FMGE 2025 Practice Questions

Q: On January 1, 2024, an area with a population of 10,000 had 100 TB cases. During the year, 30 patients were cured and 10 died. Twenty new TB cases were reported, and 5 of them were cured before December 31, 2024. What is the incidence and prevalence of TB cases?

2 and 1.2. ***2 and 1.2*** - **Incidence** represents the rate of new cases occurring during the year. With 20 new TB cases in a population of 10,000, the incidence rate is: $$\frac{20}{10,000} \times 1000 = 2 \text{ per 1000 population}$$ - **Prevalence** in this context appears to refer to the cumulative case load or period prevalence. The total number of cases that existed at any point during the year = Initial cases + New cases = 100 + 20 = 120 cases. Expressed as a percentage: $$\frac{120}{10,000} \times 100 = 1.2\%$$ - This interpretation gives us **incidence of 2 per 1000** and **prevalence of 1.2%** *1.2 and 10* - Incidence of 1.2 would suggest only 12 new cases per 10,000 population, which is incorrect. The actual number of new cases is 20, giving an incidence of 2 per 1000 - The value 10 represents the number of deaths, not the prevalence rate *1.2 and 12* - Incidence of 1.2 is incorrect as explained above - While 12 per 1000 (or 1.2%) could represent prevalence, pairing it with the wrong incidence value makes this option incorrect *2 and 10* - Incidence of 2 per 1000 is correct - However, 10 represents the number of deaths, not the prevalence. The prevalence value should be 1.2% (representing 120 total cases as a percentage of the population) **Key Epidemiological Concepts:** - **Incidence** = Number of NEW cases during a time period / Population at risk - **Prevalence** = Total number of existing cases / Total population - In this question, the prevalence of 1.2% represents the cumulative case burden (100 initial + 20 new = 120 cases) expressed as a percentage of the population (120/10,000 × 100 = 1.2%)

Q: In which of the following should a cotton swab with pus be discarded?

Yellow non-chlorination bag. ***Yellow non-chlorination bag*** - Cotton swabs soiled with pus are classified as **Soiled Waste** (infectious waste) which must be collected in the designated **yellow bag**.- To prepare this waste for final disposal via **incineration** or deep burial, it should not undergo pre-treatment like chlorination; hence, it goes into a non-chlorination yellow bag.*Yellow chlorination bag*- Chemical disinfection, such as **chlorination**, is primarily performed on liquid microbiological waste or highly contaminated liquid waste before discharge, not typically inside the collection bag for solid soiled cotton waste.- Soiled waste collected in the yellow bag is destined for **high-temperature treatment** (incineration), making immediate chlorination within the bag unnecessary and potentially hazardous.*Red chlorination bag*- The **red bag** is designated for **contaminated recyclable plastic waste** (like IV bottles, catheters, syringes without needles), which is processed via autoclaving/microwave disinfection.- Cotton swabs are non-plastic, **non-recyclable soiled waste** and therefore do not belong in the red category.*Red non-chlorination bag*- The **red bag** is strictly reserved for contaminated **plastic and rubber items** that require disinfection before recycling.- Since the cotton swab is **soiled non-plastic waste**, it must be segregated into the yellow category, regardless of whether chlorination is used or not (which it is not for this item).

Q: What is the eye manifestation seen in HLA B27-positive patients with ulcerative colitis?

