FMGE 2026 Practice Questions

Q: A chronic alcohol abuser is brought to hospital with complains of chronic liver diease. Which of the following you will add in the treatment?

Vitamin B1. ### ***Vitamin B1 (Thiamine)*** - Chronic alcohol use leads to **thiamine deficiency** due to inadequate dietary intake and impaired GI absorption, necessitating prophylactic oral or parenteral supplementation. - Deficiency puts the patient at high risk for **Wernicke-Korsakoff syndrome**, a potentially irreversible neurological disorder characterized by confusion, ophthalmoplegia, and ataxia. *Vitamin A* - While patients with chronic liver disease might develop deficiencies due to impaired storage, routine supplementation is generally not indicated without evidence of deficiency. - Excessive Vitamin A supplementation can be **hepatotoxic**, worsening underlying liver damage in this patient population. *Vitamin C* - Vitamin C deficiency is not a primary or immediate concern in the management of chronic alcohol-associated liver disease. - It is water-soluble but does not carry the same critical neurological risk profile associated with alcohol misuse as thiamine does. *Vitamin D* - While patients with cirrhosis are at risk for metabolic bone disease and Vitamin D deficiency, it is not the immediate, life-saving prophylaxis required upon admission. - Supplementation is typically guided by serum **25-hydroxyvitamin D levels** rather than being a mandatory first-line intervention like thiamine for preventing neurological catastrophe.

Q: A trekker at high altitude develops ataxia and confusion, followed by pulmonary edema. What is the most appropriate management?

Rapid descent. ***Rapid descent*** - This patient is presenting with symptoms of both **high-altitude cerebral edema (HACE)**, indicated by **ataxia** and **confusion**, and **high-altitude pulmonary edema (HAPE)**. - Regardless of the altitude illness type, **immediate descent** to a lower altitude is the single most effective, life-saving intervention and the gold standard for treatment. *Spironolactone* - This is a potassium-sparing diuretic that is not indicated for the management of altitude illnesses. - It lacks the rapid therapeutic efficacy required to reduce pulmonary or cerebral edema in an acute emergency setting. *Steroids* - **Dexamethasone** is an important adjunct for treating **HACE**, as it reduces cerebral edema, but it does not treat the primary cause or the pulmonary component. - It should never delay the primary, definitive treatment, which is descent to lower elevation. *Acetazolamide* - This medication is primarily used for the **prophylaxis** of acute mountain sickness or as an adjunct to aid acclimatization. - While it may be used as an adjunct in mild cases, it is insufficient as a standalone treatment for life-threatening conditions like severe **HACE** and **HAPE**.

Q: A child with low IQ, poor communication, presented with loss of bladder control/urinary incontinence. Which of the following is the most likely diagnosis?

Heller’s disease. ***Heller’s disease*** - Also known as **Childhood Disintegrative Disorder**, it is characterized by a marked regression in multiple areas of development, such as language, social skills, and bladder/bowel control, following a period of normal development for at least two years. - Diagnosis is often suspected when a child demonstrates a significant loss of previously acquired skills, often accompanied by global developmental delays (low IQ) and communication deficits. *Refsum’s disease* - This is a rare autosomal recessive metabolic disorder characterized by **phytanic acid accumulation** due to a deficiency in phytanoyl-CoA hydroxylase. - Clinical presentation typically includes **retinitis pigmentosa**, peripheral neuropathy, and cerebellar ataxia rather than developmental regression and urinary incontinence. *ADHD* - ADHD is a neurodevelopmental disorder marked by persistent patterns of **inattention**, **hyperactivity**, and **impulsivity** that interfere with functioning or development. - It does not involve the loss of previously acquired milestones or bladder control typically seen in degenerative or disintegrative disorders. *Weil’s disease* - This is the severe form of **Leptospirosis**, caused by infection with *Leptospira* bacteria, and presents with jaundice, acute kidney injury, and hemorrhage. - It is an acute infectious process, not a developmental disorder, and does not cause a loss of communication skills or developmental regression.

