FMGE 2026 Practice Questions

Q: A patient presents with multiple painful genital ulcers associated with tender cervical/inguinal lymphadenopathy. The ulcers are soft and irregular as shown in the image. What is the most likely causative organism?

Haemophilus ducreyi. ***Haemophilus ducreyi*** - This organism causes **chancroid**, which classically presents as **multiple, painful, necrotic ulcers** with irregular borders and a gray/yellowish exudate. - It is further characterized by severe, tender **inguinal lymphadenopathy** (buboes) which may rupture, helping to distinguish it from the painless ulcers of syphilis. *Chlamydia trachomatis* - Serovars L1-L3 of *C. trachomatis* cause **lymphogranuloma venereum (LGV)**, which typically presents with a small, painless primary ulcer that often goes unnoticed. - The hallmark of LGV is painful, matted, **inguinal lymphadenopathy** (the 'groove sign'), appearing weeks after the primary lesion rather than concurrent with a painful ulcer. *Klebsiella granulomatis* - This bacterium is the causative agent of **granuloma inguinale (donovanosis)**, characterized by painless, beefy-red, friable ulcerations. - It is not associated with significant **lymphadenopathy**, as it primarily manifests as a slowly progressive, chronic granulomatous disease. *Treponema pallidum* - This organism causes **syphilis**, where the primary lesion (chancre) typically presents as a single, painless, indurated ulcer with clean, raised borders. - Unlike chancroid, the clinical presentation of primary syphilis involves non-tender regional **lymphadenopathy** and lacks the soft, irregular, painful ulcer characteristics described.

Q: A young woman presents with vesiculobullous lesions involving the upper lips and target lesions on extremities. What is the most likely diagnosis?

Erythema multiforme. ***Erythema multiforme*** - Classically presents with **target lesions** (iris lesions) on the extremities and **mucosal involvement** (like lips/oral cavity) with vesiculobullous eruptions. - It is a **type IV hypersensitivity reaction**, most commonly triggered by **Herpes Simplex Virus (HSV)** infection, especially in recurrent cases. *Dermatitis herpetiformis* - Characterized by **pruritic vesicles** symmetrically distributed on extensor surfaces, elbows, and buttocks. - It is strongly associated with **celiac disease** (gluten-sensitive enteropathy), not target lesions. *Bullous pemphigoid* - Typically occurs in the **elderly** as tense, **subepidermal bullae** on flexural surfaces. - Mucosal involvement is much less common and less severe compared to pemphigus vulgaris or EM. *Pemphigus vulgaris* - Manifests as **flaccid bullae** and mucosal **ulcerations** that rupture easily due to autoantibodies against **desmoglein 3**. - It shows a **positive Nikolsky sign** and acantholysis on histology, unlike the target lesions seen in EM.

Q: A truck driver presents with a single painless genital ulcer that appeared 3 weeks after an unprotected sexual encounter. There is associated non-tender inguinal lymphadenopathy. What is the most likely diagnosis?

Primary syphilis. ***Primary syphilis*** - The classic presentation is a **chancre**, which is a **solitary, painless, indurated ulcer** that typically appears 2-4 weeks after infection with *Treponema pallidum*. - It is commonly associated with **rubbery, firm, non-tender inguinal lymphadenopathy** occurring shortly after the ulcer develops. *Chancroid* - Caused by *Haemophilus ducreyi*, it presents with a **painful, ragged ulcer** with a purulent base, distinguishing it from the painless chancre of syphilis. - Lymphadenopathy in chancroid is typically **painful, suppurative, and matted** (buboes), unlike the non-tender node in this patient. *Genital herpes* - Caused by HSV-1 or HSV-2, this typically presents as **grouped, painful vesicles** that progress to shallow ulcers with an erythematous base. - Patients often report significant **local pain, burning, or itching** and systemic constitutional symptoms, which are absent in this presentation. *Lymphogranuloma venereum* - Caused by *Chlamydia trachomatis* (serovars L1-L3), it typically presents as a **small, transient, painless papule** or ulcer that may go unnoticed. - The hallmark clinical feature is **painful, massive, fluctuant inguinal lymphadenopathy** (groin buboes), which is distinct from the non-tender findings described.

