FMGE 2025 Practice Questions

Q: Identify the tarsal bone marked by the arrow in the given X-ray of the right foot.

Navicular. ***Navicular*** - The arrow correctly identifies the **navicular** bone, a boat-shaped tarsal bone situated on the **medial side** of the midfoot. It articulates proximally with the head of the **talus** and distally with the three **cuneiform** bones. - The navicular is a crucial component of the **medial longitudinal arch** of the foot and is a common site for avascular necrosis (**Köhler disease** in children) or stress fractures. *Cuboid* - The **cuboid** bone is located on the **lateral aspect** of the foot, articulating with the calcaneus proximally and the fourth and fifth metatarsals distally. The structure indicated by the arrow is on the medial side. - It forms the keystone of the **lateral longitudinal arch** and is not the bone indicated in the X-ray. *Intermediate cuneiform* - The **intermediate cuneiform** bone is located **distal** (further towards the toes) to the navicular bone, between the medial and lateral cuneiforms. - It articulates distally with the base of the **second metatarsal**, forming part of the **Lisfranc joint** complex. *Lateral cuneiform* - The **lateral cuneiform** is also situated **distal** to the navicular, lateral to the intermediate cuneiform, and medial to the cuboid bone. - It articulates distally with the base of the **third metatarsal** and is not the bone marked by the arrow, which is more proximal.

Q: Identify the bone indicated by the arrow in the image.

Navicular. ***Navicular*** - The arrow points to the navicular bone, a key tarsal bone located on the **medial side** of the foot. It articulates proximally with the **talus** and distally with the three **cuneiform** bones. - Its characteristic boat-like shape is identifiable on this AP radiograph, and it serves as the keystone of the **medial longitudinal arch** of the foot. *Cuboid* - The **cuboid** bone is located on the **lateral side** of the foot, articulating proximally with the **calcaneus** and distally with the fourth and fifth metatarsals. The indicated bone is medial. - The cuboid has a more cubical shape, which differentiates it from the scaphoid or boat-like shape of the navicular. *Intermediate cuneiform* - The **intermediate cuneiform** is located **distal** to the navicular bone and proximal to the base of the second metatarsal. The arrow points to a more proximal bone. - It is situated between the medial and lateral cuneiforms, forming part of the transverse arch of the foot. *Lateral cuneiform* - The **lateral cuneiform** is also located **distal** to the navicular, articulating with the third metatarsal. The arrow indicates the bone proximal to the cuneiform row. - It articulates with the intermediate cuneiform medially and the cuboid bone laterally, which is inconsistent with the indicated structure.

Q: In a study, an investigator compared the mean blood pressure and standard deviation between two independent groups. Which of the following is the most appropriate statistical test to assess the significance of the difference between the two means?

Unpaired t-test. ***Unpaired t-test***- It is the most appropriate statistical test used to compare the means of two independent (unrelated) groups when the data is continuous (like **blood pressure**).- This test assesses the null hypothesis that there is no significant difference between the **population means** of the two comparison groups.*Paired t-test*- This test is specifically designed to compare means when the observations are dependent, meaning the data comes from the **same subjects** measured twice (e.g., pre-treatment and post-treatment).- It is used for **within-group comparisons** rather than comparisons between two independent cohorts, as requested in the scenario.*Chi-square test*- The chi-square test is used to determine the association between **two categorical variables** (e.g., proportions or frequencies).- It is unsuitable here because the variable being compared (blood pressure) is **continuous data**, and the study requires comparing means, not counted frequencies.*ANOVA*- ANOVA (Analysis of Variance) is used when comparing the means of **three or more** independent groups.- While acceptable for two groups (where it gives equivalent results to the t-test), the **unpaired t-test** is the most specific and standard test for comparing means of exactly two independent samples.

Q: Fetal anaemia is primarily determined by Doppler assessment of which artery?

