FMGE 2026 Practice Questions

Q: An individual develops a high-grade fever lasting for 3 days, after which a vesicular rash appears. The rash is predominantly centripetal, involving the trunk more than the extremities, as shown in the image. What is the most likely diagnosis?

Chickenpox (Varicella). ***Chickenpox (Varicella)*** - The classic presentation involves a prodromal **fever** followed by a **centripetal distribution** of rash, where lesions are most concentrated on the **trunk** rather than the extremities. - The rash typically appears in **crops** and progresses through stages of **macules, papules, vesicles, and crusts** simultaneously (pleomorphism). *Dengue* - Characterized by a **biphasic fever** (

Q: A woman with diabetes mellitus presents with an asymptomatic skin lesion present for the past one year. On examination, there is a non-scaly, annular lesion as shown in the image. There is no itching or pain. What is the most likely diagnosis?

Granuloma annulare. ***Granuloma annulare*** - This condition is classically associated with **diabetes mellitus** and presents as **asymptomatic, non-scaly**, annular plaques with a smooth surface. - The lesions are typically characterized by a **ring of papules** with central clearing and are frequently found on the **dorsal surfaces of the hands** and feet. *Tinea corporis* - This is a **dermatophyte fungal infection** that typically presents with **scaly, erythematous borders** and active peripheral inflammation. - Unlike the lesion in the prompt, tinea corporis is usually **pruritic** and requires antifungal treatment, making it less likely in an asymptomatic, non-scaly presentation. *Annular lichen planus* - While lichen planus can present with annular plaques, the lesions are typically **violaceous, flat-topped papules** with characteristic **Wickham striae** (white lacy lines). - Lichen planus lesions are notoriously **pruritic** and often affect flexural surfaces, distinguishing them from the asymptomatic, non-scaly nature of granuloma annulare. *Annular psoriasis* - Psoriasis of the annular type, like other forms of psoriasis, typically presents with **thick, silvery-white micaceous scales**. - The condition is often **symptomatic** (itching) and does not show the smooth, non-scaly border characteristic of the patient's lesion.

Q: A 25 year old male presented with fast moving serpiginous rash on the body. What is the causative agent?

S. stercoralis. ***S. stercoralis*** - This presentation is characteristic of **larva currens**, a cutaneous eruption caused by subcutaneous migration of **Strongyloides stercoralis** larvae. - It is distinguished by its extremely rapid movement, often advancing at a rate of up to **5-10 cm per hour**. *Ancylostoma braziliense* - This organism causes **cutaneous larva migrans (CLM)**, which is characterized by slowly advancing, pruritic, serpiginous tracts. - Unlike *S. stercoralis*, the movement of the larval tracts in CLM is very slow, typically only **a few millimeters to centimeters per day**. *Cutaneous larva migrans due to hookworm species* - This is a clinical description of the condition caused by animal hookworm larvae penetrating the skin. - It is defined by slow progression and intense **serpiginous itching**, lacking the pathognomonic speed of **larva currens**. *Sarcoptes scabiei* - This parasite causes **scabies**, which presents with intense nocturnal pruritus and localized burrows, particularly in finger webs. - The burrows are typically stationary and do not manifest as rapidly extending, migratory serpiginous rashes.

Q: A patient presents with a history of chemical injury to the eye. Based on the image shown, what is the most likely diagnosis?

Symblepharon. ***Symblepharon*** - This condition represents a **fibrous adhesion** between the bulbar conjunctiva and the palpebral conjunctiva, often occurring as a long-term complication of severe **chemical burns**. - It results from the inflammatory destruction of the **conjunctival epithelium**, causing raw surfaces to adhere during the healing process. *Ankyloblepharon* - This refers to the **abnormal fusion** of the upper and lower eyelid margins, often occurring congenitally or following severe trauma. - It is distinct from symblepharon because it involves the closure of the **palpebral fissure** itself, rather than adhesion between the eyeball and eyelid. *Entropion* - Characterized by the **inward turning** of the eyelid margin, causing eyelashes to rub against the cornea. - While chemical injuries can cause scarring leading to cicatricial entropion, it describes the **malposition** of the lid margin rather than a direct adhesion between the conjunctival layers. *Trichiasis* - This describes the **misdirection** of eyelashes toward the eyeball, which often rubs against the cornea and causes irritation. - It is a common secondary consequence of eyelid inflammation or scarring, but it defines the **aberrant growth angle** of individual cilia rather than a symblepharon adhesion.

Q: Festooned (irregular) pupil is most commonly seen in which type of glaucoma?