Q: A child presents with severe itching involving the extensor surface, especially at night . There is a positive family history of asthma in father. On examination, the child has dry, itchy skin with eczematous lesions. What is the most likely diagnosis?

Atopic dermatitis. ***Atopic dermatitis*** - This condition, often part of the **atopic triad (asthma, allergic rhinitis, atopic dermatitis)**, is strongly supported by the patient's positive family history of **atopy**. - Intense **pruritus** is the hallmark symptom, and chronic scratching leads to the observed eczematous lesions, which can present on **extensor surfaces** in infants/young children before shifting to flexural areas later in childhood. *Scabies* - Caused by the mite **Sarcoptes scabiei**, it presents with **nocturnal pruritus** but typically involves **interdigital spaces**, wrists, and axillae. - Look for **burrows** on examination; while a family history is often positive due to contagion, the clinical distribution and morphology here favor eczema. *Cradle cap (Seborrheic dermatitis)* - Typically presents in infancy as **greasy, yellow scales** on the scalp and face, rather than generalized eczematous skin. - It is not associated with severe **pruritus** or a personal/family history of **atopic diseases** like asthma. *Contact dermatitis* - Requires a history of exposure to an **irritant** or **allergen**, such as soaps, nickel, or plants, which is not mentioned. - The distribution is usually localized to the **area of contact** rather than the generalized pattern seen in atopic dermatitis.

Q: Identify the given fingerprint pattern: .

Whorl. ***Whorl*** - A **whorl** fingerprint pattern is characterized by circular, spiral-shaped, or concentric ridges that make at least one complete circuit. - It is distinguished by the presence of **two deltas** (triradii) on either side of the pattern, which is the defining feature for identifying it as a whorl. *Loop* - This is the most common fingerprint pattern, characterized by ridges that enter from one side, curve, and exit on the same side. - It typically possesses only a **single delta**, which distinguishes it from the whorl pattern. *Arch* - The **arch** pattern is the simplest, where ridges enter from one side, rise in the middle, and exit from the other side in a wave-like motion. - It is notable for the complete absence of **deltas** within the pattern, making it clearly distinct from a whorl. *Composite* - A **composite** pattern is a complex type that combines two or more different pattern types (e.g., a loop and a whorl or two loops) into a single print. - Because it is a combination, it lacks the uniform, symmetrical structure characteristic of a standard circular **whorl**.

Q: A male is brought for medicolegal examination after sustaining a firearm injury. On examination, there is tattoing of skin, but no burning, singeing of hair, or charring is present. The margins of the wound are inverted. What is the most likely range of fire in this case?

Intermediate range. ***Intermediate range*** - The presence of **tattooing** (or powder stippling) on the skin without any **burning**, **singeing of hair**, or **charring** is pathognomonic for an intermediate range firearm injury. - At this distance, unburnt or partially burnt gunpowder particles are deposited on the skin, but the weapon is far enough away to avoid flame effects. *Close range* - Characterized by the combination of **tattooing** and flame effects, such as **singeing** of hair or **burning** of the skin edges. - This occurs when the weapon is near the target, allowing both particulate powder and hot gases to contact the skin. *Contact range* - Produces **charring**, **burning**, and **singeing** due to direct contact of the pressurized discharge gases with the skin. - Often presents with a **muzzle imprint** and **stellate, ragged margins** on the skin due to rapid gas expansion between the skin and underlying subcutaneous tissue. *Distant range* - Characterized by the complete absence of any discharge residue (powder **tattooing** or **soot**) and flame effects (**singeing/burning**). - The entrance wound typically shows only a simple perforation with an **abrasion collar**, as only the projectile strikes the skin.

Q: A young male is brought for a medico-legal examination under court orders to determine his age for criminal liability for a rape case. Based on the given radiographic findings, what is the most likely age of the accused?

