FMGE 2025 Practice Questions

Q: A patient with a long-standing history of diabetes presents with cataracts. Which of the following metabolic products is primarily responsible for cataract formation in this condition?

Sorbitol. ***Sorbitol*** - When blood glucose is elevated in diabetes, the enzyme **aldose reductase** converts excess glucose into **sorbitol** (a polyol) in tissues like the lens, which do not require insulin for glucose uptake. - Sorbitol is poorly permeable across cell membranes. Its accumulation creates a significant **osmotic gradient** within the lens fibers, causing water influx and subsequent lens swelling and opacification (cataract formation). *Mannitol* - **Mannitol** is a polyol often used as an osmotic diuretic in clinical settings to reduce cerebral edema or intraocular pressure. - Although chemically similar to sorbitol, mannitol accumulation is not the primary mechanism of **cataract formation** specifically linked to chronic hyperglycemia. *Galactitol* - **Galactitol** is NOT responsible for cataract formation in diabetes, but is specifically responsible for cataracts in individuals with **galactosemia** (inability to metabolize galactose). - It is formed from **galactose** via aldose reductase, making it the incorrect metabolite in a patient with diabetes-related cataracts. *Fructose* - **Fructose** is formed when sorbitol is further metabolized by the enzyme **sorbitol dehydrogenase**. - While present in the polyol pathway, **sorbitol** itself is the product whose high intracellular concentration and osmotic activity is the direct cause of the diabetic cataract.

Q: A married female died under unnatural circumstances within 3 years of marriage. Her father filed a report to police and inquiry will be done under which section?

196 BNSS/176 CrPC. ***196 BNSS/176 CrPC*** - This section (formerly **176 CrPC**, now **196 BNSS**) mandates a **Magistrate Inquiry** when a married woman dies under suspicious circumstances (e.g., unnatural death, suicide, accidental death) within **seven years** of marriage. - Since the death occurred within 3 years and was reported by the father as suspicious, a compulsory inquiry by an Executive Magistrate is legally required under this provision. *194 BNSS/174 CrPC* - This section (formerly **174 CrPC**, now **194 BNSS**) deals with the general procedure for **Police Inquest** (investigation into unnatural deaths). - While the police inquiry starts under 194 BNSS, it is insufficient alone; the death of a married woman within seven years necessitates the mandatory higher inquiry by a Magistrate specified under 196 BNSS. *116 BNS & 194 BNSS* - **116 BNS** (Bhartiya Nyaya Sanhita) pertains to the criminal offense of **abetment of offenses punishable with imprisonment for life or imprisonment**, which relates to the crime, not the procedural inquiry into the death. - Pairing a substantive criminal law section (116 BNS) with a procedural section (194 BNSS - Police Inquest) does not accurately describe the specific mandatory inquiry process required for this suspicious death. *106 BNS & 194 BNSS* - **106 BNS** (Bhartiya Nyaya Sanhita) deals with the offense where an act is done without the intention to cause death or grievous hurt, but is likely to cause death, known as **culpable homicide not amounting to murder**, which is unrelated to the inquiry itself. - This combination incorrectly merges a substantive criminal offense and the investigation procedure, failing to identify the mandatory Magisterial Inquiry section (196 BNSS).

Q: Leading questions can be asked in?

Cross-examination. ***Cross-examination*** - **Leading questions** are permitted during **cross-examination** as a tool to test the veracity, depth, and clarity of the witness's testimony elicited during the Examination-in-chief. - This is allowed because the witness being cross-examined is generally considered hostile to the party conducting the cross-examination, and suggestive questions are necessary to uncover inconsistencies. - According to **Section 142 of the Indian Evidence Act, 1872**, leading questions may be asked in cross-examination. *Re-examination* - **Leading questions** are generally *not* permitted during **re-examination**, which follows cross-examination. - The purpose of **re-examination** is strictly to clarify doubts arising from cross-examination, and introducing new evidence or suggesting answers is restricted. *Anytime* - This is incorrect; there are specific legal stipulations regarding when **leading questions** can be asked, primarily limiting them to **cross-examination**. - Allowing them **anytime** would undermine the fairness of judicial proceedings (e.g., prohibited during **Examination in chief**). *Examination in chief* - **Leading questions** are strictly prohibited during the **examination in chief** (the first questioning of a witness by the party calling them) as per **Section 141 of the Indian Evidence Act, 1872**. - This restriction ensures that the testimony presented is the witness's own uninfluenced account, preventing the counsel from suggesting answers to their own witness.

