FMGE 2025 Practice Questions

Q: Which of the following best describes the characteristic lesion of Kaposi sarcoma?

A raised, purple-red lesion. ***A raised, purple-red lesion*** - Kaposi sarcoma is a vascular tumor caused by **Human Herpesvirus-8 (HHV-8)**, presenting as violaceous (purple-red) macules, papules, or nodules on the skin and mucosa. - These lesions are common in immunocompromised individuals, particularly those with **HIV/AIDS**, and are characterized by the proliferation of endothelial cells. *A yellow lesion containing pus* - This description is characteristic of a **pustule** or an **abscess**, which are typically signs of a bacterial infection, such as those caused by **Staphylococcus aureus**. - Kaposi sarcoma is a neoplastic lesion, not an acute purulent infection, and does not contain pus. *A white, striated lesion that cannot be scraped off* - This is the classic presentation of **oral hairy leukoplakia**, a benign mucosal lesion caused by the **Epstein-Barr virus (EBV)**, also seen in immunocompromised patients. - It differs from Kaposi sarcoma in its color (white vs. purple-red), location (typically lateral tongue), and causative virus. *Small, red erosions* - This description is more consistent with conditions like **herpes simplex virus (HSV)** infection, where vesicles rupture to form erosions, or with erosive inflammatory dermatoses. - Kaposi sarcoma typically manifests as proliferative papules or nodules, not as primary erosions.

Q: A patient with borderline tuberculoid leprosy presents with the following findings. Which type of hypersensitivity reaction and nerve is enlarged?

Type 4 & greater auricular nerve. ***Type 4 & greater auricular nerve*** - Borderline tuberculoid leprosy is characterized by a strong **cell-mediated immune response** against *Mycobacterium leprae*, which manifests as a **Type 4 (delayed-type) hypersensitivity** reaction leading to granuloma formation. - The image shows a thickened, cord-like structure in the neck, which is characteristic of an enlarged **greater auricular nerve**, the most commonly involved cutaneous nerve of the head and neck in leprosy. *Type 1 & greater auricular nerve* - **Type 1 hypersensitivity** is an immediate, **IgE-mediated** reaction (e.g., anaphylaxis) and is not the immunological basis for nerve damage or skin lesions in tuberculoid leprosy. - The pathogenesis of tuberculoid leprosy involves a **delayed-type** T-cell response, which takes days to develop, unlike the rapid onset of Type 1 reactions. *Type 2 & greater auricular nerve* - **Type 2 hypersensitivity** is an **antibody-dependent cytotoxic** reaction, which is not the primary mechanism in tuberculoid leprosy's pathology. - While immune reactions occur in leprosy, Type 2 is not the correct classification for the T-cell-mediated granulomatous inflammation seen in the tuberculoid form. *Type 3 & anterior auricular nerve* - **Type 3 hypersensitivity** involves **immune-complex deposition** and is characteristic of **Erythema Nodosum Leprosum (ENL)**, a complication typically seen in lepromatous leprosy, not borderline tuberculoid. - The enlarged nerve shown is clearly the **greater auricular nerve** due to its location crossing the sternocleidomastoid muscle; the **anterior auricular nerve** is located more anteriorly and is not typically affected this prominently.

Q: A patient presents to the dermatology clinic reporting recurrent skin lesions as seen on the image. He describes that these lesions emerge within hours each time he takes NSAIDs. What is the most likely diagnosis?

Fixed drug eruptions. ***Fixed drug eruptions*** - This is the classic presentation of a fixed drug eruption (FDE), characterized by the recurrent appearance of one or more well-demarcated, erythematous to violaceous patches or plaques in the **exact same location** each time the causative drug (in this case, **NSAIDs**) is administered. - The lesions typically appear within hours of drug exposure and resolve over days to weeks, often leaving behind a slate-gray or brown **post-inflammatory hyperpigmentation**. *Erythema multiforme* - This condition is characterized by distinctive **targetoid lesions** (iris lesions), which have at least three concentric zones of color change. The lesion in the image is a uniform plaque, not a target lesion. - While drugs can be a cause, erythema multiforme is most commonly triggered by infections, particularly the **Herpes Simplex Virus (HSV)**. *Drug Induced Pigmentation* - This refers to a discoloration of the skin caused by drugs, but it typically lacks the acute inflammatory features (erythema, edema) seen in an FDE. It is a more chronic and insidious process. - It is commonly associated with drugs like **minocycline**, **amiodarone**, or antimalarials and presents as diffuse or patterned hyperpigmentation, not as a recurrent inflammatory plaque. *Herpes* - Herpes virus infections classically present as grouped **vesicles** (small blisters) on an erythematous base, which then evolve into pustules and crusted erosions. The image shows a plaque, not vesicles. - Recurrence is common with herpes, but it is not triggered by medication ingestion; rather, it's often precipitated by stress, illness, or immunosuppression.

