Anatomy
1 questionsWhat is the embryological basis for the uterine anomaly shown in the images?
FMGE 2025 - Anatomy FMGE Practice Questions and MCQs
Question 401: What is the embryological basis for the uterine anomaly shown in the images?
- A. Failure of fusion of metanephric duct
- B. Non-fusion of mesonephric duct
- C. Complete agenesis of Müllerian structures
- D. Non-fusion of paramesonephric ducts (Correct Answer)
Explanation: ***Non-fusion of paramesonephric ducts*** - The image shows a **uterus didelphys**, which is a complete duplication of the uterus and cervix. This anomaly occurs due to a complete failure of the two **paramesonephric (Müllerian) ducts** to fuse medially during embryogenesis. - The **paramesonephric ducts** are the embryological precursors to the fallopian tubes, uterus, cervix, and the upper one-third of the vagina. Their proper fusion is essential for forming a single uterine cavity. *Non-fusion of mesonephric duct* - The **mesonephric (Wolffian) ducts** are precursors to male internal genitalia (e.g., epididymis, ductus deferens, seminal vesicles) and largely regress in females. - Remnants of the mesonephric duct in females may form **Gartner's cysts**, but they do not contribute to the formation of the uterus. *Failure of fusion of metanephric duct* - The **metanephric duct**, or **ureteric bud**, is involved in the development of the urinary system, specifically the ureters, renal pelves, calyces, and collecting ducts of the kidneys. - This structure is entirely unrelated to the embryological development of the female reproductive tract. *Complete agenesis of Müllerian structures* - Complete agenesis of the **Müllerian structures** results in the congenital absence of the uterus, fallopian tubes, and upper vagina, a condition known as **Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome**. - The image clearly depicts the presence of uterine horns and a cervix, which contradicts a diagnosis of agenesis (complete absence).
Anesthesiology
1 questionsThe waveform shown in the image represents which of the following physiological parameters?
FMGE 2025 - Anesthesiology FMGE Practice Questions and MCQs
Question 401: The waveform shown in the image represents which of the following physiological parameters?
- A. Tidal volume
- B. Arterial oxygen saturation
- C. Functional residual capacity
- D. End-tidal carbon dioxide (Correct Answer)
Explanation: ***End-tidal carbon dioxide*** - The image displays a **capnogram**, which is a graphical representation of the concentration or partial pressure of **carbon dioxide (CO2)** in respiratory gases over time. The y-axis is clearly labeled **CO2 (mmHg)**. - The characteristic rectangular waveform represents the respiratory cycle: the plateau indicates the exhalation of **alveolar gas**, and the peak at the end of the plateau is the **end-tidal CO2 (ETCO2)**, which normally ranges from 35-45 mmHg. *Arterial oxygen saturation* - Arterial oxygen saturation (SpO2) is measured by **pulse oximetry** and is reported as a **percentage**, not in mmHg. - The waveform associated with pulse oximetry is a **plethysmograph**, which reflects changes in blood volume in the tissue with each heartbeat, not respiratory gas exchange. *Functional residual capacity* - **Functional residual capacity (FRC)** is a static lung **volume** (measured in liters or milliliters), representing the amount of air remaining in the lungs after a normal exhalation. - It is not a dynamically changing parameter measured with each breath and cannot be represented by this type of real-time waveform. *Tidal volume* - **Tidal volume** is the **volume** of air inhaled or exhaled during a single breath, measured in milliliters or liters. - A graph of tidal volume over time (spirometry) would show a sinusoidal wave representing the volume change, which looks distinctly different from the capnogram shown.
Community Medicine
1 questionsWhich of the following refers to the tendency of an individual’s relative position within a distribution (e.g., BP levels) to remain consistent over time, meaning those with high BP in childhood often remain at the higher end of BP in adulthood, and those with low BP tend to stay lower, even though absolute values may change with age?
FMGE 2025 - Community Medicine FMGE Practice Questions and MCQs
Question 401: Which of the following refers to the tendency of an individual’s relative position within a distribution (e.g., BP levels) to remain consistent over time, meaning those with high BP in childhood often remain at the higher end of BP in adulthood, and those with low BP tend to stay lower, even though absolute values may change with age?