Middle cerebral artery. ***Middle cerebral artery***- The **Middle Cerebral Artery (MCA) peak systolic velocity (PSV)** is the most reliable non-invasive method for detecting moderate to severe fetal anemia.- An elevated MCA-PSV indicates increased cerebral blood flow velocity due to reduced blood viscosity (from anemia) and the **brain-sparing effect**.- *Umbilical artery*- Doppler assessment of the umbilical artery primarily evaluates **placental vascular resistance** (e.g., in fetal growth restriction) using indices like the resistive index (RI) or pulsatility index (PI).- While abnormalities like absent or reversed diastolic flow indicate severe placental insufficiency, they are not the primary diagnostic measure for fetal anemia.- *Ductus venosus*- Ductus venosus Doppler evaluates **fetal cardiac function** and is critical in assessing fetal compromise, especially in conditions leading to hydrops fetalis.- Although reverse flow can be an indicator of severe compromise and impending heart failure (potentially caused by severe anemia), it is secondary to MCA-PSV for the specific diagnosis of anemia.- *Uterine artery*- Uterine artery Doppler assesses **maternal placental perfusion** and resistance, primarily used for screening and monitoring conditions like **preeclampsia** and **fetal growth restriction**.- It measures maternal blood flow to the placenta and has no direct correlation or role in determining the severity of fetal anemia.

Q: A 24-year-old primigravida presents with painful vaginal bleeding in the first trimester. On USG, a well-formed gestation ring with central echoes from the embryo indicates a healthy fetus, and there is observation of fetal cardiac motion. What is the most probable diagnosis?

Threatened abortion. ***Threatened abortion***- This diagnosis applies when there is **vaginal bleeding** (often painful) in the first 20 weeks of pregnancy, but the **cervix is closed** and **fetal viability** (confirmed by fetal cardiac motion) is observed on ultrasound.- It is the most common cause of bleeding in early pregnancy and signifies that while the pregnancy is at risk, it is still continuing with a live fetus.*Inevitable abortion*- This diagnosis is characterized by vaginal bleeding accompanied by cervical changes, specifically **cervical dilation**, making continuation of the pregnancy unlikely.- Viable fetal cardiac activity rules out inevitable or ongoing abortion processes.*Incomplete abortion*- This involves the partial expulsion of the products of conception; USG would show **retained placental tissue** or fetal tissue and the loss of fetal viability.- The existence of **fetal cardiac motion** and a complete gestation ring confirms the pregnancy is still intact and rules out incomplete expulsion.*Complete abortion*- In this scenario, all products of conception have been expelled, resulting in an **empty uterine cavity** on ultrasound.- The presence of a **well-formed gestation ring** and an actively moving embryo/fetus clearly excludes complete abortion.

Q: A patient with a known marginal placenta presents for follow-up. On ultrasound, a 4 x 4 cm placental mass is noted invading into the urinary bladder. What is the most likely diagnosis?

Placenta percreta. ***Placenta percreta*** - This is the most severe form of the **placenta accreta spectrum**, where the placental villi penetrate through the entire uterine wall, including the **serosa**, and invade adjacent organs. - The ultrasound finding of a placental mass invading the **urinary bladder** is the classic presentation of **placenta percreta**. *Placenta previa* - This term describes the location of the placenta, where it partially or completely covers the **internal cervical os**. It does not describe the depth of invasion. - Although **placenta previa** is a significant risk factor for placenta accreta spectrum disorders, the invasion into the bladder points to a specific diagnosis of abnormal adherence, not just location. *Placenta increta* - In **placenta increta**, the placental villi invade into the **myometrium** (uterine muscle) but do not penetrate through to the serosa or adjacent organs. - This represents the intermediate form of the accreta spectrum, more severe than accreta but less severe than percreta. *Placenta accreta* - In **placenta accreta**, the placental villi are abnormally attached to the **myometrium**, but they do not invade the uterine muscle itself. This is the least invasive form of the spectrum. - The finding of invasion into the **urinary bladder** rules out simple accreta, as this requires penetration through the entire myometrium and serosa, which is characteristic of percreta.

Q: A patient develops profuse uterine bleeding after a lower segment cesarean section (LSCS). Despite administration of oxytocin and other uterotonics, the bleeding continues. What is the 1st line conservative surgical management?

