FMGE 2026 Practice Questions

Q: After a mass accident on national highway a 20 years old male was brought with following finding what is the color coding according to triage?

Yellow. ***Yellow*** - Defined as the **delayed** category, it is assigned to patients who have serious but non-life-threatening injuries, such as stable **fractures** or minor burns, that do not require immediate intervention. - These patients can wait for medical treatment for a short period, as their condition is stable and unlikely to deteriorate rapidly, provided they are reassessed periodically. *Red* - Designated as the **immediate** category for patients with life-threatening injuries, such as **airway obstruction**, severe hemorrhage, or **shock**, who require rapid stabilization. - This color is reserved for patients for whom an intervention will likely result in a significant improvement in outcome within a short period. *Black* - Represents the **expectant** or deceased category, assigned to victims who have sustained injuries incompatible with life, such as **massive head trauma** or **cardiac arrest**. - Resources are not expended on these individuals during a mass casualty incident because their clinical status indicates a poor prognosis despite intervention. *Green* - Known as the **minor** or walking wounded category, assigned to patients with superficial injuries like **abrasions** or minor lacerations who can ambulate themselves. - These individuals are capable of self-care and do not require urgent medical attention, allowing providers to focus on more critically injured patients.

Q: Identify the type of skin graft?

Split thickness skin graft. ***Split thickness skin graft*** - This graft includes the **epidermis** and a **variable thickness of the dermis**, which allows the donor site to heal by re-epithelialization from the remaining adnexal structures. - It is the **most versatile** option for covering large surface area wounds as it provides a reliable take, though it has a higher tendency for secondary contraction and pigment dyschromia compared to full-thickness grafts. *Full-Thickness Skin Graft* - This graft contains the **entire epidermis** and **entire dermis**, which provides better durability, color match, and minimal wound contraction post-healing. - Due to the complete removal of the dermis, the donor site cannot heal spontaneously and requires **primary closure** or another skin graft. *Composite Graft* - This type of graft involves two or more tissue types (e.g., skin and cartilage) harvested as a single unit, often used for **nasal or ear reconstruction**. - It lacks an intrinsic blood supply and depends entirely on receiving revascularization from the host bed, limiting its size to usually **less than 1 cm** to ensure survival. *Biomesh* - This is a **biological scaffold** or extracellular matrix (ECM) derived from human or animal tissue rather than a traditional skin graft. - It is primarily used for **tissue regeneration** and hernia repair rather than surface coverage of skin defects.

Q: A 65-year-old man presents with dysphagia, halitosis, and regurgitation of undigested food several hours after eating. What is the likely diagnosis of this barium study?

Zenker's diverticulum. ***Zenker's diverticulum*** - Occurs due to a herniation of the pharyngeal mucosa through the **Killian’s dehiscence** (a weakened area between the thyropharyngeus and cricopharyngeus muscles). - Typical presentation involves **oropharyngeal dysphagia**, **halitosis** (due to food stagnation), and **regurgitation** of undigested food, often occurring hours after meals. *Killian-Jamieson Diverticulum* - Represents a rare protrusion through the anterior cervical esophagus, inferior to the **cricopharyngeus muscle**. - Unlike Zenker's, these tend to be smaller, generally asymptomatic, or manifest as localized **neck swelling** rather than the severe dysphagia and halitosis seen here. *Achalasia* - Characterized by the failure of the **lower esophageal sphincter (LES)** to relax, typically causing dysphagia to both solids and liquids. - On imaging, it often presents with a **bird-beak appearance** of the distal esophagus, rather than a pulsion diverticulum in the proximal neck. *Laryngocele* - A dilation of the **ventricle of the larynx** that communicates with the laryngeal lumen. - It typically presents as a neck mass that increases in size with **Valsalva maneuver** or increased intrathoracic pressure, not with dysphagia and food regurgitation.

Q: A 22 year old male patient sustained a burn and presented to the emergency department, on examination nasal hair were singed, on blood investigation Carboxy Hb was raised to 18.5%, and oxygen saturation was 81%, what is the next best step?

Intubation. ***Intubation*** - The patient presents with **singed nasal hair**, which is a significant clinical indicator of **upper airway inhalation injury**, necessitating early airway protection. - A **Carboxyhemoglobin (COHb) level >10-15%** associated with inhalation injury, combined with clinical signs of airway compromise, mandates **prophylactic endotracheal intubation** to prevent airway obstruction due to evolving edema. *100% O2 with NVA* - While **100% oxygen** is the definitive treatment for **carbon monoxide poisoning** to shorten the half-life of COHb, it does not secure the airway in a patient with impending respiratory obstruction from inhalation injury. - This intervention is insufficient as the primary management step when there is an immediate threat to airway patency evidenced by **singed nasal hair** and associated burn stigmata. *Fluid resuscitation according to parkland formula* - Although aggressive **fluid resuscitation** is vital for burn management to prevent hypovolemic shock, it is secondary to **Airway (A)** management in the A-B-C priority framework. - Ensuring a patent airway takes precedence over initiating the **Parkland formula**, even though fluid resuscitation will be required shortly thereafter. *Tracheostomy* - A **tracheostomy** is an invasive surgical procedure typically reserved for cases where **endotracheal intubation** fails or is impossible due to severe upper airway anatomy distortion. - It is not the first-line intervention for immediate airway management in a patient presenting to the emergency department; **orotracheal intubation** is the standard for rapid airway control.

