Community Medicine
2 questionsOn 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?
In which of the following should a cotton swab with pus be discarded?
FMGE 2025 - Community Medicine FMGE Practice Questions and MCQs
Question 571: 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?
- A. 2 and 1.2 (Correct Answer)
- B. 1.2 and 12
- C. 2 and 10
- D. 1.2 and 10
Explanation: ***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%)
Question 572: In which of the following should a cotton swab with pus be discarded?
- A. Yellow chlorination bag
- B. Yellow non-chlorination bag (Correct Answer)
- C. Red non-chlorination bag
- D. Red chlorination bag
Explanation: ***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).
Internal Medicine
1 questionsWhat is the eye manifestation seen in HLA B27-positive patients with ulcerative colitis?
FMGE 2025 - Internal Medicine FMGE Practice Questions and MCQs
Question 571: What is the eye manifestation seen in HLA B27-positive patients with ulcerative colitis?
- A. Iridocyclitis
- B. Scleritis
- C. Uveitis (Correct Answer)
- D. Conjunctivitis
Explanation: ***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.
Pathology
2 questionsA 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?
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?
FMGE 2025 - Pathology FMGE Practice Questions and MCQs
Question 571: 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?
- A. Hepatitis B (Correct Answer)
- B. Hepatitis D
- C. Hepatitis A
- D. Hepatitis C
Explanation: ***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.
Question 572: 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?
- A. Ischemic
- B. Mechanical
- C. Pressure
- D. Enzymatic degradation (Correct Answer)
Explanation: ***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.
Pediatrics
5 questionsAn 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?
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?
Which of the following is considered harmful to a newborn baby in the immediate postnatal period?
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?
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?
FMGE 2025 - Pediatrics FMGE Practice Questions and MCQs
Question 571: 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?
- A. Behavioral modification (Correct Answer)
- B. Start desmopressin therapy
- C. Order renal ultrasound and voiding cystourethrogram
- D. Prescribe oxybutynin
Explanation: ***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.
Question 572: 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?
- A. Total Anomalous Pulmonary Venous Connection
- B. Atrial Septal Defect
- C. Tetralogy of Fallot (Correct Answer)
- D. Transposition of the Great Arteries
Explanation: ***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.
Question 573: Which of the following is considered harmful to a newborn baby in the immediate postnatal period?
- A. Giving a bath immediately after birth (Correct Answer)
- B. Placing the baby on the mother's chest
- C. Cleaning the eyes with a wet sterile swab
- D. Initiating breastfeeding within 1 hour
Explanation: ***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**.
Question 574: 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?
- A. Severe pneumonia (Correct Answer)
- B. Pneumonia
- C. Severe asthma
- D. Common cold
Explanation: ***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.
Question 575: 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?
- A. Biliary atresia (Correct Answer)
- B. Crigler-Najjar syndrome
- C. Gilbert’s syndrome
- D. Physiological jaundice
Explanation: ***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.