Uveitis. ***Uveitis***- **Anterior uveitis** (or iritis) is the most common ocular manifestation associated with **HLA-B27 positive spondyloarthropathies** (like ankylosing spondylitis), which frequently co-occur with **ulcerative colitis** (UC) [1].- This association highlights a shared inflammatory pathway between the gut, joints, and eyes, typical of **extra-intestinal manifestations of IBD** [2]. *Conjunctivitis*- **Conjunctivitis** is a non-specific, less severe eye manifestation sometimes seen in IBD, but it does not carry the strong, specific association with the **HLA-B27** genotype.- It typically involves inflammation of the conjunctiva and is generally self-limiting, unlike the vision-threatening nature of uveitis.*Scleritis*- **Scleritis** involves painful, severe inflammation of the sclera and is a less frequent, though severe, ocular complication of IBD.- While associated with UC, scleritis is clinically distinct from uveitis and is more strongly linked to systemic vasculitides like **Polyarteritis Nodosa** or **Rheumatoid Arthritis** rather than the primary HLA-B27/IBD link.*Iridocyclitis*- **Iridocyclitis** is anatomically synonymous with **anterior uveitis**, describing inflammation of the iris and ciliary body.- As **Uveitis** is the standard, encompassing term used in MCQs for the classic HLA-B27 associated ocular pathology, it is the best fit, even though iridocyclitis describes the pathology precisely.

Q: A 58-year-old male with history of multiple sexual partners presented with anorexia and jaundice. The biopsy shows ground-glass opacity in the cells. What is the most probable diagnosis?

Hepatitis B. ***Hepatitis B***- The biopsy finding of **ground-glass opacity** in hepatocytes is pathognomonic for chronic **Hepatitis B Virus (HBV)** infection, caused by the accumulation of **Hepatitis B surface antigen (HBsAg)** in the endoplasmic reticulum [1].- The patient's presentation of jaundice and anorexia, combined with the risk factor of **multiple sexual partners**, is highly suggestive of HBV transmission [3].*Hepatitis A*- Hepatitis A is transmitted via the **fecal-oral route** and rarely leads to chronic liver disease, making it unlikely given the patient's risk profile and chronic signs [2].- Histologically, it causes predominantly **acute panlobular hepatitis** without the distinguishing ground-glass inclusions.*Hepatitis C*- Histologic evaluation of Hepatitis C often reveals **lymphoid aggregates** within the portal tracts and prominent **steatosis** (fatty change), rather than ground-glass inclusions [1].- While transmitted parenterally and potentially sexually, the absence of the characteristic HCV histological features makes this diagnosis less likely.*Hepatitis D*- Hepatitis D is a **defective virus** requiring co-infection or superinfection with **Hepatitis B** for replication.- Although often co-existing with HBV, the specific **ground-glass appearance** results from the accumulation of **HBsAg**, the protein produced primarily by the Hepatitis B virus [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 843-844. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 844-845. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 838.

Q: A diabetic male presented with seizures. Radiological examination shows a lesion. Histopathological examination shows liquefactive necrosis. What is the most important mechanism responsible for this?

Enzymatic degradation. ***Enzymatic degradation*** - Liquefactive necrosis, common in the brain (e.g., in stroke or brain abscess as suggested by the presentation in a **diabetic** patient), is defined by the complete dissolution of dead tissue into a viscous liquid mass [1]. - This dissolution is mediated by the robust release of **hydrolytic enzymes** from inflammatory cells (like **neutrophils** in an abscess) and the deceased parenchymal cells themselves, leading to the formation of a fluid-filled cavity [1]. *Mechanical* - Mechanical injury (trauma) is a *cause* of cell death and tissue damage, but it does not describe the specific biochemical process of liquefying the dead cells. - Mechanical factors primarily lead to **coagulative necrosis** initially if blood supply is compromised, or immediate cellular disruption, which is then processed by other mechanisms. *Ischemic* - Ischemia (lack of blood flow) is a common *cause* of necrosis (e.g., cerebral infarction), which often results in liquefactive necrosis in the CNS due to its high lipid content [1]. - While ischemia is the initiating event in many cases of liquefaction (especially stroke), the actual conversion of solid dead tissue into a liquid consistency requires the action of catabolic **enzymes**. *Pressure* - Pressure usually leads to generalized **atrophy** or localized **ischemia** (e.g., pressure sores or hydrocephalus), but it is not the fundamental molecular mechanism defining liquefactive necrosis. - Severe localized pressure that compromises microcirculation leads to ischemic injury, and the subsequent type of necrosis (liquefactive or coagulative) depends on the affected organ. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1268-1269.