Q: A child was brought with c/o multiple lesions. O/E multiple vesicular lesions are seen on the palms, soles, and oral mucosa. Which of the following is the most likely etiological agent causing the disease?

Coxsackie virus. ***Coxsackie virus*** - The clinical presentation of vesicular lesions on the **palms**, **soles**, and **oral mucosa** is the classic triad for **Hand, Foot, and Mouth Disease (HFMD)**. - **Coxsackievirus A16** and **Enterovirus 71** are the most common causes of HFMD, a typically self-limiting illness in young children that spreads via fecal-oral or respiratory routes. *Varicella-zoster virus* - This virus causes **chickenpox**, which presents as a generalized, pruritic, vesicular rash in various stages of healing, typically starting on the **trunk** and spreading centrifugally. - The characteristic distribution of chickenpox is **centripetal**, and prominent involvement of palms and soles is uncommon. *Measles virus* - Measles presents with **maculopapular rash** that begins on the face and spreads cephalocaudally, accompanied by the **3 Cs** (cough, coryza, conjunctivitis) and **Koplik spots** on the buccal mucosa. - The rash is **not vesicular** and typically **spares the palms and soles**, unlike HFMD. *Human-herpesvirus 6* - HHV-6 is the cause of **roseola infantum** (exanthem subitum), characterized by a high fever that resolves, followed by a blanching **maculopapular rash** on the trunk. - Roseola does not cause vesicular lesions and characteristically **spares the palms and soles**.

Q: Oral contraceptive pill prevents all except?

Cervical cancer. ***Cervical cancer***- Oral contraceptive pills (OCPs) are associated with an *increased* risk of **cervical cancer**, particularly with prolonged use (typically >5 years), not a protective effect. - The mechanisms are unclear, but OCPs may increase the risk of persistent **HPV infection** or cervical ectopy, making the cervix more vulnerable.*Epithelial ovarian cancer*- OCPs provide substantial and long-lasting protection against **epithelial ovarian cancer**, with the benefit persisting for decades after cessation.- The protection is thought to be due to the suppression of **ovulation** and resultant decrease in the number of repair cycles of the ovarian surface epithelium.*Endometrial cancer*- OCPs significantly reduce the risk of **endometrial cancer** by providing a continuous supply of progestins.- The **progestin** component of OCPs counteracts the proliferative effects of estrogen on the endometrium, preventing hyperplasia and subsequent carcinogenesis.*Colon cancer*- OCP use is associated with a modest but consistent reduction in the incidence of **colorectal cancer** across numerous studies.- This protective effect is hypothesized to be due to OCP-induced changes in **bile acid metabolism** or effects on local hormone receptor signaling in the colon.

Q: What is the importance of the following manoeuvre?

To protect from tearing of the perineum. ***To protect from tearing of the perineum*** - The maneuver shown, known as **guarding the perineum**, involves one hand supporting the perineal body while the other hand controls the delivery of the fetal head. - This technique allows for a slow, controlled stretching of the perineal tissues, which significantly reduces the risk of **perineal lacerations** during the second stage of labor. *To pull the baby out faster* - Applying traction to the fetal head to expedite delivery is contraindicated as it increases the risk of both maternal trauma, such as severe **perineal tears**, and fetal injury, like **brachial plexus injury**. - The goal of modern obstetrics is a controlled, gentle delivery, not a rapid one, to ensure the safety of both mother and baby. *To facilitate controlled extension of the fetal head* - While controlling the extension of the fetal head is part of the maneuver (performed by the hand on the occiput), its primary purpose is to prevent sudden expulsion, which would tear the perineum. - Therefore, controlled extension is a means to achieve the ultimate goal of **perineal protection**, making it a secondary objective of the overall maneuver shown. *To rotate the shoulders during delivery* - Rotation of the fetal shoulders, specifically to an **anteroposterior diameter**, is performed only *after* the head has been fully delivered and has undergone **restitution** (external rotation). - The image depicts the **crowning** of the fetal head, which is the stage just before the head is born and well before the shoulders are delivered.

