FMGE 2025 Practice Questions

Q: Which of the following is not a food adulteration disease?

Fluorosis. ***Fluorosis***- It results from excessive intake of **fluoride**, primarily through naturally occurring high levels in **drinking water**.- While fluoride can be present in food, it is generally considered an **environmental exposure disease** rather than one caused by intentional food adulteration.*Lathyrism*- Caused by chronic consumption of **khesari dal** (*Lathyrus sativus*), which is often mixed as an adulterant in pulses like *Arhar dal*.- The toxicity is due to the neurotoxin **beta-N-oxalylamino-L-alanine (BOAA)**, leading to irreversible lower limb paralysis (**neurolathyrism**).*Dropsy*- Also known as **epidemic dropsy**, it is caused by edible oils (most commonly mustard oil) adulterated with **Argemone mexicana oil**.- The toxic substance responsible for the disease is **sanguinarine**, causing generalized edema, cardiac failure, and glaucoma.*Aflatoxicosis*- Caused by ingesting food (such as groundnuts, maize, or cereals) contaminated with **aflatoxins**, which are toxic metabolites produced by the fungus *Aspergillus*.- While often resulting from contamination due to poor storage, aflatoxins represent a major form of food poisoning resulting from the poor quality or mixing of contaminated ingredients, causing severe **hepatotoxicity**.

Q: A patient presents with unilateral throbbing pain, photophobia, nausea, and vomiting. The symptoms improve after taking sumatriptan. What is the most likely diagnosis?

Migraine. ***Migraine*** - The presentation of **unilateral**, **throbbing pain** combined with associated symptoms like **photophobia**, **nausea**, and **vomiting** constitutes the classic criteria for migraine [1]. - Dramatic symptomatic relief after taking **sumatriptan** (a **triptan**) is highly characteristic, as these drugs are specific abortive treatments for acute **migraine** attacks. *Tension headache* - This headache is typically **bilateral**, described as a **tightening** or **band-like** pressure, and is non-throbbing [1]. - It usually lacks associated features such as **nausea**, **vomiting**, or severe photophobia, and does not typically respond well to triptans. *Cluster headache* - While also highly painful and unilateral, cluster headaches are characterized by **excruciating, non-throbbing** pain, often localized to the **periorbital** or retro-orbital region [1]. - Key associated features are **autonomic**, including ipsilateral **lacrimation**, ptosis, miosis, and rhinorrhea, features not mentioned in this presentation. *Sinus headache* - This diagnosis is associated with symptoms of **sinusitis**, such as facial pressure, pain over the sinuses, fever, and purulent nasal discharge. - The pain is usually localized to the **maxillary** or **frontal** regions and is not typically a severe, throbbing pain that uniquely responds to triptans.

Q: A patient with a history of pneumonia develops pleural effusion. What is the expected finding in the pleural analysis for a complicated parapneumonic effusion?

Pleural pH less than 7.2. ***Pleural pH less than 7.2***- This finding is the critical biochemical parameter defining a **complicated parapneumonic effusion** or **empyema** [1].- The low pH results from high local acid production (lactic acid, CO2) due to bacterial metabolism and inflammatory cell activity, which strongly indicates the need for **chest tube drainage** [1].*Pleural protein/plasma protein ratio less than 0.5*- This ratio is characteristic of a **transudative pleural effusion** (e.g., heart failure or nephrotic syndrome).- Parapneumonic effusions are inflammatory processes that result in **exudative effusions**, where this ratio is typically greater than 0.5 according to **Light’s criteria** [1].*Pleural LDH less than 2/3rd of plasma LDH*- High pleural fluid LDH is a key feature of an **exudative effusion**; therefore, LDH levels would generally be expected to be higher than this threshold in a parapneumonic effusion.- The standard Light's criteria dictate that pleural LDH must be greater than 2/3rds the upper limit of normal serum LDH for an effusion to be classified as an **exudate** [1].*Pleural LDH less than 0.6 of plasma LDH*- In an exudative process like a parapneumonic effusion, the pleural fluid LDH to serum LDH ratio is expected to be **greater than 0.6**.- A ratio less than 0.6 is characteristic of a **transudative effusion**.

Q: A 72 y/o woman presents with severe chest pain and shortness of breath after a stressful argument. She is post-menopausal with no history of heart disease. O/E, she is slightly tachycardic with normal blood pressure. An echocardiogram shows left ventricular ballooning during systole, and cardiac enzymes are minimally elevated. What is the most likely diagnosis?