Acute uveitic glaucoma. ***Acute uveitic glaucoma*** - Festooned pupils occur due to the formation of **posterior synechiae**, which are adhesions between the iris and the lens capsule, commonly seen in **anterior uveitis**. - When the pupil is dilated (e.g., in a darkened room or with drops), the iris adheres to the lens at certain points, preventing uniform dilation and resulting in an irregular, or "festooned," pupil shape. *Primary angle-closure glaucoma* - This condition typically presents with a **mid-dilated, non-reactive pupil** due to iris ischemia, not a festooned shape. - The primary mechanism involves **pupillary block**, which increases intraocular pressure rather than causing synechial iris deformation. *Open-angle glaucoma* - This is characterized by a pathologically **open drainage angle** and leads to progressive optic nerve damage without acute anatomical changes to the pupil. - Patients typically exhibit no acute iris changes, and the pupil remains round and reactive unless secondary pathologies are present. *Pseudoexfoliation glaucoma* - This condition is characterized by the accumulation of **fibrillar, eosinophilic material** on the lens capsule, iris margin, and trabecular meshwork. - While iris atrophy can occur, the hallmark feature is **exfoliative material deposition**, rather than the inflammatory synechiae that specifically define a festooned pupil.

Q: A young patient presents with this sign. Diagnosis is best made by:

Corneal topography. ***Corneal topography*** - This is the **gold standard** diagnostic tool for detecting early and subclinical forms of **keratoconus**, as it provides a detailed map of the corneal curvature. - It identifies characteristic patterns like **inferior steepening** and **asymmetric bowtie** appearance which precede clinical signs visible on slit-lamp examination. *Keratometry* - Keratometry measures the **corneal power** at two principal meridians but is unable to map the entire corneal surface. - It is generally insufficient for the early diagnosis of keratoconus as it only provides averaged readings of the **central cornea**. *Pachymetry* - While pachymetry measures **corneal thickness** and may show localized thinning, it is not a diagnostic tool for mapping the surface curvature. - It is an adjunctive test; thinning is a structural change, but topography provides the functional assessment of the **corneal shape** necessary for diagnosis. *A-scan* - A-scan ultrasonography is primarily used to measure the **axial length** of the eye, typically for **intraocular lens (IOL) power calculations**. - It offers no diagnostic utility in assessing the **topographical curvature** or surface irregularities characteristic of corneal ectasias.

Q: Best treatment for a small boy with itching in summers and Horner-Trantas spots:

Topical mast cell stabilizers + steroids. ***Topical mast cell stabilizers + steroids*** - **Horner-Trantas spots** (limbal white dots) combined with seasonal itching in a young boy is pathognomonic for **Vernal Keratoconjunctivitis (VKC)**, a chronic allergic ocular condition. - First-line management involves **topical mast cell stabilizers** (such as sodium cromoglycate) for maintenance and **topical corticosteroids** for acute exacerbations to rapidly control severe inflammation. *Oral antihistaminics* - These are typically reserved for **systemic allergic reactions** or when allergic rhinitis is present as a comorbidity. - They are generally ineffective as monotherapy for severe, localized **allergic conjunctivitis** compared to topical agents. *Antibiotics* - **Antibiotics** are strictly indicated for **bacterial conjunctivitis**, which presents with mucopurulent discharge and conjunctival injection rather than intense itching. - Their use in this scenario is inappropriate as it does not address the underlying **type I hypersensitivity reaction** causing the disease. *Surgery* - **Surgery** (such as excision of giant papillae) is reserved only for rare, refractory cases with significant **mechanical keratopathy** or visual impairment unresponsive to medical therapy. - It is never the first-line treatment for the management of the inflammatory component of **Vernal Keratoconjunctivitis**.

Q: A patient came with redness and pain, and you dilated the pupil to break the synechiae. Which drug was used, looking at this picture?

Atropine. ***Atropine*** - Atropine is a **muscarinic antagonist** that acts as a potent **cycloplegic** and mydriatic, essential for breaking **posterior synechiae** in acute iridocyclitis. - It provides prolonged **ciliary muscle paralysis**, which helps relieve the **ciliary spasm** and pain associated with anterior uveitis. *Phenylephrine* - Phenylephrine is an **alpha-adrenergic agonist** that causes pupil dilation through **iris dilator muscle contraction** but lacks cycloplegic effects. - Because it does not cause **ciliary muscle paralysis**, it is ineffective at relaxing the ciliary body to break synechiae compared to cycloplegics. *Scopolamine* - Scopolamine has a shorter duration of action compared to atropine and is less commonly used as the first-line agent for **breaking synechiae** in severe inflammation. - While it is a **cycloplegic agent**, it is often reserved for patients who have sensitivity to atropine or require a shorter-acting therapeutic agent. *Miotics* - Miotics, such as **pilocarpine**, cause **pupil constriction** (miosis) by contracting the sphincter pupillae. - These are contraindicated in the treatment of synechiae because they would worsen existing **posterior synechiae** and increase the risk of **pupillary block**.

