FMGE 2026 Practice Questions

Q: A particular parasite commonly associated with water bodies shown in the below image has been eliminated from this habitat. Which of the following parasites is it?

Guinea worm. ***Guinea worm*** - Known as **Dracunculiasis**, this parasitic infection is transmitted by drinking contaminated water containing **copepods** infected with *Dracunculus medinensis* larvae. - It is currently on the verge of **global eradication** due to successful water safety and community-based surveillance programs. *Whipworm* - Caused by *Trichuris trichiura*, it is an **intestinal helminth** transmitted via fecal-oral route, usually through soil contaminated with eggs. - It remains endemic in many tropical regions and has not been targeted for eradication like the Guinea worm. *Hookworm* - Infections by *Ancylostoma duodenale* or *Necator americanus* occur when larvae penetrate the **skin** after contact with contaminated soil. - It is a common soil-transmitted helminth and remains a significant public health issue without an eradication status. *Roundworm* - *Ascaris lumbricoides* is transmitted via fecal-oral contamination of **soil** and is one of the most common human helminth infections worldwide. - It poses a high global burden of disease and is managed through mass drug administration rather than eradication.

Q: A patient presents with a painless ulcer over the leg with a characteristic black eschar at the center, as shown in the image. There is surrounding edema with minimal pain. Which of the following is the most likely causative organism?

Bacillus anthracis. ***Bacillus anthracis*** - Cutaneous anthrax typically presents as a **painless ulcerative lesion** with a pathognomonic **central black eschar** (necrotic scab). - The lesion is classically surrounded by **extensive edema** and an erythematous rim, with notably disproportionate lack of pain. *Staphylococcus aureus* - Commonly causes **furuncles**, **carbuncles**, or **cellulitis**, which are typically very painful and tender. - These infections typically result in **purulent discharge** and abscess formation rather than a dry, black necrotic eschar. *Clostridium perfringens* - Primarily associated with **gas gangrene**, which presents with crepitus, severe pain, and rapidly spreading tissue necrosis. - This condition is characterized by **foul-smelling exudate** and systemic toxicity, unlike the localized, relatively painless presentation of anthrax. *Rickettsia conorii* - Etiological agent of **Mediterranean Spotted Fever**, which typically presents with a **tache noire** (black spot) at the site of the tick bite, accompanied by fever and rash. - Unlike the isolated lesion of cutaneous anthrax, this is generally associated with a **triad of fever**, **rash**, and the **eschar**.

Q: Which of the following mechanisms of genetic transfer is illustrated here?

Transduction. ***Transduction*** - Involves the transfer of bacterial DNA from one bacterium to another by a **bacteriophage** (bacterial virus) acting as a vector. - This can occur via **generalized transduction** (random segments of DNA packaged) or **specialized transduction** (specific genes near the phage integration site). *Transformation* - Involves the uptake of **naked or environmental DNA** by competent bacteria from the surrounding medium. - Does not require a vector or cell-to-cell contact and is historically demonstrated in **Streptococcus pneumoniae**. *Conjugation* - Requires **direct cell-to-cell contact** between bacteria, typically mediated by a **sex pilus** encoded by an **F-plasmid**. - Results in the unidirectional transfer of plasmid DNA or sometimes chromosomal DNA, often leading to rapid spread of **antibiotic resistance**. *Transposition* - Refers to the movement of **transposons** ('jumping genes') from one location to another within or between DNA molecules. - This is an **intracellular process** and does not act as a primary mechanism for horizontal gene transfer between distinct bacterial cells.

Q: A 32-year-old woman presents for contraception counseling. Which of the following is a contraindication to the use of combined oral contraceptive pills?

