FMGE 2025 Practice Questions

Q: The development of cataracts in patients with Diabetes Mellitus is primarily due to the accumulation of which of the following substances in the lens?

Sorbitol. ***Correct Option: Sorbitol*** - In the setting of chronic **hyperglycemia**, excess glucose is converted into **sorbitol** by the enzyme **aldose reductase** via the polyol pathway. - Sorbitol is poorly transported out of the lens cells and its accumulation creates an internal **osmotic gradient**, drawing water into the lens, which leads to cell swelling, lens fiber disruption, and eventual **cataract** formation. - This is the **primary mechanism** of diabetic cataract development. *Incorrect Option: Galactitol* - **Galactitol** (also known as dulcitol) is the specific sugar alcohol that accumulates when there is deficiency of **galactokinase** or **galactose-1-phosphate uridyltransferase**. - Its accumulation is characteristic of **galactosemia**, where high galactose levels lead to its formation via aldose reductase, causing congenital cataracts in that condition, not diabetic cataracts. *Incorrect Option: Fructose* - While **fructose** is produced from sorbitol by sorbitol dehydrogenase in the polyol pathway, it is readily metabolized and does not accumulate in lens tissue. - Fructose itself does not cause osmotic damage or cataract formation in diabetes. *Incorrect Option: Mannitol* - **Mannitol** is a hexahydric sugar alcohol primarily used pharmacologically as an osmotic diuretic for conditions like **cerebral edema**. - It is not an endogenous product of glucose metabolism in the lens and is not associated with diabetic cataract formation.

Q: A patient with a history of Graves' disease underwent I-131 ablation therapy. Which of the following is the most likely long-term side effect of this treatment?

Hypothyroidism. ***Hypothyroidism*** - The primary mechanism of **I-131 ablation** is the destruction of functional thyroid tissue by radiation, leading to a permanent reduction in hormone production. - **Hypothyroidism** is the most common and often inevitable long-term complication following successful **radioiodine ablation** for conditions like Graves' disease or thyroid cancer, occurring in 80-90% of patients within the first year [1]. - Requires lifelong thyroid hormone replacement therapy. *Acute Thyroiditis* - This is a possible immediate side effect, known as **radiation thyroiditis**, causing transient local pain and tenderness within days to weeks of treatment. - It is a short-term inflammatory response due to radiation-induced thyroid cell damage, not the defining long-term side effect [1]. - Usually self-limiting and managed with NSAIDs or corticosteroids. *Hyperthyroidism* - Although an initial transient surge of thyroid hormones (due to tissue destruction releasing stored hormone) can occur within the first 1-2 weeks after I-131, this is temporary [2]. - The treatment's primary purpose is to permanently cure hyperthyroidism by destroying thyroid tissue. - Persistent or recurrent hyperthyroidism would indicate treatment failure, not a side effect. *Thyroid Storm* - A **thyroid storm** is an acute, life-threatening exacerbation of hyperthyroidism usually precipitated by factors like infection, surgery, or trauma [2]. - While extremely rare, radioiodine therapy can theoretically precipitate a storm in inadequately prepared, severely hyperthyroid patients [2]. - This is **not a likely or common side effect** compared to permanent hypothyroidism, and proper pre-treatment with antithyroid drugs minimizes this risk.

Q: Shoulder dystocia is diagnosed when the anterior shoulder fails to deliver after what time following delivery of the head?

60 sec. ***60 sec*** - Shoulder dystocia is generally defined as the failure of the shoulders to deliver spontaneously after the head is already delivered, requiring additional obstetrical maneuvers. - Using a time criterion, the condition is classified when the interval between the delivery of the fetal head and the delivery of the shoulders exceeds **60 seconds (1 minute)**. - The definition is established at **60 seconds** because delays exceeding this time significantly elevate the risk of fetal injury, particularly **brachial plexus injury**. *15 sec* - This time interval is typically too short to define true shoulder dystocia, as spontaneous delivery of the shoulders often occurs within the first 30 seconds. - A delay of **15 seconds** usually reflects normal variation in the second stage of labor. *30 sec* - While a delay greater than **30 seconds** is sometimes cited as an *increased risk* indicator, it is not the standard, universally endorsed cutoff for formally diagnosing shoulder dystocia. - Most major obstetric guidelines (ACOG and RCOG) use the **60-second** criterion. *45 sec* - Although indicative of a slower process, **45 seconds** falls short of the critical **60-second** mark used by most major obstetric guidelines to classify the complication. - Using 45 seconds could lead to over-diagnosis, while the 60-second rule ensures appropriate identification of high-risk cases.