16-18 years. ***16-18 years*** - In a medico-legal age estimation for criminal liability, fusion of the **epiphysis** with the **metaphysis** of the **iliac crest** typically completes during this age bracket (often cited as occuring between 16-19 years). - Fusion of the **medial end of the clavicle** (the last ossification center to fuse) is the definitive marker for reaching skeletal maturity, which typically occurs by age **21-25**; therefore, an individual with partially fused or unfused medial clavicular epiphyses but completed fusion elsewhere is often classified as under 18. *12-14 years* - At this age, the **pelvis** and **vertebral bodies** show significant active growth, and the **iliac crest** epiphysis would generally be absent or just appearing. - **Secondary ossification centers** in the long bones are typically not fully fused at this developmental stage. *14-16 years* - While the **ischial tuberosity** might show signs of fusion, complete union of the **iliac crest** typically has not occurred yet. - Radiographically, this age reflects a stage where many **epiphyseal centers** are still open or actively fusing rather than reaching maturity. *18+ years* - Once an individual is 18+, the **medial end of the clavicle** should typically show signs of fusion, and the **iliac crest epiphysis** should be completely fused. - If the radiographic markers (specifically the **iliac crest** and **medial clavicular epiphysis**) show complete fusion, it is used to assign an age of maturity, typically excluding the 16-18 range.

Q: A 29-year-old male presents within 24 hours of an alleged sexual assault by a co-worker. Which of the following sites is the most appropriate for specimen collection within 24 hours?

Anus for epithelial cells and semen. ***Anus for epithelial cells and semen*** - In cases of sexual assault occurring within 24 hours (or up to 72 hours), the **anal canal** is a prime site for collecting biological evidence including **spermatozoa** and **epithelial cells** (from the perpetrator). - This collection is prioritized because biological fluids and foreign DNA are rapidly lost through washing, defecation, or time, making early collection critical for **forensic identification**. *Oral cavity for semen* - While the oral cavity is a potential site for specimen collection, semen is typically cleared from the oral cavity relatively quickly, often within **6 to 12 hours**. - Given the 24-hour presentation limit, the likelihood of recovering viable **spermatozoa** or **DNA** in the oral cavity is significantly lower compared to the anal canal. *Nails* - **Nail scrapings** or clippings are collected specifically when there is a history of physical struggle or scratching during the assault. - They are not considered a primary or high-yield site for semen or epithelial cells in the absence of a reported physical altercation utilizing the hands. *Blood test* - Blood tests in sexual assault cases are primarily conducted to screen for **sexually transmitted infections (STIs)** or to detect **rape-facilitating drugs** (if intoxication is suspected). - They are not the method for collecting **biological trace evidence** (DNA/semen), which is essential for identifying the assailant.

Q: Which among the following is the best sample for DNA in advanced burnt dead body?

Femur. ***Femur*** - The **femur** is a large, dense, long bone that provides significant protection to the embedded **marrow** and **osteocytes** from high-heat damage. - It is currently recognized as the **gold standard** sample for DNA extraction in decomposed, skeletonized, or severely **burnt remains** due to its resistance to thermal degradation. *Spleen* - The **spleen** is a soft tissue organ that undergoes rapid putrefaction and decomposes early after death. - It is highly susceptible to heat damage in burnt bodies and is generally unsuitable for **DNA isolation** once soft tissues are compromised. *Enamel* - Although **enamel** is high in mineral content and can withstand extreme temperatures, it is almost entirely acellular and contains negligible amounts of **genomic DNA**. - While teeth (especially the **pulp chamber**) can provide good DNA, the enamel surface itself is not the source of DNA. *Sternum* - The **sternum** is a cancellous, porous bone that is more susceptible to thermal destruction compared to the thick, cortical structure of the long bones. - It is often prioritized for **bone marrow** collection in fresh bodies, but it does not offer the same protection against fire as the dense, cortical bone of the **femur**.

Q: Which paraphilia involves sexual gratification from wearing clothes of opposite gender?

