FMGE 2025 Practice Questions

Q: A 60 y/o male suddenly experiences an intense headache, described as the worst headache of his life, followed by vomiting and photophobia. O/E he has neck stiffness and a dilated pupil on the right side. A CT scan reveals bleeding in the subarachnoid space. Which of the following is the most common cause of this condition?

Intracranial aneurysm. ***Intracranial aneurysm***- Rupture of an intracranial **saccular (berry) aneurysm** accounts for approximately 85% of all non-traumatic subarachnoid hemorrhage (SAH) cases, making it the most common cause [2].- The classic presentation of the **"worst headache of his life"** (thunderclap headache), meningismus (**neck stiffness**), and potential Third nerve palsy (dilated pupil due to compression) are highly suggestive of aneurysmal SAH [1].*Hypertension*- Uncontrolled **chronic hypertension** is the leading cause of non-traumatic **intraparenchymal hemorrhage (ICH)**, typically affecting deep brain structures like the basal ganglia.- While hypertension is a major risk factor for SAH, it is not the primary mechanism of bleeding; the rupture of an aneurysm is the direct immediate cause [1].*Arteriovenous malformation (AVM)*- AVMs are abnormal connections that can rupture, causing hemorrhagic stroke, but they are the second most common cause of SAH, accounting for less than 10% of cases.- AVM rupture often leads to a combination of **intraparenchymal hemorrhage** and SAH, and they are typically associated with younger patients.*Brain tumour*- Tumors rarely cause acute, massive SAH; when they bleed, it typically occurs within the tumor mass itself (**intratumoral hemorrhage**).- The clinical presentation usually involves subacute onset of symptoms and progressive focal neurological deficits, rather than the sudden, dramatic thunderclap headache characteristic of SAH [1].

Q: A 25-year-old female presents with complaints of a yellowish-green, foul-smelling vaginal discharge. She reports painful urination and pain during intercourse & no itching. On speculum examination, her vulva and vaginal walls appear inflamed. What is the causative agent?

Trichomonas vaginalis. ***Trichomonas vaginalis***- The classic clinical presentation of **trichomoniasis** includes a copious, frothy (though not always), **yellowish-green**, and distinctly **foul-smelling** vaginal discharge.- The organism causes inflammation and tissue damage (vaginitis/vulvitis), leading to common symptoms like **dysuria** and **dyspareunia**, often without significant pruritus (itching). *Candida albicans*- This fungal infection typically causes a thick, **white, 'cottage cheese-like'** vaginal discharge.- The hallmark symptom is intense **vulvovaginal pruritus** (itching), which is explicitly reported as absent in this patient. *Gardnerella vaginalis*- This bacterium is the most common cause of **Bacterial Vaginosis (BV)**, which produces a thin, **grayish-white** discharge with a characteristic **fishy odor**.- BV often causes minimal inflammation (no significant vulvitis) and typically does not present with the bright yellowish-green discharge described. *Neisseria gonorrhoeae*- While *N. gonorrhoeae* can cause **cervicitis** and **urethritis** (leading to dysuria), the discharge is usually described as **mucopurulent** rather than copious, foul-smelling, and yellowish-green.- The overall clinical picture (discharge color, odor, and inflammation) points more specifically toward a **prototozoal vaginitis**.

Q: A 38 year old woman presents with complaints of heavy menstrual bleeding, pelvic discomfort, and frequent urination. On physical examination, her uterus is found to be irregularly enlarged. Which of the following is the most likely diagnosis?

Leiomyoma. ***Leiomyoma***- The constellation of **heavy menstrual bleeding (menorrhagia)**, pelvic pressure symptoms (like frequent urination), and an **irregularly enlarged uterus** is the classic clinical presentation for **uterine leiomyomas (fibroids)**.- These benign tumors of the myometrium cause menorrhagia if they are submucosal, and pressure symptoms if they grow large and compress the surrounding bladder or bowel.*Endometriosis*- This condition is characterized by endometrial tissue outside the uterus, leading primarily to severe **dysmenorrhea**, **dyspareunia**, and chronic pelvic pain due to adhesions.- While it can cause pelvic symptoms, it does not typically result in an **irregularly enlarged uterus**; that finding strongly points to fibroids or adenomyosis.*Ovarian cyst*- A mass due to an ovarian cyst is an **adnexal** finding, meaning it arises from the ovary and is distinct from the uterine corpus.- Although very large cysts can cause pressure on the bladder, the uterus itself would not be described as **irregularly enlarged** in this diagnosis.*Polycystic ovary syndrome (PCOS)*- PCOS is defined by chronic anovulation and hyperandrogenism, typically leading to **oligomenorrhea** (infrequent periods) or **amenorrhea**.- This diagnosis does not cause structural changes to the uterus (like enlargement) or primary symptoms of **menorrhagia**.

