FMGE 2025 Practice Questions

Q: A young male presented with weakness in the lower half of the right side of his face, with drooping of the angle of his mouth. He is unable to raise his eyebrows and close his eyes on the right side. Which of the following is the most appropriate diagnosis?

Infranuclear facial palsy on right side. ***Infranuclear facial palsy on right side***- **Infranuclear (peripheral) facial palsy** involves the facial nerve (CN VII) distal to the nucleus, causing paralysis of the entire ipsilateral side of the face.- The inability to move the upper facial muscles (closing the eye, raising the eyebrow) combined with lower face weakness (mouth drooping) on the right side indicates complete paralysis of the **right facial nerve**.*Supranuclear facial palsy on left side*- A **supranuclear (central) lesion** (e.g., stroke) affects the face contralaterally, leading to weakness on the right face, but the upper face (forehead) would be spared [1].- The ability to move the forehead is preserved in supranuclear palsy because the upper facial nucleus receives bilateral cortical input, which contradicts the bilateral/right upper face involvement described here [1].*Infranuclear facial on left side*- This diagnosis would cause complete paralysis (upper and lower face) on the **left side**.- The patient presents with clinical signs of paralysis (drooping mouth, inability to raise eyebrow) primarily on the **right side**, making a left-sided lesion incorrect.*Supranuclear facial on right side*- A **supranuclear lesion** on the right side would cause weakness of the muscles of the **left lower face** (contralateral presentation).- Supranuclear lesions never cause involvement of the upper facial muscles (unable to raise eyebrows) as seen in this patient [1].

Q: A patient presents with the palsy of the face as shown. Which of the following is most likely involved?

7th nerve palsy. ***7th nerve palsy*** - The image shows features of a **lower motor neuron (LMN) lesion** of the **7th cranial (facial) nerve**, affecting both the upper and lower face. Note the inability to wrinkle the left forehead, incomplete eye closure, and drooping of the left corner of the mouth. - This condition, often idiopathic and termed **Bell's palsy**, results in paralysis of all ipsilateral muscles of facial expression, which are innervated by the facial nerve. *3rd nerve palsy* - A **3rd cranial nerve (oculomotor)** palsy would present with **ptosis** (drooping eyelid), a dilated pupil, and the eye positioned "down and out" due to unopposed action of the superior oblique and lateral rectus muscles. - It does not cause paralysis of the lower facial muscles, such as those involved in smiling. *Erb's palsy* - This is an injury to the **upper trunk (C5-C6)** of the **brachial plexus**, typically occurring at birth, which affects the muscles of the shoulder and arm. - It results in the characteristic "**waiter's tip**" posture of the arm and has no effect on the facial muscles. *Orbicularis oculi palsy* - This describes an isolated paralysis of the muscle that closes the eyelids. While this is a component of 7th nerve palsy, it is not the complete diagnosis. - The patient clearly has paralysis of other facial muscles, such as the **frontalis** (forehead) and **zygomaticus** (mouth), indicating a lesion of the main facial nerve trunk, not just a single branch.

Q: A patient presents with respiratory difficulty and a history of chronic smoking. Pulmonary function testing shows a decrease in FEV1/FVC ratio. What is the most probable diagnosis?

Chronic Obstructive Pulmonary Disease (COPD). ***Chronic Obstructive Pulmonary Disease (COPD)*** - COPD is the most likely diagnosis given the history of **chronic smoking** and pulmonary function tests showing a **decreased FEV1%**, which is a hallmark of an **obstructive lung disease**. - The pathophysiology involves **bronchiolar obstruction** leading to **air trapping**, which results in an elevated **Residual Volume (RV)** and **Total Lung Capacity (TLC)**, consistent with the provided flowchart. *Pulmonary Fibrosis* - This is a **restrictive lung disease**, characterized by scarring of the lung tissue, which would cause a **decrease**, not an increase, in Total Lung Capacity (TLC). - Spirometry in pulmonary fibrosis typically shows a **normal or increased FEV1/FVC ratio**, as both FEV1 and FVC are reduced proportionally. *Interstitial Lung Disease* - This is a broad category of **restrictive lung diseases**, which includes pulmonary fibrosis. These conditions make the lungs stiff and difficult to expand. - The characteristic PFT finding is a **restrictive pattern** (decreased TLC, FVC, and FEV1) with a normal or high FEV1/FVC ratio, which contradicts the patient's results. *Asthma* - Although asthma is an **obstructive disease** that can cause a low FEV1%, the airflow limitation is typically **reversible** with bronchodilators. - While both can present similarly, the patient's history of **chronic smoking** makes COPD, a progressive and largely irreversible condition, the more probable diagnosis.