Q: A 27-year-old woman presents with irregular periods, acne & excessive hair growth. What is the first line management?

Lifestyle modifications. ***Lifestyle modifications***- As many patients with **PCOS** are overweight or obese, lifestyle changes (diet and exercise) are crucial for tackling associated **insulin resistance** and obesity.- Weight loss, even modest amounts (5-10%), often significantly improves menstrual regularity, metabolic profiles, and symptoms of **hyperandrogenism**.*Metformin*- Used primarily to improve **insulin sensitivity** and may help regulate cycles, but it is typically initiated after lifestyle interventions have proven insufficient or when glucose intolerance is confirmed.- It is not recommended as the initial management strategy unless the patient has confirmed **Type 2 Diabetes** or severe insulin resistance.*OCPs*- Oral contraceptive pills are highly effective for managing symptoms like **hirsutism** (by increasing **SHBG** and decreasing free testosterone) and regulating menses.- While effective symptomatically, they are usually introduced after lifestyle changes have failed, or if symptoms are severe and require immediate hormonal suppression.*Clomiphene citrate*- This medication is specifically used as a **fertility treatment** to induce ovulation in anovulatory women with PCOS who are seeking pregnancy.- It does not treat the hyperandrogenism (acne, hirsutism) or metabolic issues associated with PCOS, and thus is not the first-line management for the presenting symptoms.

Q: What is the hormonal check for pregnancy at home?

Beta-HCG. ***Beta-HCG***- This hormone (specifically the **beta subunit of Human Chorionic Gonadotropin**) is detected by **home pregnancy test kits** in the urine, offering a simple and rapid test for confirming pregnancy.- It is produced by the **syncytiotrophoblast** cells after implantation and is the earliest reliable hormonal biomarker for clinically diagnosing pregnancy.*Estrogen*- While estrogen levels (e.g., **estriol**) increase significantly throughout pregnancy, they are not the hormone used for rapid, qualitative, early, **home-based detection**.- Estrogen levels fluctuate widely during the normal menstrual cycle, making it an unreliable early marker compared to HCG.*Progesterone*- Progesterone is essential for maintaining the uterine lining (**endometrium**) and supporting early pregnancy, but its measurement is typically reserved for evaluating **corpus luteum function** or threatened miscarriage.- Since progesterone levels rise naturally during the luteal phase of the regular cycle, it does not confirm pregnancy with the high specificity HCG offers.*HPL*- **Human Placental Lactogen (HPL)**, also known as **chorionic somatomammotropin**, is produced relatively later by the placenta.- Its primary role is in regulating maternal metabolism and fetal growth, and it is not typically detectable or useful for confirming a very **early home diagnosis** of pregnancy.

Q: A child presents with micrognathia and low-set ears. These clinical features are commonly associated with which type of genetic abnormality?

Deletion. ***Correct: Deletion*** - **Micrognathia** and **low-set ears** are characteristic features of many syndromes caused by chromosomal deletions, such as **DiGeorge syndrome** (22q11.2 deletion) or **Cri-du-chat syndrome** (5p deletion). - The loss of a significant segment of a chromosome leads to **haploinsufficiency** for multiple genes, severely impacting craniofacial and auricular development. *Incorrect: Translocation* - This involves the exchange of segments between non-homologous chromosomes; while it can cause genetic disorders, it is not the most common genetic mechanism leading to the specific classic combination of micrognathia and low-set ears. - **Balanced translocations** usually do not cause clinical symptoms in the carrier, but can lead to abnormal gametes and offspring with partial monosomy or trisomy. *Incorrect: Amplification* - This refers to the increase in the copy number of a gene or DNA sequence, which is primarily linked to cancer development (**oncogenesis**, e.g., *HER2* amplification), not generalized congenital dysmorphism. - While large segmental duplications (a form of gain) can cause syndromes, specific amplification events are rarely the cause of micrognathia or low-set ears. *Incorrect: Inversion* - This involves a chromosomal segment reversing its orientation; the primary concern is the formation of **unbalanced gametes** during meiosis, particularly with **pericentric inversions**. - Although offspring can inherit unbalanced chromosomes resulting in abnormalities, deletions remain the most common cause for the specific constellation of features mentioned.

