FMGE 2026 Practice Questions

Q: What is the Mallampati score?

Type 1. ***Type 1*** - In this classification, the **tonsillar pillars**, **faucial pillars**, **uvula**, and **soft palate** are clearly visible, indicating an easy airway for intubation. - A **Class 1 airway** is associated with the lowest risk of difficult laryngoscopy and intubation. *Type 2* - This class allows visualization of the **uvula**, **faucial pillars**, and **soft palate**, but the **tonsillar pillars** are obscured. - While generally manageable, it represents a slightly more restricted view compared to Class 1, though it is still considered a **predictive low-risk** airway. *Type 3* - Only the **base of the uvula** and the **soft palate** are visible, with the faucial pillars and tonsillar pillars hidden from view. - This indicates a potentially **difficult airway** and requires careful preoperative planning for airway management. *Type 4* - In this class, only the **hard palate** is visible, while the soft palate, uvula, and all pillars are completely obscured. - This is highly predictive of a **difficult intubation** and suggests that alternative intubation strategies should be prepared.

Q: Identify the needle shown in the image:

Tuohy epidural needle. ***Tuohy epidural needle*** - This needle features a **distal curved tip (Huber point)** which helps to deflect the **epidural catheter** cranially or caudally upon insertion. - It is specifically designed for the **loss of resistance** technique to identify the **epidural space**. *Quincke spinal needle* - Characterized by a **cutting tip** designed to pierce the dura mater during **spinal anesthesia**. - The **sharp bevel** helps to minimize force required for insertion but increases the risk of **post-dural puncture headache (PDPH)**. *Huber needle* - Originally designed with a **90-degree bend** and an **anti-coring point** for accessing **implanted ports**. - It is used specifically to prevent coring of the **silicone septum** of central venous access devices. *Veress needle* - A spring-loaded, blunt-tipped needle used during **laparoscopic surgery** to establish a **pneumoperitoneum**. - It includes a **safety mechanism** with an inner stylet that retracts when it encounters resistance and clicks forward upon entering the **peritoneal cavity**.

Q: A patient undergoing surgery shows a sudden drop of end -tidal CO₂ (ETCO₂) to zero on capnography. What does this most likely indicate?

Embolism. ***Embolism*** - A sudden drop of **end-tidal CO₂ (ETCO₂)** to near zero is a classic sign of **massive pulmonary embolism** or **venous air embolism**, which causes a sudden obstruction of pulmonary blood flow. - This obstruction prevents carbon dioxide from reaching the lungs to be exhaled, leading to a precipitous decline in measured CO₂ levels. *Hypothermia* - Hypothermia generally results in a **gradual decrease** in ETCO₂ due to decreased oxygen consumption and carbon dioxide production, rather than an abrupt drop to zero. - The ETCO₂ decline in hypothermia is proportional to the drop in cellular metabolism. *Hyperthermia* - Malignant hyperthermia typically causes a **rapid increase** in ETCO₂, not a decrease, due to hypermetabolism. - This rise in CO₂ is a hallmark early monitoring sign of excessive metabolic demand. *Hypotension* - Severe hypotension or low cardiac output can *reduce* ETCO₂ by limiting pulmonary perfusion, but it rarely causes a sudden drop to zero. - A sudden zero value represents a complete **mechanical disconnection** or cessation of blood flow (embolism or arrest), not simply a reduction in cardiac output.

Q: A 35-year-old patient presents with hearing loss. Clinical examination reveals a Rinne test where Air Conduction is greater than Bone Conduction in both ears. The Weber test lateralizes to the left ear. What is the most likely diagnosis?