Takotsubo Cardiomyopathy. ***Takotsubo Cardiomyopathy*** - **Stress-induced cardiomyopathy** (broken heart syndrome) typically affects **post-menopausal women** following emotional or physical stress [2]. - Classic presentation: **chest pain mimicking acute MI** with **minimal cardiac enzyme elevation** (troponin may be mildly elevated but disproportionately low for the degree of wall motion abnormality) - **Pathognomonic finding**: **Apical ballooning** (or mid-ventricular ballooning) on echocardiography during systole, with **hyperkinetic basal segments** creating characteristic "octopus trap" appearance - Usually **reversible** within weeks to months with supportive care - Coronary angiography shows **normal or non-obstructive coronary arteries** *Incorrect: Coronary Artery Disease* - Would show **significantly elevated cardiac enzymes** (troponin, CK-MB) proportionate to myocardial damage [1]. - Echo would show wall motion abnormalities in **coronary artery distribution** (not apical ballooning pattern) - Risk factors and chronic history more common [3]. *Incorrect: Pulmonary Embolism* - Would present with **right ventricular strain** on echo, not left ventricular ballooning - Different chest pain character (pleuritic), associated with **hypoxemia** and **tachypnea** - D-dimer elevated, cardiac enzymes usually normal unless massive PE *Incorrect: Hypertensive Heart Disease* - Patient has **normal blood pressure** on examination - Would show **left ventricular hypertrophy** and diastolic dysfunction, not acute ballooning - Chronic presentation, not acute stress-related event

Q: A 68-year-old male patient with a history of hypertension presents to the emergency department in acute distress. He is diaphoretic, tachycardic, and complains of severe chest pain. His vital signs show a heart rate of 180 bpm with a regular, wide-complex tachycardia consistent with ventricular tachycardia. The patient appears hemodynamically unstable. What is the most appropriate immediate management for this patient?

Synchronized cardioversion. Detailed Analysis of Ventricular Tachycardia Management: ***Synchronized cardioversion*** - The ECG shows a regular, wide-complex tachycardia, consistent with **ventricular tachycardia (VT)**. The patient's clinical presentation with severe chest pain and diaphoresis indicates **hemodynamic instability** [1]. - For any unstable tachyarrhythmia, including VT, immediate **synchronized electrical cardioversion** is the first-line treatment to restore sinus rhythm and prevent cardiovascular collapse [2]. *Amiodarone* - Amiodarone is an antiarrhythmic medication that is appropriate for **stable ventricular tachycardia**, where the patient has adequate blood pressure and is not in acute distress. - In an unstable patient, electrical cardioversion should not be delayed for a trial of pharmacologic therapy, as this can lead to further deterioration [2]. *Radiofrequency catheter ablation* - This is an elective, invasive procedure used for the long-term prevention of recurrent arrhythmias, not for the acute management of an unstable patient. - Catheter ablation is typically considered after the patient has been stabilized and if they experience recurrent episodes of VT. *Digoxin* - Digoxin is primarily used for rate control in supraventricular tachycardias like **atrial fibrillation** and is not effective for treating ventricular tachycardia [3]. - Administering digoxin in this setting is inappropriate and can potentially worsen the arrhythmia or cause toxicity [3].

Q: A 35-year-old female patient presents to the clinic for evaluation of her fertility status. She has been trying to conceive for over a year without success. Which of the following is the single best test for assessing her ovarian reserve?

Anti-Müllerian hormone (AMH). ***Anti-Müllerian hormone (AMH)***- **AMH** is currently considered the single **best test** for assessing ovarian reserve because it is produced by **granulosa cells** of pre-antral and small antral follicles, directly correlating with the size of the **remaining follicle pool**.- It can be measured reliably at **any time** during the menstrual cycle or even while using oral contraceptives, providing a highly stable and convenient assessment compared to cycle-dependent hormones.*Follicle-stimulating hormone (FSH) on day 3*- While commonly used, day 3 **FSH levels** are less sensitive than AMH because they reflect the degree of **luteal-follicular axis feedback** rather than the absolute number of follicles.- FSH levels are subject to significant **cycle-to-cycle variability**, and elevated readings often represent an already **advanced stage** of ovarian decline.*Estradiol on day 3*- Day 3 **Estradiol** is primarily measured to exclude premature follicle recruitment (which could suppress FSH), but it is a **poor independent predictor** of ovarian reserve.- Estradiol levels fluctuate greatly and high levels can **falsely mask** elevated FSH readings, limiting its utility as a primary diagnostic tool.*Serum inhibin levels on day 5*- **Inhibin B** is produced by developing follicles and reflects ovarian reserve, but it exhibits significant **menstrual cycle variability**, making interpretation challenging.- It is considered a **secondary marker**; it is less standardized and has lower predictive accuracy for future fertility compared to **AMH**.

Q: A 22-year-old male presents with pain and swelling over the distal radius. X-ray shows an expansile lytic lesion in the metaphysis. Fine needle aspiration (FNA) reveals a bloody aspirate with hemosiderin-laden macrophages. What is the most likely diagnosis?