Transvestic fetishism. ***Transvestic fetishism*** - This condition is characterized by intense sexual arousal from **cross-dressing**, which is usually done by heterosexual males wearing the clothing of the opposite sex. - While the individual may experience sexual arousal, the primary motivation is the **act of dressing** in gender-discordant clothing, which is distinct from gender identity disorder where the motivation is to align with the opposite gender. *Eonism* - This is an archaic term often used interchangeably with **cross-dressing** or gender non-conformity, rather than referring specifically to a sexual disorder. - It does not specifically define the **sexual gratification** arising from the act, making it a broader and less clinically precise term than transvestic fetishism. *Fetishism* - This involves sexual arousal from **non-living objects** (e.g., shoes, undergarments) or specific **non-genital body parts**. - While transvestic behavior can involve fetishistic elements, the specific definition of gratification derived from wearing the **clothing itself** fits the diagnosis of transvestic fetishism more accurately. *Voyeurism* - This is a paraphilic disorder involving sexual arousal from **observing unsuspecting people** who are naked, undressing, or engaging in sexual activity. - It differs completely from transvestic behavior, as it relies on the act of **peeping** or clandestine observation rather than personal adornment.

Question 1

A patient presents with multiple painful genital ulcers associated with tender cervical/inguinal lymphadenopathy. The ulcers are soft and irregular as shown in the image. What is the most likely causative organism?

Accepted Answer

Haemophilus ducreyi

Answer

Chlamydia trachomatis

Answer

Klebsiella granulomatis

Answer

Treponema pallidum

Question 2

A young woman presents with vesiculobullous lesions involving the upper lips and target lesions on extremities. What is the most likely diagnosis?

Accepted Answer

Erythema multiforme

Answer

Dermatitis herpetiformis

Answer

Bullous pemphigoid

Answer

Pemphigus vulgaris

Question 3

A truck driver presents with a single painless genital ulcer that appeared 3 weeks after an unprotected sexual encounter. There is associated non-tender inguinal lymphadenopathy. What is the most likely diagnosis?

Accepted Answer

Primary syphilis

Answer

Chancroid

Answer

Genital herpes

Answer

Lymphogranuloma venereum

Question 4

A child presents with severe itching involving the extensor surface, especially at night . There is a positive family history of asthma in father. On examination, the child has dry, itchy skin with eczematous lesions. What is the most likely diagnosis?

Accepted Answer

Atopic dermatitis

Answer

Scabies

Answer

Cradle cap (Seborrheic dermatitis)

Answer

Contact dermatitis

Question 5

Identify the given fingerprint pattern: .

Accepted Answer

Whorl

Answer

Loop

Answer

Arch

Answer

Composite

Question 6

A male is brought for medicolegal examination after sustaining a firearm injury. On examination, there is tattoing of skin, but no burning, singeing of hair, or charring is present. The margins of the wound are inverted. What is the most likely range of fire in this case?

Accepted Answer

Intermediate range

Answer

Close range

Answer

Contact range

Answer

Distant range

Question 7

A young male is brought for a medico-legal examination under court orders to determine his age for criminal liability for a rape case. Based on the given radiographic findings, what is the most likely age of the accused?

Accepted Answer

16-18 years

Answer

12-14 years

Answer

14-16 years

Answer

18+ years

Question 8

A 29-year-old male presents within 24 hours of an alleged sexual assault by a co-worker. Which of the following sites is the most appropriate for specimen collection within 24 hours?

Accepted Answer

Anus for epithelial cells and semen

Answer

Oral cavity for semen

Answer

Nails

Answer

Blood test

Question 9

Which among the following is the best sample for DNA in advanced burnt dead body?

Accepted Answer

Femur

Answer

Spleen

Answer

Enamel

Answer

Sternum

Question 10

Which paraphilia involves sexual gratification from wearing clothes of opposite gender?

Accepted Answer

Transvestic fetishism

Answer

Eonism

Answer

Fetishism

Answer

Voyeurism

FMGE 2026

Dermatology

Forensic Medicine

Psychiatry