ENT
2 questionsA patient presents with a fish bone stuck in the pyriform sinus. During the removal procedure, there is accidental nerve injury. Which nerve is most likely to be damaged?
Human papillomavirus (HPV) infection is most strongly associated with which of the following head and neck cancers?
FMGE 2025 - ENT FMGE Practice Questions and MCQs
Question 521: A patient presents with a fish bone stuck in the pyriform sinus. During the removal procedure, there is accidental nerve injury. Which nerve is most likely to be damaged?
- A. Internal branch of the superior laryngeal nerve (Correct Answer)
- B. Recurrent laryngeal nerve
- C. Glossopharyngeal nerve
- D. External branch of the superior laryngeal nerve
Explanation: ***Internal branch of the superior laryngeal nerve***- This nerve branch runs immediately beneath the **mucosa** of the pyriform sinus before piercing the thyrohyoid membrane, making it highly susceptible to injury during instrumentation or foreign body manipulation in this area.- It is the principal **sensory nerve** supply to the laryngeal cavity above the vocal cords; injury would result in loss of sensation in this region, often leading to laryngeal incompetence and aspiration.*Recurrent laryngeal nerve*- This nerve is located more inferiorly within the **tracheoesophageal groove**, supplying motor innervation to nearly all intrinsic muscles of the larynx.- Injury to the recurrent laryngeal nerve would cause **vocal cord paralysis** and hoarseness, which is less likely given the specific location of minimal trauma in the high hypopharynx.*Glossopharyngeal nerve*- The glossopharyngeal nerve (**CN IX**) supplies sensation to the posterior third of the tongue, tonsils, and **oropharynx**, and is not directly related to the pyriform sinus mucosa.- Injury would primarily manifest as loss of the **gag reflex** and sensory deficits in the posterior pharynx, which is topographically distant from the immediate site of endoscopic manipulation in the hypopharynx.*External branch of the superior laryngeal nerve*- This nerve primarily provides **motor innervation** to the **cricothyroid muscle**, responsible for lengthening and tensing the vocal cords (pitch control).- Anatomically, it descends alongside the **superior thyroid artery** and is situated deeper and more anteriorly, placing it at less risk of superficial mucosal trauma than the internal branch.
Question 522: Human papillomavirus (HPV) infection is most strongly associated with which of the following head and neck cancers?
- A. Laryngeal carcinoma
- B. Hypopharyngeal carcinoma
- C. Oropharyngeal carcinoma (Correct Answer)
- D. Nasopharyngeal carcinoma
Explanation: ***Oropharyngeal carcinoma***- HPV (high-risk types, especially **HPV-16**) is the primary etiologic agent for a distinct and increasing subtype of **oropharyngeal squamous cell carcinoma (OPSCC)**, mainly affecting the tonsils and base of the tongue.- HPV-positive OPCs are biologically distinct from those caused by tobacco and alcohol, typically present in younger patients, and have a significantly improved prognosis.*Nasopharyngeal carcinoma*- The strongest viral association with nasopharyngeal carcinoma (NPC) is the **Epstein-Barr virus (EBV)**, not HPV.- NPC is also strongly linked to dietary factors (salted fish) and genetic predisposition, often showing a different geographic distribution.*Hypopharyngeal carcinoma*- This cancer is predominantly caused by heavy use of tobacco and alcohol, placing it firmly in the category of traditional **squamous cell carcinoma** risk factors.- HPV positivity in hypopharyngeal cancers is rare and not considered a major causative factor.*Laryngeal carcinoma*- Laryngeal squamous cell carcinoma is overwhelmingly associated with **tobacco smoking** and, secondarily, alcohol use.- While HPV can cause laryngeal papillomatosis, its definitive causal role in invasive laryngeal *carcinoma* is weak and inconsistent compared to its strong association with the oropharynx.
Forensic Medicine
1 questionsA patient presents with lung injury and tympanic membrane rupture following a blast exposure. These injuries are characteristic of which level of blast wave effect?
FMGE 2025 - Forensic Medicine FMGE Practice Questions and MCQs
Question 521: A patient presents with lung injury and tympanic membrane rupture following a blast exposure. These injuries are characteristic of which level of blast wave effect?