Uterine balloon tamponade. ***Uterine balloon tamponade*** - This is the **first-line conservative surgical intervention** when uterine atony persists despite maximum medical management (oxytocin, methylergometrine, carboprost, misoprostol). - Devices like the **Bakri balloon** are inserted rapidly to apply counter-pressure to the uterine walls, effectively halting bleeding in 80-90% of cases while preserving the uterus. - This is a **Tier 2 intervention** that bridges medical management and invasive surgical procedures. *Uterine artery embolization* - This specialized technique requires immediate availability of an **interventional radiology suite** and hemodynamically stable patient for transport. - It is typically pursued after conservative mechanical procedures (tamponade or compression sutures) have failed, or in specialized centers where it's immediately available. - Considered a **Tier 3 intervention**. *Internal iliac artery ligation* - This complex invasive surgical procedure is performed when simpler techniques like **balloon tamponade** or **B-Lynch compression sutures** have failed. - It is typically reserved as a step before hysterectomy, aimed at reducing pelvic blood flow. - Also a **Tier 3 intervention**. *Hysterectomy* - **Hysterectomy** is the **last-resort, life-saving measure** (Tier 4) when all conservative mechanical, surgical, and medical options have failed to control massive hemorrhage. - The goal is to implement conservative measures rapidly to **preserve fertility** before resorting to definitive surgery.

Q: Identify the investigation shown in the image:

Mammography. ***Mammography*** - The image displays the characteristic features of a mammogram, which is a specialized **low-dose X-ray** of the breast used for screening and diagnosis. - It clearly delineates the breast's internal structures, including **glandular tissue**, **adipose tissue**, and **ducts**, which is the primary purpose of this imaging modality. *CT* - A **Computed Tomography (CT)** scan produces cross-sectional (slice) images, whereas the image shown is a projectional view of the entire breast, typical of mammography. - CT scans of the chest would typically show surrounding structures like ribs, lungs, and the sternum, which are absent in this focused view. *X-ray* - While mammography is a type of X-ray, in clinical practice, the term "X-ray" usually refers to a standard radiograph (e.g., chest X-ray) that is not optimized for detailed **soft-tissue differentiation** of the breast. - The technique involves breast compression and specific views (like mediolateral oblique or craniocaudal) that are unique to mammography, not general radiography. *MRI* - **Magnetic Resonance Imaging (MRI)** of the breast produces images with different tissue contrast and appearance, often using gadolinium contrast to assess vascularity. - The texture and resolution of an MRI are distinct, and it does not typically show microcalcifications with the same clarity as a mammogram.

Q: What does a linear accelerator (LINAC) produce in radiation therapy?

X-rays and electrons. ***X-rays and electrons*** - A linear accelerator (LINAC) accelerates **electrons** to high energies, which can be used directly as an **electron beam** to treat superficial tumors. - To treat deeper tumors, these high-energy **electrons** are made to strike a heavy metal target (like tungsten), which then produces high-energy **X-rays** (photons) through a process called **bremsstrahlung**. *Alpha and beta rays* - **Alpha particles** (helium nuclei) and **beta particles** (electrons from nuclear decay) are forms of particulate radiation emitted by radioactive substances, not generated by a LINAC. - While the LINAC beam consists of electrons, it does not produce **alpha particles**, which have very low penetration and are not used in external beam radiotherapy. *X-rays and gamma rays* - A LINAC produces **X-rays**, but not **gamma rays**. Although both are high-energy photons, their origin differs. - **Gamma rays** are emitted from the nucleus of a decaying radioactive atom (e.g., Cobalt-60), whereas **X-rays** from a LINAC are produced extranuclearly when electrons interact with a target. *Neutrons and positrons* - **Neutron therapy** is a specialized form of radiation that requires different equipment, like a cyclotron, and is not a primary output of a standard medical LINAC. - **Positrons** are the antimatter counterpart of electrons and are used in diagnostic imaging (**Positron Emission Tomography or PET**), not for therapeutic purposes in a LINAC.

