Community Medicine
6 questionsAn elderly man presents with leg deformities and skeletal abnormalities. On examination, he is using crutches and has visible bowing of the legs. It is also noted that several other villagers exhibit similar symptoms. Considering the cluster of cases in the same geographic area, which of the following is the most appropriate next step in the investigation?
A patient presents with increased consumption of Bajra (pearl millet) roti and now complains of drowsiness and giddiness. What is the most likely diagnosis?
Out of the MR & Pentavalent vaccine, which can be reused, and which one should be discarded when the vial is opened according to the open vial policy?
In a group, the mean blood glucose level is 105 mg/dL with a standard deviation of 10 mg/dL. Assuming a normal distribution, what is the expected range of blood glucose values for approximately 95% of the population?
In a family with three siblings, the eldest sibling moves out of the household, and a new (third) child is born. What is this change in the family structure called?
A person has recently moved from Nigeria to the United States. Which of the following vaccines is required for international travel from Nigeria to the USA?
FMGE 2025 - Community Medicine FMGE Practice Questions and MCQs
Question 581: An elderly man presents with leg deformities and skeletal abnormalities. On examination, he is using crutches and has visible bowing of the legs. It is also noted that several other villagers exhibit similar symptoms. Considering the cluster of cases in the same geographic area, which of the following is the most appropriate next step in the investigation?
- A. Collect and analyze water samples for fluoride content (Correct Answer)
- B. Perform parathyroid hormone (PTH) assay
- C. Check serum vitamin D levels
- D. Measure serum calcium levels
Explanation: ***Collect and analyze water samples for fluoride content*** - The presentation of a cluster of cases with **skeletal deformities** (bowing of the legs) in a single geographic area strongly suggests an endemic condition related to an **environmental exposure**, such as a contaminated water source. - The clinical picture is highly consistent with **skeletal fluorosis**, and the accompanying image showing mottled enamel is a classic sign of **dental fluorosis**, both caused by chronic high intake of fluoride. *Check serum vitamin D levels* - Vitamin D deficiency causes **osteomalacia** in adults, which can lead to bone deformities, but it does not cause the specific **dental fluorosis** seen in the image. - While a community-wide nutritional deficiency is possible, the combination of skeletal and dental findings makes an environmental toxin a more specific and likely cause to investigate first. *Measure serum calcium levels* - Serum calcium levels are typically **normal** in patients with skeletal fluorosis, so this test would have low diagnostic yield for the suspected condition. - While metabolic bone diseases can present with abnormal calcium, they do not explain the endemic nature of the presentation or the characteristic dental findings. *Perform parathyroid hormone (PTH) assay* - **Hyperparathyroidism** is an endocrine disorder that is unlikely to affect multiple individuals in the same village simultaneously. - The clinical and radiological features of hyperparathyroidism, such as **osteitis fibrosa cystica**, differ from those of skeletal fluorosis, and it is not associated with dental fluorosis.
Question 582: A patient presents with increased consumption of Bajra (pearl millet) roti and now complains of drowsiness and giddiness. What is the most likely diagnosis?
- A. Fusarium Toxicity
- B. Ergotism (Correct Answer)
- C. Botulism
- D. Epidemic Dropsy
Explanation: ***Ergotism*** - This condition results from ingesting grains, such as **pearl millet (Bajra)**, contaminated by the fungus *Claviceps fusiformis*. - The neurotoxic effects of **ergot alkaloids** cause the central nervous system (CNS) symptoms of the convulsive form, including **drowsiness** and **giddiness**. *Epidemic Dropsy* - This toxicity is caused by ingesting edible oils (typically mustard oil) contaminated with **argemone oil**. - The cardinal features are non-pitting **edema** (dropsy), skin pigmentation, and rarely, secondary glaucoma, not primarily CNS giddiness. *Botulism* - This illness is caused by the potent neurotoxin produced by *Clostridium botulinum*, usually found in improperly canned or preserved food. - The defining clinical presentation is a classic descending, symmetric **flaccid paralysis** often starting with cranial nerve symptoms (**diplopia, dysphagia**). *Fusarium Toxicity* - This involves various mycotoxins (e.g., **fumonisins, T-2 toxin**) contaminating cereals, most commonly maize. - Clinical syndromes include severe immunosuppression (Alimentary Toxic Aleukia) or liver/kidney damage, not the primary presentation of acute drowsiness and giddiness.
Question 583: Out of the MR & Pentavalent vaccine, which can be reused, and which one should be discarded when the vial is opened according to the open vial policy?