Q: An 8-year-old child presents with enuresis (bedwetting). The parents mention the child had a fall from bed once, but has no other significant medical history. There are no signs of urinary tract infection or neurological deficits. What is the best next step in management?

Behavioral modification. ***Behavioral modification*** - **Behavioral modification** is the established first-line management approach for **monosymptomatic nocturnal enuresis (MNE)** in children aged 5 years and older, particularly when underlying organic causes are ruled out. - This includes techniques like **bedwetting alarms** (most effective long-term treatment), motivational therapy, and restricting evening fluid intake. *Start desmopressin therapy* - **Desmopressin (DDAVP)** is the most common pharmacological agent for MNE, used for severe symptoms or situational control (e.g., sleepovers). - However, desmopressin is typically initiated *after* an adequate trial (3-6 months) of **behavioral therapies** has failed, making it a second-line, not first-line, option. *Order renal ultrasound and voiding cystourethrogram* - Imaging studies are **not routinely indicated** in uncomplicated primary MNE without red flags. - These investigations are reserved for cases with **secondary enuresis**, daytime symptoms, recurrent UTIs, abnormal physical findings, or suspected anatomical abnormalities. - The current presentation has no concerning features warranting immediate imaging. *Prescribe oxybutynin* - Oxybutynin is an anticholinergic agent used primarily when enuresis is due to **reduced functional bladder capacity** or **daytime wetting** associated with urgency. - It is typically a **second-line agent** or used only when a full workup identifies specific bladder dynamics issues, following the failure of behavioral therapy.

Q: A 5-year-old child presents with exertional dyspnea and a history of cyanotic spells. On examination, there is clubbing and a harsh systolic murmur heard at the left upper sternal border. Chest X-ray is shown below. What is the most likely diagnosis?

Tetralogy of Fallot. ***Tetralogy of Fallot*** - The clinical triad of **exertional dyspnea**, **cyanotic spells** (tet spells), and a **harsh systolic murmur** at the left upper sternal border (due to pulmonary stenosis) is classic for this condition. - The chest X-ray shows a characteristic **"boot-shaped heart"** (coeur en sabot), which results from **right ventricular hypertrophy** (forming the toe) and a concave main pulmonary artery segment. *Total Anomalous Pulmonary Venous Connection* - The classic chest X-ray finding for TAPVC is a **"snowman sign"** or **"figure-of-eight"** appearance, which is not seen in the provided image. - While it is a cyanotic condition, it results from the mixing of oxygenated and deoxygenated blood and is associated with signs of right heart failure and pulmonary edema. *Transposition of the Great Arteries* - This condition typically presents with severe **cyanosis at birth** and requires immediate intervention for survival; presentation at age 5 is highly unlikely without prior surgery. - The characteristic radiographic sign is an **"egg-on-a-string"** appearance with a narrow superior mediastinum, differing from the boot shape seen here. *Atrial Septal Defect* - An ASD is an **acyanotic** heart defect (left-to-right shunt), so it does not cause cyanotic spells or clubbing in a 5-year-old. - The hallmark physical finding is a **wide, fixed splitting of S2**, not a harsh systolic murmur.

Q: Which of the following is considered harmful to a newborn baby in the immediate postnatal period?

