FMGE 2025 Practice Questions

Q: A female presents with multiple small, pink, umbilicated papules on the face. What is the most likely diagnosis?

Molluscum contagiosum. ***Molluscum contagiosum*** - This condition, caused by a **poxvirus**, classically presents as multiple, discrete, small (2-5 mm), dome-shaped, pink or skin-colored papules with central **umbilication**. - It is a common, benign skin infection that spreads through direct contact or fomites and is frequently seen in children, sexually active adults, and immunocompromised individuals. *Herpes simplex* - Herpes simplex virus infection typically manifests as clusters of painful **vesicles** (small blisters) on an erythematous base, which later ulcerate and crust over. - The primary lesions are not solid papules and lack the characteristic central umbilication seen in molluscum. *HPV* - Human Papillomavirus (HPV) causes warts (verrucae), which are typically rough, hyperkeratotic papules (**verruca vulgaris**) or flat-topped papules (**verruca plana**). - Warts do not characteristically present with the smooth surface and central depression seen in molluscum contagiosum. *Acne vulgaris* - Acne is a disorder of the pilosebaceous unit, presenting with a variety of lesions including **comedones** (blackheads and whiteheads), inflammatory papules, and pustules. - Acne lesions are not umbilicated and are often associated with follicular inflammation and sebum production.

Q: Identify the given condition and its treatment.

Staphylococcal scalded skin syndrome with Inj cloxacillin. ***Staphylococcal scalded skin syndrome with Inj cloxacillin*** - This is a **systemic toxin-mediated illness** caused by exfoliative toxins (ET-A and ET-B) from *Staphylococcus aureus*, leading to widespread **skin desquamation** and erythema far from the initial infection site via desmoglein-1 cleavage. - Treatment requires **systemic anti-staphylococcal antibiotics** — injectable **cloxacillin** is the drug of choice (IV/IM), with alternatives including **nafcillin** and **cefazolin**. Note: cephalexin is an oral-only drug and has no injectable form. *Epidermolysis bullosa with bandaging* - This is a group of **inherited genetic disorders** causing extreme skin fragility and blistering in response to minimal trauma, not an infectious process. - The clinical presentation involves **mechanically-induced bullae** and erosions rather than the infectious pustules and systemic toxin effects seen in SSSS. *Impetigo bullosa with antibiotics* - Bullous impetigo is a **localized skin infection** with flaccid bullae caused by *S. aureus* exotoxins, confined to the area of direct bacterial invasion. - Unlike SSSS, it lacks **systemic toxin circulation** and presents with localized lesions without widespread skin sloughing or systemic symptoms like fever and irritability. *Erythema multiforme with steroids* - This is an immune-mediated **hypersensitivity reaction**, most commonly triggered by infections like **Herpes simplex virus** or medications. - The characteristic skin lesions are **targetoid papules** and plaques with central clearing, which are morphologically distinct from the diffuse skin sloughing and Nikolsky sign positivity of SSSS.

Q: A girl, after returning from a picnic, complains of pain in her eyes. She had not maintained proper hygiene of her contact lenses. What would be the cause?

Acanthamoeba. ***Acanthamoeba*** - **Acanthamoeba** is a free-living amoeba commonly found in water sources (tap water, lakes, swimming pools) and soil. - Poor contact lens hygiene, such as rinsing lenses or storing them in non-sterile solutions (like tap water, which might be encountered during a picnic or travel hygiene lapse), is a key risk factor for **Acanthamoeba keratitis (AK)**. - AK is characterized by severe ocular pain, often disproportionate to the clinical findings, and can lead to a pathognomonic **ring-shaped corneal infiltrate**. - The combination of **outdoor water exposure + contact lens use + poor hygiene** strongly suggests Acanthamoeba. *Pseudomonas aeruginosa* - **Pseudomonas aeruginosa** is the most common cause of **bacterial keratitis** in contact lens users, especially with improper hygiene. - It typically causes rapidly progressive, purulent corneal ulceration with a characteristic greenish discharge. - While very common in contact lens wearers, the clinical picture here (picnic setting with potential water exposure) more specifically points to a protozoal etiology. *Herpes simplex virus* - **Herpes simplex virus (HSV)** causes recurrent viral keratitis, typically presenting with characteristic **dendritic ulcers** on the cornea. - HSV transmission is via contact with infected bodily fluids or reactivation of latent virus, not through contact lens solution contamination. *Fusarium* - **Fusarium** is a fungus that can cause fungal keratitis in contact lens wearers, particularly with exposure to organic matter or contaminated lens solutions. - Fungal keratitis tends to have a more indolent course with feathery, elevated stromal infiltrates. - While possible in contact lens users, the specific epidemiological context and clinical pattern here favor Acanthamoeba over Fusarium.