- A. Level II
- B. Level I (Correct Answer)
- C. Level III
- D. Level IV
Explanation: ***Level I*** - Level I, often equated with **primary blast injury**, results directly from the unique effects of the **blast overpressure wave** on the body. - Air-filled organs are most susceptible; **tympanic membrane rupture** is the most common primary injury, and significant **blast lung** (pulmonary contusion/hemorrhage) is the most lethal. *Level II* - Level II injuries, or **secondary blast injuries**, are caused by objects or fragments energized by the explosion impacting the victim. - These manifest as **penetrating injuries**, lacerations, or embedded foreign bodies, distinct from the pressure effects seen in the lung and ear. *Level III* - Level III injuries, or **tertiary blast injuries**, occur when the victim is displaced (thrown) by the blast wind and subsequently impacts a surface. - This mechanism typically causes blunt trauma, resulting in **closed and open fractures**, crush injuries, and significant blunt head trauma. *Level IV* - Level IV injuries, or **quaternary blast injuries**, encompass all other blast-related injuries not covered by the first three categories. - These include **burns** from flash fire, toxic inhalation exposure, exacerbation of chronic illnesses, and crush injuries from structural collapse.
Internal Medicine
2 questionsA patient presents with blackish discoloration of the nasal cavity and posterior buccal mucosa. He has a history of high-dose steroid use. What is the most appropriate drug for treatment?
A patient with hypertension is taking anti-hypertensive drugs but BP is not controlled even after adding diuretics in treatment. Patient's serum electrolyte shows hypokalemia. What is the next step in treatment of this patient?
FMGE 2025 - Internal Medicine FMGE Practice Questions and MCQs
Question 521: A patient presents with blackish discoloration of the nasal cavity and posterior buccal mucosa. He has a history of high-dose steroid use. What is the most appropriate drug for treatment?
- A. Amphotericin B (Correct Answer)
- B. Fluconazole
- C. Griseofulvin
- D. Itraconazole
Explanation: ***Amphotericin B*** - The patient's signs (**blackish discoloration** of the nasal and buccal mucosa) coupled with profound immunosuppression (high-dose steroids) strongly suggest **Rhinocerebral mucormycosis**, an aggressive angioinvasive fungal infection caused by **Mucorales** [2]. - **Amphotericin B** (liposomal formulation preferred) is the drug of choice for empirical and definitive treatment of life-threatening mucormycosis due to its potent fungicidal activity against **Zygomycetes** [2]. - Early surgical debridement combined with Amphotericin B therapy is essential for optimal outcomes [2]. *Fluconazole* - **Fluconazole** has no reliable activity against **Mucorales** (causative agents of mucormycosis) [3]. - It is primarily used for *Candida* and *Cryptococcus* infections, completely lacking the spectrum needed for this severe angioinvasive process [1][3]. *Itraconazole* - **Itraconazole** is typically ineffective against **Mucorales** and is generally reserved for endemic mycoses (*Histoplasma, Blastomyces*) or step-down therapy for *Aspergillus* [3]. - It does not achieve adequate fungicidal activity needed for aggressive invasive fungal sinusitis. *Griseofulvin* - **Griseofulvin** is indicated only for **dermatophytosis** (superficial tinea infections of skin, hair, and nails). - It has no role or efficacy in treating severe, systemic, or angioinvasive fungal infections like mucormycosis.
Question 522: A patient with hypertension is taking anti-hypertensive drugs but BP is not controlled even after adding diuretics in treatment. Patient's serum electrolyte shows hypokalemia. What is the next step in treatment of this patient?
- A. KCL
- B. Hydrochlorothiazide
- C. Spironolactone (Correct Answer)
- D. Torasemide
Explanation: ***Spironolactone*** - The combination of **resistant hypertension** (uncontrolled BP despite standard therapy including a diuretic) and **hypokalemia** strongly suggests **Primary Aldosteronism**. - **Spironolactone** is an **aldosterone antagonist** (potassium-sparing diuretic) and is the drug of choice for treating hypertension secondary to hyperaldosteronism, as it corrects both the hypokalemia and the high blood pressure [1]. *KCL* - **Potassium chloride** (KCL) would correct the hypokalemia temporarily, but it does not address the underlying cause (aldosterone excess) or control the **resistant hypertension** [1]. - Supplementation alone is insufficient when the source of hypokalemia is excessive renal potassium loss driven by high aldosterone levels. *Torasemide* - **Torasemide** is a **loop diuretic**; adding it to the regimen will significantly increase potassium excretion, thereby **worsening the existing hypokalemia**. - Loop diuretics are potent potassium-wasting agents and are contraindicated when the suspicion is high for Primary Aldosteronism presenting with hypokalemia. *Hydrochlorothiazide* - **Hydrochlorothiazide** (HCTZ) is a **thiazide diuretic** (also a potassium-wasting drug). - Similar to Torasemide, adding HCTZ would exacerbate the **hypokalemia** and is not the appropriate therapy for hypertension suspected to be caused by mineralocorticoid excess.