Q: Which of the following statements is correct regarding indirect ophthalmoscopy?

It provides 3-5x magnification.. ***It provides 3-5x magnification.*** - Indirect ophthalmoscopy typically provides a lower magnification, ranging from **3x to 5x**, which is essential for yielding a much **wider field of view** - The wide field of view allows the examiner to visualize large areas of the **peripheral retina**, facilitating screening for detachments or tears - This lower magnification is a trade-off for the **stereoscopic viewing** and **broader illuminated area** *The image is erect and real.* - The image formed by indirect ophthalmoscopy is **real** but **inverted** (upside down), not erect - The examiner must mentally reorient the inverted image during examination - An **erect (upright)** and **virtual** image is characteristic of **direct ophthalmoscopy** *The condenser lens needs to be kept close to the eye.* - The **condenser lens** is held at **arm's length**, at its **focal distance** from the patient's eye (not close to the examiner's eye) - Typically held at about 10-15 cm from the patient's cornea - If held too close or too far, the examiner will lose the **red reflex** or clear retinal details *It provides 15x magnification.* - A magnification of approximately **15x** is characteristic of **direct ophthalmoscopy**, not indirect - Direct ophthalmoscopy is used for fine detail work near the macula and optic disc - Indirect ophthalmoscopy sacrifices magnification for a **broader field of view** and **stereoscopic depth perception**

Q: A baby is born with microcephaly, intracerebral calcification and chorioretinitis. Which teratogenic infection is the mother suffering from?

Toxoplasma. ***Toxoplasma*** - The triad of **microcephaly**, diffuse **intracerebral calcifications**, and **chorioretinitis** is pathognomonic for symptomatic congenital **Toxoplasmosis**. - This parasitic infection, caused by *Toxoplasma gondii*, is often acquired by the mother through exposure to **cat feces** or ingestion of **undercooked meat** during pregnancy. *CMV* - While CMV causes microcephaly and calcifications (part of the TORCH complex), its calcifications are typically located **periventricularly** rather than diffusely throughout the cortex. - CMV is the leading infectious cause of **sensorineural hearing loss** in children, a major feature often emphasized in its presentation. *Varicella* - Congenital varicella syndrome typically involves specific cutaneous findings, such as **zig-zag skin scarring**, along with **limb hypoplasia**. - Ocular findings in varicella are usually limited to **microphthalmia** and cataracts, not the characteristic chorioretinitis seen here. *Rubella* - Congenital rubella syndrome is defined by defects like **sensorineural hearing loss**, ocular abnormalities (e.g., **cataracts**), and congenital heart defects (**patent ductus arteriosus**). - Although it causes microcephaly, it usually does **not** cause prominent diffuse intracerebral calcifications or chorioretinitis as the primary ophthalmic lesion.

Q: Which of the following conditions is not reversed with the administration of atropine?

Muscle weakness due to neuromuscular blockade. ***Muscle weakness due to neuromuscular blockade*** - Atropine is a **muscarinic receptor antagonist** and therefore has no direct effect on the **nicotinic receptors** responsible for neuromuscular transmission and muscle strength. - The reversal of **non-depolarizing neuromuscular blockade** requires increasing acetylcholine via a **cholinesterase inhibitor** (e.g., neostigmine), which acts at the **neuromuscular junction**. *Bradycardia* - Atropine blocks **M2 receptors** on the heart's sinoatrial (SA) node, inhibiting **vagal tone** and increasing the heart rate, thereby reversing bradycardia. - It is the primary drug used to treat hemodynamically significant **bradyarrhythmias**. *Excessive salivation* - Atropine is an anticholinergic agent that blocks **M3 receptors** on exocrine glands, effectively reducing all secretions, including **saliva**. - This is why it is often used as a pre-anesthetic agent to dry secretions and reduce the risk of **aspiration**. *Bronchoconstriction* - Atropine blocks **M3 receptors** in the bronchial smooth muscle, leading to relaxation and **bronchodilation**. - While effective, related synthetic compounds like **ipratropium** are often preferred for treating bronchoconstriction due to fewer systemic anticholinergic side effects.

Q: During spermatogenesis, which of the following hormones inhibits Follicle-Stimulating Hormone (FSH) secretion?