Q: A 25-year-old female presents with irregular menstrual cycles, acne, and excessive hair growth. An ultrasound reveals multiple ovarian cysts. What is the most likely diagnosis?

Polycystic Ovary Syndrome (PCOS). ***Polycystic Ovary Syndrome (PCOS)*** - This diagnosis is strongly suggested by the combination of clinical hyperandrogenism (**hirsutism** and **acne**) and chronic **anovulation** (irregular menstrual cycles). - PCOS is further supported by the **polycystic ovarian morphology** seen on ultrasound, fulfilling the diagnostic criteria (often Rotterdam criteria). *Endometriosis* - Endometriosis is characterized by the presence of **endometrial tissue outside the uterus**, classically presenting with chronic pelvic pain or **dysmenorrhea** (painful periods). - It typically does not cause the severe **hyperandrogenism** (acne, hirsutism) or chronic anovulation seen in this patient. *Hypothyroidism* - While hypothyroidism is a common cause of menstrual irregularities, it typically causes symptoms such as fatigue, weight gain, and **cold intolerance**. - It does not cause signs of **hyperandrogenism** like acne and hirsutism, which are key differentiating features in this case. *Ovarian hyperstimulation syndrome (OHSS)* - OHSS is an iatrogenic condition, almost exclusively occurring after intensive **gonadotropin stimulation** used in fertility treatments. - It presents acutely with severe ovarian enlargement, abdominal distension, and potentially **third-spacing of fluids**, not as a chronic condition causing hirsutism.

Q: A newborn male presents with urinary retention, lethargy and a distended bladder. Antenatal ultrasound showed a "keyhole sign" with a thickened bladder wall. Which of the following is the most likely diagnosis?

Posterior urethral valves. ***Posterior urethral valves***- The **"keyhole sign"** seen on antenatal ultrasound, characterized by a dilated posterior urethra and a thickened, distended bladder, is highly specific for **posterior urethral valves (PUV)**.- PUV is the most common cause of severe **lower urinary tract obstruction** in male newborns, leading directly to symptoms like lethargy, a palpable **distended bladder**, and urinary retention.*Hypospadias*- *Hypospadias* is an abnormal location of the **urethral meatus** on the ventral aspect of the penis.- It does not cause the severe **obstructive uropathy** (like urinary retention and bladder distension) or the **keyhole sign** observed in this patient.*Vesicoureteral reflux*- *Vesicoureteral reflux* (VUR) involves the reflux of urine from the bladder back up to the ureters and is typically a **non-obstructive** cause of hydronephrosis and UTIs.- While VUR can coexist with PUV, it is the secondary phenomenon, and VUR itself does not cause the primary **urethral obstruction** or the characteristic **keyhole appearance**.*Neurogenic bladder*- A *neurogenic bladder* results from impaired nerve supply, often due to conditions like **spina bifida**, leading to poor bladder emptying.- While it can cause retention, the unique finding of the **keyhole sign** points specifically to a fixed, **anatomical obstruction** in the posterior urethra, which is not characteristic of neurological issues.

Q: A 45-year-old male patient was brought to the emergency department following a road traffic accident. O/E, he had multiple injuries all over his body and was found to be in class III hemorrhagic shock. The percentage of blood loss would be between:

30-40%. ***30-40%***- **Class III hemorrhagic shock** is defined by an estimated blood loss of **30-40%** (approximately 1500 to 2000 mL in an adult).- Clinically, patients in Class III shock present with **marked tachycardia** (>120 bpm), significant **hypotension**, and altered **mental status** (confusion).*5-15%*- This range corresponds to **Class I hemorrhagic shock**, which involves minimal blood loss (up to 750 mL).- Patients in **Class I** typically present with near-normal vital signs or mild **tachycardia** only, not the severe clinical picture described.*>40%*- This defines **Class IV hemorrhagic shock**, representing extremely severe and **life-threatening** blood loss (over 2000 mL).- Patients in **Class IV** present with profound **hypotension** and absent peripheral pulses; they are often unresponsive.*15-30%*- This range characterizes **Class II hemorrhagic shock**, which involves moderate blood loss (750 to 1500 mL).- Patients exhibit **tachycardia** (100–120 bpm) and decreased **pulse pressure**, but usually maintain adequate blood pressure and good mental status, unlike the patient described.