- A. Regression to the mean
- B. Tracking of blood pressure (Correct Answer)
- C. Rule of halves
- D. Cohort effect
Explanation: ***Correct Option: Tracking of blood pressure*** - This phenomenon refers to the **stability of an individual's percentile ranking** (high, average, or low) for a physiological variable like BP, **cholesterol**, or **BMI** over time, even as absolute values increase with age - It is crucial in epidemiology because it allows for the early identification of individuals who are consistently at higher risk for developing adult diseases like **hypertension** - **Key concept**: Those with high BP in childhood often remain at the higher end of BP distribution in adulthood, maintaining their relative position *Incorrect Option: Regression to the mean* - **Regression to the mean** is a statistical concept stating that an extreme measurement (very high or very low), often due to random error or temporary fluctuation, will likely be followed by a measurement closer to the **average (mean)** upon retesting - It is a statistical artifact that must be considered when interpreting extreme results but does not explain the long-term, relative stability of an individual's rank within a population distribution - **Key difference**: This describes temporary fluctuation returning to average, not consistent relative position over time *Incorrect Option: Rule of halves* - The **Rule of Halves** is a public health concept, often applied to hypertension, stating that only half of patients with the condition are aware of it, and only half of those aware are adequately treated - It describes **gaps in diagnosis and treatment** of chronic disease, not the longitudinal consistency of an individual's biological measurement - **Key difference**: This is about healthcare delivery gaps, not individual BP trajectory patterns *Incorrect Option: Cohort effect* - A **cohort effect** describes differences in health outcomes or characteristics that arise from groups (cohorts) having been born and exposed to differing environmental or societal factors during specific time periods - This concept explains variations between *groups* based on their birth decade or shared experience, rather than the stability of an **individual's relative position** over time - **Key difference**: This compares different birth cohorts (groups), not individual tracking within a cohort
Internal Medicine
1 questionsWhich of the following is a recommended treatment for esophageal varices?
FMGE 2025 - Internal Medicine FMGE Practice Questions and MCQs
Question 401: Which of the following is a recommended treatment for esophageal varices?
- A. Transjugular intrahepatic portosystemic shunt (TIPS)
- B. Endoscopic ligation (Correct Answer)
- C. Intravenous labetalol
- D. Oral amoxicillin
Explanation: ***Endoscopic ligation*** - This is a first-line endoscopic therapy for both actively bleeding esophageal varices and for the primary and secondary prevention of variceal hemorrhage [1]. - The procedure, also known as **variceal banding**, involves placing small rubber bands around the varices to ligate them, leading to thrombosis and eventual sloughing off [1]. *Transjugular intrahepatic portosystemic shunt (TIPS)* - TIPS is considered a second-line or salvage therapy for variceal bleeding that is refractory to endoscopic and pharmacological treatments [2]. - It is an invasive procedure that creates a shunt to reduce **portal pressure**, but it is reserved for uncontrolled bleeding due to risks such as **hepatic encephalopathy** [2]. *Intravenous labetalol* - While non-selective beta-blockers like **propranolol** or **nadolol** are used for the prophylaxis of variceal bleeding, they are not the treatment for an acute bleed. Vasoactive drugs like **terlipressin** or **octreotide** are used instead [1]. - Labetalol is a beta-blocker primarily used to manage **hypertension** and is not indicated for the acute management of variceal hemorrhage. *Oral amoxicillin* - Antibiotic prophylaxis (typically with intravenous third-generation cephalosporins like **ceftriaxone**) is recommended in patients with cirrhosis and variceal bleeding to prevent **spontaneous bacterial peritonitis (SBP)**. - Antibiotics do not treat the varices directly or stop the bleeding; they are given to reduce mortality associated with infections in this patient population.
Obstetrics and Gynecology
4 questionsAfter an initial serum $\beta$-hCG test in a patient with suspected pregnancy, when should the repeat $\beta$-hCG level ideally be checked to assess viability or progression?
A pregnant woman with a short cervix undergoes a cervical cerclage procedure. The image shows a key step during the procedure. What is the most likely procedure being performed?
A patient presents with obstructed labor, and on abdominal examination, a groove or band is palpable across the uterus. What is the most likely diagnosis?
A pregnant woman is being assessed for induction of labor. On vaginal examination: Cervical dilation: 2 cm, Effacement: 20%, Cervical consistency: Soft, Position: Midline, Station: -2. What is the modified Bishop Score?
FMGE 2025 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 401: After an initial serum $\beta$-hCG test in a patient with suspected pregnancy, when should the repeat $\beta$-hCG level ideally be checked to assess viability or progression?