Inhibin. ***Inhibin*** - **Inhibin** is produced by **Sertoli cells** in the seminiferous tubules, acting as a crucial regulator of spermatogenesis. - It specifically targets the anterior pituitary gland to implement a **negative feedback loop**, reducing the secretion of **FSH** (Follicle-Stimulating Hormone) when sperm production levels are adequate. *Testosterone* - **Testosterone** is the primary androgen required for the maintenance and stimulation of spermatogenesis within the seminiferous tubules. - High systemic levels of testosterone primarily inhibit the secretion of **GnRH** (from the hypothalamus) and **LH** (from the pituitary), rather than specifically inhibiting FSH production. *Luteinizing Hormone (LH)* - **LH** acts on the **Leydig cells** in the testes, stimulating them to produce testosterone. - It does not directly inhibit FSH; rather, it is part of the **Hypothalamic-Pituitary-Gonadal (HPG) axis** regulation system. *Estrogen* - While small amounts of **estrogen** are produced in males (via aromatization of testosterone), it does not play a primary role in the negative feedback inhibition of FSH during spermatogenesis. - In males, **inhibin** is the specific hormone that directly targets FSH secretion from the anterior pituitary.

Q: A 28-year-old woman diagnosed with schizophrenia had been compliant with her prescribed olanzapine for several months. However, she discontinued the treatment. Which of the following is the most likely reason for her discontinuation?

Weight gain. ***Weight gain*** - **Olanzapine** is associated with one of the highest propensities among all antipsychotics for causing significant **weight gain** and metabolic syndrome (dyslipidemia, hyperglycemia). - For young women, this effect is often highly stigmatizing and is the leading cause for non-adherence and treatment discontinuation after several months of successful compliance. *Acute dystonia* - This is an acute **Extrapyramidal Symptom (EPS)** characterized by sudden, sustained muscle contractions, typically appearing within the first few days or weeks of starting treatment. - Olanzapine has a low rate of acute dystonia, and it would likely have caused discontinuation much earlier than several months into therapy. *Akathisia* - **Akathisia** is characterized by distressing subjective restlessness and motor agitation; although possible, it usually manifests early in the treatment course or after dose increases. - While bothersome, weight gain accumulated over several months is a statistically more frequent reason for patient-led drug discontinuation in this population than chronic akathisia. *Tardive dyskinesia* - **Tardive dyskinesia (TD)** is an involuntary movement disorder that is a late-onset side effect, typically developing after years of cumulative antipsychotic exposure. - Given that she was compliant for only several months, the development of severe TD causing discontinuation is highly improbable compared to chronic, rapidly accumulating metabolic side effects like weight gain.

Q: A patient shows flat affect. What does it indicate?

Negative symptom. ***Correct: Negative symptom*** Flat affect refers to the **reduction** or **absence** of emotional expression, which is defined as a deficit in normal function or experience. Along with **alogia** (poverty of speech), **avolition** (lack of motivation), and **anhedonia** (inability to feel pleasure), flat affect is a core component of the **negative symptom** cluster, particularly in **schizophrenia**. Negative symptoms represent deficits or diminutions in normal emotional, motivational, and social functioning. *Incorrect: Positive symptom* Positive symptoms involve the **presence** or **addition** of abnormal mental phenomena, such as **hallucinations** (perceptual disturbances), **delusions** (fixed false beliefs), or **disorganized behavior**. Flat affect represents a **diminution** of normal emotional expression and is therefore categorized as a negative symptom, opposite to the addition of phenomena seen in positive symptoms. *Incorrect: Affect symptom* While flat affect is fundamentally related to the expression of **affect** (emotion), "affect symptom" is not a standard clinical classification used in psychiatric diagnostic systems. Psychiatric symptoms are primarily categorized into **positive**, **negative**, and **cognitive** domains for diagnostic and treatment purposes, particularly in disorders like schizophrenia. *Incorrect: Cognitive symptom* Cognitive symptoms relate to deficits in **executive function**, **attention**, **working memory**, and **processing speed**. These involve difficulties with thinking, concentration, and mental organization. Flat affect is categorized as an **emotional expression deficit** (negative symptom), which is distinct from the primary cognitive processing difficulties related to thought and memory.

Q: A young man with a psychiatric disorder has become very aggressive. He speaks very rapidly and sleeps very little. He exhibits hyperactive behavior after discontinuing his prescribed medication. What is the most likely diagnosis?