Q: A patient with a history of breast cancer underwent Cobalt-60 radiotherapy. She now presents with respiratory distress, and imaging shows haziness in the left lung. What is the most likely diagnosis?

Radiation Pneumonitis. ***Radiation Pneumonitis*** - This is a non-infectious inflammatory response of the lung parenchyma following radiotherapy, typically occurring **1-6 months** after treatment, which fits the patient's timeline after **Cobalt-60 therapy**. - Imaging findings classically show **diffuse haziness**, consolidation, or ground-glass opacities that are sharply demarcated and conform to the **radiation port**, as seen in the provided chest X-ray. *Recurrence of Breast Cancer* - **Pulmonary metastases** from breast cancer usually present as discrete **nodules**, masses, or lymphangitic carcinomatosis on imaging, not a diffuse haziness confined to a prior radiation field. - The onset of symptoms in this case is more acute and temporally related to radiation therapy, making an inflammatory process like pneumonitis more likely than metastatic recurrence. *Pulmonary Embolism* - While cancer is a risk factor for **pulmonary embolism (PE)**, a chest X-ray is often normal or shows non-specific findings like atelectasis or a **Hampton's hump**; the diffuse haziness seen here is not a typical feature of PE. - Diagnosis of PE requires a **CT pulmonary angiogram (CTPA)** or V/Q scan, as the clinical signs can overlap but the radiographic evidence points elsewhere. *Infective Pneumonia* - **Infective pneumonia** typically presents with symptoms like **fever**, chills, and a productive cough, which are not described in the clinical vignette. - The radiographic opacities in bacterial pneumonia are usually lobar or segmental and do not have the sharp, straight borders that correspond to a radiation field.

Q: Which of the following is a primary use of this imaging modality? ![img-42.jpeg](img-42.jpeg)

Staging of esophageal cancer. ***Staging of esophageal cancer*** - The image displays an **Endoscopic Ultrasound (EUS)**, which is the most accurate modality for the locoregional staging of esophageal cancer. - EUS provides detailed imaging of the esophageal wall layers, allowing for precise assessment of the **depth of tumor invasion (T stage)** and involvement of **regional lymph nodes (N stage)**, which is critical for treatment planning. *Evaluation of gastroesophageal reflux disease (GERD)* - The diagnosis of GERD is primarily based on clinical symptoms and may be confirmed with **upper endoscopy** to look for esophagitis or **ambulatory pH monitoring**. - EUS is not used for evaluating reflux itself, as it doesn't measure acid exposure or lower esophageal sphincter function. *Identifying the cause of dysphagia* - The initial investigation for dysphagia typically involves a **barium esophagram** or a standard **upper endoscopy** to visualize the esophageal lumen directly. - EUS is a secondary test used to further characterize a mass or stricture already identified by other means, rather than as a primary tool for dysphagia workup. *Assessing cardiac and aortic pathology* - While EUS can visualize adjacent mediastinal structures, including the heart and aorta, it is not the primary imaging modality for their assessment. - **Echocardiography** is the standard for cardiac evaluation, and **CT or MR angiography** is superior for assessing aortic pathology.

Q: What is the investigation shown in the image?

Intravenous Pyelogram (IVP). ***Intravenous Pyelogram (IVP)*** - This investigation involves the intravenous injection of a **water-soluble iodinated contrast agent**, which is then excreted by the kidneys, allowing visualization of the entire urinary tract. - The image shows a plain radiograph where the **renal pelves**, **calyces**, both **ureters**, and the **bladder** are simultaneously opacified, which is characteristic of contrast being filtered and passed down the urinary system. *Retrograde Pyelogram* - In this procedure, contrast is injected directly into the **ureteric orifices** via a catheter placed during **cystoscopy**, filling the system from the bottom up. - It typically provides a denser opacification than an IVP and is often performed unilaterally. It does not assess renal function as the contrast is not filtered by the kidneys. *Computed Tomography (CT) Urography* - CT Urography uses intravenous contrast but acquires images using **computed tomography**, producing detailed, cross-sectional, and 3D reformatted images of the urinary tract. - The image provided is a two-dimensional **projectional radiograph** (a standard X-ray), not a CT scan which would show axial, coronal, or sagittal slices. *Magnetic Resonance Urography* - This technique uses **magnetic fields and radio waves** to generate images, avoiding ionizing radiation. It is excellent for visualizing soft tissues. - The image shown is clearly an X-ray, identifiable by the high contrast visualization of dense structures like bone, which differs significantly from the appearance of an MR image.