Q: During a forensic examination, a skull bone was brought by police whose cephalic index came out to be 85. Skull bone belongs to which race?

Mongoloids. ***Mongoloids*** - The **cephalic index (CI)** is calculated as (Maximum breadth / Maximum length) × 100. A CI of 85 places the skull in the **Brachycephalic** category (broad head, CI 80-85). - This high cephalic index is a key characteristic used in forensic anthropology to identify skulls belonging to the **Mongoloid race**, which includes East Asian populations who typically have brachycephalic to hyperbrachycephalic skull shapes. *Negroes* - Skulls of the **Negro** (African) race are typically **dolichocephalic** (long-headed), characterized by a cephalic index generally below 75. - Their maximum length is significantly greater than their maximum breadth, making a CI of 85 highly unlikely. *Aryan* - The term "Aryan" generally refers to populations whose skulls fall into the **mesocephalic** range (CI 75-80). - A CI of 85 is significantly higher than the characteristic index associated with typical mesocephalic populations. *European* - Skulls of the general **European** (Caucasoid) population are most often categorized as **mesocephalic** (CI 75-80), sometimes tending towards dolichocephalic. - A CI of 85 indicates a skull that is very broad relative to its length (brachycephalic), which is not the standard finding for general European skulls.

Q: A patient presents with breathlessness and is diagnosed with a Pancoast tumor. Which of the following findings is not typically associated with this condition?

Exophthalmos. ***Exophthalmos***- This finding, characterized by the **protrusion of the eyeball**, is typically associated with conditions like **Graves' disease** (hyperthyroidism) or orbital tumors.- It is *not* a component of **Horner's syndrome**, which is the classic neurological manifestation of a Pancoast tumor due to damage to the sympathetic chain.*Anhidrosis*- Pancoast tumors (superior sulcus tumors) often invade the **stellate ganglion** or other parts of the sympathetic chain.- Damage to sympathetic fibers causes reduced or absent sweating on the ipsilateral face and neck, manifesting as **anhidrosis**.*Miosis*- This refers to the **constriction of the pupil** and is a classic sign resulting from the loss of sympathetic input, which normally causes pupillary dilation.- The resulting unopposed action of the parasympathetic system leads to **miosis**.*Ptosis*- Ptosis, or the **drooping of the upper eyelid**, occurs due to paralysis of the **superior tarsal muscle** (Müller's muscle).- This small muscle is innervated by the sympathetic pathway, and its dysfunction results in mild **ptosis**, a core component of Horner's syndrome.

Q: A 70-year-old man with a prosthetic valve was admitted with a murmur and blood culture positive for Gram-positive cocci. Choose the most common agent causing prosthetic valve infective endocarditis.

Staphylococcus epidermidis. ***Staphylococcus epidermidis***- This is the most common cause of **early** prosthetic valve endocarditis (PVIE), which typically occurs within 60 days following surgery, often due to contamination during the replacement procedure.- This organism is a **coagulase-negative Staphylococci** known for forming protective **biofilms** on the prosthetic surface, leading to severe device-related infections.*Streptococcus viridans*- This is the most common cause of **native valve** infective endocarditis (NVIE), frequently associated with dental procedures or poor oral hygiene.- While it can cause PVIE, it is typically responsible for late-onset cases, and overall less common than **Staphylococcal species** in prosthetic valve disease.*Staphylococcus aureus*- This highly virulent organism causes a rapidly destructive form of endocarditis (both NVIE and PVIE), often associated with **IV drug use** or healthcare-associated infections.- Although a major cause of PVIE, *S. epidermidis* is **statistically more frequent** overall in this setting, especially in early postoperative infections.*Enterococci*- Enterococcal endocarditis is often seen in older men or patients who have recently undergone **genitourinary or gastrointestinal** instrumentation or surgery.- While it causes both NVIE and PVIE, its incidence in prosthetic valve disease is lower than the **Staphylococcal species**.