Bipolar disorder - manic episode. ***Bipolar disorder - manic episode*** - The constellation of extremely elevated mood features, including **rapid speech** (or pressured speech), severely **decreased need for sleep**, highly aggressive and **hyperactive behavior** (psychomotor agitation), defines a **manic episode**.- Discontinuation of established mood-stabilizing medication is a very strong predictor for relapse into a full-blown manic state in individuals with **bipolar disorder (Type I)**.*Depression* - Depression typically manifests with symptoms opposite to those observed, such as **low energy**, pervasive sadness, **anhedonia**, and often psychomotor **retardation**.- The patient's **aggression**, **hyperactivity**, and **pressured speech** are inconsistent with the core diagnostic features of a depressive episode.*Schizophrenia* - Schizophrenia is characterized fundamentally by prominent **psychotic symptoms** (hallucinations, delusions) and profound **disorganization** in speech and thought.- While agitation can occur, the cyclical mood features, specifically the dramatic decrease in the **need for sleep** and **pressured speech**, are hallmarks of mania, not schizophrenia.*Substance- induced mood disorder* - This diagnosis requires symptoms to be directly attributable to the physiological effects of **substance intoxication** or withdrawal.- Although substance use can mimic mania, the presence of a known **psychiatric disorder** and the exacerbation following cessation of **prescribed medication** make primary Bipolar I disorder relapse the most likely explanation.

Question 1

A young male presented with weakness in the lower half of the right side of his face, with drooping of the angle of his mouth. He is unable to raise his eyebrows and close his eyes on the right side. Which of the following is the most appropriate diagnosis?

Accepted Answer

Infranuclear facial palsy on right side

Answer

Supranuclear facial palsy on left side

Answer

Infranuclear facial on left side

Answer

Supranuclear facial on right side

Question 2

A patient presents with the palsy of the face as shown. Which of the following is most likely involved?

Accepted Answer

7th nerve palsy

Answer

Erb's palsy

Answer

3rd nerve palsy

Answer

Orbicularis oculi palsy

Question 3

A patient presents with respiratory difficulty and a history of chronic smoking. Pulmonary function testing shows a decrease in FEV1/FVC ratio. What is the most probable diagnosis?

Accepted Answer

Chronic Obstructive Pulmonary Disease (COPD)

Answer

Interstitial Lung Disease

Answer

Pulmonary Fibrosis

Answer

Asthma

Question 4

Which of the following statements is correct regarding indirect ophthalmoscopy?

Accepted Answer

It provides 3-5x magnification.

Answer

The image is erect and real.

Answer

The condenser lens needs to be kept close to the eye.

Answer

It provides 15x magnification.

Question 5

A baby is born with microcephaly, intracerebral calcification and chorioretinitis. Which teratogenic infection is the mother suffering from?

Accepted Answer

Toxoplasma

Answer

CMV

Answer

Varicella

Answer

Rubella

Question 6

Which of the following conditions is not reversed with the administration of atropine?

Accepted Answer

Muscle weakness due to neuromuscular blockade

Answer

Bradycardia

Answer

Bronchoconstriction

Answer

Excessive salivation

Question 7

During spermatogenesis, which of the following hormones inhibits Follicle-Stimulating Hormone (FSH) secretion?

Accepted Answer

Inhibin

Answer

Luteinizing Hormone (LH)

Answer

Testosterone

Answer

Estrogen

Question 8

A 28-year-old woman diagnosed with schizophrenia had been compliant with her prescribed olanzapine for several months. However, she discontinued the treatment. Which of the following is the most likely reason for her discontinuation?

Accepted Answer

Weight gain

Answer

Tardive dyskinesia

Answer

Acute dystonia

Answer

Akathisia

Question 9

A patient shows flat affect. What does it indicate?

Accepted Answer

Negative symptom

Answer

Affect symptom

Answer

Cognitive symptom

Answer

Positive symptom

Question 10

A young man with a psychiatric disorder has become very aggressive. He speaks very rapidly and sleeps very little. He exhibits hyperactive behavior after discontinuing his prescribed medication. What is the most likely diagnosis?

Accepted Answer

Bipolar disorder - manic episode

Answer

Schizophrenia

Answer

Substance-induced mood disorder

Answer

Depression

FMGE 2025

Internal Medicine

Ophthalmology

Pediatrics

Pharmacology

Physiology

Psychiatry