Giving a bath immediately after birth. ***Giving a bath immediately after birth***- Immediate bathing is associated with a high risk of **neonatal hypothermia** due to rapid evaporative heat loss, as newborns have immature thermoregulatory systems.- Current guidelines (e.g., WHO) recommend delaying bathing for at least 6 hours, and ideally 24 hours, to allow for temperature stabilization and to preserve the protective **vernix caseosa**.*Cleaning the eyes with a wet sterile swab*- This is standard practice, usually followed by applying prophylactic eye ointment (e.g., erythromycin), to prevent **ophthalmia neonatorum** caused by organisms like *Neisseria gonorrhoeae* or *Chlamydia trachomatis*.- It is a safe and necessary procedure to prepare the eyes for prophylaxis, ensuring the area is free of potentially infectious material.*Initiating breastfeeding within 1 hour*- Early initiation of breastfeeding is part of **Essential Newborn Care** and is highly beneficial, helping to stabilize the neonate's blood glucose levels and preventing **hypoglycemia**.- Colostrum provides crucial passive immunity and facilitates strong **maternal-infant bonding**, stimulating uterine involution in the mother.*Placing the baby on the mother's chest*- This practice, known as **skin-to-skin contact** (SSC), is vital for maintaining the baby's temperature, as the mother’s chest provides optimal **thermal regulation**.- SSC reduces infant stress, stabilizes heart rate and respiration, and greatly facilitates the transition to **early breastfeeding**.

Q: A 4-month-old infant is brought to the emergency department with a respiratory rate of 66 breaths per minute, along with chest indrawing and nasal flaring. There are no other significant findings. What is the most likely diagnosis?

Severe pneumonia. ***Severe pneumonia*** - According to **WHO/IMCI guidelines**, pneumonia in infants (2-12 months) is classified based on clinical signs. - This 4-month-old has a respiratory rate of **66 breaths/minute** (tachypnea, as RR ≥ 50 is abnormal) along with **chest indrawing** and **nasal flaring**. - The presence of **chest indrawing** is the defining feature that classifies this as **severe pneumonia** rather than simple fast-breathing pneumonia. - WHO classification: Fast breathing alone = pneumonia; Fast breathing + chest indrawing = **severe pneumonia**; danger signs (inability to feed, lethargy, cyanosis) = very severe disease. *Pneumonia* - Simple **pneumonia** (or fast-breathing pneumonia) would be diagnosed if the infant had only **tachypnea** (RR ≥ 50/min) **without** chest indrawing or other danger signs. - Since this infant has **chest indrawing**, it automatically upgrades the classification to severe pneumonia per WHO/IMCI criteria. - This distinction is clinically important as it determines management (severe pneumonia requires hospitalization and parenteral antibiotics). *Severe asthma* - **Asthma** is very uncommon in a 4-month-old infant, as it typically develops later following sensitization and recurrent episodes, often associated with atopy. - The hallmark feature of asthma is audible **wheezing**, which is not mentioned in this presentation. - While respiratory distress can occur in asthma, the absence of wheezing and the age make this diagnosis unlikely. *Common cold* - A **common cold** is a mild upper respiratory tract infection (URTI) that presents with nasal congestion, rhinorrhea, and possibly mild cough. - It does not cause significant respiratory distress such as severe **tachypnea** (RR 66/min) or **chest indrawing**. - The degree of respiratory compromise described here is far beyond what would be expected in a common cold.

Q: A 2-week-old infant presents with high conjugated (direct) bilirubin, dark-colored urine, and clay-colored stools. On examination, the infant appears jaundiced, but is feeding normally. What is the most likely diagnosis?

Biliary atresia. ***Biliary atresia*** - High **conjugated hyperbilirubinemia** combined with characteristic signs of biliary obstruction, such as **acholic (clay-colored) stools** and **dark urine**, is the classic presentation of **biliary atresia** in infants typically presenting after the first week of life. - This condition involves progressive obliteration of the extrahepatic **biliary tree**, requiring urgent diagnosis and treatment (Kasai procedure) before 60 days of age to prevent irreversible **cirrhosis**. *Crigler-Najjar syndrome* - This disorder results from a severe deficiency or absence of **UGT1A1** activity, leading exclusively to severe **unconjugated hyperbilirubinemia** and a high risk of **kernicterus**. - It does not involve excretion issues causing **conjugated hyperbilirubinemia** or evidence of biliary blockage like **acholic stools**. *Gilbert's syndrome* - This syndrome is characterized by **unconjugated hyperbilirubinemia** due to reduced activity of the hepatic enzyme **UDP-glucuronosyltransferase (UGT1A1)**, not the conjugated form seen here. - It is generally an inherited, benign condition that presents later in life (adolescence/adulthood) and does not cause **biliary obstruction** symptoms (clay stools, dark urine). *Physiological jaundice* - **Physiological jaundice** typically presents with **unconjugated hyperbilirubinemia**, begins *after* 24 hours of life, peaks around 3-5 days, and usually resolves by 1-2 weeks. - The presentation at 2 weeks with *conjugated* hyperbilirubinemia (which is always pathological) and signs of obstruction rules out this benign, self-limiting cause.

