods) or **amenorrhea**.- This diagnosis does not cause structural changes to the uterus (like enlargement) or primary symptoms of **menorrhagia**.
Question 282: A 25-year-old female presents with irregular menstrual cycles, acne, and excessive hair growth. An ultrasound reveals multiple ovarian cysts. What is the most likely diagnosis?
- A. Polycystic Ovary Syndrome (PCOS) (Correct Answer)
- B. Ovarian hyperstimulation syndrome (OHSS)
- C. Hypothyroidism
- D. Endometriosis
Explanation: ***Polycystic Ovary Syndrome (PCOS)*** - This diagnosis is strongly suggested by the combination of clinical hyperandrogenism (**hirsutism** and **acne**) and chronic **anovulation** (irregular menstrual cycles). - PCOS is further supported by the **polycystic ovarian morphology** seen on ultrasound, fulfilling the diagnostic criteria (often Rotterdam criteria). *Endometriosis* - Endometriosis is characterized by the presence of **endometrial tissue outside the uterus**, classically presenting with chronic pelvic pain or **dysmenorrhea** (painful periods). - It typically does not cause the severe **hyperandrogenism** (acne, hirsutism) or chronic anovulation seen in this patient. *Hypothyroidism* - While hypothyroidism is a common cause of menstrual irregularities, it typically causes symptoms such as fatigue, weight gain, and **cold intolerance**. - It does not cause signs of **hyperandrogenism** like acne and hirsutism, which are key differentiating features in this case. *Ovarian hyperstimulation syndrome (OHSS)* - OHSS is an iatrogenic condition, almost exclusively occurring after intensive **gonadotropin stimulation** used in fertility treatments. - It presents acutely with severe ovarian enlargement, abdominal distension, and potentially **third-spacing of fluids**, not as a chronic condition causing hirsutism.
Question 283: A 25-year-old female presents with complaints of a yellowish-green, foul-smelling vaginal discharge. She reports painful urination and pain during intercourse & no itching. On speculum examination, her vulva and vaginal walls appear inflamed. What is the causative agent?
- A. Candida albicans
- B. Neisseria gonorrhoeae
- C. Gardnerella vaginalis
- D. Trichomonas vaginalis (Correct Answer)
Explanation: ***Trichomonas vaginalis***- The classic clinical presentation of **trichomoniasis** includes a copious, frothy (though not always), **yellowish-green**, and distinctly **foul-smelling** vaginal discharge.- The organism causes inflammation and tissue damage (vaginitis/vulvitis), leading to common symptoms like **dysuria** and **dyspareunia**, often without significant pruritus (itching). *Candida albicans*- This fungal infection typically causes a thick, **white, 'cottage cheese-like'** vaginal discharge.- The hallmark symptom is intense **vulvovaginal pruritus** (itching), which is explicitly reported as absent in this patient. *Gardnerella vaginalis*- This bacterium is the most common cause of **Bacterial Vaginosis (BV)**, which produces a thin, **grayish-white** discharge with a characteristic **fishy odor**.- BV often causes minimal inflammation (no significant vulvitis) and typically does not present with the bright yellowish-green discharge described. *Neisseria gonorrhoeae*- While *N. gonorrhoeae* can cause **cervicitis** and **urethritis** (leading to dysuria), the discharge is usually described as **mucopurulent** rather than copious, foul-smelling, and yellowish-green.- The overall clinical picture (discharge color, odor, and inflammation) points more specifically toward a **prototozoal vaginitis**.
Question 284: A 35-year-old female patient presents to the clinic for evaluation of her fertility status. She has been trying to conceive for over a year without success. Which of the following is the single best test for assessing her ovarian reserve?