Q: Identify the breathing pattern shown in the image below:

Cheyne -Stokes breathing. ***Cheyne-Stokes breathing*** - Characterized by a **gradual waxing and waning** of tidal volume (amplitude) with periods of **apnea** between cycles. - Commonly associated with **congestive heart failure**, **stroke**, or severe **metabolic encephalopathy** due to impaired feedback loop sensitivity in the brainstem. *Biot's breathing* - Features **irregular** episodes of rapid, shallow breaths followed by unpredictable, variable periods of **apnea**. - Most typically associated with **increased intracranial pressure** or damage to the **medulla oblongata**. *Kussmaul breathing* - Presents as a deep, rapid, and **labored breathing** pattern characterized by a **sighing** quality. - Typically triggered by severe **metabolic acidosis**, most classically seen in **diabetic ketoacidosis (DKA)**. *Apneustic breathing* - Characterized by prolonged, **gasping inspirations** followed by extremely short, insufficient expirations. - Results from damage to the **pons**, often due to severe ischemic or hemorrhagic stroke.

Q: In the following Pressure-Volume curve of the bladder, what is the physiological basis for the segment labeled 1b?

Law of Laplace. ***Law of Laplace*** - Segment 1b on a bladder pressure-volume curve represents the **filling phase** of the bladder (cystometrogram), where the bladder wall exhibits **high compliance**. - This allows the bladder to accommodate increasing **volumes of urine** with minimal change in **intravesical pressure**, a property directly related to the **Law of Laplace** (P = 2T/r), which explains how the bladder wall tension adjusts to maintain low pressure even as the radius increases. *Sympathetic control* - Sympathetic stimulation occurs primarily during the **storage (filling) phase** via the **hypogastric nerve**, which promotes relaxation of the **detrusor muscle** (beta-3 receptors) and contraction of the **internal urethral sphincter** (alpha-1 receptors). - While the sympathetic system facilitates storage, segment 1b specifically describes the **passive mechanical property** of the bladder wall rather than the neural input itself. *Parasympathetic control* - Parasympathetic activation is the primary driver of the **voiding (micturition) phase**, mediated by the **pelvic splanchnic nerves** releasing acetylcholine onto **M3 receptors**. - This control leads to active **detrusor contraction** and a sharp rise in **intravesical pressure**, which corresponds to a different phase of the curve than the compliant filling phase. *Urethral valve* - The **urethra** and its associated sphincters act as the outlet mechanism, but they do not dictate the passive pressure-volume relationship of the **bladder wall** itself during filling. - The function of the urethral sphincter is to maintain **continence** to prevent leakage, rather than determining the **compliance** of the bladder reservoir.

Q: Based on the provided image of a nerve action potential, at which marked point is the combined transport of Na+ and K+ ions at its minimum?

Point E. ***Point E*** - This represents the **after-hyperpolarization phase** where voltage-gated **Na+ channels are inactivated** and **delayed rectifier K+ channels are closing**, resulting in minimal ion movement. - The membrane potential approaches the **K+ equilibrium potential**, and only the **Na+/K+-ATPase pump** operates at baseline levels to maintain ionic gradients. *Point A* - This is the **resting membrane potential** with continuous activity of **leak channels** allowing steady Na+ influx and K+ efflux. - Despite appearing stable, there is significant **background ion transport** through leak channels that maintains the resting potential. *Point B* - This marks the **threshold/depolarization phase** with massive opening of **voltage-gated Na+ channels** causing rapid Na+ influx. - This represents the **highest combined ion transport** phase, directly opposite to the minimum transport asked in the question. *Point C* - This corresponds to the **repolarization phase** with opening of **voltage-gated K+ channels** causing significant K+ efflux. - High **K+ conductance** results in substantial outward potassium transport to restore the membrane potential.

Q: Why is no new impulse generated during the depolarization phase of an action potential?