Q: A patient presents with a history of dilation & curettage (D&C). Subsequent diagnostic tests reveal all hormone levels, including progesterone and estrogen, to be within the normal range. Based on this clinical presentation, which of the following is the most likely diagnosis?

Asherman Syndrome. ***Asherman Syndrome***- This diagnosis is characterized by the presence of **intrauterine adhesions** (synechiae), typically caused by injury to the **basal layer of the endometrium** following procedures like **D&C**.- The normal **estrogen** and **progesterone** levels indicate normal ovarian function, suggesting the pathology is uterine (end-organ failure to respond to hormones/obstruction) rather than central or ovarian.*Polycystic Ovary Syndrome (PCOS)*- PCOS is associated with chronic **anovulation** and features of **hyperandrogenism** (hirsutism, acne) but usually presents with oligomenorrhea rather than complete amenorrhea following D&C.- Hormonal analysis typically shows an elevated **LH/FSH ratio** and potentially high androgens, resulting in *abnormal* cyclical hormone patterns, unlike the normal levels noted here.*Premature Ovarian Insufficiency (POI)*- POI is characterized by the cessation of ovarian function before age 40, leading to a state of **hypoestrogenism** and low progesterone.- Lab tests would reveal *markedly elevated* **FSH** and *low* **estrogen** due to loss of negative feedback, directly contradicting the finding of normal hormone levels in this patient.*Endometriosis*- Endometriosis involves ectopic endometrial tissue and typically presents with symptoms like **severe dysmenorrhea**, **dyspareunia**, and chronic pelvic pain.- While severe cases can impact fertility, it does not typically cause complete secondary amenorrhea with *normal* cyclical estrogen and progesterone levels; this clinical picture points overwhelmingly to a mechanical uterine issue.

Q: The following light reflex is seen in a patient. How much is the deviation?

45 PD. ***45 PD*** - The image displays the **Hirschberg test** (corneal light reflex test), which estimates the angle of strabismus. The light reflex is displaced nasally in the left eye, indicating an outward deviation (**exotropia**). - A reflex located approximately midway between the pupil margin and the limbus corresponds to a deviation of about 22.5 degrees, which is equivalent to **45 prism diopters (PD)**. *30 PD* - A deviation of 30 PD corresponds to approximately 15 degrees, where the light reflex would be seen at the **pupillary margin**. - This represents a smaller deviation than what is depicted in the image. *90 PD* - This value corresponds to a large deviation of 45 degrees, where the light reflex would be located at the **limbus** (the junction of the cornea and sclera). - The light reflex in the image is positioned midway between the pupil and limbus, indicating a smaller deviation than what would be seen with a full 90 PD deviation. *90°* - This is an extremely large deviation and is also an incorrect unit of measurement for this test; **prism diopters (PD)** are the standard unit used to quantify strabismus. - One degree of deviation is roughly equal to two prism diopters, making a 90-degree deviation (180 PD) anatomically inconsistent with the image.

Q: A patient presents with a down and out right eye with ptosis since birth. What is the nerve palsy?

3rd nerve palsy. ***3rd nerve palsy (Correct Answer)*** - The **oculomotor nerve (CN III)** supplies the levator palpebrae superioris, leading to **ptosis**, and most extraocular muscles (superior rectus, medial rectus, inferior rectus, and inferior oblique) - When CN III is paralyzed, the unopposed actions of **CN IV (superior oblique)** and **CN VI (lateral rectus)** pull the eye into the characteristic **"down and out"** position - **Congenital 3rd nerve palsy** presents with ptosis and the down-and-out eye position from birth - This is the classic triad: **ptosis + down and out eye + dilated pupil** (if pupil-involving) *4th nerve palsy (Incorrect)* - Palsy of the **trochlear nerve (CN IV)** affects only the superior oblique muscle - Presents with impaired **downward and inward movement** and **intorsion** - Typically causes **vertical diplopia** (especially on downward gaze) and compensatory **head tilt** to the opposite side - Does **NOT** cause ptosis or the pronounced "down and out" position *6th nerve palsy (Incorrect)* - Palsy of the **abducens nerve (CN VI)** affects only the lateral rectus muscle - Causes failure of **abduction** (outward movement), resulting in the eye being pulled **inward** (esotropia) - Does **NOT** cause ptosis or downward deviation of the eye *7th nerve palsy (Incorrect)* - The **facial nerve (CN VII)** controls facial muscles, including orbicularis oculi - Causes **lagophthalmos** (inability to close the eyelid) and facial weakness, NOT ptosis - Does **NOT** affect extraocular movements or eye position

Q: A posterior staphyloma was observed on indirect ophthalmoscopy. What is the likely diagnosis?