Q: A 20-year-old male presents to the outpatient department with a swelling on his wrist. He reports fluctuation in size, mild numbness in the hand, and occasional pain. What is the most likely diagnosis?

Ganglion cyst. ***Ganglion cyst*** - This is the most common benign soft-tissue tumor of the hand and wrist, often arising from a **joint capsule** or **tendon sheath**. The classic presentation includes a smooth, round swelling on the wrist that can fluctuate in size. - Symptoms like mild pain and numbness can occur due to **nerve compression**, which is consistent with the patient's presentation. On examination, they are typically firm and **transilluminate**. *Lipoma* - A lipoma is a benign tumor composed of **adipose tissue** (fat). It typically presents as a soft, mobile, and “doughy” subcutaneous mass, which differs from the usually firm consistency of a ganglion cyst. - Lipomas do not fluctuate in size and are less likely to be found on the dorsal aspect of the wrist compared to ganglion cysts. *Dermoid cyst* - A dermoid cyst is a **congenital** lesion (a type of teratoma) containing dermal structures like hair follicles and sebaceous glands. They are most commonly found in the midline, face, or neck. - Their presence on the wrist is extremely rare, and they do not typically fluctuate in size like a ganglion cyst. *Hematoma* - A hematoma is a localized collection of blood, usually resulting from **trauma**. The patient's history does not mention any injury. - An acute hematoma would be tender and associated with **ecchymosis** (bruising), and it would be expected to resolve over time rather than fluctuate.

Q: A patient with dilated tortuous veins of the leg presented to the OPD and is diagnosed with varicose vein of grade C4a. What is the best preferred treatment?

Endothermal ablation. ***Endothermal ablation***- Guidelines recommend **endothermal ablation** (e.g., **EVLA** or **RFA**) as the first-line definitive treatment for symptomatic varicose veins (C2-C6), especially those causing **C4a skin changes** due to underlying reflux.- This technique is minimally invasive, highly effective at eliminating **saphenous vein reflux**, and leads to faster recovery and reduced recurrence rates compared to surgery.*Compression*- Compression therapy is mandated for all CEAP classifications (C0 to C6) but only serves as **conservative management** to alleviate symptoms and manage edema and skin changes (C4a).- It does not address the underlying **venous valve incompetence** leading to the venous hypertension and is therefore not the definitive preferred treatment.*Non endothermal non tumescent ablation*- These techniques, such as **mechanochemical ablation** (MOCA) or **cyanoacrylate glue**, are effective and avoid the need for general anesthesia or tumescent local anesthesia, making them suitable alternatives.- However, endothermal modalities are often preferred as first-line due to extensive long-term data supporting their effectiveness and durability in treating major **truncal reflux**.*Open surgery*- **High ligation and stripping** used to be the gold standard but is now generally reserved for complex cases where ablation is not technically feasible, such as large tributary veins or extreme **tortuosity**.- Open surgery involves greater morbidity, longer hospital stays, and potentially higher risks of **injury to nerves** (e.g., saphenous nerve) compared to endothermal methods.

Q: In a follow-up case of prostate cancer, what do we need to check?

