FMGE 2025 Practice Questions

Q: A known case of hyperthyroidism, who is not on medication, is scheduled for total thyroidectomy. The PAC check was not done properly. What is the leading complication that can occur during surgery?

Arrhythmia. ***Arrhythmia***- Uncontrolled **hyperthyroidism** significantly increases sympathetic cardiovascular stimulation, making the heart susceptible to **tachycardia** and cardiac instability during stress.- Intraoperative stress (from anesthesia and surgery) can trigger a **thyroid storm**, where the resulting severe ventricular tachycardia or **atrial fibrillation** poses the greatest immediate threat to life during the procedure.*Hyperthermia*- Although **hyperthermia** (high fever) is a critical classic sign of a **thyroid storm**, immediate cardiovascular collapse due to **arrhythmias** typically precedes or dominates the intraoperative crisis.- The underlying increase in the **basal metabolic rate (BMR)** in hyperthyroidism predisposes the patient to thermal dysregulation, which is exacerbated during surgery.*Hypothermia*- **Hypothermia** (low body temperature) is extremely unlikely as the leading complication in an actively hyperthyroid patient due to their persistently elevated **BMR**.- This complication would be more typical of severe non-thyroid disease or prolonged surgery with poor thermal management, not directly caused by unmedicated hyperthyroidism itself.*Hypothyroidism*- **Hypothyroidism** is a predictable *long-term complication* following a successful **total thyroidectomy** and subsequent removal of functional thyroid tissue.- This condition is not an acute, intraoperative complication resulting from the lack of proper preoperative control of the underlying **thyrotoxicosis**.

Q: What is the name of the technical platform developed under India’s National Tele Mental Health Programme (NTMHP) to deliver mental healthcare services through a multi-tiered system via telephone, digital platforms, and online portals?

Tele-MANAS. ***Tele-MANAS*** - **Tele-MANAS** (Tele-Mental Health Assistance and Networking Across States) is the specific technical platform designated under the National Tele Mental Health Programme (NTMHP) of India. - It provides comprehensive, multi-tiered, 24/7 mental healthcare services through a national toll-free helpline number and digital platforms, aiming to strengthen **mental health support** accessibility. *NIKSHAY* - **NIKSHAY** is the web-enabled system used by the Government of India for surveillance, monitoring, and management of the **National Tuberculosis Elimination Programme (NTEP)**. - It is focused exclusively on **tuberculosis** management and tracking, not tele-mental health services. *Aarogya Setu* - **Aarogya Setu** is a mobile application developed by the Government of India for **COVID-19 contact tracing and health status tracking**. - While it is a digital health initiative, it is not the dedicated platform for the National Tele Mental Health Programme. *e-Sanjeevani* - **e-Sanjeevani** is India's national telemedicine service that provides general healthcare consultations (Doctor-to-Doctor and Patient-to-Doctor) across various medical specialties. - While it is a telemedicine platform, the dedicated platform for the NTMHP's specific mental health service delivery model is **Tele-MANAS**.

Q: During a field visit to monitor training given to an ANM (Auxiliary Nurse Midwife) on safe immunization practices, you observe that she has used a syringe with a needle, a vaccine vial, and a cotton swab. After completing the immunization, which of the following statements about biomedical waste disposal is correct?

A used cotton swab should be discarded in a yellow bag. ***A used cotton swab should be discarded in a yellow bag*** - Used cotton swabs contaminated with blood or body fluids are classified as **soiled waste** (Category 3) under the **Biomedical Waste Management Rules 2016**. - Soiled waste including cotton swabs, dressings, and gauze must be disposed of in **YELLOW bags** for treatment and disposal as per current BMW Rules. *The syringe with the needle should be disposed of in a black translucent container* - Used needles and syringes are categorized as **sharps waste** (Category 4) under BMW Rules 2016. - They must be collected in **WHITE translucent puncture-proof containers**, not black containers which are for general non-biomedical waste. *The used vaccine vial should be discarded in a blue bag* - Used vaccine vials made of glass are classified as **waste sharps** including glass materials. - As per BMW Rules 2016, glass vials should be discarded in **BLUE containers/boxes** specifically designed for pharmaceutical waste, not blue bags. *The needle should be bent and thrown in a red bag* - **Bending, breaking, or recapping** used needles is strictly prohibited as it poses high risk of **needle-stick injuries**. - Used needles must be immediately placed into a **WHITE translucent puncture-proof sharps container** without any manipulation or bending.

Q: Who is primarily responsible for registering eligible couples for family planning and maintaining their records under the national health system?