Migraine with aura. ***Migraine with aura*** - Combined oral contraceptive pills are contraindicated in patients with migraine with aura due to a significant increase in the risk of **ischemic stroke**. - The use of **estrogen** in these patients is associated with vascular events, leading to a categorization of **Category 4 (unacceptable health risk)** by the CDC Medical Eligibility Criteria. *Iron deficiency anemia* - COCPs are often beneficial for patients with iron deficiency anemia because they reduce the duration and volume of **menstrual blood loss**. - This is not a contraindication; in fact, the **progestin component** helps to regulate and often decrease menses. *Polycystic ovarian syndrome* - COCPs are a first-line treatment for managing symptoms of PCOS, such as **menstrual irregularities**, acne, and hirsutism. - The estrogen component increases **sex hormone-binding globulin (SHBG)** levels, which helps lower free testosterone levels. *Dysmenorrhea* - COCPs are frequently prescribed as a therapeutic option for dysmenorrhea because they suppress **ovulation** and thin the **endometrial lining**. - By decreasing the production of **prostaglandins** in the endometrium, they effectively reduce uterine cramping during menses.

Q: A patient is shown using a metered -dose inhaler as shown in the image. Which of the following statements about spacer use is correct?

Decreases drug wastage & reduces oropharyngeal deposition. ***Decreases drug wastage & reduces oropharyngeal deposition*** - Spacers act as a reservoir, allowing the medication particles to slow down and suspend in the device, which ensures that more **medication reaches the lower airways** rather than impacting the back of the throat. - By minimizing **oropharyngeal deposition**, spacers significantly reduce the risk of common side effects like **oral candidiasis** and dysphonia, particularly with inhaled corticosteroids. *Increases systemic absorption of the drug* - The primary goal of a spacer is to improve **local delivery** to the lungs, not to increase systemic uptake. - In fact, by reducing deposition in the oropharynx, the amount of drug swallowed and subsequently absorbed into the **systemic circulation** from the GI tract is typically **decreased**. *Makes inhaler technique more complicated and less effective* - Spacers actually simplify the **coordination** required between actuating the inhaler and inhaling, making the process much easier for patients, especially children and the elderly. - They are proven to **improve overall drug delivery efficacy** in patients who struggle with the

Q: A patient started on a new cholesterol -lowering medication develops facial flushing and erythema, as shown in the image. Which of the following drugs is most likely responsible for this presentation?

Niacin. ***Niacin*** - Facial flushing and erythema are the most common **dose-limiting side effects** of niacin therapy, caused by prostaglandin-mediated **vasodilation**. - This reaction can be significantly reduced by premedication with **aspirin** or by starting at a low dose and titrating slowly. *Lovastatin* - Statins generally do not cause flushing; their primary adverse effects include **myopathy**, myalgia, and asymptomatic elevations in **transaminases**. - **Rhabdomyolysis** is a rare but serious potential complication, not associated with the skin findings described. *Ezetimibe* - Ezetimibe is generally well-tolerated and does not typically present with significant cutaneous side effects like flushing. - Its primary concerns involve gastrointestinal symptoms such as **diarrhea** and abdominal pain, or rare elevated **liver enzymes** when used with statins. *Gemfibrozil* - Fibrates like gemfibrozil may increase the risk of **gallstones** due to increased cholesterol excretion in bile. - They do not typically cause facial flushing; their primary side effect is an increased risk of **myopathy**, especially when combined with statins.

Q: Which of the following drugs is least commonly used as first -line therapy for uncomplicated urinary tract infections ?

Fluoroquinolones. ***Fluoroquinolones*** - Due to their potential for **serious side effects**, such as **tendonitis**, **tendon rupture**, and **peripheral neuropathy**, the FDA has restricted their use for uncomplicated urinary tract infections. - They are typically reserved for **complicated infections**, such as **pyelonephritis**, because they should be preserved for more severe conditions to prevent the development of **antibiotic resistance**. *Nitrofurantoin* - This is a standard **first-line agent** for the treatment of uncomplicated **cystitis** due to its high concentration in the urine. - It has a low rate of resistance and is generally well-tolerated, making it an excellent choice for outpatient therapy. *Sulfonamides* - Trimethoprim-sulfamethoxazole (TMP-SMX) is widely recommended as a **first-line treatment** for uncomplicated UTIs in areas where resistance rates are known to be low. - It is effective against most common uropathogens, particularly **Escherichia coli**. *Fosfomycin* - Often administered as a single-dose therapy, **fosfomycin** is an approved **first-line agent** for uncomplicated lower urinary tract infections. - It is highly effective due to its ability to maintain high concentrations in the bladder and its unique mechanism of action which helps overcome **multidrug resistance**.