Aneurysmal bone cyst. ***Aneurysmal bone cyst*** - This diagnosis is highly suggested by the patient's age (young adult) and the finding of an **expansile and lytic metaphyseal lesion** in a long bone like the distal radius. - The fine needle aspiration finding of a bloody aspirate containing numerous **hemosiderin-laden macrophages** is characteristic, reflecting the hemorrhagic, non-neoplastic, multicystic nature of an aneurysmal bone cyst (ABC). *Giant cell tumor* - While GCT is also lytic and occurs in young adults, it classically arises in the **epiphysis** (subarticular region) of long bones, especially around the knee (distal femur, proximal tibia). - Histologically, GCT shows numerous evenly distributed **multinucleated giant cells** and mononuclear stromal cells, which would dominate the aspirate rather than just blood and macrophages. *Osteosarcoma* - Osteosarcoma is typically an aggressive malignant tumor that often presents with mixed lytic and **sclerotic** features and frequently shows significant periosteal reaction (e.g., **Codman triangle** or **sunburst pattern**). - Cytology would reveal highly **anaplastic malignant cells** actively producing osteoid, which is the defining characteristic. *Chondroblastoma* - This is an uncommon benign tumor that characteristically arises in the **epiphysis** of long bones (e.g., proximal humerus, femoral condyles). - Histology is defined by compact polygonal cells called **chondroblasts** often surrounded by deposits of **chondroid matrix** and characteristic **"chicken-wire" calcification**. - The metaphyseal location and bloody aspirate with hemosiderin-laden macrophages do not fit this diagnosis.

Question 1

Which of the following is not a food adulteration disease?

Accepted Answer

Fluorosis

Answer

Lathyrism

Answer

Aflatoxicosis

Answer

Dropsy

Question 2

A patient presents with unilateral throbbing pain, photophobia, nausea, and vomiting. The symptoms improve after taking sumatriptan. What is the most likely diagnosis?

Accepted Answer

Migraine

Answer

Cluster headache

Answer

Sinus headache

Answer

Tension headache

Question 3

A patient with a history of pneumonia develops pleural effusion. What is the expected finding in the pleural analysis for a complicated parapneumonic effusion?

Accepted Answer

Pleural pH less than 7.2

Answer

Pleural LDH less than 0.6 of plasma LDH

Answer

Pleural protein/plasma protein ratio less than 0.5

Answer

Pleural LDH less than 2/3rd of plasma LDH

Question 4

A 65-year-old male with chronic stable angina presents with worsening chest pain during routine activities. His current medications include aspirin, clopidogrel, metoprolol, and atorvastatin, but his symptoms persist. ECG shows ST-segment depression in V5-V6, and coronary angiography reveals 80% stenosis of the left anterior descending (LAD) artery. What is the most appropriate intervention?

Accepted Answer

Percutaneous coronary intervention (PCI) with drug-eluting stent (DES)

Answer

Add ranolazine to medical therapy

Answer

Increase the dose of beta-blockers

Answer

Refer for coronary artery bypass grafting (CABG)

Question 5

A 72 y/o woman presents with severe chest pain and shortness of breath after a stressful argument. She is post-menopausal with no history of heart disease. O/E, she is slightly tachycardic with normal blood pressure. An echocardiogram shows left ventricular ballooning during systole, and cardiac enzymes are minimally elevated. What is the most likely diagnosis?

Accepted Answer

Takotsubo Cardiomyopathy

Answer

Pulmonary Embolism

Answer

Coronary Artery Disease

Answer

Hypertensive Heart Disease

Question 6

A 68-year-old male patient with a history of hypertension presents to the emergency department in acute distress. He is diaphoretic, tachycardic, and complains of severe chest pain. His vital signs show a heart rate of 180 bpm with a regular, wide-complex tachycardia consistent with ventricular tachycardia. The patient appears hemodynamically unstable. What is the most appropriate immediate management for this patient?

Accepted Answer

Synchronized cardioversion

Answer

Amiodarone

Answer

Radiofrequency catheter ablation

Answer

Digoxin

Question 7

A 35-year-old female patient presents to the clinic for evaluation of her fertility status. She has been trying to conceive for over a year without success. Which of the following is the single best test for assessing her ovarian reserve?

Accepted Answer

Anti-Müllerian hormone (AMH)

Answer

Serum inhibin levels on day 5

Answer

Estradiol on day 3

Answer

Follicle-stimulating hormone (FSH) on day 3

Question 8

A 28-year-old pregnant woman at 33 weeks gestation presents for a routine prenatal visit. She reports decreased fetal movements over the past two days. She has a history of gestational diabetes, and her pregnancy has been otherwise uneventful. The doctor decides to perform antepartum fetal surveillance. Which of the following is the most appropriate initial test to assess the fetal well-being in this scenario?

Accepted Answer

Non Stress test

Answer

Biophysical profile

Answer

Amniotic fluid index

Answer

Contraction Stress test

Question 9

During the active management of the third stage of labor, which intervention is recommended to prevent postpartum hemorrhage primarily due to uterine atony?

Accepted Answer

Administration of uterotonic agent (oxytocin 10 units IM) within 1 minute of birth

Answer

Immediate administration of 20 units of undiluted oxytocin intravenously

Answer

Controlled cord traction with immediate removal of the placenta

Answer

Oxytocin 10 units IM with crowning

Question 10

A 22-year-old male presents with pain and swelling over the distal radius. X-ray shows an expansile lytic lesion in the metaphysis. Fine needle aspiration (FNA) reveals a bloody aspirate with hemosiderin-laden macrophages. What is the most likely diagnosis?

Accepted Answer

Aneurysmal bone cyst

Answer

Giant cell tumor

Answer

Chondroblastoma

Answer

Osteosarcoma

FMGE 2025

Community Medicine

Internal Medicine

Obstetrics and Gynecology

Orthopaedics