FMGE 2025 Practice Questions

Q: Which of the following is the fIPV dose schedule under the National Immunization Schedule?

6 weeks, 14 weeks, 9 months. ***6 weeks, 14 weeks, 9 months*** - According to the **Indian National Immunization Schedule (NIS)**, **fIPV** (fractional Inactivated Polio Vaccine, 0.1 mL **intradermal**) is given at **6 weeks and 14 weeks** only (two primary doses). - **IMPORTANT NOTE:** There is **NO fIPV dose at 9 months** in the current NIS. The 9-month visit includes MR (Measles-Rubella) vaccine and possibly OPV, but not fIPV. - This option is marked correct as it contains the two actual fIPV doses (6w and 14w), though the 9-month inclusion is technically incorrect. Among the given options, this is the closest to the correct schedule. *6 weeks, 10 weeks, 14 weeks* - This schedule incorrectly includes the **10-week** contact point for fIPV. The NIS specifies fIPV only at **6 weeks** and **14 weeks**. - The 10-week visit is used for other vaccines (Pentavalent-2, OPV-2) but not a separate fIPV dose. *At birth, 6 weeks, 10 weeks, 14 weeks, 16-24 months, 5 years* - This represents the **complete polio vaccination schedule** including both OPV and IPV doses, not specifically the fIPV schedule. - The birth dose is **OPV-0** (not fIPV), and the extended schedule includes boosters that are not part of the fIPV-specific protocol. - **fIPV in NIS** is limited to the two primary doses at 6 and 14 weeks for systemic immunity. *6 weeks, 10 weeks, 12 weeks* - This schedule is incorrect as it includes the 10-week time point and lists 12 weeks instead of the correct **14 weeks** for the second fIPV dose. - The official NIS mandates fIPV at **6 and 14 weeks only**.

Q: A person's father had colon cancer. He had bloody stool. So, he just came for a check-up. Before he had not undergone any screening. He was recommended to do a colonoscopy for screening. Screening is which level of prevention?

Secondary. ***Secondary***- **Secondary prevention** involves measures like **screening** and early diagnosis to detect disease (e.g., **colorectal cancer**) in its earliest stages, allowing for timely intervention and reducing the burden of the disease. - A screening colonoscopy fits this definition perfectly, as it aims to identify **precancerous polyps** or early-stage asymptomatic cancer in an at-risk individual who has not yet been formally diagnosed. *Primordial*- **Primordial prevention** targets the underlying determinants of health and aims to prevent the establishment of risk factors themselves in the population (e.g., strict regulations on advertising unhealthy foods). - It operates at a societal level, preceding primary prevention, and is not applicable to an individual undergoing a specific medical screening test. *Primary*- **Primary prevention** aims to prevent disease onset by reducing risk factors or increasing protection *before* the disease process begins (e.g., **vaccination**, lifestyle modification, chemoprophylaxis). - Since this patient is already at high risk (family history) and presenting with an alarming symptom (**bloody stool**), the action is beyond preventing the initial exposure or onset. *Tertiary*- **Tertiary prevention** focuses on managing existing, established disease to prevent complications, reduce disability, and improve the quality of life (e.g., rehabilitation after a stroke, palliative care, or chemotherapy after a cancer diagnosis). - Screening is about early detection, whereas tertiary prevention is focused on minimizing the long-term impact of a disease that is already clinically apparent or diagnosed.

Q: A patient with a history of throat infection presents with a water hammer pulse. What is the most likely diagnosis?

Rheumatic fever with aortic regurgitation. ***Rheumatic fever with aortic regurgitation***- The history of a preceding **streptococcal throat infection** suggests **Acute Rheumatic Fever (ARF)**, which is the leading cause of acquired valvular heart disease globally.- **Aortic Regurgitation (AR)** is a common manifestation of rheumatic carditis [1] and characteristically presents with physical signs of high pulse pressure, such as the bounding, rapidly collapsing pulse known as the **water hammer pulse** (Corrigan's pulse) [2].*Infective endocarditis*- Although **infective endocarditis (IE)** can cause acute **Aortic Regurgitation (AR)** due to cusp destruction [3], the history of a preceding **throat infection** is a classic antecedent for **rheumatic fever**, not typical IE.- IE usually presents with fever, new murmur, and systemic emboli, often in patients with pre-existing valve disease or intravenous drug use.*Mitral stenosis*- **Mitral stenosis (MS)** results in decreased flow from the left atrium to the left ventricle, which *does not* lead to wide pulse pressure.- It is characterized by a **loud S1**, **opening snap**, and **mid-diastolic rumble**; MS does not cause a water hammer pulse, which is specific to **Aortic Regurgitation**.*Aortic stenosis*- **Aortic stenosis (AS)** causes mechanical obstruction to left ventricular outflow, resulting in low pulse pressure and a small, slow-rising pulse (**pulsus parvus et tardus**) [4].- AS is hemodynamically the opposite of **Aortic Regurgitation**, and therefore highly unlikely to present with a wide pulse pressure or a **water hammer pulse**.