Multipurpose Worker (Female). ***Multipurpose Worker (Female)***- The Multipurpose Worker (Female) (also known as Auxiliary Nurse Midwife or ANM in some contexts) is the primary worker at the sub-centre level responsible for providing **Maternal and Child Health (MCH)** and **family planning** services.- Their core duties include identifying, counseling, and formally **registering eligible couples (ECs)** in the operational area and maintaining detailed records (like the EC register) of their contraceptive choices and follow-up.*ASHA*- ASHAs (Accredited Social Health Activists) are primarily **community-level linkages** and promoters, tasked with mobilization, counseling, and facilitating the uptake of services.- They refer eligible couples to the sub-centre or Primary Health Centre (PHC), but the **official record-keeping and maintenance** are done by the MPW (F)/ANM.*Village Health Guide*- The role of the Village Health Guide was established to provide basic health education and first aid, often serving as a primary link between the PHC and the community.- This cadre is often being phased out or subsumed by ASHA; they do not have the **formal administrative responsibility** for maintaining designated family planning registers.*Anganwadi Worker*- Anganwadi Workers are primarily focused on the **Integrated Child Development Services (ICDS)** scheme, concentrating on nutrition, growth monitoring, and pre-school education.- While they aid in health awareness and may assist in gathering community data, they are not the designated functionary for **family planning service registration** and record maintenance under the national health system.

Q: A patient presents with palpitations, headache, and sweating. His BP is $180/100 \mathrm{mmHg}$ . 24-hour urinary metanephrine values are elevated. What is the diagnosis?

Pheochromocytoma. Pheochromocytoma - The constellation of symptoms—palpitations, episodic sweating, severe headache, and hypertension (the classic triad)—is highly suggestive of excessive catecholamine release. - The diagnosis is confirmed by the elevated 24-hour urinary metanephrines (metabolites of epinephrine and norepinephrine), which is the definitive biochemical hallmark of this adrenal medullary tumor. Carcinoid tumor - This tumor primarily secretes serotonin and other vasoactive substances, leading to symptoms like flushing, diarrhea, and bronchospasm (carcinoid syndrome) [1]. - The biochemical marker for this condition is elevated urinary 5-hydroxyindoleacetic acid (5-HIAA), not metanephrines. Carcinoid crisis - This represents a severe, life-threatening exacerbation of carcinoid syndrome involving severe flushing, profound hypotension, and cardiac arrhythmias. - It is typically an acute event triggered by stressors such as surgery or chemotherapy, unlike the chronic presentation described. Neuroblastoma - This malignant tumor of the neural crest primarily affects infants and young children (usually under 5 years old), making it unlikely in an adult patient. - Although it can secrete catecholamines, its primary presenting features usually include an abdominal mass, fever, and metastasis, and the key diagnostic marker is often high urinary VMA (Vanillylmandelic acid) and HVA (Homovanillic acid).

Q: A 30-year-old male presents with deep-seated retro-orbital pain from cluster headache. What is the best management?

Oxygen. ***Oxygen*** - **High-flow oxygen** (100% at 7-15 L/min) is the safest and most effective **first-line abortive treatment** for an acute cluster headache attack [1] - It works rapidly to cause **vasoconstriction** and often terminates the severe retro-orbital pain within **15 to 20 minutes** - This is the preferred treatment for acute attacks due to its rapid onset and excellent safety profile *Verapamil* - Verapamil is a calcium channel blocker and is considered the **first-line prophylactic agent** for both episodic and chronic cluster headache, not acute treatment [1] - Its mechanism of action requires time, rendering it ineffective for terminating an ongoing acute pain episode - Used to prevent future attacks, not to abort current ones *Lithium* - Lithium is a prophylactic treatment reserved mainly for patients with **chronic cluster headache** or those who do not respond to Verapamil [1] - It has a slow onset of action and is not used to manage the acute pain of a cluster attack - Requires therapeutic monitoring due to narrow therapeutic window [1] *Topiramate* - Topiramate is an established prophylactic treatment primarily for **migraine**, and occasionally used as a second-line prophylactic agent for cluster headache - As a prophylactic medication, it plays **no role** in the acute termination or abortive management of a cluster headache episode

Q: Patient presents with hypertension and hypokalemic metabolic alkalosis. CT scan shows a unilateral adrenal mass with elevated ARR. What is the next best step for the management of this patient?