- A. Anti-Müllerian hormone (AMH) (Correct Answer)
- B. Serum inhibin levels on day 5
- C. Estradiol on day 3
- D. Follicle-stimulating hormone (FSH) on day 3
Explanation: ***Anti-Müllerian hormone (AMH)***- **AMH** is currently considered the single **best test** for assessing ovarian reserve because it is produced by **granulosa cells** of pre-antral and small antral follicles, directly correlating with the size of the **remaining follicle pool**.- It can be measured reliably at **any time** during the menstrual cycle or even while using oral contraceptives, providing a highly stable and convenient assessment compared to cycle-dependent hormones.*Follicle-stimulating hormone (FSH) on day 3*- While commonly used, day 3 **FSH levels** are less sensitive than AMH because they reflect the degree of **luteal-follicular axis feedback** rather than the absolute number of follicles.- FSH levels are subject to significant **cycle-to-cycle variability**, and elevated readings often represent an already **advanced stage** of ovarian decline.*Estradiol on day 3*- Day 3 **Estradiol** is primarily measured to exclude premature follicle recruitment (which could suppress FSH), but it is a **poor independent predictor** of ovarian reserve.- Estradiol levels fluctuate greatly and high levels can **falsely mask** elevated FSH readings, limiting its utility as a primary diagnostic tool.*Serum inhibin levels on day 5*- **Inhibin B** is produced by developing follicles and reflects ovarian reserve, but it exhibits significant **menstrual cycle variability**, making interpretation challenging.- It is considered a **secondary marker**; it is less standardized and has lower predictive accuracy for future fertility compared to **AMH**.
Question 285: A 28-year-old pregnant woman at 33 weeks gestation presents for a routine prenatal visit. She reports decreased fetal movements over the past two days. She has a history of gestational diabetes, and her pregnancy has been otherwise uneventful. The doctor decides to perform antepartum fetal surveillance. Which of the following is the most appropriate initial test to assess the fetal well-being in this scenario?
- A. Non Stress test (Correct Answer)
- B. Biophysical profile
- C. Amniotic fluid index
- D. Contraction Stress test
Explanation: ***Correct Option: Non Stress test*** - This is the preferred **initial test** for **fetal surveillance** when a patient reports decreased fetal movements, as it is non-invasive, quick, and provides immediate information about **fetal well-being** through assessment of fetal heart rate accelerations in response to movement. - A reactive NST (showing adequate accelerations) indicates intact fetal **CNS function** and adequate **oxygenation**, which is reassuring. - Given the history of **gestational diabetes**, which increases the risk for **uteroplacental insufficiency** and fetal compromise, a reactive NST is crucial to rule out acute distress. *Incorrect Option: Biophysical profile* - A BPP is generally reserved as a **secondary test** if the initial Non Stress Test (NST) is **non-reactive** or otherwise unsatisfactory, or if a more comprehensive assessment (including **fetal tone, breathing, movement, and amniotic fluid**) is required in a high-risk setting. - Though highly comprehensive, it is more time-consuming (up to 30 minutes) and involves ultrasound, making the rapid, simpler **NST** the most appropriate initial screening tool. *Incorrect Option: Amniotic fluid index* - AFI assesses the volume of **amniotic fluid**, which is a marker of **chronic placental function** and fetal renal perfusion, useful for identifying **oligohydramnios**. - While an important parameter, it is usually used as part of a **Biophysical Profile** or modified Biophysical Profile, not as the primary, standalone initial screen for decreased movement or acute compromise. *Incorrect Option: Contraction Stress test* - The CST assesses **uteroplacental reserve** by inducing contractions (using **oxytocin** or nipple stimulation) and observing FHR response, but it carries risks (like inducing labor) and has many contraindications (e.g., placenta previa, prior classical C-section, preterm labor risk). - Due to its invasiveness, time commitment, contraindications, and the availability of safer alternatives like the NST and BPP, the CST is rarely used today for routine or initial fetal surveillance.
Question 286: During the active management of the third stage of labor, which intervention is recommended to prevent postpartum hemorrhage primarily due to uterine atony?