Voltage-gated sodium channels are inactivated. ***Voltage-gated sodium channels are inactivated*** - During the depolarization and early repolarization phases, **voltage-gated sodium channels** enter an **inactivated state** (the ball-and-chain mechanism), preventing further influx of sodium. - This state creates the **absolute refractory period**, meaning no new action potential can be triggered regardless of the strength of the stimulus. *Potassium channels are closed* - Voltage-gated potassium channels are actually **opening** during late depolarization and repolarization, not closing. - Closing these channels would promote further depolarization, not prevent the generation of a new impulse. *Sodium channels are closed* - This refers to the **resting state** of sodium channels, where they are closed but capable of opening, not the inactivated state. - If sodium channels were merely in the closed

Q: A patient is getting irritated, having fluctuation of emotions. He reports of hearing voices talking about his actions. He has poor eye contact with the people and wants to stay alone. These symptoms are there for more than two months. Which of the foll owing is pointing towards the diagnosis of schizophrenia and not delusional disorder?

Second person, third person auditory hallucinations. ***Second person, third person auditory hallucinations*** - **Auditory hallucinations** are a hallmark symptom of **schizophrenia**, specifically often described as voices talking about or to the patient in the third person or commenting on their actions. - These hallucinations help differentiate schizophrenia from **delusional disorder**, which is primarily characterized by non-bizarre delusions without significant hallucinations or other prominent **negative symptoms**. *Emotional problem/depression* - While **mood symptoms** can occur in schizophrenia, they are not diagnostic of the disorder itself and are often considered a comorbid feature or part of a schizoaffective presentation. - Emotional flattening and social withdrawal are considered **negative symptoms** that support a diagnosis of schizophrenia, but depression alone is nonspecific and does not confirm psychosis. *Delusion of persecution* - This is a common type of **delusional content** seen in delusional disorder, where fixed, false beliefs are the primary feature of the illness. - In schizophrenia, delusions are often present, but they are typically accompanied by other **psychotic symptoms** like hallucinations, disorganized speech, or catatonia, which are not required for a diagnosis of delusional disorder. *Symptoms are there for more than 2 months* - The duration criterion for schizophrenia requires signs of the disturbance to persist for at least **six months**, including at least one month of symptoms that meet the full diagnostic criteria. - While the duration of greater than one month is necessary for both, the presence of symptoms for two months is insufficient on its own to confirm schizophrenia versus other psychotic disorders without assessing the **nature of the symptoms**.

Q: A young boy bright in studies, securing good grades in class now has poor performance. Parents notice a change in behaviour, he avoids speaking to others, often comes home late in the night. Which of the following is the likely cause?

Recent drug use. ***Recent drug use*** - A sudden decline in **academic performance** associated with profound **behavioral changes** and suspicious activities, such as coming home late, is a classic warning sign of **substance use disorders** in adolescents. - Social withdrawal or **isolation** from family and previous friends is a common mechanism used by adolescents to hide drug-seeking or drug-using behavior. *Depression / Mania* - While **depression** can lead to school failure and withdrawal, it usually presents with persistent **low mood**, lack of energy, or vegetative symptoms rather than sudden, secretive behavioral changes. - **Mania** would typically present with **pressured speech**, increased energy, and irritability, which contradicts the described withdrawal and avoidance of speaking to others. *Personality disorder* - **Personality disorders** are generally diagnosed in adulthood (typically over 18 years) after patterns of behavior have become ingrained, not as a sudden onset of symptoms in a previously high-functioning young boy. - The presentation of an acute decline in a historically high-achieving student is much more suggestive of an **acquired external factor** than an evolving developmental personality pathology. *Peer pressure* - While **peer pressure** is a significant psychosocial influence, it is usually a contributing factor or a mechanism leading to behaviors like **substance use** rather than a primary psychiatric diagnosis in itself. - The specific combination of functional decline and secretive behavior points more strongly toward the **consequences of substance abuse** rather than just social influence.

Q: Young adult female who was bullied in class throughout school period, later on in life she started having stage fear, anxiety, low mood. What is the cause of her diagnosis?