High myopia. ***High myopia*** - A **posterior staphyloma** is an outpouching of the sclera at the posterior pole of the eye, which is a pathognomonic sign of **pathological** or **high myopia** due to excessive axial elongation. - Other associated fundus findings in high myopia include **chorioretinal atrophy**, **lacquer cracks** (breaks in Bruch's membrane), and an increased risk of **retinal detachment**. *Hypermetropia* - Hypermetropia (farsightedness) is characterized by a **shorter axial length**, which is the opposite of the anatomical changes seen in high myopia that lead to staphyloma formation. - Fundus examination in hypermetropia may reveal a small, crowded optic disc, sometimes referred to as **pseudopapilledema**, but not scleral ectasia. *Primary open-angle glaucoma* - The primary funduscopic sign of glaucoma is progressive damage to the **optic nerve head**, manifesting as an increased **cup-to-disc ratio** and thinning of the neuroretinal rim. - While a myopic optic disc can be difficult to assess for glaucoma, a staphyloma itself is a feature of the sclera and retina, not a primary sign of glaucoma. *Retinitis pigmentosa* - This is an inherited retinal dystrophy with characteristic fundus findings including **bone-spicule pigmentation** in the mid-periphery, **arteriolar attenuation**, and **waxy pallor of the optic disc**. - These changes result from photoreceptor and retinal pigment epithelium degeneration, and are not associated with the formation of a posterior staphyloma.

Q: A person has a false belief that he owns a lot of property and that someone he knows is trying to take it away from him. Which of the following best describes the type of delusions he is experiencing?

Delusion of grandeur and persecution. ***Delusion of grandeur and persecution***- The belief in owning a lot of property reflects **delusion of grandeur**, which is characterized by an exaggerated belief in one's wealth, importance, or abilities.- The belief that someone is trying to take their property away indicates a **delusion of persecution**, where the individual feels threatened or believes others are conspiring to harm them.*Delusion of grandeur and reference*- This option correctly identifies **delusion of grandeur** (owning vast property), but incorrectly identifies the second component.- **Delusion of reference** refers to the erroneous belief that common events, objects, or people have a specific, usually negative, meaning directed towards oneself (e.g., people on TV are talking about them). The patient is directly targeted, indicating persecution.*Delusion of nihilism*- Neither of the patient's described beliefs fit **delusion of nihilism** (Cotard syndrome), which is the false conviction that one's self, parts of the body, or the entire world do not exist.- This patient exhibits high self-importance (**grandeur**) and being targeted (**persecution**), not beliefs related to non-existence.*Delusion of grandeur and nihilism*- While **delusion of grandeur** is present, the patient's worry about someone stealing property is a persecutory type of delusion, not a **delusion of nihilism**.- The themes of persecution and grandeur found here are inconsistent with the theme of non-existence or loss of existence central to **nihilistic delusions**.

Q: A patient with schizophrenia, developed muscular dystonia and was treated for it. The patient now presents with complaints of dry mouth, dizziness, and hypotension. What is the most likely drug causing these side effects?

Benzotropine. ***Benzotropine***- This drug is an **anticholinergic agent** administered specifically to treat **extrapyramidal symptoms (EPS)** like acute muscular dystonia caused by antipsychotics.- **Dry mouth** is a characteristic manifestation of its peripheral **anticholinergic side effects**, while **dizziness and hypotension** can occur due to central effects or potentiation of adrenergic blockade, particularly when co-administered with antipsychotics.*Risperidone*- Although Risperidone (an atypical antipsychotic) commonly causes EPS and strong **orthostatic hypotension** due to **alpha-1 adrenergic blockade** (dizziness/hypotension), it has moderate anticholinergic activity, making it less likely to be the sole cause of prominent dry mouth.- The patient's presentation suggests a new medication was introduced *after* the dystonia developed; Risperidone was likely the cause of the *initial* dystonia.*Haloperidol*- Haloperidol, a high-potency typical antipsychotic, is a common cause of **muscular dystonia** (EPS).- It has relatively **low anticholinergic activity** and is therefore an improbable cause of severe **dry mouth** compared to agents like Benzotropine.*Propranolol*- Propranolol is a **beta-blocker** typically used to treat antipsychotic-induced **akathisia** or tremor, not acute dystonia.- Its most prominent side effects are related to beta-blockade, such as **bradycardia** and fatigue; it is not routinely associated with significant **dry mouth**.

Q: According to DSM-5 classification, what is the diagnosis for a child who exhibits below-average mathematical skills despite having a normal IQ and age-appropriate learning abilities in other areas, and remains unaffected by a year-long private mathematics tutoring?