- A. Immediate administration of 20 units of undiluted oxytocin intravenously
- B. Administration of uterotonic agent (oxytocin 10 units IM) within 1 minute of birth (Correct Answer)
- C. Controlled cord traction with immediate removal of the placenta
- D. Oxytocin 10 units IM with crowning
Explanation: ***Administration of uterotonic agent (oxytocin 10 units IM) within 1 minute of birth*** - This is the **cornerstone of active management of third stage of labor (AMTSL)** - **WHO/FIGO guidelines** recommend oxytocin 10 units IM administered within 1 minute after birth of the baby - This is the **most effective intervention** for preventing postpartum hemorrhage due to uterine atony - Reduces PPH risk by approximately **60%** - Standard dose is **10 units IM** or 5 units slow IV (over 1-2 minutes) *Immediate administration of 20 units of undiluted oxytocin intravenously* - **Dangerous practice**: 20 units IV undiluted can cause severe hypotension, cardiac arrhythmias, and cardiovascular collapse - Standard dose for IV is **5 units diluted**, given slowly over 1-2 minutes - Bolus IV oxytocin is associated with significant cardiovascular side effects *Controlled cord traction with immediate removal of the placenta* - Controlled cord traction (CCT) is part of AMTSL but is done **after signs of placental separation**, not immediately - CCT alone does not prevent uterine atony - the uterotonic agent is primary - CCT is performed with counter-traction on the uterus to prevent uterine inversion *Oxytocin 10 units IM with crowning* - Incorrect timing: oxytocin should be given **after delivery of the anterior shoulder** or within 1 minute of birth - Administration at crowning (before delivery) is not part of AMTSL protocol - May cause complications if given before full delivery of the baby
Orthopaedics
1 questionsA 22-year-old male presents with pain and swelling over the distal radius. X-ray shows an expansile lytic lesion in the metaphysis. Fine needle aspiration (FNA) reveals a bloody aspirate with hemosiderin-laden macrophages. What is the most likely diagnosis?
FMGE 2025 - Orthopaedics FMGE Practice Questions and MCQs
Question 281: A 22-year-old male presents with pain and swelling over the distal radius. X-ray shows an expansile lytic lesion in the metaphysis. Fine needle aspiration (FNA) reveals a bloody aspirate with hemosiderin-laden macrophages. What is the most likely diagnosis?
- A. Aneurysmal bone cyst (Correct Answer)
- B. Giant cell tumor
- C. Chondroblastoma
- D. Osteosarcoma
Explanation: ***Aneurysmal bone cyst*** - This diagnosis is highly suggested by the patient's age (young adult) and the finding of an **expansile and lytic metaphyseal lesion** in a long bone like the distal radius. - The fine needle aspiration finding of a bloody aspirate containing numerous **hemosiderin-laden macrophages** is characteristic, reflecting the hemorrhagic, non-neoplastic, multicystic nature of an aneurysmal bone cyst (ABC). *Giant cell tumor* - While GCT is also lytic and occurs in young adults, it classically arises in the **epiphysis** (subarticular region) of long bones, especially around the knee (distal femur, proximal tibia). - Histologically, GCT shows numerous evenly distributed **multinucleated giant cells** and mononuclear stromal cells, which would dominate the aspirate rather than just blood and macrophages. *Osteosarcoma* - Osteosarcoma is typically an aggressive malignant tumor that often presents with mixed lytic and **sclerotic** features and frequently shows significant periosteal reaction (e.g., **Codman triangle** or **sunburst pattern**). - Cytology would reveal highly **anaplastic malignant cells** actively producing osteoid, which is the defining characteristic. *Chondroblastoma* - This is an uncommon benign tumor that characteristically arises in the **epiphysis** of long bones (e.g., proximal humerus, femoral condyles). - Histology is defined by compact polygonal cells called **chondroblasts** often surrounded by deposits of **chondroid matrix** and characteristic **"chicken-wire" calcification**. - The metaphyseal location and bloody aspirate with hemosiderin-laden macrophages do not fit this diagnosis.