Q: A 6-year-old child presents with a refractive error of -2D in the right eye and +1D in the left eye. Visual acuity is normal in both eyes with correction, and fundus examination reveals normal retinal findings. What is the most likely diagnosis?

Anisometropia. ***Anisometropia*** - This diagnosis refers to the condition where the two eyes have significantly **unequal refractive powers**, usually a difference of 2 diopters or more, as seen in this case (-2D vs +1D = 3 diopters). - Anisometropia is critical because the brain suppresses the blurred image from the eye with the greater refractive error, making it the most important cause of **refractive amblyopia** in children. *Myopia* - Myopia (nearsightedness) refers to the refractive error where light focuses in front of the retina, characteristic only of the **right eye** (-2D). - This term fails to describe the overall condition, which involves two different types of errors (**myopia and hyperopia**) in the same patient. *Hyperopia* - Hyperopia (farsightedness) refers to the refractive error where light focuses behind the retina, characteristic only of the **left eye** (+1D). - Applying this term alone ignores the presence of myopia in the right eye and the crucial **disparity in focus** between the two eyes. *Amblyopia* - Amblyopia (lazy eye) is reduced vision in an eye uncorrectable with lenses, often due to conditions like anisometropia that cause visual deprivation during the critical period. - The key differentiating factor here is that the patient is noted to have **normal visual acuity** despite the refractive disparity, meaning amblyopia has not yet developed (though the patient is at high risk).

Q: Which of the following is NOT a feature of Horner's Syndrome?

Exophthalmos. ***Exophthalmos*** - **Exophthalmos** (bulging of the eyeball) is caused by hyperactivity of the sympathetic system (e.g., in *hyperthyroidism*) or orbital mass effects, making it *NOT* a feature of sympathetic paralysis. - Horner's Syndrome, due to paralysis of the **Müller's muscle** in the orbit, actually causes the opposite effect: apparent **enophthalmos** (sinking of the eyeball). *Anhidrosis* - **Anhidrosis** (lack of sweating) on the ipsilateral face and neck is a crucial component of Horner's syndrome, particularly if the lesion is located preganglionic or centrally. - This occurs because the sympathetic fibers supplying the **sweat glands** are disrupted along the pathway. *Miosis* - **Miosis** (constricted pupil) is a hallmark feature resulting from the unopposed action of the parasympathetic system's **sphincter pupillae muscle**. - The sympathetic nerves responsible for innervating the **dilator pupillae muscle** are paralyzed, leading to relative pupil constriction that is more pronounced in dim light (*anisocoria*). *Ptosis* - **Ptosis** (droopy eyelid) is a characteristic symptom caused by the paralysis of the sympathetically innervated **Müller's muscle** (superior tarsal muscle). - This results in a mild degree of eyelid drooping (partial ptosis), often less severe than the ptosis seen with **Oculomotor Nerve (CN III) palsy**.

Q: When is a blood sample taken to diagnose neonatal hypothyroidism?

72 hours after delivery. ***72 hours after delivery*** - Newborn screening for congenital hypothyroidism is ideally performed **48-72 hours after birth** - This timing avoids false-positive results from the **physiological TSH surge** that occurs in the first 24-48 hours of life - At 72 hours, TSH levels have stabilized and accurately reflect thyroid function - Early detection allows prompt treatment to prevent neurodevelopmental impairment *Immediately from the umbilical cord* - Too early - will capture the physiological TSH surge immediately after birth - Results in high false-positive rate - Not recommended for screening *24 hours after delivery* - Still within the period of physiological TSH elevation - May yield false-positive results - Not optimal timing for screening *23-48 hours after delivery* - The lower end (24-48 hours) is acceptable in some screening programs - However, 48-72 hours is preferred to ensure TSH has normalized from the physiological surge - 72 hours provides more reliable results

Q: A 3-year-old child presented with multiple burn injuries involving the entire head, neck & one upper limb. What is the percentage of burn?