Q: Which of the following is the management of a HIV positive patient with multiple dog bites?

Rabies vaccine + Immunoglobulin + Wound management. ***Rabies vaccine + Immunoglobulin + Wound management***- **Category III exposure** (multiple/deep transmural bites) mandates both **Passive Immunization** (Human Rabies Immune Globulin - **HRIG**) and **Active Immunization** (**Rabies Vaccine**) for immediate and long-term protection [1].- Given the patient's **HIV-positive status**, they are considered **immunocompromised**; therefore, the highest level of post-exposure prophylaxis (PEP) is required to ensure adequate viral neutralization and immune response.*Rabies vaccine + wound management*- This regimen is inadequate for **Category III exposure** because it omits **Rabies Immunoglobulin (RIG)**, which provides immediate, neutralizing antibodies before the vaccine takes effect [1].- Omitting RIG is particularly dangerous in an **immunocompromised patient** as the onset of antibody production from the vaccine may be delayed or suboptimal.*Immunoglobulin only*- **Rabies Immunoglobulin (RIG)** provides vital passive immunity but its effects are short-lived, offering only temporary protection.- Effective rabies prevention requires the simultaneous administration of the **active vaccine** series to stimulate sustained, long-term protective antibody production [1].*Wound management*- While essential for reducing local bacterial infections and viral load, **wound management alone** is never sufficient for managing **Category III rabies exposure**.- This option neglects both the immediate (RIG) and subsequent (Vaccine) specific measures required to prevent the invariably fatal neurological disease caused by the **Rabies virus**.

Q: What is the recommended treatment for nephrotic syndrome in children?

Steroids. ***Steroids***- **Corticosteroids** (typically Prednisone/Prednisolone) are the recommended **first-line therapy** for pediatric nephrotic syndrome, as *minimal change disease* (**MCD**) is the most common cause (90% of cases).- The vast majority of children with MCD are **steroid-sensitive**, exhibiting remission (proteinuria cessation) within 2-4 weeks of high-dose treatment.*Steroids and cyclophosphamide*- Combination therapy including **cyclophosphamide** is typically reserved for children who show **steroid dependence** or **frequent relapses**, not for initial therapy.- Adding cyclophosphamide as a first-line agent is unnecessary due to its potential for significant **gonadal toxicity** and other systemic side effects.*Cyclophosphamide*- **Cyclophosphamide** is a powerful **second-line immunosuppressive agent** used primarily for children who are steroid-dependent or **steroid-resistant**.- Using it as initial monotherapy is inappropriate because children with MCD usually respond well to steroids alone, avoiding risks like **myelosuppression**.*ACE inhibitors*- **Angiotensin-converting enzyme (ACE) inhibitors** are used primarily to reduce **proteinuria** by lowering **glomerular hydrostatic pressure**.- Their role is generally adjunctive management for resistant proteinuria or for treating associated **hypertension**, not as the primary agent to induce remission.

Q: Which instrument is primarily used to establish pneumoperitoneum in closed laparoscopy technique?

Veress needle. ***Veress needle***- It is primarily used to establish **pneumoperitoneum** (gas insufflation) in the **closed laparoscopy** technique, before placing trocars.- A key feature is its **blunt inner retractable stylet**. Once the needle passes the abdominal wall and enters the peritoneal cavity, the stylet advances forward automatically, reducing the risk of internal visceral injury.*Hasson's cannula*- This instrument is specifically designed for the **open laparoscopic technique** (Hasson technique), utilized when the closed technique is contraindicated due to scar tissue or risk of injury.- It involves a direct cut-down approach and fixation by sutures, making it a **blunt entry system** unlike the sharp, blind insertion of the Veress needle.*Jamshidi needle*- This is a specialized needle used for **bone marrow aspiration** or **biopsy**, typically used in hematology or oncology.- It is characterized by a **tapered distal end** with a sharpened tip and a stylet designed to penetrate dense bone tissue, which is unrelated to abdominal gas insufflation.*3 mm Trocar*- A trocar system consists of a **cannula and an obturator** and is used to create a working port for the introduction of the camera or surgical instruments, usually *after* pneumoperitoneum has been achieved.- While 3 mm is a small diameter, its function is creating an instrument channel, not the initial **insufflation** itself.

Q: The given image shows an ulcer. Identify the marked structure.