- A. 48 hours (Correct Answer)
- B. 96 hours
- C. 24 hours
- D. 72 hours
Explanation: ***Correct: 48 hours*** - In a viable, intrauterine pregnancy, serum β-hCG levels typically **double approximately every 48 hours** (or show a rise of at least 35% in 48 hours) during the initial weeks. - This standard **48-hour interval** is critical as it provides the most timely and appropriate benchmark to determine if the required doubling is occurring, aiding in the assessment of viability. - This is the **gold standard timing** for repeat β-hCG testing in early pregnancy monitoring. *Incorrect: 24 hours* - This interval is generally **too short** to observe the significant rise needed to confidently distinguish a normal, viable doubling rate from an abnormal or insufficient rate. - Due to natural variations in hormone secretion, a 24-hour reading often yields an overlapping range, making interpretation of the trend difficult. *Incorrect: 72 hours* - Although a check at 72 hours is sometimes used (as doubling can take up to 72 hours), waiting this long can **delay critical diagnosis** of urgent conditions like a non-ruptured **ectopic pregnancy** or ongoing miscarriage. - The 48-hour check remains the standard benchmark providing the earliest necessary data for management decisions. *Incorrect: 96 hours* - Waiting 96 hours (4 days) is generally **too long** and could significantly delay necessary intervention or further management for a non-viable or **ectopic pregnancy**. - While β-hCG doubling slows down significantly after approximately 6 weeks of gestation, the initial assessment requires the tighter 48-hour timeframe.
Question 402: A pregnant woman with a short cervix undergoes a cervical cerclage procedure. The image shows a key step during the procedure. What is the most likely procedure being performed?
- A. Shirodkar
- B. Modified McDonald's
- C. Modified Shirodkar (Correct Answer)
- D. McDonald's
Explanation: ***Modified Shirodkar*** - The image displays the dissection of the **vesicocervical mucosa** (bladder flap) which is a crucial step in the Shirodkar procedure, allowing the suture to be placed high on the cervix near the **internal os**. - This technique involves a submucosal placement of a non-absorbable suture (like Mersilene tape) which is then buried, providing better support for an incompetent cervix compared to lower-placed sutures. *Modified McDonald's* - The McDonald's procedure and its modifications are simpler techniques that place a **purse-string suture** around the cervix without any dissection of the cervical mucosa. - This procedure is less invasive but the suture is placed lower on the cervix, which might offer less support than a high cerclage like the Shirodkar. *McDonald's* - This is a transvaginal **purse-string suture** placed around the body of the cervix, cinching it closed. It is a common and relatively simple method of cerclage. - Crucially, it does not involve the **bladder dissection** shown in the image, which is the key differentiating feature of the Shirodkar technique. *Shirodkar* - While the procedure shown is a Shirodkar type, the **Modified Shirodkar** is the version most commonly performed today and is therefore the most precise answer. - The original Shirodkar technique often involved a permanent suture requiring a **cesarean delivery**, whereas the modified version uses a suture that can be removed to allow for a trial of vaginal delivery.
Question 403: A patient presents with obstructed labor, and on abdominal examination, a groove or band is palpable across the uterus. What is the most likely diagnosis?
- A. Bandl’s ring (Correct Answer)
- B. Constriction ring
- C. Contraction ring
- D. Schroeder's ring
Explanation: ***Bandl’s ring***- This is the **pathological retraction ring** that forms in cases of prolonged **obstructed labor**, separating the thick, upper, contracted uterine segment from the thin, distended lower uterine segment.- Its presence as a palpable groove or band across the abdomen is a critical sign of **impending uterine rupture** and mandates immediate intervention.*Constriction ring*- This is a localized persistent contraction or **spasm of the circular uterine muscle fibers** occurring at any level, hindering the passage of the fetus but not necessarily indicating imminent rupture.- Unlike Bandl's ring, it is usually not a high, visible, or palpable abdominal band indicating severe obstruction and **uterine overdistention**.*Schroeder's ring*- This term is not the standardized term used to describe the **pathological retraction ring** visible externally in severe obstructed labor.- While it may sometimes be confused with terms related to cervical changes, **Bandl's ring** is the definitive diagnosis for the palpable groove in this clinical context.*Contraction ring*- This term is often used synonymously with the normal **physiological retraction ring** which forms between the active and passive segments during normal labor.- Although it involves muscle contraction, it lacks the specific **pathological significance** and height within the abdomen characteristic of Bandl’s ring in severe obstruction.
Question 404: A pregnant woman is being assessed for induction of labor. On vaginal examination: Cervical dilation: 2 cm, Effacement: 20%, Cervical consistency: Soft, Position: Midline, Station: -2. What is the modified Bishop Score?