- A. Reuse both MR and Pentavalent
- B. Discard MR, reuse Pentavalent (Correct Answer)
- C. Discard both MR and Pentavalent
- D. Discard Pentavalent, reuse MR
Explanation: ***Discard MR, reuse Pentavalent***- The **MR (Measles-Rubella) vaccine** is a **lyophilized (freeze-dried) live attenuated vaccine** that is reconstituted with a diluent; once reconstituted, it must be discarded within **6 hours** or at the end of the immunization session, whichever comes first, due to the lack of an effective preservative.- The **Pentavalent vaccine** is a multi-dose, liquid formulation that contains an antimicrobial **preservative** (usually **thiomersal**), allowing the open vial to be reused for up to **28 days**, provided the cold chain is maintained and the vial has not been contaminated (Open Vial Policy eligibility).*Discard Pentavalent, reuse MR*- The **Pentavalent vaccine**, being a liquid multi-dose form with a preservative, is a designated candidate for reuse under the **Open Vial Policy**, allowing its continued use up to 28 days.- **MR vaccine** cannot be reused beyond the 6-hour limit because reconstitution significantly reduces its stability and introduces contamination risk in the absence of an effective preservative.*Discard both MR and Pentavalent*- Discarding the **Pentavalent vaccine** after every session contradicts the fundamental principle of the **Open Vial Policy**, which aims to maximize vaccine utilization and minimize wastage for multi-dose preserved vaccines.- While **MR vaccine** must be discarded as per protocol, the Pentavalent vaccine is stable and safe for reuse up to 28 days if specific conditions (like proper storage and lack of vial submersion) are met.*Reuse both MR and Pentavalent*- Reusing the **MR vaccine** beyond 6 hours or the session end is medically inappropriate and risky due to the high susceptibility of the reconstituted vaccine to bacterial growth and potential loss of vaccine potency.- Only vaccines that are liquid, contain a preservative, and are supplied in multi-dose vials (like Pentavalent) are eligible for the extended 28-day reuse under the standard **Open Vial Policy**.
Question 584: In a group, the mean blood glucose level is 105 mg/dL with a standard deviation of 10 mg/dL. Assuming a normal distribution, what is the expected range of blood glucose values for approximately 95% of the population?
- A. 85 – 125 mg/dL (Correct Answer)
- B. 101 – 110 mg/dL
- C. 95 – 115 mg/dL
- D. 90 – 125 mg/dL
Explanation: ***85 – 125 mg/dL*** - This range is calculated using the **Empirical Rule** ($\text{Mean} \pm 2 \text{ SD}$), which states that approximately 95% of observations in a **normal distribution** fall within two standard deviations of the mean. - Calculation: $105 \text{ mg/dL} \pm (2 \times 10 \text{ mg/dL}) = 105 \pm 20 \text{ mg/dL}$, resulting in the range **85 – 125 mg/dL**. *101 – 110 mg/dL* - This range is too narrow, only covering values $5 \text{ mg/dL}$ above and below the mean, and does not represent the required **95%** coverage for a 10 mg/dL standard deviation. - Using this small range indicates an incorrect application of the **standard deviation** multiplier necessary for determining large confidence intervals. *90 – 125 mg/dL* - While the upper limit ($125 \text{ mg/dL}$) is correct ($\text{Mean} + 2 \text{ SD}$), the lower limit ($90 \text{ mg/dL}$) is incorrect, as it must be symmetrical around the mean in a **normal distribution**. - This asymmetrical range does not accurately represent the **95% confidence interval** defined by $\text{Mean} \pm 2 \text{ SD}$. *95 – 115 mg/dL* - This range is calculated using $\text{Mean} \pm 1 \text{ SD}$ ($105 \pm 10 \text{ mg/dL}$), which only includes approximately **68%** of the data according to the **Empirical Rule**, not 95%. - To capture **95%** of the population data, clinicians and students must use **two standard deviations** from the mean.
Question 585: In a family with three siblings, the eldest sibling moves out of the household, and a new (third) child is born. What is this change in the family structure called?
- A. Contraction
- B. Formation
- C. Complete extension (Correct Answer)
- D. Extension
Explanation: ***Complete extension*** - This stage of the family life cycle begins with the birth of the **last child**, representing the point at which the family has reached its maximum size. - Although the eldest sibling has moved out (a contraction event), the birth of the new child marks the completion of the family's growth phase. *Formation* - The formation stage starts with **marriage** and lasts until the birth of the **first child**. - This family already has multiple children, indicating they are well beyond the initial formation stage. *Contraction* - The contraction stage begins when the **first child leaves home** and ends when the last child leaves, leading to the "empty nest" stage. - While a child leaving home is an event of contraction, the overall stage is defined by the final birth, which is complete extension. *Extension* - The extension stage is a broader phase that starts with the birth of the **first child** and continues as more children are born. - "Complete extension" is the more specific and accurate term for the point when the **last child** is born, finalizing the family's size.
Question 586: A person has recently moved from Nigeria to the United States. Which of the following vaccines is required for international travel from Nigeria to the USA?