Q: Identify the sign.

Hegar's sign. ***Hegar's sign*** - This sign is demonstrated during a **bimanual pelvic examination** where the lower uterine segment (isthmus) feels extremely soft and compressible, almost as if the cervix and the body of the uterus are separate structures. - It is a **probable sign of pregnancy**, typically appearing between 6 to 12 weeks of gestation, caused by hormonal changes leading to increased vascularity and softening of the uterine isthmus. *Chadwick's sign* - This is a visual finding, not a palpable one, characterized by a **bluish or purplish discoloration** of the cervix, vagina, and vulva. - It is an early, **presumptive sign** of pregnancy caused by increased blood flow (**venous congestion**) to the area, usually visible from about 6-8 weeks of gestation. *Goodell's sign* - This refers to the marked **softening of the cervix** itself, which changes from a consistency similar to the tip of the nose to that of lips. - While it is a probable sign of pregnancy also appearing around 6-8 weeks, it is distinct from Hegar's sign, which involves the softening of the **uterine isthmus** above the cervix. *Piskacek's sign* - This is the palpable **asymmetric enlargement** and softening of the uterus, where the area of implantation feels like a bulge or tumor. - It occurs when the embryo implants near one of the uterine cornua, leading to an uneven shape of the uterus, and is not what is depicted in the image.

Q: A child accidentally took a bottle full of iron tablets. Which of the drugs is used as an antidote for iron poisoning?

Deferoxamine. ***Deferoxamine***- It is the standard **chelating agent** administered via intravenous or intramuscular routes for treating life-threatening acute **iron overdose** (toxicity) [1].- It binds strongly to free **ferric iron (Fe3+)** in the circulation, forming the non-toxic, water-soluble complex *ferrioxamine* which is then excreted in the urine [1].*Luspatercept*- This is an **erythroid maturation agent** used to treat **anemia** associated with *myelodysplastic syndromes* (MDS) and *beta-thalassemia*.- It functions by modulating the **TGF-β signaling pathway** to reduce ineffective erythropoiesis, not by direct heavy metal chelation.*Deferiprone*- This is an **oral iron chelator** primarily used for the management of **chronic iron overload**, often seen in patients receiving frequent blood transfusions (e.g., thalassemia).- While it removes iron, it is generally less effective and not the first-line choice for the management of acute life-threatening pediatric poisoning, where **intravenous Deferoxamine** is mandatory.*DMSA*- DMSA (Succimer) is a heavy metal chelating agent primarily indicated for poisoning by **lead**, **arsenic**, and **mercury**.- It is administered orally and is structurally distinct from iron chelators like deferoxamine, making it unsuitable for treating acute iron toxicity.

Q: A patient presents with severe headache. A CT scan of the brain reveals hyperdense areas in the right basal region, marked as 'X'. Which of the following is the most likely diagnosis?

Subarachnoid hemorrhage. ***Subarachnoid hemorrhage*** - The non-contrast CT scan shows **hyperdensity** (appears white) within the basal cisterns and Sylvian fissures (indicated by 'X'), which is the classic appearance of acute blood in the subarachnoid space. - This condition classically presents with a sudden, severe "**thunderclap headache**" and is most commonly caused by a ruptured **berry aneurysm**. *Meningococcal meningitis* - A non-contrast CT in meningitis is often normal. Key findings like **meningeal enhancement** would only be visible on a post-contrast CT scan, which is not the pattern seen here. - The clinical presentation typically involves a triad of **fever**, **nuchal rigidity**, and altered mental status, which are classic signs of meningeal irritation. *Brain abscess* - A brain abscess on a non-contrast CT typically appears as a **hypodense** (dark) or isodense mass within the brain parenchyma, often with surrounding vasogenic edema. - On a contrast-enhanced CT, it characteristically shows a **ring-enhancing lesion**, which is not depicted in this image. *Pneumocephalus* - Pneumocephalus refers to air within the cranial cavity, which appears as profoundly **hypodense** (black) on a CT scan. - The primary finding in the image is **hyperdensity** (blood), not the extreme hypodensity characteristic of air.