Pharmacology
4 questionsWhat is the preferred preoperative drug for managing blood pressure in a patient with pheochromocytoma?
A woman taking cetirizine for allergic rhinitis complains of excessive sleepiness. Which of the following is the best alternative with minimal sedative effect?
Which of the following drugs acts by inhibiting the catechol-O-methyltransferase enzyme?
A patient is brought to the emergency department with signs suggesting opioid poisoning. What is the antidote of choice?
FMGE 2025 - Pharmacology FMGE Practice Questions and MCQs
Question 521: What is the preferred preoperative drug for managing blood pressure in a patient with pheochromocytoma?
- A. Prazosin
- B. Phenoxybenzamine (Correct Answer)
- C. Propranolol
- D. Labetalol
Explanation: ***Phenoxybenzamine***- It is the standard first-line agent, administered 10–14 days preoperatively, because it is a **non-selective**, **irreversible alpha-adrenergic blocker**.- This irreversible blockade prevents the high concentrations of circulating **catecholamines** (epinephrine and norepinephrine) resulting in severe **hypertensive crisis** during surgical tumor manipulation.*Propranolol*- Propranolol and other pure **beta-blockers** should only be initiated *after* adequate **alpha-blockade** is established, typically to control tachycardia.- Giving a beta-blocker alone leaves the **alpha-1 receptors** unopposed, leading to unchecked systemic **vasoconstriction** and severe, potentially fatal, hypertension.*Prazosin*- Although Prazosin is an **alpha-1 selective blocker**, it is generally less preferred because it is a *reversible* antagonist.- **Phenoxybenzamine** is favored because its irreversible action provides superior, more stable, and prolonged protection against massive **catecholamine surges** during surgery.*Labetalol*- Labetalol is generally avoided for initial control because its **beta-blocking action** significantly outweighs its alpha-blocking action (high beta:alpha ratio).- This dominant beta blockade can induce **unopposed alpha vasoconstriction**, similar to pure beta-blockers, resulting in paradoxical and severe **hypertension**.
Question 522: A woman taking cetirizine for allergic rhinitis complains of excessive sleepiness. Which of the following is the best alternative with minimal sedative effect?
- A. Promethazine
- B. Fexofenadine (Correct Answer)
- C. Diphenhydramine
- D. Hydroxyzine
Explanation: ***Fexofenadine***- It is a second-generation H1 antihistamine that has the **lowest lipophilicity** and is actively transported out of the central nervous system (CNS) by the **P-glycoprotein** pump.- This mechanism results in **minimal to virtually no sedative effects**, making it the best non-sedating alternative to cetirizine.*Hydroxyzine*- This is a first-generation H1 antihistamine that easily crosses the **blood-brain barrier** (BBB).- It is known for its significant **sedative** and **anxiolytic properties**, and would worsen the patient's complaint of excessive sleepiness.*Diphenhydramine*- As a highly lipophilic, first-generation antihistamine, it exhibits profound CNS penetration and causes profound **drowsiness** and cognitive impairment.- It also possesses potent **anticholinergic effects**, which contribute significantly to various side effects but not lack of sedation.*Promethazine*- This drug is a first-generation antihistamine known for its **strong antiemetic** and highly **sedative** properties.- It is structurally related to phenothiazine antipsychotics and would likely cause **more severe sleepiness** than cetirizine.
Question 523: Which of the following drugs acts by inhibiting the catechol-O-methyltransferase enzyme?