25-30%. ***Correct Answer: 25-30%*** Using the **Modified Rule of Nines for Pediatric Burns** (for children aged 1-4 years): **Calculation:** - **Head & Neck:** ~18% (children have proportionally larger heads compared to adults) - **One Upper Limb:** ~9% - **Total TBSA (Total Body Surface Area):** 18% + 9% = **27%** This falls within the range of **25-30%**, making this the correct answer. **Why Other Options are Incorrect:** *Incorrect: 5-10%* - This significantly underestimates the burn area. Head and neck alone account for ~18% in young children. *Incorrect: 18-20%* - This would represent only the head and neck, failing to account for the upper limb involvement. *Incorrect: 40-44%* - This overestimates the burn area. Even if both upper limbs were involved (18%), the total would be ~36%, not 40-44%. **Clinical Pearl:** In pediatric burns, remember that children have different body surface area proportions than adults - the head is proportionally larger (18% vs 9% in adults), while the lower limbs are proportionally smaller. Always use age-appropriate burn assessment charts.

Question 1

A patient with a long-standing history of diabetes presents with cataracts. Which of the following metabolic products is primarily responsible for cataract formation in this condition?

Accepted Answer

Sorbitol

Answer

Galactitol

Answer

Mannitol

Answer

Fructose

Question 2

A married female died under unnatural circumstances within 3 years of marriage. Her father filed a report to police and inquiry will be done under which section?

Accepted Answer

196 BNSS/176 CrPC

Answer

116 BNS & 194 BNSS

Answer

194 BNSS/174 CrPC

Answer

106 BNS & 194 BNSS

Question 3

Leading questions can be asked in?

Accepted Answer

Cross-examination

Answer

Re-examination

Answer

Anytime

Answer

Examination in chief

Question 4

During a forensic examination, a skull bone was brought by police whose cephalic index came out to be 85. Skull bone belongs to which race?

Accepted Answer

Mongoloids

Answer

European

Answer

Negroes

Answer

Aryan

Question 5

A patient presents with breathlessness and is diagnosed with a Pancoast tumor. Which of the following findings is not typically associated with this condition?

Accepted Answer

Exophthalmos

Answer

Ptosis

Answer

Miosis

Answer

Anhidrosis

Question 6

A 70-year-old man with a prosthetic valve was admitted with a murmur and blood culture positive for Gram-positive cocci. Choose the most common agent causing prosthetic valve infective endocarditis.

Accepted Answer

Staphylococcus epidermidis

Answer

Staphylococcus aureus

Answer

Streptococcus viridans

Answer

Enterococci

Question 7

A 6-year-old child presents with a refractive error of -2D in the right eye and +1D in the left eye. Visual acuity is normal in both eyes with correction, and fundus examination reveals normal retinal findings. What is the most likely diagnosis?

Accepted Answer

Anisometropia

Answer

Myopia

Answer

Amblyopia

Answer

Hyperopia

Question 8

Which of the following is NOT a feature of Horner's Syndrome?

Accepted Answer

Exophthalmos

Answer

Miosis

Answer

Ptosis

Answer

Anhidrosis

Question 9

When is a blood sample taken to diagnose neonatal hypothyroidism?

Accepted Answer

72 hours after delivery

Answer

Immediately from the umbilical cord

Answer

23-48 hours after delivery

Answer

24 hours after delivery

Question 10

A 3-year-old child presented with multiple burn injuries involving the entire head, neck & one upper limb. What is the percentage of burn?

Accepted Answer

25-30%

Answer

5-10%

Answer

40-44%

Answer

18-20%

FMGE 2025

Biochemistry

Forensic Medicine

Internal Medicine

Microbiology

Ophthalmology

Pediatrics

Surgery