Q: A patient undergoing chemotherapy develops hemorrhagic cystitis. Which of the following drugs is most commonly responsible?

Ifosfamide. ***Ifosfamide*** - Ifosfamide is an alkylating agent known to cause **hemorrhagic cystitis** due to the accumulation of its toxic metabolite, **acrolein**, in the bladder. - To prevent this complication, **mesna** (2-mercaptoethane sulfonate) is routinely administered alongside ifosfamide to neutralize acrolein. *Bleomycin* - The primary and most serious dose-limiting side effect of bleomycin is **pulmonary fibrosis**. - It is not associated with bladder toxicity or hemorrhagic cystitis, as it mainly affects the lungs and skin. *Vincristine* - Vincristine is a vinca alkaloid that commonly causes **peripheral neuropathy**, manifesting as loss of deep tendon reflexes. - It is generally **myelosparing**, meaning it does not typically cause the bone marrow suppression seen with other chemotherapeutic agents, nor does it cause cystitis. *Methotrexate* - Methotrexate is an antimetabolite primarily associated with **mucositis** and **stomatitis** due to its effect on rapidly dividing cells. - It can cause hepatotoxicity and myelosuppression, but it is not a classic cause of bladder inflammation like ifosfamide.

Q: A 40-year-old patient with refractory epilepsy is on a multi-drug antiepileptic regimen. Two weeks after a dosage adjustment, he develops diffuse morbilliform rash, fever and oral mucosal erosions. Which of the following antiepileptic drugs can most saf ely be continued?

Clobazam. ***Clobazam*** - Clobazam is a **benzodiazepine** that acts as a positive allosteric modulator of GABA-A receptors, which is structurally distinct from traditional aromatic antiepileptic drugs (AEDs) like phenytoin or lamotrigine. - It is not associated with the **hypersensitivity reactions** (like DRESS syndrome or SJS/TEN) commonly triggered by the aromatic AEDs involved in the patient's current regimen. *Phenytoin* - Phenytoin is a known culprit for drug-induced **hypersensitivity reactions** (DRESS syndrome) due to its metabolites (arene oxides) that cause immune dysregulation. - It is strictly contraindicated in patients presenting with **morbilliform rashes** and systemic symptoms like fever and mucosal involvement, as continuation can lead to fatal complications. *Valproate* - Valproate is an aliphatic AED, but it can contribute to **DRESS syndrome** and also causes **hepatotoxicity**, which exacerbates the patient's systemic inflammatory response. - It is generally advised to discontinue implicated agents in a multidrug regimen to stabilize the patient, making it an unsafe drug to continue in this clinical context. *Lamotrigine* - Lamotrigine has a high potential for causing **severe cutaneous adverse reactions (SCARs)** such as **Stevens-Johnson Syndrome (SJS)** and **Toxic Epidermal Necrolysis (TEN)**, especially when titrated rapidly. - Given the presence of **oral mucosal erosions**, this drug is a highly suspicious trigger and must be discontinued immediately to prevent further progression.

Q: Which immunosuppressive medication blocks the effects of interleukin -2 (IL-2) without inhibiting calcineurin activity?