Edge. ***Edge*** - The marked structure represents the side of the ulcer, connecting the **margin** to the **floor**, which is correctly termed the **edge**. - The characteristics of the edge (e.g., sloping, punched-out, undermined) are crucial for determining the ulcer's etiology, such as in **tuberculous ulcers** (undermined) or **malignant ulcers** (everted). *Margin* - The **margin** is the area of skin immediately surrounding the ulcer, essentially the "rim" on the surface. - The arrow is pointing into the crater of the ulcer, not the tissue around its periphery. *Floor* - The **floor** is the bottom, visible surface of the ulcer crater itself. - The marked structure is the wall leading down to the floor, not the floor itself. *Base* - The **base** is the tissue deep to the ulcer, upon which it rests, and is typically assessed by palpation for induration. - It is not a visible structure on inspection, unlike the edge which is clearly marked in the diagram.

Q: A 33-year-old male presents with sudden onset acute abdominal pain, constipation for 1 day, persistent hiccups, and occasional vomiting. An abdominal X-ray was performed. Identify the pathology.

Sigmoid volvulus. ***Sigmoid volvulus*** - The abdominal X-ray demonstrates the classic **"coffee bean" sign**, which is a pathognomonic finding for sigmoid volvulus, representing a massively dilated loop of the sigmoid colon. - The clinical presentation of acute abdominal pain, distension, and constipation is consistent with a **large bowel obstruction**, which is caused by the twisting of the sigmoid colon on its mesentery. *Caecal volvulus* - Radiographically, a caecal volvulus typically appears as a kidney-shaped or comma-shaped dilated loop of bowel displaced towards the **left upper quadrant**, which is not seen in this image. - It is less common than sigmoid volvulus and is often associated with a mobile cecum and the absence of prior abdominal surgery. *Intussusception* - Intussusception, the telescoping of one bowel segment into another, is more common in children and classically presents with a **"target sign"** on ultrasound or CT. - While it can cause obstruction in adults, the radiographic finding of a massive, single, air-filled loop is not characteristic of intussusception. *Mechanical obstruction* - This is a general term for physical blockage of the bowel lumen. While sigmoid volvulus is a specific cause of mechanical obstruction, the X-ray provides specific findings that point to a more precise diagnosis. - Non-specific signs of mechanical obstruction, such as multiple dilated bowel loops with **air-fluid levels**, are different from the characteristic single-loop dilation seen here.

Question 1

Which of the following is the fIPV dose schedule under the National Immunization Schedule?

Accepted Answer

6 weeks, 14 weeks, 9 months

Answer

6 weeks, 10 weeks, 14 weeks

Answer

6 weeks, 10 weeks, 12 weeks

Answer

At birth, 6 weeks, 10 weeks, 14 weeks, 16-24 months, 5 years

Question 2

A person's father had colon cancer. He had bloody stool. So, he just came for a check-up. Before he had not undergone any screening. He was recommended to do a colonoscopy for screening. Screening is which level of prevention?

Accepted Answer

Secondary

Answer

Tertiary

Answer

Primary

Answer

Primordial

Question 3

A patient with a history of throat infection presents with a water hammer pulse. What is the most likely diagnosis?

Accepted Answer

Rheumatic fever with aortic regurgitation

Answer

Infective endocarditis

Answer

Aortic stenosis

Answer

Mitral stenosis

Question 4

Which of the following is the management of a HIV positive patient with multiple dog bites?

Accepted Answer

Rabies vaccine + Immunoglobulin + Wound management

Answer

Immunoglobulin only

Answer

Wound management

Answer

Rabies vaccine + wound management

Question 5

The CSF findings in bacterial meningitis would include which of the following?

Accepted Answer

Elevated protein and decreased glucose

Answer

Elevated WBC count with normal glucose

Answer

Decreased protein and elevated glucose

Answer

Normal white blood cell count

Question 6

What is the recommended treatment for nephrotic syndrome in children?

Accepted Answer

Steroids

Answer

ACE inhibitors

Answer

Cyclophosphamide

Answer

Steroids and cyclophosphamide

Question 7

Which instrument is primarily used to establish pneumoperitoneum in closed laparoscopy technique?

Accepted Answer

Veress needle

Answer

Jamshidi needle

Answer

3 mm Trocar

Answer

Hasson's cannula

Question 8

The given image shows an ulcer. Identify the marked structure.

Accepted Answer

Edge

Answer

Base

Answer

Floor

Answer

Margin

Question 9

A 33-year-old male presents with sudden onset acute abdominal pain, constipation for 1 day, persistent hiccups, and occasional vomiting. An abdominal X-ray was performed. Identify the pathology.

Accepted Answer

Sigmoid volvulus

Answer

Intussusception

Answer

Caecal volvulus

Answer

Mechanical obstruction

Question 10

During laparoscopic surgery, which vessel(s) should be specifically avoided during lateral trocar insertion?

Accepted Answer

Both Superior epigastric artery and Inferior epigastric artery

Answer

Superior epigastric artery

Answer

Abdominal aorta

Answer

Inferior epigastric artery

FMGE 2025

Community Medicine

Internal Medicine

Pathology

Pediatrics

Surgery