Adrenalectomy. ***Adrenalectomy*** - The combination of **hypertension**, **hypokalemic metabolic alkalosis**, elevated **Aldosterone-to-Renin Ratio (ARR)**, and a unilateral **adrenal mass** is diagnostic for Primary Aldosteronism, likely due to an Aldosterone-Producing Adenoma (**APA**) [1]. - **Unilateral adrenalectomy** is the definitive, potentially curative treatment for a confirmed APA, addressing the root cause of the hyperaldosteronism and hypertension [1]. *Spironolactone on a lifelong basis* - This treatment involves a **Mineralocorticoid Receptor Antagonist** and is the preferred therapy for patients with **Bilateral Adrenal Hyperplasia (BAH)** or for patients with an APA who are not surgical candidates [1]. - Since a likely unilateral adenoma is identified and surgery offers a cure, medical therapy is not the *next best step*. *ACTH stimulation test* - This test is used primarily to evaluate the reserve capacity of the adrenal cortex and diagnose **Adrenal Insufficiency** (e.g., Addison's disease or secondary adrenal insufficiency) [2]. - It is not indicated for the diagnosis or management of hyperaldosteronism. *Dexamethasone suppression test* - This test is the standard screening tool used to diagnose **Cushing's syndrome** (hypercortisolism) by assessing the feedback loop involving the hypothalamic-pituitary-adrenal axis [3]. - It is irrelevant in the workup for primary hyperaldosteronism.

Q: A 35-year-old male has had chronic hypercalcemia for the last 1.5 years, but PTH levels are normal. Which of the following is most likely the cause?

Sarcoidosis. ***Sarcoidosis*** - Causes hypercalcemia via ectopic synthesis of **1,25-dihydroxyvitamin D** (calcitriol) by activated macrophages in the granulomas, leading to increased intestinal calcium absorption [1]. - Although the resulting hypercalcemia usually suppresses PTH (making it low), in chronic, mild cases, the PTH level may appear in the lower end of the **normal reference range**, consistent with the clinical picture of a non-PTH-mediated cause [1]. *Malignancy* - Hypercalcemia related to solid tumors (Humoral Hypercalcemia of Malignancy) is typically mediated by **PTH-related peptide (PTHrP)**, resulting in high calcium. - This non-PTH mediated hypercalcemia leads to appropriate **suppression of the parathyroid glands**, meaning PTH levels would be significantly **low or undetectable**, not normal [1]. *Parathyroid hyperplasia* - This condition represents **primary hyperparathyroidism**, characterized by autonomous secretion of PTH [1]. - In primary hyperparathyroidism, PTH levels are typically inappropriately **elevated** (or grossly high-normal) despite the presence of hypercalcemia, which contradicts a normal PTH value [1]. *C.K.D* - Chronic kidney disease usually results in **hypocalcemia** due to impaired 1-alpha-hydroxylase function and resultant low 1,25(OH)₂D levels [2]. - If hypercalcemia were present (e.g., due to tertiary hyperparathyroidism), PTH levels would be markedly **elevated**, not normal, due to persistent glandular stimulation [2].

Q: A HIV-positive patient presents with chronic diarrhoea for 4 weeks. Stool microscopy shows oval/ elliptical cysts measuring 16 X 20 μm. Diagnosis is?

Cystoisospora. ***Cystoisospora*** - The finding of large, oval/ellipsoidal oocysts (typically **20-33 μm** long, range includes the 16 x 20 μm given) in the stool of an HIV patient with chronic diarrhea is diagnostic of **Cystoisospora belli** infection. - *Cystoisospora* causes chronic, profuse watery diarrhea in immunocompromised hosts (like those with **AIDS**) and is effectively treated with **trimethoprim-sulfamethoxazole (TMP-SMX)**. *Cryptosporidium* - This parasite is characterized by small, **spherical oocysts** measuring only **4–6 μm** in diameter, which is much smaller than the size reported (16 x 20 μm). - While *Cryptosporidium* is a common cause of chronic diarrhea in AIDS, the oocyst morphology does not match the description. *Cryptococcus* - **Cryptococcus** is a fungal pathogen (*C. neoformans*) primarily known for causing **meningoencephalitis** in HIV patients, not typically large oval/elliptical oocysts in stool causing chronic primary diarrhea. - Diagnosis relies on visualization of encapsulated yeast in CSF (e.g., **India ink stain**) or **cryptococcal antigen (CrAg)** testing. *Cyclospora* - *Cyclospora cayetanensis* oocysts are medium-sized and **spherical**, typically measuring **8–10 μm** in diameter. - Although it causes prolonged diarrhea in immunocompromised individuals, the oocyst shape (**oval/elliptical**) and size (16 x 20 μm) clearly distinguish it from *Cyclospora*.

Q: A patient with osteoarthritis, for the last 3 months, has been taking ibuprofen and has developed occult GI bleeding. Which is correct about the cause?