- A. Amantadine
- B. Selegiline
- C. Tolcapone (Correct Answer)
- D. Rotigotine
Explanation: ***Tolcapone***- **Tolcapone** is a potent inhibitor of **catechol-O-methyltransferase (COMT)**, an enzyme responsible for metabolizing dopamine and levodopa. - By inhibiting COMT, Tolcapone increases the bioavailability and half-life of **levodopa** in the brain, thereby improving motor symptoms in **Parkinson's disease**.*Amantadine*- Amantadine is thought to enhance the synthesis and release of **dopamine** from presynaptic nerve terminals. - It also acts as a non-competitive antagonist of the **N-methyl-D-aspartate (NMDA) receptor**, providing benefit primarily for **dyskinesia** associated with long-term levodopa use.*Rotigotine*- **Rotigotine** is classified as a non-ergot **dopamine agonist**, meaning it directly stimulates post-synaptic dopamine receptors (D2 and D3). - It is often administered as a **transdermal patch** for continuous dopamine stimulation, helping to manage motor fluctuations in Parkinson's disease.*Selegiline*- **Selegiline** is an inhibitor of **Monoamine Oxidase type B (MAO-B)**, an enzyme subgroup that preferentially metabolizes dopamine in the brain. - By selectively blocking MAO-B, it reduces the breakdown of dopamine, thereby potentiating the effects of endogenous and administered levodopa.
Question 524: A patient is brought to the emergency department with signs suggesting opioid poisoning. What is the antidote of choice?
- A. Flumazenil
- B. Physostigmine
- C. Naloxone (Correct Answer)
- D. Atropine
Explanation: ***Naloxone***- **Naloxone** is the drug of choice for treating opioid poisoning, acting as a competitive antagonist at **mu**, kappa, and delta opioid receptors [1]. - It reverses the life-threatening effects of opioid overdose, primarily **respiratory depression** and **central nervous system depression**, within minutes of administration [3].*Flumazenil*- Flumazenil is the specific antagonist used to reverse the effects of **benzodiazepine overdose**, acting at the GABA-A receptor.- It is generally ineffective and not indicated for pure opioid toxicity.*Atropine*- Atropine is an **anticholinergic agent** used primarily in the treatment of symptomatic **bradycardia** and **organophosphate poisoning** [2].- It does not antagonize opioid receptors and has no direct role in reversing opioid-induced respiratory depression.*Physostigmine*- Physostigmine is a **reversible acetylcholinesterase inhibitor** used mainly for reversing severe central nervous system effects of **anticholinergic poisoning** (e.g., tricyclic antidepressants).- Increasing acetylcholine is irrelevant and potentially counterproductive in treating opioid-induced respiratory depression.
Radiology
1 questionsThe X-ray image provided (img-41.jpeg) shows multiple cylindrical objects in the abdominal area. Which of the following conditions is most likely represented by this image?
FMGE 2025 - Radiology FMGE Practice Questions and MCQs
Question 521: The X-ray image provided (img-41.jpeg) shows multiple cylindrical objects in the abdominal area. Which of the following conditions is most likely represented by this image?
- A. Body packer syndrome (Correct Answer)
- B. Pica due to anaemia
- C. Bezoar
- D. Constipation due to fecalith
Explanation: ***Body packer syndrome*** - The X-ray shows multiple, well-defined, uniformly shaped, dense, cylindrical objects throughout the gastrointestinal tract, a classic radiographic finding for **body packer syndrome**. - These objects are ingested packets containing illicit drugs, often showing a "double-condom sign" (a thin lucent rim of air trapped in the wrapping), confirming their manufactured nature. *Bezoar* - A **bezoar** is a mass of indigestible material (like hair or vegetable fiber) that appears as a single, mottled, intraluminal mass on X-ray, not multiple discrete packets. - The objects in the image have a uniform shape and density, which is inconsistent with the heterogeneous appearance of a bezoar. *Pica due to anaemia* - **Pica** involves the ingestion of non-nutritive substances, which would result in radiopaque foreign bodies of various, irregular shapes (e.g., coins, stones), not uniform cylindrical packets. - While associated with conditions like **iron-deficiency anaemia**, the radiographic findings of pica do not match the organized, manufactured appearance of the objects shown. *Constipation due to fecalith* - A **fecalith** is a hardened mass of stool that appears as a mottled density within the colon, conforming to the haustral pattern, and lacks the smooth, well-defined borders seen here. - While severe **constipation** leads to significant stool burden, it does not present as multiple, encapsulated, geometrically regular objects.