Q: A chest X-ray is shown below. What is the most likely diagnosis?

Pulmonary oedema. ***Pulmonary oedema*** - The chest X-ray shows classic features of pulmonary oedema, including **bilateral diffuse opacities**, particularly in the perihilar region (a "bat's wing" appearance), and **cephalization** of the pulmonary vessels. - These findings indicate the accumulation of fluid within the lung's interstitial and alveolar spaces, commonly due to increased pulmonary capillary hydrostatic pressure, often from **left-sided heart failure**. *Hydrothorax* - Hydrothorax refers to the accumulation of serous fluid (transudate) specifically within the **pleural space**, not the lung parenchyma itself. - Radiographically, this would present as **blunting of the costophrenic angle** and a **meniscus sign**, which are not the primary features seen in this image. *Pleural effusion* - This is a general term for fluid in the pleural space. The dominant pathology in the provided X-ray is within the **lung parenchyma**, not the pleural cavity. - While a small reactive effusion can accompany pulmonary oedema, the main findings are the diffuse **alveolar infiltrates**, not a large fluid collection obscuring the lung base. *Pulmonary fibrosis* - Pulmonary fibrosis involves chronic **scarring of lung tissue**, which appears as **reticular patterns**, **honeycombing**, or traction bronchiectasis on an X-ray. - The opacities in this image are hazy and "fluffy," which is characteristic of acute fluid accumulation, not the fine, linear patterns of chronic fibrosis.

Question 1

The development of cataracts in patients with Diabetes Mellitus is primarily due to the accumulation of which of the following substances in the lens?

Accepted Answer

Sorbitol

Answer

Galactitol

Answer

Fructose

Answer

Mannitol

Question 2

A patient with a history of Graves' disease underwent I-131 ablation therapy. Which of the following is the most likely long-term side effect of this treatment?

Accepted Answer

Hypothyroidism

Answer

Thyroid Storm

Answer

Hyperthyroidism

Answer

Acute Thyroiditis

Question 3

Shoulder dystocia is diagnosed when the anterior shoulder fails to deliver after what time following delivery of the head?

Accepted Answer

60 sec

Answer

15 sec

Answer

45 sec

Answer

30 sec

Question 4

A 27-year-old woman presents with irregular periods, acne & excessive hair growth. What is the first line management?

Accepted Answer

Lifestyle modifications

Answer

OCPs

Answer

Metformin

Answer

Clomiphene citrate

Question 5

What is the hormonal check for pregnancy at home?

Accepted Answer

Beta-HCG

Answer

Estrogen

Answer

Progesterone

Answer

HPL

Question 6

A child presents with micrognathia and low-set ears. These clinical features are commonly associated with which type of genetic abnormality?

Accepted Answer

Deletion

Answer

Amplification

Answer

Inversion

Answer

Translocation

Question 7

A patient with a history of breast cancer underwent Cobalt-60 radiotherapy. She now presents with respiratory distress, and imaging shows haziness in the left lung. What is the most likely diagnosis?

Accepted Answer

Radiation Pneumonitis

Answer

Infective Pneumonia

Answer

Pulmonary Embolism

Answer

Recurrence of Breast Cancer

Question 8

Which of the following is a primary use of this imaging modality?

![img-42.jpeg](img-42.jpeg)

Accepted Answer

Staging of esophageal cancer

Answer

Evaluation of gastroesophageal reflux disease (GERD)

Answer

Identifying the cause of dysphagia

Answer

Assessing cardiac and aortic pathology

Question 9

What is the investigation shown in the image?

Accepted Answer

Intravenous Pyelogram (IVP)

Answer

Retrograde Pyelogram

Answer

Computed Tomography (CT) Urography

Answer

Magnetic Resonance Urography

Question 10

A chest X-ray is shown below. What is the most likely diagnosis?

Accepted Answer

Pulmonary oedema

Answer

Hydrothorax

Answer

Pleural effusion

Answer

Pulmonary fibrosis

FMGE 2025

Biochemistry

Internal Medicine

Obstetrics and Gynecology

Pathology

Radiology