PSA. ***PSA***- **Prostate-Specific Antigen** is the primary biomarker used for routine surveillance and follow-up after definitive treatment (like prostatectomy or radiation) for prostate cancer. - A sustained rise in PSA levels, known as **biochemical recurrence**, is the earliest sign that prostate cancer may have returned locally or metastasized. *Alkaline phosphatase* - **Alkaline phosphatase (ALP)** levels are primarily followed when there is suspicion of **bony metastasis**, as high ALP reflects increased osteoblastic activity. - It is used to stage and evaluate advanced disease or monitor response to treatment for bone mets, but it is not the primary marker for general recurrence detection. *Testosterone* - **Testosterone** levels are monitored primarily in patients receiving **androgen deprivation therapy (ADT)** to ensure that castrate levels of androgens are being maintained. - Changes in circulating testosterone do not reliably indicate cancer recurrence or progression in patients not undergoing hormonal manipulation. *Acid phosphatase* - **Acid phosphatase (ACP)**, specifically prostatic acid phosphatase (PAP), is a historical tumor marker that has been superseded by PSA in nearly all aspects of follow-up. - Elevated ACP is usually associated with **advanced or metastatic disease** but lacks the sensitivity of PSA for detecting early biochemical recurrence.

Question 1

A 60 y/o male suddenly experiences an intense headache, described as the worst headache of his life, followed by vomiting and photophobia. O/E he has neck stiffness and a dilated pupil on the right side. A CT scan reveals bleeding in the subarachnoid space. Which of the following is the most common cause of this condition?

Accepted Answer

Intracranial aneurysm

Answer

Hypertension

Answer

Brain tumour

Answer

Arteriovenous malformation (AVM)

Question 2

A 25-year-old female presents with complaints of a yellowish-green, foul-smelling vaginal discharge. She reports painful urination and pain during intercourse & no itching. On speculum examination, her vulva and vaginal walls appear inflamed. What is the causative agent?

Accepted Answer

Trichomonas vaginalis

Answer

Candida albicans

Answer

Neisseria gonorrhoeae

Answer

Gardnerella vaginalis

Question 3

A 38 year old woman presents with complaints of heavy menstrual bleeding, pelvic discomfort, and frequent urination. On physical examination, her uterus is found to be irregularly enlarged. Which of the following is the most likely diagnosis?

Accepted Answer

Leiomyoma

Answer

Ovarian cyst

Answer

Endometriosis

Answer

Polycystic ovary syndrome (PCOS)

Question 4

A 25-year-old female presents with irregular menstrual cycles, acne, and excessive hair growth. An ultrasound reveals multiple ovarian cysts. What is the most likely diagnosis?

Accepted Answer

Polycystic Ovary Syndrome (PCOS)

Answer

Ovarian hyperstimulation syndrome (OHSS)

Answer

Hypothyroidism

Answer

Endometriosis

Question 5

A 30-year-old female presents to the OPD with a 3 cm breast lump in the upper medial quadrant. The lump has an uneven, bosselated surface, and the overlying skin is mildly ulcerated. Microscopic examination reveals the given findings. What is the most likely diagnosis?

Accepted Answer

Phyllodes tumor

Answer

Fibroadenoma

Answer

Paget's disease

Answer

Galactocele

Question 6

A newborn male presents with urinary retention, lethargy and a distended bladder. Antenatal ultrasound showed a "keyhole sign" with a thickened bladder wall. Which of the following is the most likely diagnosis?

Accepted Answer

Posterior urethral valves

Answer

Hypospadias

Answer

Vesicoureteral reflux

Answer

Neurogenic bladder

Question 7

A 45-year-old male patient was brought to the emergency department following a road traffic accident. O/E, he had multiple injuries all over his body and was found to be in class III hemorrhagic shock. The percentage of blood loss would be between:

Accepted Answer

30-40%

Answer

>40%

Answer

5-15%

Answer

15-30%

Question 8

A 20-year-old male presents to the outpatient department with a swelling on his wrist. He reports fluctuation in size, mild numbness in the hand, and occasional pain. What is the most likely diagnosis?

Accepted Answer

Ganglion cyst

Answer

Dermoid cyst

Answer

Lipoma

Answer

Hematoma

Question 9

A patient with dilated tortuous veins of the leg presented to the OPD and is diagnosed with varicose vein of grade C4a. What is the best preferred treatment?

Accepted Answer

Endothermal ablation

Answer

Non endothermal non tumescent ablation

Answer

Open surgery

Answer

Compression

Question 10

In a follow-up case of prostate cancer, what do we need to check?

Accepted Answer

PSA

Answer

Acid phosphatase

Answer

Alkaline phosphatase

Answer

Testosterone

FMGE 2025

Internal Medicine

Microbiology

Obstetrics and Gynecology

Pathology

Pediatrics

Surgery