Specific learning disorder. ***Specific learning disorder***- The presentation meets the criteria for **Specific Learning Disorder (SLD)**, characterized by persistent difficulties in learning core academic skills (in this case, mathematics) that are significantly below expected levels, despite having **average intellectual functioning (normal IQ)**.- The failure to show improvement despite targeted intervention (private tutoring for a year) confirms the persistence and severity of the **neurodevelopmental basis** of the learning difficulty, which is central to the diagnosis of SLD.*ADHD*- **Attention-Deficit/Hyperactivity Disorder (ADHD)** primarily involves persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning or development.- While ADHD can impair academic performance, the primary deficit described here is specific to **mathematical calculation and reasoning**, rather than generalized difficulties arising from attention regulation issues. *Mathematics learning disorder*- This term refers to the specific impairment outlined (often called **Dyscalculia**), but in the DSM-5, it is classified as a **specifier** under the broader diagnosis of Specific Learning Disorder (SLD), specifically "Specific Learning Disorder, With Impairment in Mathematics."- Since **Specific learning disorder** is provided as an option, it is the formal and overarching diagnostic category that applies in this clinical setting.*Aspergers syndrome*- **Asperger's Syndrome** is an outdated term now grouped under **Autism Spectrum Disorder (ASD)**, which is fundamentally characterized by deficits in social communication and interaction, and restricted, repetitive patterns of behavior.- While individuals with ASD may have uneven skill profiles, the history focuses exclusively on a **specific, isolated academic impairment** in mathematics, without mentioning the core criteria of social deficits.

Question 1

A female presents with multiple small, pink, umbilicated papules on the face. What is the most likely diagnosis?

Accepted Answer

Molluscum contagiosum

Answer

Acne vulgaris

Answer

HPV

Answer

Herpes simplex

Question 2

Identify the given condition and its treatment.

Accepted Answer

Staphylococcal scalded skin syndrome with Inj cloxacillin

Answer

Impetigo bullosa with antibiotics

Answer

Erythema multiforme with steroids

Answer

Epidermolysis bullosa with bandaging

Question 3

A girl, after returning from a picnic, complains of pain in her eyes. She had not maintained proper hygiene of her contact lenses. What would be the cause?

Accepted Answer

Acanthamoeba

Answer

Pseudomonas aeruginosa

Answer

Herpes simplex virus

Answer

Fusarium

Question 4

A patient presents with a history of dilation & curettage (D&C). Subsequent diagnostic tests reveal all hormone levels, including progesterone and estrogen, to be within the normal range. Based on this clinical presentation, which of the following is the most likely diagnosis?

Accepted Answer

Asherman Syndrome

Answer

Endometriosis

Answer

Premature Ovarian Insufficiency (POI)

Answer

Polycystic Ovary Syndrome (PCOS)

Question 5

The following light reflex is seen in a patient. How much is the deviation?

Accepted Answer

45 PD

Answer

90 PD

Answer

30 PD

Answer

90°

Question 6

A patient presents with a down and out right eye with ptosis since birth. What is the nerve palsy?

Accepted Answer

3rd nerve palsy

Answer

4th nerve palsy

Answer

6th nerve palsy

Answer

7th nerve palsy

Question 7

A posterior staphyloma was observed on indirect ophthalmoscopy. What is the likely diagnosis?

Accepted Answer

High myopia

Answer

Retinitis pigmentosa

Answer

Primary open-angle glaucoma

Answer

Hypermetropia

Question 8

A person has a false belief that he owns a lot of property and that someone he knows is trying to take it away from him. Which of the following best describes the type of delusions he is experiencing?

Accepted Answer

Delusion of grandeur and persecution

Answer

Delusion of grandeur and nihilism

Answer

Delusion of grandeur and reference

Answer

Delusion of nihilism

Question 9

A patient with schizophrenia, developed muscular dystonia and was treated for it. The patient now presents with complaints of dry mouth, dizziness, and hypotension. What is the most likely drug causing these side effects?

Accepted Answer

Benzotropine

Answer

Propranolol

Answer

Risperidone

Answer

Haloperidol

Question 10

According to DSM-5 classification, what is the diagnosis for a child who exhibits below-average mathematical skills despite having a normal IQ and age-appropriate learning abilities in other areas, and remains unaffected by a year-long private mathematics tutoring?

Accepted Answer

Specific learning disorder

Answer

Mathematics learning disorder

Answer

Aspergers syndrome

Answer

ADHD

FMGE 2025

Dermatology

Microbiology

Obstetrics and Gynecology

Ophthalmology

Psychiatry