Question 1

On January 1, 2024, an area with a population of 10,000 had 100 TB cases. During the year, 30 patients were cured and 10 died. Twenty new TB cases were reported, and 5 of them were cured before December 31, 2024. What is the incidence and prevalence of TB cases?

Accepted Answer

2 and 1.2

Answer

1.2 and 12

Answer

2 and 10

Answer

1.2 and 10

Question 2

In which of the following should a cotton swab with pus be discarded?

Accepted Answer

Yellow non-chlorination bag

Answer

Yellow chlorination bag

Answer

Red non-chlorination bag

Answer

Red chlorination bag

Question 3

What is the eye manifestation seen in HLA B27-positive patients with ulcerative colitis?

Accepted Answer

Uveitis

Answer

Iridocyclitis

Answer

Scleritis

Answer

Conjunctivitis

Question 4

A 58-year-old male with history of multiple sexual partners presented with anorexia and jaundice. The biopsy shows ground-glass opacity in the cells. What is the most probable diagnosis?

Accepted Answer

Hepatitis B

Answer

Hepatitis D

Answer

Hepatitis A

Answer

Hepatitis C

Question 5

A diabetic male presented with seizures. Radiological examination shows a lesion. Histopathological examination shows liquefactive necrosis. What is the most important mechanism responsible for this?

Accepted Answer

Enzymatic degradation

Answer

Ischemic

Answer

Mechanical

Answer

Pressure

Question 6

An 8-year-old child presents with enuresis (bedwetting). The parents mention the child had a fall from bed once, but has no other significant medical history. There are no signs of urinary tract infection or neurological deficits. What is the best next step in management?

Accepted Answer

Behavioral modification

Answer

Start desmopressin therapy

Answer

Order renal ultrasound and voiding cystourethrogram

Answer

Prescribe oxybutynin

Question 7

A 5-year-old child presents with exertional dyspnea and a history of cyanotic spells. On examination, there is clubbing and a harsh systolic murmur heard at the left upper sternal border. Chest X-ray is shown below. What is the most likely diagnosis?

Accepted Answer

Tetralogy of Fallot

Answer

Total Anomalous Pulmonary Venous Connection

Answer

Atrial Septal Defect

Answer

Transposition of the Great Arteries

Question 8

Which of the following is considered harmful to a newborn baby in the immediate postnatal period?

Accepted Answer

Giving a bath immediately after birth

Answer

Placing the baby on the mother's chest

Answer

Cleaning the eyes with a wet sterile swab

Answer

Initiating breastfeeding within 1 hour

Question 9

A 4-month-old infant is brought to the emergency department with a respiratory rate of 66 breaths per minute, along with chest indrawing and nasal flaring. There are no other significant findings. What is the most likely diagnosis?

Accepted Answer

Severe pneumonia

Answer

Pneumonia

Answer

Severe asthma

Answer

Common cold

Question 10

A 2-week-old infant presents with high conjugated (direct) bilirubin, dark-colored urine, and clay-colored stools. On examination, the infant appears jaundiced, but is feeding normally. What is the most likely diagnosis?

Accepted Answer

Biliary atresia

Answer

Crigler-Najjar syndrome

Answer

Gilbert’s syndrome

Answer

Physiological jaundice

FMGE 2025

Community Medicine

Internal Medicine

Pathology

Pediatrics