Sirolimus. ***Sirolimus*** - Sirolimus binds to the **FK-binding protein 12 (FKBP-12)**, forming a complex that specifically inhibits **mTOR (mammalian target of rapamycin)** kinase. - By inhibiting mTOR, it disrupts cell cycle progression from the G1 to the S phase, effectively blocking the **IL-2-mediated signal transduction** pathway without affecting calcineurin. *Tacrolimus* - Tacrolimus acts by binding to **FKBP-12**, but the resulting complex specifically inhibits **calcineurin**. - This inhibition prevents the dephosphorylation and activation of **NFAT (nuclear factor of activated T-cells)**, thereby suppressing IL-2 transcription. *Mycophenolate mofetil* - This drug acts by inhibiting **inosine monophosphate dehydrogenase (IMPDH)**, which is the rate-limiting enzyme in the **de novo synthesis of guanosine nucleotides**. - It primarily targets lymphocyte proliferation by depleting the guanosine pool, rather than interacting with IL-2 pathways or calcineurin. *Azathioprine* - Azathioprine is a prodrug of **6-mercaptopurine**, an antimetabolite that gets converted into thioinosinic acid. - It inhibits **purine synthesis** and DNA replication, causing toxicity to rapidly dividing cells like lymphocytes, but it does not specifically block the IL-2 receptor signaling pathway.

Question 1

A particular parasite commonly associated with water bodies shown in the below image has been eliminated from this habitat. Which of the following parasites is it?

Accepted Answer

Guinea worm

Answer

Whipworm

Answer

Hookworm

Answer

Roundworm

Question 2

A patient presents with a painless ulcer over the leg with a characteristic black eschar at the center, as shown in the image. There is surrounding edema with minimal pain. Which of the following is the most likely causative organism?

Accepted Answer

Bacillus anthracis

Answer

Staphylococcus aureus

Answer

Clostridium perfringens

Answer

Rickettsia conorii

Question 3

Which of the following mechanisms of genetic transfer is illustrated here?

Accepted Answer

Transduction

Answer

Transformation

Answer

Conjugation

Answer

Transposition

Question 4

A 32-year-old woman presents for contraception counseling. Which of the following is a contraindication to the use of combined oral contraceptive pills?

Accepted Answer

Migraine with aura

Answer

Iron deficiency anemia

Answer

Polycystic ovarian syndrome

Answer

Dysmenorrhea

Question 5

A patient is shown using a metered -dose inhaler as shown in the image. Which of the following statements about spacer use is correct?

Accepted Answer

Decreases drug wastage & reduces oropharyngeal deposition

Answer

Increases systemic absorption of the drug

Answer

Makes inhaler technique more complicated and less effective

Answer

Has no effect on drug delivery

Question 6

A patient started on a new cholesterol -lowering medication develops facial flushing and erythema, as shown in the image. Which of the following drugs is most likely responsible for this presentation?

Accepted Answer

Niacin

Answer

Lovastatin

Answer

Ezetimibe

Answer

Gemfibrozil

Question 7

Which of the following drugs is least commonly used as first -line therapy for uncomplicated urinary tract infections ?

Accepted Answer

Fluoroquinolones

Answer

Nitrofurantoin

Answer

Sulfonamides

Answer

Fosfomycin

Question 8

A patient undergoing chemotherapy develops hemorrhagic cystitis. Which of the following drugs is most commonly responsible?

Accepted Answer

Ifosfamide

Answer

Bleomycin

Answer

Vincristine

Answer

Methotrexate

Question 9

A 40-year-old patient with refractory epilepsy is on a multi-drug antiepileptic regimen. Two weeks after a dosage adjustment, he develops diffuse morbilliform rash, fever and oral mucosal erosions. Which of the following antiepileptic drugs can most saf ely be continued?

Accepted Answer

Clobazam

Answer

Phenytoin

Answer

Valproate

Answer

Lamotrigine

Question 10

Which immunosuppressive medication blocks the effects of interleukin -2 (IL-2) without inhibiting calcineurin activity?

Accepted Answer

Sirolimus

Answer

Tacrolimus

Answer

Mycophenolate mofetil

Answer

Azathioprine

FMGE 2026

Community Medicine

Microbiology

Obstetrics and Gynecology

Pediatrics

Pharmacology