Q: The following radiological image was taken to assess the urinary tract. Identify the investigation shown below.

Intravenous pyelogram (IVP). ***Intravenous pyelogram (IVP)*** - An **IVP**, also known as intravenous urography (IVU), involves injecting a radiopaque **contrast agent** intravenously, which is then excreted by the kidneys, allowing for visualization of the entire urinary tract including the kidneys, ureters, and bladder. - This investigation provides both anatomical detail, such as identifying obstructions or masses, and functional information about the kidneys' ability to excrete the contrast. *Pelvic X-ray* - A standard **pelvic X-ray** is primarily used to evaluate the bony structures of the pelvis and would not typically involve contrast media to outline the urinary tract. - While it can reveal radiopaque **kidney stones** (calculi) or bladder stones, it does not provide detailed visualization of the kidneys or ureters as an IVP does. *Retrograde pyelogram* - In a **retrograde pyelogram**, contrast dye is injected directly into the ureters or renal pelvis via a catheter inserted through a **cystoscope** into the bladder. - This procedure visualizes the collecting system in a retrograde fashion (from bottom to top) and does not assess renal excretory function. *Micturating cystourethrogram (MCU)* - An **MCU** (also known as voiding cystourethrogram or VCUG) involves retrograde filling of the bladder with contrast through a urethral catheter, followed by fluoroscopic imaging during voiding. - This investigation is primarily used to evaluate **vesicoureteral reflux** and urethral anatomy, not for assessing the upper urinary tract (kidneys and ureters) as shown in an IVP.

Question 1

Which of the following best describes the characteristic lesion of Kaposi sarcoma?

Accepted Answer

A raised, purple-red lesion

Answer

Small, red erosions

Answer

A white, striated lesion that cannot be scraped off

Answer

A yellow lesion containing pus

Question 2

A patient with borderline tuberculoid leprosy presents with the following findings. Which type of hypersensitivity reaction and nerve is enlarged?

Accepted Answer

Type 4 & greater auricular nerve

Answer

Type 1 & greater auricular nerve

Answer

Type 3 & anterior auricular nerve

Answer

Type 2 & greater auricular nerve

Question 3

A patient presents to the dermatology clinic reporting recurrent skin lesions as seen on the image. He describes that these lesions emerge within hours each time he takes NSAIDs. What is the most likely diagnosis?

Accepted Answer

Fixed drug eruptions

Answer

Erythema multiforme

Answer

Herpes

Answer

Drug Induced Pigmentation

Question 4

A child was brought with c/o multiple lesions. O/E multiple vesicular lesions are seen on the palms, soles, and oral mucosa. Which of the following is the most likely etiological agent causing the disease?

Accepted Answer

Coxsackie virus

Answer

Varicella-zoster virus

Answer

Measles virus

Answer

Human-herpesvirus 6

Question 5

Oral contraceptive pill prevents all except?

Accepted Answer

Cervical cancer

Answer

Colon cancer

Answer

Endometrial cancer

Answer

Epithelial ovarian cancer

Question 6

What is the importance of the following manoeuvre?

Accepted Answer

To protect from tearing of the perineum

Answer

To rotate the shoulders during delivery

Answer

To facilitate controlled extension of the fetal head

Answer

To pull the baby out faster

Question 7

Identify the sign.

Accepted Answer

Hegar's sign

Answer

Goodell's sign

Answer

Piskacek's sign

Answer

Chadwick's sign

Question 8

A child accidentally took a bottle full of iron tablets. Which of the drugs is used as an antidote for iron poisoning?

Accepted Answer

Deferoxamine

Answer

DMSA

Answer

Deferiprone

Answer

Luspatercept

Question 9

A patient presents with severe headache. A CT scan of the brain reveals hyperdense areas in the right basal region, marked as 'X'. Which of the following is the most likely diagnosis?

Accepted Answer

Subarachnoid hemorrhage

Answer

Brain abscess

Answer

Pneumocephalus

Answer

Meningococcal meningitis

Question 10

The following radiological image was taken to assess the urinary tract. Identify the investigation shown below.

Accepted Answer

Intravenous pyelogram (IVP)

Answer

Pelvic X-ray

Answer

Retrograde pyelogram

Answer

Micturating cystourethrogram (MCU)

FMGE 2025

Dermatology

Microbiology

Obstetrics and Gynecology

Pharmacology

Radiology