FMGE 2025 Practice Questions

Q: Identify the structure marked in the image given below.

Pharyngobasilar fascia. ***Pharyngobasilar fascia*** - The image shows the layers of the tonsillar bed. The arrow points to the **pharyngobasilar fascia**, which lies between the tonsillar capsule medially and the superior constrictor muscle laterally. - This fascia is the aponeurotic upper part of the superior constrictor muscle, attaching the pharynx to the base of the skull. *Buccopharyngeal fascia* - This fascia covers the **external surface** of the pharyngeal constrictor muscles and the buccinator muscle. - It is located more laterally than the structure indicated by the arrow, outside the superior constrictor muscle. *Capsule* - The **tonsillar capsule** is a thin, fibrous layer that directly covers the lateral surface of the palatine tonsil, separating it from the peritonsillar space. - The arrow is pointing to the layer just lateral to the tonsillar capsule, not the capsule itself. *Superior constrictor muscle* - This muscle forms the lateral wall of the tonsillar fossa and is situated laterally to the **pharyngobasilar fascia**. - The indicated structure is a fascial layer medial to this muscle.

Q: Identify the structure indicated by the arrow in the image.

Pharyngobasilar fascia. ***Pharyngobasilar fascia*** - This is the fibrous internal lining of the pharynx, located between the **mucous membrane** medially and the **pharyngeal muscles** laterally, which matches the position indicated by the arrow. - It provides structural integrity to the pharyngeal wall, particularly in the upper part where it attaches the pharynx to the **base of the skull**. *Buccopharyngeal fascia* - This fascia covers the *external* surface of the **pharyngeal constrictor muscles** and is continuous with the fascia on the buccinator muscle. - The arrow points to a structure *internal* to the pharyngeal muscles, making this an incorrect choice. *Capsule* - The palatine tonsil is enclosed by its own fibrous **tonsillar capsule**, which is immediately adjacent to the tonsillar tissue. - The arrow indicates the fascial layer of the pharyngeal wall, which is located lateral and deep to the tonsillar capsule. *Superior constrictor muscle* - This muscle forms the lateral wall of the oropharynx and serves as the **tonsillar bed**. - The arrow is pointing to the fascial layer just internal to this muscle, not the muscle layer itself.

Q: According to the American Heart Association (AHA), what is the 6th link added to the chain of survival?

Recovery and rehabilitation. ***Recovery and rehabilitation*** - The American Heart Association (**AHA**) added this as the **6th link** to the chain of survival to emphasize the importance of post-event care for cardiac arrest survivors. - This link focuses on the long-term health outcomes, addressing physical, cognitive, and emotional needs to improve the survivor's **quality of life**. *Rapid defibrillation* - This is the **fourth link** in the chain of survival, often grouped with Advanced Life Support (ALS). - It is a critical intervention for shockable rhythms like **ventricular fibrillation (VF)** and **pulseless ventricular tachycardia (VT)**, but it precedes post-cardiac arrest care and recovery. *High-quality CPR* - This is the **third link** in the chain of survival, immediately following activation of the emergency response system. - Its purpose is to maintain vital organ perfusion until defibrillation or the return of spontaneous circulation is achieved. *Advanced airway management* - This is a component of **Advanced Life Support (ALS)**, which is part of the fourth link in the chain. - While crucial during the resuscitation effort, it is an acute intervention and not the distinct final step focused on long-term patient recovery.

Q: A patient presents with fever, neck rigidity, headache, vomiting, and petechial rashes on the lower limbs. What is the most likely causative organism?

Neisseria meningitidis. ***Neisseria meningitidis***- This gram-negative diplococcus is the most likely causative agent as it classically causes **meningococcal meningitis** combined with **meningococcemia**, which highly correlates with the presence of **petechial or purpuric rashes** on the skin.- The rash results from **endotoxin** (lipooligosaccharide) damage to the blood vessel walls, leading to **vasculitis** and hemorrhage, often progressing to severe complications like the **Waterhouse-Friderichsen syndrome**.*Clostridium perfringens*- This organism is primarily known for causing **gas gangrene** (myonecrosis) and tissue necrosis, often following severe trauma or surgery.- It is not a common cause of primary community-acquired bacterial meningitis, and its clinical presentation focuses on localized **soft tissue infection** rather than systemic meningoencephalitis.*Cryptococcus neoformans*- This is a **fungal pathogen** that causes meningitis, usually in patients with **severe immunosuppression** (e.g., uncontrolled HIV infection).- Although it causes fever and signs of meningeal irritation, the presentation is typically subacute or chronic, and a hemorrhagic rash is not a standard clinical feature.*Clostridium difficile*- This bacterium is the causative agent of **antibiotic-associated diarrhea** and **pseudomembranous colitis**.- Its effects are localized almost exclusively to the colon, and it does not cause acute bacterial meningitis with systemic rash.

Q: A person came with the H/o thorn prick a week ago. A few days later, he developed ulcers along lymphatic drainage. Choose the correct organism.