Sensorineural hearing loss in the right ear. ***Sensorineural hearing loss in the right ear*** - A **positive Rinne test** (AC > BC) in both ears indicates that the inner ear function is compromised, suggesting **sensorineural hearing loss** (SNHL) rather than conductive pathology. - In SNHL, the **Weber test lateralizes to the better hearing ear** (the side without the pathology), meaning the left ear is the better hearing ear, confirming SNHL in the right ear. *Conductive hearing loss in the left ear* - In **conductive hearing loss**, the Rinne test would be negative (BC > AC) on the affected side, which contradicts the finding of AC > BC in both ears. - Furthermore, a conductive deficit would cause the **Weber test to lateralize to the affected side** (left), but the Rinne test results do not support a conductive etiology. *Conductive hearing loss in the right ear* - If the right ear had **conductive hearing loss**, the Rinne test would show BC > AC in that ear, failing to match the clinical finding of a positive Rinne. - The **Weber test lateralizing to the left ear** indicates the left ear is either normal or has better conduction, ruling out right-sided conductive pathology. *Sensorineural hearing loss in the left ear* - If the SNHL were in the left ear, the **Weber test** would typically lateralize to the right ear (the healthy side). - Since the Weber test lateralizes to the left, this implies the left ear is actually the one with better sensory function, making right-sided SNHL the correct diagnosis.

Q: A factory worker presents with bilateral hearing difficulty. Audiometry is as shown in the image. This pattern is characteristic of:

Noise-induced hearing loss. ***Noise-induced hearing loss*** - Audiometry typically reveals a **classic 'notch' at 4000 Hz** (4 kHz), which is the hallmark diagnostic finding for occupational exposure to loud noise. - This condition results from damage to the **outer hair cells in the organ of Corti**, primarily in the basal turn of the cochlea, leading to high-frequency hearing loss. *Presbycusis* - Characterized by **bilateral symmetric progressive high-frequency sensorineural hearing loss** that typically begins above 2000 Hz, unlike the specific 4 kHz notch. - This is primarily due to **age-related degeneration** of the cochlea and neural pathways, not occupational trauma. *Meniere’s disease* - Often presents with **low-frequency sensorineural hearing loss**, which is the inverse of the high-frequency loss seen in noise trauma. - Associated with a **triad of symptoms**: episodic vertigo, fluctuating hearing loss, and aural fullness. *Sudden sensorineural hearing loss* - Defined as a rapid reduction in hearing (usually >30 dB in at least three contiguous frequencies) occurring within **72 hours**. - It is generally **unilateral** and idiopathic, whereas noise-induced hearing loss is typically bilateral and chronic.

Q: A patient presents with chronic sinusitis, nasal crusting, and saddle nose deformity. What is the most likely diagnosis?

Granulomatosis with polyangiitis. ***Granulomatosis with polyangiitis*** - Classically presents with the triad of **upper airway involvement** (chronic sinusitis, **nasal crusting**, **saddle nose deformity**), **lower airway involvement** (lung nodules/cavitation), and **glomerulonephritis**. - Laboratory workup typically reveals **antineutrophil cytoplasmic antibodies (ANCA)**, specifically **PR3-ANCA** (c-ANCA) positivity. *Allergic rhinitis* - Presents with sneezing, rhinorrhea, and **nasal congestion** often triggered by specific **allergens** like pollen or dust. - Does not cause destructive lesions like **saddle nose** or systemic vasculitis manifestations. *Nasal polyposis* - Characterized by soft, gelatinous, **non-tender growths** on the nasal mucosa, often associated with asthma or **aspirin sensitivity**. - It does not cause the severe mucosal ulceration, crusting, or the cartilaginous inflammatory destruction seen in **saddle nose deformity**. *Rhinoscleroma* - A rare chronic granulomatous disease caused by **Klebsiella rhinoscleromatis**, typically seen in endemic regions. - Primarily presents with a painless, slowly progressive **nasal mass** or

Q: The ideal age for surgical correction of the condition shown in the image is:

6 years and above. ***6 years and above*** - Surgical correction (otoplasty) for **prominent ears (bat ears)** is ideally performed after the age of 6, as the ear reaches approximately **85-90% of its adult size** by this age. - Operating at or after this age allows for adequate structural development and ensures the child has better psychological readiness to cope with the procedure and postoperative care. *At birth* - Surgical intervention is not indicated at birth because maternal hormones like **estrogen** have a circulating effect that allows for **nonsurgical ear molding** (splinting) during the first few weeks of life. - If nonsurgical correction fails or is not attempted, surgery is then deferred until the ear cartilage matures. *1 year and above* - While the ear grows significantly during this period, operating this early is generally avoided due to the higher risk of **anesthesia complications** in infants. - Furthermore, the **cartilage is too soft and thin**, making it difficult to maintain the new shape after correction. *Anytime after adolescence* - There is no clinical mandate to wait until after adolescence; surgery can be safely performed anytime from age 6 through adulthood. - Waiting until after adolescence is often counterproductive, as the child may already have suffered years of **psychological distress** or teasing regarding their appearance.