- A. Score 5 - Unfavorable (Correct Answer)
- B. Score 7 - Favorable
- C. Score 6 - Borderline
- D. Score 3 - Highly unfavorable
Explanation: ***Score 5 - Unfavorable*** - This score is calculated by assigning points based on cervical parameters: **Dilation 2 cm (1 pt)**, **Effacement 20% (0 pts)**, **Consistency Soft (2 pts)**, **Position Midline (1 pt)**, and **Station -2 (1 pt)**, totaling **5 points**. - A Bishop Score of 5 or less indicates an **unfavorable cervix**, suggesting a low likelihood of successful vaginal delivery following induction without prior cervical ripening. *Score 7 - Favorable* - A score of 7 or higher is generally considered highly **favorable** for successful induction, meaning the cervix is likely to respond well to oxytocin. - To reach a score of 7, the patient would need two additional points, such as effacement of 60% (2 points) instead of 20% (0 points), or improved station. *Score 6 - Borderline* - A score of 6 is considered **borderline** or marginally favorable, but many clinicians still prefer cervical ripening before proceeding with oxytocin. - This would require an improvement in one parameter, such as the fetal station moving from -2 (1 pt) to -1 or 0 (2 pts). *Score 3 - Highly unfavorable* - A score of 3 indicates a very **unripe cervix** (e.g., firm consistency, posterior position, minimal dilation and effacement) with very low chance of successful induction. - The current patient scores 5 points with favorable features (soft consistency, midline position), making a score as low as 3 impossible with the given findings.
Surgery
2 questionsA 2-month-old male infant presents with a scrotal swelling that has been present since birth. Now, the swelling has become suddenly painful, red, and irreducible. What is the most likely diagnosis?
A patient underwent split-thickness skin grafting for a burn injury on the arm. On post-operative day 6, he develops stiffness of the arm during physiotherapy. What is the most appropriate next step in management?
FMGE 2025 - Surgery FMGE Practice Questions and MCQs
Question 401: A 2-month-old male infant presents with a scrotal swelling that has been present since birth. Now, the swelling has become suddenly painful, red, and irreducible. What is the most likely diagnosis?
- A. Incarcerated inguinal hernia
- B. Strangulated inguinal hernia (Correct Answer)
- C. Acute epididymo-orchitis
- D. Testicular torsion
Explanation: **Strangulated inguinal hernia** - The presence of a scrotal swelling since birth strongly suggests an underlying indirect inguinal hernia, common due to a **patent processus vaginalis** in infants. - Sudden onset of severe pain, marked **irreducibility**, and **erythema** (redness) indicates vascular compromise of the contents (often bowel), classifying it as a surgical emergency (strangulation). *Acute epididymo-orchitis* - This condition is exceedingly rare in 2-month-old infants unless associated with underlying **urinary tract anomalies** or sepsis, and typically presents acutely without a long-standing mass. - The pain and swelling would usually involve the testicle/epididymis itself, accompanied by fever, and is less likely to present with the history of a mass existing **since birth**. *Testicular torsion* - Torsion usually presents with an extremely rapid onset of severe testicular pain without a history of a chronic mass, and often occurs due to inadequate fixation (**bell-clapper deformity**). - While painful, torsion involves the testicle and is generally diagnosed by absence of flow on **Doppler ultrasound**, unlike a hernia mass. *Incarcerated inguinal hernia* - An incarcerated hernia is irreducible because the contents are trapped, but the key differentiating factor is the lack of **vascular compromise**. - The presence of severe pain, tenderness, and redness (erythema) indicates progression beyond simple incarceration to **strangulation**, necessitating immediate intervention.
Question 402: A patient underwent split-thickness skin grafting for a burn injury on the arm. On post-operative day 6, he develops stiffness of the arm during physiotherapy. What is the most appropriate next step in management?
- A. Continue physiotherapy without intervention
- B. Surgical excision of contracture
- C. Remove the graft and regraft the area
- D. Passive extension of the joint under direct visualization of the graft (Correct Answer)
Explanation: ***Passive extension of the joint under direct visualization of the graft***- Stiffness noted around post-op day 6 points to the formation of an **early, immature fibrous band** crossing the joint, often seen after split-thickness skin grafting.- Gentle but firm **passive extension** at this time is the standard management to **break the fibrous band** before it matures into a fixed contracture, while direct visualization prevents graft avulsion.*Surgical excision of contracture*- This intervention is reserved for **mature, established contractures** that have failed conservative management, typically occurring months post-injury.- Performing surgical release on post-op day 6 is premature and risks **damaging the viable graft** and exposing underlying structures.*Continue physiotherapy without intervention*- If **early stiffness** is present, continuing standard physiotherapy alone will not overcome the developing fibrous tether and will likely result in a **fixed joint contracture**.- **Forced extension** is needed at this stage to actively address the limitation in **range of motion (ROM)**.*Remove the graft and regraft the area*- This approach is indicated only for complications like **graft necrosis** or **complete graft failure**, not for the formation of stiffness or contractures.- The graft is viable and the issue relates to peri-articular scar formation, making **graft removal unnecessary** and harmful.