- A. Japanese Encephalitis (JE) vaccine
- B. Yellow Fever (17D) vaccine (Correct Answer)
- C. Measles vaccine
- D. Rabies vaccine
Explanation: ***Yellow Fever (17D) vaccine*** - This vaccine is **required** because Nigeria is considered **endemic for Yellow Fever** and is listed under the **International Health Regulations (IHR)** as a country requiring proof of vaccination. - The US government and the WHO mandate an **International Certificate of Vaccination or Prophylaxis (ICVP)** showing YF vaccination for travelers arriving from or transiting through endemic countries. - This is a **mandatory port of entry requirement** for international travel from Nigeria to the USA. *Japanese Encephalitis (JE) vaccine* - The Japanese Encephalitis virus circulation is limited to **Asia and the Western Pacific**, making it irrelevant for travel originating in Africa (Nigeria) to the USA. - This vaccine is recommended only for prolonged travel or residence in endemic rural or agricultural areas of Asia, not for Nigeria-USA travel. *Measles vaccine* - The Measles vaccine (MMR) is part of **routine immunization** recommendations, but it is not the specific **mandatory port of entry requirement** triggered by Nigeria's endemic disease status. - While immigrants to the US often require proof of age-appropriate vaccinations, Yellow Fever is the specific and critical requirement for international clearance from Nigeria. *Rabies vaccine* - The Rabies vaccine is a **pre-exposure prophylaxis** recommended for high-risk individuals (veterinarians, prolonged rural stay, contact with animals) but is **not a universally mandated travel requirement**. - Rabies is not classified as a quarantinable disease for which vaccination is strictly required for entry into the US from Nigeria.
Internal Medicine
1 questionsA teenage boy, who was previously raised as a girl, presents with primary amenorrhea and lack of secondary sexual characteristics. On examination, he has tall stature, small testes, and gynecomastia. Which of the following is the most likely genotype?
FMGE 2025 - Internal Medicine FMGE Practice Questions and MCQs
Question 581: A teenage boy, who was previously raised as a girl, presents with primary amenorrhea and lack of secondary sexual characteristics. On examination, he has tall stature, small testes, and gynecomastia. Which of the following is the most likely genotype?
- A. 47,XYY
- B. 47,XXY (Correct Answer)
- C. 45,X
- D. 46,XX
Explanation: ***Correct: 47,XXY (Klinefelter Syndrome)*** - This patient presents with **classic features of Klinefelter syndrome**: tall stature, small firm testes, gynecomastia, and hypogonadism [1]. - The **47,XXY karyotype** results from meiotic nondisjunction leading to an extra X chromosome. - **Hypogonadism** causes decreased testosterone, leading to lack of secondary sexual characteristics and increased FSH/LH [1]. - Patients typically have **eunuchoid body proportions** (tall stature with long limbs) due to delayed epiphyseal closure [1]. - The presence of **gynecomastia** is due to relative estrogen excess compared to testosterone [1]. - Primary amenorrhea mentioned here likely refers to the lack of pubertal development (developmental delay). *Incorrect: 47,XYY (Supermale Syndrome)* - These individuals are **tall males with normal virilization** and normal-sized testes - No gynecomastia or hypogonadism - Often associated with learning difficulties but normal sexual development *Incorrect: 45,X (Turner Syndrome)* - Presents in **phenotypic females** with **short stature** (not tall) [2]. - Features include webbed neck, shield chest, coarctation of aorta - Primary amenorrhea present but patient would be raised as female throughout - Does not explain male phenotype or gynecomastia in this case *Incorrect: 46,XX (Normal Female Karyotype)* - Normal female karyotype would not explain **male phenotype** with testes - Does not account for gynecomastia or the clinical presentation described
Pediatrics
3 questionsA newborn presents with jaundice, conjugated hyperbilirubinemia, intrahepatic cholestasis, and elevated alkaline phosphatase. Liver biopsy reveals eosinophilic, PAS-positive cytoplasmic granules in hepatocytes. What is the most likely diagnosis?
A child presents with recurrent sinusitis and repeated lung infections. Genetic testing shows a mutation in the CFTR gene. Which test is considered the gold standard to confirm the diagnosis?
A mother brings her 9-month-old baby, concerned that no BCG scar has appeared, although the baby received the BCG vaccine at birth. What is the next best step?
FMGE 2025 - Pediatrics FMGE Practice Questions and MCQs
Question 581: A newborn presents with jaundice, conjugated hyperbilirubinemia, intrahepatic cholestasis, and elevated alkaline phosphatase. Liver biopsy reveals eosinophilic, PAS-positive cytoplasmic granules in hepatocytes. What is the most likely diagnosis?