Social anxiety disorder. ***Social anxiety disorder*** - The patient's history of **bullying** serves as a significant **psychosocial stressor** that frequently predisposes individuals to develop a marked, persistent fear of social or performance situations. - Symptoms like **stage fear**, **anxiety**, and **low mood** in the context of feared social interactions are clinical hallmarks of **social anxiety disorder (social phobia)**. *Personality disorder* - Characterized by enduring maladaptive patterns of inner experience and behavior that deviate from cultural expectations, typically manifesting in **adolescence** or early adulthood. - While bullying can be a risk factor, the specific clinical presentation given is more characteristic of an **anxiety disorder** rather than a personality dysfunction such as **avoidant** or **borderline**. *Anxiety disorder* - While this diagnosis is technically in the same umbrella, it is a broad category; **social anxiety disorder** is the specific, precise diagnosis for fear centered around performance and social scrutiny. - A general diagnosis of anxiety does not account for the specific **trigger** (performance/social observation) described in the patient's history. *Peer pressure* - This describes an **environmental influence** or social phenomenon rather than a psychiatric diagnosis or clinical condition. - While negative peer experiences can contribute to developing pathology, it acts as an **etiological factor** rather than the diagnosis itself.

Question 1

A chronic alcohol abuser is brought to hospital with complains of chronic liver diease. Which of the following you will add in the treatment?

Accepted Answer

Vitamin B1

Answer

Vitamin A

Answer

Vitamin C

Answer

Vitamin D

Question 2

A trekker at high altitude develops ataxia and confusion, followed by pulmonary edema. What is the most appropriate management?

Accepted Answer

Rapid descent

Answer

Spironolactone

Answer

Steroids

Answer

Acetazolamide

Question 3

A child with low IQ, poor communication, presented with loss of bladder control/urinary incontinence. Which of the following is the most likely diagnosis?

Accepted Answer

Heller’s disease

Answer

Refsum’s disease

Answer

ADHD

Answer

Weil’s disease

Question 4

Identify the breathing pattern shown in the image below:

Accepted Answer

Cheyne -Stokes breathing

Answer

Biot's breathing

Answer

Kussmaul breathing

Answer

Apneustic breathing

Question 5

In the following Pressure-Volume curve of the bladder, what is the physiological basis for the segment labeled 1b?

Accepted Answer

Law of Laplace

Answer

Sympathetic control

Answer

Parasympathetic control

Answer

Urethral valve

Question 6

Based on the provided image of a nerve action potential, at which marked point is the combined transport of Na+ and K+ ions at its minimum?

Accepted Answer

Point E

Answer

Point A

Answer

Point B

Answer

Point C

Question 7

Why is no new impulse generated during the depolarization phase of an action potential?

Accepted Answer

Voltage-gated sodium channels are inactivated

Answer

Potassium channels are closed

Answer

Sodium channels are closed

Answer

The neuron is hyperpolarized

Question 8

A patient is getting irritated, having fluctuation of emotions. He reports of hearing voices talking about his actions. He has poor eye contact with the people and wants to stay alone. These symptoms are there for more than two months. Which of the foll owing is pointing towards the diagnosis of schizophrenia and not delusional disorder?

Accepted Answer

Second person, third person auditory hallucinations

Answer

Emotional problem/depression

Answer

Delusion of persecution

Answer

Symptoms are there for more than 2 months

Question 9

A young boy bright in studies, securing good grades in class now has poor performance. Parents notice a change in behaviour, he avoids speaking to others, often comes home late in the night. Which of the following is the likely cause?

Accepted Answer

Recent drug use

Answer

Depression / Mania

Answer

Personality disorder

Answer

Peer pressure

Question 10

Young adult female who was bullied in class throughout school period, later on in life she started having stage fear, anxiety, low mood. What is the cause of her diagnosis?

Accepted Answer

Social anxiety disorder

Answer

Personality disorder

Answer

Anxiety disorder

Answer

Peer pressure

FMGE 2026

Internal Medicine

Pediatrics

Physiology

Psychiatry