Q: A 12-year-old child presents with a midline neck swelling that moves upward with deglutition. She undergoes surgical removal, and postoperatively, she cannot raise her voice. What is the most likely nerve injury?

Unilateral superior laryngeal nerve palsy. ***Unilateral superior laryngeal nerve palsy*** - The **external branch of the superior laryngeal nerve** (SLN) supplies the **cricothyroid muscle**, which is responsible for tensioning the vocal cords to produce high-pitched sounds. - Injury to this nerve during the excision of a **thyroglossal duct cyst** or thyroid surgery leads to difficulty in producing high-pitched tones and **vocal fatigue**. *Bilateral recurrent laryngeal nerve palsy* - Bilateral injury to the **recurrent laryngeal nerve** (RLN) typically results in **stridor** and **respiratory distress** due to the vocal cords remaining adducted in the paramedian position. - The primary deficit is airway compromise rather than a selective loss of vocal pitch. *Hypoglossal nerve injury* - The **hypoglossal nerve** (CN XII) innervates the muscles of the tongue, and its injury results in **tongue deviation** toward the side of the lesion and potential **dysarthria**. - It is located superiorly to the cricothyroid area and is not typically injured during the surgical excision of a midline thyroglossal duct cyst. *Vagus nerve injury* - Injury to the **vagus nerve** (CN X) higher up in its course would present with a broad array of symptoms, including **palatal paralysis** and **absent gag reflex**. - This injury is highly unlikely during a localized neck surgery for a thyroglossal duct cyst.

Q: A patient presents with difficulty swallowing and regurgitation of undigested food with foul- smelling breath. The lateral neck X-ray is as shown. The diverticulum occurs due to herniation between which muscles?

Cricopharyngeus and Thyropharyngeus. ***Cricopharyngeus and Thyropharyngeus*** - Zenker's diverticulum is a **pharyngoesophageal diverticulum** caused by the herniation of mucosa through **Killian's dehiscence**, a point of weakness in the posterior pharyngeal wall. - This anatomical gap is located between the **thyropharyngeus** (oblique fibers) and the **cricopharyngeus** (transverse fibers) muscles of the inferior pharyngeal constrictor. *Cricopharyngeus and Sternocleidomastoid* - The **sternocleidomastoid** is a muscle of the neck responsible for movement, not a component of the pharyngeal wall architecture. - It is located deep to the platysma and has no role in the formation of pharyngeal diverticula. *Thyropharyngeus and Inferior constrictor* - The **thyropharyngeus** is actually a part of the **inferior constrictor muscle**, making this description redundant rather than specifying the true site of herniation. - The correct anatomical defect specifically requires the boundary between the oblique and transverse fibers of the pharynx. *Inferior constrictor and Sternocleidomastoid* - The **inferior pharyngeal constrictor** surrounds the defect, but the sternocleidomastoid is entirely unrelated to the specific site of the **Killian's dehiscence**. - This option incorrectly pairs an internal pharyngeal structure with a superficial neck muscle.

Q: Furosemide -induced hearing loss occurs primarily by damaging which structure?