- A. Neonatal hepatitis (Correct Answer)
- B. Physiological
- C. Hypoplasia of the biliary tract
- D. Choledochal cyst
Explanation: ***Neonatal hepatitis***- **Neonatal hepatitis** is a broad term encompassing various causes of **intrahepatic cholestasis** in infants, including viral infections and metabolic disorders like **Alpha 1 AT deficiency**.- The presence of eosinophilic, **PAS-positive cytoplasmic granules** in the liver biopsy is virtually pathognomonic for **Alpha 1 AT deficiency**, which is a leading identifiable cause grouped under this overall diagnosis.*Hypoplasia of the biliary tract*- This refers to a reduction or paucity of bile ducts (e.g., in **Alagille syndrome**) leading to cholestasis, but it is less common than other causes of intrahepatic cholestasis.- While it causes conjugated hyperbilirubinemia, the damage pattern is primarily related to duct paucity rather than the specific hepatocyte injury and granule accumulation of **A1AT deficiency**.*Choledochal cyst*- A **choledochal cyst** is an extrahepatic cause of cholestasis resulting from obstruction and dilatation of the **common bile duct**.- It typically presents with extrahepatic obstruction, and while it causes conjugated hyperbilirubinemia, it would not explain the classic **intrahepatic cellular findings** (PAS-positive granules) seen with A1AT deficiency.*Physiological*- **Physiological jaundice** is caused by the inability of the immature liver to process bilirubin, resulting exclusively in **unconjugated hyperbilirubinemia**.- Since this neonate presents with **conjugated hyperbilirubinemia**, physiological jaundice is excluded, as this finding always mandates immediate investigation for underlying pathology (**cholestasis**).
Question 582: A child presents with recurrent sinusitis and repeated lung infections. Genetic testing shows a mutation in the CFTR gene. Which test is considered the gold standard to confirm the diagnosis?
- A. Chest X-ray
- B. Lung biopsy
- C. Nasal swab culture
- D. Sweat chloride test (Correct Answer)
Explanation: ***Sweat chloride test*** - It is recognized as the **gold standard** test for diagnosing Cystic Fibrosis in patients with suggestive symptoms or positive genetic screening (CFTR mutation). - The test measures non-reabsorbed chloride ions in the sweat, with levels **≥ 60 mEq/L** typically confirming the diagnosis due to **CFTR protein dysfunction**. *Lung biopsy* - This is an **invasive procedure** with significant risk and is not required for the standard diagnosis of Cystic Fibrosis. - While it might show findings consistent with severe CF (e.g., **bronchiectasis**), genetic testing and the sweat test provide definitive, less invasive confirmation. *Chest X-ray* - A Chest X-ray is a **radiographic imaging tool** used to monitor the progression of lung disease (e.g., presence of **hyperinflation** or **bronchiectasis**). - It is not a diagnostic test for the underlying CFTR defect and cannot definitively confirm the diagnosis of Cystic Fibrosis. *Nasal swab culture* - This test is used to identify common pathogens such as **Pseudomonas aeruginosa** or **Staphylococcus aureus**, which frequently colonize the airways of CF patients. - It is essential for managing **pulmonary exacerbations** and guiding antibiotic selection but does not assess CFTR function or establish the primary diagnosis.
Question 583: A mother brings her 9-month-old baby, concerned that no BCG scar has appeared, although the baby received the BCG vaccine at birth. What is the next best step?
- A. Do the Mantoux test & wait for the result
- B. Refer the baby for a chest X-ray & further evaluation
- C. Give the BCG vaccine immediately
- D. Reassure the mother (Correct Answer)
Explanation: ***Reassure the mother*** - The absence of a characteristic **BCG scar** up to 9 months later is common and does not indicate **vaccination failure** if the vaccine was properly administered and documented. - Standard vaccination protocols generally recommend **no re-vaccination** or immediate investigation solely based on the lack of a scar in an otherwise healthy infant. *Give the BCG vaccine immediately* - **Re-vaccination** without evidence of non-conversion (which is not routinely assessed) is not standard practice and carries the risk of increased **local adverse reactions**. - Current public health policies consider a single documented BCG dose adequate protection, regardless of the subsequent **cutaneous reaction**. *Do the Mantoux test & wait for the result* - The **Mantoux test (TST)** is not recommended solely for assessing BCG efficacy or scar absence in asymptomatic children due to difficulties in defining a protective threshold. - Finding a negative TST result does not currently mandate **re-vaccination**, as international guidelines prioritize coverage reliability over scar/TST status. *Refer the baby for a chest X-ray & further evaluation* - Extensive investigations, including a **chest X-ray**, are reserved for children presenting with signs or symptoms highly suggestive of **active tuberculosis disease**. - Performing aggressive workups on an asymptomatic child solely for an absent scar constitutes an excessive response and is not supported by clinical guidelines.