Q: A 52-year-old male outdoor worker presents with a fleshy growth in his left eye associated with foreign body sensation and redness for 3 years. On examination, a triangular fibrovascular tissue is seen arising from the nasal conjunctiva and encroaching 3 mm onto the cornea, crossing the pupillary axis. Best-corrected visual acuity is reduced to 6/18, and keratometry reveals significant with-the-rule astigmatism. There is no evidence of active inflammation. What is the most appropriate management for this patient?

Excision with conjunctival autograft. ***Excision with conjunctival autograft*** - This technique is considered the **gold standard** for primary pterygium surgery as it significantly reduces the **recurrence rate** compared to simple excision. - It is indicated here because the pterygium is **progressive** (encroaching 3mm onto cornea and affecting vision) and has induced significant **astigmatism**. *Simple excision (bare sclera technique)* - Associated with a high **recurrence rate** (often reported >30-50%), making it generally unsuitable for modern management of primary pterygium. - Leaving the sclera exposed creates a large **conjunctival defect**, which triggers aggressive fibrovascular proliferation during healing. *Topical corticosteroids and sunglasses* - While this might provide symptomatic relief for mild irritation, it has **no role** in reducing the size of an established, vision-threatening fibrovascular lesion. - It does not address the **corneal encroachment** or the structural corneal changes causing the patient's blurred vision. *Observation with lubricating eye drops* - Inappropriate in this case because the lesion is already **encroaching onto the cornea** and crossing the pupillary axis, causing a documented reduction in **visual acuity**. - Observation is only acceptable for small, **stationary/quiescent** pterygia that do not cause visual impairment or significant discomfort.

Question 1

An individual develops a high-grade fever lasting for 3 days, after which a vesicular rash appears. The rash is predominantly centripetal, involving the trunk more than the extremities, as shown in the image. What is the most likely diagnosis?

Accepted Answer

Chickenpox (Varicella)

Answer

Dengue

Answer

Smallpox

Answer

Measles

Question 2

A woman with diabetes mellitus presents with an asymptomatic skin lesion present for the past one year. On examination, there is a non-scaly, annular lesion as shown in the image. There is no itching or pain. What is the most likely diagnosis?

Accepted Answer

Granuloma annulare

Answer

Tinea corporis

Answer

Annular lichen planus

Answer

Annular psoriasis

Question 3

A 25 year old male presented with fast moving serpiginous rash on the body. What is the causative agent?

Accepted Answer

S. stercoralis

Answer

Ancylostoma braziliense

Answer

Cutaneous larva migrans due to hookworm species

Answer

Sarcoptes scabiei

Question 4

A patient presents with a history of chemical injury to the eye. Based on the image shown, what is the most likely diagnosis?

Accepted Answer

Symblepharon

Answer

Ankyloblepharon

Answer

Entropion

Answer

Trichiasis

Question 5

Festooned (irregular) pupil is most commonly seen in which type of glaucoma?

Accepted Answer

Acute uveitic glaucoma

Answer

Primary angle-closure glaucoma

Answer

Open-angle glaucoma

Answer

Pseudoexfoliation glaucoma

Question 6

Absolute contraindication for LASIK is:

Accepted Answer

Central corneal thickness < 480 µm

Answer

Age < 13 years

Answer

Myopia of −4 D

Answer

Stable refraction for 1 year

Question 7

A young patient presents with this sign. Diagnosis is best made by:

Accepted Answer

Corneal topography

Answer

Keratometry

Answer

Pachymetry

Answer

A-scan

Question 8

Best treatment for a small boy with itching in summers and Horner-Trantas spots:

Accepted Answer

Topical mast cell stabilizers + steroids

Answer

Oral antihistaminics

Answer

Antibiotics

Answer

Surgery

Question 9

A patient came with redness and pain, and you dilated the pupil to break the synechiae. Which drug was used, looking at this picture?

Accepted Answer

Atropine

Answer

Phenylephrine

Answer

Scopolamine

Answer

Miotics

Question 10

A 52-year-old male outdoor worker presents with a fleshy growth in his left eye associated with foreign body sensation and redness for 3 years. On examination, a triangular fibrovascular tissue is seen arising from the nasal conjunctiva and encroaching 3 mm onto the cornea, crossing the pupillary axis. Best-corrected visual acuity is reduced to 6/18, and keratometry reveals significant with-the-rule astigmatism. There is no evidence of active inflammation. What is the most appropriate management for this patient?

Accepted Answer

Excision with conjunctival autograft

Answer

Simple excision

Answer

Topical corticosteroids and sunglasses

Answer

Observation with lubricating eye drops

FMGE 2026

Dermatology

Ophthalmology