Sporothrix schenckii. ***Sporothrix schenckii*** - This dimorphic fungus is introduced via cutaneous trauma, classically associated with exposure to vegetation (e.g., **thorn prick**, sphagnum moss), leading to the term **Gardener's disease**. - The characteristic presentation of a primary nodule followed by secondary subcutaneous nodules or ulcers tracking along the proximal lymphatic drainage is diagnostic of **lymphocutaneous sporotrichosis**. *Coccidioides immitis* - This fungus causes **Coccidioidomycosis** (Valley fever), generally acquired by inhaling arthroconidia, leading primarily to pulmonary infection. - While disseminated infection can involve the skin, it does not typically present as a localized inoculation lesion with subsequent **ascending lymphangitis** from a thorn prick. *Aspergillus flavus* - **Aspergillus** species usually cause infections in immunocompromised patients (e.g., invasive pulmonary aspergillosis) or superficial infections such as fungal keratitis. - It is not the organism characteristically associated with traumatic inoculation from plant material causing a **sporotrichoid pattern** of lymphatic spread. *Trichophyton rubrum* - This is a common **dermatophyte** that causes superficial cutaneous infections of the keratin layer, such as tinea (ringworm) of the skin, hair, or nails. - It lacks the invasive capability to establish a deep infection followed by **lymphatic involvement** and ulceration after subcutaneous inoculation.

Q: A patient presents with eyelid crusting and a thready sensation between the cornea and lids. What is the most likely diagnosis?

Chronic Blepharitis. ***Chronic Blepharitis***- This condition is characterized by chronic inflammation of the eyelid margins, leading directly to the observed **eyelid crusting** and debris accumulation at the base of the eyelashes. - The **thready sensation** (often described as a foreign body sensation or stringy mucus) is classic, resulting from poor tear film stability and excessive friction between the chronically inflamed lid margin and the ocular surface.*Dry Eye Syndrome*- While it causes a foreign body sensation, primary uncomplicated dry eye syndrome is less typically associated with significant, persistent **eyelid margin crusting**.- Symptoms are primarily due to inadequate aqueous tear production or excessive evaporation, leading to ocular surface damage, often diagnosed using the **Schirmer test** or tear film breakup time.*Meibomian Gland Dysfunction*- MGD is specifically an obstruction or hypersecretion disorder of the meibomian glands, typically manifesting as poor **lipid layer quality** of the tear film.- Key clinical findings include inspissated gland orifices and telangiectasia on the lid margin, rather than the primary presenting complaint being generalized **eyelid crusting** and debris.*Conjunctivitis*- This typically involves generalized **conjunctival injection** (redness) and discharge (watery, purulent, or mucoid) affecting the entire ocular surface.- While it can cause morning crusting (matting), the chronic presentation focused on the lid margin with persistent **thready sensation** is more characteristic of blepharitis than acute or subacute conjunctival inflammation.

Q: A patient presents with proptosis that increases when bending down. What is the most likely diagnosis?

Orbital Varices. ***Orbital Varices***- This condition involves abnormal orbital veins that swell when orbital venous pressure increases, hence the classic finding of worsening proptosis or **intermittent proptosis** upon bending down or performing the **Valsalva maneuver**.- The proptosis is usually non-pulsatile and often unilateral, resulting from passive congestion of the venous malformation.*Thyroid Eye Disease*- Proptosis in **Thyroid Eye Disease** (**Graves' ophthalmopathy**) is typically caused by chronic inflammation and expansion of **extraocular muscles** and orbital fat, making the proptosis constant.- The severity of proptosis is usually stable and does not fluctuate rapidly or dramatically with maneuvers that increase venous pressure.*Cavernous Sinus Thrombosis*- This condition presents acutely with constant, painful, and progressive proptosis accompanied by **ophthalmoplegia** (due to multiple cranial nerve palsies) and systemic signs like high fever and severe headache.- The clinical picture is typically severe and life-threatening, involving signs of inflammation and infection, not positional congestion.*Orbital Cellulitis*- **Orbital cellulitis** is an acute infectious process characterized by constant, painful, and typically unilateral proptosis, along with severe eyelid swelling (*chemosis*) and **systemic symptoms** (fever).- Proptosis in this condition is fixed and progressive, driven by inflammation and pus formation, and not prone to intermittent worsening simply upon bending down.

Q: Which of the following describes the chloride ion exchange in red blood cells, where bicarbonate ions are exchanged for chloride ions to maintain electrical neutrality?

Chloride shift. ***Chloride shift***- This is the term for the exchange of a **bicarbonate ion** ($ ext{HCO}_3^-$) moving out of the red blood cell for a **chloride ion** ($ ext{Cl}^-$) moving into the cell to maintain **electrical neutrality**. - It is essential for the efficient transport of **carbon dioxide** ($ ext{CO}_2$) from peripheral tissues to the lungs in the form of dissolved bicarbonate. *Haldane effect* - Describes the process where the unloading of **oxygen** in peripheral tissues increases the affinity of hemoglobin for **carbon dioxide** ($ ext{CO}_2$) and $ ext{H}^+$ (and vice versa in the lungs). - It primarily relates to the interaction between $ ext{O}_2$ saturation and $ ext{CO}_2$ binding, not the ion exchange itself. *Root effect* - This effect describes the decrease in the **oxygen carrying capacity** of hemoglobin caused by a drop in pH, often seen in fish. - It is a specialized form of the **Bohr effect**, but specifically refers to the non-sigmoidal shape of the $ ext{O}_2$-Hb curve at low pH. *Bohr effect* - This phenomenon explains that an increase in $ ext{PCO}_2$ or a decrease in pH (more **acidity**) shifts the oxygen-hemoglobin dissociation curve to the **right**. - This shift promotes the release of **oxygen** from hemoglobin to active tissues where $ ext{CO}_2$ production is high.