Q: What is the diagnosis ?

Ureterocele. ***Ureterocele*** - A ureterocele is a **congenital cystic dilation** of the distal intravesical portion of the ureter, often presenting as a **"cobra-head" sign** on intravenous pyelography or a round, thin-walled cyst within the bladder on ultrasound. - It frequently results from an obstruction at the **ureterovesical junction** and is commonly associated with a **duplex collecting system** (ureter duplex), particularly following the Weigert-Meyer rule. *Bladder diverticula* - A bladder diverticulum appears as an **outpouching** of the bladder wall rather than an intravesical cystic structure originating from the ureter. - They are typically associated with **bladder outlet obstruction** or chronic neurogenic bladder, rather than being a primary developmental anomaly of the distal ureter. *Pseudoureteroceles* - Pseudoureteroceles are extrinsic processes, such as an **impacted distal ureteral stone** or focal bladder tumor, that mimic the appearance of a ureterocele. - Unlike true ureteroceles, the imaging appearance is caused by **edema** or mass effect around the ureteral orifice rather than intrinsic cystic dilation of the ureter. *Gartner's duct cysts* - Gartner's duct cysts represent remnants of the **mesonephric (Wolffian) duct** located in the lateral wall of the vagina, not the bladder lumen. - They are **gynecological findings** found in females and do not involve the ureterovesical junction or produce imaging findings mimicking a bladder ureterocele.

Q: Mother noticed swelling in groin region while child was coughing and crying, what is diagnosis?

Indirect inguinal hernia. ***Indirect inguinal hernia*** - This is the **most common type of inguinal hernia** seen in children, resulting from a **patent processus vaginalis** that fails to close. - The swelling typically becomes prominent or increases in size with **increased intra-abdominal pressure**, such as during **coughing, crying, or straining**. *Direct inguinal hernia* - Rare in children, as it is typically an **acquired condition** resulting from weakness in the **Hesselbach triangle** floor, often seen in adults. - It does not involve the **patent processus vaginalis** and protrudes directly through the abdominal wall, typically medial to the **inferior epigastric vessels**. *Undescended testis* - Presents as an **empty scrotum**, rather than a reducible bulge, although it can be associated with a hernia. - The mass, if palpable in the inguinal canal, will typically feel like a firm **testicular body** rather than a compressible, reducible bowel segment. *Femoral hernia* - Located inferior to the **inguinal ligament** and medial to the **femoral vein**, appearing as a bulge in the upper thigh. - Extremely rare in children and carries a high risk of **incarceration** or strangulation due to the narrow nature of the **femoral ring**.

Q: A child is born with following finding what is best step in line of management?

Operate after 1 year age. ***Operate after 1 year age*** - This timing is typically associated with the surgical management of a **hydrocele of the canal of Nuck** or certain types of **inguinal hernias** that are asymptomatic and reducible in infants, allowing for potential closure or stabilization. - Waiting until 1 year reduces the **anesthetic risks** associated with early infancy and allows for more mature anatomical development of local structures. *Immediately operate* - Emergency surgery is reserved for **incarcerated** or **strangulated hernias** presenting with signs of bowel obstruction, severe pain, or skin changes. - It is not the standard of care for uncomplicated presentations, as it significantly increases the risk of **anesthetic complications** and **iatrogenic injury** to the spermatic cord in neonates. *Aspiration* - Aspiration is generally contraindicated in pediatric hydroceles due to the high risk of **infection** and the extremely high rate of **recurrence**. - It does not address the underlying patent **processus vaginalis**, which is the primary pathology in communicating hydroceles or inguinal hernias. *I & D* - Incision and drainage (I & D) is the treatment for **abscesses** and infection, not structural congenital malformations like hydroceles or hernias. - Performing I & D on a sterile hydrocele would introduce bacteria, leading to **pyocele** and potential damage to scrotal contents.

Q: What is the best investigation to check for extra thyroid spread of thyroid gland neoplasm ?

MRI. ***MRI*** - **MRI (Magnetic Resonance Imaging)** is the gold standard for evaluating retrosternal extension, airway infiltration, and **extra-thyroidal soft tissue invasion** due to its superior soft tissue contrast resolution. - It provides detailed, cross-sectional anatomy necessary for surgical planning when distinguishing between capsular invasion and surrounding neurovascular bundle involvement. *USG* - **Ultrasonography** is the primary modality for detecting thyroid nodules and regional cervical lymphadenopathy, but it has significant **limitations in evaluating deep structures** or retrosternal extension. - Its field of view is too restricted to assess the full extent of invasive disease beyond the immediate thyroid bed and cervical compartment. *Iodine scan* - **Radioiodine scanning** is primarily used for the functional assessment of differentiated thyroid cancer **metastases** or residual tissue rather than anatomical staging. - It cannot assess structural invasion of contiguous organs or soft tissues like the trachea or larynx. *PET scan* - **PET scanning** (usually with FDG) is highly sensitive for detecting metabolic activity in distant metastases or recurrent disease but lacks the **spatial resolution** of MRI to define local anatomical invasion. - It is generally reserved for de-differentiated tumors or cases where radioiodine scans are negative despite elevated thyroglobulin levels.