Q: A patient presents with bilateral hilar lymphadenopathy with eggshell calcification on chest X-ray. What is the most likely diagnosis?

Silicosis. ***Silicosis*** - The presence of **bilateral hilar lymphadenopathy** with **eggshell calcification** is a classic, pathognomonic finding for silicosis. - This pneumoconiosis is caused by inhalation of silica dust, often seen in miners and sandblasters, and typically shows multiple small nodules predominantly in the **upper lung zones**. *Sarcoidosis* - While sarcoidosis is a common cause of **bilateral hilar lymphadenopathy**, the presence of **eggshell calcification** is much less frequent compared to silicosis. - Calcification in sarcoidosis, when it occurs, is more often amorphous or diffuse, not the distinct peripheral rim seen in the image. *Tuberculosis* - Tuberculosis can cause hilar lymphadenopathy, but it is often **unilateral**, and calcification typically occurs in a healed **Ghon complex** as a solid, dense nodule. - The specific pattern of **eggshell calcification** is not a characteristic feature of tuberculosis. *Pneumoconiosis due to asbestos* - Asbestosis characteristically involves the **lower lung zones** and is associated with **pleural plaques**, pleural thickening, and interstitial fibrosis. - Significant hilar lymphadenopathy and **eggshell calcification** are not typical features of asbestos-related lung disease.

Question 1

Identify the tarsal bone marked by the arrow in the given X-ray of the right foot.

Accepted Answer

Navicular

Answer

Cuboid

Answer

Intermediate cuneiform

Answer

Lateral cuneiform

Question 2

Identify the bone indicated by the arrow in the image.

Accepted Answer

Navicular

Answer

Intermediate cuneiform

Answer

Lateral cuneiform

Answer

Cuboid

Question 3

In a study, an investigator compared the mean blood pressure and standard deviation between two independent groups. Which of the following is the most appropriate statistical test to assess the significance of the difference between the two means?

Accepted Answer

Unpaired t-test

Answer

Chi-square test

Answer

ANOVA

Answer

Paired t-test

Question 4

Fetal anaemia is primarily determined by Doppler assessment of which artery?

Accepted Answer

Middle cerebral artery

Answer

Umbilical artery

Answer

Uterine artery

Answer

Ductus venosus

Question 5

A 24-year-old primigravida presents with painful vaginal bleeding in the first trimester. On USG, a well-formed gestation ring with central echoes from the embryo indicates a healthy fetus, and there is observation of fetal cardiac motion. What is the most probable diagnosis?

Accepted Answer

Threatened abortion

Answer

Inevitable abortion

Answer

Complete abortion

Answer

Incomplete abortion

Question 6

A patient with a known marginal placenta presents for follow-up. On ultrasound, a 4 x 4 cm placental mass is noted invading into the urinary bladder. What is the most likely diagnosis?

Accepted Answer

Placenta percreta

Answer

Placenta accreta

Answer

Placenta previa

Answer

Placenta increta

Question 7

A patient develops profuse uterine bleeding after a lower segment cesarean section (LSCS). Despite administration of oxytocin and other uterotonics, the bleeding continues. What is the 1st line conservative surgical management?

Accepted Answer

Uterine balloon tamponade

Answer

Hysterectomy

Answer

Internal iliac artery ligation

Answer

Uterine artery embolization

Question 8

Identify the investigation shown in the image:

Accepted Answer

Mammography

Answer

CT

Answer

X-ray

Answer

MRI

Question 9

What does a linear accelerator (LINAC) produce in radiation therapy?

Accepted Answer

X-rays and electrons

Answer

Alpha and beta rays

Answer

X-rays and gamma rays

Answer

Neutrons and positrons

Question 10

A patient presents with bilateral hilar lymphadenopathy with eggshell calcification on chest X-ray. What is the most likely diagnosis?

Accepted Answer

Silicosis

Answer

Tuberculosis

Answer

Sarcoidosis

Answer

Pneumoconiosis due to asbestos

FMGE 2025

Anatomy

Community Medicine

Obstetrics and Gynecology

Radiology