Q: A lady presents to the hospital after having a fight with her husband. She reports that she is unable to speak. However, all neurological and physical examinations are normal, and she does not seem concerned about her health status. What is the most likely diagnosis?

Conversion Disorder. ***Correct: Conversion Disorder*** - Patient presents with **acute loss of function (mutism)** following a psychological stressor (marital conflict) - **Neurological examination is normal**, ruling out organic causes - Most characteristic feature: **La belle indifférence** - lack of appropriate concern about the disability - Conversion disorder involves neurological symptoms (paralysis, blindness, mutism, seizures) that cannot be explained by medical conditions - Symptoms are **unconscious** (not intentionally produced) and follow psychological stress *Incorrect: Somatic Symptom Disorder* - Involves **excessive thoughts, feelings, or behaviors** related to somatic symptoms - Patients show **high anxiety** and preoccupation with their symptoms (opposite of la belle indifférence) - Symptoms are persistent (>6 months), not acute - Does not typically present with complete loss of function like mutism *Incorrect: Adjustment Disorder* - Involves emotional/behavioral symptoms in response to stressor - Does NOT present with **neurological deficits** like mutism - Symptoms are mood-related (depression, anxiety) rather than functional neurological symptoms - Would not explain the dramatic presentation of complete speech loss *Incorrect: Malingering* - **Conscious, intentional** production of symptoms for secondary gain (financial, avoiding work/legal issues) - No clear secondary gain mentioned in this scenario - Malingerers typically show concern and emphasize their symptoms (not la belle indifférence) - Would be suspected if obvious external incentive present

Question 1

Identify the structure marked in the image given below.

Accepted Answer

Pharyngobasilar fascia

Answer

Buccopharyngeal fascia

Answer

Superior constrictor muscle

Answer

Capsule

Question 2

Identify the structure indicated by the arrow in the image.

Accepted Answer

Pharyngobasilar fascia

Answer

Capsule

Answer

Superior constrictor muscle

Answer

Buccopharyngeal fascia

Question 3

According to the American Heart Association (AHA), what is the 6th link added to the chain of survival?

Accepted Answer

Recovery and rehabilitation

Answer

Advanced airway management

Answer

High-quality CPR

Answer

Rapid defibrillation

Question 4

A patient presents with fever, neck rigidity, headache, vomiting, and petechial rashes on the lower limbs. What is the most likely causative organism?

Accepted Answer

Neisseria meningitidis

Answer

Cryptococcus neoformans

Answer

Clostridium difficile

Answer

Clostridium perfringens

Question 5

A person came with the H/o thorn prick a week ago. A few days later, he developed ulcers along lymphatic drainage. Choose the correct organism.

Accepted Answer

Sporothrix schenckii

Answer

Trichophyton rubrum

Answer

Coccidioides immitis

Answer

Aspergillus flavus

Question 6

A patient presents with eyelid crusting and a thready sensation between the cornea and lids. What is the most likely diagnosis?

Accepted Answer

Chronic Blepharitis

Answer

Meibomian Gland Dysfunction

Answer

Dry Eye Syndrome

Answer

Conjunctivitis

Question 7

A patient presents with proptosis that increases when bending down. What is the most likely diagnosis?

Accepted Answer

Orbital Varices

Answer

Orbital Cellulitis

Answer

Cavernous Sinus Thrombosis

Answer

Thyroid Eye Disease

Question 8

An unvaccinated 5-year-old child of a migrant worker family was brought to the casualty with fever and a characteristic skin rash. Upon eye examination, Bitot's spot was seen. What is the appropriate management?

Accepted Answer

Isolate and give nutritional supply with vitamin A supplement

Answer

Only measles vaccine

Answer

Institutional Isolation, nutritional management with vitamin A supplement

Answer

Give measles vaccine and vitamin A supplement

Question 9

Which of the following describes the chloride ion exchange in red blood cells, where bicarbonate ions are exchanged for chloride ions to maintain electrical neutrality?

Accepted Answer

Chloride shift

Answer

Root effect

Answer

Bohr effect

Answer

Haldane effect

Question 10

A lady presents to the hospital after having a fight with her husband. She reports that she is unable to speak. However, all neurological and physical examinations are normal, and she does not seem concerned about her health status. What is the most likely diagnosis?

Accepted Answer

Conversion Disorder

Answer

Somatic Symptom Disorder

Answer

Adjustment Disorder

Answer

Malingering

FMGE 2025

Anatomy

Anesthesiology

Internal Medicine

Microbiology

Ophthalmology

Pediatrics

Physiology

Psychiatry