Q: Ductal carcinoma in situ treated with lumpectomy, and was found to have margins of 2mm, what is the next best management ?

Radiotherapy. ***Radiotherapy*** - Following **lumpectomy** (breast-conserving surgery) for **ductal carcinoma in situ (DCIS)**, adjuvant **whole-breast radiotherapy** is standard of care to significantly reduce the risk of **local recurrence**. - Even with clear margins (defined as ≥2mm in most modern guidelines), radiotherapy is recommended for patients undergoing breast-conserving therapy to improve long-term outcomes. *Mastectomy* - **Mastectomy** is generally reserved for extensive disease, multifocal or multicentric disease, or cases where clear margins cannot be achieved with breast-conserving surgery. - Since clear margins (2mm) were achieved in this case, proceeding directly to a major surgical procedure like mastectomy is overtreatment and not indicated. *BCT* - While **breast-conserving therapy (BCT)** refers to the combination of surgery (lumpectomy) and **adjuvant radiotherapy**, stating

Q: A 43 years presented with 4.6cm breast lump with ipsilateral mobility present, Axillary LN without distant metastasis, which stage does it belongs to?

Stage 2b. ***Stage 2b*** - This stage is defined by a tumor size of >2 cm but ≤5 cm with mobile axillary lymph nodes (T2, N1, M0). - The presentation of a **4.6 cm lump** (T2) and **ipsilateral mobile lymph nodes** (N1) with **no distant metastasis** (M0) fits the criteria for T2N1M0, which is classified as Stage 2B. *Stage 2a* - This stage typically corresponds to T0, N1, M0 or T1, N1, M0; a **4.6 cm tumor** exceeds the T1 size classification. - It does not account for the tumor size being greater than 2 cm, as T2 stage starts at >2 cm. *Stage 3c* - This stage represents **locally advanced breast cancer** and includes any tumor size with metastases to infraclavicular, supraclavicular, or specific axillary node levels (N3). - The patient has no evidence of extensive nodal involvement or **skin involvement** typical of locally advanced disease. *Stage 4* - This stage is reserved for patients with **distant metastasis** (M1), such as spread to bones, lungs, liver, or brain. - Since the patient has **no distant metastasis** as noted in the prompt, this classification is incorrect.

Question 1

After a mass accident on national highway a 20 years old male was brought with following finding what is the color coding according to triage?

Accepted Answer

Yellow

Answer

Red

Answer

Black

Answer

Green

Question 2

Identify the type of skin graft?

Accepted Answer

Split thickness skin graft

Answer

Full-Thickness Skin Graft

Answer

Composite Graft

Answer

Biomesh

Question 3

A 65-year-old man presents with dysphagia, halitosis, and regurgitation of undigested food several hours after eating. What is the likely diagnosis of this barium study?

Accepted Answer

Zenker's diverticulum

Answer

Killian-Jamieson Diverticulum

Answer

Achalasia

Answer

Laryngocele

Question 4

A 22 year old male patient sustained a burn and presented to the emergency department, on examination nasal hair were singed, on blood investigation Carboxy Hb was raised to 18.5%, and oxygen saturation was 81%, what is the next best step?

Accepted Answer

Intubation

Answer

100% O2 with NVA

Answer

Fluid resuscitation according to parkland formula

Answer

Tracheostomy

Question 5

What is the diagnosis ?

Accepted Answer

Ureterocele

Answer

Bladder diverticula

Answer

Pseudoureteroceles

Answer

Gartner's duct cysts

Question 6

Mother noticed swelling in groin region while child was coughing and crying, what is diagnosis?

Accepted Answer

Indirect inguinal hernia

Answer

Direct inguinal hernia

Answer

Undescended testis

Answer

Femoral hernia

Question 7

A child is born with following finding what is best step in line of management?

Accepted Answer

Operate after 1 year age

Answer

Immediately operate

Answer

Aspiration

Answer

I & D

Question 8

What is the best investigation to check for extra thyroid spread of thyroid gland neoplasm ?

Accepted Answer

MRI

Answer

USG

Answer

Iodine scan

Answer

PET scan

Question 9

Ductal carcinoma in situ treated with lumpectomy, and was found to have margins of 2mm, what is the next best management ?

Accepted Answer

Radiotherapy

Answer

Mastectomy

Answer

BCT

Answer

Regular follow up

Question 10

A 43 years presented with 4.6cm breast lump with ipsilateral mobility present, Axillary LN without distant metastasis, which stage does it belongs to?

Accepted Answer

Stage 2b

Answer

Stage 2a

Answer

Stage 3c

Answer

Stage 4

FMGE 2026

Community Medicine

Dermatology

Internal Medicine

Pediatrics

Radiology

Surgery