PGE-2 and prostacyclin production were reduced. ***PGE-2 and prostacyclin production were reduced***- NSAIDs like **ibuprofen** inhibit cyclooxygenase-1 (**COX-1**), which is responsible for synthesizing protective prostaglandins like **PGE2** and **prostacyclin (PGI2)** in the GI mucosa.- The loss of these protective factors impairs the mucosal barrier's ability to withstand acid, leading to ulceration, erosion, and subsequent **occult GI bleeding**. *Increased acid production*- NSAIDs primarily cause mucosal injury by reducing protective factors, not by significantly increasing **basal acid production**.- Although excess acid facilitates damage, the core mechanism of NSAID injury is the loss of **prostaglandin-mediated cytoprotection**. *PGE-1 and prostacyclin production were reduced*- While **prostacyclin (PGI2)** reduction is key, **PGE2** (not PGE1) is the major endogenous prostaglandin responsible for maintaining gastric mucosal integrity in humans.- Misrepresenting the primary protective prostaglandin (PGE2 vs PGE1) makes this option medically less precise than the former. *Mucosal injury due to inhibition of COX-2*- The severe gastrointestinal side effects, including bleeding and ulceration, are predominantly due to the inhibition of the constitutive **COX-1 isoenzyme**.- Selective **COX-2 inhibitors** (coxibs) were specifically designed to minimize GI toxicity by sparing the protective functions of COX-1.

Question 1

A known case of hyperthyroidism, who is not on medication, is scheduled for total thyroidectomy. The PAC check was not done properly. What is the leading complication that can occur during surgery?

Accepted Answer

Arrhythmia

Answer

Hypothyroidism

Answer

Hypothermia

Answer

Hyperthermia

Question 2

What is the name of the technical platform developed under India’s National Tele Mental Health Programme (NTMHP) to deliver mental healthcare services through a multi-tiered system via telephone, digital platforms, and online portals?

Accepted Answer

Tele-MANAS

Answer

Aarogya Setu

Answer

e-Sanjeevani

Answer

NIKSHAY

Question 3

During a field visit to monitor training given to an ANM (Auxiliary Nurse Midwife) on safe immunization practices, you observe that she has used a syringe with a needle, a vaccine vial, and a cotton swab. After completing the immunization, which of the following statements about biomedical waste disposal is correct?

Accepted Answer

A used cotton swab should be discarded in a yellow bag

Answer

The used vaccine vial should be discarded in a blue bag

Answer

The needle should be bent and thrown in a red bag

Answer

The syringe with the needle should be disposed of in a black translucent container

Question 4

Who is primarily responsible for registering eligible couples for family planning and maintaining their records under the national health system?

Accepted Answer

Multipurpose Worker (Female)

Answer

Village Health Guide

Answer

Anganwadi Worker

Answer

ASHA

Question 5

A patient presents with palpitations, headache, and sweating. His BP is $180/100 \mathrm{mmHg}$ . 24-hour urinary metanephrine values are elevated. What is the diagnosis?

Accepted Answer

Pheochromocytoma

Answer

Carcinoid crisis

Answer

Neuroblastoma

Answer

Carcinoid tumor

Question 6

A 30-year-old male presents with deep-seated retro-orbital pain from cluster headache. What is the best management?

Accepted Answer

Oxygen

Answer

Verapamil

Answer

Lithium

Answer

Topiramate

Question 7

Patient presents with hypertension and hypokalemic metabolic alkalosis. CT scan shows a unilateral adrenal mass with elevated ARR. What is the next best step for the management of this patient?

Accepted Answer

Adrenalectomy

Answer

Spironolactone on a lifelong basis

Answer

Dexamethasone suppression test

Answer

ACTH stimulation test

Question 8

A 35-year-old male has had chronic hypercalcemia for the last 1.5 years, but PTH levels are normal. Which of the following is most likely the cause?

Accepted Answer

Sarcoidosis

Answer

Malignancy

Answer

C.K.D

Answer

Parathyroid hyperplasia

Question 9

A HIV-positive patient presents with chronic diarrhoea for 4 weeks. Stool microscopy shows oval/ elliptical cysts measuring 16 X 20 μm. Diagnosis is?

Accepted Answer

Cystoisospora

Answer

Cryptosporidium

Answer

Cyclospora

Answer

Cryptococcus

Question 10

A patient with osteoarthritis, for the last 3 months, has been taking ibuprofen and has developed occult GI bleeding. Which is correct about the cause?

Accepted Answer

PGE-2 and prostacyclin production were reduced

Answer

PGE-1 and prostacyclin production were reduced

Answer

Increased acid production

Answer

Mucosal injury due to inhibition of COX-2

FMGE 2025

Anesthesiology

Community Medicine

Internal Medicine

Microbiology

Pharmacology