Na⁺-K⁺-2Cl⁻cotransporter in stria vascularis. ### ***Na⁺-K⁺-2Cl⁻ cotransporter in stria vascularis*** - Furosemide is a **loop diuretic** that inhibits the **Na⁺-K⁺-2Cl⁻ cotransporter (NKCC2)** in the thick ascending limb of the loop of Henle, but it also inhibits the **NKCC1** isoform found in the **stria vascularis** of the inner ear. - This inhibition disrupts the **endocochlear potential** by reducing potassium secretion into the endolymph, leading to temporary or permanent **sensorineural hearing loss**. *Outer hair cells in Organ of Corti* - While aminoglycosides are known to be directly **ototoxic** to the **outer hair cells** of the Organ of Corti, this is not the primary site of damage for loop diuretics. - Loop diuretics specifically alter the ionic gradient between the **endolymph** and the **perilymph** rather than causing direct cellular toxicity to hair cells. *Vestibulocochlear nerve* - The **vestibulocochlear nerve (CN VIII)** is typically damaged by acoustic neuromas or toxins like heavy metals, but it is not the target of furosemide-induced injury. - Symptoms of loop diuretic toxicity involve hearing loss rather than the primary neuropathic deficits associated with direct nerve toxicity. *Cochlear duct basement membrane* - Damage to the **basilar membrane** (often via noise-induced trauma or mechanical injury) results in hearing loss, but this is a structural failure unrelated to furosemide. - Furosemide mechanism is **biochemical/metabolic** regarding electrolyte transport, not an injury to the physical architecture of the membrane.

Question 1

What is the Mallampati score?

Accepted Answer

Type 1

Answer

Type 2

Answer

Type 3

Answer

Type 4

Question 2

Identify the needle shown in the image:

Accepted Answer

Tuohy epidural needle

Answer

Quincke spinal needle

Answer

Huber needle

Answer

Veress needle

Question 3

A patient undergoing surgery shows a sudden drop of end -tidal CO₂ (ETCO₂) to zero on capnography. What does this most likely indicate?

Accepted Answer

Embolism

Answer

Hypothermia

Answer

Hyperthermia

Answer

Hypotension

Question 4

A 35-year-old patient presents with hearing loss. Clinical examination reveals a Rinne test where Air Conduction is greater than Bone Conduction in both ears. The Weber test lateralizes to the left ear. What is the most likely diagnosis?

Accepted Answer

Sensorineural hearing loss in the right ear

Answer

Conductive hearing loss in the left ear

Answer

Conductive hearing loss in the right ear

Answer

Sensorineural hearing loss in the left ear

Question 5

A factory worker presents with bilateral hearing difficulty. Audiometry is as shown in the image. This pattern is characteristic of:

Accepted Answer

Noise-induced hearing loss

Answer

Presbycusis

Answer

Meniere’s disease

Answer

Sudden sensorineural hearing loss

Question 6

A patient presents with chronic sinusitis, nasal crusting, and saddle nose deformity. What is the most likely diagnosis?

Accepted Answer

Granulomatosis with polyangiitis

Answer

Allergic rhinitis

Answer

Nasal polyposis

Answer

Rhinoscleroma

Question 7

The ideal age for surgical correction of the condition shown in the image is:

Accepted Answer

6 years and above

Answer

At birth

Answer

1 year and above

Answer

Anytime after adolescence

Question 8

A 12-year-old child presents with a midline neck swelling that moves upward with deglutition. She undergoes surgical removal, and postoperatively, she cannot raise her voice. What is the most likely nerve injury?

Accepted Answer

Unilateral superior laryngeal nerve palsy

Answer

Bilateral recurrent laryngeal nerve palsy

Answer

Hypoglossal nerve injury

Answer

Vagus nerve injury

Question 9

A patient presents with difficulty swallowing and regurgitation of undigested food with foul- smelling breath. The lateral neck X-ray is as shown. The diverticulum occurs due to herniation between which muscles?

Accepted Answer

Cricopharyngeus and Thyropharyngeus

Answer

Cricopharyngeus and Sternocleidomastoid

Answer

Thyropharyngeus and Inferior constrictor

Answer

Inferior constrictor and Sternocleidomastoid

Question 10

Furosemide -induced hearing loss occurs primarily by damaging which structure?

Accepted Answer

Na⁺-K⁺-2Cl⁻cotransporter in stria vascularis

Answer

Outer hair cells in Organ of Corti

Answer

Vestibulocochlear nerve

Answer

Cochlear duct basement membrane

FMGE 2026

Anesthesiology

ENT

Pharmacology